Michigan Estate Planning Blog

Medicaid Misunderstandings Costly

When an elderly person is ready for the nursing home, some families are entirely understanding, in agreement, and financially able. As a result, the transition happens smoothly. Unfortunately, for a far larger number of families and elderly persons, some trip to the hospital will happen in between and may even immediately precipitate the transition to nursing home care. If that’s the case, then there are important hospital and Medicare policies of which you should be forewarned. Enter “observation care” which can make for a big bill upfront and even far bigger ones down the line. According to a recent article in the Wall Street Journal, and their sources at the Medicare Rights Foundation, the number of “observation hours” has been steadily growing for years. Tragically, such observation hours count as “outpatient services,” even if the service lasts for several days (as it sometimes does with the elderly) and Medicare pays for inpatient and outpatients services in entirely different ways. As you likely know, Medicare Part A pays for inpatient bills, so those are usually taken care of, but Medicare part B is what takes care of outpatient services. And those services can add up to a far greater cost. It’s often vital to know the distinction between the two types of services from the hospital, and yet it’s also fairly difficult. Medicare advises to simply ask, but then there are certain documents such as the “Important Message from Medicare” which accompanies inpatient care, but not outpatient. Still, the hospital can switch with little to no notice. It’s actually even more important than the size of the immediate bill. Medicare will only pay for nursing home expenses if the person was admitted inpatient at a hospital for at least three days, excluding the discharge day. For so many families that’s the sole reason why it takes a hospital visit to arrange for the transition to nursing home care in the first place, but if you are put under observation or other so-called “outpatient” care, and without your notice, it can literally mean thousands of dollars out-of-pocket down the line. Bottom line: It all hinges on hospital practice and Medicare definitions.

Reference: The Wall Street Journal (February 5, 2012) “Check Hospital Tab”

A National Alzheimer’s Agenda

With budget plans just now coming to a head, it’s good news for many of us that Alzheimer’s has become one of the “we can’t wait” initiatives in President Obama’s plan. Such measures still need to be passed through Congress, and positive advances may not be immediately forthcoming. However, it is heartening to see fiscal support for an issue that affects so many of us and our loved ones. If all goes to plan and the approach makes it through Congress – a politically trepidatious journey these days even for the most common-sense and appealing legislation – then the budget will earmark an infusion of $156 million for Alzheimer’s research and care. In many ways it’s the flesh and bones to an earlier announcement from the administration regarding a national plan toward treating Alzheimer’s that came out to some guffaws due it’s lack of a clear source of funding. The full details on allocation are still forthcoming, but at least a small portion of that infusion, some $26 million, is intended for immediate use and care of Alzheimer’s patients. The rest is to go toward research and the hope of improving future care, and also perhaps systematic prevention. How this news will affect us, and whether it will weather violent political and economic seas is yet to be seen, but it’s a powerful promise for many.

Reference: The Kaiser Health News (February 7, 2012) “Alzheimer’s Research Gets Funding Boost

Loans vs. Gifts – When It’s All in the Family

A loan is not a gift; if you’ve spoken with a bank representative or a particularly pennywise relative. We talk a lot about gifts when it comes to estate planning, but loans are just as important, as evident in a recent piece on the New Old Age Blog. In the article, a piece by Craig Reaves, past president of the National Academy of Elder Law Attorneys, a family had their mother’s estate plan in shambles. The culprit? A small notebook found under her bed. Apparently, there were many disagreements, but none so deep seated as those caused by the notebook. Why? Because it has a little ledger of the “loans” she had made to all the family members. Some of the family members hadn’t received any money, but at least one had received $20,000. Other family members had repaid in full and some had not so much as begun to do so. This case raises an important question: To what extent does the amount of an unpaid loan get added to the decedent’s estate, and does it simply come out of each family member’s share in proportion to their loans? One thing that’s clear, of course, is that the money is not gone and out of the estate. Why, it’s a loan and not a gift, after all. The second thing that’s clear is that the mother hadn’t thought about how these “loans” figured into her estate. That family aside, it should be noted that any loan evidenced by a signed promissory note can become an asset in the estate. And, even if it’s a family loan, the promissory note has to be repaid. An estate planner can ease this problem with a bit of foresight. For example, the loan can be forgiven, meaning they relinquish any expectation of being repaid. For that matter, too, the loan can be “offset” and thereby deducted from any assets made available through inheritance. While there are a number of things that can be done, forgetting the loan is not one of them. After all, the IRS is waiting just within earshot and has a trained eye to recognize the difference between a loan and a gift, as well as the additional tax burdens it can assign if it spots a gift or a poorly executed loan.

Reference: The New York Times – The New Old Age Blog (November 15, 2011) “Ask the Elder Law Attorney: Family Loans”

Simple Math Makes it Even More Difficult to Find a Nursing Home for Dad

Finding a nursing home for an ailing loved one, and a good nursing home that is affordable, is already a fairly difficult task. Unfortunately, it’s only likely to grow in difficulty as the number of elderly in need of care begins to peak. Unfortunately, too, there are some factors that you just might not think of. Like this: it is disproportionately difficult to find a nursing home for a male patient. This fact was recently pointed out over at the New Old Age Blog and I thought it was worth sharing. What is working against our male elderly loved ones is not much more than simple math, with a bit of Medicare policy work at play. As you are likely aware, women have a longer life span on average and therefore there are more women in nursing homes to begin with; that’s already a bottleneck based on population statistics. Then you throw in the fact that, under Medicare rules, most rooms in nursing homes are no more than “semi-private”, a delicate euphemism, and co-ed rooms aren’t allowed either. Thus, with more women already in such rooms the more that only women can be admitted into a facility. The math is fairly easy to figure out, but it’s a strange and unintended consequence nonetheless.

Reference: The New York Times The New Old Age Blog (January 30, 2011) “Fewer Beds For Men Entering Nursing Homes”

Medicare Confuses Many Seniors

As many readers will know, it’s fairly critical to understand the rules for filing for Social Security. Likewise, the rules for filing for Medicare benefits can make or break your retirement. Unfortunately, it’s also fairly easy to forget about the basics of Medicare filing, as a recent article out of Reuters highlights the importance of filing earlier rather than later. For each full 12-month period that a senior could have had coverage but didn't sign up, the monthly Medicare Part B premium jumps 10 percent. The average monthly cost of Part B coverage is $99.90, so just a few years delinquency will result in $20, $30, or more a month; that adds up, is unnecessary waste, and is permanent. Suffice it to say that the government really wants you do sign up when it’s time. But why is that difficult? Well, for one, the full retirement age for Social Security is no longer the age for Medicare enrollment. As a result, many otherwise forward-thinking people are waiting until age 67 to enroll in Social Security (for the maximum monthly benefit), but 65 is the age for Medicare. In addition, with so few people actually leaving the workforce it’s easy to forget (or fail to realize, since you’re not really retired) that it might be time for Medicare. That also can depend on the nature of your employment. For example, if you are still working at age 65 and your employer has fewer than 20 employees, Medicare is the primary payor; at companies with more than 20 workers, the employer's plan is primary. In the latter situation, a senior can postpone filing for Parts A (hospitalization) or Part B, although many choose to enroll for Part A anyway, since it doesn't require premium payments. If you delay your Part B coverage, you can enroll without penalty when you do retire for up to eight months following that point. The bottom line is to keep all of this on your radar, regardless whether you will be relying on Medicare. In fact, not relying on Medicare may be the source of the problem. If you are employed it may be worth a visit with the company accountant to be sure on which side of the line the company falls, and therefore what your insurance ought to be like.

Reference: Reuters (January 20, 2012) “Big penalties await those who delay Medicare filing

ELDER LAW

On the topic of disclosures, a reader inquired about what to do about her family of eight siblings and one elderly father. Long ago the siblings got together and put two of the sisters in charge of their father, largely because his will and other directives advised as much. As a result, they were granted power-of-attorney and access to his accounts. Now, the reader has discovered that they aren’t forthcoming with information about their father, his care, and his finances. The reader is worried that she won’t hear anything until there’s a demand for money to care for their elderly father, and, perhaps, that the original funds weren’t adequately used. The response of Craig Reaves is tailored to the reader’s unique situation, but his advice is applicable for many in this same or similar position. As a preliminary caveat, there are specific state laws (i.e., like those regarding “powers of attorney”) that govern the authority, responsibility and liability of agents and fiduciaries. Read Craig Reaves’ enlightening response in his original post.

Reference: The New York Times – The New Old Age Blog ( January 18, 2012) “Ask the Elder Law Attorney: Disclosures and Loans”

Hospice: Medicare and Medicaid Profit Center?

Healthcare lawsuits involving the various ways that the elderly can be taken advantage of turn up in the news on a daily basis these days. Why? Well, partly for political reasons and partly for the sheer number of egregious situations that have been created. As an informed citizen/taxpayer, it’s important to think about and understand the big picture. However, as a family member, it’s vitally important to remember them for the sake of your elderly loved ones. A new legal battle has begun to churn, as recently reported at Kaiser Health News. Yet another healthcare company is being accused of taking advantage of the elderly and their families to draw the greatest yield from Medicare and Medicaid coffers. Here a large company, operating across several states, is accused of actively recruiting and cycling patients through nursing home and hospice services. Such companies are compensated by Medicare based on the length of time patients receive care. Medicare picks up the entire nursing home tab for the first 20 days (after that the patient has to contribute), and conversely, if a patient spends too much time in hospice care, Medicare demands their money back since the patient was clearly admitted to end-of-life care under false pretenses. Here’s the rub: If you cycle between nursing home regimens and then jump into hospice care as early as possible (but not too early), Medicare will pick up the entire tab and for the maximum amounts, and that’s the issue. The legal battles, as well as the politics and economics aside, stories like these also demand a certain amount of attention since they could directly impact your family. If you have a loved one in need of nursing home and/or hospice care, it’s important that they find and receive that care… and that they not be abused by an uncaring system.

