Senior Living LIVE! How to Plan for Aging Related Issues

Video Transcription

Good afternoon everybody and welcome into Senior Living Live. My name is Melissa. As always, thank you so much for being with us here today. Our webinar this afternoon covers, quite a bit of ground as we discuss age related care, financial and legal considerations as it relates to the varying levels of senior living care, and that's what we are all about.

Senior living. Kathleen Bowling will be our guest presenter today, and not only will she answer your questions throughout her webinar, but she will also be available at the end of her presentation to answer your questions directly. So get your pen and paper out. Get ready.

Settle in. We're going to be here for about an hour now to be a part of the conversation, which we always appreciate you and give you the opportunity to do. You can type them out at the bottom of your screen in the chat box and we will be happy to read those out live during the presentation and get all of those answers for you throughout our hour together today. Kathleen, it is so wonderful to have you here.

We are excited for this wealth of knowledge that you're going to give us here in the next sixty minutes.

The webinar is all yours.

Thank Thank you so much, Melissa, and thank you to the Arbor team for welcoming us today.

I am Kathleen Bowling. I am the Director of Care Coordination at Rothkoff Elder Law Group. We are an elder and disability law firm located in the Philadelphia area and South Jersey. So we have several office locations in our area, but I will share with you we are part of a larger organization, which is the Life Care Planning Law Firm Association, which is located throughout the United States with various locations, and there might be a closer Life Care Planning Law Firm in your area. So I encourage you to look into that if you are navigating this ever changing long term care maze and finding resources that might be available to you or to someone that you love and are supporting. With that, we are going to dive right into today's presentation.

As Melissa said sorry about that. There we go. As Melissa said, today's conversation is going to be focusing on the social, financial, and legal issues that surround health care and long term care advocacy.

The learning objections today, we're going to dive into the different levels of care. We're going to look into what is available both in the home setting, but if an individual is required to move to a higher level of care, whether that's a personal care or assisted living, memory care, nursing home, what does that look like? And identifying some common financial, legal, care related issues that might arise in each level of care and opportunities that we as professionals or we as family members can best advocate for ourselves or our loved ones. And we'll touch briefly on some resources that might be available, whether that's collaborating with a elder care law firm, a social worker, that might be available in your area.

With that, because we are a law firm, one of the first things we do when we're talking about being proactive and planning ahead is to make sure that we have our essential legal documents in place.

So oftentimes, you'll hear the term POA or power of attorney. This is a document that allows for someone to act on our behalf if and when we are unable to make decisions.

And that could be very limited. You think about when you purchase a car, you may be signing a power of attorney document for a limited need to help you purchase that vehicle and access alone. Or it could be very broad and allow essentially someone to step into our shoes if and when we're unable to make decisions, and they can do anything that we would be able to do. The two primary powers of attorney that we look to are the health care and the durable general power of attorney, or the financial power of attorney. These are typically two separate documents. You may have a document that encompasses everything, but these are the two focus areas that these powers of attorney touch on.

Now, the durable general power of attorney, that's the financial document. So that gives us as the individual authority to make someone make decisions or make financial decisions, the personal decisions on our behalf or the principal.

So it could be determined that this is only used if and when I'm incapacitated and physicians are saying I'm unable to make decisions, or it can go into effect almost immediately.

So it's something to keep in mind when you're thinking about who's going to serve in this capacity, and we'll touch on that in a minute.

This document should be reviewed and revised regularly. Oftentimes, we have clients that come into our office, and it's a married couple, a husband serving for wife, wife serving for husband, or adult child serving for their mother. But what happens if something happens to that individual and they can no longer serve in that capacity?

These documents should be reviewed on an ongoing basis. We typically say about every five years, but if there's any significant changes in your life that require them to be reviewed, it's worth updating. And again, we'll dive into that in a few slides.

So again, this document would allow anyone to sell a home, access funds from a retirement account to pay for care, talk to a change of health insurance.

This is essentially allowing anyone to act on their behalf when it comes to a financial decision making.

The alternative to this is the health care power of attorney. So this is essentially giving our agent or the person that we've named the ability to access any type of medical information and make any medical decisions that we may need. So it allows us to talk to the doctors, talk to the hospital staff, and in an end of life situation, make an end of life decision for someone that is otherwise incapacitated.

Now, the living will and advance directive is sometimes included in that health care power of attorney, and that's essentially a written statement that details what our wishes would be in an end of life situation.

It may include instructions regarding pain relief, blood transfusions, feeding and hydration, do you want extreme measures or do you not, and end of life resuscitation or do not resuscitate.

Now, this differs from the healthcare power of attorney that essentially is naming someone to make that decision, but the advanced directive clearly outlines what we would want in that situation if we were otherwise unable to communicate our needs.

