Michigan Estate Planning Blog

An Intermediary Care Service

Caring for an elderly loved one is, more often than not, ensuring that they receive the right care at the right time, and neither too much of it nor too little. This balancing act can be difficult, expensive and exhausting. Elder care options are often appreciated and one intermediary option was recently covered in an ElderLawAnswers post titled “Adult Day Care: Providing a Break for Caregivers.” While there are a number of types of actual facilities, sometimes you don’t quite want or need a facility. Perhaps you are not ready just yet or you hope to avoid them entirely. Increasingly, families are choosing to personally care for their elderly loved ones at home. The difficulty faced is the burden this places on the caregiver, and the limitations it imposes on the lifestyle of the elderly loved one. A convenient solution is adult day care, a service less diminutive than the name suggests and rather quite useful as an intermediary option to take much of the burden off of the caregiver. Adult day care programs vary widely, both in substance and in availability. As a result, it is wise to snoop around in your local area and consider your needs. The costs tend to be modest, in the grander scheme, and various health insurances or long-term care insurances will cover or defray the cost. Medicare, unfortunately, does not yet pay for this type of service.

Reference: ElderLawAnswers.com (April 11, 2014) “Adult Day Care: Providing a Break for Caregivers”

For more information, see www.jerryreiflawyer.com

Estate Planning And The Specter Of Alzheimer’s

Alzheimer’s is no ordinary condition. What it means to the patient and to their mind is simply unique, just as it is uniquely meaningful to the family. Unfortunately, it is also a uniquely meaningful condition when it comes to estate planning and there are very important steps to take sooner rather than later. Planning for one’s estate and for one’s late-in-life plans requires more than a bit of wherewithal. This is not only an empirical fact but also a legal one. Because Alzheimer’s and dementia affect the mind means certain legal choices, whether regarding healthcare or disposition of property to one’s heirs, simply have to be down and in writing well before they are questionable. It’s a complex problem. Fortunately, there are some important tools to keep in mind early and get a plan in place. Some of the basics were helpfully pointed out in a LifeHealthPro article last month titled “4 things to know about Alzheimer’s and estate planning.” The four things? • Collect Your Documents: that is, all of the important documents should be easily at hand or easily discoverable for when they are needed, and not by the patient but by whoever cares for them. • Property Management: perhaps more appropriately, you should have a plan for assets in this life and an estate plan to direct assets thereafter. • Advanced Directives: these documents spell out important decisions and/or give that decision-making power to others through a Durable Power of Attorney, a Living Will, and Medical Directives (like a Do Not Resuscitate order). • A Living Trust: a trust can be all the more useful in organizing and disposing of property as well as allowing another to manage it, which is that much more powerful for an Alzheimer’s patient. These are just the basics. Regardless, and not without coincidence, these are important basics steps and tools when it comes to any estate plan. Planning in anticipation of Alzheimer’s is no different than the planning one ought to do anyway. But then, to the extent many of us will be affected by Alzheimer’s or dementia, it only stands to reason that we should all be diligent in our planning. Once we have one of these conditions, it could be too late to plan for anything. Be sure to get your own estate in place and work with your elderly loved ones to ensure they have the plans in place allowing for you to care for them.

Reference: LifeHealthPro (March 11, 2014) “4 things to know about Alzheimer’s and estate planning”

For more information, see www.jerryreiflawyer.com

Study Shows Higher Estimates Of Deaths From Alzheimer's

Alzheimer’s disease is a unique challenge to a family. As you plan for old age, and even while planning for the estate itself, it is essential to plan accordingly. Unfortunately, some recently released bad news regarding Alzheimer’s has brought the need for proper planning into even sharper focus. Earlier this month, Reuters reported on a recent Alzheimer’s study in an article titled “Alzheimer's deaths much more common than realized: study.” Alzheimer’s is actually a fatal disease. However, the real toll from the disease occurs first during life. More to the point, the recent study found that, “Nearly half a million elderly Americans likely died from Alzheimer's disease in 2010, a figure almost six times higher than previous estimates of annual deaths.” The original Reuters article has much to say about the study and about the nature of the disease itself. Nevertheless, beyond the data, this news should get us thinking about what it means to be living and planning for old age or an estate in an era of Alzheimer’s. This is a story about medical facts, but Alzheimer’s also brings economic and legal issues to confront. If a loved one already shows signs of the disease, then there is much to learn and understand. Do not ignore the matter. Get help now, not later. Contact a qualified elder law attorney to help you with the legal issues and coordinate the professional resources you will need.

