Saturday, December 7, 2013

Non-Taxable Personal Injury Payments


When a person is injured in an accident, he or she may pursue legal action to recover the costs of medical treatment. These lawsuits are useful mechanisms for individuals needing to cover high medical costs, especially due to the rising costs of healthcare. Technically speaking, this money counts as income, meaning that it becomes a consideration for federal taxes. However, due to the purpose of these funds, they are not treated in the same way as other forms of income.

According to the federal tax code, the government will not tax any personal injury funds resulting from an injury claim. This can include compensation received for physical injury, medical expenses, emotional damages, and even lost wages. In the case of lost wages, compensation will prove non-taxable while the actual wages themselves would have been regularly taxed.

Some individuals may attempt to use the medical expense deduction when filing for their income tax return. However, if the funds were received without tax as a part of a settlement or judgment, this deduction must be adjusted by filing these funds as income in the tax return.

There is one instance when this money becomes taxable. If a person is injured in an accident and receives a sum of interest as a part of the settlement total, that additional income is considered a separate taxable entity from the actual compensation sum. As a result, any money received through interest, not the compensations funds themselves, will be considered taxable income by the IRS.

To learn more about tax statuses with car accident injury claim funds, contact an auto accident lawyer.

Signs That Your Parent Might Need Assisted Living Services


It can be a difficult decision to make when you need to sign your parent up for assisted living services, but ultimately, it is for the better. The difficult part is being aware of the signs that your parent might be in need of the services. When you start to notice some of these things, it is time to consider your options. Both your life and the life of your parent will be better when they are in a place where they can get the help that they need to live their lives right.

Some of the signs are obvious, while others you will need to watch out for. Depression is a common sign that assisted living services might be needed. While it is normal after the passing of a spouse, it is not something that should persist for years after. And though depression is not a clear indicator of the need for help, not having food in the refrigerator or failing to maintain the yard and the cleanliness of the home are much more clear indications. These things show that the senior is not only physically unable to do the work, but also that they do not notice the need or do not care about it any longer.

Sometimes, seniors that are in need of assisted living services will start wear the same outfits every day. They might also stop showering or brushing their teeth. If you ever notice this, you need to take action quickly, as their health is at stake. The same is true if you notice them getting bruises or cuts frequently. As their skin becomes frailer and their body is not able to heal itself as quickly, being able to receive the proper care is necessary.

So while it can be a very difficult decision to make, sometimes assisted living services are by far the best thing that you can do for an elderly parent. It will allow them to get the care they desperately need, and they won't have to worry about difficult things like cleaning or taking care of the yard anymore. In the end, they will be much happier and healthier, and you will be able to rest easy that they are constantly being taken care of.

Characteristics of Good Senior Home Care Providers


Home care providers and home health care are a unique breed. While training is needed to meet job requirements, home health care providers must also possess other innate qualities that enable them to compassionately perform job functions, as per patient wishes and the wishes of their families.These special qualities are what make all the difference between average home care and excellent senior care providers. This article examines caregiver characteristics that are necessary for providing invaluable services within homes and communities everywhere.

Senior home health care providers must be able to perform all of the following job functions, including:

  • Assisting clients, seniors, and care recipients with daily living activities.

  • Preparing meals for clients.

  • Any necessary assistance with ambulation.

  • Light housekeeping tasks, cleaning, laundry, trash removal, tidying up.

  • Attending to all safety needs, ensuring a safe environment for patients and care recipients.

  • Effective and compassionate communication with patients, family, coworkers, and all interested parties.

  • Confidentiality, as per the wishes of family and patients.

  • Understanding and following through on all requirements for the care of the patient or senior loved one, including special needs and patient wishes.

Beyond those basic functions and responsibilities lie the real substance of a home health care provider's role; that of the compassionate personal attendant. Caregivers must go beyond handling the needs of care recipients and responding appropriately to certain job situations, but demonstrate compassion, love, caring, and thoughtfulness. When those qualities are present, you'll know you have a caregiver who not only loves their job, but love those they provide care for. Caregivers, home health care providers, and senior caregivers are dedicated individuals who have a passion for helping people, and are selfless in their desire to improve the quality of life for senior loved ones. Home health providers work as facilitators to achieve a better quality of life for elders in need of support.

Other characteristics of exceptional home care providers include:

Commitment and dedication. Families and elderly individuals in need of home care should rely on workers to be available when needed, honor their commitments, and carry out all job related responsibilities in a highly professional manner. When a family chooses to bring a home health care provider into their environment, the caregiver should be respectful of the situation, as well as any hardships the family or patient faces on an everyday basis.

Creativity. Great home care providers are always thinking of new activities and ideas to introduce to clients, designed to better their quality of life or improve a situation, helping them gain comfort and independence. Additionally, they should focus on creating new ways elderly individuals can carry out tasks and learn new skills.

Judgment. Home health caregivers should always exercise good judgment, and maintain confidentiality, but not when a patient or client is in danger.

Senior home care find their careers very rewarding, and perform invaluable services in homes and communities everywhere. A home health care provider with willingness to help elderly patients and loved ones in need and a caregiving individual who chooses to make themselves available as relief for families is invaluable.

Home care is an excellent option for seniors who wish to continue living in their community and home to feel secure, despite difficulties they may be experiencing. Home care and assisted living providers work with you and your loved one to create a specially tailored plan to meet the personalized needs and services required-and this plan can be adjusted at any point in time to ensure the proper care is provided, as conditions can change. Learn more about home health care services and find out if that type of support would benefit your loved one and improve their safety, health, and well being.

3 Reasons Why Long Term Ventilated Patients Need Specialised Intensive Home Care Nursing Services


Reason one: Quality of Life for Customers and their families. There is no such thing as Quality of Life for a long-term ventilated Patient with Tracheostomy in Intensive Care. I vividly remember this 38 year old gentlemen being diagnosed with Guillan Barre- Syndrome. He spent a good three and a half months in ICU on a ventilator with a Tracheostomy. Hell was he depressed and frustrated- and so was his family. His elderly Parents, his young wife and his two young children spent far too much time in Intensive Care, with their family life, their health and their general well being suffering. This gentlemen could have gone home after one month, if specialised services had been available. The only thing that kept him in Intensive Care was his ventilator dependency and the lack of specialised home Intensive Care Nursing services.

Reason two: Quality of-end-of-Life for Customers and their families. The full force of exposure to suffering, pain and vulnerability hits when somebody is dying slowly on a ventilator with Tracheostomy in ICU. Everybody who has witnessed the slow death of a Patient dying on a ventilator with Tracheostomy in Intensive Care, will not forget the experience. I remember a number of cases vividly over recent years, but the one that probably stood out most, was a young lady in her mid- fifties. After a new set of lungs had given her a few more years to live, she now was readmitted back to Intensive Care and the full force of respiratory failure hit her. Over a good 8-12 week period, this lady and her family went through hell. Fully conscious most of the time, she occupied a bed space in midst of the unit, glaring at people who passed by. Intensive Care is a very busy 24/7 environment- I had to throw that in- and in the middle of this 24/7 thoroughfare was this lady, surrounded by her family, most of the time and everybody could actually see what was going on. People should have seen her husband. I remember that at the beginning of the lady's ICU admission, he was full of strength, very supportive and always friendly and chatty' with the staff. Towards the end of his wife's stay in Intensive Care, he could hardly walk with a sore back. I think he felt the full force of what him and his wife had been through, despite of all the efforts of the marvellous ICU staff.

Quality- of-end-of -life is not a term Health services, hospitals or even palliative services use and I believe it is so underrated. Shouldn't?Palliative services' be renamed to Quality of-end-of-life services'? Shouldn't we strive to provide Quality of-end-of-life, just as much as we strive to get Patients out of Intensive Care in a better condition than what they came in for? Isn't it a privilege to provide Quality at the end of somebody's life? I believe it is. Death is part of life- and the sooner we accept and embrace it and make it part of our day to day living, the more creative and accepting we get of the fact that there is Quality, even at the end of our lives.

Reason three: Quality of work environment for staff in Intensive Care. Everybody who has worked in Intensive Care for a period of time, whether Nurses, Doctors, Physiotherapists or anybody else who has come in contact with a long- term mechanically ventilated Patient with Tracheostomy and their families, knows the feeling and the uneasiness when a Patient has been in Intensive Care for sometimes many weeks or many months. Those Patients are very often not on the 'top priority' list of anyone within the ICU environment. Depending on the Intensive Care unit layout, those Patients might be left in a side room, with an Agency nurse looking after the Patient, because the permanent staff, have lost their enthusiasm looking after the Patient. So the Patient is then left with the Agency Nurse looking after the 'day 68 Trachy Patient'. Now, no disrespect to Agency nurses, but it is usually the permanent staff of an organisation that is usually more engaged with Patient care.

Furthermore, the Patient has also 'slipped' down the priority list of the Medical staff. They very often come and see this Patient last on their ward rounds. As nothing is moving forward with this Patient anyway and everybody is feeling the burden of not really making any progress with this Patient, everybody is a bit like, "well there is not much we can do with Joe anyway. He's got a Trachy and is still ventilated- so what are we going to do?". The discussion around Joe is not going to move forward, as the ICU team has not many more options to provide Quality of Life for Joe.

Once again, everybody who knows and understands how an ICU operates and functions, knows that the morale of staff is usually at its lowest, if there has been one or more long- term Patients in Intensive Care, as for Staff in Intensive Care, the higher turn- over Patients are more rewarding, especially if quick and marked improvements can be seen.

