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Long-term care is big business. For many years now, companies that work in these fields have grown in size, scope, and influence, emerging as powerful entities making significant profits. There is nothing inherently good or bad about the changing nature of the industry so long quality, affordable options exist for seniors and their families.

Yet, in recent years observers have noticed that the increase in need for senior care services creates a natural business opportunity which are leading to some questionable practices. Take, for example, the growth of “pop up” senior centers in New York. The Brooklyn Eagle recently reported on these facilities and the scrutiny that is being directed their way.

City Council Questioning

The New York Medicaid program has been making many headlines in recent months. Implementation of the Affordable Care Act and efforts to control state spending all have significant implications for the program. Interestingly, these developments have opposing outcomes. As the Affordable Care Act provisions are unrolled the program will be expanded, offering services to more New Yorkers. Conversely, the state’s push to control costs and root out fraud limits services in a few ways, sometimes impacting local seniors and their families.

Fraud Repayment From Estate

On the fraud issue, the NY Daily News reported last week on a settlement reached between the Attorney General and the estate of a former nursing home owner.

Over the last few years elder care advocates have issued a steady drumbeat of concern: mistreatment of seniors is on the rise. The rates of neglect and abuse are not necessarily rising, but the total number of seniors affected are–a product of the changing demographics. The problem is only expected to get worse in the coming years.

It is important to keep in mind that research consistently shows that even “minor” forms of neglect can prove deadly. The U.S. Department of Human Services’ Administration for Community Living points out the stark difference in morbidity rates for abused versus non-abused seniors. Even when split only between those who received adequate care and those who received “modest forms of abuse” there is a 300% increase in the death rate for the mistreated seniors.

In other words, even small difference between the quality of long-term care facilities–both nursing homes and less-intensive assisted living facilities–can have life or death consequences. All of this makes the process of choosing a proper facility a critical task for seniors and their families.

One overlooked aspect of elder caregiving is the difficulty of the transition time itself. While some seniors may suffer serious medical events (stroke, heart attack, etc.) which require adult children to manage affairs overnight, in many cases the need for support happens only gradually. This presents a challenge as children must delicately broach the topic with parents who may be uninterested in change. At the same time, sibling rivalry, hurt feelings, misunderstood intentions, lack of information about savings, and many other details are thrown into the mix.

Put another way, before even deciding the best way to provide “financial caregiving” for an elderly parent, one must first figure out when to begin and how to get the parent to concede that help is needed.

A CNBC article last week examined this sensitive subject. The article provides reasonable advice while noting that “the shift [to financial caregiving by adult children] can be less stressful if everyone takes it slow, seeks advice and remembers that helping to maintain a loved one’s well-being is the primary goal.

It is no secret that most New Yorkers would prefer to “age in place” instead of moving into a nursing home. For one thing, having access to the comforts of one’s own home and the freedom to live as independently as possible is a natural goal. On top of that, however, are the myriad of horror stories that continue to pop up regarding mistreatment, neglect, and outright abuse that is sometime perpetrated at skilled nursing facilities. If you read enough of those harrowing accounts, it is easy to get the impression that these homes are no place to thrive in your golden years.

A new story coming out of Queens offers little relief. As reported this weekend in the NY Daily News, a former director of nursing at a Queens facility is now facing criminal charges for her conduct following a resident’s wandering from the facility.

Authorities explain how two weeks ago a 74-year old resident of the facility went missing. He was apparently not properly supervised and wandered out of the home without notice of the caregivers. The man has dementia, and obviously is at risk of serious harm while alone in the community. The senior has still not been found.

The Sun Sentinel recently published an interesting story on the growth of luxury services for those making funeral and burial decisions. While it may seem strange to some for such focus on high-end items in the afterlife, those familiar with estate planning appreciate the intensely personal nature of these decisions.

