Nursing Homes|Nursing Home Abuse|Assisted Living Facilities

An adult family care home is in the assisted living category of retirement living. The services are the same and they have to abide by the same laws as an assisted living facility. The only difference is that an adult family care home can only have up to 5 residents.

True to the name, these types of homes provide family-style living in a private home. The 5 full time residents are elderly or disabled adults who are not related to the owner of the home. The residents can either share a room with another resident or they can have a room all to themselves.

The owner who lives in the home provides-by way of a contracted nurse or outsourced caregiver- the same services that are provided in a larger assisted living facility and include but are not limited to:

• Social and recreational activities
• Daily health monitoring
• Residential supervision
• Medication disbursement and/or assistance by a nurse or contracted caregiver
• Respite care (short term care of a senior meant to provide relief to a caregiver)
• Transportation arrangement and escorting to doctors' appointments
• Assistance with daily activities like walking, bathing, housekeeping, eating, and moving from one room to another, etc.
• Healthcare planning and organization

Just like and assisted living facility, an adult family care home may contract an independent skilled nurse or employ a skilled nurse to take vital signs such as blood pressure, temperature, respiration and pulse. Keep in mind however, you are allowed to bring in your own home healthcare provider to administer these services.

These homes are licensed by the Agency for Health Care Administration and require that residents must be able to perform with assistance, daily activities like bathing, dressing, and eating. The residents are not allowed to live in an AFCH if they are bedridden or if they need 24-hour supervision. They also can not have stage 3 or 4 pressure sores. These are minimum requirements and residents must meet other conditions as outlined in the Florida regulations.
Like a larger assisted living facility, if you end up needing more health care than allowed by law for an adult family care home, you may be asked to move on to a nursing home.

There are pros and cons associated with both assisted living facilities and adult family care homes. It would seem that one of the benefits of living in an AFCH would be that there is more of an intimate family-style atmosphere. In addition to that, these homes are typically more affordable than an assisted living facility.

Once you decide exactly which type of assisted living situation you want your loved one to settle into, it might be a good idea to talk to an elder law attorney. There is usually a bunch of paperwork to fill out before you can move in.

The stories about elder abuse keep getting worse and worse. As more of our seniors are retiring, elder care facilities are bursting at the seams. Every year up to 2,000,000 vulnerable elders are abused or neglected. Those are the cases we know about. For every one of those there are five more that are never reported.

Many politicians feel that not enough attention is being given to the problem. They point out that penalties for animal abuse are more severe than for elder abuse.

"It's hard to know because of the secrecy when nursing home residents are cared for at night with some of the staff or the secrecy that occurs behind closed doors in anyone's individual homes," says Iris Freeman of the Center on Elder Justice and Policy at the William Mitchell College of Law.

"Many cases of deprivation occur in such secrecy, in such silence, that by the time the victim is found there has been such disastrous harm that the victim is not likely to live," says Iris.

There was a government survey done not long ago that showed as many as 60% of all long-term care facilities had employees with criminal records.

The home healthcare industry is barely regulated and so the chance for abuse is even greater. With more families opting for hiring their own care workers the opportunities for abuse in a home healthcare setting is much more obvious.

Part of the problem is due to the growth in the nursing home and long-term care industry. Because of that growth there is a higher demand for employees, and quite frankly there just aren't enough qualified ones to go around which leads to shortcuts in the vetting process for employees. Employers feel it's better to have a warm body than a qualified body. Therein lies the problem.

So if you have parents that are in a long-term care facility, nursing home or home healthcare setting, one of the best things you can do is install a motion activated Covert Hidden Camera in their room to keep an eye on them to see what is going on with them. Most hidden cameras have DVRs in them so they can record motion activation and allow you to play back easily on an SD card that's in the DVR. If abuse is detected, you have strong visual evidence that will aid in prosecution.

Often in these cases, especially with Alzheimer's patients, the credibility of the patient is questioned and they are not given much credence. This can be eliminated by having strong visual evidence that only a hidden camera can produce.

Most family members feel disappointed when their parents have to move in a nursing home. This subject is definitely one of the problems the family would try to avoid as much as possible, but no matter how they try to, this situation is inescapable.

The question is why children fear sending their parents in a nursing home. Well, many nursing homes today cost around $80,000, and these figures go upward each year. Imagine how much savings you need to keep your loved one/s in the facility. And don't forget that your loved one might extend his or her stay there for few months or years that would eventually gobble up your savings. Therefore, financial planning is extremely crucial, and buying long term care insurance means a lot when considering nursing home care in the future.

What nursing home care? Why it is expensive? Nursing home care provides various services that can be a combination of personal care and skilled medical services. The extent of level of care depends on the person's needs and/or the request of the physician. Intermediate care is provided to patients with long-term medical condition. Skilled care, on the other hand, is much more costly because it provides 24-hour of health care assistance to the patient.

How do residents pay nursing home expenses? According to survey, a non-profit organization, a third of residents pay out-of-pocket expenses for nursing home care services, while only five percent purchases long term care insurance. Unfortunately, most of those residents fall heavily on either Medicaid Medicare assistance as their last resort, especially for low income families.

Many Americans boldly ignore private long term care insurance, hoping that Medicaid and Medicare will shoulder everything. While everyone seems so attached with Medicaid, please be reminded that this program is very limited in nature. Low income individuals are given priority to receive Medicaid benefits; thus, if you fall in the middle income group, you must meet Medicaid's asset limit. However, if you abide to this, you will just lose your savings for something that is not worth risking for. People with Alzheimer's are generally not covered in Medicaid because this disease is considered as mental disorder. There are also other mental impairment and health disorders that are not covered in Medicaid.

Medicare is another federal program that is available to all American citizens age 65 and older. Like Medicaid, Medicare does not provide modest long term care services because it covers up to 90 days only in selected facilities, particularly in hospitals. Think hundreds of times before jumping in either Medicaid or Medicare to avoid regrets.

As what has been mentioned earlier, very few people purchase long term care insurance because they are misled of the advantages of Medicaid and Medicare. Long term care insurance is the best financial investment intended primarily for long term care because it provides options and flexibility to meet your needs. This allows you to choose your preferred form of care whether at home or in a facility. You have the full control to determine your daily or monthly benefits and how you are going to use them.

By following several simple steps you can learn a great deal about the nursing home you are considering for your loved one. There are sources of public information which will help you avoid selecting a facility where residents have been neglected and abused.