Reference: Kaiser Health News (January 4, 2012) “Lawsuit Accuses Company of Fraudulently Cycling Patients through Nursing Homes, Hospice Care.”

Medicare and Medicaid Dodge The Budget Bullet (For Now)

Have you heard the news? It seems the grand experiment failed. The Congressional supercommittee, charged with doing what the Congress at large could not do, has run out of time. And, by running out of time, failed in its mission to come up with budget cuts. What does that mean for Medicare and Medicaid beneficiaries? As Reuters reports, in the event the supercommittee should fail, as it has, then automatic and sweeping cuts go into effect. For Medicare, that means a two percent cut across the board, or about $123 billion over the next decade. However, it might have been $500 billion to $700 billion in cuts, if various supercommittee arguments had prevailed. Nevertheless, as it stands, there definitely will be a little pain, but not quite as much for individual beneficiaries. No, likely it will hit hospitals and doctors the hardest. Why? In the aggregate, that’s where the money tends to end up. Of course, we’re not yet out of the woods. Just as it became clear last summer that we’d have to wait until the winter for some kind of budget solution from Congress, it now seems that we’ll have to wait for the upcoming election season. In turn, expect things to intensify even further and for budget discussions to become all the more drastic.

Reference: Reuters (November 22, 2011) “U.S. healthcare cuts minimal, more pain looms”

 

Unclaimed “Death Benefits” Await Claims

To make a broad but warranted generalization, life insurance companies generally don’t like to pay out death benefits. After all, they make their profits on betting not to pay out death benefits or to pay out less in death benefits than they take in as premiums. A recent article in the Wall Street Journal may give you pause regarding whether you might be owed some life insurance money. According to state regulators, as much as one billion dollars is languishing in the form of uncollected life insurance death benefits. All is right by the insurers, however, as most policies require the beneficiary to file a claim to collect. This occurs when a beneficiary doesn’t collect or doesn’t know that they are entitled to collect. Unjust or not, this phenomenon has raised regulator suspicions and, out of good will or regulator urgings, some companies have started programs to determine if policy holders have passed and whether claims ought to be filed. Still, it is a difficult enterprise, and one of the reasons insurers let beneficiaries make the claims in the first place, so there is room for error. So, if you want to ensure that you (or your loved ones) receive all that is owed, consider doing some sleuthing yourself. The original article has some advice regarding how to find out about a missed policy. An even bigger lesson is for policy holders, and estate planners generally. One billion dollars sits in policies that were meant to care for the policy holders’ families, and it is there mostly because it’s unknown. As a result, the most important part of proper planning, whether elaborate or simple, is making your family aware of what you own, what your plan is, and how it is to work. This especially includes any life insurance you may own.

Reference: The Wall Street Journal (December 31, 2011) “Are You Owed Life Insurance?”

ELDER CARE – TRANSITION TREVAILS

Moving between hospitals or into rehabilitation and other care centers can be a stressful time, especially for an elderly loved one. Unfortunately, too, these “care transitions” can create far greater problems than stress, as they also are prone to creating problems with the patient’s care. Potentially, these problems can have long-term affects. Care transitions are not a recent concern of health professionals, but been on their radar screen for some time. In fact, a recent study is the subject of a recent post on the New York Times’s blog series, “The New Old Age.” According to the study, a very large Canadian study of older adults and published in the Journal of the American Medical Association found that the main problem is with essential medications. It seems these meds can be accidentally stopped by healthcare professionals when the patient is in transition. And, older persons can be on many medications at once, often with little understanding of each drug and with complete faith in the multiple doctors prescribing them. For example, what happens if an elderly loved one (who may be on as many as 10 medications) has an “episode” requiring a trip to the emergency room? The emergency room staff may have to take them off some of those medications to administer needed care. Unfortunately, thereafter the doctors may forget to have those medications started up again once they are stabilized, moved to regular care or even transferred out to a rehabilitation center. In turn, your loved one might not notice any changes without the meds, or simply might assume the doctors know what’s best. Ultimately, this lack of communication and coordination in transition care can be life threatening. It’s something that happens all too often, particularly with medications for cardiac and blood conditions, such as statins (e.g., Lipitor) and blood thinners (e.g., Plavix). All of this gives family caregivers one more thing to bear in mind when tending to an elderly loved one, but it can also be an important one. It’s important to ask questions and be aware of all medications an elderly loved one is taking, and if these meds change (or stop) after a hospital visit… find out why.

Reference: The New York Times Blogs (September 8, 2011) “A Big Risk in the Health Care Handoff”

Tax Breaks for Caregivers Worth A Look

If you have had to arrange for a caregiver for an aging loved one, then you have some appreciation of the enormity of the costs often involved. It’s important, then, not to overlook tax breaks that just might help reduce the economic pain. A recent article from Forbes offers a helpful reminder. The costs of a caregiver, under certain circumstances, can be partially tax deductible as medical expenses. After all, they are, in fact, very important and very costly medical expenses. However, conditions for taking the deduction essentially amount to proving that fact to the IRS. So, what are some of these key conditions? For one, you must document a care regimen for someone who is chronically ill. This means a licensed health care practitioner has to prescribe it. Unfortunately, it can’t be up to your own discretion, but such prescriptions and suggestions are common for aging persons, especially when they suffer from dementia. Next, there is an expense threshold. Medical expenses are deductible only to folks who itemize, and then only to the extent that the expenses exceed 7.5% of adjusted gross income. Itemizing taxes can be a little more of a burden, but with the associated medical costs involved it is generally easy to qualify. Caregiving expenses are generally rather expensive and include the wages, employment taxes, and actual medical costs along with the associated living costs from meals to even costs of rent, if live-in care is needed. Finally, this deduction is not without caveats and the IRS watches those who try to abuse it. For example, if the cost of the caregiver is covered by insurance (e.g., long-term care or medical insurance) then you can’t double-dip and claim both costs. This is a complicated issue. There are many moving pieces. Fortunately, the Forbes article shares some anecdotes from some illustrative cases and tax court challenges. Nevertheless, if you’re using a caregiver now (or will in the future), don’t overlook this potentially valuable deduction.

Reference: Forbes (December 8, 2011) “Tax Breaks For Caregiving Expenses Help Sandwich Generation”

ALZHEIMER’S: BE PREPARED!

It’s important not to forget about Alzheimer’s. Medical research and advocacy are vital causes to uphold. Nevertheless, it is a disease that you and your loved ones might have to face directly, if you have not already. The reality of Alzheimer’s or dementia striking close to home, then some understanding and prior planning can help you in terms of the extensive economic toll and the unique legal ramifications. According to a recent Forbes article, Alzheimer’s is as widespread as it is demanding. Consider this: Another American citizen will develop Alzheimer’s every 69 seconds. The symptoms are oftentimes subtle, at least initially. Some estimate that more than 13 million Americans will have the disease by 2050 and run up as much as $1 trillion in costs. Because of the progressive nature of the disease, most of the costs and problems won’t develop until later on. Nevertheless, significant planning must take place at the time of diagnosis, if not anticipated beforehand. So, what is the scope of this “significant planning”? First, you will need to secure medical care, both for now and for the future. That means fundamental financial planning need to be addressed, to include securing government benefits like Medicare and Social Security Disability Insurance. Second, because of Alzheimer’s progressive cognitive degeneration, estate planning must occur early in the process to secure and protect family assets. Fundamentally, it’s important to understand that Alzheimer’s is not the same as other diseases. Through it all, competent counsel will be necessary to properly assess the needs and possibilities, as well as to ensure that everything is in place when needed most

Reference: Forbes (September 21, 2011) “September Marks World Alzheimer's Month as Advocates Push for Early Diagnosis and Health Care Planning”

Filling the Medicare Donut Hole

There is some good news for many Medicare recipients, present and future. According to new Medicare figures, the cost of falling into the “doughnut hole” is shrinking. The “doughnut hole,” as many know all-too-well, is the treacherous territory you fall into when you have spent too much of your Medicare Part D benefits to continue receiving full benefits (but not so much of your own money to qualify for “catastrophic coverage”). It’s an easy hole to fall into, especially if you have a special medication. With the new health law, however, pharmaceutical companies have begun offering a 50% discount on medications to beneficiaries in the gap, and that has meant a great deal of savings. According to the figures, the average beneficiary who falls into the coverage gap already would have spent $1,504 this year on prescriptions. Yet, with the new law, that cost fell to $901, with each individual doing better or worse depending on which medicines they use.