For example, the article includes an interview with one man who decided to build a large mausoleum where dozens of his family may one day be buried. The retiree explained: “I was making good money, and I could afford to do that for my family. It was the idea that most of my family preferred to be buried above ground rather than in the ground.”

Industry insiders working on these burial details note that there is a significant market for more high end plots and amenities. Some include large indoor mausoleums, granite-walled locations and even entire private burial estates with air conditioning provided for visiting guests.

This week Forbes published an article that outlines the basics of how to fund an estate plan for spouses. The story is a helpful reiteration of many of the basic issues that are common for all New York couples thinking about their future and trying to create security no matter what the future holds.

Helpfully, the story explains how estate planning is not the creation of a stack of legal documents that are signed and then stored until needed. Instead, the process is far more comprehensive and involves examination of all of one’s assets, wishes, legacy interests, elder care goals, and more.

As a general matter, on the estate planning side, one of the main goals is avoiding probate at all costs. That means that something like a last will and testament is inefficient. Instead, for most New York couples it is best to create a series of revocable living trusts which are far superior, allowing property to be protected and passed to others without the need for court intervention. After the trust is created spouses transfer property directly into the trust.

Epic estate planning battles–particularly involving the wealthy and famous–have long been fodder for newspapers. There have even been a few high-profile movies touching on the topic, like the recent George Clooney film, “The Descendants.” But now it appears that the sagas may make their way into yet another medium: television.

Reality TV continues to captivate audiences, and now some are looking to cast a new television show based on unique, intense, and interesting inheritance fights. The Trust Advisor recently shared information on the project which, if it becomes popular, is sure to raise awareness of common estate planning issues even more.

The show is still in the early stages of development, but it is clear that a large TV production team is looking for families to be filmed as their inheritance issues and planning details are sorted out. These early reports suggest that the show will center on inheritance and trust disputes among wealthy families. The purpose, one presumes, is to find families with the most unique issues, including family businesses, generations-long dynasties, and large personalities. The filming (and packaging as a television show) will likely highlight both the characters themselves as well as the unique processes involved in settling estate fights. While it may seem common knowledge to those of us working on these affairs, it is easy to forget that for most community matters, estate planning issues are foreign.

The New York Times shared a story late last week on developments in the settling of the estate of copper heiress Huguette Clark. It is a reminder of the sensitive nature of estate planning, particularly for those with wealth, and the lengths that all involved parties may go to influence one’s decisions regarding inheritance.

As many know, Ms. Clark was very reclusive, living the final two decades of her life at the Beth Israel Medical Center, even though for most of that time she did not actually need hospital care. According to new reports (and allegations from family members), almost as soon as she arrived the hospital engaged in a complex campaign to receive donations from the heiress. Apparently the facility had administrative officials sent to her frequently to build trust. After some time the officials, including the hospital’s CEO allegedly, began talking with her about creating a will. All of this was after officials researched the family history in the hopes of making a more personalized connection with Ms. Clark. It goes without saying that this sort of treatment is not provided to all patients at the facility.

All of this is only recently being made public as part of a high-profile legal challenge filed by some of Clark’s relatives angling for a larger share of her $300 million estate. The legal challenges began almost immediately after her death in 2011, and they are still raging. A trial in the matter is scheduled for September.

Most lists of “common estate planning mistakes” include the frequent error of failure to properly update beneficiary designations. Yet, even that mistake is deceiving, because updating is just one thing to consider with these designations. Even if the names are evaluated on a consistent basis, it is still important to ensure that the person named as the beneficiary fits in with other aspects of an overall estate plan.

Fox Business recently published a story listing ten different ways that life insurance beneficiary designation decisions are made in error. The story is worth browsing to get a feel for some common issues.

For example, it is critical to name someone who can actually receive the funds. Parents may name their minor child as the beneficiary, but the insurance company will not dispense funds directly to a child. Without a trust or similar arrangements, then this designation will cause problems. A guardian must be appointed, leading to costly and timely court proceedings being necessary.

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