Category: Caregivers

What are Home Caregiving Options for Parents?

What are Home Caregiving Options for Parents?

At least 2.4 million U.S. workers provide in-home personal and health care for older adults and people with disabilities. That number has more than doubled since 2010, according to PHI, a New York–based nonprofit advocacy group that works to improve the quality of direct-care services and jobs. What are the best home caregiving options for your parents?

AARP’s recent article entitled “How to Hire a Caregiver” says that a shift in long-term care from institutional settings like nursing facilities to those aging in place in their own homes and communities has fueled the growth. This is also likely to continue as the population ages. The U.S. Census Bureau projects that the 65-and-older population, which was just over 54 million in 2019, will grow to 94.7 million by 2060.

There are several types of paid in-home caregivers that provide a range of services.

  • Personal Care Aides. PCAs aren’t licensed and have varying levels of experience and training. They serve as helpers and companions. They can provide assistance with bathing, dressing and do some housekeeping, as well as transportation to shopping and appointments. Training requirements for caregivers vary by state, and some states have no formal standards. This will be an out-of-pocket expense because Medicare or private health insurance typically doesn’t cover them.
  • Home Health Aides. HHAs monitor the patient’s condition, check vitals and assist with activities of daily living, such as bathing, dressing and using the bathroom. HHAs also provide companionship, do light housekeeping and prepare meals. This group must meet a federal standard of 75 hours of training. Their training and certification varies by state.
  • Licensed Nursing Assistants (LNAs) and Certified Nursing Assistants (CNAs). LNAs and CNAs observe and report changes in the patient, take vital signs, set up medical equipment, change dressings, clean catheters, monitor infections, conduct range-of-motion exercises, offer walking assistance and administer some treatments. Any medical-related tasks are performed as directed by a registered nurse (RN) or nurse practitioner (NP). CNAs also provide help with personal care, such as bathing, bathroom assistance, dental tasks and feeding, as well as changing bed linens and serving meals. As with home health caregivers, federal law requires nursing assistants to get at least 75 hours of training, but some states have other requirements.
  • Licensed Practical Nurses (LPNs). These skilled nursing providers have to meet federal standards for health and safety and are licensed by states. They evaluate, manage and observe a senior’s care and provide direct care that nonmedical and home health aides can’t. Their tasks could include administering IV drugs, tube feedings, and inoculations; changing wound dressings; and educating caregivers and patients. Some LPNs are trained in occupational therapy, physical therapy and speech therapy. Medicare covers home health skilled nursing care that is part-time or intermittent, doctor-prescribed and arranged by a Medicare-certified home health agency.
  • Registered Nurses (RNs). This group has a nursing diploma or an associate degree in nursing. They’ve passed the National Council Licensure Examination and have satisfied the other licensing requirements mandated by their state’s nursing board. RNs provide direct care, administer medications, advise family members, operate medical monitoring equipment and assist doctors in medical procedures.

These are some of the best home caregiving options for your parents. Work closely with an elder law attorney to ensure you have all of the options available to you and your family. If you would like to learn more about home care, and other long term care issues, please visit our previous posts. 

Reference: AARP (Sep. 27, 2021) “How to Hire a Caregiver”

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ways to reduce financial elder abuse

Ways to reduce Financial Elder Abuse

The numbers are chilling. One in ten Americans age 60+ has experienced elder abuse. One of the most common forms of elder abuse is financial, says a recent article from Forbes titled “What Is Elder Financial Abuse—And How Do We Prevent It?”  There are ways to reduce financial elder abuse.

Financial elder abuse is defined as when someone illegally or improperly uses an elderly person’s money for their own use. Elderly people are easy victims for obvious reasons. They may be mentally vulnerable, suffering from Alzheimer’s or other form of dementia. They may also be lonely and find the company of a new “friend” is so delightful that it impairs their judgement.

Financial elder abuse occurs most often from adult children, but also in nursing homes and assisted living facilities. Be on the watch for those new friends who enter senior’s lives, especially if they seek to limit contact with family members.

Caregivers or nursing staff have access to resident’s possessions, including checkbooks, ATM cards and credit cards. Monitoring an elderly parent’s bank accounts on a regular basis should be part of caregiving by adult children. Unusual transactions, large withdrawals or unlikely purchases by credit card should immediately be reported to their bank or credit card company.

