Independence and the Elderly

We all want to be independent. Everyone wants to be able to do things on their own. That’s the very definition of independence! Being able to accomplish a task, no matter how simple, without the aid of someone else brings good feelings—accomplishment and pride. And while independence is something that’s important to everyone, let us not forget that a sense of independence doesn’t have an age limit. It’s just as important to the elderly as it is to younger generations.

Getting older, however, often brings its own limitations into the picture, thereby hindering the goal of being independent—at least to the degree we or an elderly loved one wants to be. A lot of the time, seniors can live completely normal, independent lives. But there are some that may experience some issues such as decreased mobility or illness that can prove to be a stumbling block for them. If this is the case, then a caregiver may be just who they need to help them keep that sense of independence they once had and that which they now crave, even if it isn’t to the extent it once was.

Going hand in hand with that feeling of independence is that the elder be involved in his or her own care. Unless specifically stated otherwise, they should be allowed to do the things they are still capable of doing. Many older adults can still do things in daily life, like light chores (cleaning, cooking, or even grocery shopping), and all of these can be vital to providing them with and maintaining a sense of independence.

If you are considering becoming a caretaker for an elderly individual, you should know that besides performing normal household duties, you also need to be willing to participate in other activities with the senior, like playing games, going for walks, eating together or simply having a good conversation. It’s crucial that the elderly people living on their own be involved in caring for themselves, since that can work to instill a sense of purpose in life for them. That, in turn, will lead to that sense of accomplishment we mentioned before and helps to solidify that sense of stability and independence.

While some may not be able to quite reach that end goal of complete independence on their own, all is not lost. By having someone available to help in the areas they need it, that goal can become a part of their daily reality.

If you or someone you love needs assistance with Elder Care law issues, call 856-281-3131. Let us help ease your stress and give you a plan.

Home Health Care Services

Home Health Care services are exactly what they sound like, but Home Health Care agencies do vary greatly when it comes the types of services they provide. And while home health care and home services do sound similar, home care is medically inclined. Let’s look at some of the medically-related tasks home health care helps with:

  • Provides or assists with patient’s personal care, including but not limited to: bathing, shampoo hair, oral hygiene, and general skin care. Helps patients with dressing or grooming. All care is consistent with a “Plan of Care.”
  • Helps patients or clients with mobility and ambulation, with consistency to Plan of Care. Such things might include transfers, assistance with walker use, etc.
  • Prepares and serves meal, as needed. May also feed and/or give fluids as directed in Plan of Care.
  • Helps patients with toileting activities, including, when appropriate: bedpan use, commode or toilet; or changing diapers. Takes and records oral, rectal and auxiliary temperatures, pulse and respiration, and/or blood pressure.
  • Turns and positions those who are bed-bound, and provides preventative skin care techniques like back rubs and other measures.
  • Performs a range of motion and other simple things as instructed by therapists or nurses.
  • Helps patients and clients in the self-administration of medicines. Aides do not administer medicine but assist patients.
  • Performs household tasks like changing sheets, washing dishes, vacuuming and dust mop floors, dusting furniture, grocery shopping, emptying trash, etc. as appropriate and outlined in Plan of Care.
  • Reports observations in a timely manner to RN Case Manager, in order to get nursing attention to patient changes or other urgent needs, as well as documentation of observation and duties.
  • Makes use of personal protective equipment when completing tasks where contact with blood or body fluids is possible. Involve patient is socialization or other types of diversionary activities to help with mod and self-esteem enhancement.

In the realm of Nursing Care, RN’s or LPNs give more advanced skilled care, like:

  • Skilled Nursing evaluations
  • Observation and assessment
  • Catheter care
  • Cardiac rehabilitation
  • Congestive Heart Failure
  • Pre & Post Heart Transplant
  • Inotropic Home IV Therapy
  • Tracheostomy Care
  • Wound care and dressings
  • Wound Vac Care
  • Injections
  • Physical Therapy
  • Intravenous Therapy
  • Tube feedings and care
  • Ostomy care and teaching
  • Diabetic care and teaching
  • Disease process education
  • Post stroke care
  • Hypertension, congestive heart failure (CHF) and Emphysema (COPD) care
  • Medication management
  • Family Counseling and Teaching

And the following specialty services may be provided, dependent on the needs of the client and the resources of the agency:

  • Medical Social Worker
  • Physical Therapy
  • Occupational Therapy
  • Speech Therapy
  • Hospice Care
  • Chaplain Services

If you or someone you love needs assistance with Elder Care law issues, call 856-281-3131. Let us help ease your stress and give you a plan.

