Elder Law Commons^™

The Generational Squeeze: A Commentary On Multi- Generational Special Needs And Benefit Planning In Georgia, Christopher Wages

Mercer Law Review

As the generation of baby boomers—individuals born between 1946 and 1964—grow older, their children are being progressively squeezed between caring for aging parents and the demands of a family of their own, giving rise to the term “sandwich generation.” The current population of fifty-three million baby boomers over the age of sixty-five accounts for 16% of the populace. As such, younger generations are finding themselves sandwiched between the financial, emotional, and physical needs of their aging parents and young children. This challenging situation is further exacerbated for families dealing with disabilities, and this scenario is only becoming more ubiquitous. In …

The Coronavirus And The Risks To The Elderly In Long-Term Care, William Gardner, David States, Nicholas Bagley

Articles

The elderly in long-term care (LTC) and their caregiving staff are at elevated risk from COVID-19. Outbreaks in LTC facilities can threaten the health care system. COVID-19 suppression should focus on testing and infection control at LTC facilities. Policies should also be developed to ensure that LTC facilities remain adequately staffed and that infection control protocols are closely followed. Family will not be able to visit LTC facilities, increasing isolation and vulnerability to abuse and neglect. To protect residents and staff, supervision of LTC facilities should remain a priority during the pandemic.

The Perplexities Of Age And Power, Sharona Hoffman

Faculty Publications

The elderly population in the United States is growing dramatically and is expected to reach over seventy-two million, or twenty percent of the citizenry, by 2030. But serious legislative and regulatory gaps leave the surging population of older adults with many unmet needs. Many Americans are aware of the Social Security and Medicare funds’ financial woes. This Article emphasizes that these challenges are only the tip of the iceberg. In addition, the elderly face under-funded Older Americans Act programs, unaffordable long-term care, inadequate driving regulations that fail to identify and protect at-risk drivers, and a significant shortage of geriatricians, among …

Selective Issues In Effective Medicaid Estate Recovery Statutes, Raymond C. O'Brien

Catholic University Law Review

Medicaid is a joint federal-state partnership program that provides medical care to the elderly, blind, and disabled poor. Unlike Medicare, Medicaid will pay for long-term care, leading millions of persons in need of such care to “spend-down” income or assets to qualify as sufficiently needy or poor. However, the state can eventually seek recovery of expenditures made through estate recovery programs following the death of both spouses. As it currently stands, states have no choice but to become increasingly vigilant in pursuing private funds in order to pay for Medicaid expenditures. As a result, elderly citizens and their families will …

Financial Security Scorecard: A State-By-State Analysis Of Economic Pressures Facing Future Retirees, Christian Weller, Nari Rhee, Carolyn Arcand

Public Policy and Public Affairs Faculty Publication Series

As Americans increasingly worry about their retirement prospects, states play an important and growing role in retirement security policy. States already manage long-term care programs for the elderly through Medicaid. Concerned about the impact of future elder poverty on state and local budgets and their local economies, a number of states are exploring the creation of low-cost and low-risk retirement savings plans for private sector workers who lack access to pensions or 401(k)s on the job. Some states have developed programs to help older workers find work.

This report presents the Financial Security Scorecard, designed to inform state-level stakeholders and …

Implications Of Rhode Island’S Global Consumer Choice Compact Medicaid Waiver For Rebalancing Long-Term Care Under The Affordable Care Act, Edward Alan Miller, Divya Samuel, Susan Allen, Amal Trivedi, Vincent Mor

Gerontology Institute Publications

Federal approval of Rhode Island’s Global Consumer Choice Compact Global Waiver in 2009 provided Rhode Island with greater flexibility to modify its Medicaid program. Because 96% of long-term care expenditures in Rhode Island were directed toward institutional settings, a primary goal was to facilitate the state’s efforts to shift the locus of long-term care to non-institutional settings. This study draws lessons from Rhode Island’s experience with the Global Waiver for the long-term care rebalancing provisions of the Patient Protection and Affordable Care Act of 2010. Data derive from 325 archival sources and 26 semi-structured interviews. Results suggest that prospectively documenting …

Implications Of Rhode Island’S Global Consumer Choice Compact Medicaid Waiver For Designing And Implementing State Health Reform, Edward Alan Miller, Divya Samuel, Susan Allen, Amal Trivedi, Vincent Mor

Gerontology Institute Publications

Provisions in the Medicaid statute permit states to apply for waivers from traditional program requirements. On January 16, 2009, the federal government approved Rhode Island's Global Consumer Choice Compact Waiver. In exchange for a cap on combined federal and state spending of $12.075 billion through 2013, Rhode Island received greater flexibility to adopt certain Medicaid program changes. This study analyzes the design and implementation of the Global Waiver to draw general lessons for health reform at the state-level, a key concern given ongoing state discretion to improve their health care systems under the Patient Protection and Affordable Care Act. Data …

Confronting The Elder Care Crisis: The Private Long-Term Care Insurance Market And The Utility Of Hybrid Products

Marquette Elder's Advisor

No abstract provided.