Senator Kennedy's Legacy - The CLASS Act


One of the most important pieces of the recently enacted "Patient Protection and Affordable Care Act" is the "CLASS Act", which stands for the Community Living Assistance Services and Supports program. Authored by Senator Ted Kennedy and others, it creates -- for the very first time -- a long term care insurance plan to help those with functional impairments pay for necessary care at home or in their communities. While the daily benefit is limited, the CLASS Act will ultimately help many continue to live at home or in assisted living facilities, rather than be forced prematurely into a nursing home in order to qualify for government assistance. Some key features of the program are:

(1) enrollment is open to those who are employed and choose to make voluntary monthly contributions to the program, and there is no underwriting exclusion based on pre-existing conditions; enrollment will open January 1, 2011;

(2) eligibility kicks in only after the individual has been enrolled in the voluntary payroll deduction program for 5 years, but the payout will not begin until 2017;

(3) benefits will be a minimum of $50/day but be scaled up as high as $75/day, depending upon the degree of impairment, and there is no lifetime "cap" on payout;

(4) benefits will coordinate with government assistance from the Medi-Cal program (called "Medicaid" in many states), such that CLASS benefits will have no effect on eligibility for Medi-Cal, Medicare, Social Security Retirement or Disability benefits, nor SSI. In fact, persons in nursing homes who qualify for CLASS benefits will be able to retain 5% of their daily or weekly cash benefit without seeing a reduction in their Medi-Cal subsidy.

Unfortunately, because of the 5 year vesting requirement and the companion requirement that the individual be employed for at least 3 out of those 5 years, most currently retired seniors will not see any direct benefit from the program. However, seniors can, and should in our view, encourage their children and family members who are still employed to sign up. That encouragement can be a part of the parents' legacy to their own children, just as Senator Kennedy left his legacy to the nation.

Elder Abuse - Protecting Your Parents at Home Or in a Nursing Home


I consider myself lucky to live where I do. It is in a "55+" community. I have come to realize that is a new euphemism for "not quite ready for assisted living." Most of the occupants of the hundred and twenty apartments in my building either have home healthcare or are getting ready for it. Probably 20 percent of them are on oxygen. So if you're a smoker cross our building off your list.

The most rapidly growing population segment in the United States is our seniors. The proliferation of assisted care, nursing homes and what other names you want to call it is skyrocketing. Here in Colorado Springs it seems like a new one is going up every week with a waiting list to get in.

There are other options. Home healthcare is absolutely huge. The demand for home healthcare and the demand for staff at assisted living facilities has placed a huge shortage on labor and I mean qualified labor. You don't want to leave the care of your parents to some teenager or even some unskilled adult.

The shortage of qualified labor as part of the reason why there are so many problems with elder abuse in home healthcare, nursing homes and assisted living facilities. It has been estimated that as many as 40 percent of all of these facilities report some kind of elder abuse. That abuse can come in many ways: from verbal abuse; Psychological abuse; and God help us physical abuse.

The dilemma of course is what can you do to protect your parents at home or in a nursing home facility? It starts at the beginning by picking a good quality place. Quality usually translates to cost. As in anything else, the better the quality the more expensive it is. Most people cannot afford the $8-$10,000 a month a halfway decent assisted care facility commands. So right off the bat people have to sacrifice something.

One of the best ways to protect your folks is with a hidden spy camera. These are simply board cameras mounted inside a common household item. The newest ones have DVR's in them are motion activated and are run by a remote control device. While these are very effective they have traditionally been expensive enough to put them out of reach of many people.

Enter the spy camera rental program. Like a lot a uses for hidden spy cameras they are usually on a temporary basis and so buying a $500.00 camera doesn't make much sense. With this new program you can rent one for as long as you like with a one-week minimum.

The cameras come with everything you need instructions, remote control and even technical help if you should need it.

Friday, December 6, 2013

Understanding the Threat of Nursing Home Abuse and Neglect


It is a difficult and often sad time when a person must make the decision to place their elderly loved one in a nursing home, but that decision is usually made with the expectation that their loved one will receive better medical attention and care than they can provide themselves. The unfortunate reality, however, is that nursing home residents oftentimes suffer from abuse and neglect, which not only causes illness and injury, but also significantly lowers their quality of life. In order to protect your loved ones from falling victim to such unacceptable practices, it is important to understand how often it occurs, what actually constitutes nursing home abuse and neglect, the signs of such abuse/neglect, and what you can do about it if it does happen.

Elder Neglect and Abuse Statistics
According to the Centers for Disease Control and Prevention (CDC), more than 500,000 adults over the age of 60 are neglected, abused or financially exploited every year in the U.S. In fact, the number is very likely much higher, considering only one in every 14 incidents of abuse is never followed up on by authorities. Other notable statistics, provided by the National Center on Elder Abuse (NCEA), claim that:


  • More than 1 in 10 elders may suffer neglect and abuse, but only 1 in 5 are ever reported; and

  • Between 1 and 2 million elders, aged 65 and older, have been exploited, injured or otherwise mistreated by someone they depended on for protection and/or care.

These statistics demonstrate that nursing home abuse and neglect are indeed a problem in need of resolution.

Types of Nursing Home Abuse
Different states may focus on different categories of elder abuse and neglect; however, generally, there are seven categories, as established by the NCEA:


  • Physical Abuse - Using force to physically injure or threaten a vulnerable elder;

  • Emotional Abuse - Using threats, isolation, verbal attacks, rejection, or other belittling actions to cause distress, pain or mental anguish to an elder;

  • Sexual Abuse - Forced, tricked, threatened or otherwise coerced sexual contact on a vulnerable elder. This also includes any elder who is unable to give consent;

  • Exploitation - Theft, fraud, use of undue influence and neglect or misuse of authority to gain control over an elder's money or property;

  • Neglect- Refusing or failing to provide for a vulnerable older adult's safety and/or physical or emotional needs;

  • Self-Neglect - Being unable to understand the consequences of one's own inaction or actions, which could lead to endangerment or harm; and

  • Abandonment - Deserting a frail or vulnerable elder.

Common Signs of Nursing Home Neglect
Elders in nursing homes are dependent on other people for their medical attention and care and so when one of those people neglects or abuses them, it will likely never be reported. This is why it is important to be aware of the common signs of abuse and neglect, so that you can stop the abuse that your loved one is afraid to report. Some common signs of neglect and abuse include, but are not limited to:


  • Dehydration;

  • Unexplained bruising;

  • Bed sores;

  • Dirty and/or tattered clothing;

  • Unexplained/sudden changes in finances;

  • Altered wills;

  • Poor or lack of personal hygiene;

  • Fatigue and/or listlessness;

  • Constant hunger, and even begging for food;

  • Lack of dental or medical care;

  • Malnutrition; and

  • Left unattended for long periods of time.

If ignored, these signs may eventually result in serious illness, injury or even death. It is unacceptable that nursing homes, which should be run for the care and benefit of its residents, are instead often being run to benefit its owner and executives, who often cut corners in staffing and supplies in order to maximize profits for themselves.

Health Care Providers Should Hang on Tight - ZPIC Audits of Medicare Claims Are Increasing


The first half of 2010 has been hard on health care providers. With Recovery Audit Contractor (RAC) audits ramping up around the country, many providers have found that while RAC audits may be on their way, a more pressing concern is represented by the Zone Program Integrity Contractor (ZPIC) responsible for auditing Medicare providers in their "zone." ZPICs are but one of the commercial contractors hired by CMS to conduct the medical reviews of Part A and Part B health care providers. Over the last year, ZPICs have been taking over where Program Safeguard Contractors (PSCs) left off. While our firm is still handling a number of cases that were initiated by PSCs, all of our recent cases have involved ZPICs.

As PSCs and ZPICs have been so quick to point out, they are not paid a percentage of the Medicare overpayments identified like their fellow medical reviewers - Recovery Audit Contractors (RACs). Nevertheless, as you will soon see, they are handsomely paid for their efforts, albeit in a different fashion than are RACs.

It is essential to keep in mind that both RACs and ZPICs are designed to "find and prevent waste, fraud and abuse in Medicare." Further, like their RAC cousins, ZPICs look at billing trends and patterns, focusing on providers whose billings for Medicare services are higher than the majority of providers in the community (e.g. their peers).

ZPICs are responsible for conducting:

  • Medicare fraud investigations, including referrals to law enforcement;

  • Medicare data analyses (discovery, detection, investigation, and overpayment projection);

  • Medical reviews to support fraud case development, including coverage and coding determinations;

  • Reviews, audits, settlements, and reimbursement of cost reports, and conducting specified audits;

  • IT systems activities for case and decision tracking and data warehousing;

  • Interface services with Medicare contractors, the medical community (outreach & education), and law enforcement; and

  • Medicare / Medicaid data matching program safeguard work for each state in their particular zone.

ZPIC Extrapolations of Alleged Damages:

Over the years, we have gone up against PSCs and ZPICs numerous times, challenging their interpretation of LMRPs / LCDs and assessing the methods they utilized to engage in a statistical extrapolation of the alleged damages in our client's cases. To give these companies their due - the statistical experts they employ are smart, aggressive and do not hesitate to respond when their methods have been challenged. We like that - it keeps us sharp.

With the help of some of the best statisticians in the country, in many cases, we have been able to show that their extrapolation of damages has not complied with applicable requirements, and is therefore invalid. To be fair, every extrapolation is different, both in terms of facts, the methodology employed, and in the associated calculations conducted. As attorneys, we work with our experts to break down and assess the ZPIC's calculations. Perhaps they handled it appropriately - or maybe they didn't. There really isn't any way to know if it was handled properly without a complete copy of their file (including associated work papers and calculations) so that we can fully assess their actions.

