What is the Difference Between a Simple Will and a Pour-Over Will?

What is the Difference Between a Simple Will and a Pour-Over Will?

How do you know which type of will is best for your needs? While most people likely assume a simple will or last will and testament will cover their wishes, it can provide great peace of mind to have this legal process secured before an emergency develops. Learn the difference between simple wills and pour-over wills by seeking legal advice.

Simple Wills

One of the most important estate planning documents is a simple will. For those who die intestate, i.e., without leaving a will, the cost to the estate can be significant. State law determines who will inherit the property of a person who dies intestate. (Family members are often required to cover the costs of funeral expenses and probate process.) Additionally, the state’s legal requirements may distribute assets in a way that the decedent never would have intended. All too often, disputes over property can cause family feuds.

A simple will or last will and testament can avoid some of these issues. A simple will is a legal document that states who you want to inherit your assets and belongings after you pass away.

Pour-Over Wills

Some people in Florida who have created an estate plan that is primarily based on a living trust might also want to make a pour-over will. The advantage of a pour-over will is that it can ensure that any assets not placed in the trust or passing through other means, such as a beneficiary designation, will become part of the trust when the person dies.

A pour-over will is intended to act as a safeguard. It is better to review an estate plan annually or when there are major changes to the family, care decisions, tax laws, or assets. A wise place to keep any type of will when it is not being used or reviewed is in a safe deposit box.

If a person does not have a pour-over will or a will that designates what will happen to assets not placed in the trust, those assets may be distributed according to state law. The result could be family members receiving assets they were not intended to have or being denied assets you wanted them to receive.

People who do not have a trust as part of an estate plan might want to discuss the advantages with an estate planning attorney. A trust may be useful to control how assets are distributed to a beneficiary who may be irresponsible with an inheritance, to a relative with special needs, or to a minor child, etc. A person can specify when distributions are made or set up the trust so that the trustee manages when distributions happen. There are several other complex ways to set up trusts to reduce estate tax or provide charitable contributions. In some cases, an irrevocable trust may be used to protect assets such as personal property, a life insurance policy, social security, etc. against creditors or debt collectors.

Learn more about Wills and Trusts at an Estate Planning Workshop. Please contact the Law Offices of Amy B Van Fossen for legal advice related to wills, estate planning, and more. 

 

Editor’s Note: This content was originally published in June 2021 and has been updated for freshness and accuracy. 

 

Private Duty Home Care

Private Duty Home Care

No one said the “Golden Years” would be easy but thank goodness Brevard County has a wealth of senior resources to get us through! One valuable resource to seniors in our area is the availability of home health services and we have quite a selection to choose from. As discussed in the previous article, check out FloridaHealthFinder.gov for a complete list of licensed agencies and take time to review the information provided.

This article will focus on two types of home health providers – Skilled Home Health and Private Duty Home Care – and the differences between each that might make one a better fit than the other. Though, you can have both at the same time! We’ll get there…

Let’s start with a common scenario.

Seniors would rather age in their own homes than move to a senior living community. When seniors exercise that choice, with it comes certain compromises in health, nutrition, medication awareness, and safety. The perfect storm of these compromises can result in what will be referred to as a “qualifying event.” More specifically, a fall resulting in an injury that requires hospitalization and possibly surgery and a short-term skilled rehab stay.

Skilled Home Health Care

After a short-term rehab stay, whether the senior individual returns home or relocates to a senior living environment that offers more oversight, there is often a doctor’s order for Skilled Home Health Care. The skilled home health care may be providing nursing care for a post-surgical wound and, most likely, continued therapies that were received while in skilled rehab – physical, occupational, and speech therapies. These services will be provided through a Home Health Agency that provides licensed providers in each of these areas and progress according to a written plan of care will be reviewed periodically with the doctor.

These services will be limited to the duration as approved by Medicare or insurance, whoever is paying the bill. If additional therapy services are desired after a Medicare or insurance benefit has been exhausted, the senior individual can contract to receive services on a private pay (out-of-pocket) basis with a provider who is licensed to provide these services on a private pay basis.

If additional therapy services are wanted, ask your Skilled Home Health Care Provider for a referral for Medicare Part B services, if appropriate. Sometimes you can even keep the same therapist while using the benefits of your Part B Medicare coverage. This will keep you from paying privately for therapy and may satisfy the time you needed to fully recover.

