Fong Law Group

Investigation Uncovers Food Insecurity in Nursing Homes

Takeaways

• A recent investigation found many nursing homes spend less than $10 per day on food per resident, raising concerns about malnutrition and food quality.
• There has been an increase in food-related sanctions, dietary complaints, and disease outbreaks in nursing homes.
• Residents report unappetizing food and inadequate portion sizes, highlighting a lack of accommodation for dietary needs.

Nutrition plays an essential role in the healthy aging. The American Medical Association (AMA) reports that healthy eating reduces mortality by 20 percent. Adequate nutrition is of particular importance for older adults with complex medical needs who reside in long-term care facilities.

Yet, a recent journalistic investigation has identified problems with food in nursing homes across the United States. The report raises concerns that many long-term care residents are at risk of malnutrition, foodborne illness, and neglect that manifests as limited access to quality food options.

Many nursing homes — acquired by private equity firms in the wake of the pandemic — cut food costs, with more than a quarter of nursing home operators spending less than $10 per day on food per resident and some spending as low as $4 a day, according to the report published by NewJersey.com.

Long-term care facility operators may be cutting food costs because there is no federal minimum standard for food spending per resident. Operators may see food as a less-regulated area to reduce spending.

Nursing Homes

Many people rely on nursing homes for 24-hour care, as these facilities provide housing, medical assistance, and meals. The Kaiser Family Foundation (KKF) reports that over 1.2 million individuals reside in nursing homes in the United States. According to the Centers for Disease Control and Prevention (CDC), of the 15,300 nursing homes in the U.S., 70 percent were for-profit in 2020.

Nursing homes are expensive, with costs representing a significant financial responsibility for individuals and their families. In 2024, the national median cost of a private room in a nursing home ranged from $9,733 ($320 a day) to $10,645 per month. While Medicaid covers the cost of a Medicaid-certified nursing home care for individuals who qualify based on need, these individuals often reside in lower-quality nursing homes, per research published by the National Library of Medicine.

People residing in nursing homes constitute a vulnerable population with complex medical needs that make independent living more challenging. According to the Alzheimer’s Association, almost half — 48 percent — of nursing home residents have Alzheimer’s or related dementias.

Given the vulnerability of those in nursing homes and the high cost of long-term care, it is surprising and heartbreaking that food insecurity is a real concern in nursing homes across the country.

Highlights From the Investigation

Reporters reviewed thousands of federal cost reports filed with the Centers for Medicare and Medicaid Services. They worked with Rutgers University academics and data experts to identify several troubling findings in addition to low food-spending in nursing homes:

• Writeups for food-related sanctions tripled from 2021 to 2024.
• Dietary complaints to ombudsman offices increased by more than 50 percent from 2020 to 2023.
• Disease outbreaks, such as E. coli, listeria, and salmonella, are on the rise in nursing homes nationwide. This is worrisome as foodborne illnesses can be especially harmful to older adults
• Residents interviewed commonly complained that the food was unappetizing — even when it met nutritional standards. One resident commented that the food in prison tasted better. Another resident stocked up on canned goods in his room.

Food access was another concern the investigation highlighted, with facilities offering small portions — such as a single ravioli or a rationed cup of milk. This is particularly troubling as individuals who live in nursing homes already face a greater risk of malnutrition and dehydration.

The investigation also found a pattern of facilities not accommodating residents’ needs, such as failing to provide soft food for those without teeth and not providing bananas to a woman who needed more potassium per her doctor’s orders.

The report suggests that many nursing homes have significant room to improve in how they feed residents. For those navigating long-term care options, these findings are concerning. Older adults considering long-term care and their families may wish to consider how much a nursing home spends per resident on food, whether fresh fruits and vegetables are available, and how the facility accommodates dietary needs and restrictions.

Ensuring the Rights of Long-Term Care Residents

If you have concerns about a loved one in a nursing facility, be sure to reach out to us or the long-term care ombudsman in your state. We can assist long-term care residents by advocating for their rights and helping to ensure they receive quality care; address issues such as substandard treatment, lack of access to food, and financial exploitation; and help navigate complex regulations, resolve disputes with the facility, file complaints, and ensure compliance with care plans. treatment

How Older Adults Can Stay Safe During Heat Waves

Takeaways

• Older adults are particularly susceptible to heat-related illnesses due to chronic conditions, medications, and physiological changes, making it crucial for them and their caregivers to recognize symptoms of overheating.

• Preventative measures such as staying in air-conditioned environments, staying hydrated, and seeking financial assistance for cooling can help older adults stay safe during heat waves.

The United States set a record in 2023 for heat-related deaths, and the planet recorded its highest-ever average temperatures in 2024. Hot weather poses a particularly significant risk for vulnerable populations such as older adults. As the Centers for Disease Control and Prevention (CDC) reports, those 65 and older are predisposed to experience heat-related health problems. By understanding how chronic conditions and medications can exacerbate heat complications, older people and their loved ones can take steps to help them stay safe during heat waves.

Excessive Heat Is Dangerous for Older Adults

Elevated temperatures can be hazardous for seniors. With lower muscle mass, decreased reflexes, and lower immunity, older adults generally have a higher risk of experiencing disorders that affect the body’s ability to maintain a normal temperature. When the weather fluctuates, it can be more difficult for older individuals to adjust to these changes.

Older adults are also more prone to chronic conditions that can impact how their bodies respond to heat. Managing chronic conditions can involve taking prescription or over-the-counter medications that shape how the body controls temperature or sweat to keep cool.

According to one study, neurocognitive diseases, including Parkinson’s and Alzheimer’s diseases, cause the body to encounter problems controlling temperature. Medications these patients take to manage these conditions can further alter how their body maintains its temperature, causing both too-high and too-low extremes.

In addition to Parkinson’s and Alzheimer’s diseases, other disorders of the central nervous system can put aging adults at risk during heat waves. These include certain brain injuries, spinal cord injuries, and tumors, which may impair sensing and central control.

Endocrine disorders can lead to problems with regulating one’s temperature as well. Certain thyroid conditions, for one, can cause someone to become too cold or too warm. Those with diabetes become dehydrated more quickly, and complications from diabetes can lead to heat exhaustion and heat stroke, according to the CDC.

Other medications that many older adults may rely on can aggravate heat problems, the Associated Press reports. Blood pressure pills can cause dehydration, antidepressants can interfere with cooling, and aspirin and other over-the-counter pain relievers can reduce fluid sodium levels, making it challenging to respond to high temperatures.

Heat Complications in Aging Adults: What to Watch Out For

Overheating can cause several health problems, which may prove severe and require immediate medical attention.

Because heat-related illnesses can involve dizziness, confusion, and dehydration, it can be difficult for someone experiencing one to think clearly. Older adults, their caregivers, and loved ones should look out for signs of overheating.

Note that while sweat can indicate a problem, some heat-related illnesses and chronic conditions impair sweating. A lack of sweating can in fact indicate too much heat.