Reference: ABC News (November 27, 2011) “AP Newsbreak: Medicare’s Drug Coverage Gap Shrinks”

ELDER CARE – TRANSITION TREVAILS

Moving between hospitals or into rehabilitation and other care centers can be a stressful time, especially for an elderly loved one. Unfortunately, too, these “care transitions” can create far greater problems than stress, as they also are prone to creating problems with the patient’s care. Potentially, these problems can have long-term affects. Care transitions are not a recent concern of health professionals, but been on their radar screen for some time. In fact, a recent study is the subject of a recent post on the New York Times’s blog series, “The New Old Age.” According to the study, a very large Canadian study of older adults and published in the Journal of the American Medical Association found that the main problem is with essential medications. It seems these meds can be accidentally stopped by healthcare professionals when the patient is in transition. And, older persons can be on many medications at once, often with little understanding of each drug and with complete faith in the multiple doctors prescribing them. For example, what happens if an elderly loved one (who may be on as many as 10 medications) has an “episode” requiring a trip to the emergency room? The emergency room staff may have to take them off some of those medications to administer needed care. Unfortunately, thereafter the doctors may forget to have those medications started up again once they are stabilized, moved to regular care or even transferred out to a rehabilitation center. In turn, your loved one might not notice any changes without the meds, or simply might assume the doctors know what’s best. Ultimately, this lack of communication and coordination in transition care can be life threatening. It’s something that happens all too often, particularly with medications for cardiac and blood conditions, such as statins (e.g., Lipitor) and blood thinners (e.g., Plavix). All of this gives family caregivers one more thing to bear in mind when tending to an elderly loved one, but it can also be an important one. It’s important to ask questions and be aware of all medications an elderly loved one is taking, and if these meds change (or stop) after a hospital visit… find out why.

Reference: The New York Times Blogs (September 8, 2011) “A Big Risk in the Health Care Handoff”

Medigap Policies Catch (Unfavorable) Attention of Congress

Are you (or a loved one) a Medicare beneficiary? If yes, then likely you already know that it doesn’t always cover all the costs in a time of crisis. That’s why there are Medigap policies. Unfortunately, Medigap policies might just be the next thing to get Congress’s unwanted attentions according to a recent article through the Kaiser Health News. A Medigap policy is actually a private, supplemental form of insurance to cover medical bills Medicare doesn’t cover. Medigap is especially important in a crisis, since it can kick in for hospital visits that otherwise would go uncovered. Accordingly, this can prevent a financial crisis on top of a medical one. If nothing else, a good Medigap policy offers a bit more peace of mind. The problem some are citing against Medigap policies, from a budget perspective, is that they offer too much peace of mind and allow beneficiaries to seek medical care even when it’s not absolutely necessary. As a result, this puts a strain on Medicare itself. So, does the argument bear any weight? It’s hard to say, and it’s certainly hard to quantify. In addition, it’s difficult to make sense of the social safety net (Medicare) – or a private supplement to it (Medigap) – that doesn’t offer some peace of mind. Whatever may come from it, if it touches you (or your loved ones), its worth keeping up with potential Congressional scrutiny. The original article offers the recent history of Medigap policies and the attitude of Congress regarding them.

Reference: The Kaiser Health News (November 21, 2011) “Officials Looking to Cut Federal Spending Eye Medigap Policies”

Medicare and Medicaid Dodge The Budget Bullet (For Now)

Have you heard the news? It seems the grand experiment failed. The Congressional supercommittee, charged with doing what the Congress at large could not do, has run out of time. And, by running out of time, failed in its mission to come up with budget cuts. What does that mean for Medicare and Medicaid beneficiaries? As Reuters reports, in the event the supercommittee should fail, as it has, then automatic and sweeping cuts go into effect. For Medicare, that means a two percent cut across the board, or about $123 billion over the next decade. However, it might have been $500 billion to $700 billion in cuts, if various supercommittee arguments had prevailed. Nevertheless, as it stands, there definitely will be a little pain, but not quite as much for individual beneficiaries. No, likely it will hit hospitals and doctors the hardest. Why? In the aggregate, that’s where the money tends to end up. Of course, we’re not yet out of the woods. Just as it became clear last summer that we’d have to wait until the winter for some kind of budget solution from Congress, it now seems that we’ll have to wait for the upcoming election season. In turn, expect things to intensify even further and for budget discussions to become all the more drastic.

Reference: Reuters (November 22, 2011) “U.S. healthcare cuts minimal, more pain looms”

Loans vs. Gifts – When It’s All in the Family

A loan is not a gift; if you’ve spoken with a bank representative or a particularly pennywise relative. We talk a lot about gifts when it comes to estate planning, but loans are just as important, as evident in a recent piece on the New Old Age Blog. In the article, a piece by Craig Reaves, past president of the National Academy of Elder Law Attorneys, a family had their mother’s estate plan in shambles. The culprit? A small notebook found under her bed. Apparently, there were many disagreements, but none so deep seated as those caused by the notebook. Why? Because it has a little ledger of the “loans” she had made to all the family members. Some of the family members hadn’t received any money, but at least one had received $20,000. Other family members had repaid in full and some had not so much as begun to do so. This case raises an important question: To what extent does the amount of an unpaid loan get added to the decedent’s estate, and does it simply come out of each family member’s share in proportion to their loans? One thing that’s clear, of course, is that the money is not gone and out of the estate. Why, it’s a loan and not a gift, after all. The second thing that’s clear is that the mother hadn’t thought about how these “loans” figured into her estate. That family aside, it should be noted that any loan evidenced by a signed promissory note can become an asset in the estate. And, even if it’s a family loan, the promissory note has to be repaid. An estate planner can ease this problem with a bit of foresight. For example, the loan can be forgiven, meaning they relinquish any expectation of being repaid. For that matter, too, the loan can be “offset” and thereby deducted from any assets made available through inheritance. While there are a number of things that can be done, forgetting the loan is not one of them. After all, the IRS is waiting just within earshot and has a trained eye to recognize the difference between a loan and a gift, as well as the additional tax burdens it can assign if it spots a gift or a poorly executed loan.

Reference: The New York Times – The New Old Age Blog (November 15, 2011) “Ask the Elder Law Attorney: Family Loans”

Impoverished Seniors Rate Nearly Doubles

It’s been fairly clear that medical expenses were becoming an immense financial drain on the elderly. If you are elderly or have an elderly loved one, then this is a given, as supported by recent census data. As reported in Reuters, the number of poor persons hit a record high in 2010, and poverty rates among the elderly have had the steepest gain. In fact, according to the census, a record 49 million Americans (i.e., 16 percent of the population) qualify as impoverished. When it comes to the elderly, the poverty level jumped to 15.9 percent, or roughly 1 in 6, from the previous year’s nine percent. It’s true that the census study and methods have become a political flashpoint. However, the new analysis takes a broader look at life and includes government benefits. Previous studies used older methods that failed to account for how people maintained their standard of living. Politics aside, it’s still a sobering data. If government benefits have become that much more of the equation, then it goes a long way towards showing what’s at stake in the present and upcoming political storms.

Reference: Reuters (November 7, 2011) “New Census data raise number of poor to 49 million”

ESTATE PLANNING / POWER OF ATTORNEY

Some people who thought they had covered all their bases and acted responsibly to care for loved ones in the event of a debilitating illness or incapacity are finding their plans un-done by strict banking policies. Bank of America recently updated their online security procedures, and no longer accepts a power of attorney for online banking. As Bernard Krooks wrote last week for Forbes, this strict policy came to light when Chicago resident Eva Kripke was blocked from accessing her husband’s Bank of America account. According to Krooks, Mrs. Kripke had been handling her husband Sidney’s bank accounts as agent under a power of attorney ever since he was diagnosed with Lew body dementia four years ago. Suddenly now, however, she is denied access under the bank’s updated security procedures. The bank suggested she to go to her local branch and get a printout of her husband’s account information. Unfortunately, Mrs. Kripke felt this was unacceptable because her husband’s health status requires close financial oversight. Perhaps more unfortunate, her options are limited because her husband’s illness has rendered him incompetent. Rules such as these are becoming increasingly prevalent and significant as more people are called upon to care for an aging population and their attendant disabilities. An experienced elder law attorney can provide guidance in situations where powers of attorney are limited.

Reference: Forbes – Bernard A. Krooks (July 7, 2011) “Power of Attorney Does Not Grant Access to Online Banking, Says Bank of America”

Government Medical Care And Senior “Double-Dippers”?

Are you or an elderly loved one receiving benefits from Medicare or Medicaid? If yes, then likely you already appreciate the funding problems facing Congress and its appointed “super committee” regarding the future of these programs. However, for many of today’s elderly, certain changes to these programs may be real and immediate. As a result, careful attention to the associated political developments is important. One area of specific focus is “dual-eligibles.” Seniors receiving aid from both Medicare and Medicaid are so-called “dual-eligibles” and, as such, their benefits are under scrutiny from the super committee. In fact, changes may be in the wings, according to Reuters. Medicare and Medicaid spend about $300 billion a year for “dual-eligibles,” making them a prime target. Here’s what that means: Roughly 39 percent of the Medicaid program costs and 27 percent of Medicare costs are going to 15% and 16% of program enrollees respectively - and at the same time. Of course, these patients also tend to be the ones in the greatest need, with half of them under treatment for five or more chronic conditions. What’s going to happen? As usual, that’s far from clear. Many states and insurers are pushing for managed care options to handle all aspects of care. This would help reduce the present bureaucratic overlap and, hopefully, cut costs. On the other hand, there are the detractors. The problem of dual-eligibles is likely to continue to rise in budget and debt discussions, along with a host of other little issues. What can you do? Keep a close eye (and open ear) on the decision-making process (and the decision-makers), especially if those changes may threaten your health care. It probably wouldn’t hurt to contact your representatives in Congress.

Reference: Reuters (September 28, 2011) “Debt panel eyes dual Medicare/Medicaid patients”

ALZHEIMER’S: BE PREPARED!