Over the last year, we have seen a marked increase in Medicare ZPIC contractor participation (as "participants" not as "parties") in ALJ hearings. Their experts have consistently been professional, concise and ready to answer any questions posed by the ALJ. Our recommendation - both counsel and their defense expert better be prepared. It's never to early to start thinking about how to best contest the extrapolation that has been conducted. As a final point, we are aware of a number of instances where a provider (or their representative) has chosen to ignore the extrapolation as a contestable issue. In other words, they just accept the extrapolation as a foregone conclusion and focus solely on the claims. We strongly disagree with that approach. If we identify deficiencies with the extrapolation, we aggressively challenge its application.

AdvanceMed's Medical Reviews:

Once a provider has been identified as an outlier (or identified as a possible problem through a variety of other mechanisms), a medical review of their claims is often conducted by a ZPIC.

A number of year ago, Kevin Gerold, CMS' former Acting Deputy Director for Program Integrity was quoted as saying that the agency had revamped its approach to claims processing in an effort to better "grasp the experience of the patient encounter." Mr. Gerold was further quoted as saying that CMS was going to "let medical reviewers assess a claim's legitimacy based on the big picture of the patient encounter, not on a nit-picking slavery to perfect documentation." Unfortunately, in our humble opinion, many ZPIC medical reviews have conducted have been extremely technical - resulting in the denial of many claims based on minor omissions, technical deficiencies and / or the contractors' own peculiar spin regarding the application of an LCD.

In responding to a ZPIC's reasons for denial, it is essential that you obtain each and every reference relied upon by the contractor when denying the claims at issue. We have identified multiple instances where a contractor (not necessarily AdvanceMed) attempted to apply an LCD retroactively. Moreover, it is important to examine the underlying statutory authority to determine whether the contractor's interpretation of a coverage provision is consistent with the underlying law or regulation. Finally, it isn't enough to merely "poke holes" in the ZPIC's reasons for denial - we like to go one step further - show that the particular claims at issue do, in fact, qualify for coverage and payment. Should you learn that your practice or clinic is under review, we recommend that you immediately contact an experienced attorney to represent your practice and handle your defense.

Trendsetters in Senior Living, Several Top Executives Reveal Careers in Serving Seniors


Being a top executive in the senior living business takes more than visionary leadership skills, financial expertise, strategic operational know-how, and a gift for organizational management; it takes passion. And, more often than not, it's a passion that's been around for a very long time.

"Very few people just walk into this position," says Joe Mikalajunas, president of Greensboro, North Carolina-based Bell Senior Living. Most senior living executives "start in the same place-in a community, serving seniors-and then work their way up the corporate ladder." But here's the kicker, Mikalajunas adds, "We all have a passion for serving seniors. It's hard to be successful in this industry if you don't have that passion."

Passion is just one of the many characteristics Mikalajunas has in common with the eight other industry leaders-each of whom participated in exclusive interviews with Assisted Living Executive-who have been named Trendsetters in Senior Living for 2009.

Thilo Best
Chairman/CEO
Horizon Bay Retirement Communities
Tampa, FL

Industry debut: Although Best technically entered the industry in 1987, his first experiences (at Prudential Insurance Company of America and Holiday Retirement Corp.) focused on the finance side of the business. The operational side never seemed all that far away, though. "I kept getting pulled in that direction," says Best, who finally took the plunge in 2001 to manage Horizon Bay Retirement Communities.

Top professional accomplishment: "I'm extremely proud of the culture we've built at Horizon Bay," Best says. "It's a caring culture, but it's also a pragmatic culture." It's important to maintain a balance between the two, he adds, because "you can't be so bureaucratic that you forget your day-to-day mission of taking care of your residents, but you also can't be so focused on customer service that you ignore your margins."

Greatest industry challenge on the horizon: "I think our biggest challenge will come from new regulations," Best says. "At both the state and federal level, we seem to be in an era where some people believe more regulation is better than less, and I think they may try to fix the things they believe require more oversight through additional regulation. This could pose a real threat to the industry."

Outside the c-suite: Although Best enjoys playing tennis, traveling, and reading when he's not in the office, he says his favorite off-the-clock activity is "spending time with my two daughters. It gives me a wonderful perspective on things, it keeps me humble, and it helps me work on my main weakness: patience."

Vicki Clark
President
Vintage Senior Living
Newport Beach, CA

Industry debut: Clark has been working in the senior housing space for three decades. In the early '90s she left the apartment side of the sector to join ARV Assisted Living. A few years later, she joined two of her former colleagues at ARV, Eric Davidson and Brian Flornes, who, established Vintage Senior Living in 1998. "I feel like I've always been in the right place at the right time," Clark says of both transitions.

Favorite part of the job: Because all of Vintage's properties are within close proximity of each other, "we're able to bring all of our executive directors together every single month for training and education," Clark says. "Being able to see each of their faces and hear each of their success stories every month is especially great." These meetings are structured around a cultural environment that employees learn best when they share experiences, peer to peer. Their purpose is "to help our EDs work through their challenges and struggles by talking with their peers," she says.

Top professional accomplishment: In 2006, Clark was named the 50+ Housing Council's Person of the Year, a program of the Building Industry of America. "I'll never forget standing on that stage, staring out at about 200 of my peers in the audience," she says. "I do what I do because I love it, but it's nice to be honored for it, too." Clark says she remembers the experience whenever she's feeling overwhelmed. "I look at that award, take a deep breath, and tell myself, 'You know what? We'll get through this!'"

Greatest on-the-job challenge: "Hiring and retaining the right teams," Clark says. The right assessment tool might help her-and her industry cohorts-be more successful at both tasks, she adds, "but right now it seems like we're all using individual tools." In the coming years, Clark says she "would like to see everyone come together to find the right [tool] for our industry-one that would point us toward the best executive directors, because finding the right people for those positions is critical not only to the success of a community but to our industry as a whole."

Outside the c-suite: Like many senior living executives, Clark likes to explore the world when she has the time. "I try to expand my horizons figuratively and literally," she says. Regarding the former, Clark says she often takes time to "see what senior housing looks like in whatever country I'm visiting. It's just a blush look and see, really, but it still gives me some insight into the differences and similarities between our models."

Granger Cobb
President & Co-CEO
Emeritus Senior Living
Seattle, WA

Industry debut: After spending four years early on in his career as the executive director of a board-and-care property in southern California, Cobb convinced his wife that they should sell their home and buy an independent living community a few hours north in the San Francisco Bay area. Thirteen other communities eventually joined the company called Cobbco Inc., which merged with Summerville Senior Living in 1998 (and which, in turn, merged with Emeritus Senior Living in 2007). "I like to say that I've been with the same company for 20 years, but it's had three different names in that time," Cobb says.

Top professional accomplishment: Cobb says he is most proud of "fostering open and collaborative communication across all disciplines." He's also happy that he's been able to make information and systems available to staff that "allow them to make good decisions." Both have been "cornerstones of every company I've been involved with," Cobb says. "I focus on them wherever I am."

Greatest on-the-job challenge: "Managing my time and reassessing my priorities," Cobb answers. "The list of things I have to do on any given day goes on and on, so it can be a challenge to prioritize everything and then find the time to check as many things off that list as possible." He copes by relying on technology-"my laptop and my iPhone synch up with everything in my office, so I'm connected no matter where I am."

Outside the c-suite: Cobb lists golf and skiing among the activities he enjoys when he's not working. "Unfortunately, I haven't been able to spend much time on either activity the past few years," he says. "I have two girls who are now in college, but when they were growing up, we all golfed and skied together-along with my wife. I'd like to get back to those activities with them. In the meantime, I run several times a week with my dog."

Rosemary Esposito
COO
Five Star Senior Living
Newton, MA

Industry debut: "Having provided care to seniors for many years, you could almost say I started working in senior living while I was still working in acute care," says Esposito, who began her career as a medical surgical nurse before moving into hospital administration. Those experiences are a far cry from the ones she's become accustomed to since she joined the assisted living industry a dozen years ago. "Today's seniors have a greater array of health-care and lifestyle alternatives," she says. "The advent of assisted living has contributed to that in a big way."

Top professional accomplishment: When Five Star Senior Living was formed in 2000, the goal of its founders was to turn around communities that had just come out of bankruptcy. "We were a newly formed team, but we had a unified objective and strategy," Esposito recalls. "Not only did we successfully turn those operations around, but we became an independent, publicly traded company by the end of our first year."

Greatest industry challenge on the horizon: Due to uncertainty in the current economy, many companies will have to make difficult decisions about cost-cutting measures in the months and years ahead, Esposito says. "During this time, it will be more important than ever to maintain focus on our customers' needs," while thinking strategically and not acting impulsively. Until the market recovers, we must be able to cope with external pressures by making the most of our expenditures and controlling costs without sacrificing quality or services."

Outside the c-suite: "I like to do anything that involves the sun and beach: swimming, going on long walks, reading a book, photographing a glorious sunset, or simply collecting seashells," Esposito says. "For me, even work would be a relaxing activity if I could set up my office on a sunny beach."

G. Michael Leader
President & CEO
Country Meadows Retirement Communities
Hershey, PA

Industry debut: It isn't a stretch to say that Leader grew up in the senior living industry, given that his parents started a nursing home company in 1962. "It's kind of like growing up on a farm: Everyone has a role, even if it's only to listen to the discussions at the dinner table." Although Leader helped out as a youngster, he didn't join the family business full time until 1973. Ten years ago, Leader replaced his retiring father as CEO and today he works alongside his brother, David, and his brother-in-law, Ted Janeczek.

