Pros and Cons of a Medicaid Asset Protection Trust

A Medicaid Asset Protection Trust (MAPT) is one option a person may consider to protect their assets from Medicaid and nursing homes or long-term care. A MAPT is an irrevocable trust created during your lifetime. The primary goal of a MAPT is to transfer assets to it so that Medicaid will not count these assets toward your resource limit when determining whether you qualify for Medicaid benefits. However, creating an irrevocable trust comes with a certain lack of control over the assets you transfer to this trust. Before making such a significant decision, consider some pros and cons to see if this long-term care strategy is right for you.

Benefits of a MAPT

1. You Can Still Benefit From the Assets of a MAPT Although transfers of assets to a MAPT cause you to relinquish your ownership and control of them, the finality of the arrangement is not as harsh as it sounds. In creating a MAPT, you select a person (trustee) who manages the trust assets for your benefit. So, if you transfer investment accounts to the MAPT, you can still receive the income generated from these investments. If you transfer your home, you can still live there. In exchange for giving up control of your assets to a MAPT, your assets no longer count against you for Medicaid eligibility purposes.

2. Your Assets Are Safe From Medicaid and Other Long-Term Care Creditors Once your assets are in a MAPT and other criteria are met, Medicaid can’t seize them or ask you to spend them down to pay for your nursing home or long-term care costs. These assets also are not subject to Medicaid’s estate recovery program. As a result, your heirs can benefit from the assets without the interference of Medicaid or liens it could otherwise file against your estate after you pass.

3. You Can Choose Your Beneficiaries A MAPT also functions as an estate planning tool. This is because you can designate who receives what remains of the trust upon your passing. The beneficiaries you choose will receive the assets per the terms of the trust agreement, and the chances of a probate court getting involved are diminished. In addition, you may be able to retain what is called a “limited power of appointment.” This allows you to change who the beneficiaries of the MAPT will be, should your wishes or family circumstances change.

4. Assets Are Protected From Your Beneficiaries’ Creditors Even though you can designate a MAPT’s beneficiaries now, those beneficiaries do not have full access to the trust’s assets because of how it is structured. This also means their creditors do not have access to it. And, if your child is a beneficiary and is going through a messy divorce, neither does their spouse. You can also designate how bequests to beneficiaries can be used.

5. Protection From Capital Gains Taxes A properly drafted MAPT preserves the full capital gains tax exclusion on the primary residence (currently $250,000 per spouse). Later, when a person’s beneficiaries sell the home, it would be valued at the market price at the date of gifting and not at the original purchase price. This can avoid or significantly minimize the capital gains tax that your heirs may owe.

Drawbacks of MAPTS

1. Timing Is Everything For a MAPT to function as intended, it needs to be created in advance to avoid the Medicaid lookback period. In most states, this is five years for nursing home or institutional care. In some states, there may also be a lookback period for community Medicaid care (home aides, local programs, etc.). If less than five years have elapsed since you created your MAPT, you may still be responsible for some or all of your long-term care costs until sufficient time has passed.

2. Income From MAPT Is Countable by Medicaid Although assets in a MAPT may not be “countable” by Medicaid toward your resource limit, these assets may still generate income. If this income is payable to you, it may cause you to exceed the income limit permitted in your state. If this happens to you, you may have other options, such as utilizing a pooled income trust, or may decide you will contribute partially toward your care.

3. Giving Up Control Is Non-Negotiable A trust will not qualify as a MAPT if you retain control other than the limited power of appointment that may be permitted in your situation. You must accept that a person you select to act as trustee will manage the trust, distribute funds and income from the trust, and also be the effective owner of the assets. In addition, creating a MAPT but not transferring assets to it is ineffective. You need to fully commit to the concept for it to benefit you.

4. Setting Up a MAPT Is Costly Creating and implementing a MAPT is a complex legal task requiring many hours of work and expenditures made on your behalf. In addition, because MAPTs are tied to individual state and federal laws, the expertise of a qualified Medicaid attorney is essential. You should expect that this expertise comes at the cost of several thousand dollars or more. However, your potential savings could be exponentially greater for you and your family. For this reason, the price is often well worth it.

5. Potential Effects on Care It’s important to realize that while the MAPT strategy is designed to preserve assets and wealth, it assumes that a person will rely on Medicaid to pay for a portion of their care. However, Medicaid does not cover all facilities. For example, many assisted living facilities are not licensed as assisted living programs and only accept private pay residents. Thus, relying on Medicaid could affect the choice and quality of care a person may receive.

The pros and cons discussed above are not exhaustive, and there may be other ones that apply to your situation. Investing in a MAPT is a highly fact-specific process, and MAPTs are not suitable for everyone. You should speak with your attorney to discuss how a MAPT may affect other benefits you receive, your overall estate plan, its tax consequences, and whether it is right for you.

Couple embracing.

Speak with an Attorney

Planning for your future includes making sure your estate planning is up to date and reflects your wishes. Set up a free 15-minute consultation with one of our attorneys to to discuss your planning goals. Our law firm helps families with elder law planning, special needs planning, general estate planning and probate matters.

Low-Cost and Free Education Opportunities for Older Adults: Part II

Art lecture. Image by Antenna @antenna on unsplash.

