losr Long Term Care


n passing health care reform, Congress included provisions that are beneficial to seniors. Among those are the following:

  1. A phase out of the Medicare Part D “donut hole” or “coverage gap” by 2020
  2. The elimination of Part D cost-sharing for full-benefit dual eligible beneficiaries (those eligible for both Medicare and Medi-Cal/Medicaid) receiving home-based and community-based services
  3. Increased federal funding for states that provide home-based and community-based services for seniors with Alzheimers rather than only providing care through nursing homes
  4. Beginning next year, Medicare coverage without cost for preventive care services, such as colorectal screenings, mammograms and an annual wellness visit and creation of a personalized prevention and assessment plan
  5. An estimated 9-year extension of the Medicare Trust Fund beyond the previously-estimated 2017 depletion

Seniors are living longer and healthier, in large part due to prescription medications which sometimes consume a significant portion of the average senior’s budget. Medicare Part D is a prescription drug program, which pays part of the costs of a person’s prescription drugs for a monthly premium, at least until the person reaches the “donut hole”. In the 2010 Medicare Part D plans, the “donut hole” starts when the retail cost of the medications (not what the senior pays) reaches $2,830 and continues until the retail cost of the medication reaches $6,440, which is when the Medicare Part D beneficiary has spent $4,550 in out of pocket costs for their medications. The $4,550 does not include the portion of their prescription expenses paid by the insurance carrier or their monthly premiums. The existence of the “donut hole” creates quite a financial burden for many seniors. Beneficiaries reaching the “donut hole” in 2010 will receive a one-time $250 rebate. Over the next decade the “donut hole” will be phased out until it is eliminated in 2020.

Some of the additional benefits for seniors are an increase in primary care doctors, nurses, and physician assistants to provide better access to care through expanded training opportunities, student loan forgiveness, and bonus payments; increased support for community health centers; community health teams to coordinate patient care; and programs directed to reducing re-admissions to the hospital when patients are discharged.

A version of this article originally appeared in the Bulletin of the Alameda County Bar Association.

“The National Academy of Elder Law Attorneys, Inc. (NAELA) newsletter recently profiled a useful guide on when to apply for Social Security benefits, saying:

The Center for Retirement Research at Boston College has made available a handy guide that addresses the question, “At what age should you begin claiming Social Security benefits?” If you’re approaching retirement, it’s the most important financial decision you’ll likely make. The Social Security Claiming Guide sorts through all the options near-retirees need to consider. Presented in an easy-to-read, colorful format, the Claiming Guide shows you where to begin, spells out how much you can get, and answers frequently asked questions about how the claiming process works. A must read for your clients nearing the age of 62!”

Phone: (617) 552-9143
Link: Social Security Claiming Guide
Updated: 21 Apr 2010


are management agency Eldercare Services is presenting a workshop entitled Families Dealing with Dementia, which will cover:

  • Overview of the Dementias
  • Communication Strategies
  • Perspective through Award Winning Film & Personal Journeys

The workshop is scheduled on July 22, 2010 from 10AM until Noon (RSVP by July 19) and on August 18, 2010 from 6PM until 8PM (RSVP by August 16). It will be presented at the Eldercare Services Classroom, 1808 Tice Valley Blvd., Walnut Creek, CA. There is no charge, but RSVP is requested to (925) 937-2018.

You can see Eldercare Services schedule of workshops and their support group meeting schedule at EldercareAnswers.com.

“Institute on Aging (IOA) is a community-based, not-for-profit organization that touches the lives of thousands of seniors in San Francisco, Marin, and the Peninsula. IOA’s service mission is to enhance the quality of life for our diverse community of adults as they age. Our breadth of services enable elders in the San Francisco Bay Area to maintain their health, well-being, independence, and participation in the community. In our 25+ years of serving the Bay Area, IOA has developed and provided innovative programs in health, social service, creative arts, spiritual support, education, and research.”

Phone: (415) 750-4111
Toll Free: (877) 750-4111

Link: Institute on Aging (IOA)
Updated: 27 May 2010


he Commonwealth Club of San Francisco and Linda Fodrini-Johnson, MA, MFT, CMC of Eldercare Services will be presenting The Great Debate: Should I Move to a Retirement Community or Stay in My Home? on Wednesday June 23, 2010 at 5:15PM in the Gold Room, SF Commonwealth Club Office, 595 Market Street, San Francisco.

Making plans for retirement as the economy has challenged savings and home values is a concern for many. Fodrini-Johnson will discuss the pros and cons of either choice in the dilemma over whether to make the big move. She will explain the options and costs and provide tips on how to make this decision based on individual values.

Tickets are $12 members, $20 non-members, $7 students (with valid ID). For more information please call the Commonwealth Club at (415) 869-5930 or Eldercare Services at (415) 469-8338.


he Elder Financial Protection Network in partnership with Bank of the West and NBC Bay Area has produced a 30-minute documentary entitled Wise Money: Be Wise, Be Aware, Prevent Elder Financial Abuse.

