A hot topic in today’s world is Long Term Care, otherwise known as:  How to pay for the very expensive cost of Nursing Home Care.  Seniors are living longer; life expectancies are growing; and Health Care costs are increasing.  What does this mean for us?

I started law school at Columbia University in 1999.  In the short decade and a half since I started studying elder law, I’ve seen the average cost of nursing home care go from about $3,000 per month to a whopping $12,500 per month.  This is an increase of about 400%, which works out to 10% compound interest for 15 years. Using the official government-published CPI, the increase in the cost of $3,000 worth of goods and services from 1999 to 2013 is about $4,290, or approximately 2.4% compounded.  Why is there such a big difference? What’s going on here?

Without getting too heavily into anything that sounds like a conspiracy theory by the government, the CPI is artificially skewed down by excluding certain products and services that increase too quickly in price each year.  So, by definition it won’t reflect the reality of the world we live in. Unfortunately, along with food and gas—two things we buy the most—long term health care costs is among the categories with the most rapidly increasing prices.

What this means is that seniors will need more and more money just to pay for their upcoming long term care costs.  And yet, there is a new problem rapidly rising in the world:  Abuse, neglect, and exploitation of the elderly.

Abuse can be anything from emotional and/or verbal abuse to physical and/or sexual abuse.  Neglect is when someone who has a duty to care for the person does not provide for the elderly person’s daily needs.  Finally, exploitation is when an elderly or disabled person has someone take advantage of him or her financially.

Many seniors are being exposed to these problems. Sadly, the abuse, neglect, or financial exploitation usually comes at the hands of a trusted relative or friend; sometimes a care-giver.  What can we do to prevent these problems? Here are a few pointers to help protect against these problems.

First, make a plan for transition before it’s too late!  Long before any problems arise, and before you become physically or mentally incapacitated, work with an elder law attorney to develop a transition plan.  It should include whom you want to make decisions regarding your health care and who should be managing your money and other assets when you are not able to. By having the proper documentation in place ahead of time, someone you trust will be to step in and help out when it’s necessary.

Second, it’s probably a good idea to have regular annual meetings scheduled with your estate planning attorney so that if any irregularities do arise, you’ll have an advocate to vouch for your wishes and any suspicious circumstances can be reported to the proper investigative authorities.  I often see situations where families come to our law office after their parent has been exploited, their money is all gone, or their home has been transferred—and all this has often happened while the parent was supposedly incapacitated.  If necessary, this problem can sometimes be fixed through the courts, but that’s not always the case—and it is always expensive to do so.

Finally, look for red flags—signs that your loved one might be in trouble or need outside help.  Some of the common indications of abuse, neglect or exploitation include the following (although there are many other indications that might catch your attention so don’t be shy, speak up):

  • The appearance of unexplained bruises;
  • The senior appears to be fearful, anxious, or withdrawn;
  • The senior has bed sores indicating sheets haven’t been changed;
  • A care-giver or any person denies other family members access to the senior;
  • Financial or other legal documents go missing or can’t be found;
  • The will, trust, or power of attorney are changed; or a new lawyer is suddenly involved without adequate explanation;
  • Home property or other liquid assets are transferred inconsistently with the plan of distribution;
  • New credit card or other financial statements show up;
  • New living situations are suddenly set up (unknown caregiver suddenly moves in without family’s knowledge).


Although this is not an exhaustive list, I’m sure that you can start to see things that might catch your attention to help others who could be suffering from one of these problems.  If you suspect someone you know is being abused, neglected, or exploited—say something!  Call adult protective services; tell other family members; and inform professional contacts like the attorney and/or CPA.  Make sure that your loved one gets help and stays protected.  All too often concerned family members stay quiet for fear of making waves. It’s better to bring up a question and find out that there’s nothing to worry about than to let a problem go un-checked for a long time and then find out years down the road that nothing can be done to fix it anymore.



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Ethan R. Okura received his Doctor of Jurisprudence Degree from Columbia University in 2002.  He specializes in Estate Planning to protect assets from nursing home costs, probate, estate taxes, and creditors.


This written advice was not intended or written to be used, and it cannot be used by any taxpayer, for the purpose of avoiding penalties that may be imposed on the taxpayer.  (The foregoing legend has been affixed pursuant to U.S. Treasury Regulations governing tax practice.)


This column is for general information only.  The facts of your case may change the advice given.  Do not rely on the information in this column without consulting an estate planning specialist.