As we discussed in our earlier blog posts “The Benefits of Lifelong Learning” and “Low-Cost and Free Education Opportunities for Older Adults in Ohio: Part I,”  there are a lot of benefits to engaging in Lifetime Learning.  Fortunately in Northeast Ohio there are some wonderful low cost and free opportunities for older adults.  In this blog post we are going to hi-light some other continuing education opportunities for older Ohioans.

Ohio's four-year universities and two-year technical colleges allow residents age sixty and older to attend classes at no cost. Participation is limited to classes with space available. In most cases, no college credit is earned and some costs (such as books, equipment and lab fees) may apply.

Akron University: For more information visit The Sixty Plus (60+) Program online at https://www.uakron.edu/60/, e-mail them at sixtyplus@uakron.edu, or call them at 330-972-5793.

Cleveland State University: For more information visit Project 60 online https://www.csuohio.edu/project60/project60, e-mail them at project60@csuohio.edu, or call them at 216.687.5411. 

Cuyahoga Community College: For more information visit Program 60 online at https://www.tri-c.edu/program-60/index.html or call them at 216-273-1075. For information by e-mail, contact the Eastern Campus Enrollment Center (Highland Hills) at EastRegistration@tri-c.edu, the Western Campus Enrollment Center (Parma) at WestStudentHelp@tri-c.edu or the Westshore Enrollment Center (Westlake) at WSRegistration@tri-c.edu.

Kent State University: For more information visit the Senior Guest Program online at https://www.kent.edu/seniorguest, e-mail them at continuinged@kent.edu, or call them at 330-672-3100.

Lakeland Community College: For more information on auditing courses, visit the Admissions Office online at https://www.lakelandcc.edu/web/about/admissions-requirements#senior, e-mail them at or call them at 440-525-7000.

Visit https://www.ohiohighered.org/students/lifelong-learning to see colleges throughout Ohio that allow residents age sixty and older to attend classes at no cost.

Speak with an Attorney

Planning for your future includes making sure your estate planning is up to date and reflects your wishes. Set up a free 15-minute consultation with one of our attorneys to to discuss your planning goals. Our law firm helps families with elder law planning, special needs planning, general estate planning and probate matters.

Thanks to Angela Ugran for writing this helpful series of blog posts.

Low-Cost and Free Education Opportunities for Older Adults in Ohio: Part I

College classroom from above. Image by Mikael Kristenson @mikael_k on unsplash.

As we first discussed in our blog post titled “The Benefits of Lifelong Learning,” there are a lot of benefits to engaging in Lifetime Learning.  Fortunately in Northeast Ohio there are some wonderful low cost and free opportunities for older adults.  In this blog post we are going to hi-light some opportunities at Cuyahoga Community College or Tri-C.

Tri-C’s Encore 55+ Learning Program provides Friday lifelong learning opportunities for students age 55 and up at the Eastern Campus in Highland Hills, the Western Campus in Parma, and the Westshore Campus in Westlake. Offerings are expansive and include art, health, computers, history, and so much more! Are you interested in exploring familiar and not so familiar places in the greater Cleveland area including historical landmarks and places of worship? Tour with Encore’s “Neighborhood” Scholars program. Not ready to return to campus? Check out “Encore on the go!” for virtual offerings.

The next session begins September 23, 2022. In-person sessions run on Fridays in the Fall and Spring semesters and cost $99 for 1-6 courses or $30/class. Watch here for the full Fall 22 schedule: https://www.tri-c.edu/encore-senior-adult-programs/index.html. 

There is something for everyone, but if you find the schedule lacking in a way that YOU can remedy, consider offering your expertise as an Encore instructor. You don’t need a teaching license, advanced degree, or certification to become an Encore instructor — but you do need expertise in your subject and a passion for sharing it with others.

For more information call 216-987-2274, send an e-mail to encore@tri-c.edu, or join their Facebook group, https://www.facebook.com/groups/TriCsenioradulteducation. 

Additionally, through Program 60, Ohio residents age sixty and older may register for regularly scheduled credit and a limited number of noncredit classes on an audit, tuition-free, space-available basis. Audit courses do not receive college credit or count toward a degree. Program 60 students must meet all prerequisites for credit courses. Documentation in the form of college transcripts may be required to confirm. Program 60 allows individuals to enroll in noncredit recreation classes, but does not apply to noncredit courses hosted by Corporate College West, Corporate College East, or Workforce Solutions. Program 60 does not cover the cost of textbooks or other course materials.

To register for Program 60 courses in person visit a campus Enrollment Center or call 216-273-1075 for more information. Click here for Tri-C’s comprehensive class search tool. 

Speak with an Attorney

Planning for your future includes making sure your estate planning is up to date and reflects your wishes. Set up a free 15-minute consultation with one of our attorneys to to discuss your planning goals. Our law firm helps families with elder law planning, special needs planning, general estate planning and probate matters.

Thanks to Angela Ugran for writing this helpful series of blog posts.

The Estate Planning Documents Everyone Should Have in Place

There are several important legal documents that all adults should have, regardless of age.  These documents include a will, a durable power of attorney, a healthcare power of attorney and a living will.  Unfortunately, only about half of Americans have any of these documents – and the number is even smaller for those under age 50.  So what are these documents?