HIPAA: What is It and Why do I Need It?

Many of us have probably heard of HIPAA at one time or another, but we may be otherwise unfamiliar with it, what it does, or why we even need it to begin with. Let’s clear up any potential confusion right now.

The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that authorized the creation of national standards to be put in place to protect the privacy of a patient’s health care information. The Privacy Rule—which began on April 14, 2003—controls both the use and disclosure of any “Protected Health Information.” What this refers to, in a broad sense, is simply “individually identifiable health information transmitted or maintained in any form which:

  • Is held by a covered entity or its business associate;
  • Identifies the individual or offers a reasonable basis for identification;
  • Is either created or received by a covered entity or an employer; or
  • Relates to a past, present, or future physical or mental condition, provision of health care or payment for health care.

HIPAA limits covered entities from sharing any protected health information. These entities include health care providers that conduct electronic transactions, health care clearinghouses, and health plans. It puts a limit on any health care provider or insurance company that uses computers through their normal course of business.

Those entities that violate the terms of HIPAA can face both civil fines and criminal penalties, along with possible jail time. Civil fines can range from $100 per violation up to an annual maximum of $1.5 million in the case of willful violations. Those entities that knowingly obtain or disclose any identifying information can face some criminal penalties, including fines up to $50,000 and prison time for a one-year period. Those who violate the terms with intent to sell, transfer, or use individually identifiable health information for any kind of commercial advantage, personal gain or malicious harm face fines of $250,000 and jail time of up to 10 years.

A well-made medical power of attorney should be sufficient enough legally to authorize an otherwise reluctant health care provider to share any medical information with the health care agent. If the document doesn’t explicitly authorize the transmission of health information, as required by HIPAA, the doctor may refuse to share any such information with the agent, who may need it in order to make medical decisions for you in your stead. Remember, your health care agent cannot act on your behalf until your doctor determines that you do not have the capacity to make decisions on your own, so you might want someone to be able to get access to your records prior to that time.

For example, you might want your agent to call the doctor’s office for questions regarding bills, or to discuss medical conditions you have with the doctor in case of your hospitalization. Having a HIPAA authorization can allow them to do that for you.

Because of this, a lot of law professionals often recommend their clients fill out and sign a separate document that authorizes disclosure of any protected health information. This authorization also lets you name someone to be able to have access to any of your medical information so that your doctor or insurance company has no qualms about sharing any protected medical information with them.

If you or someone you love needs assistance with Elder Care law issues, call 856-281-3131. Let us help ease your stress and give you a plan.

Heat Stroke and the Elderly

As we age, our bodies begin to become more susceptible to a number of things it wouldn’t have when we were younger. We should always be on the

lookout for any hazards if and when we spend ample amounts of time outdoors, especially in the case of warmer weather. There are a great many potentially hazardous things in the environment for an elderly person, but for the sake of time, we’ll focus on just one, as that’s easier than making a laundry list of things to lookout for. That said, one of the deadliest hazards of the outdoors to the elderly, or indeed anyone, is heat stroke.

Heat stroke is the most serious heat-related illness, and it happens when the body suddenly becomes unable to control its own temperature. As temperature increases, the body loses its ability to sweat, thus, it cannot cool down as it should. Body temperatures can raise to 106 degrees Fahrenheit in as little as 10 to 15 minutes, and either death or permanent disability can happen if proper emergency treatment isn’t carried out as soon as possible.