Top professional accomplishment: "One of the things I'm most proud of is that for three straight years, we've been named one of the best 100 places to work in Pennsylvania," Leader says. "These are hard jobs, so it's encouraging to know that our coworkers-which is what we call our employees-enjoy working here."

Greatest on-the-job challenge: Leader isn't alone when he says he considers dealing with the current economic environment to be his greatest challenge. "We want to continue to provide quality and value to our customers, of course, but quality comes at a price and we have to make sure we price our services so they're affordable to the market we serve," he explains. "It's especially important to remember that when people are both practically and psychologically constrained by the economy."

Greatest industry challenge on the horizon: It's no secret that the senior living industry is going to be flooded with customers in the coming years, but Leader wonders if there will be enough employees to care for all of them. "We have to find the right people to care for all of those customers," he says, "but those people have not been available in abundance in recent years."

Deborah McAneny
COO
Benchmark Assisted Living
Wellesley, MA

Industry debut: Before being enticed by Chairman and CEO Tom Grape to join Benchmark Assisted Living two years ago, McAneny made her living in the investment management industry, making her one of the few executives who are somewhat new to senior living. She didn't sweat transitioning from one sector to another, though. "I'm a firm believer that leadership is consistent across all asset classes," McAneny says. "Regardless of which industry you're in, it's all about attracting and retaining great talent, being courageous as a manager, and creating a shared vision."

Favorite part of the job: "I love the challenge and complexity of running and operating a business like this," McAneny says "A lot of components have to be moving in the same direction for it to work and work well." The former Arthur Andersen auditor doesn't spend all her time contemplating the company's operational present and future from her corner office, though. "I go into the communities whenever possible so I can see the amazing culture we've created here in action," she adds.

Greatest industry challenge on the horizon: "I think there's a lack of a differentiated customer experience in our industry," McAneny answers, adding, "I'm not sure our average customer can tell one assisted living provider from another-or can say what makes one provider better than another." Of course, she says, "that can be both a challenge and an opportunity."

Outside the c-suite: Along with spending time with her family, McAneny says, "I love to ski, I love to bike, and I love to travel. Basically, I find my peace in the mountains in the winter and I find my peace on the bike path or at the ocean in the summer."

Joe Mikalajunas
President
Bell Senior Living
Greensboro, NC

Industry debut: "I've always had a passion for helping people," Mikalajunas says. After a stint as a mental health professional, he transitioned into the senior living business when he joined Sunrise Senior Living's Executive Associate Program in 1996. Later, while working at Harbor Retirement Associates, Mikalajunas met with Steven Bell about an opening at Bell Senior Living. "I wasn't looking. I was happy where I was," Mikalajunas recalls. He eventually agreed to the interview, "expecting nothing more than to add some new friends to my Rolodex. Instead I came away impressed. I knew it was a place I could call home."

Favorite part of the job: "I like seeing the look on someone's face when they do something they thought they couldn't do- that look of serendipitous surprise when they realize, 'Wow, I really did it!'" he says. Mikalajunas laments not being able to get into the communities more these days, but enjoys building the teams that do. "I don't get to spend as much time with the residents as I use to when I was in a community. However, at least I'm still able to do that through my teams. That's what it's all about at this level-building the teams that go out there and make a difference in people's lives."

Greatest on-the-job challenge: "Not allowing complacency to set in," Mikalajunas answers. "I think getting people excited about doing the same thing today that they did yesterday, and to a higher level of excellence, is the most difficult thing you have to do in this position." How does he accomplish that? "I get them to look past the task at hand to look at the bigger picture, which is to care for people and make a difference in their lives," Mikalajunas says.

Outside the c-suite: "I've received more ridicule for this than anything else in my career, but I'm going to fess up to it anyway: I'm an avid online gamer," Mikalajunas says. He started playing games like World of Warcraft years ago as a way to connect with his children while he was on the road for work. "I could sit in a hotel room 1,000 miles from home and still spend time with them," Mikalajunas says. He keeps at it today because "it helps me clear my mind. I can go into a game and not have any responsibilities. I can just have fun."

Mark Ordan
CEO
Sunrise Senior Living
McLean, VA

Industry debut: A tour of Sunrise Senior Living's community in McLean, Virginia, was all it took to convince Mark Ordan to say goodbye to his 25-year career in the retail industry. "It was the first time I'd ever been in an assisted living community, and I was amazed by what I saw," says the former founder and CEO of Fresh Fields Markets Inc., a chain of natural foods stores he eventually sold to Whole Foods. "I saw a level of care and devotion that I had never before seen in a business setting."

Favorite part of the job: "This is the first time in my career that I've been able to lead a company that at its core is all about service to others. I've never been part of something quite like this," Ordan says. "I'm guessing a lot of people who have been in this industry for a long time have almost gotten used to that by now, but I still feel like pinching myself."

Greatest on-the-job challenge: "My biggest challenge is figuring out a way to steer this company through a very difficult economic environment while also finding a way to take us to even greater levels of care and service." The latter can't suffer at the expense of the former, he adds, since "the reason Sunrise exists is to serve seniors. We can't forget that even when we're going through tough times like we are now."

Outside the c-suite: When he's not working, Ordan trades his land legs for his sea legs. "I love boating," he says. "I guess you could say being on the water takes me away." He doesn't get to feel the wind in his hair as often as he'd like these days, but that's OK. "I'm so grateful to be where I am," Ordan says. "After 25 years of running a wide range of businesses, it's nice to find myself at one with such an amazing core sense of purpose."

Bill Sheriff
CEO
Brookdale Senior Living
Brentwood, TN

Industry debut: Although founders Thomas Frist Sr. and Jack Massey convinced him to join American Retirement Corp. (which merged into Brookdale Senior Living in 2006) back in 1984, "I'll never know exactly why they thought [the senior living industry] would be a good fit for me," says Sheriff, who previously worked for Ryder System Inc. "I'm glad they did, though. I've thoroughly enjoyed the last 25 years."

Favorite part of the job: "I love the people- serving-people aspect of the senior living industry," Sheriff says. "That's what drew me to it in the first place and that's what I've enjoyed about it ever since." Another positive: "In this business, it's not hard to feel like you're making a difference in people's lives every day, because that's exactly what you're doing. That's incredibly rewarding."

Greatest industry challenge on the horizon: Sheriff believes a challenge that has long been an issue for the senior living business will continue to be a challenge well into the future. "We have to continue to refresh our product," he says. "We have to continue to take an older asset and make it consistent with the evolving expectations of our customer-and we have to do it while also continuing to introduce innovation into our market."

Greatest on-the-job challenge: "We're facing unprecedented times and conditions," Sheriff says of the world's economic woes. "It is now and will continue to be extremely challenging for people in this and every other industry to deal with what's going on, but I think if we can stay focused on our mission like we are now, we will do well in the long run. The opportunities that come out on the other side will be significant."

Modesto Assisted Living Info


Modesto is the 16th largest city in California, located in Stanislau County, Northern California, which is about 66 miles west of Yosemite National Park and 92 miles east of San Francisco.

Surrounded by rich farmlands, it is ranked sixth in farm production among counties in California. Modesto has also been a "Tree-City Honoree" 29 times, as the city values nurturing the environment as an important aspect of caring for its people.

With its abundant farmlands and forests, the city provides a healthy atmosphere for Modesto senior living residents.

Modesto Recreation

Being home to famed film director George Lucas in his early years, Modesto celebrates summer with the revival of American Graffiti, the critically acclaimed 1973 movie of the famous filmmaker. "Graffiti Nights," the annual festival, is celebrated for the whole month of June and attracts thousands of car enthusiasts worldwide showcasing hundreds of antique and classic cars.

Seniors will likewise enjoy shopping at the Vintage Faire Mall, Vintage Commons and Plaza Parkway, all of which offer an assortment of shops and major department stores to residents in the area. Modesto also offers over 200 restaurants and dining establishments which will provide fun and activity for assisted living residents.

Modesto Activities

The Modesto Senior Citizens Center is the place where seniors gather for various services and activities such as medical programs, arts and crafts, dance clubs and other enjoyable programs.

The center also provides information and assistance on legal matters, insurance and other relevant issues.

The local government also provides educational courses for seniors, such as basic computer classes, that are designed to give them additional skills. These help Modesto senior living residents remain a valuable part of the community and provide them with a sense of accomplishment.

Modesto Medical Facilities

Healthcare is a critical issue for senior living residents and their family. One of the newest healthcare facilities in the region is the Kaiser Permanente Modesto Medical Center which provides state-of-the-art medical technology and utilizes the greenest technology in the USA. The Doctor's Medical Center is also another local hospital that specializes in acute care. Both hospitals offer various services such as cardiology, neurology, orthopedics, oncology and intensive care to ensure that Modesto senior living residents maintain their best health.

Modesto Transportation

There are three types of public transportation systems that serve Modesto residents: the Modesto Area Express (MAX), Stanislau Regional Transit (StaRT) and the San Joaquin Regional Transit District (RTD).

The MAX offers a paratransit "Dial-a-Ride" transportation service for seniors and the disabled around the city. This specialized transport service is available seven days a week, 365 days a year for people with disabilities and those 65 years and older. The MAX provides convenient service to residents of Modesto senior living communities.

Modesto is a great city where seniors can spend their years productively in comfort. It is a city that cares for the aged just as much as they care for the rest of the residents. To find assisted living for your loved one, visit our Modesto Assisted Living page.

How to Calculate the Value of a Personal Injury Case - Eleven Questions You Must Ask


"What is my case worth?" is a question clients often ask their injury attorney.

