Posts

Deducting Medical Expenses to Help Pay for Assisted Living

Our LA home for the aging provides affordable care.

Photo used under Creative Commons from www.stockmonkeys.com.

Paying for assisted living is a significant financial commitment that most seniors and their families must plan for carefully. But good news! Many of the expenses of assisted living residents are tax deductible. Such deductions can help add more flexibility to the budget and free up funds that otherwise would have gone elsewhere. A major way to find tax savings is to deduct your medical expenses. Three conditions need to be satisfied in order to get the greatest possible deduction for assisted living expenses:
  • The individual must qualify as being “chronically ill.” The Health Insurance Portability and Accountability Act of 1996 defines this as needing assistance with activities of daily living (bathing, dressing, eating, etc…) or requiring continual supervision at all hours of the day.
  • Second, the ratio of the adjusted gross income of the person paying for care to the total amount of medical expenses must be greater than 7.5%.
  • Finally, the resident’s care plan must be in accordance with the recommendations of a licensed health care provider (for example, a doctor, nurse, or social worker). Most assisted living facilities will automatically provide this and residents and their families will have official documentation that meets this requirement.
If these three items apply to you, you may be able to deduct all your assisted living costs, even those related to room and board. Even if you do not qualify as chronically ill, the portion of your assisted living fees related to medical care can still be deducted, as long as total medical expenses are greater than 7.5%. Your assisted living facility should be able to provide you with information on what part of your fees are related to medical care. All documentation related to tax deductions, whether relating directly to medical expenses or otherwise, requires meticulous record keeping. This means that you will need to be diligent about itemizing every single medical expense that you believe is eligible. Obviously, fees for appointments and prescriptions are part of this, but you can also deduct less-obvious health-related costs such as eye glasses, dentures, canes and walkers, transportation to appointments, etc… If you pay premiums for long-term care insurance, these are deductible as well. However, you cannot deduct the portion of your assisted living fees paid for by your long-term care insurance. For more information about the tax implications of being an assisted living resident, consult with your accountant to learn how the options apply to your specific situation. Your accountant can also help you identify additional tax credits that you may qualify for, as well as guide you with similar deductions for your state tax return.    
/by

How to Spot Elder Abuse

Unfortunately, there are some out there who will mistreat those who are vulnerable, including the elderly. At a certain point, it becomes elder abuse, and it’s one of the worst fears of those who have a loved one who is not fully able to fend for themselves. Elder abuse can be inflicted by a staff member in a residential institution, a fellow resident, a hired caregiver in the home, or even a family member. Our seniors deserve our gratitude and our respect, but a significant number of them are victimized and disrespected by the very people they trust. They cannot always do what it required to keep themselves safe. Elder abuse is under-reported because so few of those who are harmed by it can speak out for themselves. Because of this, it is important that family members, assisted living staff, and friends know the signs and symptoms of elder abuse. Being able to recognize abuse is the first step to putting a stop to it. There are several types, including:
  • Malnourishment – refusing to provide required food or water which can lead to serious medical problems, starvation, dehydration, and sometimes death.
  • Physical Abuse – committing physically violent acts; punching, kicking, slapping, pushing, and pinching are a few examples.
  • Sexual Abuse – committing unwanted sexual acts; molestation, harassment, rape, forced oral sex, and unwelcomed sexual language are considered forms of sexual abuse.
  • Financial Abuse – refusing seniors access to their own money, stealing, or embezzling.
  • Refusal of Medical Care – refusing them access to their physician, or refusing to provide them with their required treatments or medications.
  • Psychological Abuse – verbal abuse, name calling, demoralization, refusing seniors access to psychological care
  • Emotional Abuse – refusing them access to loved ones, telling them that no one loves them or wants to visit with them, making them believe that they are alone and utterly unloved.
  • Neglect – not providing seniors with the necessary hygienic care (bathing, brushing their hair, changing their diapers), leaving them alone for long periods of time, not providing a clean, safe and comfortable environment (no heat or air conditioning, allowing for filthy living conditions), or allowing others to abuse them.
The signs and symptoms of elder abuse include:
  • Unexplained or poorly explained bruises, broken bones, burns, abrasions, and pressure marks
  • Sudden changes in personality not explained by mental illness
  • Tension in personal relationships with family, friends, or assisted living staff
  • Unexplained withdrawal from activities that used to bring joy
If you believe that someone you love is the victim of elder abuse, they must be immediately separated from their abuser and provided with a safe, comfortable environment where they can be cared for and protected. If the abuse is taking place in an assisted living facility or other institution, speak to someone in a managerial position (assuming they are not a participant in the abuse) as soon as you can. If those in charge do not take swift action to address the issue, seek outside help. If the abuse is being inflicted by a family member, talk to other members of the family who you think can be trusted. Every state has a hotline for reporting elder abuse that will put you in touch with Adult Protective Services. In California each county has their own 24-hour reporting number (for Los Angeles County call (877) 477-3646,  (800) 510-2020, or (888) 202-4248). Start there to find expert help. You may also choose to talk to a doctor or therapist. For more information on elder abuse; what it is, what it looks like, how to stop it, or how to prevent it visit the National Center on Elder Abuse.  
/by

