William Isele, an attorney at Archer & Greiner at 700 Alexander Park, understands intimately the vulnerability of the elderly, having spent his career protecting populations at risk. His involvement with seniors started immediately after law school when he worked for the health law division of the American Medical Association. In the wake of a nationally publicized legal case about whether to disconnect the respirator from Karen Quinlan, a young woman in a persistent vegetative state, he helped develop policies about end-of-life decision-making.
After building a practice focused on guardianship and the problems of the elderly, Isele opened his own firm in 1991 in Milltown, but closed it after Governor Christie Whitman appointed him in 1998 as the state ombudsman for the institutionalized elderly in Trenton, an office he filled until 2007.
The most common issue faced by his team of a dozen investigators, who fielded in excess of 3,000 complaints a year, was neglect in understaffed nursing homes, where patients were not fed, changed, or turned often enough. Isele says that nursing homes are often understaffed because they operate on such a slim margin. His usual course of action was to sit down with administrators and discuss how they might address the problems reported.
Another issue that often faced Isele’s investigators was financial exploitation by family members trying to get an inheritance before they were entitled to it. These investigations usually grew out of reports from nursing homes that they were not getting paid; less often from other family members who were suspicious.
Isele will speak about “Legal Issues in Retirement,” Thursday, September 10, at 7 p.m., at the Princeton Public Library. The program is cosponsored by the library and the Princeton Senior Resource Center. This is the first talk in a monthly series for people thinking about retiring or making a major life change. For more information, call 609-924-7108 or E-mail email@example.com.
“There’s an expression out there that old age is not for the faint of heart, and I think it is very true,” says Isele. Careful planning, however, can avoid many pitfalls people face as their minds and bodies begin to age.
Signing documents. Isele suggests three types of documents that people need to keep in mind as they age. The first is a power of attorney. “This is one of the most useful and one of the most dangerous documents that a person can sign,” says Isele. Signing a power of attorney gives another person authorization to do everything you can do, like accessing bank accounts and selling property, explains Isele — unless it includes restrictions. “But most I’ve seen are broad-based, allowing an agent to do anything you can do; and that’s dangerous,” he says.
An attorney may also draw up a healthcare power of attorney that allows an agent to make decisions regarding healthcare.
Second, there are advance directives, which Isele explains come in three types: (1) a treatment directive specifies what kinds of treatment people do or do not want in the event they cannot speak for themselves; (2) a directive that does not specify treatment but says who will make healthcare decisions if a person is not able; or (3) a joint directive, which both appoints a proxy and gives instructions about types of treatment. Isele recommends anyone 18 or older have an advance directive, but it becomes more important as people age.
Another important document is a will. In the absence of a will New Jersey’s laws about intestate succession will define who a person’s property will go to. To specify which people and organizations will receive assets when a person dies requires a will. “A will is not just for the very wealthy,” adds Isele. “Sometimes it is more important for people who only have limited assets but who are very choosy about how they want those assets to be distributed.”
Avoiding elder scams. Elderly people who have saved and planned carefully throughout their lives often have more assets than younger folks and are perfect targets for scam artists. Although Isele suggests that now people may be more aware that E-mails from Nigerian princes or Irish sweepstakes are to be ignored, they are still infiltrating people’s mailboxes. “The basic rule,” he says, “is if it sounds too good to be true, it probably is.”
But if you receive an E-mail from your bank — or one that looks like it — you may be less careful. “Bank fraud can be extremely sophisticated,” explains Isele. “You get an E-mail that looks like it’s from your bank, with appropriate logos, saying the bank is concerned that there have been unauthorized transactions,” he says. The E-mail proceeds to request social security and bank account numbers to check on the “problem,” but of course the bank should already have these on file. “When people get this,” he continues, “they don’t stop to think. They shoot their personal information to people who are not their banks.”
Another scam still making the rounds is guys in a truck claiming to be driveway repavers. They knock on people’s doors with a spiel something like this: “I noticed that you have cracks in your driveway, and I would be glad to fix them for you. Business is a little tight, and we’d appreciate if you could help us out with some work.”
When the person agrees, the repaver asks for half of the $5,000 tab as a down payment and then walks off with check in hand, promising to be back the next week — which never happens.
Understanding financial options for health needs. Because many people do not understand the difference between Medicare and Medicaid, Isele explains that Medicare is an insurance program for the elderly that we all pay into from our paychecks; Medicaid is a federal/state joint program to provide medical care for the poor.
Medicare provides only very limited coverage for stays in a nursing home — when a person is right out of the hospital. “Most federal coverage of nursing home care is out of Medicaid,” says Isele, “and there are financial criteria as well as clinical criteria that make a person eligible.”
People need to understand the rules of Medicaid planning, says Isele. They can’t simply reduce their assets by giving them away to their children. “You can’t transfer assets without getting something of value in exchange,” he explains.
For example, when you buy a car for $20,000, you get a vehicle in exchange. But giving your son $20,000 because you like him is what is called a transfer not for value. Because Medicaid has a five-year “look-back,” if you apply for Medicaid within five years of giving your son $20,000, you will suffer a period of ineligibility of approximately three months ($20,000 divided by the $7,000 per month cost of a nursing home).
Isele also suggests that people buy long term care insurance when they are relatively young. “It’s probably just as important, and probably more so, than life insurance,” he says. “It cares for you when you are still living and probably can’t afford it.”
Understanding living options. People who are anticipating that they or their parents will need long-term care need to understand the various options that exist beyond a nursing home. “Most people have a vision of a nursing home, and they don’t like it,” says Isele. “There are options that allow people to stay in their own homes in the community.”
One such option is assisted living, where people have their own apartments and receive limited kinds of care. For example, nurses are available 24 hours a day, but not necessarily on site. “For a person with limited healthcare needs, assisted living can be good and less expensive than a nursing home,” says Isele.
Another useful option is adult day care, which allows elderly people to stay in their homes but go to a facility during the day where they can socialize, get limited medical services like medication monitoring and limited physical therapy, and participate in programs that provide mental stimulation. “For some people, this is a very important program,” says Isele. “Others may say, ‘I’m already active enough — I have my bridge club or my men’s club every couple of nights.”
Isele grew up in North Plainfield and Westfield, got bachelor and master’s degrees in philosophy from Catholic University, and received his JD from Georgetown in 1975. He has been with Archer & Greiner since 2007.
“Everybody’s needs are different, and there are various options out there,” says Isele. But making these kinds of decisions requires exploration, possibly legal guidance, and many conversations.