Assisted Living Costs You Should Know

Estate Planning Advice
for Every Stage of Life.

Assisted Living Costs You Should Know

In recent years, assisted living facilities have become a popular option for elderly people who don’t need the level of care offered in a nursing home but need assistance with activities of daily living.

To make an informed choice among the many facilities available, you need information about staff qualifications, services, costs, potential increases in fees and the circumstances that could lead to an involuntary discharge from the facility.

The average monthly base rate varies in different parts of the country. Residents often pay additional fees for special care units and other services, such as medication administration and transportation. Two thirds of assisted living residents pay out-of-pocket, although long-term care insurance may pay some costs for those with coverage.

In general, there are three rate structures to consider:

1. Flat Monthly Rate.This varies depending on the accommodations (semi-private or private rooms, suites shared bathrooms, studios with or without kitchens and one, two, or three bedroom apartments.) The monthly rent usually includes daily meals, housekeeping, laundry and transportation services. Ask about the number of meals served, inclusion of snacks, size, location and view of the room. All of these can affect the rate.

2. Base Plus.Under this structure, you pay the flat monthly fee and choose other services, each adding to the bill. For example, the amount of care under the base rate could be 30 minutes a day and anything else, such as bathing, grooming, dressing and monitoring medications, will cost extra. This can add as much as $2,000 a month to the cost.

3. Tiered Rates. This structure blends the flat rate and à la carte menu into specific levels of care, with the costs increasing along with the assistance provided. A facility’s tiered structure might work like this:

Tier One
The base rate plus
Three meals daily, daily snacks, therapeutic diets, weekly housekeeping, occasional assistance with daily activities, social, cultural and educational programs, scheduled transportation, emergency-call system, health and wellness assessments, and medication reminders
Tier Two
Tier One Services plus
Regular assistance with daily activities, assistance with self-managed incontinence, supervision of medication, occasional reality orientation, and
occasional escort service to meals and activities
Tier Three
Tier One and Two Services plus
Frequent assistance with daily activities, assistance with manageable incontinence, daily housekeeping, medication administration, escort service to meals and activities, and frequent reality orientation

The tiered structure typically continues to a level five with additional fees as the care becomes more intensive.

The price you pay the first year is likely to increase over time, perhaps substantially, so look into the past decade of price changes at facilities you are interested in. That can give you an indication of future costs.

When calculating costs, keep in mind that many of the usual costs of living will no longer apply to the person moving into an assisted living facility, including:

PERKINS & ZAYED, P.C.
1745 South Naperville Road, Suite 100
Wheaton, IL 60189
Phone: 630-665-2300 | Toll Free: 877-TRUST-50
Fax: 630-665-4343
Email: admin@trust-lawgroup.com
The information contained on this website is for informational and educational purposes only and is not legal, tax or financial advice. Always consult a qualified licensed attorney and/or appropriate professional to provide advice for your individual needs and circumstances. Use of this website does not create or constitute an attorney-client relationship. This website may include advertising material for Perkins & Zayed, P.C., The Estate and Trust Law Group. 

What are Your Rights as a Nursing Home Resident?

Estate Planning Advice
for Every Stage of Life.

What are Your Rights as a Nursing Home Resident?

The stress of moving into a nursing home is great — and it’s compounded by the loss of freedom, dignity and privacy.

Adding to the anxiety is the fact that people moving to an elder care facility often have no choice. They may no longer be able to care for themselves without risking injury.

Family members should become advocates and observe their loved one’s care and living conditions. Concerns should be discussed with the staff. And be aware that federal laws and various state laws provide nursing home residents with specific rights. For example, under the Nursing Home Reform Act, a number of protections are present, including:

Privacy and Confidentiality:

Residents can keep and use personal belongings and property as long as the items don’t interfere with the rights, health, or safety of others.

Married couples can share a room if both spouses reside in the same facility.

Confidential medical and personal records must be made available. Residents have the right to review their medical records within 24 hours of making a request, and staff members must ask permission to release personal records to others.

Residents are allowed privacy in their rooms and during medical treatments. Privacy should also be available during telephone calls, visits and meetings with other residents. Mail should be received unopened. Residents have the right to see family members, a resident advocate, a physician, service providers, or representatives of the state or federal government.

