Fong Law Group

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?

Medicaid Applicants: Protecting Your Healthy Spouse in 2025

For millions of seniors nationwide, Medicaid provides a safety net for people who find themselves requiring long-term care. Most Americans aged 65 and older – roughly 70 percent – will need these kinds of services in their later years, according to research. Meanwhile, the cost of long-term care has been rising with every passing year. In 2023, the national median cost for a semi-private room in a nursing home reached nearly $9,000 a month.

Medicaid Coverage

Run jointly by the federal and state governments, Medicaid – which sometimes goes by other names, depending on your state – provides health insurance to low-income populations. If you need to seek Medicaid coverage for long-term care, you may be aware that you must meet strict income and resources limits to qualify. In most states, you cannot have more than $2,000 in “countable” assets to your name to receive these benefits.

So, what happens if you are married? Does your healthy spouse have no choice but to live in poverty? Fortunately, no – states permit the healthy spouses of Medicaid applicants to retain a certain amount in resources to protect them from becoming impoverished.

Community Spouse Resource Allowance for 2025

Each year, the Centers for Medicare & Medicaid Services (CMS) issues updated Community Spouse Resource Allowance (CSRA) figures. These CMS guidelines outline how much of the couple’s assets the healthy spouse can keep while their Medicaid spouse gets the long-term care support they need. Generally, the CSRA increases each year.

Starting January 1, 2025, a spouse who lives at home while their partner receives Medicaid long-term care benefits can retain up to $157,920 in assets (an increase from $154,140 in 2024). Some states apply a maximum CSRA as well as a minimum CSRA. Under federal law, the minimum CSRA in 2025 will be $31,584. State Medicaid programs can then set their own limits within these federal guidelines.

Monthly Maintenance Needs Allowance for 2025

If you receive long-term care benefits through Medicaid while your healthy spouse continues residing at home, you may feel better knowing that your partner can also keep a minimum amount of income each month. The federal government calls this their monthly maintenance needs allowance (MMNA). In 2025, the maximum MMNA will be $3,948 (an increase from $3,853.50 in 2024).

Work With an Elder Law Attorney

The rules for Medicaid can quickly become complex and often vary widely by state. To ensure that you are pursuing the best coverage options for your situation, speak with a qualified elder law attorney in your area.

License Renewals: What Are the New Rules for Senior Drivers?

For better or for worse, our current culture depends heavily on cars to get where we need to be. In many places across the United States, cars serve as the only convenient link to the outside world.

Today, seniors aged 70 and older drive fewer miles than younger drivers, according to the Insurance Institute for Highway Safety (IIHS). Older drivers are also among the safest of all drivers, one AAA report showed. Nonetheless, state senior driving laws vary widely across the country.

Driver’s License Renewals and Age Restrictions

No state will revoke a driver’s license based only on the driver’s age. However, some states have placed restrictions on license renewals for elder drivers. Other states do not base license renewals on age, and still others have fewer requirements for older drivers.

The states that put age restrictions on license renewals do so in a number of ways. Many have shorter renewal periods for people over a certain age. These periods can vary widely.

For example, Arizona requires everyone aged 65 and older to renew their license every five years as opposed to every 12 years for people under age 65.

In Pennsylvania, drivers 65 and older have the choice to renew their license every two years instead of the standard four years.

In Illinois, drivers between the ages of 81 and 86 can renew for two years rather than four. For a driver aged 87 or older, the renewal period shortens to one year.

Some states, like Colorado and Washington state, require senior drivers to pass a vision test when renewing a license. Another way states monitor older drivers is by mandating drivers over a certain age to renew their licenses in person. In addition, one state – Illinois – requires a driving test if the driver is 75 years old or older.

Not all states put restrictions on license renewals. However, all state Departments of Motor Vehicles, Highway Safety, or Transportation have an office where a family member or health care professional can make a referral about an unsafe driver. The state office will investigate the claim, and the driver may have to take a road test.

Doctors are generally not required to report patients they feel are unsafe. In California, however, doctors must report dementia patients and in California and a few other states doctors must report patients with epilepsy.

The IIHS provides a state-by-state guide on license renewal procedures. However, be sure to contact your local motor vehicle services agency for the latest information.