Sources of Information About Nursing Homes
Both the State and Federal governments gather information about the quality of care delivered by all licensed nursing homes.

Where to look
Medicare has a website called Nursing Home Compare at medicare.gov/NHCompare and each state's department of health services has a similar website or document center. Information about violations of Federal and State regulations regarding the quality of care at each facility can be found on these databases.

What to look for
Each state's Department of Health Services is required to survey every nursing home in the state at least annually, to determine whether they comply with Federal and State quality of care regulations. You can contact these agencies and inspect their surveys to get a sense of the care your loved one can expect at the facility.

Neglect and Abuse
There are many signs of neglect and abuse you should look for in these records. For example, was the facility cited for any of the following: failing to follow physician's orders, failing to report a change of condition to the patient's physician, a large number of facility acquired pressure ulcers, etc.

Selecting the right Nursing Home
Nursing Home residents deserve quality of care and with a little research you can go a long way in minimizing the risk of neglect and abuse.

1. Faith or Pistis

This word is about faith; a belief of firm persuasion. It's about a firm conviction. It's a word linked with trust, being true and genuine, and truth (Greek: aletheia). This is the basis of commitment. Commitment or loyalty is such a necessary concept for the soul in life.

2. Courage or Tharseo

This is such a great word to engender empowerment. In the midst of trouble, it means to be of good courage, and to be cheerful despite the impending dire circumstances. It's about confidence and boldness in the face of fear. Closely linked to the Greek: tharreo, (to be confident and courageous), it gives us the ability to believe in our capability and capacity to achieve.

3. Overcome of Nikao

This precedes the next and alludes to it. The Greek root nik is enshrined in 'victory.' To overcome and subdue the enemy (whoever that might be) and come off superior is not the objective unless we're fighting the good fight i.e. upholding the principles of righteousness, justice, and fairness.

4. Patience or Hupomone

Strong's #5281 is used for endurance, perseverance and patience. It is actually two words combined to make a special meaning. It is Huper, as in super, over, beyond, and above,' together with Monos, which means alone, or without accompaniment, singly existent, and only. The full word, hupomone, traditionally means to bear under, or put up with, something 'over me.'

It also therefore seems to me that this word, hupomone, stands for "overcoming oneself." (Over/beyond + me/alone) It is self-mastery. Is that not patient endurance? It is a faithfulness to not give in to the powers of the situations over ourselves. It is bearing with the total pressure over us.

5. Royal or Basileion / Basilikos

This word is about royalty. It's about being above the gossip of the world whilst being intrinsically part of the mesh and grind of it. The word it leads to is Sophia i.e. wisdom. Royals are supposed to be the pillars of wisdom in society. That is to be prudent, learned, philosophical, and enlightened.

If we therefore wish to be wiser, we should try to be more regal in our behaviour. This is not so much about being toffee-nosed; it's more to do with the poise and charisma that comes from a quiet confidence and a "noble reserve of bearing that cannot be mistaken."[1]

6. Living Sacrifice or Zosan Thusian

This, according to Paul, is the way to please God. Think of it as the daily process of dying to one self's often rampant desires and giving that energy to others and to our general existence. It is being consistently altruistic, philanthropic, and humanitarian. This one's linked heavily with faith i.e. commitment.

7. Slow down or Bradus Kato

This word Bradus can mean slow to understand, as well as slow, not hasty. I'm referring to the latter. Kato simply means 'down.' We all tend to try and keep pace with this busy world and that can have the inevitable health impacts. 

Slowing down to smell the flowers regularly is a good life choice. We see a lot more when we choose to walk than we do when we drive a car.  When we slow down we reduce the pressure we self-impose. Decisions are better and our relationships benefit.

8. Thanks or Eucharistia

Oft-quoted is the Cicero, "A thankful heart is the parent of all virtues" contribution. It's the 'grand-daddy' virtue over all others. It's gratitude and cheerfulness. When we're thankful, our lives and all of those around us get better. We don't take things for granted. Grace would be the seal on everything we'd do.

G.K. Chesterton's signature quote was, "Nothing taken for granted, everything received with gratitude, everything passed on with grace." If only we could achieve this. To get close we must set out after it.

Over all these soulful words and concepts we place love, the greatest thing of all.

[All transliteration and interpretation assisted by The New Analytical Greek Lexicon, Wesley J. Perschbacher, Editor, (Peabody, Massachusetts: Hendrickson Publishers, 1990).]

Copyright © 2008, S. J. Wickham.  All Rights Reserved Worldwide.

[1] Source of quote: A.W. Tozer from Lyle Dorsett, A Passion for God: The Spiritual Journey of A.W. Tozer (Chicago, Illinois: Moody Publishers, 2008), p. 184.

Reaching the age of retirement is a well deserved event that warrants the reward of being able to really experience the greater things in life. But working hard over the span of ones life surely takes a toll on personal health. Because of this, more and more senior citizens will need some sort of aid in their living situations. Data shows that as many as 50 % of our nations elderly are in need of assisted care. In addition, as the amount of individuals needing these programs heightens, so does cost.

Fortunately, there are multiple methods to minimize month to month prices that are not nearly as complex as one may believe. One approach is to utilize the web. The internet has reinvented the buying and selling of goods and services. Therefore, it goes without saying that insurance (like everything else) is more affordable online. Being dubious about this concept is perfectly reasonable, but if bought right, it can cut your insurance costs by as much as 30 %. There are numerous reasons as to why insurance rates are lower from online retailers. Selling insurance internet is highly competitive due to the fact that so many salespersons utilize the web as a selling tool. Therefore, with increasing rivalry comes decreasing costs for potential customers. Next, think about daily operational costs for local lenders, they have supplemental costs like rental fee and office essentials to deal with. An online retailer has marginal operation cost obligations and can as a result sell at a lesser rate.

Another insurance cost slicing approach is to make your monthly payments a routine. You may not think it, but insurance suppliers notice steady payment patterns because they result in a significant amount of savings for the agency. For instance, if you pay your dues on the same day every month then the insurance firm doesn't have to worry about the cost of distributing your statement. The money you save for the agency by paying your bills on time is reprimanded via lower monthly costs.

Last but not least, the sooner you obtain a policy, the less you will have to pay in the future. Even if you are years from pension, it is crucial to note that almost ten percent of Americans, even those as young as 40, need facilitated care. Purchasing insurance earlier on in life is a safeguard for when you are older, as effective money maintenance and costs become more and more hard to overcome as you age.

