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The link between caregivers and immigration policies

Pew Research Center estimates about 10,000 individuals are turning 65 each day. As the elderly population steadily grows, so does the need for long-term care and caregivers. However, there are concerns that there will not be enough direct care workers to meet the growing demand.

Long-term care has inadvertently found itself linked to the nation’s current immigration debate. Changes in immigration laws have the potential to affect older Americans and patients with illnesses or disabilities who rely on consistent care.

According to the Paraprofessional Healthcare Institute (PHI), one out of four caregivers are immigrants. Around 34,600 individuals from Haiti, El Salvador, Nicaragua and Honduras work as home health aides, nursing assistants or in other caregiving jobs. They must either leave the United States or face deportation before their Temporary Protected Status becomes invalid at some point in the coming two years.

In an industry that is already struggling with a worker shortage, the worry is that tens of thousands of people could be left without care if immigrant caregivers are compelled to leave the country. Paul Osterman, a human resources professor at Massachusetts Institute of Technology, predicts there will be a shortage of 151,000 direct caregivers by 2030. That number is likely to rise if immigrant workers lose work permits or other industries entice direct care workers with higher wages.

“It’s impossible to imagine that the long-term care sector would survive without immigrants,” said PHI Vice President of Policy Robert Espinoza. “If you make it more difficult for people who are already documented to remain in the country, what you’re doing is you’re making it more difficult for families to find workers to care for their loved ones.”

Inevitably, a shortage of caregivers will cause the cost of care to increase. This will put even more financial pressure on individuals with the most challenging care needs.

Report warns of rising Alzheimer’s costs and their impact on families

The rising number of Alzheimer’s cases and their accompanying costs are taking a toll on caregivers and society at large. A new Alzheimer’s Association report published last March makes some worrying projections about the cost of the disease.

The population of elderly Americans with Alzheimer’s is expected to increase 29 percent from the current 5.5 million to 7.1 million by 2025. Without any headway on effective treatments by then, the number will likely skyrocket to 13.8 million people in 2050.

The report’s authors pointed out that family caregivers shoulder most of the responsibility when it comes to looking after Alzheimer’s patients. As a result, there is likely to be negative impact on their emotional, physical and financial wellbeing, the Alzheimer’s Association said in a statement.

Last year over 16 million people spent 18.4 billion hours providing unpaid care to Alzheimer’s patients. Families assume 70 percent of the lifetime cost of their care, which totaled $329,360 per patient in 2017.

The report warned of the “growing cost and impact of Alzheimer’s on the nation’s health care system.” Its authors emphasized that society would benefit greatly from the early diagnosis of Alzheimer’s disease as it would reduce long-term care costs.

The caregiving expenses for individuals with Alzheimer’s and other forms of dementia are estimated to be $277 billion this year, not including unpaid caregiving. The amount includes Medicaid and Medicare, along with out-of-pocket expenses mostly for nursing homes and private insurance.

“The need for reliable and creative approaches to pay for the devastating cost of home care and nursing home care is overwhelming,” said Michael Gilfix. Mr. Gilfix is an attorney and entrepreneur who has helped hundreds of families obtain quality care — without the loss of the family home and without financial destruction.

Long Term and Asset Protection Planning

This presentation by attorneys Michael Gilfix and Mark R. Gerson Gilfix will address:

  • Simplification of your Revocable Trust to massively save on taxes;
  • Passing assets to your children and grandchildren in ways that protect them from divorce, litigation, and estate taxes;
  • How to protect your residence and other assets – and save your family $100s of thousands - while qualifying for Medi-Cal to pay the cost of skilled nursing care;
  • Estate and gift taxes;
  • The pros and cons of reverse mortgages;
  • Long-term care insurance and planning for long term care; and
  • The value and importance of involving your children in the planning process.

Trump Tax Reform and Your Tax and Estate Planning Seminar

Uncertain about what the new tax law means for you and your family? Wondering how to proceed with your estate planning in light of President Trump’s tax reform? Gilfix and La Poll Associates is here to help.

Attorneys Michael Gilfix and Mark R. Gilfix will be leading a free seminar, which they will discuss the implications of the new tax law and provide practical tips. The seminar will present a wealth of valuable information that will allow you to take charge, plan and capture benefits. Michael Gilfix and Mark R. Gilfix will talk about both irrevocable trusts and revocable trusts, estate tax, as well as income tax punishments and opportunities. They will also cover what the new tax law means for real estate, and buying or selling a home.