Now, I have POLST up here, or P O L S T, and that's here in Pennsylvania. It's a physician's order for life sustaining treatment. It may be called something different where you live, but this form is different from the advance directive that we might have outlined.

So if I have an advance directive that says what I do or do not want in an end of life situation, that still has to be communicated to a doctor for the doctor to make that an official medical order.

Now, the POLST form or this physician's order for life sustaining treatment is a document that once it's signed by a physician, it becomes a medical order. So there's no more having the physician write another DNR every time we're in the hospital or in an institutionalized setting. So I encourage you, if you are not from Pennsylvania, to not look up the pulse number, but look up what that is in your area. This is an important document for us to have to clearly outline what our wishes are in an end of life situation.

I touched upon the choice of agent a few slides back, but because this person is essentially diving into your shoes and making any decision that you would otherwise make for yourself, you want to make sure it's a trusted individual, who is someone that is going to carry out your wishes in a situation that you would otherwise not be able to?

So it's often a spouse, as I mentioned, or a partner. It's often an adult child, but it could be a professional organization. Even within our law firm, when there are what we consider unsupported elders or individuals that don't have family to make decisions for them, our attorneys have stepped into that role and served in the capacity of an agent. There are other professional organizations or guardians that can step into this position too. So I encourage you, if you don't have an estate planning document in place or they haven't been updated or reviewed recently, I would encourage you to take a look at that.

One other thing to note is that you want to make sure you know where these documents are. It's great to have them, of course, and to keep them up and locked away in a safe deposit box. But in a time of an emergency or a crisis where you need access to these documents, you want to make sure that you know where they are, your agent knows where they are, and understand what their role is in a situation that they need to be used.

As professionals, when we enter a hospital setting or a senior living setting, professionals need to keep in mind who is the agent and who is the principal. It's one thing to have these documents in place, but as long as the individual is capable of making decisions for themselves and not otherwise determined to be considered incapacitated, the power of attorney is irrelevant. I always use the example of the flu shot. It's simple and easy to understand.

But if we have an estate planning document, I'm my own person, I name my partner as my agent under power of attorney, and I say, I don't want the flu shot. I understand the risks that are involved. I may get the flu, I may contract the flu, and I might need other medical attention, but I am choosing not to get the flu shot. Although my partner has power of attorney, they cannot override my decision making. So despite having a power of attorney, as long as the individual is capable of making their own decisions, albeit a bad decision, the power of attorney does not override their decision making.

So this is a huge opportunity for advocacy, for professionals, and for our clients to say, We recognize the risks that are involved. Someone has the right to make a decision, again, albeit a bad decision.

If you could see your screen, I have a visual up here of the long term care continuum, starting with aging in place at home through senior living, and this is just to kind of give you a visual of the different levels of care that we're going to dive into and some of the costs that are related to it and maybe some public benefits or other resources available to pay for that care, but we're going to dive into that now.

Starting in the whether it be the home setting in someone's home or in a senior living setting, whatever that individual considers to be home for them, they have access to home care. There are two different types of home care. There is skilled home care that is covered by medical insurance, and there's the nonmedical home care that is generally covered by private payment, public benefits such as Medicaid, maybe a long term care insurance, or even VA benefits if the individual is a veteran.

Now home care follows the patient. So if an individual makes the transition to a senior living setting, they can have the additional support of both skilled home care and nonmedical home care in the comfort of their own home.

Skilled home care is, as mentioned, covered by medical insurance. Because it's covered by medical insurance, it will require a script from a physician to determine the need for physical therapy, occupational therapy, speech therapy, a registered nurse, or potentially a home health aide, and the reasons why the skilled need is there, including the diagnosis.

What we often hear is that someone is not deemed to need skilled home care because they're not what's considered homebound. And this is where, again, another opportunity for advocacy comes into place. I'll give an example.

If someone discharges from a hospital setting and is independent in their own home or in their senior living community and still go out to medical appointments or religious services, and the doctor comes back and says they don't meet the criteria for homebound, therefore they can go to therapy on an outpatient basis.

Those outside services, whether it be medical appointments or religious services, if it is challenging for them to get there, meaning they require assistance from the staff of the community, an adult family member, a partner to get to those appointments, they're considered homebound. There is a need there. They're not independent in the sense that they can get themselves to and from, and they're grocery shopping on their own. So if there's any pushback when it comes to whether or not someone meets criteria for that homebound status, I welcome you to look at what are they going out for.

Are they going out for medical appointments? Are they going out for religious services? That's okay. They still meet that criteria for homebound services.

Now, I mentioned in here that skilled home care is not a reliable source of ongoing care, and what I mean by that is because it's covered by your medical insurance, it's short term.

