Choosing a Long-Term Care Facility

How to Choose a Long-Term-Care Facility for a Loved One

This step-by-step guide can help you find the right place to meet your loved one's needs.

By Cameron Huddleston, Contributing Editor, Kiplinger.com

Making the decision to move a loved one to a long-term-care facility is never easy. Finding the right facility is even tougher. I know because I made the decision recently to place my mother, who has been diagnosed with Alzheimer's, in a memory-care residence that specializes in caring for people with the disease.

After spending months agonizing over whether it was the right time to move her to a facility where she could receive 24-hour care, I spent just as long trying to find a residence that would best suit her needs. I believe, though, that all the time it took me to research and visit facilities was worth it because I did find the right place for my mom.

If you have a loved one with Alzheimer's, dementia or other disability, that person might someday need to move into a long-term-care facility. Although the majority of Americans who need care receive it at home from family or friends, those with Alzheimer's are much more likely to receive care in a nursing home. According to a 2012 report by the Alzheimer's Association, 75% of people diagnosed with the disease will be admitted to a nursing home by age 80, compared with 4% of the general population. That's why it's important to know how to choose a long-term-care facility if the need arises for someone you love. The steps below will help.

Step 1: Determine your needs

Before you can select a long-term-care facility for a loved one, you must know what sort of care he or she needs. There are several levels of care that senior-care properties provide:

Assisted living for those who need help in one or two activities of daily living, such as dressing or bathing.

Skilled nursing for those who need the attention of a nurse every day, who are bedridden or have more complicated behavior issues.

Memory care for those with dementia or Alzheimer's disease.

Some properties provide varying levels of care under one roof. That can be a good option for people who want to move to a senior-care residence when they're just starting to require help, then stay in place (by simply moving to another wing or floor) as their needs progress, says Sean Kell, CEO of A Place for Mom, a senior-care adviser service.

Kell says that, in addition to considering the level of care, people need to think about where their loved ones would want to be. That is, would they prefer living downtown or in the suburbs? In the same city where they currently live or closer to family in another city? Do they need a place that allows pets or accommodates special dietary needs, such as a kosher diet? These questions need to be addressed before you start your search in earnest.

Step 2: Assess your ability to pay

Your options may be limited if your loved one does not have long-term-care insurance or other financial resources to pay for care. Assisted living costs $3,600 a month on average, Kell says, and memory care runs about $4,700 a month on average. Skilled-nursing facilities cost an average of more than $6,700 a month and can reach as high as $10,000, Kell says.

Health insurance and Medicare do not cover this sort of long-term care. If you're a veteran, you might be able to get help paying for long-term care from the Department of Veterans Affairs. Medicaid rules vary by state, but in general the government program does pay for long-term-care services (primarily nursing-home care). However, your loved one basically has to deplete his or her assets to become eligible. Medicaid does cover assisted living in more than half of the states if the cost is less expensive than a nursing home, says Byron Cordes, president of the National Association of Professional Geriatric Care Managers. But the waiting list to get Medicaid coverage for assisted living is long, he says.

Step 3: Start your search

Once you know what type of facility would be the best match for your loved one, you can start your search. Ask doctors, as well as friends and family, for recommendations. There also are several resources to help you develop a list of senior-care properties that might fit the bill.

Eldercare Locator is a service of the U.S. Administration on Aging. It provides links to Area Agencies on Aging, which can provide a list of facilities and information about long-term-care options in your area.

Read more HERE


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The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in wills and trusts, estate planning, guardianship, probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for family law issues such as divorce, child custody and visitation, support, and military family law.

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

Planning For Your Retirement

Four Retirement Planning Mistakes to Avoid

by Donna Fuscaldo

Everyone knows you have to save for retirement, but creating and following a proper plan is easier said than done. Whether it’s establishing a savings plan too late or collecting Social Security too early, mistakes abound when it comes to adequately funding our nest eggs. 

“The biggest mistake is retiring without any real plan or investment strategy,” says Nigel Green, the chief executive of the deVere Group, a financial advisory firm. “Most aspects of life require planning in order to maximise their chances of success, and retirement is no different.”

Here’s a look at four common mistakes to avoid when planning for your retirement.

Mistake No. 1: Taking Social Security Too Early

Current regulations dictate that you can not receive full Social Security benefits until age of 66 and 2 months for those born after 1955. But just because you are eligible, doesn’t mean it makes financial sense to claim benefits.

Too often people take their benefits too early because they are worried the program won’t be adequately funded in the future or they feel they are better investing the monthly payment, according to Kevin Luss, founder and president of the Luss Group.