The seminar will offer guidance on new income tax credits for caregivers and the planning implications for the cost of long-term care. It will also answer questions like should you move your assets to Nevada? Will a “pass through” entity save you a small fortune in income tax? Gilfix and La Poll aims to address all your concerns and ensure the tax reform plan does not leave you feeling helpless.

San Francisco launches new conservatorship measures to help patients with mental illness

San Francisco Mayor Mark Farrell recently announced the addition of more conservatorship beds to help individuals who suffer from serious mental illnesses. He said with more than double the number of beds, there will be “real results” for ill patients.

The San Francisco Healing Center at St. Mary’s Medical Center received 54 new locked psychiatric beds. The beds are an effort to help people who are placed in conservatorship because they are unable to live independently due to their illnesses, but do not need constant hospital care. They provide an alternative to placing patients in out-of-county facilities, hospitals or jails.

State senators are also working on legislation to expand and strengthen California’s conservatorship laws. Conservatorships are currently limited to elderly individuals vulnerable to abuse as well as people with severe disabilities or cognitive limitations. The bill seeks to give counties more options to address homeless individuals who are trapped in a cycle of going in and out of jails, hospitals and other government services.

San Francisco Board of Supervisors President London Breed also introduced a measure that decriminalizes mental health conservatorship. It puts the city attorney in charge of overseeing such cases instead of the district attorney.

Conservatorships may be needed in circumstances where a person is unable to make one’s own financial and health care decisions due to physical or mental incapacity. In California, a civil court judge establishes a conservatorship by appointing someone to make decisions on behalf of the incapacitated individual. While a conservatorship may be necessary in some cases, it can typically be avoided if the person has previously signed an Advance Health Care Directive or Durable Power of Attorney.

California may allow on-campus medical marijuana use for special needs students

Some children who have special needs depend on marijuana for medical treatment due to its purported therapeutic properties. Now, a California senator has introduced a bill that would allow local school boards to create policies that permit on-campus medical marijuana use for special needs students or those with serious disabilities.

Sen. Jerry Hill, D-San Mateo, who introduced the bill, said in a statement that the goal is to give “students access to the medicine they need so they have a better chance for success in the classroom and in the community.”

Under the measure, the child’s parent or guardian would be able to administer medical marijuana in various forms such as capsules, topical creams, tinctures or oils on school campuses that have the approval of the school district’s governing board. Currently, students from kindergarten through grade 12 must be off campus in order to have medical marijuana administered to them.

The legislation gives charter schools, county boards of education or governing boards of school districts the option to pass more permissive policies. Students seeking to use medical marijuana on campus would need to have a doctor’s recommendation.

As there are many different laws governing medical marijuana use, lawmakers are seeking to address any statutes that could potentially conflict with the measure. It appears the key force behind the legislation is ensuring the safety of special needs students. “We want to make sure that these children are able to take this medicinally recommended product in a safe environment rather than out on the street,” Hill said.

California faces growing concerns and lawsuits over nursing home evictions

California has been at the center of a renewed focus on patient dumping and unlawful nursing home evictions. Local and federal regulators are looking to enhance the enforcement of laws that protect nursing home residents.

A lawsuit was recently filed in Santa Clara County Superior Court against SavaSeniorCare, a national nursing home chain. Six of its California facilities were accused of illegally evicting nursing home residents. They allegedly refused to provide patients with advance written notices of discharge or inform them of their right to appeal the discharge.

The lawsuit claimed SavaSeniorCare favored profit over following longstanding rules designed to protect residents. Last year, the AARP Foundation filed a similar lawsuit against a Sacramento provider.

Nursing homes have a legal duty to provide 30 days’ notice before discharging a patient involuntarily. They must also notify the appropriate parties, give a specific reason for the eviction and offer the resident a chance to contest the decision. In addition, the nursing home is required to help arrange the individual’s transfer to their home or another long-term care facility.

Evictions have to meet a limited set of criteria in order to be justified. For example, a patient may be discharged because of their failure to pay, the facility’s closure or inability to meet the resident’s needs, or because the resident poses a risk to others’ safety. Many nursing homes misinterpret the reasons and engage in patient dumping for monetary gains.

