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Elder Law

Continuing Care Retirement Communities (CCRC’s), also known as Life Care Centers, are becoming more and more popular as a housing option for seniors. Carolina Bay at Autumn Hall, Brightmore of Wilmington, and Plantation Village are all CCRC’s located here in Wilmington.  Each facility offers the promise of an active, social, and stimulating lifestyle with all of the necessary medical care and the security of knowing that you will not have to move again as your level of care increases.

A properly qualified and experienced Elder Law Attorney may be an important part of the admissions process. A CCRC contract is extremely complex and the decision to move from your home into a CCRC is not only a difficult and important life choice, it is also a difficult and important financial choice. And as with any important financial relationship, your role as a resident and the CCRC is controlled by a contract. A qualified and experienced Elder Law Attorney may be a very important part of the team when the decision is made to move to a CCRC.  The Elder Law Attorney can assist you in contract negotiations and can explain the contract so you understand your rights and responsibilities.  Most importantly, a good Elder Law attorney can help make sure that the contract meets your needs and North Carolina statutory requirements.

CCRC’s, often in exchange for a significant fee,  may provide a full spectrum of care – from independent living, to assisted living, to skilled nursing care.  Initially the CCRC may accept only people that are healthy and are able to live independently. However, once you are admitted, you are assured that you will have care that meets your needs for the rest of your life and that you will not have to move again.  A good Elder Law Attorney can help you understand who decides when you move to the next level of care (from independent living to assisted living, for example) and what criteria is used.  You should ask the CCRC what happens if your spouse requires a different level of care than you do.  Does the contract allow you to stay with your spouse or must you live separately in different levels of care?  

 

Here are some other very important questions that a qualified elder law attorney can answer after reviewing a CCRC contract:

  1. What are the payment terms of the contract? CCRC’s offer different types of contracts (from a one payment for all services model to fee for service model to a rental agreement) and each one has pluses and minuses and different payment terms.

  2. Who owns the living space?  You, the CCRC, or someone else?

     

  3. As mentioned above, how are decisions made to move residents from one level of care to the next? Often one spouse may require a different level of care than another.  Does this mean one spouse must continue to reside in independent living while another spouse moves to the assisted level of care?

     

  4. When does a resident need to supplement services with paid care?

     

  5. What happens if a resident runs out of money?

     

  6. What happens if the CCRC runs out of money/goes bankrupt?

     

  7. Is the CCRC Medicare/Medicaid certified?

     

  8. Is long-term care insurance still required when you move into a CCRC?

     

  9. What is the financial status of the CCRC?

     

  10. What happens to your funds held by the CCRC when you pass away?

     

  11. How does a resident qualify for a refund?

     

  12. Is there an arbitration provision in the CCRC contract?

  13. If you decide to move out, what does the CCRC contract require?

 

Another good resource for CCRC’s is CARF International. CARF is one of the few organizations that accredit CCRC's.  Likewise, in North Carolina the Department of Insurance puts out a reference guide to CCRC’s that is very useful.

Making the decision to move into a CCRC involves a lengthy contract, a significant amount of research, and a hefty financial commitment. A good Elder Law Attorney can help you ask the right questions and get the right answers before making the decision to move into a CCRC.

Just over one in every eight Americans age 40 to 60 is both raising a child and caring for a parent. It is estimated that between 7,000,000 to 10,000,000 adults are caring for their aging parents from a long distance. The Sandwich Generation is the generation of adults caring for both a child and an aging parent.

Carol Abaya categorizes the different scenarios involved in being a part of the sandwich generation: (1) Traditional: those sandwiched between the aging parents who need care and/or help and their own children; (2) Club sandwich: those in their 50s or 60s sandwiched between aging parents, adult children and grandchildren, or those in their 30s and 40s, with young children, aging parents and grandparents; and (3) Open faced: anyone else involved in eldercare.