Other signs of overheating include the following:

• A rapid or slowed pulse
• Flushed appearance
• Dizziness and fainting
• Confusion and difficulty thinking clearly
• Thirstiness
• Dark colored urine, indicating dehydration, or urinating less than normal
• Lethargy, fatigue, and weakness

The National Institute on Aging (NIA) flags the following heat complications that can affect older adults:

• Sudden heat-related dizziness, known as heat syncope, can happen when someone is active in hot weather.
• Cramping can occur in the stomach, arms, or legs.
• Swelling in ankles and feet is known as heat edema.
• Heat rash involves small clusters of blisters on the skin.
• Heat exhaustion causes thirst, dizziness, weakness, and nausea. Some may also feel cold and clammy or have a rapid pulse.
• When body temperature exceeds 104°F, it is a medical emergency called heat stroke. Fainting, confusion, lack of sweating despite heat, flushed skin, and changes in pulse can point to heat stroke. Seek medical attention right away.

If you or a loved one experiences symptoms of a heat-related condition, seek medical help. The NIA also recommends drinking water and resting in a cool location.

Staying Cool Amid High Temperatures

Elderly community members and their loved ones can take steps to prevent them from becoming too hot during heat waves.

• Stay inside an air-conditioned location during high temperatures. Close blinds and curtains to stop the sun from warming the home and use fans to circulate air.
• Before a heat wave, stock up on essentials to avoid needing to go out.
• Stay hydrated; drinking cold water with ice can help people stay cool while preventing dehydration.
• Take a cold shower or bath to lower body temperature.
• Seek medical attention for heat-related symptoms.
• Many seniors enjoy being active outdoors, taking part in walking, gardening, or playing pickleball. Consider engaging in these types of activities early in the morning, in the evening, or in an indoor, air-conditioned space.

If an older adult in your family or community does not have air conditioning, consider helping them get to an air-conditioned location for the duration of the heat wave. Some federal assistance is available to help low-income older adults access air conditioning, and many communities have cooling stations.

The CDC has launched an online tool where users can input their ZIP code to see forecasts for the heat risk in their area. The tool also provides recommendations on how to protect your health during a heat wave.

Access to Air Conditioning for Low-Income Older Adults

Staying inside air-conditioned residences during heat waves can help older adults avoid overheating. Seniors who may not be able to afford to keep their homes cool and have trouble avoiding extreme heat are vulnerable to its adverse health effects, particularly for those who are homebound.

The National Council on Aging identifies several programs to help older people with limited income and resources access air conditioning or other ways to keep their homes cool.

• The Low-Income Home Energy Assistance Program (LIHEAP) financially supports older adults who cannot afford heating and cooling bills. In some states, the program may pay for an air conditioner or a fan.
• The Weatherization Assistance Program (WAP) assists limited-income households in weathering their homes. Contact your state weatherization administrator to learn more about the program.

State and community programs may also be able to help. Some states have programs providing free fans to those in need. Local senior centers and service organizations may offer cooling assistance programs funded by community donors.

Many places also have cooling stations, such as libraries, school auditoriums, religious institutions, and other public spaces. These areas are often open to people who would otherwise lack access to air conditioning during heat waves. For assistance finding a cooling station, contact your local Area Agency on Aging.

Keeping Medications Safe

Many older adults rely on medications to manage chronic conditions. These medications can become ineffective if they become too hot. Exposed to heat and moisture, certain types of drugs can lose their potency before their expiration date.

Be sure to store medications as directed, often in a temperature-controlled environment away from heat and humidity. Take special note of any potential issues if you receive your medications by mail order.

Baylor College of Medicine recommends throwing away medications that show signs of heat exposure, such as changes in color, texture, or odor. Capsules or pills that stick together, show changes in hardness or softness, or have cracks and chips are additional indications that a medication may have spoiled. Consulting a doctor or pharmacist can be essential to determining whether a medication is still safe.

Report: Americans Overwhelmingly Support Social Security

Takeaways

• A new report finds that Americans overwhelmingly support preserving and strengthening Social Security benefits, even if it means paying more to address the program's long-term financing gap.

At a time when the nation is deeply divided across political lines, Americans can agree on at least one thing: Social Security benefits should not only be preserved but strengthened — even if that means they have to pay more to address the program’s long-term financing gap.

A new report, published as Social Security turns 90, finds that Americans overwhelmingly view Social Security benefits as a vital part of their retirement security and the financial well-being of seniors.

They express broad support for increasing revenues to strengthen Social Security rather than cutting benefits, with a preference for raising taxes on higher earners. Americans also value Social Security disability benefits and want to make sure they can rely on them if needed.

Social Security Turns 90

The Social Security program enters its 90th year in 2025. The largest single program in the federal budget, Social Security makes up approximately one-fifth of total federal spending.

Initially created to provide retirement income for workers over the age of 65, Social Security is funded through payroll taxes paid by workers and their employers. The program has undergone several changes over its nine-decade history in an effort to adapt to evolving economic and demographic realities while retaining its core mission of providing financial protection for our nation’s people.

Today, Social Security is a vital source of income for millions of retirees, disabled workers, and their family members. According to Social Security Administration (SSA) statistics from January 2025:

• Nearly 73 million Americans receive Social Security benefits.
• Most of these recipients (56 million) are adults aged 65 or older.
• More than 51 million retired workers receive benefits, in addition to 1.86 million spouses of retired workers and 714,000 children of retired workers.
• Survivor benefits are paid to 5.78 million children, widowers, and parents of deceased workers.
• Social Security Disability Insurance (SSDI) benefits are provided to more than 8 million Americans, including disabled workers, their spouses, and their children. Twelve percent of all Social Security benefits are disability benefits.
• Another 7.42 million people across the United States receive Supplemental Security Income (SSI) benefits. More than half of them are adults aged 18 to 64, while a third are 65 or older.

SSA describes Social Security as “one of the most successful anti-poverty programs in our nation’s history.” It is a crucial safety net for many older Americans, especially those with limited income.

Nearly nine out of 10 seniors received benefits in 2024, representing approximately 30 percent of the total income of older Americans.

For around half of seniors, Social Security provides at least 50 percent of their income; for about one in four seniors, Social Security provides at least 90 percent of their income. The average monthly benefit amount for retired workers is $1,975.34, or just over $23,700 annually.

The Center on Budget and Policy Priorities (CBPP) estimates that, without Social Security, almost 4 in 10 seniors would have incomes below the official poverty line.

Financing Gap Threatens Social Security Benefits

Social Security has a pay-as-you-go structure that means today’s revenues fund benefits paid to current recipients. Funds are deposited into two trust funds: the Old-Age and Survivors Insurance (OASI) Trust Fund and the Disability Insurance (DI) Trust Fund.

Reserve funds, generated when program revenues exceed benefits, are kept in the trust funds and invested in U.S. government securities, such as bonds. These reserves supplement revenues to meet the government’s payment obligations.

The last significant changes to Social Security were made in 1983 under President Ronald Reagan to address the looming insolvency of the trust funds. Raising the retirement age and other reforms were expected to extend the solvency of the trusts by 75 years, and from 1983 to 2009, Social Security ran a surplus. But since 2010, Social Security revenues have fallen below outlays and the trust funds are being depleted, mainly because more Baby Boomers are retiring.

According to a 2024 trustees report, Social Security trust fund reserves are projected to run out in 2035. At that time, revenues would only cover about four-fifths of scheduled benefits. To make up the difference, Social Security benefits would need to be reduced by about 20 percent to 25 percent.