In most cases, the senior can successfully complete therapies and no longer need nursing care for a post-surgical wound but still need a little… something. If they have returned home, this is almost guaranteed, and even if they have returned to a senior living environment with more oversight, additional assistance while recovering from a qualifying event like a fall is a good idea.

Private Duty Home Care

Private Duty Home Care through licensed agencies or registries provides certified nursing assistants or home health aides to assist clients wherever they reside with activities of daily living (ADLs) such as bathing, dressing, grooming, medication reminders, and toileting. A private duty licensed nurse (LPN or RN) can also fill a pill box for a senior living at home. Companions/Homemakers can do light housekeeping, meal preparation, and transportation but may not provide hands-on assistance with ADLs according to the limits of their agency license. This extra assistance can often make a huge difference in the day of a senior individual recovering from a fall.

Who Pays for Private Duty Home Care?

Private Duty Home Care is a private pay situation. If you have a long-term care insurance policy, you may want to check the requirements of coverage to file a claim. If applicable, VA Aid & Attendance provides limited reimbursement for Private Duty Home Care – see a local elder law attorney that specializes in VA benefits for full details.

Without the benefit of long-term care insurance or VA Aid & Attendance, Private Duty Home Care can be expensive, so it is important to evaluate what your needs are and make inquiries to a couple of agencies. If you only need assistance with housekeeping and meal preparation, a Companion/Homemaker would be appropriate, and they may be less expensive than a certified nursing assistant or home health aide providing hands-on assistance. Minimum hours of service will apply for most agencies, so be aware of what each agency’s minimum requirements are when calculating the cost on an ongoing basis.

The “Golden Years” can be rough, but most situations can be worked out with the forethought of a plan.  Take time to consult with an elder law attorney and create a financial plan to prepare for out-of-pocket costs that arise as you age. When you have a plan, you take pressure off yourself and your family. Knowledge is power! Take the time to explore options before you encounter a crisis.

Have questions on Home Health or creating a financial plan for a senior? Call the Law Office of Amy B. Van Fossen, P.A. We are here to help!

Home Health Care Services

Home Health Care Services

Home Health Services in the State of Florida are performed in many different ways. Home health services can be delivered by licensed and registered providers as well as independent health care providers. These providers include:

Home Health Providers in Florida

  • Home Health Agencies
  • Nurse Registries
  • Hospices
  • Home Medical Equipment Providers
  • Homemaker/Companion Services
  • Independent Health Care Professionals

These providers provide services according to how they are licensed by the State of Florida. Each provider must practice within the scope of their license and provide only those services they have been licensed to provide. These services include:

Home Health Services in Florida

  • Nursing Care
  • Physical, occupational, respiratory, or speech therapy
  • Home health aide
  • Medical social services
  • Nutritional counseling
  • Medical equipment and supplies
  • Homemaker/companion services

Home health services are provided in the home by companies who provide employees or independent contractors as well as independent healthcare professionals. You can find a complete list of companies on FloridaHealthFinder.gov. If you choose to employ an independent health care professional, be sure to determine who will be responsible for paying employment taxes, income withholding, and unemployment taxes. (It is either them or you.)

Who Provides the Services?

Home health agencies and nurse registries provide nurses, certified nursing assistants, home health aides, or homemakers/companions to offer services to the patients where they reside. Depending upon the need, these providers can offer nursing care; physical, speech, occupational, respiratory, and IV therapy; assistance with activities of daily living (bathing, grooming, dressing, toileting) or companion/homemaking services such as light housekeeping, meal preparation, and transportation. Additionally, other providers offer home medical equipment; nutritional guidance; and medical social services.

Who Pays for These Services?

Most services are available to individuals no matter where they reside if they wish to pay the provider out-of-pocket. This is often called Private Duty Home Care. If you have a long-term care insurance policy, often these services are covered though you will want to review your policy for any restrictions. Otherwise, a doctor’s order is required to obtain services that will be paid for by insurance, Medicare, or Medicaid. Although, there are specific services that are not considered “medically necessary” and therefore not covered by Medicare.

What is Not Covered by Medicare?

  • Help with Activities of Daily Living (unless skilled services are also ordered)
  • 24-hour care at home
  • Meals delivered to your home
  • Homemaker/companion services

What is the Difference Between Skilled and Non-Skilled Services?

