Falling Incidents on the Rise with Seniors

There is an entire senior industry built around preventative measures and responses to protect older people from falling, and with good reason. According to the National Council on Aging Falls Prevention Facts, “falls remain the leading cause of fatal and nonfatal injuries for older Americans.” Aside from grievous and sometimes fatal injuries, falls are costing money, lots of money. In 2015 Medicare and Medicaid paid 75 percent of the 50 billion dollars in total cost due to fall injuries. With an ever-aging US population, the financial toll is projected to reach 67.7 billion dollars in 2020.

The Centers for Medicare and Medicaid Services (CMS) made a declaration that falls should never happen in a hospital environment and created penalties that became effective in 2008. The penalty still allows for patient care billing through CMS but will no longer bump payments up to a higher level to cover the treatment of fall-related issues. The advent of the Affordable Care Act (ACA or “Obamacare”) saw Congress introduce more stringent penalties by reducing federal payments by one percent for those hospitals with the highest rates of falls as well as other hospital-acquired conditions. The financial aspect is of significant concern as the American Hospital Association (AHA) finds that nearly one-third of US hospitals report negative operating margins.

These government assessed fall penalties could damage a hospital’s reputation and reduce its profitability. As a result, many hospital policies are now overzealous with regards to fall prevention, creating an epidemic of patient immobility. While this epidemic may serve the financial interests of hospitals, it does not serve the needs of older hospitalized patients. There are nominal reasons that hospitals are promoting increased “bed rest.”  These reasons include a shortage of staff, insufficient walking equipment, and no current means to record ambulation in a patient’s electronic medical record. Some nurses and hospital aides, to evade being reprimanded if a patient under their supervision falls, find reasons to avoid getting a patient out of bed and walking. Patients themselves are being instructed not to get up on their own and are subject to bed alarms that will alert hospital staff if they do.

Elderly patients are bedbound and discouraged from walking. This practice degrades the patient’s mental well being and their ability to become well to protect hospital profitability. Many older patients are weak and frail upon hospital admission, and after a few days in bed, find their muscles can deteriorate significantly enough to bring severe long-term consequences. Dr. Kenneth Covinsky, a researcher and geriatrician at the University of California-San Francisco, states, “Older patients face staggering rates of disability after hospitalizations.” His research cites that one-third of patients age 70 or more leave the hospital more disabled than when they were admitted.

Ultimately the policies put in place to reduce the number of falls in a hospital setting have created a climate of “fear of falling.” Hospital staff feels that a patient falling on their watch will lead to blaming, reprimands, even termination when the fault of the fall might be the patient themselves. This staff self-protection mechanism creates a cycle where the patient languishes in bed, growing weaker by the day. When they do get up, the patient is more likely to fall and become more seriously injured due to a decrease in muscle coordination and an increase in strength deterioration.

Barriers to the mobilization of elderly hospital patients do them a great disservice and may lead to increased length of hospital stay as well as disability after hospitalization. The limiting of patient mobility may have begun as a response to financial penalties but has very serious, though perhaps unintended, patient health consequences. Inpatient walking activity is a good predictor of readmission in elderly Americans. Research shows that just 275 steps a day while in the hospital yields lower rates of readmission after 30 days. Programs such as the Hospital Elder Life Program (HELP) are trying to reduce the barriers to patient mobility and reverse the epidemic of elder patient immobility. Across America, there are efforts to get patients moving again in special hospital wings called Acute Care for Elders. In these specialized settings, elderly patients can be provided the proper staff and equipment to walk and enhance their rehabilitation and wellness safely. For the best elderly patient outcomes, the trend of patient immobility must become less prevalent in hospitals despite the risk of falls.

If you have any questions or need guidance in your planning or planning for a loved one, please don’t hesitate to contact our Norman, Oklahoma office by dialing us at (405) 241-5994.

sixty-fifth birthday

Understand These Health and Finance Issues Before 65

In the United States, turning 65 years of age is a milestone on many levels, but before this birthday, there is a hefty checklist that you need to address to continue aging successfully. Overall the most crucial thing to do before turning 65 is to invest your time wisely crafting the best approach possible for your health and financial security well-being.

Can you afford to retire? Are you married? Estimate your total annual spending, including a cushion for periodic or unforeseen expenses like home repairs or dental work. Total all of your potential retirement-income sources and understand the tax implications associated with their spending. Run through several scenarios where you change what year you claim social security benefits to see if you should defer collecting it to a later age. Be realistic and start adhering to a modest budget today. Very few Americans can withdraw a lot from personal savings and investments without risking running out of money too soon. As you start to gather your assessments in general about how you view your retirement, find a qualified retirement planning expert that can help you with projections that are based on realistic assumptions.