Only Congress has the authority to modify the Social Security program and ensure its long-term viability. However, there are only two general options for reforming Social Security: reduce program costs by lowering current or future benefit amounts for some or all groups of beneficiaries, or increase program revenues, either by raising taxes or adding new sources of revenue.

Americans’ Views on Social Security

It is amid this backdrop that the National Academy of Social Insurance, AARP, the National Institute on Retirement Security, and the U.S. Chamber of Commerce conducted a survey to gauge Americans’ preferences about how to fix Social Security’s long-term financing gap. Their findings are published in a new report released in January 2025.

Social Security at 90: A Bipartisan Roadmap for the Program’s Future finds that Americans are united in their support for Social Security and their desire to see it strengthened. Some of the key takeaways are:

• Social Security is crucial for Americans’ retirement. Across demographics, 81 percent of future retirees say it will be important to their monthly income.
• Most Americans favor strengthening the program’s finances through increased revenues. Eighty-five percent of respondents want to either maintain current benefits or increase them, even if it requires raising taxes on some or all Americans.
• They prefer changes that close the financing gap and improve benefits. The favored plan includes:
  • Removing the payroll tax cap for earnings over $400,000
  • Gradually increasing the payroll tax rate from 6.2 percent to 7.2 percent
  • Adjusting COLA to better reflect inflation and the spending habits of older adults
  • Providing a caregiving credit for those caring for children under 6
  • Offering a bridge benefit for older workers with physically demanding jobs
  • Reducing benefits for high-income retirees
• SSDI and SSI protections are valuable to many Americans. The vast majority (90 percent) say that SSDI would be important to their income if they experienced a work-limiting disability, including 71 percent who said it would be “very important.”
  
  Americans also express strong bipartisan support for reforming SSI, which provides modest income support to low-income Americans who are 65 and older and/or disabled and have very limited resources. SSI is not funded by the Social Security trust funds and its rules, including a $2,000 asset limit, have not been updated in decades.

Beyond these main findings, Americans favor of the following Social Security reforms:

• Using general government tax revenue to fund Social Security. Two-thirds of respondents support this idea.
• Increasing administrative funding for the SSA. SSA staffing is at its lowest level in 50 years. Americans favor giving SSA increased administrative funding — a move that could improve customer service and wait times for disability claims — by a 2-to-1 margin.
• Eliminating taxes on Social Security benefits: Beneficiaries with significant non-Social Security income pay taxes on part of their benefits if their total income exceeds a set threshold, a policy that affects around 40 percent of current beneficiaries. Around half of respondents support ending this tax and 33 percent oppose ending it. President Trump has proposed eliminating taxes on Social Security benefits.
• Raising SSI asset limits. Two-thirds of respondents support increasing SSI asset limits.

Closing Thoughts

The report concludes that “The message to Washington is clear: rather than see the gap closed by reducing benefits, Americans want to see Social Security secured and strengthened through additional revenues, and they are willing to pay more to bolster the program’s finances.”

AARP’s Chief Public Policy Officer said that the survey shows “virtually all Americans want their Social Security benefits to be preserved and are willing to do what it takes to ensure the program continues to provide meaningful support for future generations.”

The CBPP stresses that there is “no imminent crisis” in the Social Security system, and lawmakers have time to put the program on solid financial footing. However, it also notes that changes should be made as soon as possible to give workers enough time to plan their work, savings, and retirement.

If you’re concerned about the future of Social Security, there are steps you can take in older adulthood to reduce your reliance on the program and improve your retirement security. For one, start working with a financial advisor and elder law attorney. A 2023 study found that working with a financial advisor can be helpful. An elder law attorney has a role to play as well.

Find a local attorney who can help you understand the different Social Security benefit programs and work with you to create a plan that gives you financial independence into your later years.

2024 Survey Shows Long-Term Care Costs Continue to Rise

Takeaways

• The demand for long-term care services is rising due to an aging population and a shortage of health care professionals.
• The costs of long-term care have been escalating, including in-home care, assisted living care, and nursing home care.

As most of us go through our daily routines, it is hard to imagine needing help with essential daily tasks. However, research shows that most Americans over age 65 will need daily help, in the form of long-term care, at some point.

Long-term care (LTC) encompasses a range of services designed to meet the medical and personal needs of individuals who are unable to perform essential activities independently. These services include assistance with daily activities such as bathing, dressing, and eating, as well as medical care for chronic conditions. LTC can be provided in various settings, including nursing homes, assisted living facilities, and in one’s home.

Increasing Demand for Long-Term Care

The demand for LTC services in the United States is on the rise, primarily due to a growing senior population. Projections indicate that the number of Americans aged 65 and older will increase from 58 million in 2022 to about 82 million by 2050. This demographic shift is expected to strain existing LTC infrastructure and resources.

At the same time as the over-65 population is increasing, the U.S. is experiencing a significant shortage of health care professionals specializing in geriatric care. There were approximately 7,400 board-certified geriatricians in 2022, whereas an estimated 30,000 will be needed by the end of the decade to serve our aging population adequately. This shortage extends to nursing staff as well. According to a recent Agency for Healthcare Administration (AHCA) survey, staffing problems have become worse for 60 percent of nursing homes since January 2022.

Changes in Long-Term Care Costs

The costs associated with LTC have been escalating, placing a substantial financial burden on individuals and families. This upward trend in LTC costs is influenced by several factors, including increased demand for services, staffing shortages, and higher operational expenses.

An annual cost of care survey by Genworth and CareScout offers insight into the cost trends of long-term care in the U.S. The survey highlights the rising costs for in-home care, nursing homes, and community and assisted living in each state as well as nationally. According to the survey:

• The annual median cost of in-home care with a home health aide rose from $75,504 in 2023 to $77,792 in 2024.
• The annual median cost for assisted living care jumped 10 percent, from $64,200 in 2023 to $70,800 in 2024.
• The annual median cost of a private room in a nursing home rose from about $116,800 to $127,750 between 2023 and 2024.

In-Home Care Costs

According to Genworth, the national average hourly pay for in-home care rose to between $33 and $34 in 2024. In-home care includes home health aides, who provide hands-on help with tasks such as bathing and dressing, and homemaker services, which provides support with hands-off tasks, such as cleaning and cooking.

Though home health aide costs rose just 3 percent from 2023 to 2024, the cost for homemaker services rose 10 percent during that time. According to the survey, two-thirds of home care agencies now charge the same rate for both types of service.

Assisted Living Care Costs

The annual median cost of living in an assisted living community increased by 10 percent over the past year. The occupancy rates in assisted living communities increased from 77 percent to 84 percent, year-over-year. This increase in demand may have played a role in the cost increase, according to the report.

Nursing Home Costs

Genworth found that in 2024, the annual median cost of a semi-private room in a skilled nursing facility increased 7 percent, from $104,028 to $111,325, and the cost of a private room rose 9 percent, from about $116,800 to $127,750.

Estimating Your Long-Term Care Costs

In addition to their survey, Genworth and CareScout offer a free, interactive online tool to help calculate your potential costs for long-term care in the U.S. You can use the tool to estimate the cost of in-home care, nursing home care, and the cost of living in an assisted living arrangement.

You can view the cost per hour, per day, per month, and per year, according to where you live and including projected costs in the years to come. Having this information can help you plan for your future or the future of a loved one.