No one is entitled to skilled services indefinitely in the home setting.

When you think about someone that's living with a dementia or a condition that requires twenty fourseven supervision, Bringing in skilled home care is not enough to keep them safe. The physical therapist is going to be there for forty five minutes of the day. Maybe the registered nurse comes out once a week to review the patient's need. But there is twenty three hours outside of this time that this person needs care. So I encourage you to consider, if there is a need for ongoing care, skilled home care is not the reliable source of care. It's a great benefit to avail yourself to, but it's not a reliable source of ongoing care.

That's where you may see the need for home care or nonmedical home care services.

Because this is an out of pocket cost or, again, covered by other types of public benefits like Medicaid, veterans benefits, or even your long term care insurance, it's a more reliable source of in home support.

And what we see the benefit is is that even living in a senior living setting, someone might avail themselves of this additional non medical home care for added support wherever they are. So if you're looking for that reliable source of care to support your loved one, whether they be at home, in their independent home or a senior living setting, you can look to explore nonmedical home care.

Just keeping in mind what they can and cannot do.

Nonmedical home care is generally a certified nursing assistant or a home health aide, meaning they're not skilled registered nurses. They are unable to physically administer medication to a patient or manage some higher skilled care needs, sometimes like an ostomy bag or a feeding tube. So if someone is in need of that higher level of care outside of what a home health aide is approved to do, they might have to look to alternative settings or alternative care services.

As we dive into the hospitalization, some key takeaways that I want to identify are this difference between admission status and observation status.

A few years back, there was a change, I think back in twenty sixteen, there was a change called the Notice Act, in that the hospital's required to tell a patient what level of care they are in the hospital setting, whether that is a true admission, where they are admitted to the hospital, or what's considered under observation.

Now, if the person is under observation, it may greatly impact their discharge plan. And what do I mean by that? Under Medicare, and I'm talking traditional Medicare guidelines, an individual has to be admitted to the hospital for three overnights to qualify for any inpatient skilled nursing level of care upon discharge.

If someone is under what's considered observation, they are not entitled to that benefit because they were never admitted to the hospital.

This is a big issue when it comes to, again, discharge planning for a successful and safe outcome.

So how can you know what your status is? Well, with the Notice Act, they're entitled to tell you. You may receive a physical notice from the hospital saying that you are under observation or you are admitted to the hospital.

The caveat to this is that I've had a situation in which an individual was under observation for nearly two weeks.

For the husband only to go home and find this notice in the mouth having come two or three days prior. So perhaps it was mentioned to him while his wife was in the hospital setting, but with everything going on and all of the different practitioners that you're seeing, the difference between admission and observation might have just been overlooked. So at the end of her two week hospitalization, this individual is not eligible for any type of inpatient level of care at discharge and had to go back to their prior level of care.

So just keep in mind, you want to be sure you know what your status is in the hospital.

You can ask the hospital social worker or the nurse that's treating you, What is my status right now?

But it's important to identify this early on. It's not as easy to go back and change your status than identifying it first and foremost so that going forward you can be admitted versus observation. If have any specific questions about that, I'm happy to dive into this later.

But I just mentioned this because as a patient or a loved one or a professional supporting someone that's going through a hospital, make sure you understand clearly what your status is in the hospital as it can greatly affect your discharge plan.

Assuming that this person did meet that three night hospitalization under traditional Medicare, again, Advantage Plans and commercial insurances are a little different, but assuming they met that criteria for traditional Medicare's three night hospitalization, you then might be entitled to transition to a skilled nursing or a subacute rehabilitation center. In this level of care, you are surrounded twenty fourseven by skilled nursing professionals and access to physical therapists, occupational therapists, speech therapy, registered nurses, dietitian, this interdisciplinary team to manage your care needs before returning to your appropriate level of care, whether that be home or transitioning to an alternative care setting.

Now, knowing how do we be proactive? We want to know what our insurance is. We want to understand, do I need that three night hospitalization? What does my medical insurance cover? What is in my Advantage Plan or my HMO? What are the benefits that I'm entitled to? One of the key things we often hear is under traditional Medicare, I'm entitled to one hundred days of skilled level of care upon discharge from the hospital?

Yes and no. So while you may be entitled to one hundred days of skilled nursing level of care, you do have to meet certain criteria to show that you're making progress in the hospital setting.

We want to make sure that the person is still benefiting from the skilled nursing level of care and the skilled therapy services, because if they're refusing or if they have a situation that they're just not making considered enough progress, there might be discharge prior to that one hundred days. So again, while you are entitled to one hundred days, it's unlikely that you will utilize all of those one hundred days while in the skilled nursing setting.

