Fong Law Group

Which Nursing Home Rating System Should You Trust?

Choosing a Nursing Home for a loved one is a difficult decision and it can only be made more confusing by the various rating systems. A recent study found that using both Medicare’s Nursing Home Compare site and user reviews can help with the decision making. 

The official Medicare website includes a nursing home rating system. Nursing Home Compare offers up to five-star ratings of nursing homes based on health inspections, staffing, and quality measures. However, Medicare’s rating system is far from perfect. The staff level and quality statistics ratings are based largely on self-reported data that the government does not verify. The ratings also do not take into account state fines and enforcement data or consumer complaints to state agencies.  Nursing homes have learned how to game the system to improve their ratings. 

While Nursing Home Compare doesn’t include consumer feedback, Yelp and other online platforms like Facebook, Google, and Caring.com allow users to review individual nursing homes. These user reviews are highly subjective, and it can be difficult to judge their legitimacy. These reviews are not usually taken seriously--for example, consumer guides to finding a nursing home do not usually suggest that consumers consult online reviews.  (It should be noted, however, that Caring.com goes to great lengths to ensure the integrity of its reviews, including having senior care experts read every submission before publication.) 

In order to better understand what consumers were saying about nursing homes online, researchers at the University of Southern California evaluated 264 Yelp reviews and grouped them into categories. The researchers found that consumers rate different aspects of nursing home care than does the official rating system. User reviews were more emotional and more likely to focus on staff attitudes and responsiveness rather than on the quality of health care. 

The researchers concluded that user reviews can be used in conjunction with the Nursing Home Compare site to paint a fuller picture of life at the nursing home because they present complementary information. According to the study, online reviews shouldn’t be dismissed because they “directly capture the voices of residents and family members, precisely the kind of information [nursing homes] and their consumers need to hear and may want to act on, if resident-directed care is to be achieved.” 

Yelp has gone a step further than other consumer review sites and has teamed up with the investigative news organization, ProPublica, to provide users with additional information. ProPublica's Nursing Home Inspect site, allows users to compare nursing homes based on federal data. Yelp users viewing a nursing home review page see a ProPublica box that provides information on the nursing home’s deficiencies and fines.

To read an article about the study, click here.

Staying Connected to Family Members in a Nursing Home When Visits are Banned

The spread of the coronavirus to nursing home residents has caused the federal government to direct nursing homes to restrict visitor access, and many assisted livingfacilities have done the same. While the move helps the residents stay healthy, it can also lead to social isolation and depression. Families are having to find new ways to stay in touch.  

Nursing homes have been hit hard by the coronavirus. The Life Care Center of Kirkland, Washington near Seattle was one of the first clusters of coronavirus in the United States and is one of the deadliest, with at least 35 deaths associated with the facility. In response, the Centers for Medicare and Medicaid Services (CMS) issued guidance to all nursing homes, restricting all visitors, except for compassionate care in end-of-life situations; restricting all volunteers and nonessential personnel; and cancelling all group activities and communal dining. While these actions are necessary to prevent the spread of the virus, they can leave families worried and upset and residents feeling isolated and confused. 

Families are taking varying tacks to keep in contact with their loved ones, many of whom don’t fully understand why their family is no longer visiting. Nursing homes are also helping to facilitate contact. Some options for keeping in touch, include the following: 

• Phone calls. Phone calls are still an option to be able to talk to your loved one. 
• Window visits. Families who are able to visit their loved one’s window can use that to have in-person visits. You can hold up signs and blow kisses. Talking on a cell phone or typing messages on it and holding them up to the window may be a way to have a conversation. 
• Facetime and Skype. Many nursing homes are facilitating video calls with families using platforms like Facetime or Skype. Some nursing homes have purchased additional iPads, while others have staff members going between rooms with a dedicated iPad to help residents make calls. 
• Cards and letters. Sending cards and letters to your loved ones is another way to show them that you are thinking of them. Some nursing homes have also set up Facebook pages, where people can send messages to residents. 

In this unprecedented time, families will need to get creative to stay in touch with their loved ones. For more articles about how families and nursing homes around the country are coping with the new restrictions, click here, here, and here. 

Who Gets Mom’s E-books When She Dies?

“Digital Estate planning is about organizing all your digital assets and property and making arrangements that address what will happen to them. after you die or otherwise lose the ability to use or manage them.”