You may not have known but September is World Alzheimer’s Month. As the month comes to a close, it’s important not to forget about Alzheimer’s. Medical research and advocacy are vital causes to uphold. Nevertheless, it is a disease that you and your loved ones might have to face directly, if you have not already. The reality of Alzheimer’s or dementia striking close to home, then some understanding and prior planning can help you in terms of the extensive economic toll and the unique legal ramifications. According to a recent Forbes article, Alzheimer’s is as widespread as it is demanding. Consider this: Another American citizen will develop Alzheimer’s every 69 seconds. The symptoms are oftentimes subtle, at least initially. Some estimate that more than 13 million Americans will have the disease by 2050 and run up as much as $1 trillion in costs. Because of the progressive nature of the disease, most of the costs and problems won’t develop until later on. Nevertheless, significant planning must take place at the time of diagnosis, if not anticipated beforehand. So, what is the scope of this “significant planning”? First, you will need to secure medical care, both for now and for the future. That means fundamental financial planning need to be addressed, to include securing government benefits like Medicare and Social Security Disability Insurance. Second, because of Alzheimer’s progressive cognitive degeneration, estate planning must occur early in the process to secure and protect family assets. Fundamentally, it’s important to understand that Alzheimer’s is not the same as other diseases. Through it all, competent counsel will be necessary to properly assess the needs and possibilities, as well as to ensure that everything is in place when needed most.

Reference: Forbes (September 21, 2011) “September Marks World Alzheimer's Month as Advocates Push for Early Diagnosis and Health Care Planning”

ELDER CARE – TRANSITION TREVAILS

Moving between hospitals or into rehabilitation and other care centers can be a stressful time, especially for an elderly loved one. Unfortunately, too, these “care transitions” can create far greater problems than stress, as they also are prone to creating problems with the patient’s care. Potentially, these problems can have long-term affects. Care transitions are not a recent concern of health professionals, but been on their radar screen for some time. In fact, a recent study is the subject of a recent post on the New York Times’s blog series, “The New Old Age.” According to the study, a very large Canadian study of older adults and published in the Journal of the American Medical Association found that the main problem is with essential medications. It seems these meds can be accidentally stopped by healthcare professionals when the patient is in transition. And, older persons can be on many medications at once, often with little understanding of each drug and with complete faith in the multiple doctors prescribing them. For example, what happens if an elderly loved one (who may be on as many as 10 medications) has an “episode” requiring a trip to the emergency room? The emergency room staff may have to take them off some of those medications to administer needed care. Unfortunately, thereafter the doctors may forget to have those medications started up again once they are stabilized, moved to regular care or even transferred out to a rehabilitation center. In turn, your loved one might not notice any changes without the meds, or simply might assume the doctors know what’s best. Ultimately, this lack of communication and coordination in transition care can be life threatening. It’s something that happens all too often, particularly with medications for cardiac and blood conditions, such as statins (e.g., Lipitor) and blood thinners (e.g., Plavix). All of this gives family caregivers one more thing to bear in mind when tending to an elderly loved one, but it can also be an important one. It’s important to ask questions and be aware of all medications an elderly loved one is taking, and if these meds change (or stop) after a hospital visit… find out why.

Reference: The New York Times Blogs (September 8, 2011) “A Big Risk in the Health Care Handoff”

Special Needs Planning – A Changing Landscape

Estate planning is never easy, if only because it means thinking about protecting your loved ones when you’re no longer around. It’s bad enough making plans to protect self-sufficient heirs who take care of themselves and an inheritance. However, it can be a real challenge when planning for heirs with special needs for a variety of personal and legal reasons. Unfortunately, as The Wall Street Journal Online recently pointed out, with the economy and politics as they are, there are new concerns to bear in mind as you plan. Both the State and federal budgets are strapped for cash and the burden is falling on Medicare and Medicaid. It’s up to the Congressional Special Committee to consider the future of Medicare now, but many Medicaid programs already are feeling the squeeze with tighter income restrictions for benefits and services. Of course, much of the disabled population (12% of the overall population) relies on state and federal services for those services that they couldn’t afford in the private market. To plan for an heir with special needs, then, means planning to provide for them without risking their main sources of care. Now, more than ever, that means a “special needs trust,” tailored to provide the inheritance as a safety net without endangering the continuation of benefits. [Sidebar: Sometimes an older parent can make this move kill two birds with one stone. How? They create the trust now for themselves and a loved one with special needs so that both qualify for government benefits, once the “look back” period has past for eligibility disqualification. As budgets get tighter, expect greater governmental scrutiny of such moves.] The other major issue, and a related one, is housing. Many Americans with special needs live in group housing programs. These programs are, in turn, subsidized by government agencies, but are increasingly unable to meet demand and are cash-strapped. For one, the same political/economic pressure is keeping those agencies from expanding. At the same time, there simply are more prospective residents due to lengthening life expectancies. The US would have had to expand its residential-services capacity by 28% to meet the demand as of two years ago. Clearly, housing has been an issue and it will only get worse. Amidst all of this uncertainty, you still need to plan where your loved one will live. This might mean another form of trust. For example, a “Qualified Personal Residence Trust” (QPRT) would provide that you live in your home until your death, but that your family member with special needs would live there (without disqualifying ownership). Great care would need to be given in the preparation of such an arrangement. Also, it may be possible to provide a home to shelter several persons with special needs. For example, say several families pool resources, or even to leave a home to a non-profit that can convert the home into a new group home. The options are limited by your creativity. Ultimately, the best plan will depend on your own unique family circumstances, as well as the current state and federal laws governing benefits and services. Unfortunately, according to a recent study by Arc, an advocacy group, only one-third of affected actually has plans to control what happens when the caregiver grows old and after they are gone. Bottom line: Remember to engage qualified legal counsel to help you navigate the regulatory minefields.

Reference: The Wall Street Journal Online (September 3, 2011) “Taking Care of Disabled Heirs”

Elder Law – Promissory Notes May Not Be So Promising

As some of you may know, the guidelines surrounding eligibility for Medicare or Medicaid can be fairly rigid. They exist to ensure people aren’t gaming the program, but sometimes even who aren’t gaming the program (and have legitimate need) can unintentionally run afoul of the rules. For another example of what not to do, ElderLawAnswers recently analyzed the case of Jackson v. Director of Office of Medicaid (Mass. App. Ct., No. 10P706, July 19, 2011). When Raymond Duclos was entering a nursing home, his wife was making transfers to their children: $176,000 to their daughter, Susan; $11,787.83 to their son, Raymond, Jr.; and $3,000 to their other son, Michael. No good story about Medicare/Medicaid eligibility begins with the word, “transfer.” Why? Because of the look-back period for determining eligibility. In the case of the Duclos family, as opposed to these direct transfers being made without any value exchanged in return, each transfer was made in exchange for promissory notes. In fact, the largest note was an immediate annuity. Nevertheless, in the end this was considered a distinction without a difference. The state (Massachusetts) denied the claim and the appeals court upheld the state’s decision. The court’s basis: Those promissory notes weren’t “actuarially sound.” For one thing, there was no proof of Mrs. Duclos life expectancy at the time she transferred the assets and the smaller promissory notes from the sons did not prohibit cancellation at the death of the lender. This “cancellation” made the transaction appear as if there was little intention of actually fulfilling the notes. Furthermore, the larger note from the daughter was turned into an annuity, but it did not name the state as a “remainder” beneficiary. Each transfer, then, was a disqualifying one.

Reference: ElderLawAnswers.com (August 1, 2011) “Transfers to Children of Medicaid Applicant in Exchange for Promissory Notes Not Actuarially Sound”

ELDER LAW / LONG TERM CARE

There are some things you just don’t haggle about but, perhaps contrary to what you would guess, it turns out that long-term care isn’t one of those things. Long-term care is expensive, to say the least, but as explained in a recent article in SmartMoney, there are some expenses that may be negotiable. Nursing homes usually will not negotiate fees, but you may be able to negotiate with assisted-living facilities and home health care agencies. Start by arming yourself with information. You can look up local costs at Genworth.com/costofcare on a map prepared by Genworth Financial, one of the country’s largest long-term care insurers. This can help you compare costs for various types of care in your area. MetLife offers another source of area-specific information at MatureMarketInstitute.com (click on “Research” then “2010 Market Survey of Long-Term Care Costs.”) Other resources include “Medicare and Home Health Care” which describes the home health benefits that Medicare covers (available at Medicare.gov) and the United Hospital fund’s “Next Step in Care” website for family caregivers. Other bargaining strategies to keep in mind: • As if there is a waiting list at the facility. If not, you may have more room to negotiate. • While nursing homes generally do not discount rates, you may be able to negotiate for extra amenities. • If a home-care agency has rates at the higher end of your local market, you may be able to get a lower rate if you let them know you are interviewing several agencies and taking cost into consideration. • If you hire a home-care agency for a significant number of weekday hours, that agency may be willing to discount any extra fees they charge for weekend work. You can learn more long-term care options on the Long-Term Care Practice Center at our website. While you’re there, be sure to subscribe to our free monthly e-newsletter.

