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The Centers for Medicare and Medicaid Issue Guidance for Nursing Home Visitation

The Centers for Medicare and Medicaid Issue Guidance for Nursing Home Visitation

Revised guidance for nursing home visitation has been issued by the Centers for Medicare and Medicaid (CMS). It is now possible to have visitation with nursing home residents for reasons other than urgent end-of-life scenarios and, in some instances, may include physical touch. Additionally, communal activities and dining are permissible as long as the social distancing rule of 6 feet of separation, and other precautions are observed. Encouraging outdoor visits is desirable as long as the weather permits. Indoor visits are permissible if no new cases were identified in the previous two weeks, and the facility adheres to the core principles of resident and staff testing, screening, proper hygiene, social distancing, and facility cleaning.

The CMS memo contains “Core Principles of COVID-19 Infection Prevention” verbatim as follows:

  • Screening of all who enter the facility for signs and symptoms of COVID-19 (e.g., temperature checks, questions or observations about signs or symptoms), and denial of entry of those with signs or symptoms
  • Hand hygiene (use of alcohol-based hand rub is preferred)
  • Face covering or mask (covering mouth and nose)
  • Social distancing at least six feet between persons
  • Instructional signage throughout the facility and proper visitor education on COVID19 signs and symptoms, infection control precautions, other applicable facility practices (e.g., use of face-covering or mask, specified entries, exits, and routes to designated areas, hand hygiene)
  • Cleaning and disinfecting high frequency touched surfaces in the facility often, and designated visitation areas after each visit
  • Appropriate staff use of Personal Protective Equipment (PPE)
  • Effective cohorting of residents (e.g., separate areas dedicated COVID-19 care)
  • Resident and staff testing conducted as required.

CMS acknowledges that the previous months of severe visitor restrictions to slow the spread of COVID-19 were at a high cost to nursing home residents’ overall wellbeing. The revision of visitor guidance compassionately addresses resident care needs beyond protection from the coronavirus. CMS Administrator Seema Verma states, “While we must remain steadfast in our fight to shield nursing home residents from this virus, it is becoming clear that prolonged isolation and separation from family is also taking a deadly toll on our aging loved ones.”

CMS is also making available Civil Monetary Penalty (CMP) funds to ensure greater and safer access to outdoor and indoor visits. The money can purchase tents for outdoor interaction and clear dividers such as plexiglass can create physical barriers, reducing the risk of transmission during in-person visits. Funding through CMP can also provide communication aids such as tablet devices and webcams that enable virtual visits. However, each facility has a limit of $3,000 to ensure a balance in distributing CMP funds.

Compassionate care situations now include more than the end-of-life scenarios and are also included in the CMS memo. Verbatim they include but are not limited to:

  • A resident, who was living with their family before recently being admitted to a nursing home, is struggling with the change in environment and lack of physical family support.
  • A resident who is grieving after a friend or family member recently passed away.
  • A resident who needs cueing and encouragement with eating or drinking, previously provided by family and/or caregiver(s), is experiencing weight loss or dehydration.
  • A resident, who used to talk and interact with others, is experiencing emotional distress, seldom speaking, or crying more frequently (when the resident had rarely cried in the past).

In addition to family members, compassionate care visits may now also include clergy or laypersons offering religious or spiritual support that meet the resident’s needs. Personal contact is permissible during these and family visits but only when following all appropriate infection prevention guidance. This more humanized approach to nursing home care encourages facility staff to work with residents, families, caregivers, and resident representatives to identify those in need of in-person compassionate care visitation. Exceptions to compassionate visits occur when facilities have experienced COVID-19 infections within the past two weeks or when a county is experiencing a high positivity COVID-19 rate. In the absence of a reasonable safety or clinical cause, the Centers for Medicare and Medicaid make clear that failure of nursing homes to facilitate in-person visitations can be cause for citations and other penalties as CMS deems appropriate.

CMS understands that nursing home residents derive physical, emotional, and spiritual value and support through family and friend visitations, especially in trying times. No one should be made to endure this pandemic alone, least of all the most vulnerable among us. This new CMS nursing home visitation guidance is designed to help American seniors remain happier, stronger, and more resilient in the face of adversity through the personal support of those who love them most.