Skilled services are provided by a licensed individual such as a nurse, or physical, speech, occupational, or respiratory therapist. A patient’s doctor must sign a doctor’s order for skilled services and a plan of care will be developed. The patient has the right to be included in their own plan of care and their doctor will review the plan periodically to discuss progress with the home health provider.

Non-skilled services are provided by unlicensed individuals and include tasks like help with bathing, grooming, dressing, medication reminders, and toileting. Companions/Homemakers provide unskilled services such as light housekeeping, meal preparation, and transportation. These services do not require a doctor’s order or a plan of care. Often these tasks are completed by certified nursing assistants and home health aides with training appropriate to the tasks they are permitted to perform.

Do you need skilled or unskilled services and how do you find them?

Great question! We are going to take a closer look at skilled home health and private duty home care in the next article!

All facts from this article are based on information from the AHCA Consumer Guide Home Health Care in Florida.

What Expenses Should I Expect When Hiring a Probate Lawyer?

What Expenses Should I Expect When Hiring a Probate Lawyer?

When dealing with end-of-life legal issues you may hear the word, “probate.” In this post, we will define probate, share examples of the probate process, and provide contact information to hire a probate attorney in Florida. In addition, we will address the question, “What expenses should I expect when hiring a probate lawyer?” This is an important question and this information can help you and your family get through a difficult time more smoothly.

What is Probate?

The court-supervised probate process is followed in nearly all cases for a deceased person in Florida. In a typical probate proceeding, a personal representative (sometimes referred to as an executor or executrix) gathers assets, pays debts, and distributes assets and property to beneficiaries. This can take months to years, especially for complex estates.

End-of-life legal issues can be complicated so a knowledgeable probate attorney is a valuable asset. They are experts at preparing and filing court documents, inventorying personal property, estate assets, and debts, distributing assets according to your wishes, and navigating complicated issues around a deceased person’s estate.

Common Florida Probate Expenses

Now that we’ve highlighted the importance of having a qualified probate attorney, you may be wondering about the costs of probate. Probate fees can vary, but there are some expenses you can expect:

  • Fees to pay your attorney (further explanation below)
  • Filing fees for the court and paperwork
  • Accounting, land survey, and appraisal fees
  • Reasonable compensation for executors or trustees
  • Executor/probate bonds required by some Florida county courts

These are the types of probate costs that need to be paid for the probate proceeding to move forward. Your probate attorney will help you understand which probate costs you are responsible for, as well as gather and distribute them on your behalf. People with attorneys have an advantage when dealing with these common fees and processes.

How Much Will My Attorney Cost in Florida?

Florida’s status as a “reasonable compensation state” may make your attorney fees the top expense in the probate process. Rather than an hourly rate, the state has a statutory fee schedule based on the value of an estate that is commonly used. However, this is not required and fees can be determined in different ways in your representation agreement.  When using the statutory fee schedule, if an estate is valued at $200,000, the attorney fees will be higher than if the estate is valued at $90,000, and lower than if the estate is valued at $1.5 million. These costs highlight the importance of consulting with an attorney about estate planning to protect your assets as much as possible.

Remember, probate is an important and necessary court process for many estates. It is important to have legal counsel that is an expert in the law and has the compassion needed for these delicate moments. Our attorneys are ready to help you navigate this process along with many other legal services, and we also have a blog where you may find answers to other important questions. Please don’t hesitate to give us at the Law Office of Amy B. Van Fossen a call today for all your probate estate needs!

Everything You Need to Know About Skilled Nursing Facilities in Florida

Everything You Need to Know About Skilled Nursing Facilities in Florida

Skilled Nursing Facilities (SNFs) are establishments that have historically been referred to as “nursing homes” and have provided healthcare and housing for the critically and chronically ill by offering 24 hour oversight and services beyond assistance with activities of daily living. Through the years, the term “nursing home” has developed a negative connotation despite being a necessary provider in the continuum of care for the elderly. The evolution of congregate care has deep roots in nursing homes, the original reimagining of the long-ago asylums and sanitoriums, on its way to the less restrictive care we learned about previously in Assisted Living Facilities.

The Agency for Health Care Administration in the State of Florida defines nursing homes as those establishments that “provide 24-hour a day nursing care, case management, health monitoring, personal care, nutritional meals and special diets, physical, occupational, and speech therapy, social activities and respite care for those who are ill and physically infirm.” These care needs are above and beyond those that can be managed in an assisted living facility and require the watchful presence of licensed and certified staff on a 24-hour basis. 