Familiarize yourself with Medicare and its associated program variations. If you are retiring, you will approach Medicare differently than if you continue to work and have health care available through your employer. If you no longer will have health care through an employer, learn about Medigap supplemental insurance policies as Medicare will not cover all of your health care. Health insurance becomes quite complicated and varies widely depending on your overall health and personal financial situation. The National Council on Aging (NCOA), in partnership with private companies Aon Retiree Health Exchange™ and Via Benefits™, provides a checklist and timeline that can guide you through the process of enrolling in Medicare and assessing how you will cover the cost of prescription medication. If your income is low, you may qualify to enroll in Medicaid, which covers more expenses than Medicare. If you have already begun to take your social security benefits, then you will automatically be enrolled in Medicare. A packet entitled “Welcome to Medicare” will be sent to your address three months before turning 65. There are essential actions to take and deadlines associated with this packet, so read through the material carefully and meet those deadlines.

There are resources available to help you understand what your options are and the best way for you to proceed. As you approach the age of 65 many private insurance companies will lobby for your insurance dollars that will be spent on supplemental insurance. Finding a retirement planning company with insurance brokers that can sell you policies from many different insurance companies is more advantageous than locking into a group that will only sell plans that are associated with their company. A reputable insurance broker should not charge for helping you to assess your situation as they make commissions from the insurance company providing the policy to you. Check with the Better Business Bureau (BBB) online where you can plug in the name of an insurance group or retirement counselor and find out how long they have been in business, their accreditation, BBB rating, and customer reviews and complaints.

If you are over the age of 50, you can contribute an extra 1,000 dollars annually to your IRAs and an additional 6,000 dollars to 401(k)s up until the age of 65, according to Kiplinger. If you are still working, this is an excellent way to boost your retirement spending money. Before 65, you need to explore the option of a long-term care insurance policy, which helps to pay for any assisted living care needs you may require in the future. Long-term care policies can be expensive. If you do not enroll in a long-term care plan before the age of 65, the policies will become practically unaffordable.

Before turning 65, you should also come to terms with your will, advance medical directives, trusts, and the difficult conversation with your spouse or children about your end of life wishes and any funeral arrangements. Take heart, turning 65 is far from a death sentence as many Americans are living long and active lives well beyond the age of 65; however, meeting with an elder counsel attorney can save you and your heirs’ plenty of money and heartache. Do not wait until an adverse medical event forces your family or loved on to act on your behalf financially or medically. Decisions made under duress do not provide the best outcomes. Beyond your will, power of attorney and power of medical attorney, consider a dementia directive as well.

Projections for the aging US population indicate an ever-increasing number of seniors who have Alzheimer’s and other forms of dementia. Your elder counsel attorney can guide you through your options. Some states even have working templates for dementia directives. As you age, you can review your legal strategies from time to time and make adjustments as you deem necessary. It isn’t easy to discuss your end of life scenario, but once you have had the discussions and put proper legal documents into place, you can move forward with a sense of relief. It is freeing to make decisions and act on your future behalf, knowing you can always revisit your choices.

Now for the fun stuff; get excited about the senior discount. While it is true that there are discounts available as early as 55 and 62, nothing beats the senior discount at age 65. You can check off that bucket list of yours with deals on restaurant meals and travel excursions, clubs, retail stores, hotels, cinemas, smartphone plans, AARP membership discounts, and more. If you do not see an offering for a 65 senior discount posted, by all means, ask.

Beyond Medicare eligibility, you can get a onetime free physical exam if you have Medicare Part B insurance coverage. Gyms and community programs offer discounted or free physical fitness programs so that you can keep yourself moving and as healthy as possible. If you have Medicare, check out your eligibility for SilverSneakers for a 65+ fitness program. Your local senior center can keep you socially active and connected to people your age. Making friends and enjoying the simple act of conversation is known to have many benefits for your cognition and staves off isolation and depression issues.

If you retire from your job at 65, you can finally begin to collect on your pension plan or 401(k). That in itself is worth a celebration after many decades of hard work. You might also opt to collect your social security benefits, but it is generally advisable to wait until you reach full retirement age.

Homestead benefits and property tax exemptions are a considerable benefit for those who already own or plan to own a home or property. Benefits vary by state, so you will need to see what you can qualify for where you live. Your local comptrollers’ office can provide information about offers regarding homestead benefits. For property tax exemptions, you must contact your local comptroller or tax assessor’s office for exemption information.

There is a lot to discover, learn, and know about how to proceed in life at age 65 and beyond. With Social Security benefit determinations, health insurance policies, and legal documents in order, you can begin to enjoy being 65. Start your education about being 65 or more today. Stay vibrant and healthy and enjoy those things you dreamed of doing when you were your younger self.