If you have a loved one in a nursing home, check with the facility to see how or whether their visitation guidelines have changed. It may take time for local facilities to consider these new guidelines and make changes that are consistent with the recommendations from CMS.

We would be happy to discuss any questions you have, including how to choose appropriate long term care and how to pay for it. We can recommend legal ways to help ease the cost of long term care and protect your savings and home.  Simply give us a call at 1.800.660.7564 or email us at info@covertlaw.com.

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Looking for the Silver Linings Amidst a Pandemic

Looking for the Silver Linings Amidst a Pandemic

Record unemployment rates related to COVID-19 business closures have hurt business owners and their workers, many of whom are 50 years and older. Though workers of all ages have felt the effects of unemployment or reduced working hours, older workers will fare worse upon re-entering the workforce. Research shows the recession of 2008 found that those adults age 62 or more were the least likely group to re-enter the workforce, and it is most likely as the employment situation stabilizes the same will hold in 2020. Ageism plays a role when employers have huge swaths of potential employees from which to choose. 

Many unemployed older workers feel the effects of income loss and wild financial market swings wreaking havoc on their retirement savings accounts, as well as the potential that Social Security benefits may be reduced in the near future. Happily, before the pandemic, a trend towards later retirement, transitional work, and “encore” careers became the norm. Out of either necessity or desire, aging Americans choose to be active in the workforce, and policies and practices are starting to catch up to age discrimination. AARP has more than 350 companies who have signed an Employer Pledge that sources experienced workers. These companies provide job opportunities and career fairs online that are age-diverse.

Sheltering in place during this pandemic has kept many older Americans from having pre-existing physical, social, and emotional needs met as healthcare systems and network services for seniors are minimizing service to large numbers to protect and serve the most vulnerable.  This disruption of services like regular check-ups and elective procedures leads to a lack of personal care, proper nutrition, and medical management for many. Telehealth can remotely connect a patient to a medical professional, and with wearable devices, important medical information can be assessed in real-time by a doctor. If the situation warrants, medical intervention will follow. In the case of nutrition, beyond take-out and meal delivery services, grocery stores are now providing home delivery systems for fresh food. These delivery services include Instacart, Walmart Grocery, Safeway Grocery Delivery, Kroger ClickList, Vitacost, Peapod, AmazonFresh, and more.

The effects of increased isolation are producing more anxiety and depression in aging Americans. Loneliness is linked to negative mental and physical health outcomes such as cardiovascular disease, hypertension, cognitive decline, obesity, and death. The good news is that we live in a digital age where the Internet of Things (IoT) can connect people virtually. There is a steady growth of tech-savvy seniors who are well-versed in the use of digital devices and apps that let them talk real-time to family and friends. Family and inter-generational connections are stronger than ever since this pandemic has encouraged everyone to stay in touch. Programs like Students4Seniors and ZoomerstoBoomers are examples of younger generations lending a helping hand to seniors. Digital social connection is combating the negative consequences of isolationism.

Before the coronavirus, only about one half of Americans have had conversations about their end of life situation with loved ones. Only 27 percent of those have the legal documentation reflecting their wishes. The need to address mortality is uncomfortable but unavoidable for older Americans during this pandemic as they are disproportionately dying from COVID-19. There are general and specific pandemic-related end-of-life planning resources online that can help a senior think through scenarios before meeting with their attorney. Most law groups and individual attorneys are now set up to teleconference or video conference to create advance directives and associated legal documents. Many states are permitting online signature for these documents during the pandemic.

For every negative consequence of the coronavirus pandemic, there are solutions that drive positive outcomes, especially in the case of seniors. Efforts that improve the services of private and non-profit agencies, advocacy groups and policymaking, healthcare and business models are accelerating to meet the needs of our most vulnerable population. Technology, creativity, and sensitivity to senior needs are making life a better experience during a difficult time not only for seniors but also for the families and providers meeting those needs that create a stronger, more interconnected America that values its elders.  If you have questions or concerns, please feel free to contact us at any time by calling us at 1.800.660.7564 or email us at info@covertlaw.com.