Will – A will allows you to designate where your belongings should go after your death.  If you have minor children, you can also designate who will care for your children.  If you do not have a will, a court will make these decisions for you.  The court would choose who will be the guardian for your children, and this may or may not match who you would have chosen.  As to your assets, the probate court will rely on state rules of intestacy to divide your property, again regardless of what you would have wanted.

Trust – A trust is a legal structure that permits management of your assets by a trustee on behalf of your beneficiaries. A living trust is established while you are still alive, as opposed to being created upon your death. You can be the trustee for your own living trust until you are no longer able to manage your financial affairs or pass away, at which point the responsibility for managing the trust passes to someone you designate as a successor trustee. When a trust is structured correctly with the help of an experienced estate planning attorney and properly funded, your entire estate can stay out of probate court. This process not only limits court costs, but it also maintains the privacy of your financial records while enabling your beneficiaries to enjoy the benefits of the trust without disruption or delay.

Durable Power of Attorney (DPOA) – A DPOA allows you to designate someone who can make financial decisions for you.  You can name someone to act in this position immediately, or designate that it will only go into effect upon some triggering event, such as incapacity.  Without such a document, when an  individual becomes incapacitated, be it by trauma, illness or a deteriorating health condition, it will likely be necessary to have a court name a guardian to make these decisions– a sometimes long and expensive process, where once again a court decides who will make these important decisions for you. For parents of children under 18, this document names who you would want to serve as guardian if you are incapacitated. This is key as the guardian you may have named in our will does not take effect if you are still alive.

Healthcare Power of Attorney (HPOA) – With an HPOA, you can give legal authority to another person to make decisions about your health care if you are unable to make them yourself. This prevents the courts from getting involved if there is disagreement between family members and/or the medical community as to what actions you would want taken.

HIPAA Authorization Form - The Health Insurance Portability and Accountability Act (HIPAA), is a Federal law that requires the establishment of standards to protect the privacy of patients’ health care information.  A HIPAA authorization allows you to name individuals who can have access to your medical information.

Living Will – A living will, sometimes known as advanced directives, allows you to make your wishes known as to end-of-life medical care.  This can help your loved ones know what you would like to have happen if you are ever in a position that you are unable to express your wishes.

If you already have these documents, great!  Perhaps now is a good time to give them a quick review to make sure there have not been major changes and that they reflect your current intentions.

Creating these essential documents often makes us address uncomfortable topics such as health, end of life issues, and what will happen when your gone, but making these decisions will make sure that your wishes are understood and followed.  These documents can help guide your loved ones during times of extreme stress, and is actually a gift that you are giving to them.  Indeed, most people indicate relief after drafting these documents because they realize how helpful they will be to their families and loved ones.

If you would like to speak with an attorney about creating or updating these documents, please contact the office of McFadden Bushnel LLC in order to make an appointment.  We can help you work through the process of developing the legal documents that express your wishes.

This article was originally published on January 3, 2017. The current version includes some additional information.

McFadden Bushnell LLC offers a wide variety of elder law, special needs and estate planning services in the greater Cleveland and Northeast Ohio area, including Shaker Heights, University Heights, Cleveland, Cleveland Heights, Beachwood, Warrensville Heights and throughout the area.

Driving with Dementia: AARP Video That Helps with Having “That Conversation” With Your Loved One

The American Association of Retired Persons (AARP), in conjunction with The Hartford Group and MIT Agelab, has an excellent video series named “We Need to Talk.”  The series helps viewers learn how to successfully have a conversation with an older loved one about their need to stop driving. Although the video is not specifically targeting loved ones with dementia, the content is still relevant and helpful.

Having “that conversation” about the need to stop driving can be tricky and the AARP video “We Need to Talk” can help get the conversation started. The video is free, and is interactive and engaging. The video is broken into modules so that you don’t have to watch it all at once, but can complete it when you have time.

 To watch “We Need to Talk,” go to the following link at the AARP website: "We Need to Talk" video.

 Speak with an Elder Law Attorney

Properly helping a loved one with dementia can seem daunting, especially when planning for the future and other legal matters. Please call one of our experienced Elder Law attorneys for a free 15-minute consultation to discuss your concerns. Our law firm helps families with elder law planning, special needs planning, general estate planning and probate matters. Free 15-minute consultations are available.

Thanks to Therese Shuffer for writing this helpful series of blog posts.

Five Facts For Ohioans About Getting the Covid-19 Vaccination

We recently took our mother to get her second COVID-19 vaccine dose at University Hospitals in Cleveland.  The process was smooth, and mom is doing great.  After discussing this experience with friends, we discovered that many people do not know where to get the vaccine and how the process works.  To help you and others, we decided to write this blog post about getting the COVID-19 vaccine in Ohio.

1.  You do not have to pay to get vaccinated.  The government is providing the vaccine for free. However, if you have insurance, you will need to show your insurance card to the vaccine provider so that they can be reimbursed an administration fee.