“The old paradigm that you retire at 59 is getting to be outdated,” says Luss. “People are living so long that if you retire at 65 you’ll have to live in retirement for 25 years or more.” The longer you wait to collect Social Security, the greater the monthly check will you start collecting.  “There’s an exponential increase when you wait even one or two years longer.”

Mistake No. 2: Not Saving Enough

The general guideline when it comes to funding retirement is you will  need 80% of your preretirement income to maintain your current lifestyle after work.

A recent surveyed conducted by the deVere Group found that even retirees able to create a $1 million nest egg are concerned they may not be able to afford their lifestyle in retirement.

“Despite their wealth, the vast number of respondents told us that their money does not go as far as they had expected due to constantly increasing prices,” says Green.  “Our research shows that if you want to receive a pension of $33,000 a year, this currently requires pension savings of $485,000.  Naturally, if you want a higher annual retirement income the required savings also increases proportionately.”

Read more HERE 

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The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in wills and trusts, estate planning, guardianship, probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for family law issues such as divorce, child custody and visitation, support, and military family law.

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

What Do the Election Results Mean for Seniors?

Now that the votes are counted and President Obama has a second term, what does it mean for seniors?

While President Obama's re-election means Medicare and Medicaid as we know them will likely be preserved at least for the next four years, many challenges are still ahead. 

One of the biggest outcomes of the election is that the Affordable Care Act (ACA – a.k.a. "Obamacare"), which candidate Mitt Romney had promised to repeal, will almost certainly remain as law and be fully implemented.  The law is already beginning to close the gap in Medicare’s prescription drug coverage known as the "doughnut hole," as well as providing free preventative care for Medicare recipients. The ACA also included a number of provisions aimed at improving long-term care and helping recipients remain in their homes rather than be forced into nursing homes, and these will continue to be carried out.

There may be some issues ahead, however.  Before the end of the year, Congress will try to avoid going over the "fiscal cliff," which is what will happen if it fails to act on continuing at least some of the Bush-era tax cuts and fails to prevent automatic spending cuts that it agreed to as part of last year's deficit reduction deal.  Many economists believe that the combination of the two could send the fragile economy back into recession.  Lawmakers are now trying to agree on a "grand bargian," alternative spending and revenue measures that will will help reduce the deficit while not damaging the economy.

Although Medicare and Medicaid will likely maintain their current structures, cuts may be made during these negotiations or later. The President still has to deal with a Republican majority in the House of Representatives, many of whom want to cut spending and entitlement programs.

President Obama reportedly offered to increase the Medicare age to 67 in last year’s budget negotiations with Republicans.  In addition, many are worried that the President may be inclined to cut Social Security benefits as well during fiscal cliff negotiations, according to a recent policy update from the National Academy of Elder Law Attorneys.  During the first debate, the President said his position on Social Security did not differ markedly from Governor Romney's.  Romney supported raising the retirement age and privatizing Social Security benefits. 

“There is going to be the fight of our lifetime to maintain Social Security, Medicare and Medicaid,” says Eric Kingson, a professor of social work at Syracuse University quoted in a Huffington Post article titled "Obama's Second Term and Older Americans."

According to a Reuters article, congressional Republicans are also expected to ask for concessions from the ACA, including delaying and scaling back the planned expansion of Medicaid.  In addition, state lawmakers, many of whom are Republican, will decide how the ACA is carried out. Thirty states have Republican governors, some of whom have said that they will opt out of the Medicaid expansion provided for in the ACA. But President Obama's re-election may boost the prospects for expansion. According to Kaiser Health News, his win may prod reluctant states to move forward with the expansion.

The National Consumer Voice for Quality Long-Term Care warns that "hard budgetary decisions made by the President along with Congress could potentially cause some long-term care consumers to face higher care costs or a decline in access to services." The National Coalition on Health Care, a group of consumer groups, unions, and employers, has released a plan to control spending without cutting Medicare or Medicaid. More proposals and compromises are likely to be considered in the coming months.

Read original post HERE on our newsletter.

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The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in wills and trusts, estate planning, guardianship, probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for family law issues such as divorce, child custody and visitation, support, and military family law.

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

The Average Cost of Nursing Home Care Moves Upward in 2012

The cost of long-term care increased significantly, according to the 2012 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and Home Care Costs. 

Private room nursing home rates jumped 3.8 percent to $90,520 a year or $248 a day, while assisted living facility costs rose 2.1 percent on average to $42,600 a year or $3,550 a month.