Here are eleven questions you need to ask and answer to properly value your claim.

WHAT IS THE NATURE OF YOUR INJURIES?

This is the most important factor. If you have a serious injury that has a big effect on your life you should expect more compensation than someone who has a minor injury that heals up quickly.

A disc herniation that may require surgery is more valuable than a herniation that won't require surgery. And, a herniated disc is more valuable than a mere bulge.

The job of an injury attorney is to take your case and do his best to find out all your injuries and make sure they are properly diagnosed and treated.

ARE THERE PREEXISTING CONDITIONS?

Under law you are entitled to the fair value of the aggravation of your preexisting conditions.

However, if your preexisting conditions were "asymptomatic" (no pain or other symptoms) then you are entitled to compensation for pain and disability when the accident "lights up" those conditions.

In ancient England there was a man with a paper thin skull. Another man accidentally struck him on the head causing serious injury. The courts said to the at-fault person: "tough luck, it doesn't matter that you did not know of his vulnerable condition, you take your injured person as you find him".

HOW MUCH ARE YOUR MEDICAL BILLS?

In the old days (20 years ago) case valuation was easy: you totalled up the medical bills and multiplied them by three and that was the value of the case.

Those days are gone.

The system got abused by people who ran up bills artificially. Insurance companies caught on and today no longer will automatically pay "three times meds".

Still, the amount and the nature of your medical bills are factors. Surgery bills (so-called "hard meds) carry more weight than diagnostics. Chiropractic bills have value but not as much as those from an M.D.

WHAT IS THE NATURE OF THE ACCIDENT?

If your car was rear-ended by a tractor trailer driver with a blood alcohol level of .08 your case is going to be more valuable than if you were hit by a sober off duty nun driving a Corvette.

If the at-fault person was on the job it tends to add value.

On the other hand, slip and fall cases, by and large, tend to bring a lower value than the same injuries incurred in a clear liability auto accident case.

DO YOU HAVE LOST INCOME?

You have a right to be paid the full value of lost wages or other income that was caused by the accident.

But you have to prove it and if you haven't filed tax returns for the last ten years even the finest injury attorney is going to have a hard time getting the money for you.

The reasonable value of future lost income that you can prove is also yours to claim.

WHO IS THE INSURANCE COMPANY OF THE PERSON AT-FAULT?

Some insurance companies are more generous than others and insurance companies go through phases.

The "big three" have tightened up on the purse strings in recent years.

The number of insurance companies that can really be considered "generous" have grown small in number.

WHAT ARE THE POLICY LIMITS OF THE PERSON AT-FAULT?

Policy limits are a factor too. Even if your injuries are very serious, if the at-fault driver has minimal limits (25K here in Utah) then all you are going to get is 25K from his carrier.

You aren't going to go after him personally, no matter how rich he is. From experience, I can tell you: you just won't do it.

An experienced injury attorney can make sure that the settlement for policy limits with the other carrier does not preclude your right to bring your claim for underinsured motorist benefits.

WHAT ARE YOUR UNDERINSURED MOTORIST POLICY LIMITS?

Once you've recovered the policy limits from the other driver you will want to make a claim on your own underinsured motorist coverage.

If you've planned wisely you'll have very high underinsured limits. That way you can make a claim for and get fully compensated for the full extent of your injuries from your underinsured motorist coverage.

If, on the other hand, you've gotten the cheapest insurance you could get, then your underinsured motorist coverage may be $10,000 or less.

An experienced injury attorney can sometimes uncover more than one available policy to tap into so as to maximize your recovery.

WHAT ARE YOUR UNINSURED MOTORIST POLICY LIMITS?

If the other driver was uninsured you must look to your own policy to recover for bodily injury caused by an uninsured motorist.

WHAT IS YOUR ATTITUDE ABOUT MONEY AND GETTING COMPENSATED FOR YOUR INJURIES?

If you've watched or read "The Secret" this won't be much of a stretch for you but the fact is that your attitude about your case, yourself and money are factors that determine the outcome.

If you don't believe in your case it is going to be tough for any injury attorney to get fair value for you. If you have a hard time accepting money, once again the attitude will reflect in the case result.

If you have a personal injury case, this would be a great time to explore how you feel about yourself and money.

Be honest.

Most people are in delusion about their true feelings on money. If you are not already a millionaire, you have some negative money feelings holding you back.

If you have feelings of low self-worth or of not deserving money this would be a great time to release them. Many great tools exist to help you though this.

WHAT WOULD A JURY AWARD IN YOUR JURISDICTION?

What a jury would award is the gold standard. Both sides are considering their experience with and knowledge of local verdicts while negotiating a settlement.

Let's face it 99.9% of injury cases are settled short of trial. But those few that go to trial have a huge effect on the settlement values of the other cases.

Here is a simple way I've developed over the years, as a personal injury lawyer in Utah, that works quite well to help a client develop a sense of the worth of his case.

Imagine you are on a jury in the county where the accident happened. You and seven others are deciding the value of a personal injury case that involves your exact injuries, treatment and medical bills.

What would you and the seven others award that person?

I have used this approach time and again with clients and, amazingly, the numbers they come up with are actually quite close to the value I put on the case.

Try this exercise. Then compare your valuation with that of an experienced personal injury lawyer. You just might find that your value and his are not that far apart.

CONCLUSION

There you go, some, but definitely not all, of the factors that influence the amount of compensation that you will be able to get on your injury case.

How to Use Wood Display Carts to Sell Your Merchandise


There's something appealing about old-fashioned display tools. Buckets, baskets, and wooden crates are popular ways to display certain items, and they bring with them the charm and serenity of a simpler time. Another display tool that can do this for you is a wood display cart. These old-fashioned carts evoke images of covered wagons, flower carts filled with violets, or sturdy crates sitting on docks, filled with exotic goods from around the world. It's worth it to give some thought to how to use wood display carts to sell your merchandise.

Flower Carts

Though you seldom see these charming wood carts being used to sell flowers, there are dozens of other things you can do with them. Set a few tureens on them and serve up coffee, hot chocolate, and baked goods at a cold weather sporting event. In warm weather, change it to iced tea and lemonade. Contract with a local team to sell penants, ball caps, and t-shirts-some of these carts even have wood slats you can hang things from. Make it a sign-up table for volunteers, or stack it with books and wheel it around an assisted living center or hospital. If you run a grocery store or restaurant, set your portable wood cart inside the door so that customers can get an advance taste of what awaits them inside.

Wagon Display Carts

A wooden wagon display cart evokes images of autumn, hayrides, and trips through the pumpkin patch. You can keep your wagon cart stationary and surround it with bales of hay to show off your pumpkins, squash, and other fall produce. You can also take it to all your local fall festivals and push it through the highest traffic areas. Your customers will love that they didn't have to come to you; you came to them!

Crate Display Cart

This kind of wood display cart looks like something that would have been rolled off a dock 150 years ago. It's rectangular and deep, and has three different compartments; you can almost see the stevedores prying the wooden lid off with a crowbar to display the shipment inside. For display purposed, it's adjustable, so it can rest flat like a trunk, vertical like a shelf, or at a slant, to offer different levels for your displays. It rests on a wooden frame that's on casters, so it can be easily rolled to whatever location you can use it best. This is another one that can benefit from seasonal displays, using hay, pumpkins, Christmas wrappings, or a fulsome display of spring or autumn plants and flowers. You can also consider displaying clothing, bolts of cloth, or handmade quilts, which can easily be folded or draped over the wood cart's edges.

Wood display carts are so versatile and charming that people are drawn to them without even being aware of it. Now that you have some ideas on how to use wood display carts to sell your merchandise, use them to display your seasonal merchandise, or just those things that need to be portable and easy to move. You'll never regret investing in a wood display cart for your business.

Hiring a Senior Caregiver - Agency Or Hire-Direct Independent Contractor?


When the time comes for a senior to need additional care services in their home or in an assisted living community, you will have the option of hiring a senior home care agency to provide the services or finding an independent caregiver to hire directly.

Which is the right choice?It is far better to hire a quality senior home care agency to provide care services unless you are the rare individual who has adequate insurance coverage along with a care support team of family and friends to help direct and support the independent caregiver and provide back-up care when they need a day off.

Senior care is far different from child care. A family can successfully hire a nanny as an independent contractor to care for their children. This is because the parents are there every morning and every evening to supervise and monitor the care. In addition, the parents make sure the children understand the nanny is in charge. It isn't the same with senior care. There is usually no one else supervising the care. Seniors are older than their caregivers and because of this, sometimes do not choose to easily cooperate. When memory loss and other illnesses are present, the senior can become extremely difficult. They may know they need care but still be emotionally resistant. This creates a problem for the caregiver and for the family.

A senior home care agency solves this issue by providing a supervisor or case manager to manage the care and support the caregiver. They also provide a substitute caregiver when the regular caregiver needs a day off. And even more vital, the senior care agency is available for the caregiver to call when difficult situations arise (the senior won't take their medications, the senior won't take a shower, the senior won't let the caregiver in) or when they have survived a trying day (especially important when caring for seniors with Alzheimer's Disease).

This additional team support manages caregiver burnout and stress. It also prevents the negative situations which can develop when care issues are not addressed by a third party. Unlike child care, senior care involves managing many life issues such as dealing with the death of loved ones, adapting to new medical conditions and coming to terms with the aging process. And just as special training in children's education makes for a better nanny, special training in caring for specific age-related diseases makes for a better caregiver.

Senior home care agencies provide training and supervision for their caregivers. They also create a Care Plan for the daily routine to make sure the correct needs are being addressed. The care manager can also address changes in medical conditions to the family members to make sure the senior has appropriate doctors, medical equipment and other services to make their situation as comfortable as possible.