If you have any questions or need guidance in your planning or planning for a loved one, please feel free to contact our Norman, Oklahoma office by dialing us at (405) 241-5994.

The SECURE Act: How Does It Affect Your Retirement Accounts?

On December 20, 2019, President Trump signed the Setting Every Community Up for Retirement Enhancement Act (SECURE Act), which became effective on January 1, 2020. The Act is the most impactful legislation affecting retirement accounts in decades. It will have a positive impact for many older Americans but could have negative tax consequences for many beneficiaries of their retirement accounts.

The Good and the Bad

The SECURE Act makes several positive changes: It increases the required beginning date (RBD) for required minimum distributions (RMDs) from your individual retirement accounts from 70½ to 72 years of age, and it eliminates the age restriction for contributions to qualified retirement accounts.

However, perhaps the most significant change will affect the beneficiaries of your retirement accounts: The SECURE Act requires most designated beneficiaries—with some exceptions for spouses, beneficiaries who are not more than ten years younger than the account owner, the account owner’s children who have not reached the “age of majority,” disabled individuals, and chronically ill individuals—to withdraw the entire balance of an inherited retirement account within ten years of the account owner’s death.1

Under the old law, “designated beneficiaries” of inherited retirement accounts (i.e. beneficiaries who are individuals) could take distributions over their individual life expectancy. Under the SECURE Act, the shorter ten-year time frame for taking distributions will result in the acceleration of income tax due, possibly causing your beneficiaries to be bumped into a higher income tax bracket and receive less than you anticipated.

What Should You Do?

In order to protect your hard-earned retirement account and the ones you love, it is critical to act now. In addition to the tax considerations stemming from the SECURE Act, you might be concerned with protecting a beneficiary’s inheritance from their creditors, future lawsuits, and a divorcing spouse. An estate planning attorney can help you think through strategies, including the following options, to help you achieve your estate planning goals:

Review/Amend Your Revocable Living Trust (RLT) or Standalone Retirement Trust (SRT)

Depending on the value of your retirement account, you may have addressed the distribution of your accounts in an RLT or created an SRT to handle your retirement accounts at your death which included “conduit” provisions. Under the old law, the trustee would only distribute required minimum distributions (RMDs) to the trust beneficiaries, allowing the continued “stretch” based upon their age and life expectancy. The conduit trust provisions protected the account balance, and only RMDs–much smaller amounts–were vulnerable to creditors and divorcing spouses. With the SECURE Act’s passage, a conduit trust structure will no longer work for long-term asset protection and growth because the trustee will be required to distribute the entire account balance to a beneficiary within ten years of your death (unless they are an eligible designated beneficiary, discussed above). You should discuss the benefits of an “accumulation trust” with your estate planning attorney.  An accumulation trust is an alternative trust structure through which the trustee can take any required distributions and continue to hold them in a protected trust for your beneficiaries.

Consider Additional Trusts

If you have not done so already, it may be beneficial for you to create a trust to handle your retirement accounts at your death. Simple beneficiary designation forms–allowing you to name an individual or charity to receive funds when you pass away–might not fully address your estate planning goals and the unique circumstances of your beneficiaries. A trust is a great tool to address the potential downfalls to the new mandatory ten-year withdrawal rule under the SECURE Act and provide continued protection of a beneficiary’s inheritance.

Review Intended Beneficiaries

With the changes to the laws surrounding retirement accounts, now is a great time to review and confirm your retirement account information. Whichever estate planning strategy is appropriate for you, it is important that your beneficiary designation forms are filled out correctly, naming a trust or an individual as your primary beneficiary, and naming contingent beneficiaries. Your estate planning attorney can advise you about the impact of the SECURE Act on certain beneficiaries.

Other Strategies

If you are charitably inclined, now may be the perfect time to review your estate planning and possibly use your retirement account to fulfill these charitable desires. If you are concerned about the amount of money available to your beneficiaries and the impact that the accelerated income tax may have on the ultimate amount, you can explore different strategies with estate planning attorney, in collaboration with your other advisors, to infuse your estate with additional cash upon your death.

We Can Help

Although this new law may be changing the way we think about retirement accounts, we are here and prepared to help you properly plan for your family and protect your hard-earned retirement accounts. Give us a call today to schedule an appointment to discuss how your estate plan and retirement accounts might be impacted by the SECURE Act.

1If a beneficiary is not considered a “designated beneficiary,” distributions must usually be taken by the fifth year following the account owner’s death.

Your Disease’s Hidden Cause May Be Bacteria

Health experts have been advising people for years about unhealthy habits being the cause of “lifestyle” diseases that are increasing across the US. These lifestyle diseases become more common with age and include heart disease, type 2 diabetes, some cancers, and Alzheimer’s disease. Around the globe, these diseases account for 70 percent of all deaths. New Scientist magazine is reporting evidence suggesting bacteria are to blame for the diseases and that this finding will herald the coming of a revolution in medicine.