Reglan is a brand name of the generic drug metoclopramide and has some serious side effects that can cause permanent damage. Reglan is used to treat gastroesophageal reflux disease (GERD) and as a prokinetic drug to improve gastric motility of a gut that has digestive impairment due to nerve damage. With its effect on dopamine receptors, Reglan is also prescribed as an anti-nausea drug after some surgeries or prior to some procedures. As with many other drugs it is intended for short-term use as labeled for 4-12 weeks. However, many patients have been prescribed the drug for much longer periods of time.

The serious side effects of Reglan cause what is known as Tardive Dyskinesia which is involuntary muscle movements that can debilitate a person who takes it. Not all patients prescribed Reglan suffer from the more serious side effects, and some do fully recover after discontinuing use of the drug. However, for some patients who have been prescribed Reglan the involuntary muscle movements that are a serious neurological disorder do not go away.

The involuntary muscle movements of Tardive dyskinesia may be exacerbated in those who are diagnosed with Parkinson's disease. Facial grimacing movements, rapid eye blinking, uncontrolled movements of the tongue, lips or jaw, uncontrolled finger, hand and arm movements are some of the side effects, and they can even involve the arms, shoulder, trunk of the body and legs.

If the muscle movements did not exist prior to taking Reglan, and if there is no other definitive cause, Reglan should be suspected. For some patients the neurological condition will not go away due to there not being any effective methods of treatment for Tardive Dyskinesia thus making their condition permanent.

It has been found that physicians have had a tendency to over prescribe Reglan when other drugs that are known to produce less serious side effects could have been used. In the U.S. there is no other drug available that is as effective as prokinetic for nerve-damaged gastric systems thus Reglan is the sole drug for this prescribed use. However, it has been found that physicians do not explain the potential serious side effects of Reglan before prescribing it, and with the condition of Tardive Dyskinesia being irreversible this is an issue.

Seniors in nursing homes are at more risk for the overuse of Reglan to treat symptoms. As well, seniors with varying levels of dementia are not able to understand the risks of the drug or may not be in a position to say no to treatment with the drug. With the possibility of adding the serious neurological disorder of Tardive Dyskinesia to senior patients in nursing homes who obviously already have a long list of health issues, it is of major concern to get physicians to quit over prescribing a drug known to have serious side effects.

Cases of patients suffering permanent serious side effects of Reglan use are now under review with attorneys all over the U.S. Law firms all over the U.S. are open to representing clients who believe they have suffered irreversible neurological symptoms due to taking the prescription drug Reglan or the generic metoclopramide.

Senior citizens often require specialized health services. When they undergo surgery, suffered an injury, or show signs of losing their memories, seniors may need the specialized services offered at a nursing home rehabilitation center. At this facility, seniors can regain their mobility, improve their memories, and overcome challenges to their health.

The staff at a nursing home rehabilitation center caters a patient's care according to the needs of that specific individual. A person who has had surgery on a knee or hip may need physical therapy to improve his or her balance and strength in that part of the body. Physical therapy often includes working out with weights, walking around an indoor track, or bending the affected part of the body in rhythmic exercise routines. Most patients work directly with a therapist as they build up their strength and resistance to the exercises.

On the other hand, a patient who is suffering from memory loss may benefit from occupational therapy. A therapist uses flash cards, puzzles, and games to assist that person in remembering basic skills, such as placing puzzle pieces together or pronouncing words. This therapy is most often used for patients who have suffered strokes or who have been diagnosed with Alzheimer's disease or dementia.

Staff at a nursing home rehabilitation center also assists people who suffer from physical conditions that interfere with basic daily activities. For example, dysphagia tends to be a common condition among the elderly; this condition makes it difficult for seniors to swallow food, water, and medication. People with this affliction feel that they are choking or unable to swallow these substances. In worst case scenarios, sufferers lose weight, choke on their food or medication, or develop pneumonia by aspirating substances into their lungs. Therapists assist these individuals by teaching techniques that make swallowing easier. They may also position patients differently in their beds or at their tables to facilitate eating and drinking. If all else fails, therapists can discuss remedies that include feeding tubes or intravenous hydration.

Patients at this facility may be surprised that their therapies are not dull and lack entertainment. In fact, a nursing home rehabilitation center may use a Wii game system as part of people's daily therapies. Playing a virtual game of bowling, tennis, baseball, basketball, and more lets people work out while having fun. Even more, playing video games has proven to be beneficial for those who suffer from anxiety and depression. Patients often look forward to playing the Wii as part of their rehabilitation processes. This approach and others like it allow senior citizens to regain their mobility, improve their health, and overcome challenges to their wellbeing. They can benefit from staying at this facility.

During a recent property tax appeal case we were shocked to hear the local property tax assessor make the statement, "Have him close the business and I'll consider lowering the taxes". We looked at one another in sheer amazement and before I could inform the assessor that he had just admitted to taxing the business enterprise as opposed to strictly the real estate, Clay had taken out a legal pad and said "Wait! Let me quote you on that!" The confident assessor gladly made the statement once again unaware of the fact Clay was actually documenting the quote to be utilized later during a formal appeals board hearing. Real Estate Taxes are just that, a tax that is attributable to the real estate only. This assessor made it quite clear that this personal care facility was being taxed, not only on its real estate, land plus improvements, but on the business enterprise (intangible assets) associated with the business occupying the improved property.

Appraisal literature features an abundance of articles addressing the valuation of various properties with a focus on the segregation of intangible components from the tangible assets. Most state laws hold only real property and other tangible assets subject to taxation so the importance of separating these components of value is most apparent in property tax assessment. Intangible assets, though they may enhance the value of the total operating enterprise, are not subject to ad valorem taxes.

Commercial property, especially nursing homes, personal care centers, assisted living center and hospitality owners should analyze their ad valorem tax obligation immediately. We continue to find that most assessors are incorrect in the way they are assessing these specialized types of properties. Many times these properties sell and transfer including not only the real estate but the businesses themselves. The majority of the assessing officials will simply assess the property at this sale price, which often times not only include the real estate but also the personal property and business enterprise value (BEV) which is also referred to as going-concern value.

Valuing the going concern is fairly straightforward using discounted cash flow techniques or an income capitalization approach. The difficulty arises when there is a need to decompose the going concern value into the various elements as required for assessment and condemnation assignments.