Be Wise, Be Aware, Prevent Elder Financial Abuse

Be Wise, Be Aware, Prevent Elder Financial Abuse

The documentary is a cautionary tale of the ways in which elders can become the victims of the crime of financial abuse. Among the topics covered are: who is perpetrating the crime, how they target victims and who those victims are; sweepstakes scams and exploitive care givers; consumer fraud from shady auto repair shops to contractors; and what you can do to protect yourself.

The program will air on Father’s Day, June 13 at 3:00 PM. It also can be viewed at anytime on YouTube.com by clicking here (presented in three ten minute segments).

Transitions Partners describes their business thusly: “Transition Partners knows how life transitions can be particularly challenging for seniors, their families, and their caregivers. A new transition can mean moving to rejoin family, or moving to a smaller home, a retirement community, or an assisted living community. It can also mean staying in your current home (aging in place).

Transition Partners is uniquely suited to assist you with the complexities of these transitions and the emotional concerns that accompany them. We plan and organize resources to meet your needs, whether you’re relocating or choosing to remain in your current home. We take care of all of the details or some of them, it’s up to you. We have the experience and the resources to make this event a positive one! Find out who we are and how we do it.”

Rodney and his team were very helpful and compassionate. They helped moved furniture and belongings of one of my family members to her room at an Assisted Living facility. They did a beautiful job of setting things up as close as possible to how it looked at her home. They were very understanding of the situation, professional and supportive.

Phone: (510) 461-4792
Link: Rodney Walker, Transitions Partners
Updated: 21 Apr 2010

Exceptional Senior Placement describes their business thusly: “Compassion, respect and dignity are the foundation of my senior placement business. Being raised in a culture where seniors are revered for their wisdom and experience, I felt a great passion for starting a consulting service where I could be instrumental in helping families find the right placement for their loved ones.”

I have had very good experience with Mona Laichandani at Exceptional Senior Placement. She helps clients find appropriate facilities for the family member who needs care and she is quite knowledgeable about the facilities in the area including those who accept Medi-Cal. She accompanies clients to visit the facility and can help negotiate the contract at the facility. In addition, my partner Kathy reports a favorable experience with Courtney Blair, who worked with a client to find a facility that accepted Supplemental Security Income (SSI).

Phone: (510) 910-0344
Link: Exceptional Senior Placement
Updated: 21 Apr 2010

Please bring copies of the following signed original documents that you may have (we may need to retain these for reference while we work on your case and we would prefer that you safeguard the originals):

  • Any and all estate planning documents, such as a Trust (including lists of assets held inside and outside the trust) or Durable power of attorney for finance.
  • List of assets and their approximate value.
  • List of any and all real property owned and how title is held.
  • Monthly income and sources of income.
  • Current cost of care, or the approximate future cost if looking for a facility for placement.

“Adult Protective Services (APS) responds to reports from individuals, concerned citizens, social service and health providers, and law enforcement representatives about adults with developmental disabilities, physically and mentally disabled adults, and the elderly, who may be physically or financially abused, neglected, or exploited.

Anyone aged 18 to 64 who, because of their mental or physical disability, or who is aged 65 or older and is suspected of being abused or neglected, is eligible for APS without regard to income.”

Notify APS immediately if you suspect elder abuse. To obtain more information or to report adult or elder abuse call APS in the San Francisco Bay area of CA at (510) 577-3500 or toll free at (866) 225-5277 (national number), 24 hours a day and all referrals are confidential.

Phone: (510) 577-3500
Link: Adult Protective Services (APS)
Updated: 21 Apr 2010


ncreasingly, we are seeing families who feel forced to delay placing an elder in assisted living or skilled nursing facilities for economic reasons. The elder’s resources may have declined due to the recession, or the family’s overall financial situation may be compromised so that others are unable to contribute to the cost. This may result in increasingly difficult care situations at home, sometimes leading to a decline in health or even injury. For example, if Mom is falling in her home and really needs a supervised setting, a delay in placement may place her at risk for fall injuries. If Dad is repeatedly hospitalized for dehydration because he is not eating properly or consuming enough fluids, some difficult decisions may need to be made. But how is the cost to be met?

Medi-Cal pays for skilled nursing only, and then only when the resource limits are met. Many facilities do not take Medi-Cal at all. Even if the preferred one does participate in the Medi-Cal program, it may expect a period of private pay initially. As for assisted living, private resources must pay. Especially in a dementia situation, this can be quite expensive.

Rather than hope nothing drastic happens, we encourage clients to seek the help of a good placement service or care manager to assist in considering the options. Facilities with empty beds or rooms may be quite willing to negotiate about costs. A needs assessment will start identifying places that may be appropriate, given the resources available and the location preferred. Going with family members to visit those places, and asking questions that the family may not think about, the placement consultant or care manager can make the process much less stressful, and may be able to reduce the monthly cost.