Planning for Long-Term Care

Planning for long-term care and figuring out how to pay for it can seem daunting. However, investing in long-term care insurance or qualifying for Medicaid may be some of the options available to you to lessen the burden of these ever-rising costs if you are unable to afford private pay for long-term care services. Keep in mind that you and your family members should do whatever you can to be proactive in planning for these possibilities.

An experienced elder law attorney near you can help you plan ahead, find the best way to pay for your long-term care needs, and determine whether you meet the eligibility requirements for any public assistance programs.

For additional reading about navigating long-term care, check out the following articles:

• Discussing Long-Term Care With Older Adults in Your Life
• How Much Long-Term Care Insurance Should You Purchase?
• When Should You Purchase Long-Term Care Insurance?
• Activities of Daily Living and the Need for Long-Term Care
• What Are Nursing Home Residents’ Rights?

Home Safety for Aging in Place: A Guide for Older Adults

Takeaways

• Aging in place involves making modifications to ensure safety, comfort, and accessibility for older adults.

• Home modifications, measures for preventing falls, and fire and carbon monoxide safety are crucial for creating a safer environment.

• Maintaining social and mental well-being is also essential for older adults’ safety and quality of life.

Aging in place, the ability to live safely and independently in one’s home as long as possible, is a goal for many seniors. However, as we grow older, our homes may require modifications to ensure safety, comfort, and accessibility.

Whether you are planning to live in your home as long as you can or want to help an aging parent stay in their home longer, ensuring home safety is a top priority. Here are some practical steps you can take to create a safer living environment for older adults.

Home Modifications for Accessibility

Making a home more accessible can enhance independence and mobility. To do this, you can:

• Widen doorways: If possible, widen doorways to accommodate walkers or wheelchairs.
• Install ramps: Replace stairs with ramps where necessary.
• Adjust counter heights: Consider adjustable or lower kitchen counters for ease of use.
• Install lever-style door handles: Replace traditional doorknobs with lever-style handles for easier grip.

Fall Prevention

Falls are a leading cause of injury among older adults. Consider these measures to reduce risk of falling:

• Remove tripping hazards: Secure loose rugs, electrical cords, and clutter.
• Improve lighting: Install bright, motion-sensor lights in hallways, staircases, and entryways.
• Install grab bars: Place grab bars in bathrooms near toilets and showers.
• Use nonslip surfaces: Apply nonslip mats in bathrooms and kitchens.
• Ensure furniture is stable: Arrange furniture for easy navigation and avoid unstable or wobbly chairs and tables.

Fire and Carbon Monoxide Safety

Older adults are at a higher risk of fire-related injuries. Take these precautions:

• Smoke and carbon monoxide detectors: Install smoke detectors and carbon monoxide detectors in every bedroom and near the kitchen; test them monthly.
• Fire extinguishers: Keep fire extinguishers in easily accessible locations, especially in the kitchen.
• Avoid open flames: Use electric candles instead of real ones and avoid leaving cooking appliances or space heaters unattended.
• Plan an emergency exit strategy: Ensure all occupants know the quickest, safest way out of the house in an emergency.

Bathroom Safety

The bathroom can be a hazardous area due to slippery surfaces. Implement these safety measures:

• Walk-in tubs or showers: Consider replacing traditional tubs with walk-in options.
• Nonslip mats: Put nonslip mats inside and outside the tub or shower.
• Raised toilet seats: Install raised seats to make sitting and standing easier.

Kitchen Safety

Kitchens can present risks such as burns and falls. Make them safer with these strategies:

• Auto-shutoff appliances: Use appliances with automatic shutoff features.
• Easy-to-reach storage: Keep frequently used items within arm’s reach to avoid the need for step stools.
• Stable flooring: Avoid loose rugs and ensure floors are slip-resistant.

Security and Emergency Preparedness

Personal security and emergency response are crucial for older adults living alone. Some ways to ensure security and emergency preparedness include:

• Medical alert systems: Invest in a wearable emergency response system.
• Secure locks and peepholes: Ensure doors have deadbolts and peepholes for security.
• Emergency contact list: Keep a list of emergency contacts and medical information in an accessible location.

Social and Mental Well-Being

Safety isn’t just physical; it’s also about mental and emotional well-being. Consider strategies such as these:

• Check-in system: Establish a routine for family members, friends, or neighbors to check in.
• Technology aids: Use smart home devices for reminders, video calls, and security.
• Accessible transportation: Arrange for transportation options for medical appointments and social engagements.

Learn More About Late-Life Planning

Aging in place is achievable with thoughtful modifications and safety measures. Whether you are an older adult planning for the future or someone caring for an aging parent or loved one, taking proactive steps to ensure a secure and comfortable home environment can significantly improve quality of life. For more information about home safety for older adults, the National Council on Aging has a useful guide.

There is more to planning for our later years than creating a safe living environment. Working with an experienced elder law attorney near you can help you create a comprehensive plan to get the most out of your later years.

For additional reading about long-term care and aging in place, check out the following articles:

• HUD Housing Programs That Support Aging in Place
• An Elder Care Lawyer Can Help You Get Medicaid Home Care
• Reverse Mortgages: A Way to Remain at Home Longer
• Discussing Long-Term Care With Older Adults in Your Life
• Activities of Daily Living and the Need for Long-Term Care
• Is an Independent Living Facility Right for Me?

Social Security Overpayment Rules Are Changing Once Again

Takeaways

• Social Security benefits recipients who receive overpayments after March 27, 2025, will have their entire monthly benefit withheld until the overpaid amount is fully recovered.

For the past year, Social Security beneficiaries have gotten a break from the sometimes-devastating policy of withholding 100 percent of benefits if the beneficiary was overpaid. Effective March 27, 2025, the Social Security Administration (SSA) will reinstate the 100 percent policy to recover overpayments, reverting from the previous 10 percent withholding rate established in early 2024. This change is anticipated to recoup approximately $7 billion over the next decade.

Reasons for the Policy Reversal

The SSA says its decision to revert to full withholding stems from a commitment to safeguard taxpayer dollars and ensure the integrity of the Social Security trust funds. Acting Commissioner Leland Dudek emphasized the agency’s responsibility to be diligent stewards of public resources, noting that returning to full withholding aligns with practices from the Obama administration and first Trump administration.

Overpayments can occur due to various factors, including changes in a beneficiary's income, marital status, or living arrangements that are not promptly reported or processed. By reinstating the 100 percent withholding rate, the SSA aims to expedite the recovery of these funds, thereby maintaining the program's financial health.

Effects on Social Security Benefits Recipients

Under the new policy, individuals who receive overpayments after March 27, 2025, will have their entire monthly benefit withheld until the overpaid amount is fully recovered. This measure does not affect those already repaying overpayments under the previous terms; their repayment arrangements will remain unchanged. Note that the withholding rate for Supplemental Security Income (SSI) overpayments will remain 10 percent.

Beneficiaries facing financial hardship due to full withholding can request a reduced recovery rate by contacting the SSA. They also retain the right to appeal the overpayment decision or seek a waiver if the overpayment was not their fault and repayment would cause financial distress. The SSA will pause recovery efforts while an appeal or waiver is under review.