Another challenge with a direct-hire independent contractor is insurance and tax issues. Most home owner policies are limited in covering employees in the home. There are people who seek out work with seniors who know the opportunities that exist. One senior client my agency began care services for had previously hired an independent contractor caregiver who had been with her for more than a year. The senior was a widow with no family living nearby. Over the course of the year, the caregiver took out credit cards in the seniors name and used them for their own purchases. The invoices went to the financial manager who did not question them. The caregiver took many liberties with the petty cash purchases and the client's care was not their main concern. I have many more stories of starting care after a hire-direct had first been hired. Some families believe they will save money by negotiating a lower hourly fee, but this is rarely the case. Another client my thought they were paying their independent caregiver less than the agency fee but it turned out the caregiver would take $20 every time they ran a grocery store errand and charge the senior an extra fee for laundry and transportation. Many opportunities exist when no active management is involved.

Many people who hire nannies as independent contractors use a nanny agency for some of the same protections a senior home care agency offers. Maria Katris, owner of Nanny Boutique, says "Many clients repeatedly told me the value of using a nanny agency was in the background check, screening of the nanny candidate and access to additional resources such as our tax information. There is simply one more layer of assurance before allowing someone to work in your home with your loved ones. Furthermore, our clients were very aware of the tax liability involved in hiring a domestic employee and did not want to risk their careers by not paying taxes. We aided them in achieving this goal through education and partnership with a domestic employee tax company."

It is important to be cautious of "free" background checks. Usually such checks are just a name and address match to a social security number. If a website is advertising a free background check, be sure there is another fee they are charging to pay for this service as a solid criminal background check will cost at least $15 and a thorough background check will be closer to $100. Caregiverlist.com explains background check laws by state and what is typically included in a check.

A senior home care agency, as an employer of the caregiver, provides insurance protection and takes care of all the payroll taxes, as required by law. Worker's Compensation Insurance will cover on-the-job injuries (they do happen - dog bites, falls, back injuries). As an employee, the caregiver also has added benefits, including being able to collect unemployment benefits if they are laid off, collecting social security benefits when they retire and other agency benefits such as health insurance, training, team support and bonuses. The agency will also carry professional liability insurance and a fidelity bond to cover theft or financial loss.

Thursday, December 5, 2013

Accidents at Hotels


For many, hotels function as a "home away from home", providing the comfort one is used to from their own house. On a business trip or a fun vacation, hotels provide a warm bed, a hot shower and home-cooked meal for patrons. However, similar to other premises such as restaurants or supermarkets, hotels are responsible for keeping a well-maintained facility, free of hazards that may injure their guests. Management, staff and maintenance teams must keep the hotel is optimal condition, or be subject to premises liability claims. If a patron is injured due to the negligent upkeep of the facility, or some other hazard that should have been addressed, that patron may be able to sue in a court of law.

Injuries and accidents that happen at a hotel can have devastating consequences. Not only are you far away from your comfort zone (and your hometown), you also may be all by yourself with no one around to help you recover. This is the precise reason that premises liability covers not only physical suffering, but emotional suffering as well. In order to make sure you receive the financial compensation that is entitled to you in a court of law, you will want to hire an experience attorney to help present your case.

The following events could take place at a hotel:

繚 Slip and fall accident
繚 Burn injuries from fire hazards or improperly maintained electronics
繚 Harm from defective beds, chairs or couches
繚 Food borne illness from food prepared by hotel kitchen
繚 Safety concerns due to lack of security
繚 Theft by hotel employees
繚 Abuse by staff members
繚 Injuries resulting from inadequate staff training
繚 Lack or malfunction of safety equipment
繚 Lack of visibility or lighting
繚 Swimming pool injuries

Proving negligence can often be difficult in premises liability claims. For this reason, it is imperative to consult with an expert attorney immediately following your incident. If you or someone you love has been hurt by the reckless or negligent behavior of hotel staff member, you have legal rights under the law to help you recover from resulting damages. It is entirely unacceptable to allow these facilities to operate in an unsafe manner and your case can help shed light on this problem.

Why Me? I Didn't Ask For This: The Sandwich Generation, Part II


The harsh, cold winters are terrible for the elderly. Many attribute their painful physical conditions to that. There is also the risk of falling on the ice and in snow. The fact is, arthritis not only affects elderly people, but it can affect anyone at any age. However, since seniors believe that arthritis is handled better in warmer climates, many move away from their children to live in Florida where the heat is soothing. However, there are days when Florida's hot and humid weather can also cause pain. Another option that seniors have looked to is the desert climate of Arizona, which is quite advantageous for people with arthritis. Nonetheless, wherever they decide to go, the decision to leave will not diminish the fears or anxieties that their child may have in regards to their parent's well-being, especially when they are an only child. There is always the concern that something can happen that might uproot everyone's lives.

For example, you may have a situation like this:

The telephone rings. You answer. It's the emergency room at the hospital. It's the call you were dreading. The nurse speaks with a concerned voice, "Mrs. J., your mom was crossing the street on foot and was hit by a car. I want to let you know the nature of her injuries. She has internal bleeding; broken vertebrae in her back, a shattered pelvis and her arm and leg are broken as well. It's a wonder she survived. She is in a terrible amount of pain. Your father is very anxious and doesn't make sense when he talks. I think he is in shock. The doctor is examining him now. Can you please come soon? It is extremely urgent. Your mother is asking for you. The seriousness of her injuries requires immediate surgery. Your mother has agreed to it if it would stop the horrendous pain. Even with the surgery, the doctor is not sure if she will ever walk again. I am letting you know that she will have to stay here after her surgery until she is moved into a rehabilitation center."

You sit stunned by the complicating issues in this sudden, unanticipated mess, trying to figure out how best to break the news to your husband and children. How will they react when they find out you have to leave immediately? Who will take care of the kids when you're gone, perhaps a week or more? Taking mental notes, you wonder about the power of attorney and the living will that wasn't made at the time your parents moved, as they were both in full capacity and robust at the time so dad didn't think it was necessary. However, recently, dad has had some health issues with his heart which are causing you great concern. You are worried that dad might have a heart attack with all this stress. You say to yourself, 'I hope there is a will, because this can complicate matters. I don't even know if they both have life insurance and if so, how much? I'll have to take care of that later when I arrive in Florida, as one of my "Must Do's." You suddenly remembered what the nurse said, that your mom was going to be moved to a nursing home or a rehabilitation center after she leaves the hospital, if she leaves the hospital.

Now you are apprehensive, after considering the big "What If," what if they don't have long-term care insurance? My God, between the nursing-home residency, of which Medicare only covers a small portion, and the cost of long-term care, a mind-boggling figure of anywhere between $50,000 to a $100,000 a year may result.. Who is going to pay for that? "I can't think about that now," you say to yourself. "All of this is making me nervous." As you rush and make calls the wheels of your mind are still in motion pondering on the "What Ifs." You are starting to feel queasy and angry at the same time. You stop for a moment and say, "they'll have to sell their home and perhaps move into an assisted living facility which will be costly as well. Come to think of it, the worst could happen, they might just end up moving into my home. If mom can't walk, who will take care of her? Dad can't. Will I have to give up my job? Oh no, this can't be happening. WHY ME, I DIDN'T ASK FOR THIS! I don't mind dad living with us. He is such a sweetheart, but what about mom? It would be sheer hell. We never got along. To make matters worse, Jimmie dislikes my mom and the feeling is mutual. I am almost sure that my home will end up being a battle zone. I don't know what to do, why did she have only one child?" Your hands are shaking. "I hope my mother-in-law will watch the kids while I'm gone. What will Jimmy say? Now this will give him a good reason to leave.

Relieved that you were able to get a flight for that evening, you begin to pack. You inform your employer that you had a serious family emergency and need to leave immediately. You ask him if you could use your vacation time for this. His approval comes as a big relief.

Between the cost of airline tickets and other additional expenses added to the credit card, a hefty bill is tallied, adding more debt to your finances. Plus you lose your vacation time, time that was intended to be used at a later date. Whatever the results, the reality of the situation at hand is adding weight to your already hectic schedule. By now you know what's in store for you; the cost of flying back and forth between New York and Florida will become exorbitant. On the other hand, you could move to where they live, but that would wreak havoc for all back home. Lastly as a dreaded alternative, you could have your parents move into your home. This way you would be able to keep an eye on them even though this arrangement will also wreak havoc for all concerned. You find yourself trapped by making the choice between: "what you would rather do" and "what is required for you to do." You have officially joined the privileged ranks of the "Sandwich Generation," sandwiched between responsibility for those that raised you and choices that define your own life.

Whether the aging parent becomes confined to a nursing home, a rehabilitation center or an assisted living facility, the demands on the Sandwich Generation still exist. These caregiver's nerves are strained to the utmost. They suffer from depression, anxiety and even some may develop heart problems from all the stress. As it is, the wife-mother-daughter generally is a multi-tasked person holding down multiple jobs and responsibilities all at once.

Now let's take a look at another example. Mrs. B. is a sixty year old stay-at-home grandmother who never had to work because her husband always made decent money. Both of her children have married and maintain successful careers. Her daughter, Sue, finally was able to have two children after several unsuccessful attempts. With so much spare time on her hands, Mrs. B. can do all the things she wants to. Travel, play Mahjong with friends every other week, go to Broadway shows and participate in community activities. Since Mrs. B is a stay-at-home wife, she comes to be the lucky candidate who assumes the babysitter role at a moment's notice for her daughter. How can she refuse to take care of her sweet, innocent darlings once in a while? Happy and doing well, she feels her life is blessed. However, add to this context an aging mom with advanced dementia, the situation changes and becomes overwhelming, piling on additional responsibilities. Now Mrs. B's daughter has just received a promotion and has to put in more hours at her job. Sue is so excited, since it will raise her salary $30,000 a year. She's hoping that mom can take care of the kids full-time.

