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Recognizing Elder Abuse: 4 Warning Signs

June is Elder Abuse Protection and Awareness Month. For most of us, respecting and protecting our elders is a natural instinct (or a part of our upbringing). It’s hard to imagine someone taking advantage of or abusing them. Which is one of the reasons elder abuse doesn’t always get recognized or reported.

As Baby Boomers age, the 65-and-older crowd makes up the fastest growing age group in America, and incidences of elder abuse are on the rise. It doesn’t always look the way you would imagine, either. Elder abuse can take the form of physical abuse, sexual abuse, verbal abuse, neglect or financial abuse.
According to the Centers for Disease Control, “elder abuse is experienced by 1 out of every 10 people, ages 60 and older, who live at home. This statistic is likely an underestimate because many victims are unable or afraid to disclose or report the violence. Because the definition of elder abuse is so broad and its victims are often isolated, it can be difficult to detect and report. Abuse doesn’t always happen at the hands of a stranger, either.
Senior citizens with dementia are particularly at risk, because the behaviors associated with dementia can be difficult to handle at times and the person may not recognize that they are being abused or be able to speak up for themselves. It can also be highly stressful providing 24-hour care, so people who are the primary caregivers for someone with dementia or a lot of health needs may find themselves acting in a way that they wouldn’t have in the past.
Just like it takes a village to raise a child, it also helps to be an active community member when advocating for the rights and safety of our elders. The following are some of the most common indicators that someone might need advocacy or support:

  1. Unexplained physical injury – bruises, skin tears, abrasions, pressure marks. Pay close attention to explanations for the injury that don’t match the symptoms.
  2. Indicators of Neglect – poor hygiene, lack of groceries in the fridge, unexplained weight loss, dirty clothes, soiled undergarments, hoarding. If a person is cognitively impaired or mentally disabled, it is considered neglect if their family does not provide adequate care.
  3. Signs of verbal or emotional abuse – depression or withdrawal, strained relationship with the caregiver, forced isolation, nervous or fearful behavior, hearing a caregiver yell, snap or be harsh with them. Isolation and controlling behavior is a hallmark of this type of abuse, in an attempt to hide the situation from other people.
  4. Financial abuse or exploitation – probably the most common and unrecognized form of abuse. Red flags include unpaid bills, increased use of credit cards, overly friendly relationship with a stranger or acquaintance, more frequent withdrawals of cash, unexpected changes to Power of Attorney and banking. There are also predatory sales practices and schemes that directly target senior

What can you do if you suspect abuse? If you feel someone is in physical danger, the National Center on Elder Abuse recommends calling 911. If you suspect other forms of abuse, you can report them to Adult Protective Services. The phone number in Cuyahoga County is 216-420-6200. This is a central intake line, the same one that is used for Child Protective Services. If the person you are concerned about is in a facility, then report the issue to the Administrator, Director of Nursing and/or local Ombudsman.
If you’re not sure whether to be concerned, please don’t hesitate to call our offices and someone can help you assess the risk. When it comes to any form of abuse – it’s always better to err on the side of safety. When it doubt, we encourage you to talk through your concerns with someone you trust who has objective knowledge of the situation.
 

Top-rated Cuyahoga County Nursing Homes

Recently, a list of the top-rated nursing homes in each of Ohio’s 88 counties was published by the Plain Dealer. As we’ve mentioned in the past, this information is just a starting point. (See our previous response to this Plain Dealer series here.)
There are a number of personal factors that ratings can’t tell you about choosing the right facility for a loved one. To be honest, there are some facilities on the list below that surprised us. That’s why it’s important to visit facilities, ask lots of questions and seek out your own information.
You can read the full list for all 88 counties here.
Please note: This list is provided for informational purposes only. You can also view facility ratings and reports directly (this is public information) online here.
Facilities should also provide you with copies of their inspection reports upon request.