Reference: Reuters (March 5, 2014) “Alzheimer's deaths much more common than realized: study”

For more information, see www.jerryreiflawyer.com

 

No Inheritance Or Compensation For Services? Lesson Learned

Even if you do not live in Massachusetts, if you are caring for an elderly loved one and may or may not be an heir apparent, there is something to be learned from a recent case in the Bay State, Cheney v. Flood (84 Mass. App. Ct. 1134, Feb. 7, 2014). There is a difference between care given out of responsibility and that given out of expectation of payment. Similarly, there is a difference between payments for services and an inheritance. ElderLawAnswers considered the Cheney case in an article titled “Don't Just Hope for an Inheritance; Get It in Writing.” In the case in question, Suzanne M. Cheney and her family offered many services to her stepfather, Anthony R. Turco. They provided these services without an actual agreement for payment. Well, Anthony passed away and Suzanne was left out of any inheritance. Suzanne was, as a result, not happy. She took the estate to court, arguing that she was due reasonable compensation for her care independent of any inheritance. The court disagreed, finding that there was no evidence she offered her care with expectation of compensation. In reality, there truly is a difference between an inheritance and compensation for services rendered. It is easy to think the worst, but in these cases oftentimes is a very legitimate conversation to be had about the needs and expectations of the caregiver as much as the needs of the elderly loved one. If you care for an elderly loved one, there are some very real ways to structure the relationship that might serve to benefit everyone. These conversations (and written agreements) are much better worked out by family in advance than by a court later on.

Reference: ElderLawAnswers (March 17, 2014) “Don't Just Hope for an Inheritance; Get It in Writing”

For more information, see www.jerryreiflawyer.com

Planning for Late-In-Life Care

Planning for the health and proper care of an aging parent is no easy undertaking. That is a given. As a parent moves toward healthcare and assisted living there are myriad questions and issues to consider. These run the gamut from financial to medical and, yes, the emotional. By way of a primer, consider reading (and sharing) a recent Forbes article titled “The Basics: Assisted Living For Your Parent.” Some of the most important issues in planning for late- or end-of-life care include understanding the various kinds of facilities and treatments available. There is, for example, a decided difference between nursing home care and an assisted living situation. Even within assisted living communities there are many different kinds of facilities, from the large to the small and the homey to the clinical. In the end, you must know what to look for and what is appropriate for the elderly loved one in need of care. The key, if possible, is to include your loved in the evaluation process. Ensure that they are included in the discussions and options. Otherwise, expect resistance to change because the transition to care away from home is by nature very disruptive on many levels. Once you know the kind of care needed and your loved one is on board, then comes the question of how to pay for it and how to understand Medicaid, Medicare, and the programs that can help fill the gaps. Needless to say, this can be a complex process. Be sure to read and share the original article to help you and your loved one make a transition that is right for their circumstances.

Reference: Forbes (March 13, 2014) “The Basics: Assisted Living For Your Parent”

For more information, see www.jerryreiflawyer.com

Knowing Better Than The Professionals: New Medicare Rules And Knowing Your Rights

Sometimes big legal changes happen. Nevertheless, sometime you still have to point out these changes to the powers that be. Sometimes you must do so over and over for the real changes to manifest. As you may know, Medicare has recently undergone a big change affecting long-term care and the availability of skilled nursing or therapy. Namely, thousands are now eligible for Medicare benefits, but you might just have to point that out to care providers. The slow transition to full adoption of the rules and new standards of care, as well as the continuing plight of those left in a lurch, is discussed in a recent Reuters article titled “New Medicare coverage of long-term care off to a rocky start.” As pointed out there, you or a loved one may be eligible for benefits, but may need to fight to receive the benefits. Formerly, Medicare would only pay for skilled nursing or physical therapy sessions if there were signs of improvement. The trouble is that skilled nursing and therapy are not always about improvement but about maintenance, or even slowing a natural decline to keep a patient in a positive state. The rules were challenged and the case of Jimmo v. Sebelius brought about relaxed rules, allowing such services for far broader classes of patients. Medicare communicates these kinds of changes directly to healthcare providers and not to beneficiaries. However, it seems many beneficiaries are having to figure it out for themselves and push institutions to adopt the changes. As a Medicare beneficiary, it may be important to know what the new rules mean and how to advocate for your care or the care of a loved one. The original article offers some important resources like the Center for Medicare Advocacy, as well as the Medicare Rights Center. Each of these resources has some helpful guides and much more information on this and other relevant issues.