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The Top Ten Myths About Risks for Alzheimer’s Disease

The Top Ten Myths About Risks for Alzheimer’s Disease

Polling shows that the number one worry for Americans as they age is memory loss, outpacing fears of insufficient monies, and loneliness. The most prevalent among all dementia is Alzheimer’s disease. According to the Alzheimer’s Association Facts and Figures Report, Alzheimer’s accounts for an estimated 60 to 80 percent of diagnosed dementia cases. Projections for increasing numbers of Alzheimer’s patients in the coming decades is cause for concern. However, in this digital age where disinformation is in abundance, Right At Home has identified ten persistent myths about Alzheimer’s that should be dispelled for clarity’s sake and because worry increases stress levels, which is bad for the brain.

Myth #1: If I live long enough, I will likely develop Alzheimer’s disease.

The fact is that developing dementia is not a natural function of aging. While there are more diagnosed cases than ever before, and risks increase as we age, it is not inevitable that age equals Alzheimer’s. A University of Michigan poll of people in their 50s and 60s found half the respondents expect to develop serious cognitive and memory loss as they age. The statistics show only twenty percent of older adults will experience dementia.

Myth #2: If I have a genetic predisposition for Alzheimer’s disease, I can do nothing to prevent getting it.

It is a fact that a higher risk for dementia does run in some families. However, research data presented at the July 2019 Alzheimer’s Association International Conference suggest that even those with a higher genetic propensity to develop Alzheimer’s can lower their risk by adopting lifestyle choices that address brain health.Actionable lifestyle choices decreased dementia risks by 32 percent. A study of identical triplets from the University of Toronto (December 2019) revealed while two contracted dementia, the third did not. While there are no guarantees, there are preventable strategies.

Myth #3: If I already have amyloid plaques and neurofibrillary tangles in my brain, I will soon experience Alzheimer’s disease.

Today’s medical technologies like PET scans and other brain imagining techniques show that some people have these plaques and tangles but display no obvious outward disease symptoms. The brain is highly resilient and plastic, creating workarounds or backup connections that bypass the affected brain cells. 

Myth #4: Specifically engineered brain games will provide the mental exercise I need to protect against dementia.

Neurologically focused computer games, puzzles, and similar brain “training” products are somewhat useful. Still, they do not provide a greater benefit than other mind-challenging activities. You are just as well off learning a new language, taking an art class, reading, playing video games, traveling, or even working at a mentally stimulating job. These activities help the brain build new connections; in particular, learning something new is especially beneficial.

Myth #5: All I need is solitary brain exercise.

The fact is that while engaging in intense mental focus is great, interacting with other people is more beneficial. Socialization stimulates many more regions of the brain, and those who regularly engage in social activity consistently have a lower incidence of dementia. Staying connected, even virtually in this age of social distancing, also prevents becoming part of the epidemic of loneliness, which leads to many negative health consequences. There are many reasons to stay socially engaged. 

Myth #6: Skipping physical exercise is permissible as long as I get mental exercise.

It is a fact that brain stimulation matters, but it is also a fact that exercising our muscles is as important for brain health because the two work together. Physical movement requires brain and muscle memory. Whether you move about a park or a gym, you need to know where to go. You also must know what to do, how to complete each task, and move to the next. In this multi-tasking body/brain exercise work, each function enhances the other—muscles matter.

Myth #7: Only aerobic exercise benefits the brain.

Muscle-strengthening activities are as important as aerobic exercise. It is true that having an aerobically fit heart is good for a healthy brain but lifting weights, doing squats, planks, pushups, and working with resistance bands are all known to boost memory. In some instances, strength training can even reverse memory loss because building muscle makes us overall healthier, and it also increases several beneficial chemicals in the brain.

Myth #8: I can take supplements to protect my brain health.

The fact is you are better off eating a diet that includes lots of quality vegetables and fruits, grains, poultry and fish, and healthy fats like olive oil. America is overrun with vitamins, herbs, and promises of brain health substances. The World Health Organization has recently stated no reputable study confirms the value of these vitamins, herbs, or supplements. Save your money and talk to your doctor about a healthy diet instead.

Myth #9: Drinking alcohol protects my brain.