Ask any aging individual and they will adamantly tell you that they absolutely do not want to go to a nursing home. And not everybody will go to a nursing home. Employing the services of an elder care attorney in Florida is key to formulating a plan that provides for your care and wishes as you age. A family and estate lawyer that is knowledgeable in helping with a financial roadmap may keep you from residing in a nursing home but being proactive is essential. 

Why Would I Need to go to a Nursing Home?

There are a couple of reasons why you would need to go to a nursing home. Specifically, you have had a health event that requires extra medical attention and oversight. There are many kinds of events that may require additional care in a nursing home, including:

  • A cardiac event that resulted in a lengthy hospital stay and your physician wants you to go to a less restrictive facility (nursing home, skilled nursing facility, rehabilitation center) for further treatment and evaluation before returning home.
  • A fall resulting in an injury requiring a hospital stay and your physician wants you to participate in additional therapy programs (physical, occupational, speech) before returning home.
  • Medication management issues that require closer monitoring and stabilization over a short period of time

These short-term stays are typically paid for by Medicare and/or secondary insurance. They are not intended to be a long-term solution and require the patient to demonstrate improvement and positive progress in their therapeutic care plan. In these situations, it is imperative that you stay positive, participate in your plan of care, and plan ahead to be part of the decision-making process when the time comes.

Helpful Resources 

What is the best nursing home in my area? Which facility specializes in the kind of treatment I need? What facility has good ratings, outcomes, and state surveys? The answers to these questions may bring peace of mind to you and your family should you find yourself in need of a short-term nursing home stay. Knowledge is power! Do your research and be ready!

Skilled Nursing Facilities – Statewide Medicaid Managed Care Long-term Care Program

Aging is an expensive adventure. If you envision your “golden years” spent indulging in grandchildren and travel, the time to make a financial plan is now. Probably before now, but better late than never! Conservative estimates from the investment group of Bank of America suggest that individuals who plan to retire at 65 should plan to have at least $1M in savings upon retirement. Healthcare spending rises as individuals age with nearly half of those costs occurring after age 65 (FraserInstitute.org).

Poor or non-existent planning results in few options in later years. The idea that if one runs out of money, the State will foot the bill is not a solid plan. In Florida, funding of the Medicaid Program is tenuous at best each year, with the amount of contribution fluctuating each year and dedicated to programs serving residents of the state of Florida from 18 years of age to 100+.

The Statewide Medicaid Managed Care Long-term Care Program does not guarantee eligibility or funding for all who apply. The Agency for Health Care Administration (AHCA) administers the program, sets coverage policy, and assists in getting those eligible for services enrolled in a LTC plan. The Department of Children and Families (DCF) is responsible for determining financial eligibility for services. The Department of Elder Affairs is responsible for determining medical eligibility and level of care needed.

Three Steps to Application

  • Screening
  • Eligibility
  • Enrollment

Prior to the screening process, it must be determined if the individual meets the requirements for eligibility to apply to receive Long-term Care program services. This includes those who are:

  • Age 65 and over and eligible for Medicaid, or
  • Age 18 and over and eligible for Medicaid due to a disability; and
  • Determined by the CARES Program at the Department of Elder Affairs (DOEA) to be at a nursing home level of care or hospital level of care with cystic fibrosis.

The DOEA decides if an individual is medically eligible while the Department of Children and Families (DCF) determines financial eligibility for Medicaid. Once determined eligible, the individual can be screened.

Screening is completed by a local Aging and Disability Resource Center (ADRC) and consists of an initial phone call that results in a score used for placement on the waitlist to receive long-term care services. Individuals with a low score will not be placed on the waitlist and will be provided with information on community resources for assistance. Individuals with a high score will be notified that they have been placed on the waitlist.

  • Screening Exceptions:
  • An individual aged 18,19, or 20 who has a chronic debilitating disease that makes the individual dependent on 24-hour medical supervision or intervention
  • A nursing facility resident who requests a transition into the community and who has resided in a Florida-licensed skilled nursing facility for at least 60 consecutive days
  • An individual referred for temporary placement in an assisted living facility by DCF and is being funded by DCF
  • An adult with cystic fibrosis

Eligibility is determined by DCF and DOEA while the individual is on the waitlist. Release from the waitlist is not determined by how long an individual has been on the list, but rather by the score assigned and frailty-level ranking. When enrollment becomes available, the ADRC will contact the individual on the waitlist and begin the enrollment process. 

