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Elder Care

Choosing the Right Nursing Home

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What Nursing Home Is Right For My Loved One?

When families are advised that their loved one will need skilled nursing care, one of the first questions they will ask is are there any facilities that we recommend. There are a lot of factors that go into deciding if a particular facility is right for your family member. Some of those factors to consider are:

  • Proximity to where advocates and family members reside – having family visit regularly and being engaged in the care and services provided to their loved ones is critical to ensure they receive the best possible care
  • Understanding the level of care needed: certain facilities are geared toward particular conditions. Understanding a facilities specialty, if any, is important to determining if there is a fit.
  • Know how you are going to pay for the care. Once the family members Medicare benefits are exhausted, and you still require skilled nursing, understanding how to pay for the care needed and developing a path to Medicaid which will help subsidize the cost of nursing home care is critical.
  • Private Pay versus Medicaid – when visiting a facility, know what forms of payment they accept. The overwhelming majority accept Medicaid but a few do not. Follow the link in this article to find out if your facility accepts Medicaid.

Understanding The Different Levels of Care

A Nursing Home (NH) is a facility that provides 24 hour 7 day a week medical care and supervision.

A Skilled Nursing Facility (SNF) provides skilled nursing (examples: wound care, pain management, or bowel/bladder training),  and physical, occupational or speech therapy services. A SNF may also be referred to as a sub-acute rehab. Medicare may cover up to 100 days in a skilled nursing facility if you have met very specific Medicare eligibility guidelines.

Medicare does NOT cover ongoing long-term Nursing Home care. You may require additional care after your Medicare coverage ends. You may choose to pay the nursing home privately, use long-term care insurance or apply for state Medicaid.

A nursing home may also provide long-term care.

Ranking All Rhode Island Nursing Homes and What Payment Options They Accept

Since 2002, Healthcare Quality Reports has published information on the quality of care administered by nursing homes, including data on resident and family satisfaction and care outcomes. If you know in advance that you or a family member will need nursing home care, this information can help you compare nursing homes and choose among them. You can also visit nursing homes or ask friends and family for their thoughts and experiences.

The RI Department of Health’s Healthcare Quality Reporting Program has developed a Nursing Home Summary Report to help you compare Nursing Homes and choose among them. To find the most recent LIST OF NURSING HOMES and REPORT CARD click here. 

The PDF that the above link takes you to assembles many of the key pieces of information that any family will need when making an initial assessment of What Nursing Home is Right For My loved one!

Still have questions about how to proceed? Call me at 401-600-0143 for a no obligation consultation.


Helping families help their loved ones.

Funding Long-Term Care for an Aging Global Population

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Funding Long-Term Care is a Global Issue

Bobbie Preddy’s mother ran out of money years ago. She’s 98 years old and if she lives longer than six more months, Preddy might be out of cash, too.

Preddy’s mother requires round-the-clock care, due to frequent urinary tract infections and related conditions. Together, Preddy and her mother determined the only way she could get the support and care she needed was at an assisted-living facility. But costs for even one of the cheapest facilities in the market are hundreds of dollars more than Preddy’s mother can afford with her pension checks each month.

“I’m going to run out of money and my mother might still be alive,” she says. “And I don’t see anything, anywhere that can help that.”

Preddy’s dilemma is not uncommon. Her mother is one of more than 8 million individuals in the U.S. that require support from long-term care services, according to the Centers for Disease Control and Prevention, the great majority of whom are more than 65 years old. Family Caregiver Alliance, a nonprofit support organization for caregivers, lists at least 10 different options for living arrangements, each with varying degrees of provided care, independence and cost. According to the insurance company Genworth, the average annual cost for a private room in a nursing home in the U.S. is more than $90,000, and a year in an assisted-living facility is more than $40,000 , expenses that are not always covered by public insurance programs.

Globally, the number of older persons is growing faster than any other age group. In 2015, one in eight people was more than 60 years old, according to the United Nations. By 2030, they project an increase to one in six people, or 1.4 billion individuals over the age of 60.pbn-article

When it comes to aging, experts say the greatest challenge our world currently faces — more than pensions or birth rates — is planning for and financing long-term care.

Long-term care is like an “exploding bubble,” says Randall Ellis, a professor at Boston University whose research is focused on health economics. “It’s the largest uninsured risk for the aging population.”

In the U.S., when people face the dilemma that Preddy does with her mother — once houses have been sold, a lifetime of savings has been depleted and health conditions have reached the point that in-home care is not an option — others may rely on Medicaid to cover costs.

In 1965, Medicare and Medicaid became the first public health insurance programs in the U.S. when they were signed into law by President Lyndon Johnson. Medicare was intended for individuals over 65 years old and those with end-stage renal disease, or kidney failure. Medicaid was intended to cover low-income individuals. But as of fiscal year 2014, long-term care services accounted for about a third of Medicaid spending, or $152 billion.

Preddy’s mother is well beyond 65 years old and, with an annual income of about $17,000, would be considered low-income by many. Her pension is far from enough to pay for her long-term care, but it is enough to disqualify her for both public health insurance programs and leave her family scrounging for funds.