Introduction of the Social Security Overpayment Relief Act

In response to concerns about the SSA’s overpayment recovery practices, U.S. Representatives Kristen McDonald Rivet (R-Mich.) and Zach Nunn (R-Iowa) recently introduced the Social Security Overpayment Relief Act to limit the SSA’s overpayment lookback period to 10 years. Senators Ruben Gallego (D-Ariz.) and Bill Cassidy (R-La.) introduced a companion bill in the Senate. This proposed legislation aims to limit the SSA’s overpayment lookback period to 10 years, thereby capping the timeframe during which the agency can reclaim funds from beneficiaries.

Currently, the SSA can seek repayment for overpayments indefinitely, potentially burdening beneficiaries with debts stemming from errors made decades earlier. The indefinite lookback period has led to collection notices totaling tens or even hundreds of thousands of dollars, causing significant financial strain for affected individuals.

The proposed 10-year limitation would apply to recipients of Social Security retirement benefits, Social Security Disability Insurance (SSDI), and SSI. However, this limitation would not extend to cases involving fraud or criminal activity.

Sen. Gallego emphasized that seniors should not be held accountable for the government’s long-standing errors, advocating for a fairer approach to overpayment recovery.

Overpayment of SSA Benefits

Social Security benefits recipients may get an overpayment when there’s a change in their life. For example, they may have married but the SSA then doesn’t update its system right away or makes a mistake. In some cases, the SSA may not uncover these errors until years later. When the SSA finds a long-running overpayment, it can be hard for the individual to pay it back.

If you receive notice of a Social Security overpayment after March 27, 2025, and cannot afford to repay it in full, contact the SSA at 1-800-772-1213 or visit your local SSA office. You may also want to contact your elder law attorney. They will be able to offer you guidance on how best to respond.

An Elder Care Lawyer Can Help You Get Medicaid Home Care

Takeaways

• Many seniors prefer to age in place with home care assistance.
• Medicaid can provide financial assistance for home care, but eligibility requirements vary by state and can be complex.
• Elder care lawyers can help seniors navigate Medicaid planning, the application process, and spousal impoverishment protections.

The over-65 crowd is growing dramatically. Millions of Baby Boomers are transitioning into older adulthood and are living longer than previous generations. According to recent U.S. Census Bureau data, the U.S. population over the age of 65 is expected to balloon from about 56.1 million in 2020 to about 82.1 million in 2050.

This growing population segment is looking for ways to live their lives as completely as possible. Through lifestyle choices, such as eating healthfully, exercising regularly, and socializing in their communities, older adults can improve the quality of their lives.

Another way seniors are creating healthier lives is by living in their homes longer and opting to receive care at home. For many, this option reduces the stress of moving into a nursing home or assisted living facility. Aging in place also helps one retain a greater sense of independence.

Many seniors want to receive home care not only because of the benefits but also because of the frustrations they say they are experiencing with the current health care system in the United States. According to a recent study by The John A. Hartford Foundation, four out of five older adults say the U.S. health care system is not prepared for the changing needs of America’s growing senior population.

The option to receive health care at home is a growing need. Home health care is not without its costs, though.

For seniors who are struggling financially, Medicaid can provide financial assistance for home care services. However, since the federal government and the individual states run Medicaid jointly, benefits coverage is different in each state.

Qualifying for Medicaid is not only state-specific but also can be a complicated process. With the help of an elder care lawyer, seniors can navigate the Medicaid application process and more easily realize the benefits that will help them live more comfortable, independent lives.

Medicaid Eligibility Requirements for Home Care

Medicaid covers various long-term care services, including home health care, caregiver support, and personal care services for such activities as dressing, bathing, and meal preparation. However, qualifying for Medicaid home care involves meeting stringent financial and functional eligibility criteria, which vary by state.

Income and Asset Limits

Medicaid has strict income and asset thresholds that determine whether an applicant qualifies for assistance. The limits depend on the state in which the applicant lives, but they generally require individuals to have limited income and assets. Individuals with too much in savings, investments, or other assets might be denied Medicaid coverage.

Functional Needs Assessment

Besides financial eligibility, Medicaid requires applicants to demonstrate a functional need for home care services. A comprehensive assessment is often conducted to evaluate the applicant’s ability to perform daily activities.

How Elder Care Lawyers Help Seniors

Navigating Medicaid’s complex requirements can be overwhelming for seniors and their families. Elder care lawyers specialize in helping older adults manage legal, financial, and health care issues, including qualifying for Medicaid. Here’s how they can help:

Medicaid Planning and Asset Protection

Elder care lawyers can play a crucial role in Medicaid planning. This may involve legally structuring an elder’s finances to ensure they meet Medicaid’s strict asset limits using strategies such as:

• Spending down: This refers to using excess assets to pay for medical care, home improvements, or other approved expenses, reducing the senior’s assets to Medicaid-qualifying levels.
• Creating a trust: An elder care lawyer can help a senior transfer assets into certain types of trusts. For example, a Medicaid Asset Protection Trust (MAPT) or a Miller Trust can remove those assets from one’s personal estate so that they don’t count toward Medicaid’s asset limits.
• Gifting strategies: Medicaid has a lookback period (usually five years) that penalizes asset transfers or gifts made below fair market value. An elder care lawyer can help structure gifts and transfers in a way that minimizes penalties.

To make the most of Medicaid planning, be sure to work with your elder care attorney before you actually need long-term care.

Navigating the Medicaid Application Process

The Medicaid application process is complicated and often requires submitting extensive documentation, including proof of income, assets, and medical needs. Elder care lawyers help:

• Collect and organize necessary documentation: They can help ensure that all paperwork is in order before submission, reducing the risk of delays or denials.
• Avoid mistakes: Errors in the application process, such as misreporting assets or failing to disclose relevant financial information, can lead to delays or even disqualification. Attorneys specializing in elder law can help clients avoid these pitfalls.
• Appeal denials: If a Medicaid application is denied, elder care lawyers can represent seniors in the appeals process, helping them address any issues raised by Medicaid.

Protecting Spouses Through Medicaid’s Spousal Impoverishment Protections

For married seniors, qualifying for Medicaid can be especially challenging since one spouse may need Medicaid while the other does not. Elder care lawyers can assist in navigating spousal impoverishment protections. These standards, which vary by state, allow the healthy spouse to retain a certain amount of assets and income while the other spouse qualifies for Medicaid. With the help of your elder care lawyer, the healthy spouse can therefore remain financially secure.

Originally, spousal impoverishment rules applied only to married couples where the Medicaid spouse received care in a nursing home. Lawmakers have temporarily extended these protections to the spouses of patients receiving home health care through Medicaid waivers. Under current law, spouses of Medicaid patients receiving home health care will have these protections only through September 2027. Unless lawmakers extend this deadline, some states may no longer offer the same impoverishment protection for these spouses.

Paying a Family Caregiver

The majority of older adults who receive care in their homes rely at least partly on family members or friends for their care. Often the family members and friends provide this care for free. This can strain the finances of some caregivers if they have to take time off from work or leave the workforce entirely.

The good news is that Medicaid in most states will pay a family member to provide home care to an aging relative. The requirements to qualify for this Medicaid benefit vary by state. An elder care lawyer can help you navigate the process of getting compensation for a caregiver.