The Comprehensive Assessment and Review for Long-Term Care Services (CARES) Program will assess each person who requests funding from Medicaid. The assessment will determine which level of care will best meet the individual’s needs and is usually done in the person’s home setting.

Enrollment in a Statewide Medicaid Managed Care program begins when a welcome letter and information about how to select a plan is received. The plans available in each region or county are available on the Statewide Medicaid Managed Care website. Once a program is chosen, enrollees have 120 days to change plans or wait to change plans during their once-a-year enrollment period with a State-approved good cause reason.

The process of applying for Medicaid can be overwhelming. The Statewide Medicaid Managed Care Long-term Care Program website is a great resource but there is no need to go through the process alone. Arm yourself with experienced professionals who can help you with a financial plan and walk you through the steps from screening to enrollment. An elder law attorney is invaluable in executing a plan that is tailored to your goals and finances. The time to make that plan is today!

Skilled Nursing Facilities – Who Foots the Bill?

Affordable housing for all people continues to be an issue, and seniors, in particular, are hit hard in their years of decline. When it comes to the affordability of healthcare and living options for seniors, one thing we know for sure is that it pays to plan ahead. Failing to plan can be costly – emotionally, financially, and physically. What ARE the options for paying for a skilled nursing facility?

As discussed in the previous blog, skilled nursing facilities (nursing homes) are often short-term solutions to a medical incident that caused an individual to require more care on a temporary basis. In those situations, the stay is paid for by Medicare and secondary insurance plans. For those who have exhausted all options in finding living arrangements that are less restrictive than a nursing home (assisted living, private home care, living with family), a nursing home stay on a long-term basis is a very expensive living option. Yet another reason that a consultation with an elder law attorney (estate planning attorney) is time well spent and can help with financial planning, including Medicaid and/or Veteran’s benefits, if appropriate.

Options to Pay for Long-term Nursing Home Care

  • Private Pay
  • Long term Care Insurance
  • Medicaid

Paying for long-term care in a nursing home is not impossible, but it is expensive. Current monthly rates for shared rooms in local nursing homes can range from $250 – $425 per day (estimated through quick research). The pricing per facility vacillates depending upon services needed once the person arrives and throughout the stay. Basic room and board are just the starting point with care levels, therapies, and other billable services added on.

Long-term care insurance often covers nursing home care at a pre-determined daily rate as outlined in the specific policy. Depending on the policy, the daily rate can be paid indefinitely or for the period of time that was defined at the time of purchase. Long-term care policies are priced according to the length of time and per day benefit you chose. Typically, the higher the benefit, the more expensive the policy. If you have a parent going into skilled nursing (a nursing home), be sure to ask if a policy was purchased at some point in the past.  These are often forgotten even though premiums have been paid for a very long time!

The last option to help pay for a long-term nursing home stay is the benefit that is commonly referred to as Medicaid. In Florida, that program is the Statewide Medicaid Managed Care Long Term Care Program. (There is a great deal to be said about this program, so that will be the topic of a separate feature you will find posted on this site in the near future!) Medicaid Managed Care is a complex system that offers services to Florida’s most vulnerable citizens through the cooperation of several state agencies. The multi-agency effort includes the Agency for Health Care Administration (AHCA), the Department of Children and Families, and the Department of Elder Affairs.

For any senior that finds themselves in need of a stay in a nursing home – either short or long-term – the anxiety of what to expect regarding costs can be overwhelming. Be sure to make long-term care planning a part of your overall family plan and include research on how to pay for the services you expect while in their care. Knowledge is power! Consultation with an elder law attorney and the creation of a financial plan can go a long way in providing peace of mind when a crisis occurs.

For more information, call our team at 321-345-5945!

Everything You Need to Know About Assisted Living in Florida

Everything You Need to Know About Assisted Living in Florida

Senior Living vs. Assisted Living Facilities: Which Option is Best?