Reference: Reuters (April 29, 2014) “New Medicare coverage of long-term care off to a rocky start”

Long-Term Care Lapse Logistics

Do your elderly loved ones have a long-term care insurance policy or something similar? If yes, then they likely are relying on it to cover the potentially catastrophic financial risk that is long-term care. If yes, then what happens if they forget to pay the premiums? Do I have your attention now? If yes, then you will want to read a recent horror story in The New York Times - The New Old Age Blog titled “The Policy Lapsed, but No One Knew.” Generally speaking, any form of “insurance” exists to help minimize various financial risk exposures to the insured. In essence, you pay a premium you can afford (and the insurance company will accept) to cover a risk you cannot afford. Once insured, you really only need to think about the much easier task of remaining insured, which usually means making timely premium payments. Unfortunately for some families, remaining insured can sometimes present a few challenges uniquely associated with old age itself. What happens when the loved one begins to develop dementia and simply stops making the premium payments on the policy? Dementia is rather subtle before it becomes fairly dramatic. Accordingly, you may need to implement some financial safety precautions. The terrible lesson coming out of the original article is how the caregiver/son was diligent, but a mistake by his father at the bank snowballed into missed payments and a lapsed policy. The worst part of the horror story is that the cancellation notice from the insurer was never received - and the family was unaware of the policy lapse until they went to claim its benefits. Ultimately, the burden of proof was not on the insurer regarding whether the premium notice had been sent and received. Will there be a legislative reaction to stories like these? It seems this case will not go anywhere soon, but there may be more like it across the country.

Reference: The New York Times – The New Old Age (January 31, 2014) “The Policy Lapsed, but No One Knew”

For more information, see www.jerryreiflawyer.com

Medicare Rehab Requirements Relaxed?

Whenever the rules for receiving Medicare benefits change it has a real impact on real beneficiaries and patients. Sometimes legal changes occur literally overnight, while at other times the changes are more subtle. After a landmark lawsuit a year ago, there may be some tangible effects to the system – for the better. This is especially the case when an elderly loved one requires skilled nursing or physical therapy. The landmark case was Jimmo v. Sebelius. Recently, Forbes explored the legal evolution Jimmo sparked in an article titled “When Medicare Will Pay for Skilled Nursing or Physical Therapy.” The salient change concerns one of the guiding principles of Medicare, or at least what has been the common wisdom for years. This principle is the so-called “improvement standard.” The idea was that Medicare would pay for skilled nursing care or physical therapy only when the patient’s health had the potential to improve. Accordingly, the payments would cease when there was no more improvement to be had. Problem: skilled nursing and physical therapy are not necessarily just for curing a problem, but for managing it, especially among the elderly. Jimmo, however, provides that payment for these services will be made if they are “reasonable and necessary to prevent or slow further deterioration” and that benefits “cannot be denied based on the absence of potential for improvement or restoration.” Real changes have been slow as providers test the waters, and all the other rules regarding skilled care are in place. Nonetheless, an apparent misunderstanding has been put to rest and an entire class of real beneficiaries and patients can now be assured of receiving benefits. Those previously denied benefits may even have the option of having their coverage re-reviewed.