The Benefits of Assisted Living Over In-Home Care

Deciding whether to choose assisted living or home care is tough, and many emotions come up which influence the decision-making process. When you realize that you or a loved one needs some outside help, which option will work better? The answer of course is different for each individual and family, but there are certain considerations that tend to come up again and again. Two of the key features of assisted living facilities are that they’re designed so that seniors can be as independent as possible while remaining safe, and that they provide services in a cost-efficient manner (since they are shared by several or more people). On the other hand, home care has the undeniable advantage of the senior being able to remain in their home and/or with loved ones. However, the coziness of home care can also be one of its disadvantages. Having someone in the household with such extensive needs can be a burden for others in the family. We all want to feel like we’re doing as much as we can for aging loved ones, but caregiver burn-out is a real issue. Remember that before you can help others, you must help yourself: if you’re stressed or feeling negative, the senior in your life isn’t getting the best help. Allowing assisted living to take on the chores of daily care may allow you to spend the time connecting with your loved one and enjoying each other’s company. Another major issue that you should consider is the cost of the two options. Assisted living can be a very affordable solution that gives you a lot of value for your money. Just about all of life’s needs are taken care of in one fee: housing, food, utilities, housekeeping, and social activities, plus the care and assistance that helps the senior get through daily life. Many feel that a lot of worries have been taken off their shoulders when they move to assisted living. With home care, though, you’re paying on an hourly basis. The average cost of home care in California is $20 per hour, so that adds up quickly even before you throw in other needs like food and housing. Since you are managing home care yourself, you’ll need to have a plan when a hired caregiver cannot come in due to illness or any other reason. This can be addressed by using an agency, but the agency will charge higher-than-average fees for the convenience of knowing someone will always be there. Again, be sure to take into account your individual needs. There are some situations in which home care may be more appropriate. Before committing to one choice or the other, do thorough research on the actual cost and make sure you truly understand your options. Then this challenging decision may become a little more clear.
/by