Some of the warning signs and symptoms of heat stroke include:

  • An extremely high temperature (above 103 degrees Fahrenheit)
  • Red, hot, and dry skin (no sweating)
  • Rapid, strong pulse
  • Throbbing headache
  • Dizziness
  • Nausea

Heat Exhaustion

A milder form of heat-related illness that can be brought about from many days of exposure to high temperatures and inadequate or unbalanced replacement of fluids, heat exhaustion can be just as dangerous. The warning signs can include:

  • Heavy sweating
  • Paleness
  • Muscle cramps
  • Tiredness
  • Weakness
  • Dizziness
  • Headache
  • Nausea or vomiting
  • Fainting
  • Skin that’s cool and moist
  • A fast and weak pulse rate
  • Fast, shallow breathing

If you know of an older adult relative or neighbor, there are some things you can do to check on them and make sure that they are safe.

  • Visit older adults at risk at least twice during the day and look out for signs of heat exhaustion or heat stroke.
  • Encourage them to intake more fluids by drinking cool, non-alcoholic beverages, no matter the level of their activity. However, if the doctor normally limits the amount of fluid they drink or they are on water pills, they’ll need to ask their doctor how much they should drink in hot weather.
  • Take them to air-conditioned locations if they have issues with transportation.

If you witness any signs of severe heat stress, you could be dealing with a life-threatening emergency. Have someone call for medical help at once while you attend to the affected individual. Here are some things you should do:

  • Get the person to a shady area.
  • Cool the person quickly, by using whatever methods you can. For instance, immerse them in a tub of cool water; put them in a cool shower; spray them with cool water from a hose, or if humidity is low, wrap them in a cool, wet sheet and fan the person vigorously.
  • Monitor body temperature and continue cooling efforts until temperature drops to 101-102 degrees.
  • If EMS is delayed, call the hospital emergency room for more instructions
  • Do not give the person alcohol to drink.
  • Get medical help ASAP.

If you or someone you love needs assistance with Elder Care law issues, call 856-281-3131. Let us help ease your stress and give you a plan.

Important Documents for End of Life Care

Going through the last stages of life with an elderly loved one is hard enough without also having to try and remember what papers you might need to have ready too. In this article, we’ll take a quick look at some of the documents that everyone should have, and we’ll also see in another article what will happen if you don’t have the necessary documents.

Let’s get started.

The documents that everyone should have include the following:

  • Advanced Health Care Directive
  • POLST (Physicians Orders for Life Sustaining Treatment)
  • Will
  • Power of Attorney for Finance
  • Final Arrangements

Other things you might need are:

  • Trusts
  • Beneficiary forms

Now, let’s take a more in-depth look at each of these things, starting with the Advanced Health Care Directive.

Advanced Health Care Directive

What it does: An advanced health care directive allows someone to designate someone to make health care decisions for them if they are unable to speak for and do so themselves.

  • It is created by combining a living will with a durable power of attorney for health care
  • Versions of this form vary by state, but a form from one state will be recognized in another.
  • Many doctor’s offices and hospitals will provide this form at your request.
  • Those over 18 should have one
  • It should be completed while competent, so you know what you are signing. It should not be signed if you have a mental disability such as dementia.
  • It is often used to make decisions regarding feeding tubes, ventilators, or any other treatments for end of life or whenever someone is unconscious.
  • It is only required to be witnessed; it does not need to be notarized.

POLST (Physicians Orders for Life Sustaining Treatment)

What it does: The acronym stands for Physicians Orders for Life Sustaining Treatment. It replaces a DNR—or Do Not Resuscitate—order.

  • Lets those who have life-threatening illnesses to decide what treatment they do or do not want to receive. They do this with their doctor.
  • This document can be helpful if you do not wish for emergency responders to perform CPR and also informs on other such treatments you may or may not want to receive.

Will

What it does: Outlines your wishes with regard to your estate (any money and belongings), and how you wish for those things to be dispersed to family, friends, organizations, and others after you pass away.

  • Also known as a Last Will and Testament.
  • Laws regarding estates often vary from state to state, but many of them will often honor those wills made out-of-state.
  • An attorney for those estates over $100,000 isn’t required, but it’s a good idea to have one help you write the will or look over what you’ve already written with you.
  • A will has to be completed while competent, so you know what you are signing. You cannot complete a will if you have a mental complication, such as dementia or Alzheimer’s.
  • An executor or administrator can be named in a will, allow you to choose who will pay any final bills and carry out your final wishes.
  • The probate court will oversee the executor in order to ensure that wishes are carried out as outlined in the will.