Including digital assets in your estate plan, is not just for Bitcoin owners. What about less complicated digital assets, like a library of e-books or family photos that were stored in the cloud? There are a number of steps everyone needs to take, says The Eagle in the article “Your digital estate: 3 tips for the seasoned crowd.” Even if you don’t consider yourself “seasoned,” these are important steps to take to protect your online life, from fiction to finance.

Knowledgeable boomers know they need to double check their account titles, wills, trusts, insurance policies and powers of attorney. However, they don’t all realize how much of their lives is conducted online and how important those assets are to their estate plan.

Digital estate planning focuses on organizing digital assets of all kinds and making the correct arrangements for what will happen to them, after you either pass away or become incapacitated.

You don’t own any cryptocurrency? Do you have a Facebook page? Have you ever created a website or a blog? What about a LinkedIn profile? See—you have digital assets. You need a plan.

The best way to start is similar to what you do with tangible assets. Start with a list:

• Hard assets, including computers, laptops, digital readers like Kindle or Nook, smart phones and external data storage drives.
• Social media and networking sites—everything from Facebook, LinkedIn, Twitter, Instagram, Snapchat, etc. Be sure to also include any gaming websites.
• Online data storage accounts, like Dropbox.
• Domain names, regardless whether you built a website for the name.
• Intellectual property

There’s sentimental value to many of these accounts, like the photos stored in the cloud. There’s also practical value. If you pass away and your family is widespread and connects regularly on social media, would it be helpful for a family member to log into your social media accounts and share information about your passing? We used to have obituaries published in local newspapers, but today we post information online.

There may be financial value as well. If you own a website that contains copyrighted material or intellectual property, you will want an executor to gain access. You’ll also want to address the issue of your emails, especially if you are a business owner.

The next step is to review the list and see what, if any accounts, you don’t use anymore and would like to shut down. Then begin looking at each digital account you have and find out how each platform addresses access, after the owner has died or become incapacitated. Facebook allows users to memorialize the account and preserve the space for friends and families to share memories. Twitter allows immediate family members to deactivate the account, as long as proof-of-death can be documented. Google has an Inactive Account Manager service that permits the account to be transferred to a designated person, after a certain period of account inactivity.

Social media websites are increasingly aware of the issue of account owners dying, and every platform has its own process, so you’ll need to go through each, one by one.

Next, you’ll need to name a digital executor. This is not, as yet, a legally enforceable role, but it will make winding things down much easier. Your digital executor will need your passwords and user names, but they will not be able to simply log in and make changes using that information.

Reference: The Eagle (Nov. 8, 2018) “Your digital estate: 3 tips for the seasoned crowd”

Bring Your Estate Plan into Today’s Digital World 將您的資產計劃帶入今天的數碼世界 (中英對照)

“With so much of our financial information and personal information now online, estate plans today must address the fact that our digital selves will surely outlast our human selves.”

Life, as well as estate planning, used to be much more one-dimensional. Now that our lives are lived “In Real Life” (IRL) and online, estate plans need to include both aspects of our lives, according to this recent article from North Bay Business Journal titled “Your digital life likely will outlive you, so here’s how to bring your estate plan into the modern age.” You could decide not to deal with it, but then you are leaving a mess behind for your loved ones to untangle.

Here are a few of your digital assets to consider: bank accounts, email accounts, Facebook page, Linked In profile, online photo albums, blogs and websites. They’re likely to be around long after you are gone.

This is still a relatively new area of estate planning. What often happens is that heirs think they can simply find and use the decedent’s user name and passwords to access their accounts. However, what they learn is that they are legally not permitted to do so. There are state and federal laws, online platform user agreements and a host of barriers to retrieve online assets.

A new law was passed in 2017 in California that attempted to bring order to this chaos back in 2017. The Revised Fiduciary Access to Digital Assets Act allows executors and trustees to obtain disclosure of a person’s digital assets, after the original owner dies but only under certain conditions.

In the recent past, federal and state laws have made it hard for executors and trustees to gain access to these assets without a court order.

Just being the executor or trustee does not automatically give you the right to access assets. There has to be evidence that the decedent consented to disclosure and a court order may be necessary to prove the consent was correct.

The new law mainly gave social media platforms and privacy advocates what they wanted: a requirement of prior consent before disclosure.  However, the end result is that it is easier to gain access to digital assets, if executors and trustees can show that the decedent did consent to disclosure.