Less obvious and harder to track, is when someone forces a nursing home resident to sign legal documents transferring ownership of homes, cars, bank accounts and even investment accounts. They may also be pressured into creating a new will.

Here are some red flags to watch for:

  • New names being added to bank accounts or on credit cards.
  • Finding unpaid bills, letters from collection agencies or past due notices from creditors, especially when the person has sufficient funds.
  • Relatives who suddenly show up and want to be involved with an aging senior, including estranged children.
  • The unexpected transfer of any kind of asset to someone who is not a family member.
  • Any change in habits concerning money, including someone who was never worried about money suddenly being concerned about paying bills.

The elderly are often scared to report being victimized. They may fear further loss of control over their lives or be embarrassed to have been scammed. If a caregiver is stealing, they may also be physically threatened, or frightened of losing their familiar care provider.

There are ways to reduce financial elder abuse. Talk to your estate planning attorney, speak with the local Adult Protective Services office, or contact the National Elder Fraud Hotline, if you are concerned about a loved one being financially exploited.  If you believe a loved one is in physical danger, contact the local police. Don’t hesitate to ask for help. If you are interested in learning more about elder abuse, please visit our previous posts. 

Reference: Forbes (Nov. 9, 2021) “What Is Elder Financial Abuse—And How Do We Prevent It?”

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When should You Consult an Elder Law Attorney?

When should You Consult an Elder Law Attorney?

Elder law attorneys assist seniors or their family caregivers with legal issues and planning that related to the aging process. These attorneys frequently help with tax planning, disability planning, probate and administration of an estate, nursing home placement and many other legal issues. When should you consult an elder law attorney?

Forbes’ recent article entitled “Hiring an Elder Law Attorney,” explains that elder law attorneys are specialists who work with seniors or caregivers of aging family members on legal matters that older adults face as they age. Many specialize in Medicaid planning to help protect a person’s financial assets, when they have Alzheimer’s disease or another debilitating illness that may require long-term care. They can also usually draft estate documents, including a durable power of attorney for health and medical needs, and even a trust for an adult child with special needs.

As you get older, there are legal issues you, your spouse or your family caregivers face. These issues can also change. For instance, you should have powers of attorney for financial and health needs, in case you or your spouse become incapacitated. You might also need an elder law attorney to help transfer assets, if you or your spouse move into a nursing home to avoid spending your life savings on long-term care.

Elder law attorneys can help with a long list of legal matters seniors frequently face, including the following:

  • Preservation and transfer of assets
  • Accessing health care in a nursing home or other managed care environment and long-term care placements
  • Estate and disability planning
  • Medicare, Social Security and disability claims and appeals
  • Supplemental insurance and long-term health insurance claims and appeals
  • Elder abuse and fraud recovery
  • Conservatorships and guardianships
  • Housing discrimination and home equity conversions
  • Health and mental health law.

The matters listed above are all issues that should motivate you to consult an elder law attorney. Certified Elder Law attorney Melissa Donovan at The Wiewel Law Firm can help! If you would like to learn more about elder law, please visit our previous posts. 

Reference: Forbes (Oct. 4, 2021) “Hiring an Elder Law Attorney”

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Estate of The Union Episode 11-Millennials’ Mysteries Uncovered!

 

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understanding what a DNR does

Understanding what a DNR Order does

A do-not-resuscitate order, or DNR, is written document with instructions informing healthcare personnel not to perform cardiopulmonary resuscitation (CPR). However, The Petoskey News-Review’s recent article entitled “Do-not-resuscitate orders apply to use of CPR in critical situations” explains that many patients don’t have a complete understanding of what a DNR order does and its application to their medical care. The DNR is a legally binding order signed by a physician at a patient’s request that lets medical professionals know you don’t want to be resuscitated.

CPR is performed in only one situation — if a patient is unresponsive, doesn’t have a pulse and isn’t breathing. If that happens, medical personnel have two courses of action: (i) allow for a natural death; or (ii) try CPR. If you’re unresponsive, have no pulse and aren’t breathing, that is the only situation in which any medical provider should attempt CPR. Having a DNR doesn’t mean don’t treat. The fact that you have a DNR order means you should receive exactly the same treatment that another patient who doesn’t have a DNR receives, with all the same medications and procedures.