From SmartMoney (May 28, 2011) “Driving a Bargain for Long-Term Care”

 

Uncovering Dementia/Alzheimer’s Cover-ups

Dementia and Alzheimer’s are becoming increasingly common, but even if we are beginning to become more and more aware of how to spot them, it doesn’t make it any easier. Many a reader will be familiar with the terrible uncertainty and concern over their elderly parent’s thinking. Fortunately, Carolyn Rosenblatt of Forbes has more advice to give in her recent article. Among the many dangers to keep in mind when an elderly loved one starts “slipping” it that they may begin “hiding” it. For one thing, it is not something with which any senior looks forward to acknowledging, even if they are aware of some telltale symptoms. It is human nature. We all compensate or distract when there is something to hide, both from ourselves and from others. But when something like Alzheimer’s is at stake, it can be all the more difficult to get past and harmful to hide. Indeed, since there is no actual test for dementia or Alzheimer’s, it is possible that a doctor will be unable to diagnose those conditions. It is important, therefore, to observe how your loved one functions. Keep a keen eye on them and know what you are seeing, for their own sake. The original article has more advice and anecdotes to offer, but Ms. Rosenblatt sums up the steps in four points. As soon as you begin to worry you must, first, persuade your loved one to visit a doctor, and a specialist if possible, to detect it early. Second, you must secure their estate planning documents while they have legal capacity to know and understand what they are doing. Third, you must secure proper care for them. Fourth and last, you have to discuss the circumstances openly with all family members, so all may be aware of the circumstances and can work together to protect your loved one.

Reference: Forbes (August 11, 2011) “The Danger of Your Aging Parent Covering Up Dementia”

Government Cuts Affect Nursing Homes

The last few months have been a wild ride on multiple levels, to include concerns over Medicare and the “debt crisis.” While many more challenges lie ahead in terms of budget cuts, some cuts already have been made under the radar screen. Several you should know about actually go into effect this fall, as reported in a recent SmartMoney article. According to SmartMoney, nursing home residents could face higher costs or reduced care once these cuts kick in. Background On July 29, The Centers for Medicare and Medicaid Services (CMS) decided and announced that they would be compensating for last year’s $4 billion shortfall by cutting reimbursement rates to nursing homes by 11.1%. In real terms, the shortfall is going to reduce government reimbursements to nursing homes. In 2010, nursing homes increased charges on residents by an average of 5%. Bad news: These reduced government reimbursements likely will trigger even higher nursing home costs for residents beginning this fall. Alternatively, it might trigger a reduction in services to nursing home residents. Either way, the forecast is not pleasant. Perhaps I am wrong. Perhaps nursing home residents won’t see increases in costs or decreases in services. After all, the CMS actually justifies the 11.1% cut by pointing out that it is simply a more accurate reimbursement amount based on a government report indicating that Medicare has been overpaying. In fact, a spokesperson for the CMS maintains, “We do not believe that nursing homes will respond to the payment changes by decreasing the quality of care furnished to patients. However, we intend to carefully monitor changes in utilization and staffing patterns to ensure that patients continue to receive high quality care.” Still, the nursing home industry appears to be monitoring the situation with caution. Bottom line: If you have a loved one in a nursing home, then you, too, should take notice.

Reference: SmartMoney (August 18, 2011) “Medicare Cuts Could Up Nursing Home Costs”

Long-Term Care Insurance Comes Of Age

It is an unfortunate fact that healthcare costs are steadily rising and will only continue to rise in the foreseeable future. Accordingly, healthcare inflation must be considered when planning to protect your health, your family, and your financial well-being. One of the greatest threats is long-term care, especially as we age. For many, long-term care insurance is the best protection against long-term care poverty. Thankfully, as reported in a recent Reuters article, the long-term care insurance market is growing to accommodate the growing need and several new options are becoming available. Granted, we don’t like thinking about growing old and frail, perhaps with dementia or Alzheimer’s to boot. It is easy to procrastinate. Besides, who wants to pay policy premiums. As a result, people who will need long-term care insurance protection later, unfortunately have not purchased policy protection now. According to Matthew Sharpe of Genworth, “Long-term care is definitely under-penetrated, there’s no doubt about it. About 4 percent of the population that is eligible actually has a policy.” Because of this, Genworth and other companies are developing newer and easier tools for consumers to use, and that just might translate into newer and better policies for you to consider. Whether any policy option is the right option for you depends on your unique circumstances. As pointed out in the original article, the strongest reason to secure a policy may be the possibility of dementia or Alzheimer’s. While there are many ideas presented in the Reuters article for your consideration, nothing can replace the advice and counsel of an experienced long-term care insurance agent to help you navigate your options.

Reference: Reuters (August 16, 2011) “Long-Term Care Insurance Gets a Makeover”

ELDER LAW / SCAMS

Did you hear the one about the government sending out free money to seniors who just fill out a new tax return, and pay a processing fee? Ugh! Apparently, this is the latest scheme crooks have been playing on seniors, preying on their anxieties about the Cost Of Living Adjustment (COLA) – or lack thereof. According to the IRS and a recent warning from AARP, the summer has seen a dramatic increase in filing scams. Crooks spread false information that by filing again with the IRS and using new forms you can get government money. The most widespread one claims that the government is offering money to offset the lack of the annual COLA, and that by paying a $60 processing fee to a preparer with a new form you can receive as much as $3000. There is no such program, and in fact the current debt talks are already chipping away at the COLA anew rather than seeking to pay it out. That “tax preparer” just pocketed the money as well as a document laying out all your personal and financial information. One good way to protect yourself and your loved ones from these types of scams is to check with the IRS and the AARP website for information about both legitimate programs and scam or fraud warnings.

Reference: AARP.org (July 25, 2011) “No COLA? Crooks Promise Help

ELDER LAW/ ALZHEIMER’S

A diagnosis of Alzheimer’s disease can be devastating for everyone involved, including the patient and all of their family members. Should you be facing this diagnosis, there are probably a million thoughts racing through your mind, from keeping your loved one safe to caring for them as the disease progresses. One thing you might not think about is the need for estate planning. As a recent article by Reuter’s explains, if you or someone you love has a family history of dementia, is showing symptoms of Alzheimer’s or is concerned about later-life planning, it’s time to get to work. You’ll want to assemble a team that specializes in long-term planning and elder care issues. A good place to start is the National Academy of Elder Law Attorneys (NAELA). An elder law attorney can help navigate the elective transfer of decision-making authority through a power of attorney or trust and can help you qualify for needs-based programs like Medicaid and Veterans Pension Benefits if necessary. An elder law attorney also can set up a legal framework through which the client and his or her family can transfer assets and decision-making responsibilities. Alzheimer’s is the sixth leading cause of death in the U.S., with 5.4 million Americans suffering from the disease. So, health care proxies will be another important aspect of your legal plan. You can learn more about Alzheimer’s disease, at the Alzheimer’s Association online.

Reference: Reuters (July 20, 2011) “Alzheimer’s: early planning critical to financial health”

ELDER LAW / COLA

If the debt-debate in Washington gets much worse it could mean a lot more belt-tightening for America’s seniors, including changes to the COLA for Social Security, the Cost Of Living Adjustment meant to keep seniors at pace with inflation. The change proposed by both sides of Congress and the White House officials, elaborated in this SmartMoney article, is to adjust the measurement of inflation used when determining the COLA. Inflation is a fairly common concept – the general and expected upward creep of costs – but economists are less certain about the most appropriate measurement. Currently, costs of products are tracked across various economic sectors and inflation is seen as percentage increases in those products, but the economists’ argument is that when product costs rise, the first response is to switch to similar but cheaper products so the actual affect isn’t quite so bad. When a brand name product becomes too expensive people buy generic, and do so for any product that they can switch out, thus keeping costs relatively stable. The suggestion is to use a model of inflation that takes this replacement into account based on all adult consumption, in which case, the COLA would shrink. Annually, the COLA would grow 0.3% less, and so the overall Social Security payouts will decline over the beneficiary’s lifetime. Over 25 years, for example, the average retiree would receive about $18,000 less in benefits. The problem is that most seniors are already cash-strapped and that is $18,000 more they have to find to make ends meet. To make matters worse, seniors tend to switch-out products less than other adults, also largely because they are already buying the bare essentials and so are less flexible in those spending habits. Many experts worry that the proposed COLA adjustment will leave many seniors in dire straits. If you were counting on Social Security as a large part of your retirement security – as many are – you may want to start learning more about those extreme couponing schemes, or check out the generic product section at your local grocer’s.

Reference:  SmartMoney (July 13, 2011) “Coming Soon: Smaller Raises for Seniors?”

ELDER LAW / ELDER CARE / ESTATE PLANNING

Sometimes the biggest mistakes are also the most mundane, and those can make for an awful headache for even the best of us. The maxim proves itself once again in the case of Anthony Olivo, and Forbes’s recent re-telling of that story, where even a tax lawyer neglected proper record keeping of his services to his loved ones – both care-giving and estate-planning services – and the IRS had little sympathy. Anthony had been a tax lawyer for nearly two decades, even opening his own practice, until the needs of his aging parents grew too great. Anthony turned to become a full-time, live-in caregiver for his parents from 1994-2003, receiving negligible income from his practice and working long, hard hours just trying to support everything. He even become the estate-planning attorney for his parents’ estates and in this capacity brought the matter of deductions before the tax court in what became Estate of Olivo v. Commisioner. Anthony was hoping to deduct his services from his mother’s estate in three payments: $55,000 in accountant and attorney fees Anthony claimed, $44,200 in administrators commissions fees paid to him, and finally a whopping $1.24 million for care services over the 9 year period. The deductions were denied. The tax court didn’t doubt that services had been rendered, and admirable ones at that, as far as care was concerned. After all, without his care it would have taken round-the-clock care from nurses to support his parents. Nevertheless, the court found that there simply weren’t enough records. The family had never formally established that Anthony’s care services were intended to be paid for as there was no agreement and no paperwork. There wasn’t even an estimate of the value of his services in the first place since he is not a professional care-giver. Of course, he is a professional tax lawyer but even those services were contested by the court. He didn’t keep records, invoices, or provide solid values there either aside from sparing notes and estimated hours. In fact, there was even some question as to whether Anthony could bill the estate at all for legal services, much less deduct them from the estate. It simply wasn’t enough on all counts. The bottom line is that the minutia of documentation and burden formal arrangements are absolutely necessary. They are in business and they are even within the family, so far as the IRS is concerned.