However, don’t stop healthy habits just yet; findings in disease after disease indicate that bacteria are covertly involved which complicates the problem. Bacteria will invade bodily organs and then co-opt the immune system in a sort of parasitic relationship as the bacteria boosts their survival while making the human body break down. In theory, if the bacteria microbes can be stopped, there is a potential to defeat disease conditions like heart attacks or Alzheimer’s.

How can such an all-encompassing and seemingly simple underlying cause be overlooked for decades? Bacteria have eluded scientists because they work very slowly. Like a terrorist sleeper cell, the bacteria can hide or lay dormant for long periods inside of cells, and that makes them difficult to grow as a culture. DNA sequencing informs scientists and researchers that bacteria are in places they were never known or supposed to be and shaping the body’s inflammation responses.

The medical community is up-ended by this startling paradigm shift in disease causation. The information is so contrary to the current medical understanding that some scientists and researchers are only cautiously optimistic. Many scientists have spent years looking for answers to the root cause of diseases and are left frustrated by their inability to identify the reasons.

The worst offenders in the link between bacteria and disease are gum diseases.  So it is bacteria that cause gum disease that is responsible for the most widespread disease of aging. Maurizio Tonetti of the University of Hong Kong calls gum disease “the most prevalent disease of mankind.” Gum disease is prevalent in 60 percent of Americans aged 65 or more. Germ theory finds the bacterial culprit known as Porphyromonas gingivalis  (P. gingivalis) is linked to the broadest array of disease conditions.

Source New Scientist August 10-16, 2019

Source New Scientist August 10-16, 2019

Gum disease is releasing bacterial P. gingivalis into your bloodstream and promoting inflammation long before an infected tooth falls out. Americans 30 and older have a 43 percent rate of some form of gum disease, and many find dental insurance an added expense they didn’t think worth the price. What a price it turns out to be. Since bacteria cause diseases and bacteria are prevalent in the majority of Americans, what can be done to manage the role of these bacteria within the body’s immune system?

Some companies are developing drugs that will block specific inflammatory signals or responses to slow disease progression. Even if the goal to prevent a limited number of signals or responses is successful, it is unclear what tampering with the human immune system can unleash. While being a relatively simple identification with the advent of DNA sequencing, bacteria still manages to host itself in the body’s vastly complex immune system. This situation makes for a complicated fix.

Once P. gingivalis enters the bloodstream, it changes its surface protein. This change allows the bacteria to cloak itself inside the immune system’s white blood cells. Even within the cells themselves, they enter into its lining arteries. Here it can remain dormant and primarily undetected until it wakes to invade a new cell. Because bacteria are so hidden, antibiotics will not identify it to kill it, and immune defenses do not respond to it. There is much to consider from research and experimental perspectives.

Understanding the underlying cause of many diseases is a breakthrough, but an application for preventing disease based on this information is still in the developing stages. While the future does look brighter, it is always a good idea to live an overall healthy lifestyle.

If you have questions or would like to schedule a time to discuss your planning needs, please don’t hesitate to contact our Norman, Oklahoma office by calling us at (405) 241-5994.

What Millennials Don’t Know About Social Security

When the US federal government established its social insurance program on August 14, 1935, its purpose was to provide retirement, disability, and survivors’ benefits. Since that time, in part due to the disappearance of extended family networks, an increase in population, and a profound increase in life expectancy, it has become challenging for the Social Security Administration (SSA) to maintain the benefits promised to Americans.

According to a Transamerica survey, 80 percent of Millennials (born between 1979 and 2000) do not think they will receive any Social Security benefits at all. This apprehension comes as no surprise because for decades Americans have been saying that the Social Security benefits system is going to go broke. Millennials may be right to be skeptical about receiving benefits three and four decades hence, and the program does have problems but is not going broke, yet.

By its admission, the Social Security Administration reports that the Old-age and Survivors Insurance (OASI) Trust Fund and the Disability Insurance (DI) Trust Fund are scheduled to be depleted in the year 2034 if Congress doesn’t act. However, there is another source of income for Social Security benefits. Even in the absence of both SSA Trusts, hundreds of billions of dollars in payroll taxes will still be collected and billions in benefits will still be paid. Even if Congress did not intervene to address the current challenges, the system would still be able to pay 77 percent of projected benefits beyond the year 2034.