In distinguishing between BEV and real estate value, it is fundamental to recognize that income generated from a business conducted within the real estate is not the appropriate measure of real estate value. Instead, that income is the value of the going concern. For many special purpose properties, the business enterprise component is substantial, so the potential for error is large if going concern value and real estate value are confused.

In using the Income Approach, it must be kept in mind that the proprietary nursing home is more than a real estate entity consisting of land and buildings. It is a facility equipped and staffed for providing personal services. Recognition must be given to this factor in the form of a "business profit" to the owner of operator.

The real estate alone (land and buildings) is not the preponderant income-producing factor as in a facility such as an apartment building. A nursing home provides many personal services to its occupants as part of the charge for occupying a room or a bed. These include food, nursing care on a 24-hour basis, and a limited amount of entertainment....The proprietary nursing home is a "special use" property. As such, the market is quite limited. Furthermore, the special design limits the alternate uses for the real estate.

During a recently settled case of a property containing both a personal care facility and an assisted living center, we argued that the personal care facility added no value and in fact was a determent to the overall property. This was based upon the KY required payment arrangement of $37.80 per bed per day and that no prudent investor would even attempt to buy the property and continue this center based on that income. This is attributed to the going-concern and was provided to the assessor to demonstrate the lack of current success of the business within the real estate. In addition this property suffered an immeasurable amount of functional obsolescence as it was constructed in 1969. The assessor agreed and explored alternative uses for the assisted living center and was also of the opinion it did not represent the highest and best use of the property. The total assessment was lowered from $6,087,100 to $4,000,000 with an annual tax saving of $29,267 or $146,337 over the next five years. The total savings are immeasurable as they are carried into perpetuity due to the fact there is a new starting point ($4,000,000) in which the assessment may be raised in the future.

The land and buildings are not the chief income-producing factors in a nursing home......The value of a nursing home is enhanced by its reputation and good will in the medical and nursing field and in the community at large.

If a firm is prosperous it does not want to sell except for a bonus; if it is bankrupt, it often sells at a bargain upset price; and in neither case is true value measured. When Dodge Bros., automobile manufactures was purchased by capitalists, it was reported that an allowance of many millions of dollars in stock was paid for goodwill.

It is therefore readily understood that a law requiring property to be assessed at its actual value, its real value, its cash value, its market cash value or its full cash value does not mean its "transaction value" where cash paid represents but a fraction of the sales price, nor does it mean the all cash price paid at a forced sale.

This intangible value is not generally taxable. A tax assessor is often confused when an industrial property sells at a figure greatly above the assessed value. He has not the information at hand from which to fathom the intricacies of patent rights, goodwill, etc., and often the problem is left unsolved.

Ad valorem tax is one of the only taxes one pays that is based upon someone's opinion of value. Incompetence means you pay more! Don't let an incompetent assessor cost you thousands of dollars by making you pay more than your fair share by including BEV!

By Bryan S. Reynolds and Clay J. Wells

Elder abuse is a worrisome activity that occurs all throughout the country both in nursing homes and at outpatient care facilities, such as in the home of an elderly person. It involves the physical, emotional, sexual, or financial abuse of an elderly person. Oftentimes, the abuser may be the very person that is relied on to provide care for the elderly person. When something such as this occurs, the elderly person is afraid to voice their opinion in fear of retaliation or the refusal of the care that they need. If you believe that your elderly family member is suffering from some form of abuse or neglect, there are several legal actions you can take.

Some of the signs that are associated with physical elder abuse include unexplained bruising, cuts, broken bones, complaints of pain, and other types of unexplained injuries. Signs of emotional or financial elder abuse can include agitation, exaggerated emotions, anger, withdrawal from public settings, unexplained and unusual behavior towards friends or family, and unexplained withdrawals or purchases from bank accounts. Sexual abuse, a very serious type of abuse seen in nursing home facilities, is signaled by unexplained bruising near the genitals or breasts, complaints of sexual abuse, and many of the other signs that indicate physical abuse. If you believe that your family member may be exposed to instances of neglect, they may be exhibiting signs such as malnutrition, wandering, dehydration, poor hygiene, and more. No matter what type of abuse or neglect you believe your family member to be suffering from, there is something you can do about it!

By bringing the situation, or potential situation, to light, you may stop the abuse in its tracks and possibly prevent a future event from taking place. An attorney will be able to thoroughly review the case, evaluate the potential danger that your family member and others are in, and investigate the situation. If it is found that nursing home abuse or any form of elder abuse is present, including an incorrect dosage of medication being prescribed by a facility's pharmacist or medication usage for off-label purposes, the facility will be held accountable for the damage that they have caused.

This legal action will hold the abuser or abusers responsible for their wrongful actions. In turn, it may also prevent future outbreaks of physical, emotional or verbal, sexual, or financial abuse from taking place. It is very important to your loved one to get the legal help that you need and deserve in a troubling time such as this.

Home health care technology can assist baby boomers to successfully age in place by promoting independence and offering assistance when it is needed.

Boomers have made it perfectly clear they want to remain in their communities and stay in their homes for as long as possible. The results of a survey conducted by The American Association of Retired Persons of September 2008 asked baby boomers if they agreed with this statement:

"What I'd really like to do is stay in my current residence for as long as possible." The results were:

• 80% of those between the age of 55-64 agree


• 88% believe that it is likely that they can


• 75% of those that responded between the mid 50's and mid 60"s believe some aspect of their home will challenge their ability to do so (stairs being the biggest obstacle with 24%).

So here is the surprising, yet disturbing news. Clarity conducted a research study that studied two groups: Baby Boomers between the ages of 43 - 61, with aging parents and seniors, age 65 plus, and still living independently, at home.

The results of this study:

• 53% of the aging seniors in the study were concerned about their ability (despite their desire) to remain in their own homes. They cited concerns about health, memory and the ability to drive.


• When asked about fears, seniors 26% ranked loss of independence. The highest,13%, feared moving into a nursing home and 3%, had a fear of death.


• 51% of boomers believe there is technology to help their parents. But only 14% have looked for any home health care technology.

Aging seniors and baby boomers rank moving into a nursing home higher than they fear death.

Baby boomers require taking action to successfully age in place and home health care technology is there to support them and their aging loved one. It is important to be proactive and not reactive to researching home health care technology.

Research shows that most home health care technology is initiated in the home, only after an incident occurs. This incident, with an aging senior often results in an unnecessary hospitalization. Most accidents, that happen at home, can be prevented. The technology is available to maintain independence, prevent unnecessary hospitalizations and improve the quality of life of our aging seniors.