Reference: Forbes (July 18, 2011) “Tax Lawyer Son’s Help, Priceless?”

ELDER LAW / MEDICAID ELIGIBILITY

Here’s another important reminder on how much of a stickler Medicare and Medicaid can be when it comes to denying benefits: the Matter of Komanoff Ctr. for Geriatric & Rehabilitative Medicine v Daines (N.Y. Sup. Ct., App. Div., 2nd Dept., No. 2010-05776, June 28, 2011) (here summarized on ElderLawAnswers.com.) 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. Reference: Elderlawanswers (July 5, 2011) “Transfer to Daughter Without Written Agreement Triggers Medicaid Penalty”

ELDER LAW / MEDICAID & LONG-TERM CARE

It’s no secret that state (and federal) budgets are severely stressed. While lawmakers look for revenue and cost-cutting measures, Medicaid services are coming under scrutiny. Managed care plans are becoming increasingly popular as one way to cut Medicaid costs. Currently six states require the elderly and disabled who need long-term care to enroll in a managed care plan. At least 10 other states are reportedly considering the same, according to a recent article from The Kaiser Health News. Traditionally, states pay Medicaid providers directly for individual services. Under managed care, states pay health insurers a fixed monthly fee for each Medicaid patient. The lump sum is used for all the patient’s costs, including physician and nursing home care. Managed care companies say they can help states save money by keeping Medicaid patients who need long-term care at home whenever possible. Tennessee pays its Medicaid health plans an average of $4,400 per member per month. AARP and some other advocates caution that managed care plans could make it harder for patients to get the services they need. The nursing home industry, which currently gets about two-thirds of its revenues from Medicaid, is complaining as well. But state officials around the country say they have little choice but to make more aggressive use of managed care, especially for long-term care patients who account for more than two-thirds of all Medicaid spending.

ELDER LAW / MEDICARE

The Centers for Medicare and Medicaid Services recently announced they are preliminarily raising the reimbursement rate for Medicare Advantage plans by 1.6 percent in 2012. This could make the popular plans more profitable for the companies offering them, and perhaps help hold the line on premium increases.

Medicare Advantage plans are privately run versions of Medicare. Subsidized by the government, the plans offer basic Medicare coverage, but with extras like vision or dental coverage – and usually at premiums lower than standard Medicare rates.

According to Forbes, the 1.6% increase is about what investors and provider companies had expected. The final rates will come out on April 4, and the reimbursement rates may vary by plan.

There are about 11.8 million beneficiaries, or nearly a quarter of the total Medicare population, enrolled in a Medicare Advantage plan.

ELDER LAW / ELDER ABUSE

Elder financial abuse continues to the “Crime of the 21st Century,” according to a recently published MetLife study on the financial abuse of the elderly, “The MetLife Study of Elder Financial Abuse: Crimes of Occasion, Desperation, and Predation Against America’s Elders.” The study shows that elder financial abuse falls into three types of crimes: occasion, desperation and predation. Additionally the vulnerabilities of aging increase the risk of elder financial abuse, and there is a continued lack of focus (and prosecution) on the perpetrator. Elder Americans are now estimated to lose $2.9 billion every year, with significant patterns in the nature of these abuses. Most cases of abuse, 51 percent, are perpetrated by strangers, with close family and friends accounting for 34 percent. Crimes classified as “scams” committed by strangers accounted for 28 percent of all financial abuses, business-related exploits made up 12 percent, and Medicare and Medicaid fraud amounted to the most loss per case but only accounted for 4 percent of total cases. The most common perpetrator was likely to be a man between ages 30 and 59. When family or friends were involved, the study found that most cases involved forged checks, stolen credit cards, drained bank accounts, and transferred assets. The most common victims are women, who are twice as likely to be financially abused as men, especially in their 80’s. Most cases found that it was when the victim’s disabilities were outwardly apparent due to the use of a cane, handicap tags, or simple confusion, but those living alone and in need of health care or home maintenance also are at risk. The Elder Justice Act became law on March 23, 2010, and has significantly raised the national focus on elder financial abuse. Provisions of the Act are outlined in the study, which you can download here. Two of the provisions include required immediate reporting to law enforcement of crimes in a long-term care facility and civil monetary penalties for failure to report and a provision for penalties for long-term care facilities that retaliate against an employee for filing a complaint against or reporting a long-term care facility that violates reporting requirements.

Reference: Metlife.com (June, 2011) “The MetLife Study of Elder Financial Abuse: Crimes of Occasion, Desperation, and Predation Against America’s Elders” (study publication)

 

ELDER LAW / ELDER CARE

If you, your parent, or an elderly loved one is reaching the point where living alone is no longer an option – for medical reasons or otherwise – it may be time to consider some time of assisted living, whether nursing home or retirement community Increasingly, many families are looking at the “Continuing Care Retirement Community” or CCRC option. Even though the CCRC may be the pricier option, a little-known tax strategy recently explained in Smart Money could make it more financially attractive.. What is a CCRC? As SmartMoney explains: As opposed to a traditional nursing home where you simply pay a monthly fee, residents enter into a long-term contract with a CCRC. In exchange for a one-time entry fee and ongoing monthly charges, the CCRC provides housing and a range of on-site services. When a resident's health and personal care needs become more acute, the level of service can be increased to include assisted living, long-term care and skilled nursing care. The big advantage is that the resident doesn't have to move as his or her needs change. Interestingly, there is another advantage: a potential tax savings. Because part of the upfront and ongoing fees is to provide medical services – whether the resident uses them or not – a medical tax deduction may be available. This strategy was upheld in the 2004 Tax Court case, Delbert L. Baker v. Commissioner (122 TC 143, 2004). Of course, medical expenses must exceed 7.5% of adjusted gross income in order to claim the deduction. However, if you are considering a CCRC, it’s quite possible that your applicable expenses will exceed this threshold, since their fees, including the upfront buy-in, are usually quite high. Remember, too, that the percentage of costs that qualify as medical is determined by the aggregated spending of the facility itself, rather than the individual and their level of received care. The CCRC management should be able to give you estimates of the percentages, though you may have to ask for them. Also of note, remember that if you will pay some or all of your parent’s CCRC fees, you can claim the applicable percentage of the charges as a medical expense on your return – if you provide more than half of your parent’s support. Also, the IRS says these tax breaks apply only if the person enters into a CCRC-like contractual lifetime care arrangement, not just any retirement facility or nursing home. You can learn more about long-term care planning on our website. Also, be sure to sign up for our free monthly e-newsletter for regular updates

Reference: SmartMoney (June 15, 2011) “A Tax Break for Retirement Community Costs”

ELDER LAW / RETIREMENT CAREERS

In today’s economy, it seems that everything old is new again … albeit with a bit of a twist. Years ago, it was common for older couples – and frequently widows – to rent out rooms for extra income. Taking in boarders was a viable way to supplement income. Well, the idea is back, with a bit of a twist. As Baby Boomers face the cold, hard facts of retirement, they are increasingly changing the definition of the term to include at least some form of work. While you may not be ready to hang out a shingle on the front gate, “Rooms for Rent,” you might consider becoming a landlord. In fact, the venerable Wall Street Journal writes that it may be just the ticket, especially given the uncertain prospects for stocks and bonds and the meager interest rates on savings accounts. Think about it. It’s a buyer’s market now, so purchasing a multi-family home is more financially feasible. And, the trend toward the renter’s lifestyle is picking up steam. All this means you have a low cost of entry into a market that is expected to expand. Starting to make investment sense? Sure, it’s a career of sorts, but you also need to think of it as an investment. Weigh everything in the short term, including start-up and maintenance costs, as well as the marketability of the location you’re considering. But then also keep your long-term goals in mind, including appreciation and eventual sale. Buying in a depressed market, after all, is only a steal if that market bounces back. Finally, don’t overlook the possible danger of having all your eggs in one basket since being a live-in landlord will unite your home, equity, and employment, into one potentially risky asset. Like any retirement move, don’t make this one too quickly. Discuss your plans with a professional who can help you sort out the details, including how an investment rental property could affect your Social Security benefits. Remember, too, that this lifestyle may not suit you. In which case, you would be wise to explore other, more enjoyable options.

Reference: The Wall Street Journal Online (June19, 2011) “Want a job? Become a landlord.”