Other Resources for Aging Drivers and Their Loved Ones

For alternative transportation options in your area, consider public transportation, a call-and-ride program, or Uber Caregivers. Uber Caregivers is a newly launching service that seeks to make it easier for patients get to medical appointments.

Proposed Medicare Bill to Help Seniors With Medical Costs

In the ever-evolving landscape of health care, one critical challenge has been ensuring that Medicare recipients receive the coverage they need without undue financial burdens. A new legislative effort aims to address a particularly perplexing issue: the distinction between hospital observation status and inpatient status, and its effects on Medicare coverage.

Understanding Observation Status

Observation status is a classification hospitals use to determine the billing for Medicare patients. When a patient is under observation, the hospital technically considers them outpatients. (This is the case even though the patient may stay overnight or for several days in a hospital bed and receive similar care to that of an inpatient.) An inpatient is someone who has been formally admitted to the hospital.

Characteristics of Observation Status

• Temporary and Evaluative: Observation status is generally intended for patients who need short-term monitoring or further testing to determine if they should be admitted as an inpatient or if they can be discharged.
• Billing Implications: Since observation status is classified as outpatient care, patients may face higher out-of-pocket costs compared to inpatient stays, especially if they need to transition to a skilled nursing facility for further care.
• Clinical and Financial Effects: Observation status can affect clinical decisions and financial burdens for patients, as it often leads to confusion and unexpected expenses due to its distinction from inpatient care.

Challenges With Observation Status

The main challenge with observation status lies in its effect on Medicare coverage. Under current Medicare rules, time spent under observation does not count toward the three-day inpatient stay requirement for skilled nursing facility (SNF) coverage. This can lead to significant out-of-pocket costs for patients who need skilled nursing care after leaving the hospital but who did not meet the inpatient criteria.

“When seniors require hospitalization, their focus should be on their health and getting well, not on how they were admitted,” Sen. Susan Collins (R-ME), a co-sponsor of the bill, said in a news release. “Yet currently, many older Americans face severe financial consequences due to the distinction between an observation stay and inpatient admittance.”

Medicare’s Three-Day Stay Rule

Medicare’s three-day stay rule is a policy that requires a patient to have a minimum of a three-day inpatient hospital stay to qualify for Medicare Part A coverage of SNF care. This rule has significant implications for patients and their access to necessary post-acute care services.

Details of the Three-Day Stay Rule

• Inpatient Requirement: To be eligible for coverage of SNF care under Medicare Part A, you must have been an inpatient for at least three consecutive days.
• Exclusion of Observation Days: Days spent under observation status, even if in the hospital, do not count toward this three-day requirement. This can potentially disqualify patients from SNF coverage despite having spent time in the hospital.
• Financial Consequences: Patients who do not meet the three-day inpatient requirement may face substantial costs for SNF care. This can be financially burdensome and limit access to necessary rehabilitative services.

The Effect on Patients

The three-day stay rule can create a significant barrier for patients who require SNF care after a hospital stay. Many patients who have been under observation status might not meet the inpatient criteria. As a result, they may fail to qualify for Medicare coverage of subsequent skilled nursing care. This often leads to out-of-pocket expenses that can be challenging for many, particularly older adults on fixed incomes.

The Improving Access to Medicare Coverage Act

The Improving Access to Medicare Coverage Act is a bipartisan legislative proposal introduced to amend a critical shortcoming in Medicare coverage related to hospital stays. The primary goal of the bill is to ensure that time spent under observation status in a hospital counts toward the necessary days for Medicare coverage of subsequent SNF care.

Key Provisions

• Observation Status Inclusion: The Act proposes that observation status counts toward the three-day hospital stay requirement for Medicare coverage of SNF care.

• Patient Protection: By addressing the observation status issue, the Act aims to protect patients from unexpected high costs associated with not meeting the inpatient requirement for Medicare Part A coverage of SNF care.

• Improved Coverage and Access: The Act seeks to ensure that Medicare recipients have better access to necessary post-acute care services without the financial strain caused by the current policy limitations.

The introduction of this Act highlights the need for a more equitable system that recognizes the reality of hospital care, where observation status can often involve the same level of care and duration as inpatient status.