Home health care technology is available to aging baby boomers now. In order to successfully age in place requires planning. Many boomers have aging loved ones that they are presently taking care of and providing assistance in the home. It will not be long and the boomers will require care and have the same goals: aging in place. Boomers, take action now to make your goal of aging in place a reality.

This article focuses on the services provided by Assisted Living Concepts Inc., which provides assisted living accommodations to the elderly who want to maintain as much of their independence as possible. These retirees may have lost some of their physical ability to do certain things that are necessary for daily living, such as taking a bath, dressing, eating, cooking or even toileting but they do not want to lose too much of their independence. This usually happens in nursing homes but assisted living residences offer an alternative lifestyle whereby the residents have more freedom to do what they want and are assisted only when they need it. But how do you evaluate the quality of the services that are offered by a company like Assisted Living Concepts?

Some of the factors that you can check when assessing assisted living programs include the safety features, services, equipment and amenities, financial issues, atmosphere and comfort level. Do not forget to examine the different amenities and equipment that are made available based on the fees that are being charged. Some of the features that you may want to check with regards to amenities in Assisted Living Concepts and compare them with the features of others include whether they have the capacity to accommodate the specific needs of a resident, the availability of religious facilities, the provision of a telephone and television unit in every unit, the presence of exercise equipment, the presence of a kitchen unit and refrigerator, and the availability of additional storage. It is also important to check whether shopping and entertainment centers can easily be reached.

Of course, you will also need to check on the monthly expenses and if there is a deposit requirement. Other issues that you need to check include the rules of refund in the event that you want to terminate the services, credit policies, whether the housing units are furnished, the types of housing that are available, the actions taken by management in case the resident is unable to make the monthly payments, the kinds of services that are covered in the fees that are charged, and the possibility of changing the kind of care when the need arises in the future.

When checking the services offered by retirement living providers such as Assisted Living Concepts, it is also advisable to inquire as to the types of activities that are allowed. These include whether socialization is encouraged, the availability of a common dining room, whether there are plenty of chances to socialize with the neighboring communities, the presence of a lounge area and other ways that make it easier to interact with other community members. Safety features are also essential and these include the presence of hand rails, door alarms in each unit, an intercom in each unit, air conditioning, heating and ventilation, the availability of staff at any time, the availability of a doctor in the community, the presence of a hospital nearby, and the availability of a way to communicate with staff if there is an emergency.

Many elderly people dread going to nursing homes because of the bad reputation that nursing homes have in our society. Nursing homes have had some problems over the past several decades, but there are still good, reputable homes. Even so, being placed in a home will force your loved one to give up their personal freedom, privacy, and independence. If your loved one does not yet need constant medical care, there isn't a necessity to place them in a nursing home. Try considering another option.

The alternative to a nursing home is Assisted Living Facilities, popularly known as ALF. These facilities are for people needing assistance with daily living activities, but who want to live as independently as possible for as long as possible. The goal is to bridge the gap between independent living and nursing homes.

Level of Freedom

Residents in assisted living centers are not able to live by themselves, yet do not require constant care either. Such facilities offer help with eating, bathing, dressing, laundry, housekeeping, and assistance with medications. Many facilities also have centers for medical care; although, the care offered may not be as intensive as the care offered at a nursing home.

Understanding the Differences

The decision on whether to send your loved one to an assisted living facility or a nursing home rests on many factors:

* Cost: Assisted living is rather costly because individuals live in apartment-like settings. Nursing homes are cheaper because the elderly live in a more communal space, with little private space.

* Medicare is frequently available for someone in a nursing home, but may not be for someone in an Assisted Living Facility.

* Facilities: ALFs are focused on individuals. Nursing homes are focused on the collective group.

* Place: While assisted living facility is a place for a few seniors at a time, a nursing home houses many patients. The former house an individual who is given all the help and assistance he or she needs, while the nursing home gives far less individual care.

* Nursing homes are meant to care for people who have a number of health care requirements, and cannot care for themselves. ALFs are meant to assist elderly persons who can basically care for many of their personal needs themselves.

* In an assisted living facility, skilled nursing care is not usually available except on an as-needed basis. A nursing home is more similar to a hospital environment and provides full-scale, skilled nursing care.

* Assisted living facilities are meant to assist people in preparing meals, bathing, dressing or performing household chores. If your loved one is often confused or experiencing memory problems, this might be the answer. If they have a debilitating disease or condition, they might need a nursing home.

Consider Their Welfare

When deciding on either a nursing home or an assisted living facility, your major concern should be the welfare of your loved one. It may be necessary to factor in the reality of costs, but there are ways of obtaining financial aid and in the long run, you'll rest easier knowing your loved one is being well cared for. Just keep in mind that if you end up with a situation that is fraught with problems, the effort and stress you invest in resolving the situation may not be worth the dollars you thought you might save.

Elderly people who dwell in a nursing home have needs that are considerably different from those living in their own home, not to mention being constrained by a limited space. Nevertheless, the confines of a nursing home do not exclude these people from receiving tokens of appreciation. Indeed, there are still numerous valuable gift ideas for those residing in nursing homes. Not knowing what these people need or want is no excuse for not giving them gifts. Gifts are small tokens that express concern and care. Everyone longs to be remembered, most especially elderly people in nursing homes who do not experience the proximity of family and loved ones. Most people agree that thinking of gift ideas for people dwelling in nursing homes can be painstaking. The following ideas discussed in this article may help provide a spark of thought. These gift ideas for nursing home residents are generally practical and useful, and most importantly, these gift ideas embody thoughtfulness.

Those who reside in nursing homes are sometimes unable to shop for stationery, note cards, greeting cards, writing supplies, and postage stamps. A nursing home resident, who is fond of filling out letters and cards, may be given a gift of postage stamps, writing supplies, and greeting cards for all occasions. Furthermore, include an address book that contain with the names and addresses of relatives and friends. Bestowing a nursing home resident the facility to stay in touch with family and friends is a wonderful and thoughtful gift.