Because of the bipartisan support the Social Security program receives and influential lobbies including the very powerful American Association of Retired Persons (AARP), it is highly probable that Congress will intervene to strengthen Social Security’s finances. Millennials’ uncertainty about the program’s solvency may lead to poor decision making regarding their retirement savings and plan. It is never too early to start looking at the basic tenets of when you will be able to retire successfully. Just because Millennia consider the future of Social Security benefits as tenuous, it should not deter them from saving money, investing, and reviewing and updating plans as circumstances change.

The average Social Security benefit is currently slightly less than 1,500 dollars a month. To successfully use the financial planners 4 percent rule would require a savings of 400,000 dollars to generate a similar income to the average Social Security benefit. Projections by the Urban Institute estimate that Millennials will receive about one million dollars for a single adult of average-income and 2 million for a couple.

Maybe the good news about Millennials’ skepticism about the solvency of Social Security is their interest in starting retirement savings planning earlier than the generations before them. Millennials who are saving are beginning around 24 years old and with good reason. Pensions in the private work sector are becoming increasingly rare, employers may go out of business, and job-hopping is much more common among younger American workers, which can easily lead to errors in income reporting.

All Americans should create an account on the Social Security Administration’s website, which allows you to check your earnings records and have errors corrected. Even checking every three years is good enough to know that your Social Security benefits will track accurately based on your income. Before ever claiming your benefits, be sure to employ one of many software tools that educate you about claiming strategies for Social Security. Millions of Americans make the mistake of taking their benefits too early, which locks them into permanently reduced payments. The financial incentives the SSA provides for delaying when you take your benefits can net you up to 250,000 dollars more. Benefits currently increase between 7 to 8 percent for every year you delay after the age of 62, capping at maximum benefits at the age of 70.

Millennials are expecting their prime source of retirement money to come from self-funded financial vehicles like a 401(k), IRA, and other savings and investments and ultimately that is a good thing. There isn’t such a thing as “too much money” in retirement, so additional sources of income beyond Social Security benefits is an excellent strategy. The social contract the federal government made for, and funded by its citizens, in all likelihood will be there for the Millennial Generation but no one knows the future. With 18 percent of Millennials expecting to live to 100 years of age or more getting information and advice about how to achieve retirement goals is more important than ever before.

If you have any questions or need guidance in your planning or planning for a loved one, please don’t hesitate to contact our Norman, Oklahoma office by calling (405) 241-5994.

American Seniors Facing New Debt Crisis

America experienced its worst financial crisis since the great depression between 2007 and 2010. Known as the subprime mortgage crisis, it happened because home prices fell in 2006, triggering loan defaults. Then the risk spread into pension funds, mutual funds, and corporations who owned the derivatives. It also spread into the global credit market resulting in higher interest rates and reduced availability of credit. Quantitative easing was necessary for several years to lower interest rates and spur economic growth. The cautionary tale to all Americans was learning to live beneath their means and do not carry excessive amounts of debt. Many Americans did not take heed and as a result, they are in substantial debt. One of the saddest cases of all of the debtors is the senior in their 60s and 70s in retirement years, and generally on a fixed income.

According to marketwatch.com, the current financial debt crisis among seniors is worse today than it was in the earlier 2000s. First-quarter debt in the year 2019 among seniors in their 60s was 2.17 trillion dollars according to data from the Federal Reserve Bank of New York. That is almost 1 trillion dollars more than quarterly numbers being reported in 2008 just after the start of the great recession. Senior Americans in their 70s are experiencing double the collective household debt than in the late 2000s. Second-quarter 2019 debt is 1.16 trillion dollars comparative to the .54 trillion dollars of 11 years ago. While younger Americans are also experiencing debt, those numbers are more consistent or even lower than the quarterly obligations reported during the spring of 2008.

Mortgages account for the majority of household debt across all age groups with older Americans, aged 40 and beyond, typically holding the most debt. The trend of a home equity line of credit (HELOC) is highest among those in their 50s and 60s. In essence, a HELOC functions like a second mortgage based on the current value of the home. A HELOC is not the same as a reverse mortgage which requires no repayment of the loan until the sale of the house. Surprisingly even student debt accounts for over one-fifth of household debt for Americans in their 50s. Americans’ penchant for not saving and overspending is sabotaging many a retirement.

It is tempting to want to help a family member (usually adult children) by lending or cosigning a loan for education, a car, or home. However, this action can put you in great financial peril. Let that family member learn their fiscal responsibility rather than putting yours in jeopardy. Younger people have more time to rebound from an adverse economic situation. Those Americans in their 60s and 70s who are already retired and living on fixed incomes can experience crippling life events when carrying unpayable debt.

Remember that buying on credit increases the price of what you purchase. Within the credit card industry people who pay off credit cards in full every month are known as “dead beats.” Why? The lender can’t make any money off of the loan unless your payment is less than the full balance due. The lender makes the most money when you make the minimum payment and the lender can tack on interest to the debt. This is a negative debt cycle for the borrower.