However you are sandwiched, when your parents were younger they probably functioned well enough as a team and did not need your assistance to live their lives.  But as your parents get older and cope with the death of a spouse, (statistics indicate it is usually the husband who passes away first) your relationship changes and living alone may be very traumatic for your mom, the surviving wife.  She not only has lost a lifelong partner, but she also must develop new routines around the house and a different way of interacting with family and friends.  A son or daughter’s visit to a recently widowed parent, particularly when the son or daughter has their own children, can be very difficult.  Below is a checklist to guide you and your newly solo Mom (or Dad) to determine if assistance may be needed to assist Mom who is now living alone:

1. Is it safe for your aging parent to drive? Take a ride with your Mom or Dad and let them drive. Can they drive safely?  Can they find their way to the new restaurant that they heard about from their friends?  Does the car have any unexplained dents or scratches?  This is a very delicate and difficult subject because the loss of the ability to drive is associated with a loss of independence. If you feel that it is no longer safe for your parent to drive and you believe your Mom or Dad will resent you for even introducing the subject, have their physician discuss the issue. Their Doctor should be able to give medical reasons why it is unsafe for them to continue driving.  Discuss with your Mom or Dad  alternative transportation arrangements that may be used if Mom or Dad stop driving.

2. Is the mail piling up? If the mail is piling up, then it may be because your Mom can no longer understand what the mail says or how to pay the bills.  In addition to the obvious risk of the lights being turned off, there is also the risk of financial exploitation by third parties.  Gently review the financial records with your aging parent not by asking them if they need help, but by asking them to show you what bills need to be paid and how they should be paid in the event something does happen and they require assistance.  Remember that Mom has a right to refuse your assistance and access to her bills and financial information. Explain to Mom or Dad that you only wish to discuss their bills and finances to have a better understanding if you ever need to assist in the future.

3. Are prescriptions being taken as needed and in the correct dose? Check medications to see how often they are being refilled.  Ask your Mom what medication she takes, how often, and why? Make sure to confirm with her Doctor that she has answered appropriately. Note you will need your parent’s permission or a Health Care Power of Attorney to authorize the release of medical information to you.

4. Is the house being maintained? Is the house set up to prevent falls?  Is a discolored ceiling a sign of a water leak?  Is a formerly spotless house now messy?  Has the grass been cut?  Are carpets loose or are their other tripping hazards in the home?  Lack of maintenance may indicate a lack of ability to properly maintain the home.  Falls are a significant risk for the elderly and you should carefully examine the property for any tripping hazards.

5. Is your Mom eating right? Ask your parent about meals and what he or she cooks. Is the food in the refrigerator stale or expired?  Is it full of TV dinners or repeats of the same item?  If it is, then your Mom may not be eating right or forgetting what she has already purchased.  Meals may need to be delivered to the home or you may need to make other arrangements for appropriate nutrition.

We are “sandwiched” between our own lives and children and wanting what is best for Mom or Dad. Using this checklist should help indicate when in home assistance may be required if Mom wishes to continue to live in her home or, in the alternative, that living at home may not be the best arrangement.

Remember that as long as Mom has the capacity to make her own decisions, she may continue to make her own decisions regarding her finances and health care without consulting with family or friends. If you are concerned about Mom’s ability to make her own decisions, it may be helpful to speak with qualified Elder Law attorneys who may be able to assist your Mom and her family meet the changing circumstances.

As our clients age and start planning for their long term care, clients may and their families should research local Assisted Living, Memory Care, and/or Skilled Nursing Facilities before making any decisions. Certainly we encourage and assist our clients to stay in their homes as long as they wish and as long as they can get the care they need. Nonetheless, often an Assisted Living facility may be the next best step.

 

When choosing a facility, we advise our clients to take into account their resources and their health care needs. Some clients may only need Assisted Living care while others may need Skilled Nursing care. Keep in mind that the level of care required may change as the resident ages. Likewise a resident’s ability to pay may change over time. Some clients receive enough monthly income and have enough available resources to pay privately for a facility, while other clients may need to apply for Special Assistance or Medicaid Benefits.