Durable Power of Attorney for Finance

What it does: Gives a person of your choice access to your finances, like a checking account, any investments, or property so that they can pay bills for you.

  • Is valid even if you are incapacitated.
  • Has to be completed while competent, so you know what you are signing.
  • The person you name as power of attorney for finance must be someone you trust. If you don’t, you should talk with a professional.
  • A spouse might not have access to all funds unless everything, even investments, is held as joint property.

Final Arrangements

What it does: This allows you to state what happens after you pass away—whether you want to be buried or cremated—and informs your family members. Also makes your wishes known regarding things like donation of organs or any other special arrangements you might have.

  • Puts wishes in writing and consolidates them in a place that family members can easily locate them.
  • The more decisions you make prior to death, that’s fewer that your family have to make during an incredibly difficult time.

Trusts

What it does: Creates a legal entity in which to hold your assets so that your estate can skip the probate process when you pass away.

  • Also known as a living trust.
  • A trustee can be named in order to care for the trust while you are alive and distribute items in the trust to any beneficiaries when you die.
  • You are able to be the trustee while you are still alive, and are able to name a successor who will step in when you become incapacitated or die.
  • A revocable trust lets you control everything happening with the trust while you are living.
  • An irrevocable trust is unable to be changed without consent from the beneficiary.
  • A variety of options are available for trusts to serve a specific purpose:
    • Special Needs Trust: Sets aside funding for the purpose of assisting one who is disabled.
    • Charitable Trust: Contains money to be given to charity.
    • Bypass Trust: An irrevocable trust that passes assets to spouse and then children when the second parent dies. This limits taxes on the estate.
    • Life Insurance Trust: Gets rid of life insurance from the estate, thus removing estate taxes.
    • Generation Skipping Trust: Lets grandchildren inherit assets directly without paying taxes.

Beneficiary Forms

Any bank accounts, investments, insurance, or retirement plans are able to be designated as “payable on death” to a beneficiary you name. This means that funds do not pass through the probate process, and allows for immediate access to funds.

If you or someone you love needs assistance with Elder Care law issues, call 856-281-3131. Let us help ease your stress and give you a plan.

 

Estate Distribution Without a Will

If you die without a will, that’s called dying “intestate.” So, if that happens, how can your estate be divided up and distributed? Thankfully, New Jersey law has you covered. For now, though, let’s look at how just property are assets in the name of the decedent are handled:

  • If you die and leave behind a spouse and children from the same marriage, the spouse then will inherit EVERYTHING (this does not include step children or children from a prior marriage).
  • However, if you die and leave behind a spouse and children from a previous marriage, the spouse will only get the first 25% of the estate, but not less than $50,000 or any more than $200,000. They would also get one-half of any balance of the estate, while the balance would be divided equally among the children. Grandchildren, though, will take the share from their deceased parent.
  • If you die and leave behind a spouse, a child or children and a stepchild, or any stepchildren, the spouse will get the first 25% of the estate, but not any less than $50,000 or any more than $200,000, plus one-half of any balance of the estate. Children would take the balance of the estate equally, while grandchildren would take the share of their deceased parent, as stated above.
  • If you die and leave behind a spouse but no children, and are survived by your parents, the spouse inherits the first 25% of the estate, but not less than $50,000 or more than $200,000, plus three-fourths of any balance of the estate. Your parents would then take the balance equally.
  • If you die and are survived by a child or children but no spouse, the children would inherit equally while any grandchildren would take the share of their deceased parent.
  • If you die and no immediate family (i.e. spouse, children or grandchildren), your parents will inherit everything. However, if you do not have parents, any siblings you have will inherit equally. Like grandchildren, any nieces and nephews would then take the share of their deceased parent.
  • If no immediate family survives, then your property can go to more distant relatives, like grandparents, aunts, uncles, cousins, etc. Then it may go to stepchildren or can even revert back to the State.

If you or someone you love needs assistance with Elder Care law issues, call 856-281-3131. Let us help ease your stress and give you a plan.