How the Act Addresses the Issues

The Improving Access to Medicare Coverage Act aims to rectify the disparities caused by the current policy by including observation status in the calculation of the three-day hospital stay. This change is intended to:

• Enhance Equity: By counting observation days toward the three-day requirement, the bill would provide a more equitable system that acknowledges the reality of patient care needs.

• Reduce Financial Burden: The Act would alleviate the unexpected costs associated with the current exclusion of observation status, making post-acute care more affordable for Medicare beneficiaries.
• Improve Access to Care: Ensuring that more patients qualify for Medicare-covered SNF care would improve access to necessary rehabilitative services, promoting better health outcomes and quality of life for older adults.

“This bipartisan bill would deem time spent in observation status as inpatient care for the purpose of the Medicare three-day prior hospital stay requirement for skilled nursing care, which will help insulate older Americans from undue out-of-pocket costs and ensure that they get the care that they need,” said Sen. Collins.

The Improving Access to Medicare Coverage Act represents a significant step toward addressing the complexities and inequities of Medicare coverage related to hospital stays. By including observation status in the calculation of the three-day inpatient requirement, the Act seeks to ensure that patients receive the care they need without facing unnecessary financial burdens. This legislative effort underscores the importance of continually assessing and updating health care policies to meet the needs of the population and to provide fair, comprehensive access to essential health services.

Learn More About Medicare

You can learn more about Medicare benefits and your rights by contacting your elder law attorney today. They can discuss your specific situation and your options with you.

HUD Housing Programs That Support Aging in Place

Ninety-three percent of adults 55 and older want to remain in their homes as they age, according to U.S. News & World Report. “Aging in place” involves growing old comfortably and safely in one’s dwelling.

As adults age, they may want to remain in their homes and communities for several reasons. For one, remaining in one’s own residence preserves independence.

When older adults remain in their home, they can continue local activities they enjoy and maintain their routines. They may be better able to maintain their quality of life.

Staying in the same community fosters social support. It makes it easier to sustain relationships with friends, neighbors, and community members. Seniors who need long-term care services also may be able to receive at-home care.

Several barriers can prevent seniors from aging in place. Rising housing costs, home maintenance, and lack of accessibility can prompt older adults and their families to consider senior living options, such as assisted living.

The cost of housing can be a particular burden for retirees on fixed incomes. More than half of older adult renters are cost-burdened. This means that they spend more than 30 percent of their income on housing, per the Joint Center for Housing Studies of Harvard University.

The Department of Housing and Urban Development (HUD) administers programs that can help older adults age in place. HUD programs supporting seniors include the Section 202 Supportive Housing for the Elderly Program and the Section 8 Housing Choice Voucher Program. Note that moving residences to participate in one of these programs may be necessary. However, these programs can help older adults remain in communities rather than entering assisted living or long-term care facilities.

Section 202 Supportive Housing for the Elderly Program

The Section 202 Supportive Housing for the Elderly Program incentivizes the creation of housing for low-income older adults. The program funds eligible private and nonprofit sponsors to create senior housing.

Section 202 housing provides support services essential to aging in place, such as cleaning, cooking, and transportation. This type of housing is available to households with at least one adult 62 years old or older. The individual or family must meet the program’s income requirements. The household income must be less than 50 percent of the Area Median Income (AMI) for the property’s location.

Residents of Section 202 properties typically pay 30 percent of their adjusted household income for rent. The federal government covers the remaining costs.

To find Section 202 properties, consider reaching out to a HUD-approved housing counselor for guidance. Note that, as HUD does not handle leasing, prospective renters must contact a property manager or owner directly.

Section 8 Housing Choice Voucher Program

Through the Section 8 Housing Choice Voucher Program, low-income renters who are older can select privately owned housing of their choice that meets program requirements. This gives older renters greater flexibility in choosing housing that meets their needs. For example, they may be able to look specifically for accessible housing.

Public Housing Agencies (PHAs) administer this program under HUD. Participating households receive a voucher. The program pays a housing subsidy directly to the landlord for the participating family or individual.

To be eligible for Section 8 housing, families and single people must meet certain requirements. Generally, their income can be at most 50 percent to 80 percent of the median income for their region.

Apply for the Section 8 Voucher Program by contacting your local PHA. HUD offers an agency directory. While waiting lists for Section 8 Housing can be long, some PHAs prioritize older applicants. HUD permits PHAs to prioritize certain applicants, which can include older adults.