"Don't get nervous, it's only temporary until I get the hang of it, then I will put them in daycare," she says. At age sixty, Mrs. B. is not looking forward to spending 40 + hours a week taking care of a baby and a two-year-old toddler. She also has the responsibility of an aging mom with dementia. Since her father passed away over three years ago, Mrs. B. has been noticing changes in her mother's personality. Apparently she has been suffering from clinical depression with mood swings, wherein she would become enraged, unresponsive or withdrawn. She also watched her mom slowly fade into the never-ending fog of memory loss, repeating herself over and over again. Mrs. B.'s mom would become increasingly bewildered and confused, even in familiar surroundings. Lately, her appetite has been poor, and to make matters worse, she has developed a foul odor. She has been neglecting her personal hygiene as she does not realize that she has to bathe and change her clothes. Since Mrs. B. is the oldest of three sisters and as she lives the closest to mom, and supposedly had more free time on her hands than the others, she has become the designated primary caregiver, against her wishes. So as a result, Mrs. B.'s mom moves in with her daughter. Both situations have disrupted Mrs. B.'s comfort zone. It also has interfered with the quiet life that she built with her husband since the kids got married and moved out of the house.

The full-time baby-sitting issue in regards to her grandchildren is becoming a serious problem for her, going on for several months now. She cannot understand why it's taking her daughter so long to put them in daycare. Mrs. B. is too tired. She is wound tighter than a rubber band. The baby is teething and crying constantly and the toddler still in diapers is hungry, tugging at her pants. Suddenly the door bell rings. It's her next door neighbor asking if she could pick up her mail for the next four days since she won't be home. Smiling, Mrs. B. agrees and closes the door. She starts to fume, feeling envious of her neighbor, who has the freedom to take off when she wants to while Mrs. B. is trapped at home with two grandchildren, constantly changing diapers and doing the laundry.

She says, "What does she think I am, her errand girl? With all that I am doing, she has the nerve to ask!" Not even the girls at Mahjong call her anymore. They have been avoiding her like the plague. She calls her daughter constantly, complaining about the kids and her mom. The daughter, avoiding the issue, puts her on voice mail. Mrs. B. screams at her mom. She calls her sisters and vents on them for not helping out. She vents to the mailman, the supermarket cashier, whoever might lend an ear. She can't wait to vent on her husband when he comes home. There is no way for him to avoid the sound of her shrilly voice, her expression revealing her anger. He is deeply concerned that she may be having a nervous breakdown. The peaceful life of Mr. and Mrs. B. is long gone.

Meanwhile, Mrs. B. can hear her aging mom fussing because she has a terrible case of the runs, soiling her underwear and nightgown, she needs to be washed and changed just like the grandchildren she routinely babysits. Mrs. B. has found herself in a situation that is not easily solvable. She starts to freak out. She is extremely tired and cranky. She needs sleep in a desperate way. The horrible consciousness and sandwiched existence cause tears to stream from her eyes. "I can't stand it anymore. I hate what I'm doing. I don't want to do this any longer. I want it to go away," she cries. "I am only one person, how can I separate myself into so many pieces and satisfy everyone at the same time? Doesn't anyone care about me? I have needs too." She sits there stressed out, her body wracking with heart wrenching sobs. Frightened by grandma's emotional state, the baby starts to cry and her whole face turns red while the toddler starts to cry as well. Finally, she screams at the top of her lungs and says, "WHY ME? I DIDN'T ASK FOR THIS!"

Do these examples sound familiar? If so, you are not alone. Caring for aging parents is not an easy task. It saps your energy and robs you of your peace of mind. Very few people are emotionally ready to undertake this role. The comfort zone which you have created for yourself, including the freedom to come and go as you please, career fulfillment, and an active social life with your friends becomes completely disrupted. With care-giving, you feel captive to the needs of whoever you are caring for. Also, it puts you in the awkward position of parenting your own parents.

In the final part of this 3 part series, I'll address ways I have had to deal with being a member of the Sandwich Generation, and ways to help cope with the stress involved with being a caregiver.

Beware of Direct Transfer Designations - TOD's, POD's and Simple Beneficiary Designations


Direct transfer designations, like POD's (payable on death designations) and TOD's (transfer on death designations), and simple beneficiary designations, are mechanisms by which an account or other asset is transferred or paid upon the death of the account holder or asset owner to a beneficiary. They are often recommended by the administrator of the account, such as a bank, broker or life insurance company. While these can be very effective and inexpensive means by which to avoid probate and transfer assets at death, they are not without their risks and challenges. A lack of careful consideration of the risks and rewards of these mechanisms can be disastrous. A carefully prepared estate plan will consider, and resolve, all of the risks and challenges of these mechanisms.

Benefits of Direct Transfer Designations

Direct transfer designations, such as POD's and TOD's have several benefits. The most important benefits are that they are cheap and easy. Most institutions will permit you to make such designations as a service, for no additional fee. They are simple to create, and there is no need for an attorney or other professional. Most of these designations are made by account owners without legal or professional advice or counsel. Particularly because of this simplicity, they are very popular.

The second benefit is that the payment or transfer is more or less immediate and direct. Where there is a need to make cash or other liquid assets immediately available to a child or grandchild for some purpose, a TOD or POD appear attractive at first glance. Beneficiary transfers, however, typically require claim forms, and documentation in support of the claim. In reality, the process may take more time and effort than succession of ownership (such as through a living trust or joint tenancy with right of survivorship). Nonetheless, it is the assumption that funds are available immediately that often causes folks to choose direct transfer designations.

Unquestionably, direct transfers can have unique benefits as a result of this direct payment, whether or not immediate. For example, if you are widowed and want the bulk of your estate to pass to your children, but still desire a particular asset, fund, account or benefit to pass to a significant other or second spouse, without involvement of your children, a direct transfer may be warranted. Of course, such circumstances are specific, unique, and situational. The proper method for accomplishing an intended result depends upon first carefully considering all options to ensure that the proper tool is selected.

The third benefit is that a direct transfer designation may avoid probate, provided, however, that the beneficiary, transferee, or payee is alive at the death of the account holder or owner. If the beneficiary passes before or after, the asset may be probated. Particularly because the avoidance of probate may not be effective, TOD's and POD's are of limited utility in a carefully planned estate. Not surprisingly, because they are available at little or no cost, they are often used for the sole purpose of avoiding probate as an inexpensive substitute for more comprehensive planning. Make no mistake that these devices are NOT substitutes for living trusts. If you have utilized TOD's or POD's in your estate plan, particularly if you have done so without professional guidance, you may want to consider carefully the many possible disadvantages of these tools, and consider a more appropriate planning technique.

Regardless, these designations do not, at least effectively, accomplish several goals that might be accomplished by proper estate planning. For example, these devices do not avoid estate taxes, reduce the risk of guardianship, or permit management of assets during periods of incompetency or incapacity, and may not even avoid probate of the asset.

Moreover, there are several potential drawbacks to such devices, particularly if they are used without careful consideration or the advice of counsel. The biggest drawback to these plans is that they do not plan for contingencies. Additionally, use of such designations can cause illiquid estates, can lead to or cause unintended disinheritance, can lead to lawsuits or disputes, and can facilitate or encourage guardianship.

The limitations to such planning devices are discussed further below, followed by a discussion of their potential disadvantages.

Direct Transfer Designations Do Not Avoid Estate Tax

If you have any incident of ownership in or to an account or other asset, it will be included in your taxable estate for estate tax purposes. Consequently, direct transfer designations are not appropriate tools for estate tax planning, if your intention is to remove the value of the asset from your taxable estate. Generally, unless some other reason for excluding the account exists, the account will be included in your taxable estate notwithstanding the direct transfer designation.

POD's and TOD's May Not Avoid Probate

There are numerous instances where these techniques have been used to avoid probate, and yet the assets of the estate were nonetheless probated. Transfer upon death designations are not typically made for personal property, and may in fact be unavailable to transfer such assets. Under recent Ohio law, a transfer upon death deed was unavailable for real property that was owned jointly with a right of survivorship, as is most real property owned by a husband and wife. Regardless, if there are sufficient assets to probate, the other assets will pass through probate, even if liquid or other property avoids probate.

Moreover, these designations do nothing to protect assets from administration by a guardian or conservator in the event of incompetence or incapacity. They also do not prevent challenges to a will, appointment of executor, or other legal disputes which may ultimately be resolved by the probate court.

Finally, these designations will not avoid probate if the beneficiary passes away either before or after the account or asset owner. A probate administration may be necessitated, whereas property passing by way of trust will not need to be probated in the event of a death of an heir.

Direct Transfer Designations Do Not Avoid Guardianship

Direct transfer designations do nothing to protect assets from administration by a guardian or conservator in the event of incompetence or incapacity. For more information regarding the danger of guardianship, consider he Open Letter to Congress, drafted by the National Association to Stop Guardian Abuse.

Direct Transfer Designations May Create Illiquid Probate Estates

One potential drawback to these designations, particularly when placed on all liquid checking, savings, and investment accounts is that an estate can be made illiquid. Lack of liquidity can be a problem where there is real estate, personal property, or other assets that must be probated. Probate administration and estate taxes must be paid, and if the probate estate is insufficient to do so, heirs may be required to return cash to the estate, or property may be sold at fire sale prices to satisfy obligations. It is important to consider that ad hoc asset level planning to avoid probate often leaves assets to be probated.