As such, patients should know the limitations that come with CPR.

If CPR is successful, it means just one thing – that someone has regained a pulse. That doesn’t have any implications about a patient’s cognitive or mental status after CPR is administered.

Research shows that the likelihood of CPR being successful (in regaining a pulse) is in the range of 15-20% of patients. Thus, out of 100 patients who experience cardiac arrest and have CPR, about 80 to 85 of the patients will still die.

Note that there’s a difference between a hospital DNR and an out-of-hospital DNR. An out-of-hospital DNR is for those who don’t want to be resuscitated, if they have problems at home or anywhere outside of a medical facility. Those forms follow the patient, whether they are at home or not.

You should discuss these sensitive matters and signing a DNR when no one’s under pressure from a medical emergency.

The main part of advance care planning is appointing someone you trust to speak for you, if you can’t speak for yourself. With an advance care directive, you can state your preference or opposition to a DNR order.

In addition, everyone should have a healthcare power of attorney, an advance directive, or a patient advocate designation. This is where you are selecting someone to make medical decisions, when you are unable to do so for yourself. Therefore, it is vital that the person you appoint has a complete understanding of what a DNR order does.

If you would like to learn more about DNRs and advance directives, please visit our previous posts.

Reference: The Petoskey News-Review (Sep. 23, 2021) “Do-not-resuscitate orders apply to use of CPR in critical situations”

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Difference between Conservatorship and Guardianship

Difference between Conservatorship and Guardianship

It is common for people to misunderstand and confuse the difference between a conservatorship and a guardianship. A conservatorship is created to let one person manage another’s finances. The conservator is court- appointed and may be responsible for financial decisions, such as retirement planning, the purchase or sale of property and the transfer of other financial assets.

The laws for conservatorships and guardianships can vary widely in different states. A conservatorship or guardianship is typically necessitated by a disability or injury that prevents a person from caring for themselves.

US News & World Report’s recent article entitled “How Conservatorships Can Prop Up or Tear Down a Loved One” explains that once you have a conservator in place, the burden is on you to prove you no longer need it. The biggest issue in most cases is abuse of power or neglect. Either (the conservator) is doing something self-serving, such as spending money on something other than the senior’s care, or they’re not helping the conservatee, or providing the care they need.

Estate planning attorneys may recommend a conservatorship or guardianship in standard estate planning documents, like a power of attorney. A conservator can be any adult, possibly a family member, who is tasked with the responsibility of managing the person’s finances.

Because a conservator would be in charge of a person’s assets, it’s common for the same person to be named to serve as attorney-in-fact or agent with a power of attorney. However, because a guardian is in charge of the person themselves, it’s wise to nominate the same people who are named to serve as health care agents in the client’s health care proxy. Sometimes, these are the same, but if they’re different, it is important for that difference to be stated.

A guardianship is created in cases when a person can’t take care of themselves and requires another person to make some or all of their personal decisions. This might include decisions about his or her medical care, support services, housing, or finances. While a court appoints both a conservator and a guardian, a conservatorship is generally limited to financial decisions. In contrast, a guardianship deals with personal decisions, like medical care, and may, in some instances, also cover financial decisions.

Just about every state has laws designed to protect those placed in a conservatorship or guardianship. For example, in New York, individuals must satisfy medical requirements to be determined unable to care for oneself. The burden of proof to meet such restrictions is high.

In addition, individuals can seek professional help in preparing for future circumstances that may prevent them from managing their finances and personal affairs. This includes estate planning documents, such as wills, powers of attorney, beneficiary forms and health care proxies. An estate planning attorney can help you better understand the difference between a conservatorship and a guardianship, and advise you which is the best option for you and your family.

If you would like to learn more about conservatorship and guardianship, please visit our previous posts. 

Reference: US News & World Report (Aug. 19, 2021) “How Conservatorships Can Prop Up or Tear Down a Loved One”

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choosing between assisted living or memory care

Choosing between Assisted Living or Memory Care

When considering a long-term care facility, it can be difficult choosing between assisted living or memory care options. Forbes’ recent article entitled “Assisted Living vs. Memory Care: Which Is Right for You?” explains that assisted living is a long-term care facility that lets seniors remain independent, while providing help with daily tasks. It often provides a small apartment, housekeeping, community meals and activities.