Reference: Forbes (January 31, 2014) “When Medicare Will Pay for Skilled Nursing or Physical Therapy”

For more information, see www.jerryreiflawyer.com

When Your Pacemaker Outlives You

Do you or a loved one live with a pacemaker or implanted defibrillator? How do you plan for end-of-life matters when one of these miraculous medical devices can keep you going and going and going long after your other essential bodily functions are otherwise shutting down? This scenario is all too common and is presenting challenges in geriatric medicine and palliative care. Recently, The New Old Age Blog took a look at this perplexing issue in an article titled “A Decision Deferred: Turning Off the Pacemaker.” Compounding the problem is the fact that standard medical directives are designed with feeding tubes and breathing support in mind. Rarely do such legal instruments address the question of a pacemaker, implanted defibrillator or other surgically implanted electronic heart monitor. These devices may extend life, and maybe not for the better, but without the directive who is empowered to direct when or even whether they should be turned off? Simply put: no one. So how many patients with these devices have built their wishes (whether on or off) into their plans and medical directives? In one survey of 150 elderly and dying Mayo clinic patients, more than half had a medical directive (and only that -- a bad statistic in itself). However, only one medical directive addressed the issue of the patient’s defibrillator.

Reference: The New York Times – The New Old Age Blog (January 29, 2014) “A Decision Deferred: Turning Off the Pacemaker”

For more infosrmation, see www.jerryreiflawyer.com

Will Your IRA Affect Your Medicaid Eligibility?

For many of us and the older loved ones for whom we may care, receiving needed medical care in old age will mean ensuring an easy transition into Medicaid. The problem, however, is that there are some strict financial rules governing eligibility to receive Medicaid benefits. Consequently, it is often all-too-easy to run afoul of them. Here is an important question to ask: “Can an IRA Affect Medicaid Eligibility?” ElderLawAnswers posed and answered this question, noting that the greatest asset many of us will own throughout our lives and well into old age will be our IRA or other retirement account. That said, just because you have the account doesn’t mean it can or will pay for the needed care. No, in the end you might need Medicaid. However, the mere existence of the IRA may cause you some trouble getting into the program. So, can an IRA affect Medicaid eligibility? The short answer is that “it depends.” It depends upon whether or not the IRA is in “payout status” (i.e., are taking minimum required distributions?). This might actually work differently than you’d expect. If your IRA is in payout status, then you might be in the clear. Medicaid allows you to have some income for personal use, after all. As a result, the payout from an IRA might be so small as to not cross the Medicaid income threshold and larger amounts will simply go to the nursing home until reduced to the small personal expense amount. If your IRA is not in payout status, however, then the IRA is non-exempt and can be held against you, potentially to full value. What to do with the IRA depends upon state law and the possibility of transfer versus cashing-out. Either option may not be pretty or productive. With proper planning beforehand you can help ensure that your assets won’t accidentally trigger a problem. IRAs can be tricky. Much of what you should do will depend upon your needs and your assets, with more than a little hanging on state law. Interpreting the relevant laws can mean a world of difference, so seek competent Elder Law counsel in structuring a plan.

Reference: ElderLawAnswers (March 28, 2014) “Can an IRA Affect Medicaid Eligibility?”

For more information, seee www.jerryreiflawyer.com

When Home Is Where The Healthcare Is, How Good Is The Care?

Receiving medical care in old age or securing it for a loved one is a difficult and often expensive choice to navigate. There are many options, paths and plans, to be sure. In the end, however, the choice can easily come down to finding that care at home or in a facility. How does the quality of care compare? Specifically, how good is the care at home? The answer seems to range from “we don’t know” to an unhelpful “it depends.” With so many people receiving care at home, either by default or by design, it is an important option to understand. A recent article in Forbes, titled “We All Want To Live At Home In Old Age, But Know Nothing About the Quality of Care We'll Get There,” to a look under the hood on this subject. The problem is a knowledge-vacuum. There are many levels of oversight for skilled nursing homes or other care facilities. On the other hand, there are few levels for care received in the home. In-home care may be delivered by a loved one, but it may also be delivered by a paid aide through Medicare home-based long-term services or some other program. There has been large expansion in the kinds of services available, but most of us have a hard time figuring out the quality of care available. Be sure to consult an experienced elder law attorney who is “plugged into” the network of care providers.

Reference: Forbes (March 19, 2014) “We All Want To Live At Home In Old Age, But Know Nothing About the Quality of Care We'll Get There”

For more information, see www.jerryreiflawyer.com

Will Your IRA Affect Your Medicaid Eligibility?

