It’s
the case of Bernadette Jordan and how she entered a nursing home and filed for
Medicaid only to find that the State ruled her ineligible for a period of 14.31
months. Apparently, Mrs. Jordan had transferred funds from a revocable trust to
her daughter, to repay expenses that her daughter had shouldered in getting her
to the nursing home. States are skeptical of such transfers, and often examine
them carefully. In this case they found that the transfers were made at less
than fair market value for purposes of Medicaid eligibility, and so denied Mrs.
Jordan Medicaid benefits.
On
Mrs. Jordan’s
behalf, her nursing home called a hearing and later appealed. After all, the
expenses the daughter paid were documented and done with the assumption that they would be repaid
with assets from the trust. The State still denied benefits. The problem was
that there was no written document at the
time of the expenditure that specified the agreement to repay the
daughter’s expenditures.
The
moral of the story is documentation. By documenting your interactions and
intentions you can provide hard proof and avoid getting caught on a
technicality. In Mrs. Jordan’s case, 14.31 months is a long time to wait for
nursing home benefits.
Applications for Medicare and Medicaid are
important and should not be taken lightly. If you, or a loved one, need to make
plans for long-term care, then you need to schedule a consultation with us
right away, before you take any actions. Remember, good
planning is no accident.
When it comes to ensuring proper
care for your elderly loved ones, Medicaid can mean a world of difference … especially
when your loved ones are running out of assets. So when their key remaining
“countable” asset is illiquid, what options
do they have short of draining it or risking an illegal transfer?
As you may well know, Medicaid
is the source of nursing home care for many indigent Americans. Still others
are caught in a netherworld of being above the minimum asset threshold for
qualification, but having too few assets to realistically pay for their care. It’s a sticky situation.
The focus of the article is a
recent federal case out of Oklahoma, but the basics apply generally.
Essentially, an elderly woman transferred her farm and accounts to her son in
exchange for a promissory note. A note is a legally binding contract to repay
as fixed sum and so it clears the Medicaid hurdle in question.
In this instance, this approach
indeed saved the farm and the elderly woman received her nursing home care
through Medicaid. Nevertheless, a promissory note is not a full-proof plan. For
one, many states reject the idea and refuse to recognize promissory notes. For
another, the plan can only work because promissory notes are legally binding
contracts, and so if the note cannot be repaid there are potential tax burdens
that may be triggered.
The article also points out
there are several tools, like the promissory note, that can prove useful when
seeking legitimate Medicaid qualification. This especially is true if you plan
well in advance.
Danger! The Medicaid
qualification rules vary from state to state. This is not a self-help project,
as you may find yourself (and your elderly loved one) in a tricky financial and
legal purgatory if you make any missteps.
U.S. health care has been in
flux since 2010, with many aspects of health care reform still on hold. Hospice
is one area that is still waiting for help with protecting the elderly and
those in end-of-life care.
As reported quite recently
through the Kaiser Health News,
hospice care has yet to be expanded under the Medicare project set out three
years ago.
The article titled “Medicare Lags In Project to Expand Hospice”
examines the very real conflict between “curative” treatment and “palliative”
treatment. The former is meant to cure a condition and thereby prolong life,
and the latter is meant to ease the pain caused by a condition without a focus
on effecting a cure.
Naturally, the curative and
palliative treatments are often considered opposites. In fact, choosing
palliative care would mean giving up all hope on curative care. Consequently,
it is only natural that rapidly declining patients delay their entry into
palliative hospice care.
The 2010 law was to begin
inroads into exploring combined care, the possibility of both curative and
palliative concurrently. Logically, this should ease transitions without
forsaking hopes, likely reducing costs in the process. To date, however, this
has not happened.
Health care planning is complicated, and since so much
is at stake be sure to consult a professional when exploring your options.
Another oldie but goodie from January 2011 made more timely by the celebration of Mother's Day today. Our Moms (and Dads) deserve our attention when it comes to their potential long term care needs.
There is a very good chance that you or
someone you know is taking care of elderly parents now or looking at that
possibility in the near future. In 2008 a USA TODAY/ABC News/Gallup Poll of
baby boomers found that 41% who had a living parent were providing care for
them — either financial help, personal care or both — and 8% of boomers said
their parents had moved in with them.