Visits from Grandchildren in Assisted Living

Few things can brighten a senior’s day like a visit from their grandchildren and great-grandchildren. These visits can help add purpose to a senior’s life and help them maintain a connection to a world outside the facility and to the family. It also gives the grandchildren a valuable chance to get to know the grandparent. Being able to see how much they mean to older family members is an important experience for the child. But it can be challenging to think of ways to make this time meaningful and enjoyable. The first step is to prepare the child for visiting the facility. Describe what it’s like and perhaps even show pictures. Explain the purpose of assisted living and why the family decided grandma or grandpa should be there. Explain what behavior will be expected. Be sure to emphasize how happy the senior will be to see the child, but also make sure they know that their grandparent may not be feeling well that day. What to do during the visit can be a challenge. If everyone just sits around in grandma’s room, it will be boring for the children and unsatisfying for the senior. Instead, have a plan. Here are some ideas:
  • Bring children at a time when the residents are socializing. That way, the senior can introduce the child to friends and have a chance to show off their wonderful grandchildren.
  • Wear Halloween costumes so that the grandparent can see in person how cute they look and what creative ideas everyone came up with. There may be other holidays where the children are dressing up, such as Purim or Christmas, and they can show their grandparent their special outfits for these times too.
  • Have children bring a recent school project that they can show to their grandparent. Seniors are likely to be very interested in seeing what kids are learning in school these days. If the project is about something the senior doesn’t know about, that gives the child a chance to be the teacher.
  • Play games. The child can bring a favorite game to share with the grandparent, and it’s likely that the grandparent has a favorite game of their own that they can teach the child.
  • Decorate the senior’s room for an upcoming holiday. Decorations often bring out lots of excitement in children, and seniors will feel loved and have a reminder of the visit after the children have left.
  • Share riddles and jokes and silly songs. Children might be very interested to hear some of the songs the grandparent remembers from when they were the child’s age.
  • Bring photographs or video of a recent event in the child’s life, such as a chorus concert, ball game, or scouting trip. Have the child tell the grandparent stories about what happened.
  • If you’re willing to take on a bigger project, talk to the assisted living facility and the child’s school about arranging a class visit. The children could sing for the seniors or perform a skit. Another idea is to have children interview the seniors about their lives, and use the information to write short biographies that can be compiled into a collection for both seniors and the children to keep.
Seniors will be especially delighted to receive gifts, and children will feel good preparing something for them. Have children draw a picture or make a card for their grandparent. You also might consider baking sweets or making some other kind of favorite food with the child that they can then give to the senior. These are just a few ideas as to how you can create wonderful memories from children’s visits. Just because a grandparent is now in assisted living, their relationship with the family doesn’t have to suffer. In the process, children will learn valuable lessons about giving and bringing cheer to others, and they will get to enjoy precious time with their grandparent that they’ll be able to remember one day when they’re gone.
/by

Four Ways Seniors Can Keep Their Minds Sharp

Seniors entering assisted living may need help with daily tasks due to the physical limitations of old age, but often their minds are still relatively healthy. These seniors can benefit from taking simple actions that will help them continue to maintain their mental abilities. 1. Take on puzzles and games. Exercise the mind with logic challenges to keep it active. Card games are a great example: those seniors who enjoy bridge, even without realizing it, are doing more for themselves than simply having a good time enjoying competition with friends. Board games like monopoly are good choices too, and don’t forget the ever-popular Bingo (play with multiple cards to get the most brain-stimulating challenge)! Sodoku and crossword puzzles work well. The best benefit from games comes when there’s a social aspect to them: interacting with others provides additional stimulation and challenge. 2. Be social. If you’re not someone who enjoys games, even social interaction itself can benefit the mind. Talk to other residents and get to know them. Take an interest in the staff members you come into contact with and ask them about their lives outside of work–with their demanding and sometimes emotionally draining jobs, many caregivers will appreciate the chance to make a personal connection and be recognized. Check out activites being offered by the community. Social interaction has had documented positive effects not just on the mind, but on overall health as well. Seniors in assisted living, who have a community readily available, are well-situated to take advantage of these benefits. 3. Eat properly. Good nutrition and regular meals are good for both the body and the brain. Your assisted living facility can be a big help with this, providing healthy food on schedule without you having to worry about it. Eat a variety of things and for mental benefits specifically focus on colorful fruit, leafy green vegetables, and foods with omega-3 fatty acids like nuts and fish. Drink water often: seniors are more likely to become dehydrated than younger adults. 4. Move. We think of exercise as benefiting the body, but our minds thrive on it too. Don’t shy away from the chance to be active. Coordinated movements, especially dancing, can be great for keeping yourself sharp. Line dancing, for example, forces you to use your memory to learn and remember the steps. Another option is to go for a walk, even if it’s just around the hallways of the facility. Seniors have been shown to benefit from light strength training and low-impact aerobic exercises designed for them. Physical activity increases your oxygen use and blood flow to your brain. Whatever exercise you choose, to get the benefits it’s important that you be consistent.
/by