It’s critical to thoroughly review the support needs and challenges facing the person you’re supporting and to try to look honestly at what’s working and what’s not.

The best candidate for assisted living is a person who needs assistance with their activities of daily living but still has their reasoning skills intact. Residents can enjoy socialization and activities with people their own age. This helps with isolation after spouses and friends are no longer with them.

Assisted living residents frequently require personal care support. However, these seniors are able to communicate their needs. Residents may receive help with taking medicine, bathing, toileting and other activities of daily living, or ADLs.

Memory care facilities are secured facilities that serve the needs of those with some form of dementia. These facilities typically have smaller bedrooms but more available, open and inviting common spaces. Research shows the way memory care facilities are designed can be helpful in easing the stressful transition from home to a long-term care community. This includes softer colors, a lack of clutter and clear signage.

Confusion and memory loss can cause anxiety. That’s why having a predictable routine can help. As dementia progresses, a patient may forget how to do normal activities of daily living, such as brushing their teeth, eating, showering and dressing. Memory care facilities ensure that these needs are met.

A memory care facility typically has a smaller staff-to-patient ratio than assisted living because an individual suffering from dementia has greater care needs. Staff will frequently undergo additional training in dementia care.

A memory care facility isn’t always a standalone community. Assisted living or skilled nursing homes may have a separate memory care wing where seniors get the same socialization and activities but with 24/7 protection.

Rather than choosing between assisted living and memory care facilities, having both options in one place can be a plus. The person can start in a less restrictive type of setting in assisted living with the option to transition to memory care as needs, abilities and interests are changed by the condition.

Both types of care have some autonomy but help with hygiene and medication management. However, staff in a memory care unit is specifically trained to work with people with cognitive impairments.

If you would like to learn more about long term care options, please visit our previous posts. 

Reference: Forbes (Aug. 16, 2021) “Assisted Living vs. Memory Care: Which Is Right for You?”

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solutions to help seniors live well

Solutions to help Seniors live Well

With our aging population, we need more solutions to help seniors live well. That’s where universal design comes in: it’s a concept that tries to make products and structures usable by everyone, regardless of age, ability, or other factors.

Money Talks News’s  article entitled “8 Essential Home Features for Aging in Place” says that aging in place requires homes that accommodate our needs as we age. The article sets out a list of eight design features buyers focused on accessibility are looking for based on survey data from the National Association of Home Builders’ 2021 “What Home Buyers Really Want” report.

  1. Lower countertops. The kitchen is the center of most homes, and it’s an important part of universal design. Countertops that are three inches lower than the standard height of 36 inches lets seniors and those with limited mobility to fully participate in meal prep. You can round all countertop edges and corners because fewer 90-degree angles may reduce bumping and bruising and minimize injury in the event of a fall.
  2. Lower kitchen cabinets. According to Aging in Place, upper kitchen cabinets that are three inches lower than standard height lessens the tendency to overreach and potentially lose balance. Lower cabinets that feature pull-out shelves, “lazy Susan” corner cabinets and easy-pull handles offer additional convenience for seniors and those who rely on a wheelchair or mobility scooter.
  3. Bathroom aids. For seniors, using the bathroom safely can a challenge. Aging-in-place design recommends these features to make bathrooms more practical and convenient:
  • A walk-in tub or a shower with non-slip seating
  • An adjustable or hand-held showerhead
  • A comfort-height toilet
  • Ground-fault interrupter (GFI) outlets that reduce the risk of shock; and
  • Grab bars near the toilet and shower.
  1. A Stepless entrance. To age in place safely, AgingCare recommends that a home’s main entrance not have steps and should have a threshold height of no more than a half an inch. Here are a couple of ways that an entryway without steps can make life better for seniors:
  • It facilitates smooth entrance/exit by wheelchair, scooters, or walker
  • It decreases the risk of falls, particularly in snowy or icy conditions; and
  • It makes it easier to get deliveries and enter the home carrying groceries.
  1. Non slip floors. According to the CDC, more than 35 million older adults fell at least once in 2018, and 32,000 died from fall-related injuries. To help, non-slip surfaces like low-pile carpet, cork and slip-resistant vinyl can minimize the risk.
  2. Wide hallways. Wide hallways (defined as at least four feet wide) let seniors access every space in their home with a walker, wheelchair, or scooter, or with the assistance of a home health aide.
  3. Wide doorways. A standard doorway can be as narrow as 24 inches, which is a tight fit for seniors who rely on wheelchairs, scooters, or walkers. Seniors like wide doorways, defined as at least three feet wide. According to the ADA, doorways should have at least 32 inches of clear width. To help with an easy transition from room to room, thresholds should be as flush to the floor as possible.
  4. Full bath on main level. Not just convenient, it’s a critical safety feature for seniors. Besides eliminating the need to go up and down stairs several times a day, main floor bathrooms also allow the elderly to (i) respond to incontinence issues more quickly; (ii) practice regular self-care; and (iii) access a private space when required.