With this in mind, discharge happens the day of admission. Start thinking about where was I before? Where was my mom, my loved one before? What level of care? And is that still safe and appropriate? And what are the goals that we're working toward so that we're establishing realistic goals with the therapy team to make for a safe discharge?

So we want to make sure we're holding regular routine care conference meetings, and we're participating in that therapy session with the treating therapist so we are viewing what progress is being made in therapy.

And talk to the therapist. If mom was able to manage a full flight of steps to enter her home prior to discharge, we want to make sure they can manage those flight of stairs upon discharge from the skilled nursing setting. If they can, it may be time to start exploring alternative residential settings, whether that be a personal care or a memory care, assisted living, or even establishing a different layout within the home. And we'll dive more into that in a bit, too.

I mentioned on here to review contracts. This is another area which working with a law firm is beneficial. Every time we enter a facility, whether it be a short term rehab situation or long term care, we are expected to sign an agreement, and it's a legal binding contract between the individual and the community in which they're going. So you want to make sure you are reviewing these documents rather than just signing off as the power of attorney or the responsible party to understand the legalities that are established in this contract.

So I mentioned this earlier, discharge happens the day of admission. We want to ensure we're communicating regularly with the interdisciplinary team, the social worker, the therapist to understand what goals of care are we working towards to make for a safe and successful discharge.

If the need is there upon discharge for twenty fourseven care, that could be established by the non medical home care that we talked about early on, maybe moving to another level of care, such as a personal care or memory care where services would be provided in a safe setting.

Or in a situation where that might not be appropriate, there may be a need to transition from the rehab setting to long term care, whether that be within the rehab setting or another local community.

If a community where you are for rehab is a skilled nursing facility that accepts both Medicare and Medicaid as a payer source, and the recommendation is made that this individual needs long term care at discharge, the facility is required to accept them where they are. And this often comes up in situations where a community may be a dual certified, meaning it accepts both short term rehab and long term care and accepts Medicaid as a payer source, may say, We don't have a bed available, so we'll help you find an alternative setting. This is a huge opportunity for advocacy, because if that community accepts long term care and accepts Medicaid, the individual cannot be discharged due to a change in payer source.

Now, are reasons why, if a community says you need an alternative level of care, there are reasons why the facility may discharge, and I've listed them up here for you to reference.

And a good example of the first one that their needs cannot be met is a dementia or an issue or a situation in which the individual is exit seeking or an elopement risk. If the community cannot safely keep that individual with dementia from eloping or from wandering from the community, it very well could be that it's not the right setting for them.

If they don't need a nursing home level of care, sometimes we see that after an acute situation or acute hospitalization, where the individual needed that twenty fourseven care. But if they returned back to their independent baseline, it may not be required. A nursing facility may no longer be required.

They may be a danger to themselves or the staff. It could be an emergent situation.

If the facility is closing, of course, they would have to make appropriate accommodations to relocate the residence. And if there is no payer source, then the facility has the right to discharge that patient.

They are required to give thirty days notice in most situations, and you have the right to appeal that decision if you feel that it's not an appropriate discharge. But know your rights and know the rights of those that you're working with or supporting to understand if it's an appropriate discharge or not.

We're still focusing on the subacute skilled nursing level of care for this conversation.

At the end of that skilled benefit period after hospitalization when insurance is no longer covering this individual, the patient or their representative will receive a notice of Medicare non coverage or NOMIC, and in that, it will review the date of discharge, and by discharge, I mean the date that skilled nursing level of care is going to stop covering for services, and their right to appeal that decision.

So you will be given the contact number to appeal that decision in an effort to extend the skill time a little bit longer, potentially, or maybe a few weeks longer if it's appropriate. So if you are given this notice of Medicare non coverage, I would encourage you to appeal if you feel like you or the person that you are supporting isn't back to their baseline level of care.

Now, I referenced the GMO settlement on there. This was a case a few years back in which an individual had a progressive disease, and what I mean by that is something like Parkinson's, ALS, or MS, where the condition is not going to improve, and dementia is another great example of this.

Even though the individual is not making substantial gains in the rehab setting, the benefit of the therapy is slowing down the progression of the disease. So when making an appeal in this type of situation, I would encourage you to reference this GMO settlement, that without this skilled therapy level of care, the individual's condition may deteriorate or worsen, so you're looking to slow down the progression of any disease or any condition.

The Center for Medicare and Medicaid Advocacy also have great resources. I would encourage you to look those up online too, just to have those for reference in appealing the decision.

So oftentimes we might think about working with the physician or the treating doctor to help make the case or make the appeal for more skilled time. So I would always encourage families, if you feel that you're not, or your loved one's not back to their baseline level of care and it's not safe discharge yet, appeal the decision in an effort to have a third party review and ultimately make the decision as to whether or not the discharge will occur.