Everyone enjoys reminiscing happy moments in one's life, and for the elderly, the past is oftentimes more revered than the present. Anyone would certainly love to receive a scrapbook or a photo album that depict valuable memories. Pictures, as the old adage says, "are worth a thousand words," and sending someone a gift book containing familiar faces, smiles, as well as places is something that can be appreciated and looked at again and again. If the nursing resident is a friend or a family member, make copies of photographs in your possession, and solicit photographs from other family members or from mutual friends. Select a cheerful motif for the photo album, and fill the album not only with cherished photos of family, pets, friends, happy occasions, and vacations but also perhaps, some personal notes from the people whose faces appear in the album. The recipient will surely love a thoughtful gift as this, and they will be able to relive the past with each turn of a page.

Gift certificates are popular for all occasions, and fortunately gift certificates are available for every interest and age group. A gift certificate might be a very appropriate choice to give to a nursing home resident who can go outside of the facility to have a massage, professional pedicure, manicure, or hairstyle. A restaurant gift certificate might also be considered, so the recipient can use it, for instance, to treat a guest to a meal out. Also consider services and entertainment that cater the interests or the needs of the nursing home resident, and purchase a gift certificate that they can make use of.

Lastly, one might consider making a gift basket filled with useful items such as washable slippers, cologne, lip balm, small decorative trinkets, word puzzles, magazines, or books, etc. If the nursing home resident is not undergoing a restricted diet, also consider a gift basket that includes a selection of tasty snacks or fruits.

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GoldenAgeUSA -Chandeliers

Employment location or setting affects the salary of a Registered Nurse. RNs are employed by different health care facilities like hospices, homes, hospitals, clinics and schools.

How much does a registered nurse receive on the average?

In a week, RNs work for 40 hours or 2080 hours a year. Median salary is known to be $30.04 per hour. The nurse salary bracket shows the lower 10% to receive $20.20 an hour and the upper 10% to receive $41.97 + an hour.

The highest earning registered nurse takes home $85,000 a year while the lowest paid gets $37,000 a year.

The Employment Details of Registered Nurses

Approximately, 2,340,000 RNs are employed in the US and half of them are working in hospitals. 204,000 of these nurses found work in private clinics. Nursing homes employ about 104,000 nurses and about 100,000 works as traveling nurses or have jobs in employment agencies. The home health care sectors have 114,000 registered nurses employed.

Salaries of nurses being registered employed by either the private or public sectors are lower than those who are self-employed. Examples are traveling nurses who take short term employment contracts but are paid higher. Housing, bonuses and travel allowance are additional incentives travel nurses receive. Some traveling nurses work for nursing employment agencies, some work independently.

Nurses working as legal consultants and educators or are employed in other health-care related businesses receive higher RN salaries than the average.

The employer, size of business and other factors also affect an RN's benefits not only an RN's salary.

The benefits of RNs include:

• Paid time off -nurses being registered are allowed 2 weeks' worth of accumulated paid vacation. The benefit's value increases in accordance to her ability to earn higher. 2 weeks paid time off is equivalent to $2403.00
• Paid sick leave - employees get sick from time to time thus this benefit. A lot of employers grant their employees one week worth of sick time a year which can be converted to $1200.00.
• Paid Holiday Time Off - There are about 6 paid holidays in a year. This means an extra 48 hours paid without work that may be worth $1441.92 for those getting average registered nurse salary.
• SS contribution - most don't consider this a benefit as 6.7% of their salary goes to social security but employers are required to contribute roughly the same amount for the employee's SS. The average RN's salary is $30.04 an hour and annual contribution will be worth $4186.37. Add to this your employer's contribution which should be about the same amount.

A registered nurses compensation package may include Medical, Dental and Vision Insurance, Retirement Plans, Education benefits and Employee Health benefits

When a loved one gets infirm or older, sometimes the only alternative is to find them a nursing home to live out the rest of their days in relative comfort. Licensed nursing homes provide skilled care primarily to the elderly, and - hopefully - give peace of mind not only to the people living in them, but also to their relatives and friends.

These days, however, nursing home facilities provide homes not only for people who will live there for the rest of their lives, but also short- term accommodation for those recovering from an operation or hospital stay, especially Medicare patients.

If you are looking for a suitable nursing home for an aging parent or elderly aunt, the choice may be daunting - especially if you have never traveled down this road before. Here are a few tips to help you decide which nursing home is the best for you:

Start early. You never know when Auntie Hilda will suddenly take a turn for the worse, or when she suddenly gets fed up with living on her own. She might want help with daily living, or she may simply crave company. You don't want to force her to move into a place that doesn't meet her requirements. Give yourself - and her - time to nose around.

Shop around. Don't settle for the first available facility. It's best to look around and see what is on offer. Many nursing homes have guided tours in which both you and Auntie Hilda can participate. She might also want to spend an afternoon playing mahjong or canasta with the other seniors to see if she likes the feel of the place.

Check - and compare - the quality of the home. Even if Auntie Hilda loves the place, it's important to see how it adds up in comparison to other homes in the area. It's also a good idea to talk to residents and their families to see what they think of the services provided. Don't just rely on the official tour, as it can be misleading.

Have a set budget. Nursing homes vary considerably, and while you might have a top-of-the-line wish list, it's important to know what you can reasonably afford. This means not only looking at available cash and savings, but also seeing what will be covered by your insurance, Medicaid etc. If Aunt Hilda is unable to take care of herself, of course the costs will be greater.

Know Auntie Hilda's medical needs. Speak to her primary care physician to ascertain what is important for her continuing care, and if the nursing home in questions meets her needs. It's no use finding a facility that looks fantastic and has lots of activities, but doesn't provide sufficient medical care for someone like Aunt Hilda.

Prioritize what's important. The quality of care is most important, but other factors play a role as well. Does Auntie Hilda love to play bridge, does she want to be near her old neighborhood, does she like all her meals prepared in a certain way? If you are her only relative, she might want a place that is close to you and your family - or maybe somewhere that is miles away!

Other Options for More Independent Seniors

If a nursing home isn't the right choice for you, there are other options available to seniors who cannot - or do not - want to live entirely on their own, but who don't need the amount of care a nursing facility would provide. The four main ones, in alphabetical order, include:

Assisted Living. The best ones advertize themselves as a "home away from home", as residents have their own private living quarters as well as their own kitchens, bathrooms and sometimes even their own front doors. Residents are monitored regularly to make sure they are okay, and to provide assistance in

Activities of Daily Living (ADL) when needed.

Congregate Care. The best of both worlds. Seniors live in independent private living quarters but they have shared dining facilities and communal areas, along with a host of recreational activities which they can partake in or not, as they wish. Often some type of transport is also available, assisting with trips to supermarkets and the dentist or doctor.

