Littman Krooks

I recently spoke to Helene Bergman, the founder and director of Elder Care Alternatives, about the challenges faced by seniors and their caregivers.  Helene is a certified geriatric care manager and is on the board of directors of the National Association of Professional Geriatric Care Managers.

Q: You have said that with “consistent and superior care and support” any senior can remain at home throughout life.  Please explain.

A: I have managed the care of seniors with significant health issues who successfully remained at home for over a decade. However, to do so requires quality direct caregiving and other factors like adequate financial and social supports.

To design an appropriate care plan tailored to the senior’s unique care needs, we initially provide an assessment to better understand the senior’s medical and/or cognitive disabilities and to identify the supportive systems available to them. If there are family and/or friends, their roles are maximized to improve the senior’s quality of life. We link those with substantial finances to community resources, and we help others with limited finances secure Medicaid for home care. The seniors who fall in the middle class, with just adequate finances to cover their expenses, face greater challenges to remaining at home. Fortunately, in recent years, I’ve seen more situations in which long-term care insurance has eased the way for them.

There are other considerations, especially if the senior applies for Medicaid or even uses a private agency for home care. Does the senior’s residence lend itself to home-based care?  Is there a separate sleeping area for the hired caregiver? Can the senior ambulate adequately or is a lifting device (Hoyer lift) necessary.  These factors can negate eligibility and precipitate premature placement in a facility. However, if the senior can afford to pay privately for home care, even a studio apartment in New York City can be made adaptable, and the senior’s wish to remain at home can always be accommodated.

Q: Please talk about quality of life when an individual is faced with acute health problems.

A: Quality of life is a significant ethical issue for the senior and family caregivers. The question is whether to adhere to  a “wellness” regimen vs. experiencing “pleasure.” I know of an instance where a senior was recently diagnosed with diabetes, yet gourmet food and wine had long been central to his lifestyle.  Enforcing a strict dietary regimen would make him miserable, and his loved ones are struggling to balance medical advice with his way of life.

These decisions are very subjective and there is no right or wrong.  If the senior is cognitively intact, the decision should be his or hers. If the family must make executive decisions for a senior with dementia, they need to ensure that they don’t unconsciously project their own preferences when trying to envision what their loved one would want.

Q: What other tips can you offer family caregivers?

A: Be proactive—don’t wait for a crisis.  Have open discussions with your family members about how you will handle the possibility that parents will require significant care sometime in the future.

Become knowledgeable concerning your loved one’s medical and financial affairs.  Know the names of doctors and have your name placed on the third party notification list for various insurance policies.  Be in contact with your family member’s financial planner, broker and accountant so that they know who you are and will be willing to speak with you in the future, if necessary.

Finally, use this experience to begin planning for your own senior years.

Thanks, Helene.  These are issues that most families will face at some point.  I hope that your insights will be reassuring to individuals who are planning for, or currently experiencing, the changes that accompany the aging of a loved one.

Following are observations by Amy C. O’Hara, Esq., a Littman Krooks attorney who focuses on estate planning, estate administration, trust administration, guardianships, special needs planning, and elder law.

Uncertainty concerning the federal estate tax continues. Allowed to lapse entirely at the end of 2009, it’s scheduled to jump to 55 percent on January 1, 2011, on estates valued at $1 million or more.  This means that the number of estates subject to federal tax will increase by a factor of eight from 2009, when the exemption was $3.5 million.

No one envisioned this scenario.  In 2001, after dropping the estate tax from 55 percent to 45 percent, a contentious Congress gave itself an eight-year window to work through its differences. It was thought that the “threat” of a 2010 expiration would spur compromise.  But not so. Since then, the exemption has steadily grown from $675,000 to $3.5 million per individual.

All year, observers have expected that some middle ground, and possibly retroactive measures, would be legislated. All year, individuals and their estate planners have struggled with an ambiguous tax environment. Election years, though, are unpopular times for tax-related action. Regardless of one’s vote, a public official is likely to anger some constituent, and Congress has recessed without taking decisive action.

The question is whether anything will change when Congress convenes following the November elections. Assuming that our representatives and senators take action, will the new rate be 35, 45, or 55 percent?  What will be the exemption amount?

Many observers think that no action at all will be taken this year because the congressional agenda is packed and there are so few working days left in 2010. In the meantime, the best that can be done is to factor flexibility into your estate plan while you wait.