For many of us and the older loved ones for whom we may care, receiving needed medical care in old age will mean ensuring an easy transition into Medicaid. The problem, however, is that there are some strict financial rules governing eligibility to receive Medicaid benefits. Consequently, it is often all-too-easy to run afoul of them. Here is an important question to ask: “Can an IRA Affect Medicaid Eligibility?” ElderLawAnswers posed and answered this question, noting that the greatest asset many of us will own throughout our lives and well into old age will be our IRA or other retirement account. That said, just because you have the account doesn’t mean it can or will pay for the needed care. No, in the end you might need Medicaid. However, the mere existence of the IRA may cause you some trouble getting into the program. So, can an IRA affect Medicaid eligibility? The short answer is that “it depends.” It depends upon whether or not the IRA is in “payout status” (i.e., are taking minimum required distributions?). This might actually work differently than you’d expect. If your IRA is in payout status, then you might be in the clear. Medicaid allows you to have some income for personal use, after all. As a result, the payout from an IRA might be so small as to not cross the Medicaid income threshold and larger amounts will simply go to the nursing home until reduced to the small personal expense amount. If your IRA is not in payout status, however, then the IRA is non-exempt and can be held against you, potentially to full value. What to do with the IRA depends upon state law and the possibility of transfer versus cashing-out. Either option may not be pretty or productive. With proper planning beforehand you can help ensure that your assets won’t accidentally trigger a problem. IRAs can be tricky. Much of what you should do will depend upon your needs and your assets, with more than a little hanging on state law. Interpreting the relevant laws can mean a world of difference, so seek competent Elder Law counsel in structuring a plan.

Reference: ElderLawAnswers (March 28, 2014) “Can an IRA Affect Medicaid Eligibility?”

For m ore information, see www.jerryreiflawyer.com

When Home Is Where The Healthcare Is, How Good Is The Care?

Receiving medical care in old age or securing it for a loved one is a difficult and often expensive choice to navigate. There are many options, paths and plans, to be sure. In the end, however, the choice can easily come down to finding that care at home or in a facility. How does the quality of care compare? Specifically, how good is the care at home? The answer seems to range from “we don’t know” to an unhelpful “it depends.” With so many people receiving care at home, either by default or by design, it is an important option to understand. A recent article in Forbes, titled “We All Want To Live At Home In Old Age, But Know Nothing About the Quality of Care We'll Get There,” to a look under the hood on this subject. The problem is a knowledge-vacuum. There are many levels of oversight for skilled nursing homes or other care facilities. On the other hand, there are few levels for care received in the home. In-home care may be delivered by a loved one, but it may also be delivered by a paid aide through Medicare home-based long-term services or some other program. There has been large expansion in the kinds of services available, but most of us have a hard time figuring out the quality of care available. Be sure to consult an experienced elder law attorney who is “plugged into” the network of care providers.

Reference: Forbes (March 19, 2014) “We All Want To Live At Home In Old Age, But Know Nothing About the Quality of Care We'll Get There”

For more information, see www.jerryreiflawyer.com

Mental Health And Medicare Coverage Saginaw, Michigan

If you have not heard by now, as of January 1, a whole host of Obamacare provisions went into place. While we are really just beginning to parse them out, one change for elderly and Medicare beneficiaries that went into effect has been on the books since 2008 through the Medicare Improvements for Patients and Providers Act. Medicare will now cover costs for psychological care to the same degree as physical medical costs at the 80/20 Medicare/Beneficiary split. The New York Times - The New Old Age Blog took note of this change in a recent article aptly titled “Medicare to Cover More Mental Health Costs.” It seems psychological issues are often the most directly felt difficulties in the life and wellbeing of elderly Medicare beneficiaries. With the new change, the long-held gap in coverage between the costs for physical medicine and psychological care has now been closed. Consequently, more elderly beneficiaries will be able to afford the care that is uniquely suited to their own needs and happiness. Nonetheless, a few sources of disparity between medical and psychological care for the elderly remain, as further noted in the original article. Does this recent change affect an elderly loved one? If yes, be sure to help them seek appropriate mental healthcare.