Speak to Your Elder Law Attorney

Both Section 202 and Section 8 programs offer housing for low-income people. However, Section 202 specifically serves households with older adults. Section 8 housing is available to low-income households, including but not limited to families with older members.

Section 202 participants are more limited in their housing choices. They must reside in specific approved properties. Meanwhile, Section 8 participants have greater housing choice.

You may wish to remain in your home for as long as you can do it safely. As you consider housing options for aging in the community, your elder law attorney can help. They can assist you in identifying relevant housing programs and applying for Section 202 or Section 8 housing. 

States With the Highest and Lowest Assisted Living Costs

Today, 58 million adults in the United States are 65 and older. Seniors make up more than 17 percent of the American population. The U.S. Census Bureau expects this number to reach 83.7 million by 2050.

Meanwhile, one in every seven older adults will at some point need to rely on long-term care services in their later years. As a result, the growing number of aging Americans is creating an increased need for assisted living options.

What Is Assisted Living?

Assisted living is one type of long-term housing and care option for seniors. These facilities offer residential housing for older adults who need assistance with activities of daily living (ADLs). ADLs include such everyday tasks as bathing, dressing, preparing one’s meals, housekeeping, and managing one’s medication. Unlike nursing homes, assisted living facilities do not provide around-the-clock medical care to their residents.

The National Center for Assisted Living reports that there are currently more than 30,600 assisted living facilities and 1.2 million licensed beds in the U.S. According to the National Investment Center for Seniors Housing and Care, the senior housing occupancy rate rose for the ninth consecutive quarter, just surpassing 84 percent in late 2023. (The pre-pandemic rate, as of the first quarter of 2020, was 87 percent.) With this rising occupancy rate, the demand for assisted living is outpacing the number of beds available.

Seniors seeking information on assisted living options may find recent data from the Seniorly Resource Center particularly useful. The Center’s newly issued 2024 report sheds light on the costs of assisted living – from the most to the least expensive – across the U.S.

The Cost of Assisted Living

Across the country, assisted living costs an average of $4,401 monthly, increasing by 8 percent from 2021 to 2023.

During this timeframe, average assisted living costs grew in 30 states, remained about the same in six states, and fell in 15 states.

• Wyoming saw the most considerable increase. There, assisted living costs leapt by 53 percent between 2021 and 2023, from an average of $3,845 per month to $5,894 per month.
• In both New Hampshire and West Virginia, average fees rose by 46 percent. With average monthly costs rising from $5,644 to $8,248 in New Hampshire, it stands as the single most expensive state for assisted living. In West Virginia, assisted living prices went from $3,327 to $4,846 per month.
• Fees decreased by 15 percent in three states between 2021 and 2023. In Indiana, average monthly costs reduced from $4,328 to $3,695. Iowa fees lowered from $4,013 to $3,420. Washington State’s monthly assisted living fees went from $4,995 to $4,176 on average.

The Most Expensive, and Most Affordable, States for Assisted Living

While the prices of assisted living options can vary even within states, the findings identified the states with the highest and lowest fees on average.

As mentioned above, New Hampshire has the highest average monthly cost of assisted living at $8,248. Meanwhile, Louisiana has the lowest average monthly rate of $2,946.

The 10 most expensive states for assisted living, with monthly costs averaging above $5,000, are mainly located in New England and the Mid-Atlantic, reflecting the number of higher-end options available in these regions.

In-Home Care

Many seniors and their families may weigh assisted living against in-home care. Similar to assisted living, in-home care varies in affordability across states. An in-home aide costs an average of $5,462 per month in the United States.

• Minnesota is the most expensive state for home health aides, costing an average of $7,333 per month. Compared with in-home care, assisted living is in fact more affordable there, with an average cost of $3,472 per month.
• In West Virginia, home health costs an average of $3,793 per month, while assisted living costs an average of $4,846.

Weighing the pros and cons of assisted living versus in-home care remains essential. One 2022 study suggested that many seniors relying on in-home care were missing out on necessary assistance compared with those living in a residential facility setting.