As I mentioned previously, sometimes it's not appropriate or safe that the individual return to their prior level of care. They may not be appropriate to go back to their personal care setting or their assisted living if they can't meet their needs, or home might no longer be appropriate for them without the adequate support. In this case, they may need to transition to a long term care setting.

So with that, know your rights in the long term care setting and have a care plan meeting regularly with the staff. The care conferences generally include the registered nurse, the social worker, maybe the physical therapist or occupational therapist if your loved one is on caseload with them, and an opportunity for them to give you an update as to how your loved one is doing, review the service plan, as well as their goals that they're looking to meet with the patient or with the resident, rather.

It's also our opportunity as family, as advocate, to ask questions.

What concerns does our loved one have?

What issues may have arisen that have to be addressed with the interdisciplinary team? It's a great time for the individual themselves, or we as the advocate or the agent or private attorney, to really advocate for the resident.

I often will tell families too, if the individual is alert and oriented and able to clearly make their needs known, make sure that they're included in this conversation and make sure that they are advocating for themselves, that they hold so much power in advocating for themselves that we don't want to miss the opportunity.

That being said, despite having these care plan meetings on an ongoing basis or with any change, don't wait for these meetings for an opportunity to address any questions or concerns that you have. The staff make themselves readily available to answer your questions. There's a social worker that is the advocate for the resident in the nursing home to address any issues or concerns in real time versus waiting for this meeting to kind of express anything, any concerns you may be having.

Other residential options that we may be familiar with are CCRCs or continuing care retirement communities. The benefit to a continuing care retirement community is it allows residents to transition down the continuum. So they might move into an independent living setting, but maybe they need a personal care or memory care down the line, or even a short term or long term skilled nursing level of care. This is all generally within the same campus, so there's no need to make a move to another community.

It can be costly, and one challenge that often arises is when do I make that transition? When do I make the transition to the higher level of care?

There's a benefit to being in this type of setting with a couple because as their needs change at different paces, they could be within the same campus and available to one another. The other great option is assisted living or personal care. You may hear these terms used interchangeably, but this is more home like than a long term care setting. And in our office and for many individuals, the goal is to keep the individual in the least restrictive environment. The reality is nobody wants to be in a long term care skilled nursing facility. So if there's options like assisted living or personal care that gives the individual the support, care, and access to medication management, meals, and a safe environment, it's more home like than a long term care setting.

So just know what the payer sources are available for this level of care. We practice, our office practices in New Jersey and Pennsylvania, and in those two states, there's a stark difference between resources available to pay for this assisted living or personal care. Medicaid may cover it in New Jersey, while in Pennsylvania, it's strictly private pay. So as you're making the decision to move your loved one or to move yourself into this type of setting, just understand what the resources are that might be available to help pay for that care. But it's a great alternative to offer someone a supportive care environment in the least restrictive setting.

Other supports that I like to bring up are services like palliative care and hospice. When I first started in this role several years ago, I was always hesitant to bring up the word hospice or even palliative care because it's a scary word to hear. Families often think of hospice as someone is imminently dying, end of life, and that while those supports are available to someone in that situation, if referred to early enough, hospice and palliative care have so much support and benefit to give, not just the patient but to the family, too. So I would encourage you to talk with a hospice or palliative care provider to kind of debunk the myths as to what hospice is and what palliative care is. Include the resident, if it's appropriate, to help them make a decision as to whether or not it's the right fit for them and understanding the difference between the two.

Palliative care is thought of as a way to keep the patient comfortable and free from symptoms. So I use the example of a cancer diagnosis. Oftentimes when someone is going through chemo or radiation treatment, they have adverse effects from the treatment.

They may be extremely nauseous and lethargic, but they want to continue with the treatment available to them. Palliative care can come in and look at the big picture and treat the patient holistically, making sure that not only are they still getting their treatment, but that their symptoms, the adverse symptoms of the nausea and the lethargy, are being addressed appropriately.

Now, with hospice, that same individual would forfeit any type of aggressive treatment like chemotherapy or radiation.

Under hospice services, the goal strictly is comfort care and symptom management and to avoid this cycle of hospitalization, rehab, home, hospitalization, rehab, home. And it's to keep the patient free from suffering in whatever setting that they are in, and hospice follows the patient.

You can have an individual that lives in their own home, in a personal care setting, a memory care setting, with the support of hospice, and it supplements the care of that community. So it's more care. That's how I'd like to look at it. More care with the goal of focusing on comfort and symptom management.

The benefit of hospice is that if the person qualifies or the patient qualifies under their medical insurance, it is covered one hundred percent by the Medicare benefit. That would cover the additional team of nurses, home health aides, social workers, to come in and treat the patient, and it may even cover some durable medical equipment or medications that relate to the disease process for which they were signed on.