Considering Life Insurance Settlements to Pay for Assisted Living

You may have recently heard about the option of life settlements, where you sell your life insurance policy to a third party, and be considering this option in order to fund assisted living. The buyer of the policy takes responsibility for the premiums, and then receives the benefit when you pass away. These offers are certainly tempting, but make sure you’re considering all the possibilities open to you first. For example, you may be able to take out a loan on the cash value of the policy. You may also be able to reduce the death benefit in exchange for lowered premiums, which will allow you to hold on to the policy and some of its value. Finally, if you are terminally or chronically ill, you may be able to receive an accelerated death benefit while you’re still alive. Don’t make the decision to give up your life insurance lightly: if your policy has value to investors, it also has value to your heirs. Remember why you bought the policy in the first place. On the other hand, if it’s likely you will lapse on your policy anyway, a life settlement can make a lot of sense. If you have decided that a life settlement is the best choice for your situation, make sure you do your research. Different life settlement providers may make you different offers, so be sure to shop around. You may want to consider using a life settlement broker, who will act in your best interest. Also know that you do not need to sell your whole policy: you may be able to arrange to keep a portion of the benefits. How much you can get for our policy will depend on your life expectancy, how much needs to be paid in premiums to keep the policy in force, and the policy’s cash value. Think through the various implications of receiving such a large sum of money. Some of the settlement may be taxable, and any creditors you have may be able to claim the money. Also consider whether your social security or any other public benefits you receive will be affected. Beware of schemes where you buy life insurance with an agreement to sell it later. This is called Stranger-Originated Life Insurance (or STOLI) and it’s illegal in most states. Insurers may refuse to pay benefits on these arrangements. To learn more and to find out how life settlements apply to your specific situation, consult with your insurance agent, a financial advisor, or lawyer.
/by

Seniors and Pet Separation

Many of us have pets we love dearly in our lives. Seniors often find pets to be good companions when they live on their own. Indeed, studies have shown that having a pet is great for one’s health. However, pets often cannot move with a senior to assisted living, and even if they can there’s many reasons why it might not be a practical decision. What will happen to the pet is often the biggest concern about the move. It’s common for people to feel wracked by guilt over abandoning a beloved friend they have taken on the responsibility to care for. However, this guilt is misplaced if the senior is having trouble caring for the pet and it would be better off with other owners. Seniors who are ready for assisted living may have trouble with taking the dog for a walk, feeding or cleaning their pet, or getting to the vet or to the store for supplies. Indeed, families concerned about mom or dad can get a clue to how well they are able to be on their own by observing how the pet is doing. One possible solution is for the senior’s family members or a friend to adopt the pet. They can bring the animal to see their loved one regularly. Even if the pet cannot come into the facility, the senior can be brought outside to say hello. This is the ideal solution for reducing the trauma of pet separation. If this is not possible and the senior doesn’t know anyone, even living far away, who can take the pet, it will probably have to be surrendered to a shelter. Giving the animal away to strangers is not always a great idea, as they can end up with an abusive or irresponsible owner. Seek out a well-funded “no-kill” shelter to receive the animal. It’s a good sign if you have to make an appointment to surrender the pet: this shows that the shelter is working to manage their intake of new animals. There’s a good chance the pet will find a new family. Find out in advance if your pet has any issues that will make it “unadoptable” in the shelter’s eyes. Especially if the pet is old, make sure to provide the shelter with veterinary records. If a loved one entering assisted living is bereft over the loss of a pet, try to compensate with plenty of human companionship. Make sure that the senior’s family and friends visit often. Feeling involved in a community can help with the loss.
/by