Continuing Care Retirement Communities (CCRC). Housing, health services and skilled nursing are all provided, although the type of unit and level of care will vary with each individual. Seniors sign a contract which will allow them to stay in one place as they grow older and in need of more and more help.

Intermediate Care. This is for elderly people who need some assistance with their day-to-day functioning, but don't require specific nursing help. They might need help dressing, shopping or bathing themselves, but don't need the specific nursing care you would find in a skilled nursing facility hospital.

Care Outside the Home

Keep in mind that a nursing home may not be the right choice for Auntie Hilda at this time. If she chooses to live outside a nursing home, the community may be able to provide her with some of the services she would normally find in a nursing home environment. Examples include:

Meals on Wheels. Several organizations provide meals to seniors, the most well-known of which is Meals on Wheels. They bring hot, well-prepared meals directly to the door.

Community help with basic needs such as shopping and transport. Sometimes they're called Neighbor helping Neighbor programs, other times they're Adopt-a-Grandparent or care for the elderly.

Elderly visitor programs. Not having regular company is stressful and sad, making people feel isolated and alone. These programs match up individuals with volunteers who visit on a regular basis for a chat and perhaps a cup of tea or game of cards.

Senior community groups. Senior clubs and groups cater to a wide variety of interests and needs, from art, dancing or bridge to mountaineering and politics.

Adult day care. These are for people who are not ready for full-time care, or who have caregivers who need time off to work or rest. Seniors are assessed according to their needs and an active program and treatment plan is tailor-made expressly for them.

Legal assistance with everything from drawing up documents to paying the bills. Many volunteer organizations help seniors with simple things like paying their water bill on time to more complex issues such as selling a property.

Finding the right facility for a loved one is not an insurmountable task, but unless you're incredibly lucky, it's also not one that is accomplished overnight. Take your time and investigate as many possibilities until you find the best place you can. In the long run, taking the time to find the right home that provides the right care will make everyone sleep better at night - and feel a lot happier.

What is nurse staffing recourse factoring?

For the most part, recourse factoring is the most common and the most affordable nurse staffing financial help available to business owners. In this type of factoring arrangements, the accounts receivable factoring company will require an agency owner to buy an invoice back if the client does not pay within a specified amount of time. Moreover, the nurse staffing agency owner accepts full credit risk for any and all accounts receivables that it sells to the factoring company.

What is nurse staffing non-recourse factoring?

The other accounts receivable factoring option that owners have is non-recourse factoring. In a nutshell, non-recourse nurse staffing financing agreements hold the factor entirely responsible for an unpaid invoices if the following is true:

• If the hospital, nursing home or vendor management system (VMS) goes bankrupt during the time an agency owner's invoice was factored.


• If the hospital, nursing home or VMS goes out of business during the time an agency owner's invoice was factored.

It's important to keep in mind that non-recourse accounts receivable factoring does not cover the following situations:

• Very late payments when there is no insolvency


• Disputes/challenges with nurse staffing services


• General collections issues

Naturally, both options have pros and cons that an owner should consider before choosing which type of agreement to make. Typically, they will receive lower factoring fees and/or higher advance rates if they choose to enter into a recourse factoring relationship. On the other hand, a non-recourse accounts receivable factoring arrangement buys nurse staffing business owners' protection if a hospital nursing home or VMS goes bankrupt. Ultimately, agency owners need to review their accounts receivable factoring contract in detail with a lawyer to determine which type of arrangement, recourse or non-recourse, is the best fit for their agency.

In home care, a relatively recent practice, is becoming highly advocated and sought after. This type of care provides comfort, familiarity and flexibility, all while providing assistance with daily activities and medical needs. Overall, this type of care is a great way for seniors to maintain their independence while receiving the care they need and deserve. Even though in home care may be the best option for many seniors, other care facilities are also available and have positive perks. It all depends on what you are looking for when it comes to care.

As we and our loved ones age, choosing between in home care, assisted living and nursing homes is a big and important decision. Each care service provides different types of services depending on what your needs are. In home care allows for people to remain in the comfort of their own home, assisted living gives you flexibility and nursing homes provide constant medical care. If you are someone who does not have big health care demands, in home care may be the best option for you. Read on to learn more about in home care, assisted living and nursing homes and determine what might suit your needs best.

In home care can prepare a senior citizen to retire and live the golden years by looking forward to a different lifestyle. Of course it takes a bit of getting used to when transitioning to being a grandparent and having the daily stresses of a larger family and the ending of a lifelong career. It is not to say that we don't have our share of concerns for senior citizens though. Physical and mental health, finances and proper care are important to think about as we, or our loved ones, age. Finding the right kind of in or out of home care is of great importance for both seniors and their loved ones.

With the transition into this slower lifestyle we also develop a new set of concerns, among choosing between which type of care is best for you. Your physical condition is often on your mind as your body ages and undergoes changes. Maintaining a healthy lifestyle is of great importance and prolongs both your health and satisfaction. Finances can also be one of your concerns as you worry about supporting yourself, and/or your children and grandchildren. But as already stated, one of greatest concerns often thought about by senior citizens is the living circumstance or where they will end up living. The big decision regarding living lies in the choice between nursing homes, assisted living or in home care, and is based on financial and physical needs.

Depending on your physical condition, finances and preference, you can determine which type of care is the best choice is for you or your loved one.

There are a lot of options available when it comes to finding a place to live outside of your own home. Assisted living and nursing homes are two options for medical care outside the home. Assisted living provides you with the ability to stay in an apartment, probably similar to one you lived in your younger years, with medical staff and people your own age available to suit your medical and personal needs. Assisted living allows you the independence and flexibility to manage your life without the restrictions of the nursing home facility. However, assisted living does not provide the non-stop medical needs that a nursing home would.

Nursing homes provide you with the security of full-time medical staff. This is comforting for people with high health demands. Nursing homes also have exercise facilities that can fit your weekend physical needs, and cater to the needs of both meals and personal care.

These days in home care provides similar care, activities and assistance as assisted living and nursing homes. In home care allows you the flexibility and comfort of living in your own home while having caregivers and skilled nurses visit you depending on what your needs are. Nurses are available for the medical care you may need and trained individuals can run errands and complete household chores, among other tasks. In other words, you are provided all the assistance you may need while you remain in your own home and have the privacy and comfort you've been used to all of your life.

