When It’s Our Turn to Take Care of Them The unique challenges of caring for our community’s seniors

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By: Kelly Jemal Massry

Eldercare is a field fraught with tension and vulnerability. There’s so much that goes into caring for seniors over 65 - making sure that they are properly stimulated, that they that have the right insurance in place, and that their assets are being properly managed. The many facets involved from both a legal and financial perspective can be difficult to navigate. That’s where people like Victoria Sutton, Director of the Senior Services Division at Sephardic Bikur Holim, Raymond Cohen, a community activist involved for decades in advising our community on nursing home placement, insurance broker Jeffrey Ashear, and attorney Dory Salem, Esq. come in. They seek to make community seniors aware of the options available to them if they take the proper measures now, while they are still healthy. Making informed decisions about the future, while still of sound mind and body, will ensure that the government shoulders the burden of care should a disease descend, and that one’s children are amply provided for through the next generation. Certainly, it is difficult to venture into suchsensitive topics – but being under the auspices of the right individuals can make all the difference in how secure one feels as he enters the twilight of his life.

The Senior Services Division of Sephardic Bikur Holim was instituted three years ago, with the goal of becoming a one-stop shop for seniors. Over the course of the year, Director Victoria Sutton receives hundreds of calls from community members looking for a primary care physician, a geriatric physician, a PT, an OT, or guidance in nursing home placement. SBH strives to be there for both the seniors who are still independent and those who have become needy due to either old age or illness. Many seniors live alone, have decreased cognition, are disconnected from their finances, or all of the above. SBH tries to assuage their difficulties by sending seniors visitors, providing Shabbat meals for them and hosting informative lectures. Recently, a lecture was held on fall prevention, as one of the biggest causes of injury to seniors are falls inside their very own homes. Another relevant lecture was on the changes to Medicare happening in 2017. Finally, there was one on increasingly frequent financial scams that make seniors their target. Being in the know about all of these topics better equip the elderly to handle the tidal wave of aging.

SBH has a benefits and entitlement department, staffed by two people trained to guide seniors through the complexities. “We really have to fight for each case and work on every appeal to get seniors through the red tape,” Victoria says. She commonly receives requests for help either securing a home Health Aid or attaining coverage for increased hours of service. SBH partners with several home health agencies in the area and recommends Health Aids according to people’sneeds. “There’s no one-size-fits-all answer,” says Victoria. We work with each individual family and tailor each recommendation to the patient.” Unquestionably, receiving eldercare within one’s own home is the most ideal course of action. For those who are able to afford it and are not sick enough to necessitate outside resources, SBH sends visiting nurses to ensure that medication is being taken properly and that there is medication compliance. Often, receiving a stellar standard of care at home will do much to improve a person’s condition and increase their life span. In these situations, Raymond Cohen has often brought in his dear friend Pinny Most of Chayim Aruchim, who can arrange for a venting and feeding tube to be instituted in the privacy of the patient’s home. Pinny is well versed in the legal and practical aspects of end-of-life services and has given advice to many of our community rabbis. On a day-to-day level, he can provide an elite team of health care individuals to be available at all times,administering acute care as needed.

Undeniably, though, there may come a time when a person’s needs exceed what’s possible to be done for them at home. They may require two-person assistance, which is outside the bounds of home health care, or their condition may be so physically and emotionally taxing that their caregiver’s health is weakening. In all of these cases, placement in a nursing home is recommended. Raymond first refers people to the Menorah Center, providing they’re in relatively good health.For those who need a ventilator, trach, or feeding tube, he has affiliations with Palm Gardens and the Borough Park Center, both of whom are
for-profit organizations. When placing a loved one in a for-profit facility, Raymond advises, make sure that family members scatter their visits throughout the day, and are especially present during feeding times. Often, unbeknownst to the nursing staff, the resident does not eat their meals. This can very quickly lead to malnutrition. Only a family member can ensure their loved one gets the correct care, as nursing homes are often understaffed.

“There’s a stigma in this community about sending loved ones to a nursing home,” says Victoria Sutton. “We’re aware of that, and that’s why we work so closely with places likeMenorah, Chaim Solomon…. We’ve had great experiences with them, but we still urge that the family go visit the nursing homes themselves.” Walk around, Victoria urges. Get familiar with the infrastructure and protocol – and put your family member in the establishment that is most qualified to meet your loved one’s needs.

Unfortunately, sometimes it takes personal experience with this route of care to become informed about the inner-workings of nursing homes. Raymond Cohen moved from England to America in 1964. He met his wife, Rachelle Haber, in 1967 and got married shortly after. Even as he settled down to begin a new life, however, something troubled him. His mother was still living alone in England and he couldn’t abide the continent of separation. He transferred her from London and she lived with Raymond and Rachelle for the first 26 years of their marriage. “My mother was like a queen,” Raymond remembers fondly. “Always dressed stylishly, with hair and makeup immaculate. And then, in 1991, she got this dreaded disease called Alzheimer’s.
My dear wife tried her best, but between taking care of our four kids and my dear mother, it became an impossible situation.” Raymond thanks his wife Rachelle, of nearly 50 years, saying, “Hashem should reward her for all the kindness she bestowed on
my mother!”