Elder care can be a complicated. These, and many more solutions help seniors live well and comfortably.  If you would like to learn more about elder care, please visit our previous posts.

Reference: Money Talks News (Aug. 5, 2021) “8 Essential Home Features for Aging in Place”

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Can I be paid as a caregiver?

Can I Be Paid as a Caregiver?

AARP’s recent article entitled “Can I Get Paid to Be a Caregiver for a Family Member?” says that roughly 53 million Americans provide care without pay to an ailing or aging loved one. They do so for an average of nearly 24 hours per week. The study was done by the “Caregiving in the U.S. 2020” report by AARP and the National Alliance for Caregiving (NAC). This begs the question: Can I be paid as a caregiver?

Medicaid. All 50 states and DC have self-directed Medicaid services for long-term care. These programs let states grant waivers that allow qualified people to manage their own long-term home-care services, as an alternative to the traditional model where services are managed by an agency. In some states, that can include paying a family member as a caregiver. The benefits, coverage, eligibility, and rules differ from state to state.

Veterans have four plans for which they may qualify:

Veteran Directed Care. This plan lets qualified former service members manage their own long-term services and supports. It is available in 37 states, DC, and Puerto Rico for veterans of all ages who are enrolled in the Veterans Health Administration health care system and need the level of care a nursing facility provides but want to live at home or the home of a loved one.

Aid and Attendance (A&A) benefits. This program supplements a military pension to help cover the cost of paying for a caregiver, who may be a family member. These benefits are available to veterans who qualify for VA pensions and meet certain criteria. In addition, surviving spouses of qualifying veterans may be eligible for this benefit.

Housebound benefits. Vets who get a military pension and are substantially confined to their immediate premises because of permanent disability can apply for a monthly pension supplement.

Program of Comprehensive Assistance for Family Caregivers. This program allows for a monthly stipend to a vet’s family member to be paid as a caregiver to provide assistance with everyday activities because of a traumatic injury sustained in the line of duty on or after Sept. 11, 2001.

Other caregiver benefits through the program include the following:

  • Access to health insurance and mental health services, including counseling
  • Comprehensive training
  • Lodging and travel expenses incurred when accompanying vets going through care; and
  • Up to 30 days of respite care per year.

Payment by a family member. If the person requiring assistance is mentally sound and has sufficient financial resources, that person can pay a family member for the same services a professional home health care worker would provide.

So yes, under certain criteria, you can qualify to be paid as a caregiver. It is best to work carefully with an Elder Law attorney who has experience managing Medicaid and VA issues.

Reference: AARP (May 15, 2021) “Can I Get Paid to Be a Caregiver for a Family Member?”

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Address Finances if Diagnosed with Alzheimer’s

Address Finances if Diagnosed with Alzheimer’s

Learning you have Alzheimer’s or other types of dementia can be overwhelming.  There are many aspects of life that you will need to address. One of the first things you should do is address your finances if you are diagnosed with Alzheimer’s. Because of the debilitating nature of Alzheimer’s and related forms of dementia on a loved one’s ability to make sound financial decisions, the sooner you can get financial matters in order the better. The Statesville Record & Landmark’s recent article entitled “Steps to take when dealing with Alzheimer’s” lists four important steps to take:

Keep an eye out for signs of unusual financial activity. Early signs of cognitive challenges for a senior include difficulty paying a proper amount for an item, leaving bills unpaid, or making strange purchases. If you see signs of a loss in judgment related to financial matters, additional action may be required.