Preventing Resident-To-Resident Abuse In Long-Term Care: Targeting Sex Offenders But Missing The Mark

Marquette Elder's Advisor

No abstract provided.

The Role Of The Attorney As Nursing Home Advocate, Andrew P. Brusky

Marquette Elder's Advisor

This article explains the need for attorneys to keep informed about current standards and regulations related to nursing home care. The author identifies the areas of concern to clients and their attorneys such as determining the appropriate placement, or investigate financial and payment options. Surrogate decision-making options may need to be considered. Patients in nursing homes may need attorney assistance in patient rights or quality of care issues, or in disputes concerning patient abuse.

Spousal Refusal: Preserving Family Savings By "Just Saying No" To Long-Term Care Impoverishment, Scott M. Solkoff

Marquette Elder's Advisor

This is a case study of an elderly couple who executed a pre-nuptial agreement to keep their assets separated. When the husband required long-term care, the state required the assets of both to be considered in determining Medicaid eligibility. This article explores the effect and applicability of the Just Say No rule and the difficulty of preserving the assets of the non-institutionalized spouse.

Assuring Quality Long-Term Care In America, Thomas D. Begley Jr., Jo-Anne Herina Jeffreys

Marquette Elder's Advisor

Ninety percent of the 76 million baby boomers will be retired by the year 2030, and many will eventually need a continuum of care. The authors suggest that financing such care is primarily a middle-class problem, and suggest that making long-term care coverage both mandatory and universal, such as through a government program, may be the best way to spread the risk.

Naela White Paper On Long-Term Care Reform

Marquette Elder's Advisor

The current system for addressing long-term care is a non-system. It is a hodgepodge of services that fail to meet its intended needs and is economically inefficient. This White Paper analyzes the problems and proposes recommendations to serve as policy solutions for citizens and government

Reimaging The Ombudsman: An Appraisal, Beth Eisendrath

Marquette Elder's Advisor

An ombudsman program can serve as a useful alternative to the court system for nursing-home residents. This article examines issues related to the ombudsman's role in long-term care facilities, including purpose, criticisms, and local and national recommendations

Internet Resources For Long-Term Care Insurance, Robin C. Schard

Marquette Elder's Advisor

This article looks at long-term care insurance on the Web. The various perspectives represented and information provided by insurance governance, organizations, consumer advocacy groups, and insurance companies create a solid basis for beginning the decision making process with regard to LTC insurance.

Funding Long-Term Care: Is There A Way To Ensure That Our Assets Will Last Longer Than We Will?, Nathalie D. Martin

Marquette Elder's Advisor

Long-term care is subject of great concern to most elders. Stripping away the emotional hype and confusing lingo surrounding this topic is essential to making sound decisions. This article pares away all the extraneous complications and lays out the options that are currently available to elders, paying particular attention to the methods available to fund long-term care if or when it is needed

Income-Only Trusts: A Win-Win-Win Option In Estate Planning, Billie M. Castle

Marquette Elder's Advisor

When appropriate, income-only trusts can achieve the multiple objectives of preserving assets while minimizing tax liability, protecting assets against the possibility of long-term care costs, and retaining control of the grantor. This article examines the important factors that need to be considered to use income-only trusts successfully.

A Medicaid Long-Term Care Eligibility Primer: Basic Eligibility Rules

Marquette Elder's Advisor

Determining Medicaid eligibility for elders who need nursing home care is central to the practice of elder law. The purpose of various Medicaid rules, which vary from state to state, can seem incomprehensible- even for those who provide excellent Medicaid planning services.

Special Care Units: History, Regulation, And Criticism, Mollie Grande

Marquette Elder's Advisor

Special care units are nursing home areas dedicated to providing care for patients with dementia. This article describes the characteristics of individuals with dementia who need long-term care, outlines the reasons special care units were created, and discusses issues regarding their regulation.