Long before the emergence of nursing homes and assisted living facilities, families have been taking care of loved ones regardless of cost, convenience, or care needs. In the so-called simpler times, seniors moved in with adult children and grandchildren gave up time, attention, and personal space to dote on their elders during the final years of life. As time marched on, families began to move to various locations to raise their families and make a living, separating seniors from their adult children and grandchildren. This changed the delivery of senior care with impacts still evolving today.

History of Senior Living

Before assisted living facilities came to be, senior living options were limited to homes with adult children, nursing homes, or congregate care facilities. Almost four decades ago, assisted living facilities began offering a homelike alternative to the nursing home environment. The nursing home environment had grown out of the sanitariums and asylums of days gone by, improving the care practices and physical environment while remaining a congregate-care facility for the chronically and critically ill. Developers of the assisted living movement recognized that many of the residents of nursing homes could benefit from a less restrictive, homelike, and person-centered environment. They also recognized that by creating these assisted care facilities, they could reduce the average cost of care dramatically per person.  

What is Assisted Living?

The state regulatory agency, the Agency for Health Care Administration (AHCA), defines assisted living in Florida as:

“An assisted living facility (ALF) is designed to provide personal care services in the least restrictive and most home-like environment. These facilities can range in size from one resident to several hundred and may offer a wide variety of personal and nursing services designed specifically to meet an individual’s personal needs.”

Benefits of Assisted Living Facilities

  • Less restrictive
  • Homelike
  • Person-centered environment 

As assisted living facilities evolved, so did the needs of the seniors in need of care. With families spread across the country and less involved – or less of an influence – in their loved ones’ lives, seniors waited longer and longer to seek residency at these facilities. The seniors for whom these facilities were built proved to be their toughest sale, often waiting for a crisis to make a move.   

Assisted living facilities vary greatly in the services they provide, requirements of staffing, as well as admission and retention requirements. Because of these variations, it is often challenging for seniors and their families to determine what will meet their needs. And, as many want this to be their last move, which facility will meet their needs for the longest period.

Florida Assisted Living Facilities

In Florida, assisted living has been a high volume, highly evolutionary business. As of April 2022, there are 3,096 assisted living facilities (112,583 private beds) across the state. There is year-over-year growth in the number of facilities in line with the increasing number of seniors moving to the state – in 2018, Florida’s 65-and-over population was 21% of the total population, while the national average was 16%. (2019 Profile of Older Americans, Administration on Aging, U.S. Dept of HHS). The growth trajectory in the 65 and older category for Florida continues at a stunning rate through 2050.   

Assisted Living Facilities continue to be a wonderful option for some seniors. Care needs, average cost, and a strong aversion to getting rid of their “stuff” remain obstacles for families who are looking for the best option to take care of their aging loved ones. Understanding Assisted Living – and what it can and cannot do – is a logical place to begin a deeper exploration of senior living options in Florida.

  • Every facility has a standard license
  • Facilities can add a “specialty” license
  • Small or large, all licensed assisted living facilities have the same rules and laws

 Facilities are licensed to provide routine personal care services under a “Standard” license, or more specific services under the authority of “Specialty” licenses. ALFs meeting the requirements for a Standard license may also qualify for specialty licenses. The purpose of “Specialty Licenses” is to allow individuals to “age in place” in familiar surroundings that can adequately and safely meet their continuing healthcare needs.

All facilities in Florida are regulated by the same rules and laws, regardless of size. A small, residential home can serve as an assisted living facility and is beholden to the same rules and laws as the largest, resort-style facility.  Each facility is licensed as a Standard facility and can add a specialty license to offer additional services.

 

 Specialty Licenses in Florida 

The State of Florida allows for three specialty license types, each of these licenses permitting certain and specific services to their residents:

  1. Limited Nursing Services
  2. Extended Congregate Care
  3. Limited Mental Health 

A Standard License is the most basic license type that allows for assistance with personal services which can include activities of daily living, supervision of self-administration of medication, and other similar services as defined by the rule.  All facilities are licensed as a Standard facility and can choose to add the specialty licenses.

A Limited Nursing Services license allows acts that may be performed by a licensed nurse. Limited nursing services shall be for persons who meet the admission criteria established for assisted living facilities and shall not be complex enough to require 24-hour nursing supervision and may include such services as the application and care of routine dressings, and care of casts, braces, and splints.