Long-Term Care Planning

Medicaid home care can be a solution for immediate needs, but elder care lawyers also help seniors plan for future long-term care needs. This may include:

• Developing a comprehensive estate plan that aligns with Medicaid eligibility while ensuring that the senior’s assets are distributed according to their wishes.
• Establishing a guardianship or conservatorship if a senior is no longer able to make decisions for themselves. This ensures that a trusted individual manages their financial and medical affairs.

Veterans’ Benefits and Medicaid

Seniors who are veterans may be eligible for additional benefits. For instance, Aid and Attendance through the Department of Veterans Affairs can supplement Medicaid home care services. Elder care lawyers with experience in both veterans’ benefits and Medicaid can help coordinate these programs to maximize care.

Learn More About Medicaid

Qualifying for Medicaid home care is essential for low-income seniors who wish to receive care at home rather than in a nursing home. Elder care attorneys can provide critical support by helping seniors navigate Medicaid’s often complex financial and functional requirements. They can help seniors protect their assets and ensure that they receive the care they need while maintaining their financial well-being.

For families facing the challenge of securing care for aging loved ones, the guidance of an elder care lawyer can be invaluable, providing peace of mind and a clearer path forward. Speak with your elder care lawyer. They can discuss your specific situation and potential options with you.

Tax Break Helps Pay for CCRC Fees

Takeaways

• A lesser-known financial upside of Continuing Care Retirement Community (CCRCs) is the potential tax deductibility of a portion of the entrance fee and monthly fees.

Continuing Care Retirement Communities (CCRCs) provide the entire continuum of care under one roof for senior residents, from independent living to assisted living and skilled nursing care. While this model eliminates the stress and disruption of moving multiple times as care needs change, it comes with a significant financial commitment.

A little-known tax break can help defray the costs of CCRCs. That tax break and others can be used for alternative senior living options as well.

What Is a CCRC?

CCRCs, also known as life plan communities, operate on the principle of “aging in place.”

• Residents typically start in independent living units, such as apartments or cottages, enjoying a maintenance-free lifestyle with access to amenities like dining venues, fitness centers, social activities, and transportation services.
• If residents require help with daily tasks like bathing, dressing, or medication management, they can transition to assisted living, where they receive personalized support while maintaining as much independence as possible.
• For those who need 24-hour medical care and supervision, skilled nursing facilities within the CCRC provide comprehensive health care services.
• Specialized units offer a secure and supportive environment for individuals with Alzheimer's disease or other forms of dementia.

CCRCs are one of many senior living arrangements that are growing in popularity as the U.S. population ages, lives longer, and drives demand for senior housing across various levels of assistance.

There are around 2,000 CCRCs in the U.S., most of them concentrated in areas with higher populations of older adults, such as California, Florida, and the Northeast, although the Midwest has a high concentration of CCRCs relative to its senior population.

After a dip during the pandemic, CCRC occupancy rates are rebounding and were at around 85 percent to 90 percent in the third quarter of 2024. Industry analysts break down occupancy rates between facilities that charge one-time entrance fees (entrance-fee CCRCs) and those that operate on a month-to-month basis and don’t require an upfront entrance fee, but may have higher monthly costs (rental CCRCs).

The profile of a CCRC resident skews towards health-conscious, socially engaged, and independent-minded seniors who want to maintain their autonomy for as long as possible but also desire a stable living environment that can meet their future health needs.

CCRC residents also tend to be financially secure “life planners” who have chosen this arrangement carefully and with considerable savings — reflecting the fact that CCRCS are not the cheapest senior housing option.

CCRC Costs

Most CCRCs have two primary costs:

• Entrance Fee: This one-time payment can range from tens of thousands to hundreds of thousands of dollars or more, depending on factors like location, accommodation size, and contract type. The average cost of CCRC entrance fees is approximately $400,000.
• Monthly Fees: Monthly CCRC fees range from $2,000 to $5,000 or more and cover ongoing services, including maintenance, meals, utilities, amenities, and access to health care. The average rent for a CCRC in 2023 was $3,450.
  The structure of these costs, in particular the entrance fee, which may or may not be refundable, is largely dependent on the type of contract.
• Life Care (Type A): Offers unlimited access to health care services with minimal or no increase in monthly fees as care needs escalate. Type A contracts are more predictable but usually have the highest entrance fee.
• Modified Contract (Type B): Includes a preset amount of health care services in the monthly fee. If residents require care beyond this limit, they pay for it on a fee-for-service basis.
• Fee-for-Service (Type C): Fee-for-service contracts have the lowest entrance fee and focus primarily on independent living. Residents pay for health care services as needed.

Some CCRC contracts allow for a full refund of the entrance fee to a resident or their estate, regardless of how long they lived in the community. Others have a tiered, partially refundable entrance fee based on a percentage (e.g., 50 percent, 75 percent, or 90 percent) that may decline over a set period, eventually reaching zero over a certain number of years, or remain fixed.

Tax Benefits of CCRCs

A lesser-known financial upside of CCRCs is the potential tax deductibility of a portion of the entrance fee and monthly fees.

Because CCRCs provide a full range of health care services, when residents enter one of these facilities, they are contracting for future health care. These health care services may be considered qualified medical expenses under IRS rules and eligible for a tax deduction.

If your medical expenses are more than 7.5 percent of your adjusted gross income, you may be able to deduct some health care costs from your taxes.

The exact percentage of CCRC fees that are tax deductible varies considerably from CCRC to CCRC. The amount doesn’t depend on the health care services that an individual resident actually received, but rather the aggregate for the entire community.

The CCRC is responsible for informing residents about the percentage of its fees that are for medical costs. Expenses allocable to medical care include nursing care and medical equipment, in addition to amenities like meals and housekeeping that are deemed medically necessary.

Here are the basics of how the CCRC deduction works:

• If the CCRC’s entrance fee is nonrefundable, the IRS considers a portion of that fee to be prepayment of medical expenses.
• If the entrance fee is refundable, the tax deduction only applies to the portion of the fee that is nonrefundable.
• Part of the monthly fee may also be deductible.
• To claim a deduction, your total medical expenses, including those from the CCRC, must exceed 7.5 percent of your adjusted gross income (AGI). Your AGI is your total gross income minus specific deductions. 
  For example, if your AGI is $100,000, you can only deduct medical expenses exceeding $7,500.
• Each CCRC calculates the percentage of its fees that qualify as medical expenses by analyzing their overall costs related to providing health care services to all residents.
• The CCRC sends residents a Form 1099-MISC, outlining the deductible portion of their expenses.
• You must itemize deductions on Schedule A of Form 1040 to take advantage of the deduction.
• You don’t have to be actively using health care services to claim the deduction. It is available from day one, even if you don’t need health care immediately upon moving in.

The percentage of CCRC fees considered deductible can change from year to year, depending on the CCRC’s costs. Different contract types and fee structures can also impact the amount of the potential deduction.

CCRC Alternatives and Other Senior Living Tax Breaks

Data shows that the percentage of the U.S. population age 65 and older increased 34 percent from 2012 to 2022. By 2040, the 65+ demographic is expected to increase from 17 percent of the population to 22 percent.

The graying U.S. populace is driving demand for senor living facilities that provide varying levels of assistance. Housing experts estimate a need to deliver more than 42,000 new senior housing units annually to meet demand. Higher demand, plus factors like inflation and rising operating expenses, are leading to an overall cost increase for senior housing. Recent reports show increases of 5 percent or more year-over-year.