This is a big benefit, not just for the patient's overarching care needs, but also from a financial standpoint because it offers so much.

Hospice generally reviews the patient on an ongoing basis to make sure they still meet criteria, and I've had situations where, although initially hesitant to sign on to hospice, once the time comes that this person is graduating from hospice and no longer appropriate, the patient and the family are sad to see the support go because it has offered them so much over time.

So while, yes, it is available to someone that's perhaps imminently dying, depending on their circumstances, someone could be on hospice for years and even graduate from hospice if they no longer meet criteria.

So I would encourage everyone to look into this if you or someone that you know might benefit from this additional support wherever they call home.

Other programs that might get overlooked are adult medical day programs, and in our area, life or the PACE program, which might be covered by a public benefit like Medicaid. But adult medical day programs could be a great alternative to someone who is just starting to explore care options, and it may be a way of getting socialization, meals, medical oversight in a safe environment, with still giving the option to stay at home for the time being. So I would often encourage individuals who are at home to look into these two types of settings as they're exploring resources available to them.

Now, talking about ways to access funds to pay for care.

We can look to private payment, your long term care insurance policy and types of public benefits like Medicaid veterans benefits.

I mentioned the long term care insurance because you want to know what your policy covers. Some cover skilled nursing only, some cover assisted living or personal care settings, and some may cover home care support. So you want to understand what is covered in your policies and tap into it at the appropriate time.

There may also be a pending period in which the policy does not pay out yet while you are accessing funds to pay for care. Sometimes it's about sixty to ninety days before the policy may pay out. But again, understanding whichever level of care or whatever support you are exploring, how can this support be paid for? Is it available through a private payment? Is it available through a public benefit or long term care insurance or even the veteran's benefits?

If you yourself are a vet or were married to a vet, you may be entitled to home care and other medical equipment that's available through the Veterans Association. The VA offers so much to veterans, rightfully so, so if you're not already enrolled in the health system, I would encourage you to look into the VA health system if you are a vet.

Resources that may be available, I always say you want to talk with a trusted advisor or professional. Opportunities like this that Melissa offers through the Arbor Group are great ways to hear directly from professionals about different supports and services available to consumers.

What I would caution people in looking into certain supports like Facebook or friends of friends that might have gone through a similar situation, while it's always great to get helpful advice, you want to make sure you're talking to trusted advisors and professionals to understand what your individual options are and your individual rights are.

There are different care advocacy groups, the Long Term Care Ombudsman, the Department of Health. Your local area agency on aging may have a lot of support to offer, both you and your loved one, so look into what services may be available through the Office on Aging. In Philadelphia, we have Philadelphia Corporation for Aging that may have supports like adult protective services and different services available to the constituents in the area.

And of course, financial and legal supports. I mentioned early on that we are part of a larger organization, the Care Planning Law Firm Association, with various offices and practices throughout the United States. You can find that on the Life Care Planning Law Firm Association website. Legal aid or other complementary services like the VSO or the Veterans Administration. It's always a good place to start for proper direction.

So with that, Melissa, I will turn it back over to you if there's any additional questions.

I've included our events on the bottom of this page, then you're in our area and wanted to join, but I'm happy to turn it back over to you, Melissa. Thank you.

Yeah, thank you for all of that. And everybody who's watching, if you do have a question here for Kathleen, it's a great time to get it in.

We've got about twenty minutes left in our webinar and, again, to be a part of the conversation, you can go to the Q and A button at the bottom of your screen, type out your questions there, and I'll be happy to read them to Kathleen here in the next twenty minutes or so that we've got remaining in the webinar. I love what you said about hospice, and, that is, definitely a scary word for a lot of people. And, the question that I have is, when we talk about Medicare and options for payment and how that gets handled, depending on the age of the individual, obviously, how long can that go for? How long can somebody be in hospice Again, because it's not everybody who's in it is actively in the process of passing. So what does that cap look like? What can somebody expect when they are enrolled in that in terms of a time limit?

Sure, so generally speaking, I think the early, and you'll have to fact check me here, maybe a hospice provider would be a great additional support to have on here, but they generally look on a thirty, sixty, ninety day basis, then on an ongoing basis to make sure that the patient is still meeting certain criteria. That being said, someone could be on hospice for years and still benefit from the services. And what I always encourage families to do is that if you are ultimately deemed to be no longer eligible for hospice and they are saying we are going to discharge services, you have the right to appeal that decision too and have someone else, the third party, review and say, No, this person still does meet criteria.