Of those who were not caring for an
aging parent, 37% said they expected to do so in the future. About half said
they were concerned about being able to provide such care.
If financial planning and long term
care planning have not been done previous to the need for care, the burden
falls on the caregiving family member. Decisions about how care will be paid
for, who will be responsible for managing the estate as well as how the long
term care will be given can cause stress and contention among family members.
It is best for parents and all family members to be involved in planning for
future financial needs. The financial resources being used today could change
drastically with the occurrence of a stroke, illness or onset of dementia. In
order to plan financially for long term care, you need to know what the costs
are now and what they will be in the future.
Every year MetLife does a survey of
long term care costs. Their 2010 survey shows that the average daily rate for
private nursing home is $229 which is up from $219 in 2009. Assisted living
monthly base rate cost rose to $3,293 in 2010 from $3131 in 2009. Home health aides
average $21 an hour.
Planning financial needs can be very
difficult, considering you do not know when long term care will be required or
how long it will be needed. Staying in the home for care will require professional
home care assistance, travel accommodations to doctor appointments, help with
shopping, meals, medical supplies and medication and possibly a 24-hour
attendant. Even if a family member is doing most of the care, in most cases professional
care will eventually be required or a move to a nursing home facility will be
necessary.
When evaluating present income and
assets consider how they would work for future needs. Consider the following:
Here is another in our "Greatest Hits" series of blogs. This one was first published in June of 2010.
Being In Control
Perhaps the most important goal of any estate plan is to allow the client to
maintain control. Most of our clients here at Idaho Estate Planning are very
intent on “being in control” as long as possible. They want to make their own
decisions about whether to go into a “facility” or stay in their house.
(Usually the choice is to stay at home as long as possible.) However, the
ability to be in control and stay at home is challenged constantly.
Some of the challenges to
being in control consist of those disabilities we all fear: Alzheimer’s
disease, dementia, other mental challenges and numerous physical disabilities.
The biggest question becomes, “How do I maintain control if I suffer one of these
disabilities?” While these situations are varied (and extremely difficult),
there are some basics that will allow you to exercise control, that is, allow
you to voice your opinion is such a situation.
Durable Power of Attorney for
Health Care
First and foremost, you need to execute a Durable Power of Attorney for Health
Care. This is a legal document that allows you to personally choose who will
make decisions or give instructions if you are not able to, whether from mental
or physical disability. This is an extremely important document to have in your
estate plan. It is, therefore, extremely important to carefully consider who
you want giving instructions to health care providers on your behalf.
Typically, this is a spouse.
But, if the spouse is unable to
fulfill this responsibility, who will take over? This requires great thought
and consideration. Who has the skill set to take on this responsibility? Who
understands what you want to have happen? These are not easy decisions and
should not be undertaken lightly.
Living Will
A Living Will is a form created by statute that allows you to express a
preference if it is determined by two doctors that you are in a terminal state
and being kept alive by artificial life support measures. The Living Will also
applies if you are determined to be in a persistent vegetative state (some call
this being “brain dead”). The Living Will allows you three basic choices: 1) to
forego all life preserving efforts being applied whether artificial or natural;
2) to forego any life preserving efforts applied; or 3) only natural efforts
applied including food or water or both. In reality, while these situations do
occur, they are rare.
The POST
The Physician Orders for Scope of Treatment or “POST” is a more detailed legal
document that allows you be very specific in how treatment, whether artificial
or natural is applied to you. You can choose to forego intravenous feeding or
the use of a feeding tube. You can choose to forego intubation to keep you
breathing. You can choose to forego “aggressive methods” to preserve your life.
Each of these is an option that you choose.
HIPAA
If your Living Will or POST is needed, it is your Health Care Agent as
established in your Power of Attorney for Health Care who gives the
instructions to the health care professionals. These documents, then, work
together to help you maintain control of your own situation. One more document
that makes all the others work better is the HIPAA release. This is an
informational release in which you give the health care professionals
permission to provide your health information to your Health Care Agent or
other family members. In essence, the Power of Attorney allows your Health Care
Agent to talk to the doctor. The HIPAA release allows your doctor to talk to
your Health Care Agent.