 

In addition, we recommend that our Elder Law clients carefully review the admission agreements and financial stability of a facility before making a deposit or signing any documents. Important provisions include cost increases, possible tax deductions of long term care payments, who decides what level of care is required, what happens if spouses need different levels of care, what happens if a resident runs out of funds, what happens to any deposits in the event of a death, etc.

 

Below is a chart that may be useful in locating local Assisted Living, Memory Care, and Skilled Nursing Facilities in New Hanover County and surrounding counties. This list also indicates if the facility accepts Special Assistance or Medicaid payments. Special Assistance is a public benefit that provides payment for care in an Assisted Living facility or Memory Care facility for those who meet the eligibility requirements. Medicaid is a public benefit that provides payment for care in a Skilled Nursing facility for those who meet the eligibility requirements. Please note when referring to the below chart that the list is non exhaustive as some facilities did not wish to be included or did not respond to requests for information.

 

Craige & Fox, PLLC does not endorse any of the below facilities, but simply provides this list as a reference. We encourage you to visit the North Carolina Department of Health and Human Services website which provides facility inspections, ratings and penalties for Assisted Living, Memory Care and Skilled Nursing Facilities in the state of North Carolina when searching for a facility for you or a loved one. And of course there is no substitute for an on-site visit to make a determination of how a facility takes care of its residents.

 

Facility

Type of Facility

Special Assistance Accepted (when beds are available)

Medicaid Accepted (when beds are available)

Ashe Gardens

300 West Ashe St.

Burgaw, NC 28425

910-259-8070

http://www.meridiansenior.com/community

Memory Care

No

Yes

Autumn Care Nursing and Rehab Center of Shallotte

237 Mulberry Street
PO Box 2337
Shallotte, NC 28459

910-754-8858

Skilled Nursing and Rehab

No

Yes

Autumn Care of Myrtle Grove

5725 Carolina Beach Road
Wilmington, NC 28412

910-792-1455

http://www.autumncorp.com/locations.aspx?facid=13

Assisted  Living and

Skilled Nursing

No

Yes

Azalea Health and Rehabilitation Center

3800 Independence Blvd.
Wilmington, NC 28412

910-392-3110

http://azaleahealth.org/

Skilled Nursing

And Rehab

No

Yes

Brunswick Cove Nursing Center

1478 River Road, Hwy. 133 S.
PO Box 916
Winnabow, NC 28479

910-371-9894

http://www.brunswickcove.com/contact.html

Assisted Living and

Skilled Nursing

Yes

Yes

Carillon Assisted Living

1125 East Leonard Street

Southport, NC 28461

910-454-4001

http://www.carillonassistedliving.com/

Assisted Living and

Memory Care

Yes

Yes

Cedar Cove Assisted Living

420 Jasmine Cove Way

PO Box 15027

Wilmington, NC 28408

910-397-7812

Assisted Living and

Memory Care

Yes

Yes

Champions Assisted Living at the Davis Community

1007 Porter’s Neck Road

Wilmington, NC 28411

910-686-6462

http://www.thedaviscommunity.org/

Assisted Living

Yes

No

Clare Bridge of Wilmington

3501 Converse Drive

Wilmington, NC 28403

910-790-8664

https://www.brookdale.com/communities/clare-bridge-of-wilmington/?_vsrefdom=national-locations/&gclid=CNr6hbPFv8UCFcIdgQod07IAKg