Legislation that aims to deter the practice of patient dumping has been introduced in the California State Senate. The measure would ensure nursing homes discharge patients to their specified place of residence or to another licensed facility.

Unfortunately, far too many residents nationwide are unaware of their rights and are evicted without an appeal. As a result, they end up without permanent housing or the routine medical care they need upon discharge.

How robots could help ease the looming caregiving shortage

The United Nations estimates that the global population of elderly individuals will increase 56 percent by 2030. However, the number of professional caregivers is expected to fall short.

Researchers at Oklahoma State University believe that robots could be the key to meeting the growing demand for caregivers. Engineering professor Weihua Sheng and his team are developing robots that are able to provide companionship to elderly individuals and detect potential problems.

The first model is an interactive tabletop robot designed along the lines of home assistants like Alexa or Google. The robot’s capabilities include asking questions, logging vital statistics and having the ability to detect falls. After finding out where the fall occurred, the robot can then contact the person’s doctor. The second prototype is a mobile robot that is equipped to move through a single-story house.

Sheng said his project aims to improve the lives of elderly people and enable them to be more independent. “Because of the shortage of nurses and doctors and home health care providers . . . many older adults are not able to access those kinds of caregiver resources,” he said. “That’s why we need technology to help them.”

One of the main issues with robot caregiving is a lack of empathy and emotional connection with patients. Sheng and his team are planning to address that by conducting trials at a retirement community.

“We’re trying to improve the intelligence of the robots so they can recognize emotions and facial expressions, which can provide a context for the human-robot conversation,” said Sheng. He predicts similar robots will be available for sale in the next decade or so at a price point ranging from $1,000 to $2,000. Although robots are unlikely to take over the entirety of caregiving, they may help lighten the load on caregivers in the future.

Hugh Hefner’s will forbids heirs from using drugs and alcohol

Hugh Hefner was vocal about his dislike of drugs and alcohol, as well as his concerns about substance abuse. It appears that the Playboy founder, who died in September 2017 at age 91, drafted his will to reflect those views.

Hefner’s trust includes a clause that blocks his heirs from accessing their inheritance if they are found to have engaged in substance abuse. It says that if any of his four children or his widow become “physically or psychologically” dependent on drugs or alcohol, they will not be able to obtain any money. The rule also applies to clinical dependence on alcohol consumption or use of chemical substances that are not prescribed by a psychiatrist or doctor.

According to the will, the inheritance’s trustees will be responsible for determining whether the heirs have violated Hefner’s terms. The trustees can ask them to submit to drug testing at any time if substance abuse is suspected. Payments may restart once the individual in question has remained sober for 12 months or is “able to care for himself or herself again.”

Placing restrictions on an inheritance is not uncommon. Individuals may choose to include drug and alcohol testing requirements out of concern for a beneficiary’s wellbeing, especially if they have an addiction problem. Such clauses are usually intended to protect beneficiaries and ensure the inheritance is distributed according to one’s wishes.

Robot caregivers elicit mix of worry and enthusiasm among Americans

A Pew Research Center survey conducted last year offers some interesting insights into how people feel about robot caregivers and automation in general. Some Americans view robots as a possible solution to the anticipated shortage in caregivers for the nation’s aging population. However, many are concerned about the negative consequences of replacing human caregivers with technology.

One of the earliest caregiving robots ever created was PARO, a therapy robot in the form of a cuddly baby seal that helps patients who suffer from memory loss. Currently, researchers in Oklahoma State University and other institutions are developing robots that can not only serve as companions, but also perform household tasks, assess vital signs, lift people, seek assistance in emergencies and dispense medication.

Around 40 percent of survey respondents expressed interest in the idea of having a robot caregiver. They believe that such technology would help young people worry less about caring for elderly family members. In addition, robot caregivers would allow older adults more independence and enable them to remain in their own homes longer.

Among those interested in using robot caregivers, just over 20 percent feel they would provide better, more reliable care than paid human caregivers today. For example, a robot would not get tired nor let emotions or biases affect the quality of care provided. In addition, they can help ease the burden on family members who are often juggling other responsibilities.

Conversely, nearly 60 percent of adults said they would not want robot caregivers for themselves or loved ones. The main reason for this appeared to be a lack of trust and compassion. While some people believe that the human touch can never be replicated by technology, others are worried about robots making mistakes in caring for their family members. Some survey respondents liked the idea of having a human remotely monitor the robot, such as via video surveillance.