2.  The Covid-19 vaccine is being given in phases.  There is a limited quantity of the vaccine, so every state is providing it in stages based on Centers for Disease Control and Prevention (CDC) guidelines.  Currently, Ohio is vaccinating people in Phase 1B, which includes people over 65 years old or with specific health conditions.  For a more detailed description of Phase 1B, please go to the Ohio Department of Health website at https://coronavirus.ohio.gov/wps/portal/gov/covid-19/covid-19-vaccination-program

3.  You have to schedule an appointment to get a Covid-19 vaccination in Ohio. All of the providers giving the vaccine require that you schedule an appointment in advance.  At this point, you cannot walk into a location and get vaccinated.  To get a list of Ohio Covid-19 vaccine providers in your zip code, please visit the Ohio Department of Health website at https://vaccine.coronavirus.ohio.gov/

4.  There are currently two different Covid-19 vaccines.  The Food and Drug Administration (FDA) has approved the Pfizer-BioNTech and Moderna Covid-19 vaccines.  If you would like more information about these vaccines, you can get details about them (and other vaccines under development) at the CDC website at https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines.html

5.  Both of the currently approved vaccines require that you get two shots. When you receive the first shot, you will be scheduled to get your second dose three to four weeks later. The CDC recommends that people who get the Pfizer vaccine get their second shot in three weeks, and those receiving the Moderna vaccine get their second shot four weeks later.  Two shots are necessary because vaccine testing showed that two doses were more effective than one.

We hope that your experience with getting the COVID-19 vaccine will be as good for you and your loved one as it was for us with our mom.

Special thanks to Therese Shuffer for her work preparing this blog post.

Estate Planning That Expresses Who You Are: 5 Things to Talk About with Your Family

Photo by Nikoline Arns @nikoline_nik

You intend to pass along your wealth through your estate plan, but what about your wisdom? Ensuring you accomplish both calls for a family meeting to have a conversation about your money, your legacy, and your core principles.

Most families lead far-flung and busy lives, meaning the only time they see one another face-to-face is around the dinner table during a handful of major holidays. The estate planning process is a perfect opportunity to bring everyone together outside of those scheduled occasions — even if a child or grandchild has to attend via video chat.

Working with your estate planning attorney in collaboration any other advisors you have in your corner can make this legacy-enriching process seamless and genuinely enjoyable. But bringing your family and your professional advisors into the conversation is better yet, as they’ll get to learn new things about you and get to share stories and memories of their own. Here are just a few of the topics you’ll want to go over during your family meeting:

1.    Your rich life story

You may think it’s all been said before, but this is the perfect time to schedule or conduct recording sessions about your own personal life narrative. These recordings will be treasured while you’re still here and long after you’re gone. Allow your family members to ask about particularly fond memories of yours, knowing that you’re creating a time capsule of sorts that will contain the uniqueness of your personality and the experiences that shaped you into the person you are today. And perhaps most importantly, share the valuable lessons you have learned from your experiences. Your family will be better for it.

2.    How you’d like to be honored

Estate planning involves considering some weighty decisions when it comes to long-term care, powers of attorney, and other situations that may arise should you become mentally incapacitated. Although these are not the sunniest of topics, it’s important to express to your family why you’re opting for the choices you feel most aligned with. This will ease those processes for your loved ones, should these things ever come to pass. And once you get this part of the conversation covered, there are better things to come.

3.    Your family tree

Your family might be curious about more than just your own life story. Take this time to go over your family tree and answer questions the younger members of your family don’t know the answers to about your heritage. Getting a who’s who on paper and in a digital format is an excellent gift to your beneficiaries, as they’ll be able to reference it and build upon it throughout the years.

4.    Significant heirlooms

Every family has heirlooms, and every piece tells a story. It’s common for estate plans to contain physical objects that matter dearly to their owners, such as furniture, garments, jewelry, hobby collections, and memorabilia. Keeping the story of the object alive is more important than transferring its monetary value to the next generation.

5.    Your core values

Your estate plan can be customized to include specific language that carries your values along with it while still leaving room for your beneficiaries to grow and explore on their own terms. Educational, incentive, and charitable trusts are just a few methods available to you to express your values through your estate plan.

You know there’s much more to you than the wealth you’ve accumulated in your life. Likewise, your estate plan is about more than just your financial worth. After all, what’s passed down from generation to generation amounts to something far greater than numbers on paper.

We’d love to help you build your estate plan to include a balanced representation of who you are and what you believe. We’re here to help coach you through the process of going over these topics with your family and weaving them into your trusts and other critical documents. Give us a call today to set up a time, and we’ll get started right away.

Photo by Blake Barlow at _blakebarlow

The attorneys at McFadden Bushnell are there to assist with estate planning and planning for the possible future need for Medicaid and Veterans Benefits.  Please contact our office if we can be of assistance to your family.

McFadden Bushnell LLC offers a wide variety of elder law, special needs and estate planning services in the greater Cleveland and Northeast Ohio area, including Shaker Heights, University Heights, Cleveland, Cleveland Heights, Beachwood, Warrensville Heights and throughout the area.

Kids Going Away To College? Why You Should Include Estate Planning in the Preparation

You may have been running around for weeks, getting your new college student off to school. It's exhilarating, and your heart likely is bursting at the seams. You're probably prouder than you can say, but you're a little afraid, too. How can you make sure your kid is going to be safe at school, so far away from home? A new Bed Bath and Beyond matching sheet set for the dorm sounds great, but it just doesn't seem like quite enough, does it? So what else can you do?