Reference: The New York Times – The New Old Age Blog (December 27, 2013) “Medicare to Cover More Mental Health Costs”

For more information, see www.jerryreiflawyer.com

Mental Health And Medicare Coverage Mid-Michigan

If you have not heard by now, as of January 1, a whole host of Obamacare provisions went into place. While we are really just beginning to parse them out, one change for elderly and Medicare beneficiaries that went into effect has been on the books since 2008 through the Medicare Improvements for Patients and Providers Act. Medicare will now cover costs for psychological care to the same degree as physical medical costs at the 80/20 Medicare/Beneficiary split. The New York Times - The New Old Age Blog took note of this change in a recent article aptly titled “Medicare to Cover More Mental Health Costs.” It seems psychological issues are often the most directly felt difficulties in the life and wellbeing of elderly Medicare beneficiaries. With the new change, the long-held gap in coverage between the costs for physical medicine and psychological care has now been closed. Consequently, more elderly beneficiaries will be able to afford the care that is uniquely suited to their own needs and happiness. Nonetheless, a few sources of disparity between medical and psychological care for the elderly remain, as further noted in the original article. Does this recent change affect an elderly loved one? If yes, be sure to help them seek appropriate mental healthcare.

Reference: The New York Times – The New Old Age Blog (December 27, 2013) “Medicare to Cover More Mental Health Costs”

For more information, see www.jerryreiflawyer.com

Trust Funds – Not Just For The Well-To-Do Mid-Michigan

Despite much maligning and misunderstanding in the public imagination, “trust funds” are not as exotic or blue-blood exclusive as they are made out to be. In fact, the misunderstanding is an unfortunate one, and trusts are quite the powerful tool for the middle class to employ as well. Ready for a crash course in “trusts”? If yes, then check out a recent article in Fox Business titled “Is a Trust Right for You?” So is a trust right for you? Depending on your needs and the needs of your family, trusts can be as malleable as they are powerful. You can make a trust conform to just about any goal you can set. Think of it like this: a business entity, whether a corporation or a limited liability company (LLC), is something different than the owner or the manager. This is so the business entity can accomplish business goals higher and apart from the individual. Similarly, a trust is its own kind of entity, legally distinct from the one who sets it up (the settlor), the one that runs it (the trustee), and even those who receive from it (the beneficiaries). Why? Because the trust serves a singular purpose (or purposes) as determined by the settlor and carried out by the trustee. The major difference between a business entity and a trust is the focus – business or personal? So what goal(s) can move you to create this entity, the trust? There are many commonly shared goals and the original article covers the basics, to include these seven: 1. You Don’t Want Your Kids to Inherit at Age 18 2. You Want to Protect Against Creditors 3. You Want Someone Else at the Helm 4. You Have a Complicated Family Situation 5. You Want to Avoid the Probate Process 6. You Want to Take Care of a Disabled Child 7. You Want to Safeguard Your Privacy How do you accomplish these goals with a trust? Read more about it in the original article, and then put your pen to paper for a personal brainstorming session. The more you know the better you can plan for yourself and your loved ones.

Reference: FoxBusiness (October 25, 2013) “Is a Trust Right for You?”

Fior more information, see www.jerryreiflawyer.com

Medicaid Dilemma – Sell Or Keep Your Home? Mid- Michigan

The move to a nursing home is a big step. It is a major life transition for all family members. Your loved one will no longer be living in their own comfortable and familiar home. In addition, there is the issue regarding whether to retain or keep the home given the unpleasant knowledge that the home may ultimately pay for nursing home care either way.

This dilemma was the focus of a recent Q&A in ElderLawAnswers via the question, “Is It Better to Sell a Medicaid Recipient's Home Now or Wait Until Her Death?”

Essentially, by receiving Medicaid you make certain agreements as to costs and, in the case of nursing home care, the deal often hinges on that most valuable of all assets an elderly person is likely to own: their home. True, it is possible to liquidate and sell the house just to pay for the nursing home care. Although this often reduces or eliminates the costs for maintaining and insuring an empty house, this also means giving up Medicaid benefits until the sale proceeds have been expended for care.

On the other hand, Medicaid will remember your choice whether you sell the home and private pay until spend down or if you to continue receiving benefits in lieu of such sale. If a family member attempts to sell the house after the Medicaid recipient loved one passes, then Medicaid has a lien on the sale proceeds (limited to the amount Medicaid paid for the care of the Medicaid recipient). Either way, the home is subject to pay for nursing home care or to reimburse Medicaid for the cost of care.