An Extended Congregate Care license allows acts beyond personal services that may be performed by persons licensed while carrying out their professional duties and other supportive services which may be specified by rule. The purpose of such services is to enable residents to age in place in a residential environment despite mental or physical limitations that might otherwise disqualify them from residency in a facility.

A Limited Mental Health license allows for the care and concern of those determined by the State to be mental health residents. Care includes assistance with personal services as well as additional services specific to those requiring mental health programs. 

Each license allows the assisted living provider to provide services within the scope of its license offering some exceptions to those residents who consent to and are admitted to the services of a licensed hospice. These services include providing total care to bedbound residents who previously were required to leave their assisted living homes as their hospice status exceeded the scope of the facility license. 

Each assisted living facility is required to have policies and procedures to address the care services provided in their facility. Starting with the Residency Agreement, an assisted living facility puts forth in writing the services it intends to provide – which are not necessarily all of those permitted by its license. Assisted Living providers have the option of providing services allowed within the scope of their license and it is important that seniors and their families know what will be provided as the senior continues to age in place.

 

Paying for Senior Living

Assisted living is primarily private pay, out-of-pocket expense. In some cases, seniors qualify for other resources such as Veterans Aid and Attendance. In Florida, we have Medicaid/Managed Care which pays a relatively small amount towards assisted living fees and the application for such should be handled carefully and in a timely manner. 

Additionally, seniors may have signed up for long-term care insurance at some point in the past. It cannot be stressed enough – conversations regarding care and financial plans should be taking place well in advance of the actual need.  

Consult with Elder Law for Financial Plan

Consulting with an elder law attorney (certified in Veterans’ assistance, if possible, and if applicable) to establish a full financial plan is best. While some are put off by the initial cost of planning, the money you will save and, if eligible for benefits, receive, will be well worth the time and investment you make.  

What Help is Available to Navigate Facility Choices?

While it is important for seniors and their families to be familiar with some of the specifics and details, they need not be too concerned. In each community, there is typically a local agency that helps seniors and their families evaluate each facility and make recommendations about which may be the best choice. (There are national companies as well however they are not as familiar with the local assisted living market and only offer a written list of facilities to overwhelmed families who are still left to determine how to work through the list provided.) 

Local agencies are a wealth of knowledge and often provide services at no cost to the family. Facilities will contract with these local agencies, also called “placement agencies” or “referral and information agencies,” and pay them a fee for a referral that results in an admission to their facility.

One of the best attributes of a local agency is that they are very familiar with the specifics of each local facility, including licensing, and the reputation of the facility.  While there are State Inspection reports available for each facility (such as www.floridahealthfinder.gov), those often need interpreting as well. 

These local agencies are also familiar with the licensing of each facility as well as how the facility chooses to use that license. Meaning – just because they have the license, doesn’t mean they utilize all aspects of what it allows them to do. And, to be fair, they don’t have to.

Asking for Help Could Save Money

Another helpful attribute of a local agency is that they do regular business with each of these facilities. They have a relationship and a rapport with the sales staff and often the administrator and feel comfortable asking for specials or reduced pricing that you may not know to ask for, or feel comfortable asking. Perhaps it is a special that just ended at the end of the previous month or an ask to reduce the community fee (a standard fee, like a security deposit, but non-refundable). Because the agency brings them regular business, a facility is often open to a reduction in fees based on the knowledge that additional business is coming their way. Why shouldn’t the individual consumer get the benefit of volume business?

And finally, many in the senior healthcare world speak a different language. Words and phrases that may be very common to them may leave you completely lost in a conversation. Your interpretation of what was said may be different than what was meant. A local agency can serve as your interpreter and guide through this world that most only venture into once or twice in a lifetime.

Moving to assisted living is a significant transition. Advance planning and accepting guidance from knowledgeable resources are critical to avoiding costly mistakes.

When is the Time Right for Assisted Living?

A move to senior living requires accepting that a smaller space is okay. As Dr. Dennis McCullough encourages in his phenomenal book, “My Mother, Your Mother,” take a look around the space your loved one lives in now. What rooms are they actually using? Rooms used for storing “stuff” do not count!) You most likely will find that they are already limiting their space to just a room or two. 

Many seniors have lived in their current homes for decades. Some are still in the homes where they raised their children, enjoyed visits from grandchildren, and shared a lot of experiences, both bitter and sweet. These homes are filled with furniture, art, souvenirs from trips taken, and a lifetime of precious memories, the value of which can only be regarded as priceless. When it comes time to move into an assisted living facility, these possessions often become a seemingly insurmountable challenge to accomplish the move.  Assisted living apartments are designed with efficiency in mind – efficiency of steps from the bed to the bathroom, for example.  