Holding Family Meetings About Senior Care

Meetings can be very useful when a family is faced with a tough decision, like whether to move a parent to assisted living. They provide a chance for relatives to come together, pool their knowledge, and discuss various options and strategies. It can be tough even to make the decision to hold such a meeting. The most important family members may not all live close together, so location is a challenge. People’s schedules are packed and some may be reluctant to add one more thing to the calendar. Sometimes it’s assumed that other relatives don’t want to get together. However, it never hurts to ask. Due to the serious nature of the decision, people may be more inclined to be cooperative. And if their lives are heavily affected by caring for mom or dad, they will be interested in solutions that will improve the situation. It is important to include the affected senior, even if it means overcoming challenges presented by physical or mental disability or resistance to facing the need for care. There are several reasons why you may feel this is inappropriate, but making sure your loved one is included in the process is vital to making any solution work. They deserve the respect of knowing that they have say in decisions affecting their life, and you can’t find a solution for them unless you have their own opinion on what their needs are. You may be surprised to learn how they see the issue. This does not mean that the solution mom or dad would choose on their own is necessarily the best one and that they have final say, but you do need to take into account their concerns. Consider including any paid caregivers or others who provide household services. The cleaning lady who comes in on Fridays may have noticed something you haven’t. Also consider bringing in the senior’s friends and neighbors. A social worker or for families where religion is important, a spiritual advisor, may also be helpful. Try to plan the meeting at a time when it’s easier for far-flung family to travel, perhaps during the holidays. When planning the agenda, make sure everyone will get a chance to speak so that they can make their case for what is important to them, and be sure to devote significant time to what the senior has to say themselves. Have everyone in the group review the agenda in advance. Also choose people to take on different tasks: someone who can be a neutral facilitator, someone to take notes, someone to keep time. Plan to hold the meeting in a place that will comfortable and have food and beverages available. Try to choose somewhere that allows a layout where everyone can make eye contact with one another. Tension exists in any family, even those where the members are close and get along well. It’s a normal part of life. Bringing everyone together at once will cause these problems to rise to the surface. Keep conflict to a minimum by focusing everyone on finding solutions for the future, not on rehashing past grief. Remind everyone that there will be no perfect solution and there will have to be compromise in some form. You won’t be able to fix everything then and there. The point is to gather perspectives and come up with practical answers. When you’ve finished the meeting, send the notes to people who were interested but unable to attend, and follow up on whatever course of action was agreed upon. Even if you decide that assisted living is not the right choice now, in time your parent is very likely to need help. Make plans to have them visit facilities you are considering and prepare for an eventual move. It never hurts to have alternate solutions available for when they might be needed. The one thing you can always count on is change.
/by

Making a Smooth Transition to Assisted Living

Entering assisted living is a life-changing decision that can cause a lot of stress and emotion that rivals other big events. Here are some tips to make the process a little easier. 1. Plan Ahead Gather the family together and decide who will handle what. Make a list of the necessary things that need to be done, decide who will do them, and when. If possible, include the senior in these discussions as much as possible. This will help ease the anxiety they will be feeling. Planning can also involve encouraging them to maintain a productive frame of mind and remain flexible. 2. Stay Positive What you’re doing is difficult, but remember that it’s the right thing. It’s natural to feel some guilt, but try to let it go. Take care of yourself, ask for help if you need it, and manage your own stress. Keep in mind that this process takes a toll on caregivers too, sometimes even when it goes well. You may be surprised to find that you are the one feeling forgotten if your loved one makes new friends quickly and doesn’t want to spend a lot of time with you. 3. Communicate Clearly About Tough Decisions Make sure everyone knows who will be doing what and who will be making decisions about financial and medical matters. Is it necessary for a family member to have Power of Attorney? Is a Living Will in place? It’s a good idea to have a conversation with your loved one’s lawyer and doctor about your options. These discussions may or may not seem necessary when entering assisted living, but having the conversation in advance can cut down on confusion during a future medical crisis. 4. Make Assisted Living Feel Like Home Personalizing the space can go a long way towards making it feel comfortable. Hang curtains, put decorations on the walls, and use a familiar quilt or bedspread. Beyond decorating, encourage your senior to become active and make friends in their new community. It’s the people who make a home. 5. Listen to Your Loved One Don’t forget what a difficult time this is. It can be extremely hard for seniors to give up some of the control they’ve had for all their adult lives. Honor their desires as much as you can and take their concerns seriously. Reassure them that you will be there if they need help and that they’re not being abandoned. It would be a good idea to set aside some of your time to be in their lives a little more during this period. At the same time, give them the space they need to adjust on their own – they can’t become fully comfortable with their new lives if you’re always there. Also understand that at this time, emotions over seemingly small issues can really be driven by something much larger. Sadness over a pair of socks that were lost in the wash could really be sadness about giving up a home and independence. Expect the adjustment to take a few months, and don’t try to rush the process. New homes take time to get used to.
/by