The fact is experts do not agree about the studies associated with moderate drinking, in particular red wine, with brain health. However, the experts all do agree that drinking too much is very harmful to the brain. Heavy drinking shrinks the brain. The Lancet Public Health Journey states that “alcohol disorders are the most important preventable risk factors for all types of dementia.” As part of your diet plan, talk to your doctor about a safe amount of alcohol for you. 

Myth #10: Alzheimer’s disease is not related to other health conditions.

No disease is unrelated to other health conditions in our bodies. Many chronic conditions and diseases can harm our brains like high cholesterol, high blood pressure, diabetes, depression, stress, insomnia, hearing and vision loss, and even gum disease raise the risk of Alzheimer’s. Regular healthcare that manages existing conditions can also lower the risk of memory loss or slow its progression. Routine medical appointments, taking medications as prescribed, and following doctor recommendations can help to preserve brain health.

If you or a loved one have been diagnosed with Alzheimer’s, now is the time to plan. We can help create a comprehensive legal plan to address how to pay for care without losing everything you’ve saved over the years. We would be happy to talk to you about ways we can help.  Just give us a call at 1.800.660.7564 or email us at info@covertlaw.com.

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Beneficiary Designations: Pitfalls You May Not Know About

Beneficiary Designations: Pitfalls You May Not Know About

You might think that leaving your property to your heirs would be simple enough. You make a will or a trust, you do a transfer-on-death deed for your real estate, you put your kids on your bank account, you designate beneficiaries for your life insurance and retirement accounts, and you’re done.

If only things were that simple. The result you wanted can be seriously foiled, if all the above elements are not carefully coordinated.

After you consider the following, we hope you’ll agree that it’s best to consult a qualified attorney. That’s the person you need to help you construct an estate plan that will do what you want it to do.

 

A pitfall: Conflict between deeds and wills or trusts

If your will or trust conflicts with a deed for real property, the law will resolve the conflict for you by following the deed, not the will or trust. This can produce unintended results.

Suppose Mary wanted to divide her property equally between her two children, John and Jane. She recorded a beneficiary deed for John so he could inherit the house. She wrote a will leaving money to her daughter Jane that was roughly the same value as the house.

Subsequently, however, Mary forgot about John’s deed. She made another will that split everything equally between John and Jane.

On Mary’s death, John ended up getting significantly more than Jane. The portion of the second will including the house would be invalidated, because the earlier deed would supplant the will. So John got the house through the deed, plus half the money through the will. Jane got half the money only. That was not what Mary intended and the unfairness damaged John’s and Jane’s relationship.

 

A similar pitfall: Conflict between beneficiary designations and wills or trusts

Financial accounts can transfer automatically to people of your choice, avoiding probate, if you designate beneficiaries by means of “transfer on death” (TOD) through your broker. But you must not depend on your will to change TOD designations. The beneficiary designations establish a contract between the holder of the account and you. When you pass, the holder is legally obligated to transfer your account to the beneficiaries you designate, regardless what your will says. The designations, like deeds, supplant wills.

So if you have named your spouse as a beneficiary of, say, a retirement account, and then you get divorced and forget to change the beneficiary designation, your ex-spouse – and neither your new spouse nor your children nor anybody else – will receive the account proceeds when you die, regardless what your will says.

 

Underage beneficiaries and guardianship proceedings

Suppose your financial advisor calls to alert you that you have not designated beneficiaries on your accounts and that if you don’t do so, your estate will have to go through probate when you pass. By making TOD designations, your beneficiary would simply present a death certificate and the assets would transfer to him or her without the need to go to court. That sounds good. So you follow your advisor’s suggestion and designate your beneficiaries.

In the meantime, your lawyer drafts a good will for you. This will, as good wills should, contains a subtrust providing for underage beneficiaries. Your lawyer, echoing your financial advisor, explains that the subtrust is intended to avoid the necessity of court proceedings.

Your efforts to avoid court will be defeated, however, if you choose an underage beneficiary to receive your financial account through TOD. Guardianship proceedings would still be necessary to administer the money until the beneficiary came of age.