Paying for Assisted Living

In addition to the rising costs of assisted living in many places, the Seniorly report points out that inflation has exceeded the Federal Reserve’s 2 percent target since March 2021. In addition, The New York Times also reports that senior living costs have risen faster than inflation.

Given the high costs of assisted living and in-home care, paying for care can be challenging for many families. Medicare does not cover assisted living room and board. Medicaid generally does not cover these costs, either; however, numerous states offer Medicaid assisted living waivers that can help. Unfortunately, waiting lists for such waivers may be lengthy.

According to Seniorly’s report, the typical American must save for about 17 years to be able to afford a single year of assisted living costs. To calculate this, it used the Census Bureau’s 2022 median annual household income and assumed 4.1 percent savings. Based on these estimates, it would take nearly 27 years of savings to pay for a year of assisted living in New Hampshire or about 12 years to afford a year of assisted living in Maryland.

Navigating Senior Care: Speak With Your Elder Law Attorney

Your elder law attorney can help you or your loved one organize strategies for affording long-term care. Contact them today to create a long-term care plan that will work for you.

Avoiding Property Tax Foreclosures for Older Adults

If you are a homeowner who is falling behind on your real estate taxes, you may end up facing foreclosure on your property. Because your property taxes hinge on the value of your property, you may find your taxes rising beyond what you can afford. Before your situation becomes more serious, be sure to educate yourself. Get a better understanding of the laws regarding tax foreclosure – as well as where you can turn to get help.

Tax relief is available in many states, but you have to know how and where to access it. In some cases, you must apply for these tax exemptions, and meeting application deadlines is key. Many older adults remain unaware of such tax break opportunities. In fact, low-income senior homeowners are among those who, historically, have encountered challenges accessing tax relief.

One organization raising awareness regarding property tax relief for seniors is the National Center on Law and Elder Rights. In an FAQ resource and webinar on preventing tax foreclosures, it addresses points essential for advocates of older homeowners. Continue reading for some of the highlights that all senior homeowners should know.

Property Tax Foreclosure Laws

Tax foreclosure laws in each state permit liens against real estate, unpaid taxes, as well as property sales to collect on liens. These laws vary in each state, but there are similarities. In general, states assess taxes based on estimated property value, and tax bills are due annually.

If you fail to pay your property tax bills on time, your property could be subject to a tax lien. By placing a lien on your home, the government is in essence securing your home as collateral. This then allows the tax collector to auction or sell your home, if necessary, to pay off your tax debt.

Homeowners do have options to stop the tax sale process at different stages. Yet the most at-risk homeowners may need the help of an advocate right away. They frequently don’t understand what actions they need to take until it’s too late.

Why Are Older Adults at Risk?

Lenders normally insist that homeowners pay their real estate taxes through an escrow account. This helps the property owner set aside the funds monthly, prior to the annual tax bill due date. In many cases, older homeowners no longer have mortgages on their homes. If they are on a fixed or limited income and don’t budget for the funds, they may have trouble making the payment.

This is why many seniors who own their homes commonly end up in the tax foreclosure process.

Increasing Homeowners’ Ability to Afford Property Taxes

With the help of an advocate, you can potentially steer clear of the risks of tax foreclosure in several ways:

• Questioning the property value assessment
• Seeking available tax abatements, exemptions, or discounts
• Contesting tax lien enforcement or property foreclosure
• Attempting to recover a property after a tax sale

Preventing overwhelming debt is the best approach to avoiding a tax sale. If a home valuation is too high, the tax assessment may be inaccurate. As mentioned above, you can in fact appeal the valuation. (Check out this AARP story featuring how one advocate assists homeowners in his community file these kinds of appeals.)

In some states, seniors are eligible for a tax exemption or abatement program that can lower their property taxes. Advocates can help homeowners understand their rights, learn about all available tax relief programs, and apply for relief.

Recent Supreme Court Ruling Regarding Tax Foreclosure Laws

In a case decided by the Supreme Court in 2023, a senior homeowner in Minnesota lost out on funds when her foreclosed home sold. Although the sale of her home paid off her property tax debt, the county did not give her any of the surplus funds from the sale.

The court ruled that the government could not foreclose on the woman's property and keep her home equity after paying off her tax debt. This could, the court stated, also apply in situations where a private purchaser buys a tax lien. As this means that homeowners have a right to receive any surplus equity, many states will need to revise their tax foreclosure laws.