Actually, there is something, probably not yet on your to-do list, that absolutely can make all the difference. Bring your child to a local estate planning attorney.

You've probably focused on the fact that, having graduated from high school, your kid's an adult now—meaning that your child's going to spread her wings. But what is essential to remember: At 18, a college student may still want her mom and dad her side if she gets sick, but legally, decisions for medical care are hers alone. If she were say, unconscious from a serious car accident, a parent couldn't authorize medical care without first going to court. And it would be up to a judge to decide if her parent would be considered an appropriate guardian.

 We don't want to worry you, but the unfortunate reality is that, every year, some quarter of a million people between 18 and 25 wind up in the nation's hospitals, according to Forbes, and their parents are often locked out of critical decisions, even when their child is still on their health insurance plan.

 Therefore, experts recommend that everyone over the age of 18 have a basic estate plan that includes a will or trust, a power of attorney, and medical directives that would allow someone they trust to take act on their behalf, if they aren't able to.

Here are some things to take care of before you send your kid away to college:

●       A FERPA Release: The Family Educational Rights and Privacy Act is designed to protect college student's privacy, but it can leave parents locked out in an emergency. A properly worded release allows school officials to talk with you and release your child's records to you.

●       A HIPAA Authorization: The Health Insurance Portability and Accountability Act was designed protect a patient's privacy. Consider having your child signing an authorization so that—just in case—any necessary doctors can talk to you about your child's condition, care, and treatment.

●       A Durable Financial Power of Attorney: This is a legal document that allows you to take care of your child's checking or savings accounts, pay bills, etc., if the child's unable to—whether due to illness or even just location (for example, if the school is on the other side of the country). 

●       A Durable Power of Attorney for Healthcare: Like the financial version, this allows you to handle medical decisions for your child, if your child is unable to do so.

●       A Will: At first glance, this may seem a little silly for the average broke college kid. But there could be a lot of hidden complexities: The average American has some 90 online accounts, for instance. Does your child have thoughts about who should manage and close down those social media accounts? Monitor emails? Who should get the Xbox or a bank account? It’s also a great time in your young adult’s life to instill responsibility by encouraging them to think about this early in life.

 We help families attain peace of mind. Reach out to us today to protect your new college student and your family.

McFadden Bushnell offers a wide variety of estate planning, elder law, and special needs in the greater Cleveland and Northeast Ohio area, including Shaker Heights, University Heights, Cleveland, Cleveland Heights, Beachwood, Warrensville Heights and throughout the area.

Thanks to Robert Creed for his help drafting this blog post.

Long Term Care Facilities and Concerns About the Spread of Infections

Long Term Care Facilities which include nursing homes, skilled nursing facilities, and assisted living facilities, provide medical and personal care services to people who are unable to manage independently in the community. Over 5 million Americans are admitted to or reside in Long Term Care Facilities each year.

Data about infections in Long Term Care Facilities are limited, but it has been estimated in the medical literature that:

• 1 to 3 million serious infections occur every year in these facilities.

• Infections include urinary tract infection, diarrhea l diseases, antibiotic-resistant staph infections and others.

• Infections are a major cause of hospitalization and death; as many as 380,000 people die of the infections in Long Term Care Facilities every year.

If faced with admitting a family member or loved one into a Long Term Care Facilities, it is essential to ask the right questions first. Below is a list of 10 questions advised by the Center for Disease Control to obtain answers to before admittance to a Long Term Care Facilities:

1. What infections commonly occur among residents in this facility?

   Nursing home residents can have a higher chance of getting an infection due to frailty from getting older, needing more help from caregivers who may not have clean hands, and open wounds or medical devices like IV tubes going into their body that break the skin providing a path for germs to enter the body. A nursing home should be tracking the common infections in its residents so they can be sure that actions are taken (i.e. infection prevention practices) to reduce the spread of germs to residents.

2. When was the last outbreak in this facility? What was the cause?

   Shared living spaces and lots of visitors can make it easier for a contagious germ (like flu or diarrhea from norovirus) to spread quickly through a nursing home. While many facilities experience outbreaks, early detection and quickly alerting public health authorities can help limit the spread of the infection to more residents, staff and visitors.

3. How does the facility communicate with residents, family and visitors when an outbreak occurs?

   Outbreaks of infections do occur in nursing homes. It is important the facility staff have a process for notifying residents, family members and visitors so everyone can take steps to decrease the chance of spreading the infection or getting ill.

4. Is the flu vaccine mandatory for all staff working in this nursing home?

   A growing number of healthcare facilities are making flu shots a requirement for staff as a measure to protect patients and staff from flu. In nursing homes, giving a flu vaccine to staff can help reduce the spread of flu in residents.

5. If a staff member is sick, is he/she allowed to stay at home without losing pay or time off?

   Coming to work sick is never a good idea, but it can be really dangerous if a person is working with frail or older people who are at increased risk for getting severe infections.

6. How are facility staff trained to respond to questions about hand hygiene from residents and family?

   Cleaning hands before and after care for a resident is an important way to prevent the spread of infections.