Private Sector Long-Term Care Planning, Timothy M. Vogel

Marquette Elder's Advisor

America's long-term care future is fraught with risks and opportunities for a better old age. Elder law attorneys and financial professionals who understand this complex and evolving world will better serve their older clients. This author draws upon his forthcoming book to answer key questions about professional planning that will harness clients' resources to achieve private sector choice in long-term care

Counseling Clients About Long-Term Care Expense: What Are The Alternatives?, Richard W. Knueppel

Marquette Elder's Advisor

Although many Americans have purchased insurance for long-term care, other options may be available. This article explores nursing home costs, sources of payment, and insurance coverage available. Other options which might be investigated include Health Savings Accounts, Veteran's Administration benefits, adding a long-term care rider to an existing policy, selling a currently held life insurance policy, and a reverse mortgage on a home.

Consumer-Driven Long Term Care: Shaping He Government's Role, Marshall B. Kapp

Marquette Elder's Advisor

This article explores the movement of government and insurance-paid long-term care programs which tend to delineate which services are provided toward a more consumer-driven model. Kapp discusses the necessity of informing consumers of the options available, regulations needed to assure that autonomous consumers have alternative options available, and the criteria needed to assure that clients with inadequate decisional capacity have their interests represented.

Choices For Care: Consumer Choice And State Policymaking Courage Amid Medicaid's Shifting Entitlement To Long-Term Care, Tracy Bach

Marquette Elder's Advisor

This author addresses questions about the efficacy of Choices for Care (CFC), a Section 115 waiver program that allows Vermont to encourage Medicaid-eligible state residences to receive long-term care in their homes rather than nursing homes. The article addresses questions about CFC's impact on Medicaid recipients who need skilled nursing care. It also addresses questions concerning the program's cost effectiveness, and whether CFC has created additional costs. Finally, the article addresses the question of whether CFC will radically change long-term care and influence other states.

Narrowing Medicaid's Ltc Coverage? The Inplications Of The Dra's Home And Community-Based Care Benefit , Gene Coffey

Marquette Elder's Advisor

The first section of the article reviews the knowledge required to qualify for various levels of individual licensing. The second section of the article provides an overview of the financial products available in the market and attempts to analyze where the failures in investor knowledge are most apparent.

The Role Of Private Responsibility In Closing The Gap Between Knowledge And Practice In Long-Term Care, Marshall B. Kapp

Marquette Elder's Advisor

Kapp discusses the expanding need for long-term care services by looking at the goal put forward by aging policy analyst Dr. Larry Polivak of closing the gap between knowledge and practice in the United States long-term care financing and delivery system. The article first discusses points of agreement between Kapp and Polivak's viewpoints. Kapp then discusses how their viewpoints diverge and puts forth his own policy views about public versus private responsibility as it applies to long-term care.

Closing The Gap Between Knowledge And Practice In The U.S. Long-Term Care System, Larry Polivka

Marquette Elder's Advisor

The push for Medicaid reform is evident in the Deficit Reduction Act (DRA), which was crafted, in part, as a response to state-level dissatisfaction with existing waiver options. The DRA spells significant changes for Medicaid, as it institutes deep revisions of some of the program's core elements. The most significant components of the DRA's reforms include the expansion of state options and the simplification of the option approval process. This article examines the newly available options that will most notably affect Medicaid services to the elderly, especially long-term care, and it summarizes program revisions under consideration or active development.

Prescribing Practices In Long-Term Care: Invisible Influences, Diane Feeney Mahoney, Tammy Mcneill, Mj Henderson

Marquette Elder's Advisor

No abstract provided.

Forgoing Drugs On Grounds Of Cost: A Perspective From Catholic Health Care Ethics And Social Teaching, Janine Marie Idziak

Marquette Elder's Advisor

No abstract provided.

Income Tax Planning For Long-Term Care, David M. English

Faculty Publications

Planning for long-term involves more than the preparation of powers of attorney and counseling on possible asset transfers to qualify for Medicaid reimbursement. Steps should also be taken to make certain that the person receiving care continues to file an income tax return and does so at a minimum possible income tax cost. Practitioners should be familiar with the procedure for filing a return on behalf of an incapacitated individual. The medical expense deduction, while of little importance for most taxpayers, is critical for many elderly, particularly for those receiving long-term care. Long-term care insurance and life insurance may be …