I was recently honored to receive the Theresa Award at the most recent national conference of the National Academy of Elder Law Attorneys in Milwaukee. The Theresa Award is given each year by the Theresa Foundation “in recognition of their outstanding efforts and advocacy for individuals with special needs.”
The Theresa Foundation was started by Vincent and Susan Russo as a way to honor and remember their daughter who was born with microcephaly and passed away when she was just five years old. The foundation gives grants to organizations and charities, locally and around the country, which provided programs for children with special needs and supports a playground with the latest adaptive equipment designed for children with special needs.
Full disclosure: Vincent and I are longtime colleagues and friends and together we founded the Academy of Special Needs Planners.
After receiving the Award, I had the opportunity to speak to the assembled elder law attorneys. I talked about what has and has not changed in elder law and special needs planning since I got into the field almost 40 years ago and what today’s attorneys can expect in the coming decades. Here’s a summary of my remarks.
What Has Changed
Nursing homes and nursing home placements are fewer and farther between than 40 years ago. The whole industry of assisted living facilities has developed. There’s more home health assistance than ever before, whether private pay or covered by Medicaid.
There are also new models of elder care and senior living. Opus in Newton is an example, designed for the often-forgotten middle who can’t afford luxury continual care retirement communities and don’t qualify for subsidized senior housing. As part of its effort to keep costs reasonable, it requires all residents to contribute 10 hours a month of volunteer work to support the community.
On the special needs planning side, 40 years ago we did not have (d)(4)(A) or (d)(4)(C) trusts, much less ABLE accounts. The expansion of personal care attendant and home health care coverage by Medicaid means that more people of all ages can stay in their homes rather than be institutionalized. Self-direction programs permit beneficiaries to hire and manage their own care workers, even family members in many instances.
What Has Not Changed
At the same time, a lot has remained the same. Medicaid (MassHealth) is still the primary payer for long-term care. Its $2,000 asset limit and $72.80 a month personal needs allowance have not changed since 1989, despite the cost of living almost tripling in the meantime.
Elder law and special needs planning attorneys continue to help families plan for and navigate the overly complex worlds of estate, tax and public benefits planning. While that complexity is bad for consumers, I told them, it’s good for business.
What We Can Expect
And that business is going to be booming over the next couple of decades. The reason? Aging baby boomers.
Here are some of the numbers:
- 65 million. The number of baby boomers still alive today. They range in age from 62 to 80 years old. At this point, they’re mostly doing fine in terms of their health despite some aches and pains of aging. But that all changes after age 85.
- 8. People over 85 require nursing home care at eight times the rate of those between 65 and 74.
- 6. Older seniors are six times as likely as younger ones to need assistance with the activities of daily living.
- 5. The number of years until the oldest baby boomers reach 85, to be followed by tens of millions of their generation.
- 15 million. The number of Americans aged 80 or over today.
- 30 million. The number in 2045.
These numbers mean that the need for elder care will double over the next 20 years, as will the need for elder law services. As a result, we will soon face a totally-predictable elder care crisis. We can’t count on our leaders in Washington to prepare for the increasing elder care needs. As a result:
- Any action must be at the state and local level.
- Families are going to need elder law attorneys to plan for their needs and respond to them as they arise.
So We Can
One of the great benefits of the Theresa Award was that it entitled me to direct one gift from the Theresa Foundation to a charity of my choice. I chose So They Can, an Australia and New Zealand-based charity that supports schools and a teachers college in Kenya and Tanzania. The gift will go to a school for deaf children they operate in Kenya. It’s amazing how few resources schools in these countries have and what a big difference we can make with relatively small contributions.