7. Are residents with new diarrhea given separate toilet facilities until the cause of their diarrhea is determined and/or the diarrhea is resolved?

   When a person has new diarrhea it’s important to rule out contagious germs like C. difficile, as the cause. Diarrhea can contain large numbers of the germs causing it. Some of these germs, like C. difficile, are very tough and difficult to clean from the environment.

8. How is shared equipment managed to prevent the spread of germs?

   People can carry germs on their skin or other parts of the body for long periods of time without being sick. Having a process to clean and disinfect shared equipment before the next resident uses it is a way to ensure these germs are not spread to others.

9. Does the facility have private rooms for residents who develop signs or symptoms of a potentially contagious infection like new cough and fever or new vomiting and abdominal pain?

   When a resident develops signs and symptoms which could be due to a contagious germ, like flu or norovirus, one way to protect the resident and others in the facility is to provide the ill resident with a private room until the cause of their symptoms is known.

10.   Does the facility provide educational materials for residents and families on the following topics?

    • Hand hygiene  

    • Use of gowns/gloves and other equipment to prevent the spread of germs

    • Antibiotic use policies/practices in this facility

Residents and families are important partners in preventing the spread of infections and reducing misuse of antibiotics. Nursing homes should have materials to educate their residents, families and visitors on the facility’s infection prevention and antibiotic stewardship policies, and steps they can take to support a safe environment.

The attorneys at McFadden Bushnell are there to assist with estate planning and planning for the possible future need for Medicaid and Veterans Benefits.  Please contact our office if we can be of assistance to your family.

McFadden Bushnell LLC offers a wide variety of elder law, special needs and estate planning services in the greater Cleveland and Northeast Ohio area, including Shaker Heights, University Heights, Cleveland, Cleveland Heights, Beachwood, Warrensville Heights and throughout the area.

This article was first published on June 19, 2017.

Preventing Falls and Improving Balance for Older Individuals

Falls are the leading cause of death from injury among seniors, and the risk increases with age. Fully one third of those over age 65 fall each year, and many suffer severe or even fatal injuries. Additionally, a person who has fallen once has double the chance of falling again.  The statistics are disconcerting:

One in five falls results in serious injuries, including broken bones and head injuries.

• Each year, 2.8 million seniors are treated in emergency rooms for falls.

• Over 800,000 individuals are hospitalized because of falls, and at least 300,000 are hospitalized for hip fractures.

• Medical costs related to falls are approximately $31 billion annually. Centers For Disease Control and Prevention.  https://bit.ly/2mjZik6

Photo by Wavebreakmedia/iStock / Getty Images

There are numerous, often inter-related, conditions that contribute to falls.  They include, increasing body weakness, the effects of medicines, vitamin deficiencies, vision issues, tripping hazards, and walking and balancing issues.  Researchers at the Mobility and Brain Function Program at the Institute for Aging Research (Harvard Medical School) are concentrating on understanding what causes older adults to fall, which will hopefully lead to development of preventive measures. They have found a direct correlation between balance and reduction of fall risk in older adults.

In a recent article, Dr. Brad Manor, the program’s director, explains that as we grow older, our ability to efficiently perform multiple tasks at the same time start to slowly deteriorate. Even the simplest of simultaneous activities, such as walking and talking, can disrupt our balance and put us at risk for a serious fall-related injury.

Mobility, the researchers conclude, is both physical and mental. The physical part relies on the ability of your muscles and reflexes to create the movement necessary to help maintain balance. The mental part relies on your ability to pay attention to the world around you, your short-term memory of where your legs and feet are located related to the ground, and your ability to make the correct decision to change your movements when needed, such as when a sidewalk is wet or covered with snow.

In an effort to find ways to prevent falls by seniors, researchers at the Center have started looking at exercises that target both the physical and mental fundamentals in mobility. They found that the purposeful movements and fluid repetitious motions in Tai Chi not only boost muscle function but also stimulate the mental functions that make mobility easier. Yoga and dance also have great mind-body interactions and work well to improve balance in older adults. While walking on a treadmill, riding a bike or strength training are all beneficial exercises, they were found to not have the balance component necessary to most effectively prevent falls.

Often, older adults will fall, become injured and then be less active. This chain of events causes further balance deterioration and greater risk of suffering another fall in the future. Dr. Manor stresses that it’s never too late or too early to start exercises to help improve balance and prevent the debilitating results that can come with a balance-related injury later. He does caution that any balance-based exercise should be done in a group or with a partner for safety reasons, and to check with your doctor before beginning a new exercise.

In Cleveland, organizations such as Fairhill Partners offer programs to assist older individuals develop strategies and practices to improve balance, flexibility, and strength.  http://fairhillpartners.org/services/take-charge-of-your-health/a-matter-of-balance/

The attorneys at McFadden Bushnell are there to assist with estate planning and planning for the possible future need for Medicaid and Veterans Benefits.  Please contact our office if we can be of assistance to your family.

McFadden Bushnell LLC offers a wide variety of elder law, special needs and estate planning services in the greater Cleveland and Northeast Ohio area, including Shaker Heights, University Heights, Cleveland, Cleveland Heights, Beachwood, Warrensville Heights and throughout the area.