Estate Planning and the Second Marriage

“Marriage is the triumph of imagination over intelligence. Second marriage is the triumph of hope over experience.”  – Samuel Johnson

Hope does indeed spring eternal which may explain why approximately 75% of divorced people remarry. The National Stepfamily Resource Center reports that approximately 65% of these marriages will include children from previous relationships.

Before the wedding plans progress too far, the happy couple should temporarily interrupt their bliss to discuss the mundane and sometimes uncomfortable topic of wills and trusts – particularly when either or both have children. Planning issues vary widely depending on the ages of the husband and wife and the financial wherewithal of each. As the years march by, planning objectives will most likely evolve.  Arrangements regarding the couple’s estate plan are often outlined in a prenuptial agreement with contemporaneous execution of the appropriate documents.

Example: James and Karen, both widowed, reconnect at a reunion – rekindling their high school romance. After a few years of dating, they decide to get married. James has 2 grown children as well as a number of grandchildren with whom he is close. His healthy financial portfolio (close to $3,000,000) reflects years of hard work in his practice as well as a savings mentality. Karen was attracted to a career in public service because she loves to help people but didn’t think about lifestyle consequences when choosing her career path. Unfortunately, her bank account is virtually nonexistent and she lives paycheck to paycheck. She has no children.

James is head over heels in love and wants to make sure that Karen is taken care of financially in the event that he predeceases her. On the other hand, he wants to provide generously for his children and grandchildren. He is hesitant about leaving his estate outright to his beloved. What if he dies within a short period of time and Karen remarries? After all, James’ hard earned money could end up in the hands of some man that he doesn’t even know – if she remarries and names her new husband as beneficiary. Karen is particularly concerned about her ability to remain in the home (and to afford it) if he predeceases her. A number of creative plans can be designed to satisfy all objectives. The following represents only one possible solution:

Through his will, James establishes a life estate in the property for Karen’s benefit, giving his children a remainder interest. (An issue to address is whether the life estate terminates if an unrelated male moves into the property or if she vacates the property for a certain period of time.)  After calculating the amount that would allow Karen to enjoy a reasonable lifestyle, James purchases a life insurance policy naming either Karen or Irrevocable Life Insurance Trust (ILIT) as beneficiary. He devises the remainder of his assets to his children.

If James is not inclined to buy life insurance, he could set aside a portion of his estate in a Qualified Terminable Interest Property (QTIP) trust for Karen’s lifetime benefit with the remainder interest passing to his children. Under governing rules, Karen must be the sole beneficiary during her life and receive distributions of all income.  The trust document may allow for distribution of principal to her as well. The assets funding the QTIP are eligible for the unlimited marital deduction if James predeceases Karen and is included in her estate when she passes away. However, she has no power to name the beneficiary as James’ designation controls.

If you have questions about estate planning in the context of a second marriage, give us a call 856-281-3131.  We will be happy to discuss a variety of creative solutions.

Downsizing and Moving

When making the move to a long-term care facility, it can be quite difficult figuring out how to go about downsizing and actually making that move. Of course, there are necessities that the person will need as they make the transition from home to a care facility. It is a transition that can be scary for all involved, but especially the person moving. It would be a good idea to take some favorite pictures or a few small items that hold sentimental value for the person. That way, he or she can have some semblance of home in their new surroundings to make the move a little easier. If needed, perhaps another family member might be willing to look after some of the other things the person is unable to take with them. That way, those important items are with someone safe, and can be brought (and taken back) when the person comes for a visit.

If you or someone you love needs assistance with Elder Care law issues, call 856-281-3131. Let us help ease your stress and give you a plan.

Guardianship vs. Power of Attorney

While many law terms can sound quite similar to the uneducated, oftentimes, there are things that make them vastly different from one another. Two of those terms that could potentially throw people for a loop are Guardianship and Power of Attorney. Let’s check out the differences below:

With a power of attorney, an individual can name his or her own power of attorney, but the courts have to appoint a guardian. However, both of them are considered to be fiduciary and both have basically the same amount of authority to make financial decisions. If a person wants an elder to have a guardianship, they could hire an attorney, but the elder has the right to an attorney too. If he or she might require a guardian, they have the right to go to court and present evidence to the contrary.