The other thing someone could do is if one hospice provider discharges, saying that they no longer meet criteria, get a second opinion. Have the physician re refer the patient to hospice and have another hospice provider do their own independent assessment and see if there's something that maybe could qualify the patient for hospice. So it's reviewed on an ongoing basis, but it could be provided for years so long as the patient meets criteria.

Yeah, and I like that you mentioned that because I wasn't aware of that, that you could actually contest it if it is being taken away and continue to stay on it because the care you receive in that is actually pretty wonderful.

Absolutely, and it allows individuals to age safely in place, and sometimes communities may not otherwise be able to care for someone if it exceeds what their level of care is. But with the support of hospice, it allows that person not to have to transition from a personal care memory care setting, and it allows them to age successfully in place wherever they are.

Yeah, and that's the whole point of what we do. Know exactly trying to make it as easy as possible to live out your your golden years, you know, no matter what it looks like. Everybody's journey is a little bit different, but, the journey, we hope, is as smooth and seamless as possible for all of you, no matter where you happen to be.

Absolutely.

Q and A, Rodica asks, please elaborate on joint executors. Thank you.

Oh, sure. So I believe what it might be referring to is during the topic of powers of attorney. You may name or you may have a document that says, I'm Kathleen, and I'm going to name both my husband as my agent, but also my sister. And I want them to work together to make decisions for me.

Otherwise, I can say, I'm going to name my husband and my sister, but they can act independent of one another. So my husband can make a decision without consulting with my sister and vice versa. So with that in mind, while sometimes we'll see this with adult children and a parent or maybe two siblings, you want to make sure that they're aligned and that they both have your best intention, because what you don't want to see is two differing opinions and one person making a decision that's counterintuitive to the other person's decision or goals. So you can have someone that acts separately but jointly as well.

Yeah, and that's a great answer. And, Rodiga, if you have a follow-up or if you need any additional support with that question, feel free to chime in in the Q and A. But that was a very good answer.

So we hope that that answered your question. Mike has a really good, pointing out something a little bit that we don't really talk about that much. So there's a little gap, right, in terms of senior living, we're talking between the ages of fifty five and sixty two, and that's where this question is going to go. What about supported independent living resources for individuals with chronic physical disabilities younger than fifty five or sixty two who are deemed ineligible because of age at assisted living facilities or CCRCs?

Yeah, that's a great, great question, Mike, and it's something that we see very frequently. And as you were saying, Melissa, there is this gap. There are some type of living residential options that allow someone to age in an adult group home or something. But the challenging part is sometimes these individuals will then age out of that. They might go to eighteen, but what happens in that period of eighteen to fifty five, sixty two when they're then eligible for a senior living type setting? We've had individuals in our area and clients that might go to a nursing home, even though they otherwise wouldn't be nursing, your typical nursing home resident, and unfortunately, that's not a great fit either. They're not in a population that's similar to them, and they see everyone that is around them that just doesn't, they're not like them, and it's not the right fit for them.

In our area, we do have a couple of residential settings that are more focused on individuals with chronic disabilities that cater to a younger population. So without knowing specifically where you are, Mike, it's hard to say what might be available, but what I would say, it might be a great opportunity to go back to the Area Agency on Aging because there might be other services through the local Area Agency on Aging that they could tap into or at least help point you in the right direction. It's always a great place to start is that area of Agency on Aging.

Yeah, there you go. And again, just to be clear, Kathleen's out of the Philly area and the state is in And the laws change by state, as everybody knows. So what the options and resources also vary from state to state as well.

And I will say, Melissa, if I could add, at least in our area, these ideas of a personal care home or maybe some other type of setting might have extensive wait lists and admissions criteria. So it's, again, talking about planning ahead and being proactive, you want to understand what the options are that are available and how long might the wait list be before you can really tap in and take advantage of the services.

It's a really good point. I didn't think about that. And that's, where you come into play because you do have that knowledge, working, on a day to day basis covering this. It is what you do. And speaking of that, so I know today you kind of came to us with a list of topics that kind of followed, flowed in a nice way. They were kind of very similar. But I'm wondering, have you noticed any trends lately, maybe over the last five years, the last three years as it relates to seniors, senior care, senior living that maybe didn't fit within the presentation today, but you feel are relevant to talk about.

Yeah, I think one of the trends that we often talk about within our office is a younger and younger population with early onset dementia. And we talked just briefly with Mike's question of that demographic fifty five, sixty two with chronic disabilities. We have these individuals that are younger, and it's hard for the families to accept that they're moving their loved one, their mom, their spouse, into a senior living environment, again, with the population not being like them, and seeing that their loved one is deteriorating so quickly. So if I could identify kind of one trend that's been apparent of late, I think we're just seeing such younger and younger individuals with dementia and early onset dementia, and just chronic, separate from that, just chronic health issues and comorbidities.