The average cost of homemaker/companions increased by 5.3 percent to $20 per hour. The news wasn't all about increases, however. The cost of adult day care services remained the same as last year at $70 per day and the average cost of home health aides remained at $21 per hour.

The survey also reports on the cost of a semi-private room in a nursing home, which increased 3.7 percent to $222 a day, or $81,030 a year.

Once again, the highest rates for a private nursing home room in 2012 were found in Alaska, where the average cost rose from $655 a day to $687 a day. This year the lowest rates were found in Oklahoma (with the exception of Oklahoma City and Tulsa) at an average of $147 a day for a private room. Texas (with the exception of Austin, Dallas/Ft. Worth, and Houston) had the lowest rate for a semi-private room at an average of $131 per day.

The cost of assisted living continues to be the highest in the Washington, D.C., area, at $5,933 a month (up from $5,757 a month in 2011) and the lowest in Arkansas (except for Little Rock) at $2,355 a month (up from $2,156 a month in 2011). Average home health care aide services ranged from a high of $32 an hour in Rochester, Minnesota (down from $34 an hour in 2011), to $13 an hour in the Shreveport area of Louisiana (down from $14 an hour in 2011). Adult day care services were highest in Vermont at an average of $141 a day and lowest in the Montgomery, Alabama, area, at $26 a day, both down from 2011.

For the full 2012 report, including listings of average long-term care costs in selected cities, as well as the original website for this article, click HERE.  


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The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in wills and trusts, estate planning, guardianship, probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for family law issues such as divorce, child custody and visitation, support, and military family law.

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

Live Up to Your Commitment to the Nursing Home, or Beware

A recent Connecticut case highlights the risk to family members of nursing home residents who don't live up to their financial commitments to such facilities.

When her mother was admitted to the Cook Willow Health Center, Judy Andrien signed an admission agreement on behalf of her mother as "responsible relative," agreeing to take steps to ensure that the nursing home would be paid from her mother's assets or by Medicaid.

The facility sued Ms. Andrien, claiming that she did not live up to this commitment. Ms. Andrien asked the court to dismiss the case, arguing that she cannot be held liable because she did not agree to use her own funds to pay for her mother's care.

The Superior Court of Connecticut has ruled in the facility's favor, stating that the claim is not that Ms. Andrien personally guaranteed payment, but that she is in breach of contract for not using her mother's funds to pay the nursing home or taking steps to get her mother Medicaid coverage. The court's ruling means that the case will continue to trial on the nursing home's claim, which it still must prove.

The moral of this case is that even when family members do not commit their own funds to pay for the care of family members, they can be personally liable if they do not satisfy commitments they make to the facility.

Nursing facilities cannot require a personal financial guarantee as a condition of admitting a family member, and relatives of patients being admitted should sign nursing home admission agreements only as representatives of their parents (or other family members), not for themselves.  (When the case does go to trial, Ms. Andrien might argue that since the facility cannot make a family member's commitment a condition of admission, there was no consideration provided by the facility and that portion of the admission contract may not be enforced.)

To read the full text of the court’s decision in the case, Cook Willow Health Center v. Andrien, go to: http://caselaw.findlaw.com/ct-superior-court/1577974.html

Consult with your attorney before signing any agreement with a nursing home or other long-term care facility. For more on signing nursing home admission agreements, and the original location of this article, click HERE.


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The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in wills and trusts, estate planning, guardianship, probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for family law issues such as divorce, child custody and visitation, support, and military family law.

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

Book Review: Everyday Law for Seniors

Lawrence Frolik and Linda Whitton.

Everyday Law for Seniors. 

Paradigm Publishers. Boulder, CO. 2012. 189 pages.

 $24.95 from Amazon

Seniors confront many issues that require a basic understanding of the law, from financing long-term care to protecting themselves in the event of incapacity. This book provides a clearly written and concise guide to the range of legal options and rights available to seniors.

Written by two law professors and elder law experts, and part of a series of "Everyday Law" primers, Everyday Law for Seniors explains how those in their 60s and older can use the law to their best advantage. The book covers a wide variety of topics of interest to seniors, including age discrimination, Social Security, retirement benefits, Medicare and Medicaid, guardianships, powers of attorney, and elder abuse. In clear, understandable English, each chapter describes the law and gives seniors an overview of their legal rights and protections to help them make the best possible decisions.

The authors don't offer legal advice and the book is not meant as a substitute for a good lawyer. Instead, the straightforward information the book provides can help readers understand their options, ask good questions, and better comprehend any legal advice they receive.

You may find the original article, as well as links to order this book, on our newsletter HERE.