CCRCs are part of the senior housing mix, but lifestyle and cost factors mean they aren’t right for everyone. In addition to CCRCs, there are housing arrangements available to seniors that may cost less while still providing tax advantages.

• Aging in place with home modifications: If you make home modifications for medical reasons (e.g., installing a ramp due to limited mobility), the costs may qualify as deductible medical expenses, subject to the 7.5 percent AGI threshold. Some federal and state programs, such as the Older Adult Home Modification Program, also give tax credits to seniors or individuals with disabilities who make home modifications to improve accessibility.
• Assisted living facility: A portion of assisted living expenses may be deductible as medical expenses if the resident is considered “chronically ill” by the IRS and requires assistance with activities of daily living (ADLs) like bathing, dressing, and toileting.
• Memory care facility: The resident of a memory care facility who meets IRS chronic illness criteria may qualify for the medical expense deduction. Deductible expenses might cover nursing services, medication management, therapy, and personal care services. Some CCRCs have memory care units, and residents of these units may be able to deduct a portion of their fees.
• Independent living communities: Independent living facilities are usually considered housing, not health care facilities, so their costs are generally not deductible. However, if the community provides some medical services, those specific health care costs might be deductible.
• Dependent Care Credit: Those who pay for assisted living for a parent or other qualifying relative might be eligible for the dependent care credit if they meet certain dependency requirements.

Choosing the right living arrangement is a major decision for seniors that impacts their long-term health, style of living, and finances and requires planning ahead, sometimes years in advance. Rising costs can make it difficult for older Americans, especially those with fixed incomes, to afford senior housing, but tax breaks may help to make CCRCs and other arrangements more affordable.

Contact your elder law attorney to discuss the different senior housing options available and whether you are eligible to deduct medical expenses associated with senior living from your taxes.

Protecting Your Parents' Assets From Nursing Home Costs

Takeaways

• Nursing home care costs have been rising over time, with many older Americans who require long-term care unable to afford it.

• With proper planning, seniors may be able to rely on Medicaid to pay for this care – and still retain some of their assets – by exploring several different strategies.

The aging U.S. population means that more people will likely need nursing home care in the coming decades. Meanwhile, the cost of nursing home care is increasing — and expected to keep increasing.

With the exorbitant cost of nursing home care, many families worry about depleting their loved ones’ life savings to pay for the care they need. Private health insurance does not cover nursing home care, and while long-term care insurance is available to cover nursing home costs, these plans are also expensive and may come up short for long-term stays.

This leaves millions of Americans reliant on Medicaid to pay for nursing home care — a far from perfect solution that usually involves spending down assets to qualify. With proactive Medicaid planning, though, it is possible for someone to qualify for Medicaid and still retain some of their assets. The sooner you start planning, the more options you’ll have for protecting your parents’ assets from nursing home costs.

Odds of Needing Long-Term Care Are High

The lifetime likelihood of needing nursing home care is relatively high. About 70 percent of people who turn 65 today will eventually need some type of long-term care, including nursing home care.

About 1.3 million Americans aged 65 and older currently live in nursing homes, and about 40 percent of today’s 65-year-olds will spend some time in a nursing home before the end of their lives.

Women are more likely than men to need long-term care, and the older a person gets, the more likely they are to need it. At the same time, there has been a growing trend of younger adults (those under the age of 65) living in nursing homes, in part due to Medicaid eligibility expansion under the Affordable Care Act. Research shows that this group increased from 10.6 percent of total nursing home residents in 2000 to 16.2 percent in 2017.

Medicaid expansion has led to more people of all ages qualifying for the joint federal and state health insurance program. Intended as the “payer of last resort” when it comes to long-term care, Medicaid has become the primary nursing home insurance for millions of Americans due to the absence of any other public program covering long-term care.

In 2020, around 6 million Medicaid enrollees used the program to pay for long-term support and services. Around one in five enrollees received institutional care, such as care provided at a nursing facility.

After age 65, more than a quarter of adults receive at least 90 days of nursing home care. Thirteen percent of them receive long-term Medicaid-financed nursing home care.

Medicaid typically pays for 100 percent of nursing home costs and may be the only insurance option available for long-term stays. Long-term care insurance can be purchased, but most policies have limits on the maximum daily or monthly benefit amount and the total lifetime benefit, as well as terms and health requirements that may exclude coverage.

A nursing home stay isn’t necessarily permanent. About 15 percent to 20 percent of admissions are for short-term rehabilitation. Among current residents, the average stay is one year and four months. More than half of residents stay for at least 100 days, while 15 percent of older adults spend over two years in a nursing home.

With nursing home costs running $250 to $300 per day in some states, costs can add up quickly. The average nursing home stay of little over a year, or about 485 days, could end up costing upwards of $150,000.

Extrapolate these costs over multiple years, and they are unsustainable for many families.

Medicaid Planning Strategies

Whether a nursing home stay lasts months, years, or is permanent, you may have crunched the numbers and determined that Medicaid is the only feasible payment option for a parent’s nursing home care.

This is a “good news, bad news” scenario. The good news is that it’s possible for somebody who doesn’t currently meet Medicaid’s income and asset limits to “spend down” their excess assets to meet limits. The bad news is that these limits are generally only $2,000, which requires significant planning, since the average net worth of Americans is more than $1 million, including nearly $1.8 million for those 65 to 74.

Another upside is that not all a person’s assets count against the limit. A home, for example, is typically exempt. Someone can also own one car without exceeding Medicaid’s asset limits.

Many Medicaid spend down strategies take advantage of workarounds that allow nonexempt assets to be converted to exempt assets, thereby excluding them from Medicaid calculations. But these strategies often involve navigating a tricky five-year “lookback period” where past asset transfers are scrutinized to ensure applicants don’t give away assets to qualify for Medicaid.

Keeping these considerations in mind, there are financial planning strategies that can help to protect a parent’s assets from nursing home costs and a Medicaid spend down.

Medicaid-Compliant Annuities (MCAs)

MCAs, a type of single premium immediate annuity, allow countable assets (like cash or investments) to be converted into a stream of income that doesn’t count toward the Medicaid asset limit. The payout structure must be based on life expectancy, and once purchased, the annuity cannot be cashed out or changed; funds in the annuity are no longer accessible as assets.

Annuity income may affect your parents’ eligibility for other needs-based government programs, such as Supplemental Security Income (SSI). In addition, the state Medicaid agency must be the primary beneficiary in case of the annuitant’s death during the annuity period.

Medicaid Asset Protection Trusts (MAPTs)

Medicaid-compliant trusts, like MAPTs, hold assets for a set period, after which they transfer to beneficiaries (usually children or other family members).

Assets in the MAPT are no longer considered part of your parents’ estate for Medicaid purposes. They are legally owned by the trust, not your parents, although they may be able to benefit from these assets, such as remaining in a home transferred to a MAPT.

Creating a MAPT triggers a penalty period of Medicaid ineligibility under the lookback period that’s based on the value of assets transferred. A MAPT is therefore most effective when implemented well in advance of potential Medicaid need, often in conjunction with a parent’s estate plan.