“There’s an extreme bias in the allocation of resources away from older people to other groups,” says Peter Lloyd-Sherlock, a professor of social policy and development at the University of East Anglia in the U.K. whose research focuses on the social protection of older people in developing countries. Costs associated with long-term care — financial and otherwise — are inevitable, he says, and the systems created to distribute those costs exemplify the values of that society.

Taking care of an individual at home will always be less expensive than bringing him or her to a nursing home or assisted-living facility, says Terry Hokenstad, a professor of global health at Case Western University. Policies and programs that support informal caregivers like family members, he said, make it easier to keep older adults at home and out of long-term care facilities longer, therefore reducing their overall costs.

In a number of European countries, pension funds are used to compensate unpaid caregivers. Denmark and the Netherlands automatically cover time spent outside the labor force due to caregiving, while Germany and Norway reward caregivers with additional credits to their own pensions.

 “Say an older person has a stroke and goes into the hospital,” Hokenstad says. “The first thing we (Americans) think is to get them to a nursing home. The first thing they think in the Nordics is how they can get back into their own home and what sort of improvements are needed to make it happen.”

But Naoki Ikegami, president of the Japan Society of Healthcare Administration and the Japan Health Economics Association, warns against a reliance on informal care for older adults. A long-term care industry has a public responsibility and legal obligation to provide appropriate care, he said, but it’s difficult to monitor whether family members are actually caring or not.

Instead, restricting the “medicalization” of long-term care — maintaining a separation between health care spending and activities and those related to long-term care — can keep expenses down. “Health care can always be interpreted as a life or death situation,” he says. “In health care, we give doctors a blank check to do whatever the patient needs. But with long-term care, we can rely on a more objective way of measuring need.”

In 2000, Japan developed a universal insurance program for long-term care in response to public outcry against growing problems of neglect. Funded by tax revenues and higher premiums for those over 40 years old, out-of-pocket costs for long-term care services are limited to a 10 percent co-payment. A revision this year raised that rate to 20 percent for those with above average income.

Ultimately, national and global debates on long-term care come down to whether the responsibility to look after our growing elderly population should be a public or private one. Like Japan and Denmark, most developed countries have favored strong, publicly funded social safety nets.

For Josh Wiener, former director of the Aging, Disability, and Long-Term Care program for the non-profit research organization RTI International, creating a successful system is a matter of finding the political will to make long-term care a policy priority.

“Long-term care is higher on the political agenda mostly everywhere else than it is in the U.S.,” he said. “Germany established a long-term care insurance program at a time when they were dealing with the unification of the East and the West. They recognized a need and they went ahead and did it.”

The same happened in Japan, where policy makers saw they had an aging population and agreed to address it . But the U.S., he said, tends to avoid the conversation.

For a while, private insurance plans that allow individuals to protect a greater share of their assets dominated the long-term care coverage discussion in the U.S. But the number of providers for these private plans has decreased dramatically in recent years.

A voluntary public insurance program almost made its way into President Barack Obama’s health care reform plans in 2011. But the Community Living Assistance Services and Supports program, or CLASS Act, was quashed for fear of adverse selection, or attracting a disproportionate number of high-cost users, that would drive up premiums and because it couldn’t prove to be debt-free for at least 75 years as the law requires.

Bobbie Preddy and her mother share a caring and trusting relationship; they’re “simpatico,” she says. Preddy doesn’t hope for her mother to die, but she does hope that supporting her mother doesn’t have to cut too much into her own retirement savings.

Deidre McPhillips is a data reporter at U.S. News. You can find her on Twitter or email her at

The original story can be found HERE.


What is a Lady Bird Deed and are They Allowed in Rhode Island?

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Property Deed

What is a Lady Bird Deed and Are They Allowed in Rhode Island?

A Lady Bird Deed (also known as an enhanced life estate deed) is a way to transfer property to someone else outside of probate while retaining a life estate in the property. But unlike a regular life estate, a Lady Bird deed gives you the power to retain control of the property during your life, including the right to use the property for profit or to sell the property.

THE GOOD: The 2014 Rhode Island budget addressed Lady Bird Deeds and the impacts on elder care planning techniques which rely on their use.  The bill created a new statute (R.I. Gen. Laws § 34-4-2.1) which, for the first time, officially recognizes the use of these deeds which are distinguished from traditional life estate deeds in that the life estate holder also retains the power to sell, convey, mortgage or otherwise dispose of the property without the consent or participation of the remainder interest holders.

Traditionally, these deeds have sometimes been used to transfer real estate to family members while avoiding a transfer penalty for purposes of Medicaid eligibility.

THE BAD: However, the budget contains another new statute (R.I. Gen. Laws § 40-8-3.1) that effectively eliminates this planning opportunity by providing that a Medicaid applicant, who has transferred his or her primary residence using a “Lady Bird” or “Enhanced Life Estate” deed recorded after June 30, 2014, must re-convey the remainder interest to himself or herself prior to qualifying for Medicaid benefits.  Upon re-conveyance of the remainder interest, the life estate holder will again own the entire property in fee simple, as if the transfer had never occurred.

So the good news is that Rhode Island finally recognizes Lady Bird Deeds, unfortunately, the primary purpose they were used for, namely Medicaid Planning, no longer works as the new law prohibits its usage for qualification purposes.

Still have questions?  Contact our office for a free consultation what other options still exist for you!