Financial advisers will caution seniors to retire with as little debt as possible. If there is a real need to obtain cash or enter into debt, do not act rashly. Fixes like a payday loan will cost you a lot of money in the long run. It is much better to work with reliable professionals and lenders and create a realistic repayment schedule that works within your budget. If a reasonable loan cannot be struck, then look for ways to avoid needing the loan at all. The best question to ask about going into debt is, “Is this a want, or is this a need?”

We can help you work through how to handle existing or future debt as part of your overall legal plan. It does not take long for debt to pile up and destroy the hopes for a successful retirement. Contact our Norman, Oklahoma office by calling (405) 241-5994 today and schedule an appointment to discuss how we can help you with your planning.

Alzheimer's Disease

Bad Financial Decisions May Be a Sign of Dementia

Diminishing brain function due to the onset of dementia can lead to the destruction of your financial well-being. If you are age 50 or older, easy access to your financial assets like stocks and bonds, checking and savings accounts, money market accounts, and other assets can lead to loss of these funds if an unauthorized person gains access to them, or if they are mismanaged. Family members are often unaware their loved one needs help before the unintentionally mismanaged assets, now gone, bring about devastating consequences for both the person living with dementia as well as their family. The Alzheimer’s Association reports that from diagnosis to death, Alzheimer’s disease (AD) care will cost an average of $424,000 per individual, and 70 percent of that cost is out of pocket expenses to the family system of the affected loved one.

It is common to have AD symptoms long before an official medical diagnosis. Difficulty managing money is one of the first signs of Alzheimer’s disease. To spot problems early, look for the warning signs of ill-advised financial transactions through oversight. Unopened or unpaid household bills, overspending on credit cards and making just minimum payments on the debt, falling prey to frauds and scams, and not paying attention to more significant investments that constitute the bulk of a person’s wealth are all indicators of mental decline. As a whole, the situation is very concerning as the poor financial outcomes that asset spending brings about are also happening at a time when expenditures to pay for increasing caregiving needs for dementia becomes extensive.

Projections are that by 2050, the prevalence of Alzheimer’s will triple in the US. Those individuals suffering from AD who do not have personal or family financial support will most likely become a beneficiary of the US Medicaid program. Total Medicaid spending in the fiscal year 2018 was 593 billion dollars. The federal government paid 62.5 percent, and the states paid 37.5 percent of the budget. Research statistics data from the Centers for Medicare and Medicaid Services (CMS) are projecting that, under current law, from 2018 – 2027 national health spending will be nearly 6 trillion dollars with a substantial portion of that going to underfunded seniors living with dementia.

One of the best ways to protect your finances from the unintended consequence of mismanagement due to cognitive impairment is to accept that this problem exists, and there is a need to put systems in place for financial oversight long before mental decline sets it. Meet with an elder law attorney to put the legal documents in place, allowing for power of attorney, financial control, medical power of attorney, as well as a dementia directive, as early as your 50th decade. You may also allow a trusted adult family member, friend, or financial advisor to review your monthly spending habits and bill paying.  If there is a noted error in your financial judgment or a lapse in your standard financial operating procedures, they can call it to your attention well before all of your money is gone.

Alzheimer's Disease Facts

Alzheimer’s Association

According to the Alzheimer’s Association, only 16 percent of seniors regularly receive cognitive assessments in their annual medical exams. Keep yourself from becoming vulnerable by protecting your liquid assets and your net worth with provisions for financial oversight. The safety net you put in place today can protect your finances and even be an indicator that you require testing for cognitive problems. Currently, there is no solution to the problem of Alzheimer’s disease and other forms of dementia however; there are systems you can put in place to protect yourself financially. It is best to prepare for the possibility that you may develop cognitive problems and have protections in place rather than unwittingly put yourself in financial jeopardy.

If you have any questions or need guidance in your planning for yourself or a loved one, please don’t hesitate to contact our Norman office by calling (405) 241-5994.

elder abuse

How to Address Abuse in Senior Living

If you have an elderly family member or friend living in an assisted living or skilled nursing facility, it is imperative that you stay attuned to the signs of abuse to your loved one. The National Center on Elder Abuse reports the most common types of abuse include physical (29%), psychological (21%), gross neglect (14%), financial exploitation (14%), and sexual abuse (7%). While the facility’s staff perpetrates the majority of these abuse cases, 22 percent of cases are a result of resident on resident abuse. However, these statistics reveal only part of the story.

While abuse of senior residents is not the norm, according to McKnight’s Senior Living, it is a persistent and pervasive problem. Federal and State lawmakers are emphasizing the role of regulations and public policy to identify and decrease the abuse of residents while continuing to improve care quality. Once a comprehensive set of US standards for care are established, facility owners and employers will have to adhere to the best practices as outlined in order to be in compliance and eliminate resident abuse.