However, it’s still not that simple. Here are a few steps to help your loved ones deal with your digital assets:

Inventory every digital asset that you have. Create a list of log-in and password information, plus any “secret questions/answers.”

Tell your trusted family member or friend where that list is. Store it with your other estate planning documents, possibly in your attorney’s vault.

Ask your estate planning attorney how they handle digital assets. Your lawyer will know what steps are necessary in your state to ensure that someone will have legal access to your digital assets after you pass away.

Do not include your digital asset inventory, as part of your will. If your estate goes through probate, all of your account information will become part of the public record.

Many wills don’t include provisions about digital assets. If this is the case with your will, contact your estate planning attorney now to make sure your online life is as protected as your “In Real Life” life.

Reference: North Bay Business Journal (Oct. 19, 2018) “Your digital life likely will outlive you, so here’s how to bring your estate plan into the modern age”

“現今有這麼多財務及私人資料在網絡上，資產計劃今天必須解決的事實是我們的數碼資產必定是比我們自我本身恆久。”

生活以及資產規劃曾經很簡單。現在，我們生活在“現實生活中”（IRL）和網絡上，資產計劃需要包括我們這兩個方面，按照 North Bay Business Journal 題為“Your digital life likely will outlive you, so here’s how to bring your estate plan into the modern age” 你可以決定不處理，但你會留下爛攤子讓你的親人去解決。

以下是您需要考慮的一些數碼資產：銀行賬戶，電子郵件賬戶，臉書頁面，Linked In個人資料，網上相冊，博客和網站。在你離開後這些都會一直存在。

這仍然是一個相對較新的資產規劃領域。經常發生的是，繼承人認為他們可以簡單地找到並使用去世的人的用戶名和密碼來取得他們的帳戶。但是，他們得知法律上並不允許他們這樣做。有州和聯邦法律，網絡平台用戶協議及一大堆障礙去阻止他們去取得這些數碼資產。

於2017年加州通過了一項新的法律試圖把這混沌在2017年帶回正軌，數碼資產使用權限修訂可以讓執行人及受託人在原擁有人去世後在一定的條件下取得一個人的數碼資產。

最近，聯邦和州法律規定遺囑執行人和受託人在沒有法院命令的情況下很難獲得這些資產。

僅作為執行人或受託人並不會自動授予您取得數碼資產的權利。必須有證據證明得到死者同意，並可能需要法院命令來證明同意是正確的。

新法律主要為社交媒體平台和隱私主義者提供了他們想要的東西：在披露之前需事先得到同意。可是如果遺囑執行人及受託人有證據證明死者同意披露, 這樣最終結果這些數碼資產更容易被取得。

但不是那麼簡單。以下是幫助您的親人處理您的數碼資產的幾個步驟：

清點您擁有的每個數碼資產。列出所有登錄和密碼的資料，以及任何“秘密問題/答案”。

告訴您信任的親友，該列表在哪裡。將其與您的其他資產規劃文件放在一起，可能存放在您的律師中。

詢問您的資產規劃律師如何處理數碼資產。您的律師知道您所在的州的程序，以確保在您去世後有人可以合法地取得你的數碼資產。

請勿將您的數碼資產清單列入遺囑。如果您的遺產需通過遺囑認證，您所有帳戶的資料將成為公開紀錄的一部份。

許多遺囑對數碼資產沒有規定。如果您的遺囑屬於這種情況，請立即聯繫您的資產規劃律師，以確保您的網絡生活與您的“真實生活”一樣受到保障。

參考: North Bay Business Journal (Oct. 19, 2018) “Your digital life likely will outlive you, so here’s how to bring your estate plan into the modern age”

Another Reason to Update Your Will: Digital Assets 更新遺囑的另一個原因：數碼資產 (中英對照)

“Many states, including Florida, New York, California and Illinois, have recently adopted versions of the Revised Uniform Fiduciary Access to Digital Assets Act (RUFADAA). Under RUFADAA, an owner of digital property can give fiduciaries access to and disposition to manage digital assets.”

Ensuring that your property is appropriately managed and disbursed upon your incapacity or death, is no longer limited to physical or financial property. Your estate plan now needs to include digital assets, the online accounts that are in your name, says the Journal of Financial Planning in the article “Don’t Forget Digital Assets in Estate Planning.”