These, then, are the minimum
documents you need to make sure your wishes for health and medical care and end
of life decisions are honored. Now is the time to address these concerns and
plan for the most difficult of times. Once it starts raining (or hailing as it
did yesterday), it’s a little late to start fixing the roof. Once you are
incapacitated, it’s too late to do this planning.
At Idaho Estate Planning,
we understand the challenges faced by elder Americans. We have the experience
and expertise to help you maintain your options and protect yourself as well as
your loved ones now and into the future. Remember, good
planning is no accident.
This is not a new topic for us as a quick scan through our past blogs will show. I came across a nice article from Florida with some good pointers I would like to share. The article titled Scams
on the Elderly: Senior Care Tips for Fraud Prevention is a good read.
The article gives a few pointers on helping our parents or other loved ones avoid Elder Abuse.
Regularly evaluate how things are going
for your loved one. Hire a geriatric care manager to help you keep an eye on things from
a distance, get a periodic evaluation and check in with calls and in-person
visits. Continual communication can help you spot issues, as well as give your loved
one opportunities to mention concerns. A professional assessment (and ongoing evaluations)
can help determine when it may be necessary to assist with managing finances and
household maintenance. Contact us
to learn more about geriatric assessments and other eldercare assistance services.
Share information about popular scams
with your loved one and educate on issues such as giving out personal information.
Help set up a dignified "out"
for solicitations. Perhaps your loved one can say they have their "advisor"
review everything before they make decisions (whether that really is some type of
professional advisor, or running it by you). You might even suggest/share that you
do the same yourself, as it is easy for anyone to get caught up in scams and some
time to think about purchases and decisions helps.
Determine
ways to simplify finances and possibly consider a system for oversight (regular
review/access by a trusted professional or family member).
At Idaho Estate Planning,
we understand the challenges faced by elder Americans. We have the experience
and expertise to help you maintain your options and protect yourself as well as
your loved ones now and into the future. Remember, good
planning is no accident.
We tend to avoid the doctor or
hospitals unless we absolutely need one. Besides the germs and bad hospital
food, there’s all that confusing paperwork to deal with. But eventually you or
a loved one will need to visit the doctor or hospital for your health – and you
may encounter some legal red tape that makes matters even stickier.
Sometimes the red tape is simply
hospital policy gone too far. Regardless, navigating the maze requires doing
your homework ahead of time. For example, what do you know about HIPAA?
HIPAA is the “Health Insurance
Portability and Accountability Act of 1997.” The title of a recent article in
the New Old Age Blog of The New York Times summarizes the issue
well: “A Privacy Law Often Misinterpreted.”
One purpose of the law is to
ensure the privacy of medical data. Nevertheless, this doesn’t mean the
hospital is intended to protect the privacy of the patient from their loved ones, especially when that loved one is present
during an examination! In fact, HIPAA does not prevent health care providers
from sharing relevant information regarding a patient with their family
members, unless the patient objects.
The original article is a worthy
and enlightening read, whether you are a patient, a family member or even a
medical professional. Apparently, there is a lot of misinformation leading to
misinterpretation when it comes to HIPAA.
Bottom line: make sure you have
up-to-date Advance Health Directives that specifically provide your designated
agents with current and future access to all of your medical information,
verbal and written, with specific authority to execute HIPAA releases on your
behalf.
I wanted to share another blog from a few years ago that is just as valid today as it was then.
With our current economic conditions and a host of other
pressures an increasing number of American’s are considering staying in the
workforce beyond their planned retirement age. Many will have no choice after
the great losses to their retirement accounts. As the average age of the
workforce increases so too does the concern for their well-being, especially in
reference to dementia and more specifically Alzheimer’s. Right now there are
more than 5 million American’s with Alzheimer’s and that is expected to
quadruple by 2050. That could be very problematic for businesses, those
affected by the disease as well as their co-workers.
If we have a family history of dementia we would be well
served to know the early warning signs of the disease. The warnings can be hard
to notice as they are revealed rather slowly.