Gifts to Give Assisted Living Residents

When birthdays or holidays come around, people want to do something nice for the older people in their lives who are now assisted living residents. But figuring out what to give can be a challenge. Below are some gift ideas that senior will appreciate. Personal Mementos If the resident doesn’t have already have one, gather as many addresses as you can for them into a fancy address book. Enlarge a family photo for the wall (perhaps your loved one’s favorite photo of themselves in their younger days), or put together a photo album. You can buy items like coffee mugs or calendars that are customized with family photos. As long as your loved one can see the electronic screen, a digital picture frame will always give them something new to see. Some can even have pictures added to them remotely, which makes it easy for far-flung family to add their own contributions. Small Decorations A plant or flowers in a vase that you can refill every time you visit can really brighten up a room. If they have a tree outside their window, setting up a bird feeder for them that you refill periodically would be a wonderful treat. Give decorations related to an upcoming holiday for a festive change. Air fresheners or flameless candle burners make a strange room feel a little more like home. Media A subscription to a magazine or newspaper is a wonderful gift. Not only does the resident get reading material, but they also have the joy of getting interesting mail! You may choose a publication from a favorite town or city they once lived in. They would also love a CD or tape of their favorite music, or an inexpensive DVD player with movies or favorite TV shows. Books always make great gifts, but keep in mind that the resident may not be able to see well. Organizations that make materials for the visually impaired can be helpful resources in these situations: some even offer materials for free. Or you can just buy books on tape. There are even services that act like Netflix for audio books, so your senior will always have something new to listen to. Don’t forget headphones! Big old-fashioned ones are easier for seniors to handle than earbuds. Cozy Comforts Anything to keep residents warm and comfortable will likely be appreciated, especially if it’s easy for them to put on and remove. Bed jackets, shawls, and blankets are a great choice. Even though we think of them as being kids’ toys, a doll, teddy bear, or other stuffed animal can be very welcome. Practical Items Stationery and stamps are popular, especially for residents with far away friends and family. An electric toothbrush may be useful. A resident who uses a walker will get a lot of use out of a basket or pouch that they can attach to carry things. Anything related to a hobby that your loved one can still enjoy will help them feel good about themselves and keep their mind active. A flashlight might make them feel a little safer, and a fan is helpful if your resident tends to be hot. A clock with large numbers is also a great idea. Yourself What will make your loved on happiest is quality time spent with you. You don’t need to make awkward conversation for an hour if you’re not very talkative – instead you can choose an activity on the schedule to participate in with your resident. You can also volunteer to lead or help with an event, and allow your loved one to brag about how well you did later. Simply reading aloud to them counts as quality time. You can also videotape family events, such as a school band concert or a birthday party, and show it while recounting all the behind-the-scenes stories. Don’t forget to bring the kids! Time with children is especially welcome. Family members who live far away can record messages or stories that the senior can listen to again and again, or can send cards or letters. Your loved one may also enjoy a visit from a pet. You likely won’t be able to bring an animal into the facility, but you can bring the resident outside and have them meet the animal there. Residents will appreciate little trips outside the facility. Some ideas include a tour of the Christmas or Halloween decorations in nearby neighborhoods, getting an ice cream cone, watching a child’s sports game, or even just cruising around on a nice day. Short walks in nice weather will be appreciated too. Meals that are home cooked or from a favorite restaurant are a special treat. Even something like pizza or Chinese can be wonderful since it’s not something residents have often anymore (make sure this is OK for the resident’s diet). When buying gifts for your loved one, the key thing to remember is that this is a situation where less is more. Bulky or heavy gifts take up a lot of space, and even trinkets and magazines can easily become clutter in a small room. It’s usually best to avoid expensive gifts as it’s a real possibility that another confused resident can mistakenly wander off with something. For many seniors, at this point in their lives it’s the simple pleasures that matter most, and what will make them the happiest is knowing that you care and are thinking about them.
/by