Assisted Living and Memory Care

No

No

Cypress Pointe Rehabilitation Center

2006 S. 16th Street

Wilmington, NC 28401

910-763-6271

Skilled Nursing

No

Yes

Dosher Memorial Hospital Extended Care

924 N. Howe Street
Southport, NC 28461

910-454-4607 or 457-7696

http://www.dosher.org/getpage.php?name=index

Skilled Nursing

No

Yes

Health Care Center at The Davis Community

1011 Porter's Neck Road
Wilmington, NC 28411

910-686-7195

http://www.thedaviscommunity.org/

Skilled Nursing and

Memory Care

Yes

Yes

Hermitage House

4724 Castle Hayne Road

Castle Hayne, NC 28429

910-675-2988

http://www.meridiansenior.com/community/hermitagehouse

Memory Care

Yes

Yes

Huntington Health Care and Retirement Center

311 S. Campbell Street
Burgaw, NC 28425

910-259-6007

http://huntingtonhc.com/

Assisted Living and

Skilled Nursing

Yes

Yes

Karon's Family Care Home

570 Oak Tree Road
Willard, NC 28478

910-285-3246

Assisted Living

Yes

No

Liberty Commons Nursing & Rehab Center

121 Racine Drive
Wilmington, NC 28403

910-452-4070

http://www.libertyhealthcareandrehab.com/libertycommons/

Skilled Nursing and Rehab

No

Yes

Liberty Hill Family Care

1874 Farmers Union Road
Clarkton, NC 28433

910-647-0216

This email address is being protected from spambots. You need JavaScript enabled to view it.

Assisted Living

No

No

Mt. Olive Family Care

Route #1, Box 204-C
2583 Red Stone Road
Whiteville, NC 28472

910-628-7755

Assisted Living

Yes

No

New Hanover House

3915 Stedwick Court
Wilmington, NC 28412

910-632-2671

http://www.meridiansenior.com/community/

Assisted Living and

Memory  Care

Yes

Yes

Northchase Nursing & Rehab

3015 Enterprise Drive
Wilmington, NC 28405

910-791-3451

Skilled Nursing and Rehab

No

Yes

Pacifica Senior Living

2744 S. 17th Street
Wilmington, NC 28412

910-452-1114

http://www.pacificawilmington.com/

Assisted Living and

Memory Care

Yes

Yes

Pender Memorial Hospital - Extended Care

Skilled Nursing Unit

507 E. Fremont St.
Burgaw, NC 28425

910-259-5451

Skilled Nursing

No

Yes

PenDu Rest Home

685 North Carolina Hwy. 50
Wallace, NC 28466

910-259-4469

Assisted Living

Yes

No

Premier Living Inc.

106 Cameron Street
PO Box 196
Lake Waccamaw, NC 28450

910-646-3132

Skilled Nursing

No

Yes

Shallotte Assisted Living

PO Box 1559
424 Mulberry
Shallotte, NC 28459

910-754-6621

http://www.shallotteassisted.com/

Assisted Living

Yes

No

Sherwood Manor Rest Home

1605 Robinhood Rd.
Wilmington, NC 28401

910-762-9531

Assisted  Living

Yes

No

Silver Stream Nursing & Rehab. Center

2305 Silver Stream Drive
Wilmington, NC 28401

(910) 362-3621

http://www.savaseniorcare.com/

Skilled Nursing and Rehab

No

Yes

Spring Arbor of Wilmington

809 John D. Barry Drive
Wilmington, NC 28412

910-799-4999

http://springarborliving.com/locations/wilmington-nc.htm

Assisted Living and

Memory Care

Yes

Yes

The Commons at Brightmore

2320 41st Street
Wilmington, NC 28403

910-392-6899

http://www.brightmoreofwilmington.com/lifestyle-choices/memory-care/

Skilled Nursing and Memory Care

No

No

The Kempton at Brightmore

2298 41st Street
Wilmington, NC 28403

910-332-6899

http://www.brightmoreofwilmington.com/lifestyle-choices/assisted-living/

Assisted Living

No

No

Trinity Grove of Wilmington

631 Junction Creek Drive
Wilmington, NC 28412

Phone  910-442-3000

http://trinitygrove.net/

Skilled Nursing and

Memory Care

No

Yes

Wilmington Health & Rehab

820 Wellington Ave.
Wilmington, NC 28401

910-343-0425

Assisted Living and

Skilled Nursing

No

Yes

Two books, Atul Gawande’s Being Mortal:  Medicine and What Matter in the End and Roz Chast’s Can’t We Talk About Something More Pleasant, explore the real “gray” behind the graying of America.  We all know the statistics:  the number of Americans 65 and older is expected to double by the middle of the century, over 20% of the US population will be over 65 by 2050 as compared to less than 10% in 1970, Health and Medicare costs will continue to rise as Social Security runs out, etc.