Another way to combat dementia is to be proactive throughout
our lives. In the article “How to Age-Proof Your Memory” health.com lists some
interesting ideas.
In Our 30’s
Avoid stress, “Stress is toxic to the brain,” says Denise
Park, PhD, a cognitive neuroscientist at the Center for Brain Health at the
University of Texas at Dallas. The body’s stress response floods the brain with
powerful hormones. In the short-term, that helps you focus and cram to meet a
deadline, but over time it kills neurons and damages memory centers.
In Our 40’s
Try to maintain focus. “The first step to remembering is
paying attention in the first place,” says Gary Small, MD, director of the
University of California, Los Angeles, Center on Aging and author of The
Memory Bible: An Innovative Strategy for Keeping Your Brain Young. At work,
set aside daily chunks of time to unplug from email, instant messages, and
workplace chatter. When parking in a big lot, check and recheck landmarks.
In Our 50’s
Maintain close relationships. Ten minutes of talking
actually boosts memory and thinking speed afterward, according to new research.
“It takes a lot of mental work—you’re paying attention, trying to figure out where
somebody is coming from, and sometimes biting your tongue,” says study author
Oscar Ybarra, PhD, a psychologist and researcher at the University of
Michigan’s Institute for Social Research. This kind of interaction may be as
useful as doing crossword puzzles or taking reading-comprehension tests.
“Socializing,” Ybarra says, “helps you navigate the real world.”
Plan and Act Now
Taking the right steps now can affect our future well-being.
Similarly planning now for the future can positively affect our financial well
being. We all want to stay in control of our lives as long as possible and for
that we must plan. When it comes to planning for the future, the sad fact is
that every year we fail to plan we lose options. Wait long enough and the only
options left are those made for us out of desperation. Remember, timing is
everything. In order to maintain control as long as possible and have an effect
on your own quality of life decisions you must choose to act now. Your
decisions need to be made known and documented correctly. Good planning is no
accident!
With the nation's senior population growing there is more focus on programs to help seniors remain healthy and active as they age physically, mentally and emotionally.
“Most adults spend years looking forward to a healthy retirement. Whether you're still planning your retirement or you're ready to make the change, there's much you can do to ensure a healthy retirement.
Start by learning what to expect as you get older, from changes in muscle mass and sex drive to vision and cardiovascular health. After all, your dreams for a healthy retirement likely depend on good health. Then consider ways to maintain a healthy retirement, from reducing your risk of falls and staying safe behind the wheel to improving your memory.
Another important aspect of healthy retirement is long term care. Consider your options now — including type of long term care, as well as how to pay for it — to help prevent hasty decisions later.“
A new population of seniors and those nearing senior status are looking for some type of financial support to maintain their quality of life and pay for eldercare during their final years of life. The need for some form of long term care will happen to 3 out of every 5 people. Paying for this care can be devastating for those who are not prepared. For more information on attaining a healthy retirement contact
Idaho
Estate Planning and schedule a consultation. Remember, good planning is no
accident.
You can also check out our You Tube Channel, especially this video on Long Term Care.
Have you noticed that your
elderly loved one is having “memory” problems? If yes, what should you do,
especially when it comes to financial matters? Preparation is key.
Learn about the assets and financial responsibilities
you and your loved one have.
Take time to get to know your loved one’s financial
advisor, accountant, broker and banker.
Do not accept financial illiteracy.
Accept the potential responsibility you may have one
day as a way of protecting yourself against fraud and financial abuse.
Check your legal documents and be sure that you have
what is needed to take over financial management if that time comes.
Each of these points is
important. However, I will add my own to the mix – don’t ignore the issue.
While it can be hard admitting
that a loved one is “losing it” cognitively, matters are made worse when their
financial matters crash and burn, too. If you already are at that point, then
it may be wise to have a family meeting to coordinate your plan of action
together.
Even closer to home, take a good look in the mirror.
Do you have your own estate planning in place so your loved ones could take
care of your financial matters? At Idaho Estate Planning, we understand
the challenges faced by elder Americans. We have the experience and expertise
to help you maintain your options and protect yourself as well as your loved
ones now and into the future. Remember, good planning is no accident.