Besides elder abuse being a persistent and systemic problem, it is also an under-reported one. Because it is under-reported, statistical data integrity is suspect. Typically, the resident who encounters abuse is 65 years or more, and the vast majority of those who are especially at risk exhibit moderate cognitive impairment or are living with dementia. Because of their medical conditions, these seniors are often unable to communicate about or report the abuse they experience, and so it continues unabated and without consequence.

To address the abuse problem requires a multi-pronged strategy. Raising awareness of abuse and educating family members, caregivers, and managers to look for signs of abuse every day with every resident is crucial. Knowing the signs of neglect and abuse include skin tears, multiple fractures or long bone fractures as well as a resident’s inability to explain bruises. Bruising of the chest, breasts or genital regions, a sexually transmitted disease, bloody discharge, and unusually stained underwear are signs of sexual abuse. Medical neglect or abuse manifests itself both physically and psychologically. Symptoms include a resident’s poor hygiene, unintended weight loss, and dehydration. Other symptoms are marked by suspicious wounds, and poor case management of medical conditions, unmonitored prescription medications, depression, anxiety, and social withdrawal.

Certification and licensing verification, as well as criminal background checks, should be mandatory before hiring employees or volunteers to work with residents. Those individuals found guilty of any form of abuse or who have disciplinary action against their professional license should not be considered for hire. All qualified new hires should be trained on the facility’s abuse prevention policy before working with residents, and continuing education about abuse should be mandatory.

Training should encompass all aspects of potential resident abuse, mistreatment, and neglect for all staff and volunteers. Topics to cover should consist of ways to identify those residents at risk, recognizing the signs of abuse, how to properly report the violation without fear of reprisal, and understanding the Resident Bill of Rights. Staff should be trained on how to respond appropriately to difficult resident behaviors and recognize symptoms of caregiver burnout in themselves or other staff members.

Prevention policy should cover a range of procedures. Before a resident moves in, there should be an assessment made about their potential vulnerabilities. Continuing evaluations and documentation of any resident changes should be routine. Appraisals should include a review of the facility’s physical environment, number of residents, and requirements as to the risks of guarding against admitting a predatory offender as a resident. All of these preventative strategies are guided by specific Federal, State, and statutory requirements.

Reporting and response time are critical when abuse is alleged particularly in the case of serious bodily injury. Generally, most State laws and statutory requirements deem that within two hours of such an abuse a report must be filed. If abuse is not alleged and there is no evident serious bodily harm, the general rule is that it should be written up within 24 hours. Reports are filed with the facility’s executive director, state authorities, and law enforcement. Families should always be notified of allegations of or signs of abuse.

By employing these prevention techniques, focusing on policies and procedures as well as ongoing educational training, senior care residences can become a living environment where resident abuse is an unlikely event. Managing abuse risk is a significant factor in successful senior living. If your loved one is in a senior living facility, be sure to understand their vulnerabilities and the policies and procedures in place to prevent abuse.

If you have questions or would like to talk about your situation, please don’t hesitate to contact our Norman, Oklahoma office by calling (405) 241-5994.

LGBTQ Couple

Important Estate Planning Considerations for LGBTQ Couples

Everyone needs estate planning. Regardless of your age, race, gender, or sexual orientation, properly protecting your future and your loved ones requires a plan. For LGBTQ couples, there are a few things you should consider when thinking about crafting an estate plan. Each couple is unique, and it is our goal to ensure that your personal wishes are carried out and that no one else is dictating what should happen with your money, property, or children.

Existing Estate Planning

If you have already had estate planning documents prepared, you should review them periodically. If your estate planning documents were signed prior to 2015, it is crucial to have a qualified estate planning attorney review them, as same-sex marriage is now recognized in all fifty states. This recognition could open up new planning opportunities that may not have been available to you in prior years if you and your partner are now married.


As previously mentioned, with same-sex marriage recognized in all fifty states, now is an opportunity to decide, if you are not married already, whether you and your partner should tie the knot. While there are a lot of emotions behind marriage, there are also estate planning and tax considerations. Depending on your situation, we can sit down and make sure that your estate plan is drafted in such a way that ensures all of your wishes—emotional or financial—will be carried out.


If you have biological or adopted children, you will need to name someone to take care of them should something happen to you. This is especially important if your partner is not the children’s legal parent. Without the proper appointment, the court could end up placing your children with someone you would not have chosen. Alternatively, if you would like to provide for your partner’s children, but you have not adopted them, you will need to make sure that your will or trust specifically states what you would like the children to receive since they would not be entitled to anything otherwise.