If your will hasn’t been updated in the past few years, chances are good it has no provision for your digital assets. This could create a larger problem than you’d think. Bank accounts, investment accounts and small business records stored in the cloud may not be accessible to heirs. That doesn’t even include sentimental items: treasured photos and videos that never made it to paper or your computer’s hard drive.

Accounting for every single bit of data may be impossible for your heirs to recreate, unless you provide them with a complete list of all online assets.  However, that’s just for starters. With federal privacy laws, most Internet companies will not be able to assure that your heirs can access these accounts, unless arrangements have been made in advance.

This is a problem with a solution.  However, it will take some work.

First, make sure your will is up to date and includes information about providing access to your digital assets to your heirs. Do not put your passwords and user names into the will—remember, it becomes a public document at probate and you don’t want to give that information to the world at large!

Next, make a list of all online accounts. It will need to be thorough. You might start by going through sites you have bookmarked, because you use them often. Email updates from sites you subscribe to provide more information. A spreadsheet might be the easiest way to manage this data but there are also apps to assist.

Look at every account to find out what their rules are, after the owner’s death or incapacity. Each platform has its own rules. Facebook lets an immediate family member or personal administrator close the account or “memorialize” it. Someone must be identified as a “legacy” contact, who can post an obituary on the Facebook timeline, archive photos and eventually close the account. Google also has an “inactive account manager” feature. Each platform has its own rules. You’ll need to review them and act as directed.

Bear in mind that some platforms will delete the accounts, if they are inactive over a certain period of time. That could mean losing business emails and many family businesses rely on one person’s email account.

Resource: Journal of Financial Planning (April 2018) “Don’t Forget Digital Assets in Estate Planning.”

“許多州，包括佛羅里達州，紐約州，加利福尼亞州和伊利諾伊州，最近都採用了經修訂的統一信託獲取數碼資產法案（RUFADAA）。根據RUFADAA，數碼資產的所有者可以為受託人提供訪問和處置數碼資產的權利。“

根據財務規劃雜誌 (Journal of Financial Planning) 的文章 “Don’t Forget Digital Assets in Estate Planning.”(不要忘記資產規劃中的數碼資產) ，確保您的財產得到妥善管理並在您的喪失工作能力或死亡而支付這些財產，不再僅限於房地產或金融財產。您的資產計劃現在需要包括數碼資產，以您的名義開設的網上帳戶。

如果您的遺囑在過去幾年內沒有更新，那麼很可能它沒有任何條款處理您的數碼資產。這可能會產生比您想像中的更大的問題。繼承人可能無法登入存儲在雲中的銀行帳戶，投資帳戶和小型商業記錄。這不包括有個人感情的物品：從未打印的照片或在電腦的硬盤中的視頻。

除非您向繼承人提供所有網上資產的完整列表，否則他們可能無法找到每一個數碼資產。但是，那是初步的。根據聯邦隱私法，大多數互聯網公司將無法確保您的繼承人可以登入這些帳戶，除非事先做出安排。

這是一個有解決方法的問題。但是，這需要一些工作時間。

首先，確保您的遺囑是最新的，並附有包含有關您的數碼資產的登入權限的信息提供給您的繼承人。不要將您的密碼和用戶名稱放入遺囑中，因為它將成為遺囑認證的公共文件，您不希望將這些信息給全世界看！

接下來，列出所有網上帳戶。並詳細說明。您可能首先瀏覽已加入書籤的網站，因為您經常使用這些網站。來自您訂閱的網站的電子郵件更新可提供更多信息。電子表格可能是管理此數碼的最簡單方法，但也有應用程序可以提供幫助。

在所有者死亡或喪失工作能力之後，查看每個帳戶以了解他們的規則是什麼。每個平台都有自己的規則。Facebook允許直系親屬或個人管理員關閉帳戶或“紀念”它。必須將某人指定為“遺產”聯繫人，他們可以在Facebook上發布通告，存檔照片並關閉帳戶。Google還擁有“非活動帳戶管理員”功能。每個平台都有自己的規則。您需要對其進行審核並按照指示行事。

請記住，如果某些平台在一段時間內處於非活動狀態，則會刪除這些帳戶。這可能意味著丟失商業電子郵件，許多家庭企業依賴於一個人的電子郵件帳戶。

參考: Journal of Financial Planning (April 2018) “Don’t Forget Digital Assets in Estate Planning.”