If a guardian does get appointed, he or she has to keep a regular account and present to the court on how any money is being spent, and how much. The courts also have the ability to keep watch over what a guardian (or conservator) does. They can also change the guardian, expand or limit any duties, and make rulings that affect the powers given to guardians. Conversely, a power of attorney isn’t required to make reports to the court, and a durable power of attorney document doesn’t actually need the power of attorney to report on how money is spent. Further, the durable power of attorney is normally permanent.

A guardianship (or conservatorship), by contrast, can be temporary, but oftentimes becomes permanent once the court learns the elder needs a permanent guardian after the temporary one reports to the court. It also costs less to create and appoint a durable power of attorney, even if a lawyer may have drawn up the power of attorney document and spent time going over issues and explaining duties to you, as well as what the document as a whole actually means. Since the court isn’t directly involved, it’s actually a lot simpler to create and appoint a durable power of attorney than a guardianship.

If you or someone you love needs assistance with Elder Care law issues, call 856-281-3131. Let us help ease your stress and give you a plan.

How to Terminate a Guardianship

If you’re looking to terminate a guardianship, it’s going to require a court hearing in many cases. Anyone can file the papers—relatives, guardian, subject of the guardianship—and inquire of a judge to see if a guardianship is still necessary.

Let’s look at some of the reasons why you might choose to terminate a guardianship:

  • Death: When the ward dies, a final accounting is needed to close a guardianship over an estate. A hearing must be held to approve final accounting and close the case.
  • Age of Majority: This only applies if the ward was a child who has now turned 18.
  • Parents will Care for Child: Guardianships can be closed if the ward is a child and the parents are now able to care for him or her. They must prove they have fixed whatever allowed the guardianship to be granted, and that they can properly care for the child. They must show they can give shelter, food, and clothing, and that they can meet the child’s medical and educational needs.
  • Moved Out of State: A guardianship may be closed if the ward has moved to another state and the guardianship has been received in a new state. Proof of the other case has to be given.
  • Competency: This only applies if the ward is now an adult who is both competent and able to manage his or her own affairs. Two doctors need to certify that the person is competent, and any request to end a guardianship on the grounds of competency of the adult have to be supported by two letters from two doctors stating the ward is competent.

Now, let’s look in detail at the steps you’ll need to take in order to terminate a guardianship.

  1. Complete Paperwork: You’re going to have to complete a Petition to Terminate Guardianship, and a Citation or Notice of Hearing. This document tells the judge why you think that the guardianship is no longer required. Be sure to complete all the sections and attach any exhibits that support your argument.

You’ll also need to file the Citation to Appear or Notice of Hearing, and when you file it, you’ll need to have a court date for the judge and any interested parties to appear in court. If the ward is still living, complete the Citation to Appear and Show Cause; if they are passed, complete the Notice of Hearing.

  1. File the Paperwork: Just like with the other documents, you can file your documents in a few ways:
  • In person at the family courthouse
  • By mail
  • Online through Wiznet
  1. Serve the Guardians and Other Parties: THIS IS IMPORTANT! If this step is done improperly, the judge can cancel your hearing! All the documents must be mailed to guardians and relatives, and this is usually the same group who have been receiving notice of proceedings prior to this. This allows you to make sure the guardians and relatives know about the hearing and have a chance to respond. If the ward is alive, mail the petition and citation to all the required people by certified mail, return receipt requested. If the ward has passed away, you can send the petition and notice of hearing to everyone via regular mail.
  1. Submit an order to the judge one week before hearing: If the judge ends the guardianship at the hearing, he/she will sign an official order ending it. Prepare the order ahead of time and submit it to the judge so he or she will have the necessary paperwork at the hearing. Fill out the Order Terminating Guardianship and take it to the family court a week before hearing.
  1. Attend the Hearing and file final papers: Be sure and arrive to the courthouse early so you have enough time to do everything you need to beforehand. If the judge terminates the guardianship, he or she will sign the Order Terminating Guardianship. Be sure to bring it if you forgot to turn it in beforehand, and afterward, you have to make sure it is filed at the Clerk’s Office.

If you or someone you love needs assistance with Elder Care law issues, call 856-281-3131. Let us help ease your stress and give you a plan.