 

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Should I Be Worried? A Response to the Plain Dealer & Ohio's Low Nursing Home Ratings

A recent Cleveland Plain Dealer article, Ohio nursing homes among the nation’s lowest rated in quality of care: A Critical Choice included an in-depth review of investigation reports on local nursing homes. The author also cited federal statistics indicating that Ohio’s nursing homes are among the most poorly rated in the nation – capturing the deepest fears of anyone who has ever made the difficult decision to place a loved one in residential care.
First, we’d like to acknowledge that there are many hard-working, dedicated professionals who provide safe, loving care to Ohio’s seniors. By and large, it is our experience that most care concerns can be resolved through education, advocacy and cooperation. Problems can also be prevented with advance planning – not all facilities are the right fit for every person/family.
It was a long article – and if you managed to read the whole thing, you may be asking yourself what to do with all that information.  Below are some of the key takeaways and suggestions, based on our experience advocating for patients and families in some of the best and worst rated facilities throughout Cleveland and northeast Ohio.

  • Do your research. Most of the information published by the Plain Dealer is open to the public, and facilities are required by law to share it with you. Medicare even offers an online database to help you access and compare health facility ratings.
  • Get help. Talk through your questions and concerns with someone who knows the local facilities and residential care communities. This is one of the many supportive services our care coordinators offer, to help you compare care options with your loved one’s needs and priorities in mind. A facility that provided excellent care for your friend’s aunt with end stage cancer may not be the best option for a loved one with dementia.
  • Ask questions. After reviewing the investigation reports for a facility, it’s reasonable to ask how an issue was addressed/corrected. Are plans in place to prevent any future issues? Do you feel respected and heard when bringing up your concerns?
  • Stay involved. Even a perfect rating doesn’t guarantee that no problems will arise with your loved one’s care. Developing ongoing communication with staff members helps identify potential concerns ahead of time and open dialogue will make resolutions easier if any problems occur.
  • Speak up. If you have any immediate or ongoing concerns for your loved one’s safety, we encourage you bring it directly to the attention of the Administrator or Director of Nursing. In most situations, they take all such concerns very seriously and will do their best to resolve issues. If you’re not satisfied with the response or resolution you receive, please don’t hesitate to contact our office or your long term care Ombudsman for additional guidance and support.

 
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Elder Care Podcast with Karen Hale

We were happy to be asked by Karen Hale from Impossible Dream Podcast to talk about Elder Law and Life-Care Planning. Like many people, Karen had never heard of a Certified Elder Care Coordinator or a Life Care Plan. We enjoyed discussing our work with Karen in the studio and wanted to share the podcast with all of you. You can find out more about Karen’s inspiring work through the I’mPossible Dream site.

 
Life Care Estate Plan Road Map, Bradley L. Greene Attorney

Nursing Home Care Isn't the Only Option

Life Care Estate Plan Road Map, Bradley L. Greene Attorney
One of the reasons it’s important to determine health care goals and start financial planning while you are still healthy is to ensure that you have as many choices as possible when the time comes that you (or a loved one) eventually needs care.
Financial concerns, facility wait lists and lack of accurate or helpful information are some of the common reasons people find themselves choosing a long term care facility when other, more independent options, might have been possible.
For example, someone has a fall and injury, then has surgery and goes to a skilled nursing facility for recovery. When their Medicare covered rehabilitation period is over, they may not feel confident returning home alone. Without advance planning (or substantial savings) many people can’t afford assisted living or home care. And many senior living residences have wait lists, so this isn’t the kind of decision that can be made “in the moment.”
This lack of options often leads individuals who might be perfectly safe in a senior apartment to choose nursing home care, because they can’t afford assisted living and the nursing facility will help them apply for Medicaid.
Many people don’t realize that Medicaid also covers the cost of some Assisted Living facilities and home care services – not just Long Term Care. With advance planning (or even some thoughtful after-the-fact crisis planning) there are a number of options that may be less restrictive and less expensive than nursing home care.
The following five suggestions are things you can do now to ensure that you have as many care options as possible in the future:

  • Visit reputable facilities ahead of time and consider placing elderly loved ones on a wait list, even if you don’t think care will be needed any time soon. You can always decline and keep their name on the wait list, if your loved one isn’t ready when the time comes.
  • Ask potential facilities if/when they accept Medicaid payment. Some facilities require a certain period of private pay before you can transition to Medicaid payment (1,2 or 3 years) – but this might be more affordable than you realize – especially with some advance planning.
  • Review your assets, plan ahead for allowable expenses and manage health care spending to ensure a smooth Medicaid application when the time comes.
  • Establish a life-care plan with an experienced senior care professional – this includes considering what your wishes are for the future and guidelines for how care decisions should be made.
  • Any time it feels like you don’t have a choice about care options, ask more questions. Never allow someone to pressure you into making a decision before you feel ready. This is one area in which our Care Coordinators can be very helpful – because once we know what your care preferences and priorities are – our job is to help you navigate health care decision making with those goals in mind.

Bradley L. Greene, Esq. is a Life Care Planning and Elder Law firm located in Beachwood, OH specializing in Estate Planning, Medicaid Planning and Elder Abuse – offering personalized support and family guidance through all of life’s transitions.
 

Guide to Paying for Long Term Care

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Long term care is expensive.

According to the Ohio Department of Medicaid, the average rate for a semi-private nursing home room in the state of Ohio is more than $6,300 per month. Our current estimates for Cleveland and surrounding communities is closer to $9,000 per month, and these costs are expected to increase by at least 25% in the next ten years.

Factors such as age, health status, income level, family dynamics and geographic location all impact the cost of senior care. In some situations, such as recovery from surgery or accident, short term nursing home care may be covered by Medicare or your private health insurance. But care that goes beyond short-term recovery does not fall under this benefit. So how do people pay for long term care?
Out of Pocket: Very few people are in a position to pay privately for extended nursing home care. Based on the monthly estimates mentioned above, it would cost approximately $100K for one year of care in a Cleveland-area facility. The average length of stay in a nursing home is just over two years, but progressive illnesses such as dementia often involve long term care of five years or more. Even if you think you might have enough savings and investments to cover the full cost of such care, we still suggest talking to a qualified professional who can help guide you through the process and ensure that your assets and financial future are secure.
Long Term Care Insurance: Over the last 20 years, Long Term Care Insurance has become a popular option for those who anticipate they may need care in the future. Typically, the policy will pay a daily rate for home care, assisted living or long term care based on a number of factors that differ with each plan. These policies are most cost effective when purchased at a young age, as premiums increase the older you get. And high premiums don’t always ensure that a plan will cover the entire cost of long term care.
For example, if you have Social Security income of $2000 per month and your policy pays $100 per day ($3000/month), this equals a total of $5000 per month to cover care expenses. If the cost of care is $9,000 per month, then your family could be left with the responsibility of paying the remaining $4000 in care expenses, unless you have other assets to cover the shortfall.
Medicaid Spend Down: While Medicaid accounts for the largest percentage of payments to long term care facilities, most patients do not immediately qualify for Medicaid coverage. In order to qualify for Medicaid, recipients must pay for care and other qualifying expenses out-of-pocket until their assets reach below each state’s eligibility amount.  Factors to be considered include marital status, real estate, life insurance policies, business relationships, investments, etc. But once Medicaid is in place, you do not have to cover any shortfall between your income and the total cost of care.
Trusts: Whether you want to plan for the future, protect a disabled child or protect assets from long-term care costs – there are a number of legal ways to ensure that your family’s needs are provided for now and in the future. By transferring assets into a trust, families can maintain flexible control of assets on behalf of an older adult or someone with a disability. There are also specific kinds of trusts that can be established to help pay for the cost of long term care. Medicaid Pooled Trusts and Charitable Remainder Trusts are two examples of this.