ELDER LAW / ELDER CARE

When the time comes, as does for most of us, that we need assistance in our daily living, the unfortunate fact is that too many of us end up in nursing homes – not because we need constant nursing care, but because there no other good options. A provision of the new Patient Protection and Affordable Care Act may help change that. According to a recent article in the LA times, the most ambitious part of the Act, as it relates to long-term care is the Community Living Assistance Services and Supports Act, or CLASS – a voluntary, consumer-financed insurance plan to cover long-term care expenses. CLASS, scheduled to go into effect in January of 2014, is an insurance plan, similar to those currently available in the private market, with a few notable distinctions. First, the program will be administered by the government. Second, any working adult age 18 or older will be able to enroll, regardless of any pre-existing medical condition, and the benefits will be good for as long as someone needs long-term care. Perhaps even more importantly, the government plan will offer benefits that could be used for a wide variety of expenses, including hiring a home care provider and doing home modifications. Take note that Senators June Thune and Lindsey Graham on April 14 of this year introduced the Repeal the CLASS Entitlement Act. Nonetheless, the CLASS Act highlights a widespread move in the country to shift resources from nursing home-based care to home-based care as a viable and far less expensive option. The cost of nursing home care ranges from about $40,000 to $85,000 a year, according to a recent report by John Hancock Financial Services Inc. The average cost of a home health aide, on the other hand, is about $37,000 a year. The most precious detail, of course, is that the patient can remain at home. You can learn more about long term care options in the Long Term Care Practice Center on our website, or read the May issue of our monthly e-newsletter, Elder Law Elements. Reference: The Los Angeles Times (June 19, 2011) “Helping Seniors Live at Home Longer”

ELDER LAW / HOSPICE

Hospice care can provide a great benefit to many families and their dying loved ones, and Medicare has been generally praised for its support through reimbursements to providers over the past 28 years. However, according to a recent article by Kaiser Health News and The New York Times, there is growing concern now about misuse of the program by for-profit hospice providers. Hospice care is intended to provide dying patients with palliative care in their own homes, or in a hospice facility or nursing home. But, as hospice has moved into the mainstream, concerns about excessive costs and misuse have mounted. A primary concern is that Medicare’s flat-fee payment system encourages hospices to seek out patients likely to live much longer than the six month time period for which hospice was originally intended. Medicare pays a flat fee ranging from $147 to $856 a day, depending on the level of care, whether a hospice actually provides services or not. For-profit hospices in particular tend to have longer-staying patients. "The financial incentives do in fact dictate behavior," said Eugene Goldenberg, a research analyst for BB&T Capital Markets who follows the hospice industry. "It's a lucrative business, at least under the current reimbursement system." In response, Medicare has adopted a restriction: It won’t pay for hospice beyond six months unless a physician or nurse practitioner visits the patient and attests that his or her condition is still terminal. But this requirement, part of the health care law passed last year, has provoked a backlash from hospice providers who say that sending a doctor or nurse practitioner out to see every patient at the six-month mark is too expensive. But given the financial and political pressures facing Medicare, government officials are concerned that hospice care may be misused. The inspector general of the Department of Health and Human Services looked at one fast-growing segment — hospice patients in nursing homes — and found hospices routinely failed to document that those patients belonged in a hospice or that they were getting the care to which they were entitled. If you or a loved one is considering hospice care, be sure to thoroughly investigate the care provider before making a commitment. Perhaps the most chilling aspect of these findings is not that people are using a hospice benefit for too long – but that they may be enrolling too soon …perhaps before giving other, more aggressive medical procedures a chance to work .

Reference: The Kaiser Health News (June 27, 2011) “Growing Hospice Care Costs Bring Concerns About Misuse”

ELDER LAW / HOSPICE

Hospice care can provide a great benefit to many families and their dying loved ones, and Medicare has been generally praised for its support through reimbursements to providers over the past 28 years. However, according to a recent article by Kaiser Health News and The New York Times, there is growing concern now about misuse of the program by for-profit hospice providers. Hospice care is intended to provide dying patients with palliative care in their own homes, or in a hospice facility or nursing home. But, as hospice has moved into the mainstream, concerns about excessive costs and misuse have mounted. A primary concern is that Medicare’s flat-fee payment system encourages hospices to seek out patients likely to live much longer than the six month time period for which hospice was originally intended. Medicare pays a flat fee ranging from $147 to $856 a day, depending on the level of care, whether a hospice actually provides services or not. For-profit hospices in particular tend to have longer-staying patients. "The financial incentives do in fact dictate behavior," said Eugene Goldenberg, a research analyst for BB&T Capital Markets who follows the hospice industry. "It's a lucrative business, at least under the current reimbursement system." In response, Medicare has adopted a restriction: It won’t pay for hospice beyond six months unless a physician or nurse practitioner visits the patient and attests that his or her condition is still terminal. But this requirement, part of the health care law passed last year, has provoked a backlash from hospice providers who say that sending a doctor or nurse practitioner out to see every patient at the six-month mark is too expensive. But given the financial and political pressures facing Medicare, government officials are concerned that hospice care may be misused. The inspector general of the Department of Health and Human Services looked at one fast-growing segment — hospice patients in nursing homes — and found hospices routinely failed to document that those patients belonged in a hospice or that they were getting the care to which they were entitled. If you or a loved one is considering hospice care, be sure to thoroughly investigate the care provider before making a commitment. Perhaps the most chilling aspect of these findings is not that people are using a hospice benefit for too long – but that they may be enrolling too soon …perhaps before giving other, more aggressive medical procedures a chance to work.

 

ELDER LAW / RETIREMENT CAREERS

In today’s economy, it seems that everything old is new again … albeit with a bit of a twist. Years ago, it was common for older couples – and frequently widows – to rent out rooms for extra income. Taking in boarders was a viable way to supplement income. Well, the idea is back, with a bit of a twist. As Baby Boomers face the cold, hard facts of retirement, they are increasingly changing the definition of the term to include at least some form of work. While you may not be ready to hang out a shingle on the front gate, “Rooms for Rent,” you might consider becoming a landlord. In fact, the venerable Wall Street Journal writes that it may be just the ticket, especially given the uncertain prospects for stocks and bonds and the meager interest rates on savings accounts. Think about it. It’s a buyer’s market now, so purchasing a multi-family home is more financially feasible. And, the trend toward the renter’s lifestyle is picking up steam. All this means you have a low cost of entry into a market that is expected to expand. Starting to make investment sense? Sure, it’s a career of sorts, but you also need to think of it as an investment. Weigh everything in the short term, including start-up and maintenance costs, as well as the marketability of the location you’re considering. But then also keep your long-term goals in mind, including appreciation and eventual sale. Buying in a depressed market, after all, is only a steal if that market bounces back. Finally, don’t overlook the possible danger of having all your eggs in one basket since being a live-in landlord will unite your home, equity, and employment, into one potentially risky asset. Like any retirement move, don’t make this one too quickly. Discuss your plans with a professional who can help you sort out the details, including how an investment rental property could affect your Social Security benefits. Remember, too, that this lifestyle may not suit you. In which case, you would be wise to explore other, more enjoyable options.

Reference: The Wall Street Journal Online (June19, 2011) “Want a job? Become a landlord.”

ELDER LAW / ELDER CARE

When the time comes, as does for most of us, that we need assistance in our daily living, the unfortunate fact is that too many of us end up in nursing homes – not because we need constant nursing care, but because there no other good options. A provision of the new Patient Protection and Affordable Care Act may help change that. According to a recent article in the LA times, the most ambitious part of the Act, as it relates to long-term care is the Community Living Assistance Services and Supports Act, or CLASS – a voluntary, consumer-financed insurance plan to cover long-term care expenses. CLASS, scheduled to go into effect in January of 2014, is an insurance plan, similar to those currently available in the private market, with a few notable distinctions. First, the program will be administered by the government. Second, any working adult age 18 or older will be able to enroll, regardless of any pre-existing medical condition, and the benefits will be good for as long as someone needs long-term care. Perhaps even more importantly, the government plan will offer benefits that could be used for a wide variety of expenses, including hiring a home care provider and doing home modifications. Take note that Senators June Thune and Lindsey Graham on April 14 of this year introduced the Repeal the CLASS Entitlement Act. Nonetheless, the CLASS Act highlights a widespread move in the country to shift resources from nursing home-based care to home-based care as a viable and far less expensive option. The cost of nursing home care ranges from about $40,000 to $85,000 a year, according to a recent report by John Hancock Financial Services Inc. The average cost of a home health aide, on the other hand, is about $37,000 a year. The most precious detail, of course, is that the patient can remain at home. You can learn more about long term care options in the Long Term Care Practice Center on our website, or read the May issue of our monthly e-newsletter, Elder Law Elements.

Reference: The Los Angeles Times (June 19, 2011) “Helping Seniors Live at Home Longer”

ELDER LAW / ELDER ABUSE

Elder financial abuse continues to the “Crime of the 21st Century,” according to a recently published MetLife study on the financial abuse of the elderly, “The MetLife Study of Elder Financial Abuse: Crimes of Occasion, Desperation, and Predation Against America’s Elders.” The study shows that elder financial abuse falls into three types of crimes: occasion, desperation and predation. Additionally the vulnerabilities of aging increase the risk of elder financial abuse, and there is a continued lack of focus (and prosecution) on the perpetrator. Elder Americans are now estimated to lose $2.9 billion every year, with significant patterns in the nature of these abuses. Most cases of abuse, 51 percent, are perpetrated by strangers, with close family and friends accounting for 34 percent. Crimes classified as “scams” committed by strangers accounted for 28 percent of all financial abuses, business-related exploits made up 12 percent, and Medicare and Medicaid fraud amounted to the most loss per case but only accounted for 4 percent of total cases. The most common perpetrator was likely to be a man between ages 30 and 59. When family or friends were involved, the study found that most cases involved forged checks, stolen credit cards, drained bank accounts, and transferred assets. The most common victims are women, who are twice as likely to be financially abused as men, especially in their 80’s. Most cases found that it was when the victim’s disabilities were outwardly apparent due to the use of a cane, handicap tags, or simple confusion, but those living alone and in need of health care or home maintenance also are at risk. The Elder Justice Act became law on March 23, 2010, and has significantly raised the national focus on elder financial abuse. Provisions of the Act are outlined in the study, which you can download here. Two of the provisions include required immediate reporting to law enforcement of crimes in a long-term care facility and civil monetary penalties for failure to report and a provision for penalties for long-term care facilities that retaliate against an employee for filing a complaint against or reporting a long-term care facility that violates reporting requirements.