Residents can plan their own daily activities, wear their own clothes, and participate in social, religious, and community activities that do not interfere with the rights of other residents.

Medical Care:

Medications and treatments can be refused. Residents have the right to see their own doctors and must be informed about their conditions and medications.

Equal access to quality care must be provided, regardless of whether residents pay privately or receive Medicare or Medicaid benefits.

Financial:

Residents can ask a nursing home to handle personal funds, but the facility must follow state and federal recordkeeping requirements. However, residents also have the right to manage their own finances unless a guardian or conservator has been appointed.

Relocation:

Notice must be received before a resident’s room or roommate is changed.

Residents can refuse transfer to another room if the purpose is to move from a Medicare bed to a Medicaid bed, or vice versa. When it comes to a discharge or move for other reasons, such action must be necessary for the person’s welfare; required to protect other residents; or appropriate because care is no longer needed. A move or discharge can also be made because a resident failed to pay bills or the facility is closing.

Abuse:

Residents must be protected from physical and mental abuse, neglect, mistreatment and misappropriation of their property. They must be allowed to stay with other residents and remain free from physical or chemical restraints except in emergencies.

Grievances:

Complaints about care or treatment must be allowed without punishment.

Residents must be informed about their rights. The facility must provide a written statement of rights if asked. The facility must investigate all claims of violations and report the results of the investigation to authorities if warranted. There must be a quick resolution of grievances.

PERKINS & ZAYED, P.C.
1745 South Naperville Road, Suite 100
Wheaton, IL 60189
Phone: 630-665-2300 | Toll Free: 877-TRUST-50
Fax: 630-665-4343
Email: admin@trust-lawgroup.com
The information contained on this website is for informational and educational purposes only and is not legal, tax or financial advice. Always consult a qualified licensed attorney and/or appropriate professional to provide advice for your individual needs and circumstances. Use of this website does not create or constitute an attorney-client relationship. This website may include advertising material for Perkins & Zayed, P.C., The Estate and Trust Law Group. 

Keep Your Independence With Assisted Living

Estate Planning Advice
for Every Stage of Life.

Keep Your Independence With Assisted Living

Most elderly people don’t need nursing homes, but many require help with daily activities. If providing that support isn’t practical for family and friends, assisted living could be the answer.

Assisted living facilities fall somewhere between home care and nursing homes. They can provide various levels of help, depending on the individual’s needs. Assistance can range from basic housekeeping and medication monitoring to special arrangements for those with early-stage Alzheimer’s.

Some facilities have medical centers although the level of care is generally not as extensive as what is offered in a nursing home. Other services include help dressing, bathing, meals and reminders to eat.

In addition, assisted living facilities provide a social environment many elderly people crave.

Over the years, the choices have become increasingly diverse. They now include low budget to luxury facilities, studios to suites, kosher dining rooms, homes that cater to certain ethnic groups, and even facilities near college campuses that cater to alumni.

The federal government only provides minimal oversight of assisted living facilities. It does not provide regulation, as it does nursing homes that participate in federal funding programs. Instead, states license and regulate the facilities and the requirements vary widely so it’s important to carefully investigate any facility you are interested in.

Tally Up the Costs

An assisted living facility in many parts of the country is likely to average about $3,000 a month for basic care. And from there, the costs can increase depending on the services required. Generally speaking, the individuals (or their families) are responsible for paying the bills, rather than government programs making payments. Long-term care insurance can also cover some costs.

Tax Considerations

There are no specific deductions when it comes to assisted living, but there are many IRS rulings that support tax breaks when the primary purpose of the expense is to get medical care. In assisted living, that’s the norm.

Certain costs may be deductible if the assisted living resident has been certified by a licensed health care practitioner within the last 12 months as being unable to:

      • Perform at least two activities of daily living without help for 90 days.
      • Live safely without substantial supervision for 90 days.

If you provide the funds for your parent’s assisted living facility, you might qualify to deduct the payments. If two or more siblings help out, the family members might be able to take turns claiming the deduction via a multiple support agreement. Consult with your tax adviser for more information.