Promissory Notes

A promissory note is a legal agreement that allows your parents to lend money to someone (e.g., a family member) who agrees to repay the money with interest over time. This converts a lump-sum asset into a stream of income.

Not all states recognize promissory notes for Medicaid planning. In states that do allow them, they may be subject to scrutiny by state Medicaid agencies. The note must clearly outline the repayment terms and the interest rate must be at or above the applicable federal rate (the minimum interest rate the IRS allows for private loans).

Interest income from the loan may be taxed at a lower rate, and the terms can be customized to meet individual needs. For the Medicaid applicant, however, the effectiveness of a promissory note is largely dependent on the borrower’s ability and willingness to repay the loan.

Life Estates

A life estate lets your parents transfer ownership of their home to a child or other family member while retaining the right to live there for the rest of their lives. It removes the home’s value from their countable assets for Medicaid purposes and may protect the family home from Medicaid estate recovery, a program that empowers states to recoup Medicaid expenses from the deceased beneficiary’s estate.

Medicaid’s lookback policy applies to life estates, so the transfer must be done well in advance of needing care. Your parents may also lose some control over the property, and there could be tax implications.

Other Spend Down Strategies

A spend down strategy might additionally include a parent spending on needs or wants that can both enhance their quality of life and help them qualify for Medicaid.

• Paying off debts, making necessary home repairs, purchasing a new car, prepaying funeral expenses, or taking a family vacation are ways to spend down assets and derive an instant benefit.
• Gifting assets to loved ones outside of the lookback period can reduce countable assets and fit into a gifting while living strategy, but annual and lifetime gift tax exemptions apply.
• If only one spouse needs nursing home care, Medicaid allows the other spouse (the “community spouse”) to retain a certain amount of income and assets.

Because state Medicaid laws and individual nursing home care needs vary, there is no “one-size-fits-all” strategy for protecting a parent’s assets from nursing home costs and a Medicaid spend down. To develop a personalized plan that avoids penalties or disqualification from Medicaid in your state and also maximizes asset protection, consult with your elder law attorney.

Wendy Williams Case Shines Spotlight on Guardianships

Takeaways

• Guardianships may be necessary to protect individuals with cognitive impairments, but they can also limit personal freedom and autonomy.

• Wendy Williams’ guardianship case highlights the importance of legal representation and proactive estate planning.

Dementia is on the rise and is affecting millions of families across the United States. As dementia erodes a person’s mental faculties, they lose the ability to manage their life. This can lead to losing money through bad financial decisions or a higher risk of injury from falls or accidents at home or in the community. To help the affected person, family members sometimes have to turn to the court system to ensure the safety and well-being of their loved one.

A court can order a person with compromised mental faculties to be placed in a guardianship or conservatorship arrangement. (Note that the terms used can vary depending on the state.) These arrangements give a mentally able person control over certain aspects of the stricken person’s life. Though the intention of such an arrangement is to protect the afflicted person, it may also end up greatly limiting their freedom and sense of autonomy.

The recent guardianship struggles of Wendy Williams, former radio personality and talk show host for The Wendy Williams Show, and the previous conservatorship lawsuit involving pop star Britney Spears have brought significant attention to the complexities and potential pitfalls of such legal arrangements. Both cases underscore the delicate balance between protecting individuals with cognitive impairments and preserving their personal autonomy.

Wendy Williams’ Dementia and Guardianship

In early 2022, financial institution Wells Fargo froze Williams’ accounts, citing concerns over unusual activity. This action led to Williams being diagnosed with primary progressive aphasia and frontotemporal dementia (FTD) and placed under a court-ordered guardianship. Williams has contested the diagnosis and claims that she is capable of managing her affairs. She has described her experience under guardianship as isolating and akin to imprisonment, expressing frustration over her lack of freedom and limited access to her finances.

Britney Spears’ Conservatorship

Britney Spears’ conservatorship, which began in 2008, placed her personal and financial decisions under the control of her father and legal representatives. Spears publicly described the arrangement as abusive, highlighting forced work schedules, restricted personal freedoms, and financial exploitation. Her testimony in 2021, coupled with the #FreeBritney movement, culminated in the termination of her conservatorship later that year.

Issues and Solutions

Both Williams and Spears experienced legal constraints that severely limited their personal and financial freedoms, despite their public personas and professional successes. These cases highlight several critical issues:

• Oversight and Accountability. Guardianships can be susceptible to misuse and overreach. Regular, independent reviews are essential to ensure that such arrangements serve the person’s best interests.
• Legal Representation. Access to knowledgeable legal counsel is crucial for individuals under guardianship who wish to challenge unjust arrangements and advocate for their rights.
• Public Advocacy. Awareness campaigns, such as the #FreeBritney movement, can shed light on potential abuses within guardianship systems and drive legislative reforms.

FTD and Related Impairments

FTD is a group of brain disorders affecting the frontal and temporal lobes, leading to changes in personality, behavior, and language. Unlike other forms of dementia, FTD often manifests at a younger age, typically between ages 45 and 65. Symptoms vary from person to person but may include impulsive actions, inappropriate social behavior, and language difficulties. People with FTD may have a family history of this type of dementia.

Aphasia affects the frontal lobe of the brain, impairing speech and language abilities, comprehension, reading, and writing. These cognitive impairments can hinder a person’s capacity to manage their personal and financial affairs, sometimes prompting the establishment of a guardianship. As progressive conditions, FTD and aphasia both tend to come with symptoms that get worse over time.

As of this writing, Williams’ guardian, Sabrina Morrissey, and her team are calling for a new medical evaluation to confirm Williams’ diagnosis.

The Importance of Estate Planning

Proactive estate planning is vital for safeguarding one’s autonomy and ensuring that personal wishes are honored in the event of cognitive decline. Key components of your estate plan may include the following:

• Advance Health Care Directive. This legal document outlines preferred medical treatments and designates decision-makers if one becomes incapacitated.
• Durable Power of Attorney (POA). A POA appoints a trusted individual to handle financial, medical, and/or legal matters on one’s behalf.
• Living Will. This legal instrument allows one to specify their desired end-of-life care and medical interventions.

Facing a dementia diagnosis can be distressing. You want to have peace of mind that your wishes regarding your care will be respected. With an attorney’s help, you can set up these legal measures to maintain better control over your affairs and reduce the likelihood of unwarranted guardianship interventions as your cognitive abilities decline.

Learn More About Coping With Dementia

The experiences of Williams and Spears serve as cautionary tales, emphasizing the need for vigilant oversight, robust legal protections, and comprehensive estate planning to protect personal autonomy and prevent potential abuses within guardianship arrangements.

Reach out to your elder law attorney if you have questions about how to care for a loved one with dementia or to plan ahead for the possibility of dementia. These professionals can offer expert help with long-term planning and health care for those diagnosed with dementia.

An attorney can help set up a guardianship if needed but also explore less restrictive options. They can aid in navigating the complexities of Medicaid and other programs that may help cover long-term care. This may include asset protection strategies, such as creating a trust, to prevent losing the patient’s wealth to long-term care costs.

Your elder care lawyer can also assist in identifying and preventing financial abuse of people with dementia, by securing financial accounts or addressing fraud or neglect concerns. If the dementia is severe, they may be able to help secure disability benefits or other assistance the person qualifies for.