Back then, not much was known about the origin or progression of Alzheimer’s. It was written off as a mental problem and it was difficult to get proper care for those afflicted with it. In fact, many people were institutionalized in mental facilities. Raymond felt increasingly desperate as his mother worsened. “She would leave the house and we didn’t know where she was. Or she would become a recluse and refuse to leave her room and eat with us. Finally, Rabbi Shlomo Diamond came over one night and said ‘she needs to be in a nursing home.’” Emotionally, this was a hard piece of advice for Raymond to swallow, but eventually he recognized the truth in the Rabbi’s words. Going against his family’s wishes back in England and suffering painful fallout because of it, Raymond began searching for a nursing home for his mother. He recollects his experience disdainfully. “Once I accepted it, finding a nursing home was even more terrible,” he says. “There’s a lot of racially motivated elderly abuse, both physical and mental. Nursing homes need to be properly investigated, especially the ones that are driven by profit.”

Still, for his mother’s sake, Raymond researched day and night until he finally came upon The Sephardic Home for the Aged, directed by Michael New and started by the Greek and Turkish Jewish communities “Gd bless them for their wisdom in building their own home!” says Raymond. Though the building was sold two years ago, Raymond is forever grateful to the staff there. “Taking my mother to the Sephardic Home was the most difficult day of my life,” says Raymond, “but Baruch Hashem, she really blossomed there, due to the most incredible care she received.” Raymond was so proud to be the first member of our community invited to be on the Board of Directors for Sephardic Home for the Aged and helped to make it a great place, one that catered especially to the needs of our community. Raymond remembers fondly the “Syrian Culture Day” run by his wife’s aunt, Rosie Ades.

Mrs. Cohen spent six happy years at Sephardic Home for the Aged and Raymond visited her every day, driving in from Deal to do so. He credits the change in his mother to the stimulating classes she took at their school for Alzheimer’s patients called Mi Casa, established by Elliot and Alberto Sutton in memory of their mother. There, she relearned her self-care regimen and felt like a dignified woman again. Raymond served as the second Vice President for eight years and raised over three million dollars for the home. He currently serves on the grant committee of the Sephardic Home for the Aged foundation.

Raymond believes his mother flourished at the Sephardic Home precisely because it was a not-for-profit organization, with an incredible staff to resident ratio. For the 271 residents living at the home, there was a staff of 320 persons. He speaks just as excitedly about the The Menorah Center for Rehabilitation and Nursing Care. “What makes Menorah different? What makes it the best?” asks Raymond before answering his own rhetorical question. “They’re not in it for the money. They’re in it for the emet.” Menorah, a
not-for-profit organization, is located at the very end of Manhattan Beach. Its slogan is “Care Beyond Compare,” and Raymond can attest to that. “The Menorah Home gives our community VIP treatment,” he says, the gratitude evident in his voice. “When available, our residents are placed in private rooms facing the ocean. The head of admissions at Menorah, Dolores Rogue takes my calls at any time of day or night. She is a real, live angel,” enthuses Raymond. A brand new facility, Menorah was destroyed by Hurricane Sandy and rebuilt magnificently. “It’s like a 5-star hotel – but it’s a nursing home,” proclaims Raymond. Given his experience with nursing homes
across the gauntlet, this is very high praise indeed.

Raymond has several goals on the horizon. Firstly, he aims to make community members aware of Menorah’s existence, so that those who require a nursing home residency receive only the very best treatment. Secondly, he seeks to raise money for Menorah, so that they can continue to provide gold standard service. Thirdly, and most importantly, he aims to make sure people have the right insurance to ensure nursing home coverage. He recommends his own insurance broker, Jeffrey Ashear, a “service-oriented” young man whose family was one of the founding members of our community. Additionally, he wants to make sure that people are being advised by an experienced eldercare attorney, who can oversee the transferring of assets and secure Medicaid even for the very wealthy. To that end, he directs community members to attorney, Dory Salem, Esq. a wealth preservation lawyer he’s worked with for over 15 years.

“From a financial perspective, the worst-case scenario is no longer death,” Dory proclaims. “It’s becoming ill and needing
24-hour care in a nursing home for the rest of your life.” This is because when a person dies, the assets are passed on to the family; there’s no contention about it. But eldercare is trickier– and supremely costly if protective measures for one’s finances are not already in place. Medicare, the insurance granted to all seniors over the age of 65, does not pay for long-term care – it only pays for short-term care, which usually involves a limited amount of rehab. For those that need to be placed in a facility, Medicare will only pay for the first 20 days, before instituting a co-pay that may or may not be covered by insurance.