TAX COURT OKAYS MEDICAL DEDUCTION    

The fees paid by residents of a nursing home or a similar facility are deductible as medical expenses to the extent they are attributed to medical care. But one Tax Court case opened the door to bigger deductions. (Delbert L. and Margaret J. Baker, 122 TC No. 8) 
    Facts of the case: A resort-like gated retirement community owned by a nonprofit organization provided four different accommodation levels to officers of the U.S. military, their spouses and dependents:

      • Independent living apartments, duplexes and cottages.
      • An assisted living facility.
      • A special care unit for Alzheimer’s/Dementia.
      • A skilled nursing facility.

    The Bakers moved into the independent living unit that required them to pay an entrance fee of $130,000, plus ongoing monthly fees. This entitled them to lifetime residence at the California community, which operated a health center. The agreement also gave the couple the right to move to a different unit if their health deteriorated. The Bakers deducted $35,000 of the entrance fee as a medical expense.
    Eventually, the couple needed skilled nursing care. Based on the calculations of a committee at the community, they deducted about 40% of the fees (or $16,500) as medical expenses for the 1997 and 1998 tax years. The IRS, using an actuarial method projecting longevity and health care utilization, allowed the Bakers to deduct only $10,000 in monthly service fees. 
    The Tax Court approved the method used by the Bakers. The Court said the calculations by the committee effectively shifted the burden of proof to the IRS. As a result, the couple’s deduction was increased by more than 50%.
    The Court also examined whether the Bakers were entitled to deduct additional amounts for medical use of the pool, spa, and exercise facilities at the community. No deductions were allowed for those expenses because the couple did not establish the portion used for medical purposes.
     Remember that qualified medical expenses are deductible only to the extent the annual total exceeds 10% of AGI in 2018 (and 2017). Therefore, deductions are more readily available to retirees living on a fixed income than high wage-earners.  

PERKINS & ZAYED, P.C.
1745 South Naperville Road, Suite 100
Wheaton, IL 60189
Phone: 630-665-2300 | Toll Free: 877-TRUST-50
Fax: 630-665-4343
Email: admin@trust-lawgroup.com
The information contained on this website is for informational and educational purposes only and is not legal, tax or financial advice. Always consult a qualified licensed attorney and/or appropriate professional to provide advice for your individual needs and circumstances. Use of this website does not create or constitute an attorney-client relationship. This website may include advertising material for Perkins & Zayed, P.C., The Estate and Trust Law Group. 

Make the Right Senior Housing Choice

Estate Planning Advice
for Every Stage of Life.

Make the Right Senior Housing Choice

It’s never an easy task to find senior housing for a relative, close friend or yourself. The decision is often the result of failing health and the search is frequently accompanied by a sense of sadness.

Keep in mind that people going into elder housing are likely to be better taken care of than they were before — and may even be happier as a result of making new friends and having less responsibility than they previously had.

It’s difficult to know what to look for when shopping around for a housing option. An elder care professional can guide you through the options and help you decide which are best suited for the person who needs the facility.

Basically, there are three type of senior housing options, each appropriate for a different level of care:

1. Independent Living Retirement Communities

These facilities can offer such conveniences as meal preparation, housekeeping, transportation and security. They are particularly well suited to people who can live on their own and don’t have any specific needs for medical care.

2. Assisted Living Facilities

If a person needs some medical care, an assisted living facility might be a good choice. In addition to all the services of an independent living facility, this type of housing can provide help with managing medications, and, when necessary, with bathing, grooming and dressing. Facilities can range from apartment-like settings with live-in health care professionals on call or more institutional environments.

3. Nursing Homes

These facilities offer continuous round-the clock nursing care as well as other support services for the person who needs a great deal of care. If you’re looking into nursing homes, ask specifically about the way emergency care is provided, including the availability of physicians, staff certification in CPR and the qualifications of the nurses providing direct patient care. Investigate the way a nursing home deals with family visitation issues and the care of patients with conditions like Alzheimer’s and Parkinson’s disease.

You can gather valuable information about elder housing from state or local offices on aging, physicians, nurses, and other health-care providers, hospital discharge planners, social workers, and relatives and friends of people who live in senior housing.