Article originally published February 1, 2017.

A New Year’s Resolution To Top Your List: Estate Planning

January is a time of new beginnings and of resolutions for the new year.  One resolution we all should make is to have our essential estate planning documents in place.  There are several important legal documents that all adults should have, regardless of age.  These documents include a will, a durable power of attorney, a healthcare power of attorney and a living will.  Unfortunately, only about half of Americans have any of these documents – and the number is even smaller for those under age 50.  So what are these documents?

Will – A will allows you to designate where your belongings should go after your death.  If you have minor children, you can also designate who will care for your children.  If you do not have a will, a court will make these decisions for you.  The court would choose who will be the guardian for your children, and this may or may not match who you would have chosen.  As to your assets, the probate court will rely on state rules of intestacy to divide your property, again regardless of what you would have wanted.

Trust – A trust is a legal structure that permits management of your assets by a trustee on behalf of your beneficiaries. A living trust is established while you are still alive, as opposed to being created upon your death. You can be the trustee for your own living trust until you are no longer able to manage your financial affairs or pass away, at which point the responsibility for managing the trust passes to someone you designate as a successor trustee. When a trust is structured correctly with the help of an experienced estate planning attorney and properly funded, your entire estate can stay out of probate court. This process not only limits court costs, but it also maintains the privacy of your financial records while enabling your beneficiaries to enjoy the benefits of the trust without disruption or delay.

Durable Power of Attorney (DPOA) – A DPOA allows you to designate someone who can make financial decisions for you.  You can name someone to act in this position immediately, or designate that it will only go into effect upon some triggering event, such as incapacity.  Without such a document, when an  individual becomes incapacitated, be it by trauma, illness or a deteriorating health condition, it will likely be necessary to have a court name a guardian to make these decisions– a sometimes long and expensive process, where once again a court decides who will make these important decisions for you. For parents of children under 18, this document names who you would want to serve as guardian if you are incapacitated. This is key as the guardian you may have named in our will does not take effect if you are still alive.

Healthcare Power of Attorney (HPOA) – With an HPOA, you can give legal authority to another person to make decisions about your health care if you are unable to make them yourself. This prevents the courts from getting involved if there is disagreement between family members and/or the medical community as to what actions you would want taken.

HIPAA Authorization Form - The Health Insurance Portability and Accountability Act (HIPAA), is a Federal law that requires the establishment of standards to protect the privacy of patients’ health care information.  A HIPAA authorization allows you to name individuals who can have access to your medical information.

Living Will – A living will, sometimes known as advanced directives, allows you to make your wishes known as to end-of-life medical care.  This can help your loved ones know what you would like to have happen if you are ever in a position that you are unable to express your wishes.

If you already have these documents, great!  Perhaps the new year is a good time to give them a quick review to make sure there have not been major changes and that they reflect your current intentions.

Creating these essential documents often makes us address uncomfortable topics such as health, end of life issues, and what will happen when your gone, but making these decisions will make sure that your wishes are understood and followed.  These documents can help guide your loved ones during times of extreme stress, and is actually a gift that you are giving to them.  Indeed, most people indicate relief after drafting these documents because they realize how helpful they will be to their families and loved ones.

If this is one new year’s resolution that you want to keep this year, please contact the office of McFadden Bushnel LLC in order to make an appointment.  We can help you work through the process of developing the legal documents that express your wishes.

This article was originally published on January 3, 2017. The current version includes some additional information.

McFadden Bushnell LLC offers a wide variety of elder law, special needs and estate planning services in the greater Cleveland and Northeast Ohio area, including Shaker Heights, University Heights, Cleveland, Cleveland Heights, Beachwood, Warrensville Heights and throughout the area.

The Wrong Mix of Medications Can Lead to Faulty Alzheimer’s Diagnosis

Originally Posted August 23, 2016 

Memory loss, confusion and changes in personality or mood are some of the main symptoms of Alzheimer’s disease.  However, these symptoms can also be caused by medications, supplements and vitamins, or a dangerous mix of these—often resulting in a false diagnosis of Alzheimer’s.

The elderly are especially at risk of developing dementia-like symptoms because their bodies are not able to process medications as well as a younger person’s does. A lower metabolism, less lean body mass, less water in the body, and decreased kidney and liver functions make it harder to clean out toxins. As a result, drugs can accumulate in the body.

The list of drugs that can cause dementia-like symptoms is long and includes:

* antidepressants                                 * antihistamines

* anti-Parkinson drugs                       * anti-anxiety medications

* cardiovascular drugs                       * anticonvulsants

* corticosteroids                                   * narcotics

* sedatives                                              * statins

Also, seniors are usually prescribed more drugs as they get older. Polypharmacy is the term used to describe the use of five or more medications, and it is common in people over 65. This can easily happen when multiple doctors are prescribing drugs for different ailments. The more drugs they take, the greater their risk for a damaging drug reaction.

Using one pharmacist can help provide a gatekeeper, but it is vitally important to have a primary doctor oversee the person’s complete list of prescriptions, over-the-counter medications, vitamins and supplements. Alcohol, or even taking someone else’s medication, can add to the problem.