Once Medicare coverage has been exhausted, there are three ways to pay for what’s needed – be it in-house care or a nursing home residency. They are: Long-term care insurance, which is not commonly purchased, private pay, which can deplete a person’s life savings quickly, given that nursing homes cost on average $500 dailyand homecare $250, or Medicaid. Though we’ve come to understand Medicaid as a service designated for the poor, the wealthy can also receive Medicaid if their affairs are handled correctly. However, one can only receive Medicaid if he has a maximum of $14,850 to his name. This is why the transferring of assets to one’s kin or to an irrevocable trust is so vital; it sets all of the cogs in motion to enable this transition.

In order to grant another person access to his assets, an individual must sign off on something called “power of attorney,” a legal document giving another individual the authority to handle his financial affairs. For institutional Medicaid or nursing homecoverage, there is a five-year look back, so a person really does have to designate an agent while he is still healthy. The same is true for homecare in Florida and New Jersey. In New York though, coverage is immediate if the assets are transferred appropriately – there is no five-year
look-back in place. This makes Medicaid-covered homecare in New York, a viable tool for keeping individuals at home with the proper care. “A lot of times we can transfer assets to make receiving Medicaid a possibility,” saysDory, “but if we don’t have that power of attorney, the family’s hands are tied.”

By transferring his assets in advance, giving his children the ability to move his assets via power of attorney, or transferring his assets into trusts, so as to still havesome control over them, one can attain Medicaid and thereby have the government pay for his homecare or nursing home stay. In this way, his lifetime savings will remain intact and can be put to their intended use – the benefit of himself and his offspring. “Instead of paying for eldercare, you can give your money to your children,” insists Raymond. “If you’re properly protected with the right insurance and the right plan for wealth preservation your children will get the fruits of your labor, instead of the government that has already been taxing you your whole life.” Dory chimes in, “Once you’re over 65, if you have assets that you’re trying to protect for the next generation, you should definitely speak to a professional about executing a plan you’re comfortable with, to insure that whoever you want to be in charge is in charge and it’s documented. Seek the advice of those in the field. Go to an attorney or insurance broker who specializes in eldercare.”

In the absence of Medicaid, it’s recommended that Medicare beneficiaries purchase the Medicare Supplement F plan. It covers the deductibles, coinsurance and copays that standard Medicare does not cover for physician and hospital benefits. It’s also advisable to purchase a stand-alone prescription drug plan.One should be diligent in determining which plan is appropriate based on his current medications.

There’s another option called The Medicare Advantage plan, which acts like a Medicare HMO, covering the cost per day in hospitals and doctors’ offices. It is a restricted plan that removes you from original Medicare. It does cover certain benefits that Medicare does not cover but, for the most part, the out of pocket expenses associated with the plan are very high and you’re restricted to a certain region. That’s not all. Those who are unhappy with the plan are only allowed to switch once a year, in January.

For all of these reasons, the Medicare supplement F plan and a stand-alone prescription drug plan are the best options available for Medicare beneficiaries. Although the premium may be higher than a Medicare Advantage plan, the Medicare Supplement F plan does cover the Medicare Part A and Part B deductibles, as well as the 20% that is not covered by Medicare for physician services. The out of pocket cost for the Medicare beneficiary is thereby eliminated, provided that Medicare approves the service. As an added benefit, Medicare Supplement F also pays 100% of the  fifteen percent additional charges that can be filed by the Medicare provider. Under the auspices of this plan, you’ll be very thankful that you’re covered adequately when the time comes to secure the best physicians and facilities possible nationwide.

As the end of life nears or a disease advances its course, make sure you get the proper care for your loved one. Take advantage of the services offered by Sephardic Bikur Holim and Pinny Most of Chayim Aruchim. If homecare, assisted living, or a nursing home is needed, investigate so that you’re entirely comfortable with the Health Aid or institution.So, too, take the proper measures, via Dory Salem and Jeffrey Ashear, to ensure that the government rather than your own life savings covers such services. Heed the plea of Mr. Raymond Cohen and be proactive. Make the appropriate arrangements while you’restill healthy, as difficult as it can be to imagine yourself infirm and dependent. Old age will be something all of us experience, Gd willing. Ensure that you’re ready to meet it, for your sake and your loved ones’.

Raymond would like to acknowledge the following people who helped educate him in the care of the elderly: Elliot Bibi, who first took him to a nursing home 40 years ago. Dr. Victor Fariwa, who makes himself available anytime Raymond calls. Pinny Most, a real live angel of mercy from Chayim Aruchim. Michael New, Director of The Sephardic Home for the Aged, who taught him so much. Jeanne Gallagher, head of admissions at the Sephardic Home for the Aged. Lastly and most importantly, his wife Rachelle, as well as his family, for kindly excusing him during the many hours that he was called away on eldercare matters.