Reference: Metlife.com (June, 2011) “The MetLife Study of Elder Financial Abuse: Crimes of Occasion, Desperation, and Predation Against America’s Elders” (study publication)

ELDER LAW / ELDER CARE

If you, your parent, or an elderly loved one is reaching the point where living alone is no longer an option – for medical reasons or otherwise – it may be time to consider some time of assisted living, whether nursing home or retirement community Increasingly, many families are looking at the “Continuing Care Retirement Community” or CCRC option. Even though the CCRC may be the pricier option, a little-known tax strategy recently explained in Smart Money could make it more financially attractive.. What is a CCRC? As SmartMoney explains: As opposed to a traditional nursing home where you simply pay a monthly fee, residents enter into a long-term contract with a CCRC. In exchange for a one-time entry fee and ongoing monthly charges, the CCRC provides housing and a range of on-site services. When a resident's health and personal care needs become more acute, the level of service can be increased to include assisted living, long-term care and skilled nursing care. The big advantage is that the resident doesn't have to move as his or her needs change. Interestingly, there is another advantage: a potential tax savings. Because part of the upfront and ongoing fees is to provide medical services – whether the resident uses them or not – a medical tax deduction may be available. This strategy was upheld in the 2004 Tax Court case, Delbert L. Baker v. Commissioner (122 TC 143, 2004). Of course, medical expenses must exceed 7.5% of adjusted gross income in order to claim the deduction. However, if you are considering a CCRC, it’s quite possible that your applicable expenses will exceed this threshold, since their fees, including the upfront buy-in, are usually quite high. Remember, too, that the percentage of costs that qualify as medical is determined by the aggregated spending of the facility itself, rather than the individual and their level of received care. The CCRC management should be able to give you estimates of the percentages, though you may have to ask for them. Also of note, remember that if you will pay some or all of your parent’s CCRC fees, you can claim the applicable percentage of the charges as a medical expense on your return – if you provide more than half of your parent’s support. Also, the IRS says these tax breaks apply only if the person enters into a CCRC-like contractual lifetime care arrangement, not just any retirement facility or nursing home. Be sure to sign up for our free monthly e-newsletter for regular updates.

Reference: SmartMoney (June 15, 2011) “A Tax Break for Retirement Community Costs”

ELDER LAW / RETIREMENT CAREERS

If you are a Baby Boomer nearing retirement, you probably have a different concept of retirement than your parents. Retirement for you may not mean an extended vacation on some sunny shore, but rather a new phase of your working career. A phase that may, perhaps, bring more than just another paycheck, but a new sense of meaning to your life. Morningstar recently referred to this career transformation as the “encore career.” Of course, it’s not just the search for meaning that motivates Baby Boomers to pursue an encore career. As Morningstar points out, tough new economic realities have transformed career reinvention from a virtue into a necessity for millions of older Americans who aren’t ready to retire or simply can’t afford to quit working. Interestingly, though the job market looks fairly bleak today, some economists predict labor shortages in key social sector jobs. Barry Bluestone, an economist at Northeastern University in Boston, predicts that within the next eight years, there could be at least five million job vacancies in the U.S., nearly half of them in social sector jobs in education, health care, government and non-profit organization. Bluestone also predicts that Baby Boomers are going to be filling those jobs, "We're going to see a remarkable reshaping of our labor force. The rate of labor force participation by the 55-plus population is going to be much higher, and older workers will represent a much higher percentage of the overall workforce." The Morningstar article includes a table ranking Projected Encore Career Growth 2008-2018. You might want to check it out. I note that job growth is predicted to be particularly strong for teachers, nurses and other health care providers … and not so much for lawyers. Reference: Morningstar Advisors (June 6, 2011): Making Working Longer Worth It

ELDER LAW / ELDER CARE

As we and our loved ones age, we put a lot of effort (and resources) into making sure a hospital bed is available when needed. New research shows that while that hospital bed may sometimes be necessary, getting up and out of it as quickly as possible is key to recovery. As it turns out, the hospital bed is a huge contributor to old-age infirmity, as studies prove that bed-rest and immobility slow healing and stunt recuperation. A recent New York Times column, “The New Old Age” covered the results of a study conducted by University of Texas physician, Dr. Steve Fisher. Using a step activity monitor (a fancy pedometer), the Texas team found that just an extra 600 steps a day, or about 12 total minutes of slow walking, could significantly shorten hospital stays. Although Dr. Fisher calls for further study, he still offered his optimism, “It’s encouraging to think that small changes can be of broad benefit.” Though physicians may have advised nursing staff to help the patient ambulate, nurses and aides frequently have little time for these tasks and the patient may not get up and walk enough. Dr. Fisher recommends that family members take the initiative and ask about getting a physical therapist involved early on and about whether the family is permitted to help the patient walk. One obstacle to an aggressive mobility plan is the risk of falls. Not only are they a valid concern for you and your loved one, but also for the hospital. Since 2008, a fall is grounds for Medicare to refuse to reimburse a hospital for a patient’s care. So, it’s understandable that the hospital might be overly cautious about families helping elderly patients walk. Nonetheless, Dr. Fisher still encourages families to look for safe ways to help elderly patients get up and walk. While falls can indeed be dangerous, the consequences of prolonged immobility may be worse. Reference: The New York Times (June 8, 2011): Escaping from the Hospital Bed

ELDER LAW / LONG TERM CARE

There are some things you just don’t haggle about but, perhaps contrary to what you would guess, it turns out that long-term care isn’t one of those things. Long-term care is expensive, to say the least, but as explained in a recent article in SmartMoney, there are some expenses that may be negotiable. Nursing homes usually will not negotiate fees, but you may be able to negotiate with assisted-living facilities and home health care agencies. Start by arming yourself with information. You can look up local costs at Genworth.com/costofcare on a map prepared by Genworth Financial, one of the country’s largest long-term care insurers. This can help you compare costs for various types of care in your area. MetLife offers another source of area-specific information at MatureMarketInstitute.com (click on “Research” then “2010 Market Survey of Long-Term Care Costs.”) Other resources include “Medicare and Home Health Care” which describes the home health benefits that Medicare covers (available at Medicare.gov) and the United Hospital fund’s “Next Step in Care” website for family caregivers. Other bargaining strategies to keep in mind: • As if there is a waiting list at the facility. If not, you may have more room to negotiate. • While nursing homes generally do not discount rates, you may be able to negotiate for extra amenities. • If a home-care agency has rates at the higher end of your local market, you may be able to get a lower rate if you let them know you are interviewing several agencies and taking cost into consideration. • If you hire a home-care agency for a significant number of weekday hours, that agency may be willing to discount any extra fees they charge for weekend work. You can learn more long-term care options on the Long-Term Care Practice Center at our website. While you’re there, be sure to subscribe to our free monthly e-newsletter. Link: http://www.smartmoney.com/article/SB10001424052702303654804576343331172222232.html?mod=SM_plan_ls4e&link=SM_plan_ls4e From SmartMoney (May 28, 2011) “Driving a Bargain for Long-Term Care

ELDER LAW / MEDICARE & SOCIAL SECURITY

In this article, MarketWatch’s Robert Powell takes on the problems and the hype surrounding Social Security and Medicare, as well as what they mean to you. The article first moves to cut through the media-created frenzy and outline some of the reasons why the situation isn’t so bad and that it’s important not to panic (you may also want to read a related article on retirement fears, also from MarketWatch: http://www.marketwatch.com/story/dont-let-fear-ruin-your-retirement-2011-05-23.) A few of the tips: continue working at least until your full retirement age, or to age 70 if possible, keep your skills up to date, and be sure to have disability insurance in case you need it Link: http://www.marketwatch.com/story/get-ready-for-social-security-medicare-meltdowns-2011-05-19 From MarketWatch (May 19, 2011) “Get Ready for Social Security, Medicare Meltdowns”

ESTATE PLANNING / ELDER LAW

This article offers a strong case for the need to plan for one’s death for reasons that are legal, economic, and most importantly, emotional. The article uses the example of Margie Jenkins, a psychotherapist turned author and professional speaker on end-of-life planning. Jenkins offers a list of legal and economic measures to put in place, as well as less obvious ideas. “We plan for weddings, we plan for the birth of a baby, we plan for vacations, we plan for everything. We think you should plan for the end of your life, too. There are just things that we think that you should think about doing, and many of them you can do now. We think people should put them into a file, give it a name, and tell their family what they're doing. Communication is so important, and you need to talk about this, and not whisper about it. It isn't going to go away, and we're all going to die someday.” Link: http://money.usnews.com/money/blogs/the-best-life/2011/05/25/living-well-should-include-planning-for-death From U.S. News and World Report – Money (May 25, 2011) “Living Well Should Include Planning for Death”