In many cases, the cognitive symptoms vanish when medication is stopped. But don’t try to do this yourself. It is important to work with the primary doctor to determine which medications can be reduced, eliminated or replaced without adversely affecting the person’s overall well-being. Take the bottles and containers with you so the doctor can evaluate the dosages and expiration dates.

Additionally, more than 100 other conditions, from vitamin and hormone deficiencies to rare brain disorders to depression to urinary tract infections, can mimic Alzheimer’s disease. Some are readily treatable, so it is important to see a doctor when concerns about memory arise.

It’s important to know the person, be aware of medications being taken, and watch for changes in behavior. If a loved one has started exhibiting dementia-like symptoms, act quickly. Insist on an evaluation of their medications and eliminate other conditions. If dementia does exist after addressing these other health issues, it is critical to start treatment as soon as possible.

Some helpful Alzheimer and Dementia resources in the Cleveland area:

• Cleveland area chapter of the Alzheimer’s Association:  http://www.alz.org/cleveland/

• Cleveland Clinic Alzheimer’s and Dementia Overview:  http://my.clevelandclinic.org/health/diseases_conditions/hic_Alzheimers_and_Dementia_Overview

• University Hospitals information on Alheimer’s:  https://www.uhhospitals.org/health-information/health-and-wellness-library/article/Diseases-and-Conditions/alzheimers-disease

If you are helping a loved one who has been diagnosed with Alzheimer’s, advanced legal planning is important because it allows the person with dementia to have his or her wishes for future care known and documented.  For assistance in developing a plan that addresses the long-term care needs of a loved one and other elder law needs, please feel free to contact the office of McFadden Bushnell.  We would be honored to assist you with this or other legal issues related to aging.

 McFadden Bushnell LLC offers a wide variety of elder law and estate planning services in the greater Cleveland and Northeast Ohio area, including Shaker Heights, University Heights, Cleveland Heights, Beachwood, Warrensville Heights and throughout the area.

Care Options for Adults with Special Needs

There are numerous care options available for adult with special needs. The options available range for those with special needs who are able to be more independent to those who need advanced medical care. It is important to match the person’s needs and desires with the best possible living option or combination of options.

Family

Family is the first care option that most people consider. For some adults with special needs, family is a great option. Parents often care for their special needs child until they are no longer able to and then other family members, such as adult siblings, take over the care of the special needs adults. Caring for a special needs family member can be very rewarding, but can also add a lot of stress for family members.  If family members choose to care for their special needs loved one, they may want to do so in combination with respite care or day program options.  However, family may not always be the best option or may not be an option at all. Some special needs adults are able to be more independent and may wish to have living arrangements that allow for more independence.

Independent Living

Independent living is for those special needs adults who are able to complete many tasks on their own with only minimal help. Personal care professionals can come into the home and provide the assistance that may be needed. A special needs adult may have a personal care professional come in and assist for a few hours a day or more. This helps the special needs adult to be able to live on their own. There is also assistive technology available that help people with disabilities to maintain their independence. Transportation can be a limitation for those with special needs living independently. Many organizations provide for transportation to appointments and jobs to help the special needs adult maintain their ability to live independently.

Group Homes

Group homes can be an excellent option for special needs adults who do not wish to live with family, but are unable to live independently. Usually those living in group homes do not need advanced medical care. A group home is staffed with professionals who manage the home and provide assistance for the special needs of the adults living there. A group home usually consists of four to six special needs adults living together. The benefits of a group home are socialization for the special needs adults and learning to work together with others. It also allows them to still maintain some independence.

Day Programs

Day programs provide options for families who want to keep their loved one living with them, but need care during the day while working or who need respite care. Day programs are offered through independent agencies and also through some long-term facilities. Day programs are a great option for working caregivers, while also providing socialization and activity for the special needs adult. Special needs children can continue to go to public school until they are 21, but after finishing school a day program can help to continue routine and structure in the life of a special needs adult.

Long-term Care Facilities

In some cases, the special needs adults do not have family members who are able to care for them or the person may not have the means to pay for other care options. Living in a long-term care facility may be a good option for those with advanced medical care needs. These facilities are able to provide care for more extensive needs. Some higher functioning adults with special needs may also live in long-term care facilities, but there are generally other options that allow for those who are able to live more independently.

It is important to plan for the care of adult children with disabilities. Planning should include the needs of the special needs adult, the resources available, and the best options to meet those needs. Getting input from the special needs adult can make transitions to new living situations go more smoothly for everyone involved.

Milestones Organization has a helpful resource page (http://milestones.org/online-resources/resource-center/) that includes resources for families exploring residential options in Northeast Ohio.  http://milestones.org/resource-cat/residential/

If you have any questions about something you have read or would like additional information, please feel free to contact us.

The attorneys at McFadden Bushnell are there to assist with special needs planning, estate planning and planning for the possible future need for Medicaid and Veterans Benefits.  Please contact our office if we can be of assistance to your family.

McFadden Bushnell LLC offers a wide variety of elder law, special needs and estate planning services in the greater Cleveland and Northeast Ohio area, including Shaker Heights, University Heights, Cleveland, Cleveland Heights, Beachwood, Warrensville Heights and throughout the area