States also must give proper notice to property owners and other parties interested in the property. This way, they have sufficient time to take necessary action, including contesting the foreclosure or fulfilling their tax debt.

Heirs at Risk of Property Tax Foreclosure

Per the National Center on Law and Elder Rights, heirs who inherit their family home may be at high risk for property tax foreclosure. However, they, too, are eligible to apply for available tax relief. Be sure to research programs in your state to understand what discounts and exemptions you may be able to access. Consider seeking out the help of your elder law attorney to assist you.

Tax Relief Resources

For senior homeowners, property tax liens and foreclosures can take away their ability to:

• age in place,
• benefit from the equity in their home, and
• pass wealth on to their loved ones.

Nationwide, community engagement organizations seek to protect older homeowners from losing their homes to property tax foreclosure. Elder abuse scams threatening tax foreclosures also pose a risk to seniors.

A variety of tax relief programs exist to assist homeowners who are having trouble affording their household-related expenses. For example, many cities offer some kind of tax relief program for senior homeowners and other populations. Additional resources, such as the following, may also benefit you:

• Homeowner Assistance Fund. This federal program, established in 2021, helps homeowners facing financial strain as a result of the COVID-19 pandemic. Find support through this program in your state.
• Foreclosure Prevention Housing Counseling. Through the U.S. Department of Housing and Urban Development (HUD), you can seek the help of certified housing counselors. These individuals can help you understand, prepare for, and potentially avoid the foreclosure process. Search for a HUD housing counselor near you.
• Retiree Tax Map. Kiplinger's offers a free nationwide guide outlining what tax credit programs may be available to retirees in each state.

In addition, your elder law attorney can help ensure you are able to hold onto your home. If you or a loved one is facing a property tax lien or foreclosure, contact your attorney. They are familiar with state laws and programs that benefit seniors and can move quickly to help you get tax relief.

Senators Propose Boosting Seniors' Social Security Benefits

Millions of seniors nationwide are among those who rely on the financial support they receive each month via their Social Security benefits checks.

However, many say that these payouts have failed to keep up with inflation and the escalating prices of basic goods and services over time. One analysis showed that retirees have in fact lost significant buying power in the past two decades, all while they tend to face steep increases in health care costs as they age. As of 2023, Social Security benefits experienced one of the biggest losses of purchasing power – 36 percent – since 2000.

A newly introduced bill seeks to remedy this.

The Cost-of-Living Adjustment (COLA)

At the end of each year, the Social Security Administration (SSA) informs Social Security recipients about how much they can expect to see in their payouts for the forthcoming year. Benefits typically undergo some level of change based on the SSA’s annual cost-of-living adjustment (COLA). In 2024, COLA rose slightly, by 3.2 percent. For the average retiree, that equates to receiving about $59 more per month compared with 2023.

The year prior to that, COLA had increased by 8.7 percent. Current predictions for 2025’s COLA are coming in at about 2 percent.

Today, COLA calculations are based on a metric known as the Consumer Price Index for Urban Wage Earners (CPI-W). This is where the recently proposed legislation focuses on making a change.

Boosting Benefits and COLAs for Seniors Act

In late March 2024, U.S. Sen. Bob Casey (D-PA) introduced the Boosting Benefits and COLAs for Seniors Act. Four Democratic senators are serving as co-sponsors: Richard Blumenthal of Connecticut, John Fetterman of Pennsylvania, Kirsten Gillibrand of New York, and Vermont’s Bernie Sanders, plus Peter Welch, an independent from Vermont.

The Act centers on changing the formula that the SSA uses to calculate Social Security benefits for older adults. It proposes using a different metric, the Consumer Price Index for the Elderly (CPI-E). Incorporating the CPI-E into the equation would, according to advocates, better reflect the specific types of costs facing subgroups like seniors.

As co-sponsor Sen. Gillibrand puts it, the bill would “factor the high cost of health care into Social Security benefits calculations.” In turn, this would mean bigger payouts for seniors and, she adds, would “help make sure recipients aren’t forced to choose between paying for their medication and buying other necessities.”

Nearly a dozen different agencies, including Arc of the United States, the Alliance for Retired Americans, and Justice in Aging, have endorsed the bill.