Direct Transfer Designations Do Not Plan For Contingencies

The biggest disadvantage is that these devises are usually limited, and do not provide for contingencies. These plans very rarely answer the "what if?" questions considered by a carefully prepared estate plan. For example, what if the transferee or payee dies shortly before or after the owner? In most cases, the designation will simply pay the estate of the deceased transferee or payee. If, for example, the payee is your son, and he dies before you, without a will, the account or asset will be paid in whole or part to your daughter-in-law. You may desire that no part of your estate pass to the spouses of your children, in order to protect your grandchildren in the event of remarriage. Moreover, if you intended to avoid probate of your assets, you may fail in your efforts.

There are numerous examples of contingencies that a living or testamentary trust can address which are not typically addressed by POD's and TOD's. What if the property passes intentionally or unintentionally to a minor? Do you want the property to be distributed to the minor upon his or her reaching age eighteen or obtaining emancipation, or would you prefer to protect minors from their inexperience and lack of wisdom in managing assets?

What if the heir has financial difficulties, lawsuits, judgment liens, tax liens, or similar problems at the time of your death? If you do not intend your assets to pay the claims of third parties against your heirs, you should consider an alternative to a simple TOD or POD.

What if your heir is undergoing a divorce, dissolution, separation, or other marital difficulty? A TOD or POD may or may not be involved in such a dispute, depending upon a number of factors and your state law.

What if an heir is handicapped mentally or physically at the time of your death. If you want to protect that heir, you may want more than a simple TOD or POD.

What if an heir suffers from a substance abuse or other dependency that could affect their ability to manage their affairs? TOD and POD clauses rarely protect a family from such contingencies.

What if an heir joins or becomes a member of a quasi-religious organization, cult, or other organization pursuant to which your heir agrees to surrender or deliver all of the heir's assets? You may not want your worldly possessions to facilitate or benefit a cult.

What if there is a dispute, contest, or lawsuit? How is the dispute to be resolved, and on what basis?

Regardless which "what if" question concerns you now, you should consider many possible contingencies. As a result, a carefully considered and well drafted estate plan will consider and provide solutions to all of these and many more. TOD's and POD's simply have no solutions, because they are not, in and of themselves, "plans."

Direct Transfer Designations Can Lead to Unintended Disinheritance

Another disadvantage of direct transfers is that they can lead to unintended disinheritance. This occurs because folks often use these to segregate accounts. In other words, a person will select one account with a TOD or POD designation for one heir, and another account for another heir. This is often done to keep confidential account balances which may favor one heir as against another. These can be disastrous in an estate plan. Consider the following example:

Widow Smith has three children and three CD's. Two CD's are worth ten thousand dollars, but the third is worth twenty five thousand dollars. Smith's oldest daughter lives very near, is often helpful in Smith's day-to-day activities, and is Smith's designated attorney-in-fact. Smith makes the larger CD payable upon death (POD) to the oldest daughter, but makes the others payable to the other children. Unfortunately, Smith suffers a stroke and undergoes lengthy period of convalescence, including a stay in a nursing home. The expenses require the daughter, now acting through power of attorney, to liquidate one of the smaller CD's, and to liquidate the larger CD to cash, of which she spends ten thousand dollars. Assuming the only assets remaining at Smith's death are the checking account, which is now worth only approximately 15 thousand dollars, and the remaining CD which is worth ten thousand dollars, you can see how the POD failed to effectuate her wishes. The checking account is divided equally between the children (5 thousand dollars each) (Widow Smith probably assumed like many people that the checking account will only have a nominal amount of money in the account, which may not be true as the family deals with medical or other crises). Therefore instead of the oldest daughter receiving twenty five thousand dollars, she receives only five thousand. One of the other children receives fifteen thousand dollars. It is obvious the results were not in keeping with the intentions of Widow Smith.

An Attorney-in-Fact May Change Your Wishes

Most people who have utilized direct transfer designations assume that their estate plan is set, and their wishes will be followed. Sadly, nothing could be further from the truth. A direct transfer designation is typically a contractual right, which can be changed by an attorney-in-fact. Moreover, an asset can be transferred, and the designation "undone" by any person with authority over you or your estate, such as a guardian or conservator. Bottom line? A beneficiary designation is simply not an adequate estate plan for most people.

Direct Transfer Designations May Lead to Lawsuits Or Disputes

For all of the foregoing reasons, and countless others, direct transfer designations may cause your estate to be disputed, and may encourage, rather than discourage lawsuits and litigation. There is no substitute for a carefully considered and well drafted trust to ensure that your wishes are expressed and carried out.

Direct Transfer Designations May Facilitate or Encourage Guardianships

Particularly because they may create expectations in the minds of heirs, and because their use certainly does not discourage, and may encourage disputes, reliance on these in your estate plan might even encourage a guardianship application by an otherwise well-meaning heir as he or she seeks to protect their inheritance from others.

Guardianship may be necessitated by assets passing to contingent beneficiaries, as well, such as underage grandchildren. Since the goal of such designations is, in part, avoidance of probate, carefully consider their use in an estate plan.

Caring For Parents Versus Caring For Children - 10 Ways They Differ


Nearly 10 million boomers are now raising kids while at the same time, caring for at least one aging parent, according to the Pew Research Center reports. The term "Sandwich Generation" is used to describe this demographic, and lots has been written on it.

But what is not as frequently discussed, is that the strategies and techniques that are effective when caring for parents are very different from those that work well with children.

Here are 10 ways that caring for parents differs from caring for children:

1. Emotions

Emotions come into play in both care giving scenarios, but the emotions are often different. Whereas raising a child is filled with moments of joy and satisfaction, caring for your parents is often accompanied by feelings of sadness and even denial. "You grew up being taken care of by your parents. Now, you're taking care of them. People tend to underestimate how emotional that role reversal can be," says Andrea Cohen, CEO of HouseWorks home care. "It brings up emotions that people didn't think about; that they're not prepared for." The key is to talk about how you're feeling with family and friends, or with a qualified therapist.

2. Logistics

Children live with you from the moment they leave the hospital, usually until they go away to college. But with aging parents, the logistics are clearly different. There may be a move involved. Or, the caregiver must think through how they will coordinate care for a family member who lives out of town, or even state. There are many different living options to consider, and so many issues that arise. For instance, most elderly do not want to leave their home, even if living there unassisted is no longer safe. The caregiver may not be aware of what's really going on, because it's typical for elderly to mask problems or symptoms, for fear of being forced to leave their home.

3. Intellect

"Debating a child is a far cry from debating your parent," Cohen says. "It's hard to argue with a parent who you've been parented by all your life." Cohen has several recommendations if your parent is "fighting you tooth and nail." One solution is to work with a geriatric care manager, who can assess the situation and make recommendations. Often, parents will listen to an objective third parent before they listen to their child, even though you have their best interests in mind. For the same reason, asking your parent's doctor to speak with them can be helpful. Another technique Cohen recommends: Having a conversation with your parents early on, in their 60s, versus in their 70s or 80s.

4. Aging Process

Children are actually more predictable than the elderly, Cohen says. "You know at 1 year, they walk, at 2, they talk. But with parents, their health can change on a dime. Suddenly, the adult child is thrown into this world of care giving that they don't know anything about, and it's scary."

5. Financial

Caring for an elderly parent can be an unexpected expense. Some seniors planned ahead with long-term care insurance and such. Of course Medicare helps, but still too often, families are strapped with an unplanned financial strain. After all, it's hard to save for your parent's care when you're also saving for the kids' college. The good news is the financial world is coming up with solutions: Long-term care insurance, life settlements, guaranteed retirement incomes.

6. Siblings

Although they typically don't have much of a say in raising your children, siblings' votes do count when it comes to caring for parents. The situation is further complicated if some siblings live close to mom or dad, and others are out town. Resentment builds quickly when one sibling feels she is doing everything. Coordinating care among siblings is a difficult, but necessary task. This situation is one in with a third party can help: clinical social workers, geriatric care managers, and so on help the family coordinate care, and keep everyone informed.

7. Authority

Our whole lives, our parents have told us what to do, and most of the time, we listened. But in an elder care scenario, it's the child who is trying to tell the parent what to do, and can create unease and tension. But keep in mind, there may come a time when the child must speak legally and financially for the parent, so have power of attorney and other legal documents in place long before they are needed.

8. Complexities

When caring for an elderly parent, a whole new host of concerns and issues come into play: drug interactions, dementia, financial responsibility, and the list goes on. If the parent goes into an assisted living facility, adult children must be responsible for ensuring their parents are safe. Make sure the facility has the specialized services your parent needs, says Cohen, such as a dementia unit. If your parent enters the hospital, make sure you have an up-to-date list of all medications and non-prescription supplements your loved one is currently taking.

9. Quantity

While you can control the number of children you have, it is not as easy to control the numbers of elders you will be charged with caring for during your lifetime. With families extending through divorce and re-marriage, one person may care for as many as eight elders, including parents, in-laws and step-parents.

10. Work Issues

In addition to children of their own, many caregivers also have full-time jobs. Juggling responsibilities is tough. As the population increases, employees who are caring for elderly parents has become a productivity issues. As a result, employers are becoming more aware of the need for elder care provisions and benefits for their employees. There is a long way to go in this area, but inquire with you and your spouse's employer regarding elder care benefits. "Being a caregiver is tough," Cohen says.

"Being prepared, informed and organized can make the task a little easier," Cohen says.