It would have been better to route the gift to the underage beneficiary through a will or trust and not through TOD designation. If wills or trusts are properly drafted, they contain provisions to administer the underage beneficiary’s inheritance privately and thereby avoid the court guardianship proceedings.

 

Another pitfall: Disabled beneficiaries and government benefits

The pitfall here is similar to the one above. If your beneficiary is disabled and gets a TOD (or any other kind of) inheritance, the inherited money could jeopardize the beneficiary’s entitlement to government benefits. Most benefits programs are “means-tested.” To be eligible, recipients must own practically nothing. If your beneficiary were suddenly to inherit, he or she would lose benefits and end up having to pay for care until the inheritance was spent. That could involve a lot of money!

Rather, like for underage beneficiaries, the disabled beneficiary’s inheritance should be routed through a will or “supplemental needs trust” (SNT) that imposes restrictions on spending. With those restrictions in place, the benefits would keep coming, and the inheritance assets could be used to pay for “extras” that benefits don’t cover. These extras might include payment of real estate taxes, upkeep of a residence, or vacations or a flat-screen television. The inherited money would be managed by a trusted person and the disabled beneficiary would still continue to receive the crucially important benefits.

 

Bank accounts and disabled or underage beneficiaries

The pitfall is the same as above. If you have designated underage or disabled beneficiaries by making your accounts “payable on death” (POD), court proceedings will be necessary in the case of the underage beneficiary, or the inheritance could jeopardize or eliminate the disabled beneficiary’s government benefits.

 

“Spendthrift” beneficiaries

The problem is likewise similar here. If your beneficiary has a gambling habit or drug addiction, or if he or she needs bankruptcy protection from creditors, and if he or she inherits without trust protections, the inheritance could be lost to the beneficiary’s detriment.

 

Joint tenancy of real property

It may be tempting to avoid probate by putting real estate in your beneficiaries’ names as joint tenants. But if multiple people own real estate jointly, all must agree on what is to be done with the land and all should contribute equally to property maintenance expenses. This can create disputes. A better solution might be to subject the property to probate, to dispose of it in orderly court proceedings.

 

Joint bank accounts

The intent to avoid probate here is similar to joint tenancy of land, but putting your bank account in your and your children’s names exposes the funds to risk that should be avoided. Once a person is named as a co-owner of a bank account, that person has immediate and unfettered access to the funds. The funds are thus exposed to misappropriation by the joint-tenant child, or they can go instead to the child’s creditors in bankruptcy, or to ex-spouses in divorce proceedings.

It would be better to create a power of attorney that allows a trusted agent access to bank-account funds for your benefit while you are alive. Then, for when you pass, you could name beneficiaries via a POD designation with the bank – but remember the warnings above regarding underage or disabled or spendthrift beneficiaries. Those beneficiaries’ access  to funds should be protected by a trust.

 

The Worst Mistake:  Failure to Include Personal Asset Trusts™

A Personal Asset Trust™ is an asset protected sub-trust for your children, grandchildren or other beneficiaries.  Simply put, if you don’t include them and you name your children or grandchildren to inherit, then that’s exactly how they will inherit.  What does this mean?  If you child inherits in their own name and is married or gets married after receiving his or her inheritance, then your money is now subject to your child’s past and future divorces.   But your child is also subject to losing all of your money if they, or their spouse, get sued in a lawsuit and lose that lawsuit.  Or, let’s just say your child at some time in the future passes away.  Guess who gets your money?  Not your grandchildren.  Your money would probably pass to your child’s surviving spouse – because they have their own wills or trusts.  And then if your child’s surviving spouse re-marries, guess who could get all of your money?  Your child’s replacement.

The worst mistake people make is to not include Personal Asset Trusts™ for their children and grandchildren.  Learn more here.

 

A lot of moving parts

Each of the estate-planning strategies above could work well in and of themselves, but, taken together, may have an adverse impact. Crafting a plan that combines and coordinates the various strategies requires expertise and care. That care is worth taking, to safeguard the wealth you have built up over the years. Don’t risk a result you don’t want. Call on us to design a plan that harmonizes all the moving parts, so the gears will work together and you will leave the legacy you intended.  Simply call us at 1.800.660.76564 or email us at info@covertlaw.com.