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The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in wills and trusts, estate planning, guardianship, probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for family law issues such as divorce, child custody and visitation, support, and military family law.

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

Medicare Premium Rise Lower Than Expected

The Centers for Medicare and Medicaid has announced the new Medicare premiums, deductibles, and coinsurances. 

The standard Medicare Part B premium is increasing by $5 to $104.90 a month, smaller than the $9 per month increase predicted earlier in the year.

As previously reported, Social Security recipients will receive a 1.7 percent increase in payments in 2013. Most people have their Medicare premiums deducted from their Social Security benefits. The smaller-than-expected hike means that most Medicare recipients will still receive a modest boost in Social Security benefits.

Here are all the new Medicare figures:

    Part B premium: $104.90/month (was $99.90)
    Part B deductible: $147 (was $140)
    Part A deductible: $1,184 (was $1,156)
    Co-payment for hospital stay days 61-90: $296/day (was $289)
    Co-payment for hospital stay days 91 and beyond: $592/day (was $578)
    Skilled nursing facility co-payment, days 21-100: $148/day (was $144.50)

As directed by the 2003 Medicare law, higher-income beneficiaries will pay higher Part B premiums. Following are those amounts for 2012:

•     Individuals with annual incomes between $85,000 and $107,000 and married couples with annual incomes between $170,000 and $214,000 will pay a monthly premium of $146.90 (was $139.90).
•     Individuals with annual incomes between $107,000 and $160,000 and married couples with annual incomes between $214,000 and $320,000 will pay a monthly premium of $209.80 (was $199.80).
•     Individuals with annual incomes between $160,000 and $214,000 and married couples with annual incomes between $320,000 and $428,000 will pay a monthly premium of $272.70 (was $259.70).
•     Individuals with annual incomes of $214,000 or more and married couples with annual incomes of $428,000 or more will pay a monthly premium of $335.70 (was $319.70).

Rates differ for beneficiaries who are married but file a separate tax return from their spouse:

Those with incomes between $85,000 and $129,000 will pay a monthly premium of $272.70 (was $259.70).

Those with incomes greater than $129,000 will pay a monthly premium of $335.70 (was $319.70).

The Social Security Administration uses the income reported two years ago to determine a Part B beneficiary's premiums. So the income reported on a beneficiary's 2011 tax return is used to determine whether the beneficiary must pay a higher monthly Part B premium in 2013. Income is calculated by taking a beneficiary's adjusted gross income and adding back in some normally excluded income, such as tax-exempt interest, U.S. savings bond interest used to pay tuition, and certain income from foreign sources. This is called modified adjusted gross income (MAGI). If a beneficiary's MAGI decreased significantly in the past two years, she may request that information from more recent years be used to calculate the premium.

Those who enroll in Medicare Advantage plans may have different cost-sharing arrangements. On average Medicare Advantage premiums are expected to rise $1.47 per month in 2013.

For more information on the Medicare Part A numbers and the Medicare Part B numbers, click HERE to be taken to the original article.

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The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in wills and trusts, estate planning, guardianship, probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for family law issues such as divorce, child custody and visitation, support, and military family law.

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

Year-End Musings regarding Elder-Law

As I read the newspaper and hear the ongoing reports regarding the fiscal cliff and the general poor state of the economy (state and federal in the case of Rhode Islanders), I am quite concerned for my clients and for my family and friends. I attended an annual federal and state estate planning update two weeks ago and learned that the experts had no clear idea of what lies before us after January 1st. The three speakers disagreed in their predictions of what will occur and where it will leave us. So the message is “stay tuned”. Personally, I want to make sure that I make the best plans for my family but how to plan in the midst of chaos?

To move from the general to the particular, I have found that many clients come in and review their estate plan with us during what we term a “tune-up” but often they fail to follow through. Recently, a client cost his father’s chosen recipients many thousands of dollars by not checking the “transfer on death beneficiaries” of assets owned by the client’s father. The father passed away and the balance of the father’s pension contributions went to a former lady friend who had not been part of his life for more than a decade. What’s the moral of this story? It may be time for you to book a tune-up. Life has become more and more complicated by rules, regulations, and laws. It is difficult if not near-impossible to stay on top of Medicaid, Medicare, Veterans’ benefits, Social Security, state and local income tax laws, estate tax laws and the never-ending changes to all of them. We look forward to meeting with you. Then please follow through after our meeting! We at The Law Offices of Jeremy Howe and at Partners In Mediation wish you and yours a healthy and prosperous 2013.

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The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in wills and trusts, estate planning, guardianship, probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for family law issues such as divorce, child custody and visitation, support, and military family law.

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.