Confronting the Loss of Physical and Mental Autonomy

All of these warnings have been sounding for years.  What has not been discussed is how we will cope as a society, as families, and as individuals with the loss of physical and mental autonomy that accompanies age.   Likewise, how can a younger generation care for an older generation? Both Being Mortal and Can’t We Talk About Something More Pleasant bring these difficult issues to the forefront in compelling and easy to read narratives.

Dr. Gawande, a surgeon and popular author in his 40s, points out “Some will be alarmed by the prospect of doctor’s writing about the inevitability of decline and death.” Yet the very inevitability of aging and physical decline mandates a conversation because it happens to all of us whether we talk about it or not.  Without a conversation and taking steps, we cannot make a difference on how we age and how we die.

You Don't Have to Sacrifice Your Dignity as You Age

Dr. Gawande wants to improve the experience of aging by focusing on freedom and autonomy as we age and approach death.  Instead of being strapped in a wheelchair stranded in the hallway of a “Assisted” Care Facility, he wants individual rooms with locks on resident’s doors, no more than twenty residents per care facility, and the retention of the freedom  “to be authors of our lives” until the end. According to Dr. Gawande, most people do not want the “safety” of a wheelchair; they would rather have the independence of walking and risk a fall.  He supports his ideas with lively stories of tough-minded individuals, including stories of his mother-in-law and father, to make his points about what we face as a society and as mortal individuals.  We all are going to die, but that does not mean we have to sacrifice dignity for medical treatments that may actually shorten life or forego privacy in the name of safety.

Face "This Aging Thing" with Humor

Like Dr. Gawande, Roz Chast calls upon her area of expertise, as a popular cartoon artist for the New Yorker, and her parents’ experiences to illustrate and discuss aging parents.  Chast’s book is funny, insightful, and brings to light how difficult it is when the child becomes the caregiver.  Neither Ms. Chast nor Ms. Chast’s parents want to talk about death or “this aging thing,” much less assisted living.  Her parents have lived in Brooklyn forever, have done everything together (with the exceptions of WWII,  work, illness, and going to the bathroom) for decades, and are certain that they never want to be a burden to their only daughter.  

Ms. Chast uses wonderful cartoons to discuss and share the pain and absurdities of old age and dementia. Her graphic memoir talks about her mother’s gradual decline from a spotless house to clutter, dust, and piled up unopened mail.  Ms. Chast candidly and with heartfelt cartoons talks about her father’s dementia and her parents’ eventual move to “the Place” where her mother goes from a cane to a walker and where her father learns from the other residents that he talks too much.

Start the Conversation Now

Being Mortal and Can’t We Talk About Something More Pleasant are excellent reads that use personal stories to discuss the hard issues and choices we all must face as we and our loved ones age.  Although the topic is difficult to discuss, we must find ways to help our loved ones age with dignity and respect. Older adults and their families should begin a conversation now to discuss older family members’ wishes with regards to healthcare and long term care needs.

Elderly Clients are a primary practice area for Craige & Fox, PLLC. Both the North Carolina State Bar and the National Elder Law Foundation have certified Lawrence S. Craige as a specialist in Elder Law and Jennifer N. Marshall is also an experienced Elder Law attorney.

For the clients we serve and their families, long term care options are of great concern and are a very emotional topic between parents, children, and grandchildren. Planning for future long term care, however, empowers our clients and their families to make decisions now that will affect them and their loved ones in the future.  This article will address the need to plan ahead for long term care and the different care options that are available to the elderly.  It also offers some suggestions regarding the appropriate next steps and making decisions about long term care.