In one recent case, the placement consultant identified three places, visited them with the son and daughter-in-law, negotiated some cost reductions, and helped the transition by suggesting that the new room be set up exactly like the mother’s bedroom at home, down to pictures on the wall and the rug on the floor. The transition went very smoothly, and the family was happy to have a professional member on their team at this critical time. The care is still expensive, but the cost of the consultant was more than justified by the negotiated monthly savings and the stress reduction all around.


n November 12, 2009, television station CBS 5 revealed an alarming string of thefts from elderly customers by a bank employee.

In one incident, an employee ordered duplicate ATM cards when an 86-year-old customer reported his card lost. The employee had friends use the duplicates to withdraw $8,000 from the customer’s account. The customer was unaware of the theft until he was notified that his account was overdrawn, which had never happened to him before.

In another, an employee befriended a customer and was writing checks out for her to sign, some of which were for legitimate bills and others of which were payable to the employee.

Larson said an employee at this Bank of America branch in Lafayette befriended her mother [77-year-old Frances Saimons]. “He was more than very nice. He was charming,” Saimons said.

Saimons said he helped her manage her finances. “Always, he always wrote my checks out,” she said. “He would say sign there, and I would sign it.”

The customer did not realize that $28,000 in checks had been made out to the employee until a bank investigator visited her daughter. The employee claimed that the checks were loans, although the victim denied this and the bank has a policy forbidding such a practice.

Family members are often reluctant to interfere in the personal business of an elder, which is understandable. But polite inquiry about their opinion of the bank, whether they find the bank employees helpful and how, might be acceptable. Sometimes the elder will permit a family member review bank statements. The sooner problems are spotted, the more quickly damage can be limited and, hopefully, remedies sought.

Financial elder abuse can be a crime, and banks are mandatory reporters to Adult Protective Services (APS) when they become aware of such behavior. Notify the bank and APS immediately if you suspect abuse. To obtain more information or to report adult or elder abuse call APS at (510) 577-3500 or toll free at (866) 225-5277, 24 hours a day and all referrals are confidential.


lacing a relative in a nursing home is a stressful experience by itself. Add to that the complexities of the Medi-Cal system, which pays for nursing home care under certain circumstances, and it’s easy to feel overwhelmed. Here are some basic concepts that should be helpful.

Concept One: Medicare or Medi-Cal

Medicare and Medi-Cal, although they sound alike, are very different, and it’s important to understand what each does in the nursing home context. Medicare is what comes with Social Security and is not “means-tested” (explained below). It does not pay for nursing home care unless the condition is one from which a person might recover, and s/he is making progress toward recovery. Very few residents of nursing homes are covered by Medicare, and even then only for brief periods while rehabilitating from conditions such as broken hips and strokes.



ere’s a nightmare situation, not uncommon in Elder Law practice.

A parent lives in squalor, without proper nutrition, refuses to see a doctor, doesn’t bathe, doesn’t take medications that were prescribed years ago after the last contact with a doctor, refuses help, won’t move to assisted living, the house needs repair, and so on. Or, to make things even worse, there are two parents in this situation. Either way, the adult child is desperate for a solution.

It is commonly believed that establishing a Conservatorship, through a costly and stressful Court-supervised process, will force the parent(s) to cooperate, but this is often not the case. Many people in this condition don’t care what piece of paper someone has from what Court; they will not, or cannot, live a safer or more appropriate life, and will refuse to cooperate with all efforts to improve the situation. Conservatorship is not a magic wand, and comes with no method to enforce a Conservator’s decision that the parent(s) live elsewhere, eat, take pills, see a doctor, or fix the house. It may be that waiting for an acute medical condition to occur, forcing hospitalization and possibly nursing home placement of someone who is too sick to fight back, is the only solution.

This interim is a good time to ask a care manager to take a look, even though the parent adamantly refuses to consider having help in the home. When there appear to be untreated medical problems, a care manager who is an RN, or has one on staff, may be preferable. If the care manager can get into the house, options for obtaining some measure of cooperation may be apparent.

The care manager’s assessment may also help determine whether or not, if the child is considering petitioning for Conservatorship, a Conservatorship of the Person would be workable. It is not advisable to request authority to manage food, clothing, shelter, and physical health if there is no way to perform those duties. Care managers, however, often know very skillful and experienced caregivers who can be effective in the most difficult situation.

The child must be prepared to sign a contract for the assessment, and be financially responsible for it. This usually amounts to a few hundred dollars and is almost always a good investment.

Even if a solution does not immediately result, the child will have a relationship with someone who can be called in if things change, and will feel better for having done whatever is possible under the current circumstances.

A version of this article originally appeared in the Bulletin of the Alameda County Bar Association.


Heard this morning on NPR, click here to listen to a wise and moving account of a daughter’s search for a strategy to appeal to her mother to move to assisted living.

Fanni Green tells her daughter, Danyealah, about moving her mother, Pauline, into an assisted living facility after her health began to fail.

Listen to this and other stories at StoryCorps’ web site.