Studies have found that people feel more comfortable, recover faster, and feel safer in their own home than in any other facility, making in home care a great option for senior care!

Another nice thing about in home care is that it provides a much cheaper alternative than assisted-living or nursing home care. Depending on your physical needs, visits can be as infrequent as one hour per day or as much as 24 hours, making the cost per hour or the cost per day considerably less than living in a nursing home. Nowadays nursing home costs are on an annual basis of almost $100,000, which for many, is an unattainable option.

Independence, which senior citizens enjoy, is the other benefit of in home care. Even if you need transportation to hair appointments, need assistance with getting your shopping done, or any other chores, in home care simultaneously grants you the feeling of comfort and familiarity of living in your own home. As stated before, studies show that people recover faster at home than they do anywhere else.

If you need more time and further consideration when it comes to choosing care for you or your loved one, take the time to compare your options. You will come to find that, unless your physical requirements are very demanding, in home care will probably be the best and most cost-effective for you. In home care specialists are concerned with your safety and well-being, making in home care a worriless option for you as well as the people in your life who are concerned about finding you proper care.

There may come a time in your life when you will want to or have to care for an elderly parent or loved one at home. In moments like these, a senior's health can be uncertain and can turn downward quickly and deteriorate. You may not be able to manage the amount of care and attention that's now needed. That's when you will be at a crossroad not knowing which direction to take. Do you continue caring for them or do you find them an assisted living facility? When facing the choice where to move their loved one into an assisted living facility or skilled nursing facility certainly isn't a decision that should be made hastily. Because there is no certain age criteria, one must look at the actual their physical and emotional health of the person in consideration.

What Is an Assisted Living Facility?

The Department of Public Health in California licenses all assisted living facilities, also commonly known and licensed as Residential Care Facilities for the Elderly. Most of these assisted living facilities provide 24-hour guardian care and attention. Some facilities may have a certified RN nurse that can offer skilled nursing when and if needed. In many cases these facilities are Medi-Cal and are Medicare certified. Some only accept private funds.

Outside a medical facility, an assisted living facility offers the maximal level of care offered for elder adults. The staff assists the residents with meals, getting dressed, bathing, getting in and out of bed, as well as assistance with administering medication. The facilities often have a weekly calendar of planned activities and social gatherings.

Indicators of Possible Assisted Living Admission

If your loved one is moving out of their home for the first time, it can be very traumatic to the individual relocating. In either case, expect some opposition especially if there are some distinguished "warning signs" that it's time to consider the move. Please note that only a doctor can detect the correct indications of an assisted living facility. When uncertain, contact their primary physician right away:

• Disability: Seniors whom are physically disabled will benefit from this type of support. Ones who have limited mobility or that are utilizing wheelchairs will have more difficulty performing even simple tasks. Staff can help with taking care of personal needs, moving from one place to another and assist with walking without risking injury.


• Ill health: Frequent hospitalizations or requiring constant observation because of an affliction, then consider a skilled nursing facility rather than an assisted living facility. Other life-threatening health problems such as a stroke, heart attack or hip fracture are also indicators that your loved one needs the care available from a nursing home staff.


• Dementia and Alzheimer's Disease: a resident with Advanced stages of Alzheimer's Disease or type of dementia is better accommodated and at times, safer in a skilled nursing facility. Some of these "red flags" and warning signs may include; no longer being able to remember simple information or communicate clearly, unable to care for oneself, or the refusal to take prescribed medication.

In the end, you may not have a choice but to find a "home" for your senior. But as you can see, there are many benefits to choosing the best assisted living facility. Finding the "best" or actually the "right" facility doesn't come as an easy task. That's when Elder Care Referral agencies and services such as We Know A Place are useful resources. By finding an agency local to you, they will be familiar with the surrounding facilities. Once they have assessed the level of care needed, they in turn will help you determine which assisted living facility is the "best" one.

Question 1: Medicaid income eligibility requirements: Can I transfer income and assets to my children before going into a nursing home and still qualify for Medicaid?

This is likely not possible. When applying for Medicaid you must understand that under the 60-month look-back Rule, Medicaid coverage can be denied if assets have been transferred within 60 months prior to applying for the benefits. As described previously, if you were to gift or divest your assets to your children within 5 years of entering a nursing home and you apply for Medicaid online or off, you will be denied coverage until the money is returned. The real problem comes in when the children spend the money and do not have it to give back in a situation like this one.

Question 2: Medicaid application: Is it too late to give away my assets and qualify for Medicaid if I am already in a nursing home?

It's never too late to reallocate your assets. It is possible to give away all assets and then in 5 years become eligible for Medicaid.

Question 3: Should I make use of a trust to protect my assets?

It is much more beneficial to use an irrevocable trust instead of transferring assets to family members. Seek for the UltraTrust(TM) for superior irrevocable trust asset protection.

Question 4: How to apply for Medicaid: Are there other ways to protect my assets?

There are many ways to protect assets. Medicaid will not penalize anyone if they choose to spend their assets; however, one must be careful to avoid fraudulent conveyance. Fraudulent conveyance is the act of divesting your assets for less than a fair market value consideration or payment. An expert can walk you through a proper estate plan that will avoid these potential problems or contact Estate Street Partners.

Question 5: How can I protect my home?

Medicaid allows for the applicant to retain a principal residence. Your home is considered exempt property. However, unless there is a surviving spouse, Medicaid will be reimbursed if the home is sold after your death by a lien being put on the home. This is where it is advised to sell or transfer to an irrevocable trust such as the UltraTrust(TM)

Question 6: Is it wrong to hide assets to qualify for Medicaid?

When applying for Medicaid, full financial disclosure is required. It is best to consult with an elder law expert before making any decisions or contact Estate Street Partners.

Question 7: Is this information reliable?

These are just a few questions that are commonly asked. When applying for Medicaid, it is always best to do the research. Find out what the current requirements are for eligibility in your state and consult with an experience attorney or contact Estate Street Partners to discuss your assets. States typically offer online information and forms that you may download and print, however no states allow you to currently apply for Medicaid online. To get simple information about your state's Medicaid application eligibility, forms, contact information, and address as well as an overview of your states plan, click here.

Question 8: Should I hire an expert?

Simply stated: absolutely. This is the best way to make sure laws are being followed and your assets are protected.

Question 9: How do I find an expert?

Any expert that practices elder law can help or contact Estate Street Partners. Make sure the expert is experienced and has a good rapport. You want to make sure you trust the right person with your assets.