What is Long Term Care?

Long term care is a variety of services, including medical and non-medical services, for people who have a chronic illness or disability.  Examples of chronic illness or disabilities are diabetes, hyperlipidaemia, Parkinson’s disease, multiple sclerosis, speech impairments, and cancer.

Long term care assists people with support services to help with activities of daily living.  Some examples of activities of daily living include dressing, bathing, using the bathroom, feeding, or attending to personal hygiene or grooming. Long term care can be provided at home, in the community, in assisted living, or in a nursing home.

Why talk about Long Term Care now?

It is important to plan ahead for long term care as health declines with age and many older adults will need assistance with one or more activities of daily living as they age.

What Are Your Long Term Care Options?

There are several long term care options available to older adults.  The appropriate long term care option depends on the older adult’s need for assistance.  Older adults may choose from less invasive services like adult day care or home health care which allow the senior to remain at home, or the older adult may look to more invasive living arrangements like an assisted living facility or a nursing home.

Adult Day Care:

Adult day care services provide a support group for seniors with functional and/or cognitive impairments. According to the North Carolina Department of Health and Human Services, adult day care provides an organized program of services during the day with the purpose of promoting seniors’ social, emotional and physical well-being and supporting personal independence of seniors.  Adult day cares must meet specific North Carolina State Standards for Certification and receive its certification from the Division of Health Service Regulation.  These standards are enforced by the State Division of Aging and Adult Services.

Home Care:

Seniors may have the option of procuring services from a home health care provider. Home health care services may be personal care that is extensive and complex in nature requiring a certified nurse aide to help with bathing, dressing, toileting, feeding, and ambulation. These services are regulated by the North Carolina Division of Health Service Regulation.  Home health care services may also be used for home management assistance like cooking, cleaning, laundry and shopping.  These services are regulated by the North Carolina Division of Aging and Adult Services.

Assisted Living Facility:

Assisted living facilities allow provide older adults with a combination of housing and personalized care services to assist with activities of daily living.  Assisted living facilities are designed to allow older adults to live in a home-like setting and maintain as much privacy and independence as possible while still receiving assistance with activities of daily living like bathing, dressing, meal preparation and housekeeping. Assisted living facilities are licensed in North Carolina by the Department of Health and Human Services through the North Carolina Division of Facility Services.

Nursing Home:

Nursing homes are the most invasive form of long term care.  A nursing home will typically provide a secure environment and all services to meet the social, medical, and physical needs of older adults.  Residents of nursing homes typically require assistance with multiple activities of daily living such as dressing, eating, toileting, and continence.  Residents of nursing homes may also suffer from a form of dementia or other cognitive impairments. Nursing homes must be licensed and regulated by the North Carolina Division of Health Service Regulation.

How Does the Senior or the Senior’s Family Choose the Appropriate Long Term Care Option?

Older adults or their families should plan now for any future long term care needs.  Older adults should discuss with their families their wishes to remain at home, move to an assisted living facility, or receive care at a nursing home.

Older adults and their families should be clear on what services are needed and review carefully any contracts provided by the service providers.  It is imperative that the senior or the senior’s family or caregiver have a clear understanding of the servicer’s contracts, what services are provided, what services fall outside of the basic agreement, and who is obligated to pay for the services provided.

Older adults and their families should also consider the service provider’s policy regarding staff qualifications, staff training, and educational requirements.

Finally, older adults and their families should consider what long term care financing options are available to the senior. Will the senior pay for long term care out of pocket, through insurance, or with public assistance like Medicaid? An attorney may assist a senior or their family in determining the financing options available to the senior.

Conclusion

Craige & Fox, PLLC has helped numerous families face and overcome the challenges associated with long term care planning and financing through proper legal planning.  If you or a loved one need assistance in determining the best course of action for long term care needs, please contact our office.

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Craige & Fox, PLLC
701 Market Street
Wilmington, NC 28401
910-815-0085 Phone
910-815-1095 Fax

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