Your “Family”

Absent estate planning executed by you, state law will fill in the gaps by defaulting to your spouse or blood relatives. For some unmarried individuals, these could be the last individuals you want acting on your behalf or receiving your money and property. If you and your partner are not married and do not plan to get married, you will need to make sure that your estate planning specifically appoints them to the roles (e.g., personal representative, trustee, agent under a power of attorney, or patient advocate under a medical power of attorney) you want them to have and designates what your partner is to receive at your death. If you have good friends that you consider to be your family or causes that are close to your heart, you will need to have an executed estate plan to protect and provide for your true “family,” whether or not they are blood relatives.

Reducing Conflict

Additionally, if you are estranged from your family, proper planning can ensure that they will have little or no involvement in your affairs after your death, reducing the possibility of contests. This can be done by using a trust to distribute your money and property so that there is no court involvement and only those named in the trust have access to the necessary information, by explicitly stating in your will which family members are to receive nothing and by including no-contest provisions in your documents.

We are here to help you navigate this sensitive issue. Estate planning can provide you with the peace of mind that comes with knowing that your wishes will be carried out in the way you want after you are gone. Please give us a call so we can schedule an appointment to get you on the path toward protecting your loved ones.

Aging Could Be Better Living with Multiple Generations

Master plans for inter-generational community living models are changing the shape of the aging experience from the ages of 8 up to 80 years of age and beyond. Dubbed “new urbanism” it is the belief that a living environment with high standards can have a positive effect on the quality of life, local economy, and public health. The goal of new urbanism for older adults is the offering of an active lifestyle enhanced by a vibrant and bustling community composed of varying ages and ethnicities. This can help keep the brains of aging adults more agile as they challenge themselves to socialize with new people of all ages, backgrounds, and world views.

Inter-generational living is similar to multi-generational homes, just on a larger scale. Many of today’s older Americans want to maintain a connection to their community at large; offering their life experiences, knowledge, wisdom, and skill sets that can enhance lives for people of all ages. While living in a multi-generational home provides the same opportunity, the scale and needs of the people change when it is opened up to those outside of a nuclear family system. While some aging Americans prefer a retirement community of similarly aged people, many older adults are finding increased vitality and quality of life mixing with children, teens, young adults, and middle-aged people. Many aging adults prefer the stimulation of being associated with a non-homogenous group, and with their life expectancies increasing and overall health levels improving these inter-generational communities are becoming a popular lifestyle solution.

Decades ago, these types of multi-generational homes and communities would have been the norm. The Pew Research Center has reported that in the 1900s, fully 57 percent of Americans 65 and over lived with their children, grandchildren, and other family members. Communities were highly integrated into everyday life. However, the post World War II era ushered in an increase in education and loans to buy homes and start businesses. The opportunities scattered many families across the US in search of building a more prosperous life. By 1990 another Pew Research report found that only 17 percent of those 65 and older lived with their families. Now, nearly in 2020, the downward trend is reversing due to several reasons.

Immigration is one factor that explains the trend reversal. It is very commonplace around the world that multi-generational family systems live together and communities are very integrated. Longer life expectancy and the cost of continuing care retirement communities and long term care are other reasons families seek to live together. A delayed marriage pattern of younger people, as well as “boomerang” youth, are other reasons for the pattern reversal. Many children coming out of college have student loans and often wind up moving back in with parents or grandparents until they can get out of debt.

Inter-generational communities are not complex to build. Thoughtful designs of parks where park benches face each other to encourage conversation, dog walking parks, festivals, live music, art programs and more are just some of the uncomplicated techniques that help break down barriers between different age groups of people and help aging adults stay vital and integrated into life. Older Americans can experience reduced depression and loneliness, better mental stimulation, more daily activities, and can build relationships that will help them learn to rely on others, as others learn to rely on them.

Tasks like grocery shopping can be simplified if an older adult provides a shopping list to a younger community member and watches over their children while groceries can be obtained for both the younger family and the older adult. Oversight by community developers can create programs that encourage this sort of “bartering” of tasks because just plunking people in the same physical space does not necessarily build connections.

Building these inter-personal partnerships in an inter-generational community will help older adults continue to age in place and rely on community rather than a big bank account to pay for much of the help they might need. While many people opt for aging in place at the age of 50, some are interested enough in this movement of new urbanism and its many benefits, committing to the process in their thirties.

Nobody wants to have to leave their lifelong home because of aging. Many seniors are finding every day to be an adventure with never a dull moment living in inter-generational communities. Aging Americans can lead fuller and happier lives by staying invested in the process of being connected to all ages.

If you need help planning for your future or the future of a loved one, please get in touch with our Norman, Oklahoma office by clicking here to send us a message or by calling us at (405) 241-5994.

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10.0Tyler R. Barrett
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