Once you’ve narrowed down your choices, visit each facility a couple of times, giving particular attention to:

Cleanliness. Be sure the place is clean and hygiene isn’t being neglected. Also, check to see that there is adequate attention to assisting any residents who need help with personal hygiene.

Staff. Determine that there are enough employees to provide the personal attention residents need. Is the staff friendly, helpful and performing their duties well? This includes medical personnel, maintenance and kitchen staff too.

Services.
 The residence should provide for any special needs. Ask about the costs of supplies and services. Determine whether the fees seem fair, how much the regular fee increases are, and whether there are any hidden charges. Tour the facility during a meal to make sure residents are offered enough food in a relaxed manner.

When it comes time to consider long-term plans for a loved one, an elder care professional can help you investigate housing options, along with the creation or revision of estate plans and related issues.

Final note: If possible, keep the person who needs the housing involved in the decision-making because you want them to be satisfied with the final choice.

PERKINS & ZAYED, P.C.
1745 South Naperville Road, Suite 100
Wheaton, IL 60189
Phone: 630-665-2300 | Toll Free: 877-TRUST-50
Fax: 630-665-4343
Email: admin@trust-lawgroup.com
The information contained on this website is for informational and educational purposes only and is not legal, tax or financial advice. Always consult a qualified licensed attorney and/or appropriate professional to provide advice for your individual needs and circumstances. Use of this website does not create or constitute an attorney-client relationship. This website may include advertising material for Perkins & Zayed, P.C., The Estate and Trust Law Group. 

How Can Mom or Dad Still Live at Home?

Estate Planning Advice
for Every Stage of Life.

How Can Mom or Dad Still Live at Home?

There may come a time when your parent is no longer safe living at home due to physical or emotional/social concerns. Instead of moving Mom or Dad to an assisted living or nursing home, in-home care can provide a solution that makes everyone happy— your parent can stay at home in familiar surroundings and you can have peace of mind that someone is there looking after them.

Here are some tips will help you select an in-home care provider.

Determine the level of care needed. There are several options available, depending on the assistance your parent needs. Companions can provide social interaction and help with housekeeping, errands, meal preparation and medication supervision. Personal care aides provide hands-on assistance with personal hygiene, dressing and moving to different rooms. Licensed or registered nurses can provide skilled medical care. In-home care is available to even those with advanced needs.

Determine the cost and how to pay for it. According to a 2015 Genworth survey, the national median cost for a home health aide working 44 hours a week is $45,760. (Click here for costs in your state.) Actual costs will depend on the level of care and number of hours needed.

Long-term care insurance is one option to pay for in-home care, but many people have waited until the costs are prohibitive and/or they are uninsurable. (You may want to look into one of these policies for yourself now, as health care costs will only continue to increase in the future.) You can pay privately, using Social Security or pension benefits, savings or equity in the home. Medicare pays for skilled nursing care, but only for a short term. Medicaid programs are available for those with limited assets. Aid & Attendance benefits from the Veterans Administration are also available for wartime veterans and their spouses who qualify.

Decide if you want to use an agency or hire an individual. Agencies provide you with some protection. They typically run background checks and drug tests on their employees, and if there is a problem, they are usually quick to correct it. They also handle taxes and payroll, and carry liability and worker’s compensation insurance. If you prefer to hire an individual, make sure you have excellent referrals. Also find out if you are liable for payroll taxes and worker’s compensation.

Check them out. If you are evaluating agencies, check their online reviews. Whether interviewing an agency or individual, ask about licenses, training (especially if dementia is an issue), and past experiences (good and bad). Call references and conduct personal interviews.

Be prepared to make adjustments. The type of care needed is likely to change over time. You may also need to make a change due to conflicting personalities.

PERKINS & ZAYED, P.C.
1745 South Naperville Road, Suite 100
Wheaton, IL 60189
Phone: 630-665-2300 | Toll Free: 877-TRUST-50
Fax: 630-665-4343
Email: admin@trust-lawgroup.com
The information contained on this website is for informational and educational purposes only and is not legal, tax or financial advice. Always consult a qualified licensed attorney and/or appropriate professional to provide advice for your individual needs and circumstances. Use of this website does not create or constitute an attorney-client relationship. This website may include advertising material for Perkins & Zayed, P.C., The Estate and Trust Law Group.