The reality is that we're getting sicker, and individuals want to stay home as long as they can, right, or in the least restrictive environment, but the comorbidities and other health issues may be affecting what's available to them and the level of care that's appropriate for them. It's just more medically complex situations and early onset dementia have been the two biggest trends and challenges that we're seeing.

Interesting, yeah, that's very interesting.

And when you talk about the early onset dementia, do you have a specific age range that you're kind of noticing?

It's probably that fifty five to sixty five range, but we have seen individuals even younger, late 40s. I had a situation that was just tragic where the mom was in her late 40s and the poor husband who just wasn't prepared for, it just kind of deteriorated, her situation deteriorated quickly. And here he is trying to get the four year old and the eight year old off to school and also managing with his his wife's situation. And how do you explain that to four and eight year olds? What's going on with their mom? So it's just so sad. It's generally within that fifty five, sixty five range, but it's not to say it hasn't been younger than that even.

Yeah, that's really tough. It's tragic. Yeah, absolutely, yes. As it relates to our seniors, as it relates to, again, the different states and different laws, Is it a place that you know of maybe one stop shopping that somebody can go to online if they're looking for somebody just like you and they happen to live in Florida or California and they want to find somebody that they feel will be a good fiduciary, somebody who will look after them, somebody who will take care of them and give them and guide them in the right direction.

Sure, and we are part of the Life Care Planning Law Firm Association, so the acronym is LCPLFA dot org. And if you go on there, you can find in your area, there's map, there's a little tab that you can put where you are, and it might find some options in your area. We are a little bit different in the sense that as a care coordinator, I'm one of eight care coordinators within the law firm, so these law firms that are listed on that site have that both care approach as well as the legal and financial support. There are wonderful traditional estate planning attorneys that will help with the documents that we talked about. But as far as that addition of the care coordination aspect, you might be able to find that on the LCP LFA website.

Yeah, and that's not something that I think was prevalent for people maybe even just a decade ago. Mean, how common are we seeing that now where law practices are sort of extending out to have that additional care, like you mentioned? Fabulous.

Yeah, you're seeing it more and more. Will say Jerry Rothkoff, who's the managing attorney, has been we just celebrated our twentieth anniversary here in PA.

I'm sorry, twenty fifth. I might have misspoken there. So then Brian Nadler joined a few years, and he's a managing attorney in Pennsylvania. So it's been an amazing tenure for Jerry and the team to make sure that we are offering our clients the best services in the area, but you're seeing it more and more come up with this idea of a care coordinator joining the firm. So I would say within the last twenty five or so years, there's been a greater practice area.

Okay, and would you be opposed if our viewers just felt really comfortable listening to you and maybe called up in the law offices and had some questions?

Would you be able Absolutely, we want to be a resource to anybody.

This is our toll free number on the line or on the site here, but if they want to reach out to us, even if we might not be able to support your situation, we can maybe help point in another direction. Like we said earlier, we are part of the larger Life Care Planning Law Firm Association, so we have the opportunity to help refer to someone that we might know in the area or just answer some general questions that you might have. So please don't hesitate to reach out if we can be of support. We offer a lot of events, similar webinars and different continuing education, some online. So if there's an interesting topic area, again, it might be different laws, but depending on where you are, but just for the information, the knowledge base, we welcome anyone to join.

Awesome. Well, I don't want to cheat anybody the last five minutes here. You have any questions, Kathleen, it's a great time to get it in, before we hit the top of the hour and we let her go to continue her, wonderful work. And as we're waiting potentially for any, additional questions to come through, is there anything else you'd like to share with our audience before we let you go here today?

I just really appreciate, Barbara, welcoming us and inviting us. It's such an important topic, important conversations to come across. As I mentioned to Melissa early on, just looking through the different guest speakers and guest hosts that you've had, it's such a great, great source of information to get trusted information from trusted professionals. So kudos to the Arbor team for continuing to do this and for inviting us to be a part of it too.

Yeah, and the professionals just like yourself. So, Kathleen, we thank you so much again today for what we knew would be a very robust presentation that you were able to bring us a lot of wonderful knowledge in a very short period of time.

That's a professional right there that is not easy to do, but you did it in a way that we could all understand. And for that, I think we're all we should have covered a lot today, and I know that this will help all of our viewers that are watching here today and those who will watch at a later date on demand.

Thank you so much for being with us.

You so much. Have a great day, everybody.

Yeah. And that speaking of on demand webinars, all of our senior living video content is available on our website. It is w w w dot senior living live dot com. You can watch it just like Kathleen did.

All of our videos are free. They are available, of course, at your convenience. Thank you so much everybody for being a part of Senior Living Live. Have a great day.

Take care.