 Downsizing for Senior Living Communities

Adult children are finding less value in family “heirlooms” and have fully furnished homes of their own. Grandchildren are increasingly embracing minimalism and find family antiques to be less of a help and more of a hindrance to their lifestyle. The final disposition of their possessions can be a great stressor for the senior who is facing a life-changing move.  

A plan for “stuff” can be just as important as a financial plan. The available family must participate in a conversation regarding the dividing of property if the property is to be divided. All the options must be discussed with the senior and the most pragmatic of solutions must be presented and agreed upon for there to be closure with these memories.  

Even those who spend time planning for the day they will move from their home still find that Moving Day seems to sneak up very quickly. Moving to an assisted living facility is a huge transition for a senior who already may not feel well. It is a massive change in mindset as well as space. Taking the time to plan and allow big decisions like this to be processed can make all the difference in the transition to a new home and quality of life. 

What about Fido or Fluffy?

A beloved pet can also prove to be an obstacle when it comes time to move. 

Many assisted living facilities are pet friendly if the senior can still care for their pet. As facilities become more consumer savvy, some offer pet care services for a monthly fee, understanding that this is an invaluable service for those who will not leave Fido or Fluffy behind. It is important to include the senior’s pet in the planning process. Knowing that their faithful companion can join them in the move can help a transition go much more smoothly. 

Expectations and Resources

 This momentous step in the life of a senior, planned or unplanned, must be handled with a delicate firmness – an understanding like few other events in life where role reversal of adult child to decision-maker requires humility and a great deal of empathy.  

Remove Roadblocks by Planning with an Elder Law Attorney

Sometimes, possessions or a pet can be purposeful roadblocks to a senior moving to assisted living, even when they acknowledge it is a must-needed move. A desire to stay in their own home can override their recognition that they are no longer eating well, or able to manage their care. If there is family involved, it is important to stay patient and work through their concerns. 

If the senior parent has early-stage Alzheimer’s or other forms of dementia, this can be a difficult time for the family. This is where the plan a family has put in place comes in – whoever has been chosen to make decisions must step up and make those decisions based on the senior’s wishes contained within the plan. 

Expanding the Circle of Care

When a loved one moves into an assisted living facility, their village grows – the circle of concern expands – additional caregivers are introduced into the daily routine. This can be a confusing collaboration for some – the spouse may feel they have lost their primary role as caretaker, and the adult child may no longer feel as though they contribute to the day of the senior. This reorganization of responsibility can be challenging; however, it is important that each family member still see themselves with an important role in their senior loved one’s life.  

The essential role each family member has now is to encourage the senior to participate in community activities, work together with facility staff and administration, and, as positively as possible, embrace the new lifestyle they have entered.  

Secrets to Success

– Stay positive and encourage participation

– Communicate concerns and compliments to facility staff

– Stay involved, visit often, embrace the new lifestyle

While all assisted living facilities offer the same basic services – nutritional meals, housekeeping, assistance with activities of daily living – they do so in wildly varying environments. From residential homes with 5 residents to large, resort-style buildings with hundreds of apartments, there are plenty of options out there to explore. This is not a One-Size-Fits-All situation so plan ahead and take time to explore. There may be no place like home, but with the amenities offered at local assisted living facilities – you might find that your new lifestyle makes that loss more tolerable. 

It cannot be stressed enough – reach out for guidance and utilize resources. Brevard County, Florida offers a wealth of services specific to seniors and boasts a healthcare community arguably second to none. While your situation is new and unique to you, many professionals have been down that path – or a similar one – before and can offer suggestions regarding services that are available. 

We walk down the road of taking care of an aging loved one only a precious few times in life – don’t choose to go it alone. 

 

About the Author:

Kara Anderson, BSW, is a seasoned professional in the assisted living industry. A social worker by degree, Kara has spent over twenty-five years helping seniors and their families in a variety of senior services roles – including management, administration, and development of numerous assisted living facilities both in Florida and Georgia. An educator and advocate at heart, Kara currently owns an assisted living information and referral company and serves as a Florida State certified trainer for assisted living administrators.