Identify and name a power of attorney. Many people diagnosed with Alzheimer’s are hesitant to cede control of their personal finances to another. Therefore, have an honest discussion with your loved ones and help them appreciate the importance of having a trusted person in a position to look out for their interests. One person should be designated as financial power-of-attorney, who is authorized to sign checks, pay bills and help keep an eye on the finances of the affected persons.

Ask an experienced estate planning attorney about helping you draft this important document.

Examine the costs of care and how it will be covered. A primary concern is to determine a strategy for how your loved one will be cared for, especially if their cognitive abilities deteriorate.

You will need to be able to determine whether specialized care will be needed, either in the home or in a nursing or assisted living facility. If the answer is yes, you’ll need to determine if there are resources or long-term care insurance policies in place to help deal with those costs, which will impact decisions on a care strategy. Ask an elder law attorney about trusts that can be established to provide for care for the disabled loved one, while still protecting the family’s assets.

Be proactive. Don’t delay too long in addressing financial issues after an Alzheimer’s diagnosis. This can compound an already stressful and emotional time.

Be prepared to take action to get on top of the situation as soon as you’re aware that it could be a problem. Even establishing a plan for addressing these issues before a form of dementia is firmly diagnosed can be helpful.

Do not wait – address your finances early if diagnosed with Alzheimer’s. Ask an experienced elder law attorney for guidance on how to manage these challenging times.

If you would like to learn more about Alzheimer’s and how it can effect estate planning, please visit our previous posts. 

Reference: Statesville Record & Landmark (April 11, 2021) “Steps to take when dealing with Alzheimer’s”

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Can I be paid as a caregiver?

A victory for Adults caring for Aging Parents

A New Jersey Appellate Division recently reaffirmed the state’s regulation that allows older adults to transfer their homes to adult caregiver children without Medicaid penalty, reports an article titled “Major Victory for Adults Who Provide Home Care for Parents” from The National Law Review. The regulation permits the home to be transferred with no Medicaid penalty, when the adult child has provided care to the parent for a period of two years. This allows the parents to remain at home under the care of their children, delaying the need to enter a long-term care facility. It is a victory for adults caring for aging parents.

New Jersey Medicaid has tried to narrow this rule for many years, claiming that the regulation only applies to caregivers who did not work outside of the home. This decision, along with other cases, recognizes that caregivers qualify if they meet the requirements of the regulation, regardless of whether they work outside of the home.

The court held that the language of the regulations requires only that:

  • The adult child must live with the parent for two years, prior to the parent moving into a nursing facility.
  • The child provided special care that allowed the parent to live at home when the parent would otherwise need to move out of their own home and into a nursing care facility.
  • The care provided by the adult child was more than personal support activities and was essential for the health and safety of the parent.

In the past, qualifying to transfer a home to an adult caregiver child was met by a huge obstacle: the caregiver was required to either provide all care to the parents or pay for any care from their own pockets. This argument has now been firmly rejected in the decision A.M. v. Monmouth County Board of Social Services.

The court held that there was nothing in the regulation requiring the child to be the only provider of care, and the question of who paid for additional care was completely irrelevant legally.

It is now clear that as long as the child personally provides essential care without which the parent would need to live in a nursing facility, then the fact that additional caregivers may be needed does not preclude the ability to transfer the home to the adult child.

The decision is a huge shift, and one that elder law estate planning attorneys have fought over for years, as there have been increasingly stricter interpretation of the rule by New Jersey Medicaid.

It amounts to a huge victory for adults caring for aging parents. While Medicaid is a federal program, each state has the legal right to set its own eligibility requirements. This New Jersey Appellate Court decision is expected to have an influence over other states’ decisions in similar circumstances. Since every state is different, adult children should speak with an elder law estate planning attorney about how the law of their parent’s state of residence would apply if they were facing this situation. If you would like to learn more about caring for aging loved ones, please visit our previous posts. 

Reference: The National Law Review (March 22, 2021) “Major Victory for Adults Who Provide Home Care for Parents”

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Information in our blogs is very general in nature and should not be acted upon without first consulting with an attorney. Please feel free to contact The Wiewel Law Firm to schedule a complimentary consultation.
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