The answer to the question posed to ElderLawAnswers hinges on more than a few factors. That said, in most cases Medicaid payments will be less than private pay, sometimes a great deal less. Consequently, the resulting lien may be less of a burden than selling the house outright!

Is there something else at work, however? Notably, is the family home worth keeping in the family? These are situations that require some delicacy.

Reference: ElderLawAnswers (updated October 17, 2013) “Is It Better to Sell a Medicaid Recipient's Home Now or Wait Until Her Death?”

For more information, see www.jerryreiflawyer.com

 

Medicaid Dilemma – Sell Or Keep Your Home? Saginaw, MI

The move to a nursing home is a big step. It is a major life transition for all family members. Your loved one will no longer be living in their own comfortable and familiar home. In addition, there is the issue regarding whether to retain or keep the home given the unpleasant knowledge that the home may ultimately pay for nursing home care either way. This dilemma was the focus of a recent Q&A in ElderLawAnswers via the question, “Is It Better to Sell a Medicaid Recipient's Home Now or Wait Until Her Death?” Essentially, by receiving Medicaid you make certain agreements as to costs and, in the case of nursing home care, the deal often hinges on that most valuable of all assets an elderly person is likely to own: their home. True, it is possible to liquidate and sell the house just to pay for the nursing home care. Although this often reduces or eliminates the costs for maintaining and insuring an empty house, this also means giving up Medicaid benefits until the sale proceeds have been expended for care. On the other hand, Medicaid will remember your choice whether you sell the home and private pay until spend down or if you to continue receiving benefits in lieu of such sale. If a family member attempts to sell the house after the Medicaid recipient loved one passes, then Medicaid has a lien on the sale proceeds (limited to the amount Medicaid paid for the care of the Medicaid recipient). Either way, the home is subject to pay for nursing home care or to reimburse Medicaid for the cost of care. The answer to the question posed to ElderLawAnswers hinges on more than a few factors. That said, in most cases Medicaid payments will be less than private pay, sometimes a great deal less. Consequently, the resulting lien may be less of a burden than selling the house outright! Is there something else at work, however? Notably, is the family home worth keeping in the family? These are situations that require some delicacy.

Reference: ElderLawAnswers (updated October 17, 2013) “Is It Better to Sell a Medicaid Recipient's Home Now or Wait Until Her Death?”

For more information, see www.jerryreiflawyer.com

 

MOPM – Managing Other People’s Money Mid-Michigan

Managing your own finances can be difficult at times. Whether you are smart with your own money is your call, as you will be the one to reap the rewards or suffer the consequences. Managing the finances of a loved one is a far more tenuous role to occupy.

If you are caring for an elderly loved one and stepping up to oversee their finances as well, then there are some important rules to know and follow.

Recently, the Consumer Financial Protection Bureau released four helpful guides on the topic of “Managing Someone Else’s Money.” In addition, for some short tips on the subject you can review the “4 rules for managing parents’ money,” a MarketWatch article released on Veterans Day.

The four tips – paraphrased – include:

1. Understand the power, meaning you have to understand what you can and cannot do under a power of attorney document.
2. Keep accounts separate, even if it can be a pain to moderate so many accounts, avoid the temptation to commingle funds that are not yours.
3. Document everything, even if it means doubling down on the bookkeeper.
4. Be watchful for exploitation by others, because being in charge of the finances does not mean you are the only one who exerts some financial control or influence. Those seeking to take financial advantage of the elderly include strangers and loved ones themselves.

In reality, there is much more to know and follow when managing other people’s money. Nevertheless, you certainly will be held to the basics. Remember to keep the CFPB guides and the MarketWatch article available for handy reference.

In truth there are many little rules for managing finances, but these are the basics that you need to accomplish to do the job. If there is time, you and your elderly loved one ought to plan now so you are prepared to fulfill your management role and the challenges ahead.

Reference: MarketWatch (November 11, 2013) “4 rules for managing parents’ money”

For more information, see www.jerryreiflawyer.com

MOPM – Managing Other People’s Money

Managing your own finances can be difficult at times. Whether you are smart with your own money is your call, as you will be the one to reap the rewards or suffer the consequences. Managing the finances of a loved one is a far more tenuous role to occupy.

If you are caring for an elderly loved one and stepping up to oversee their finances as well, then there are some important rules to know and follow.

Recently, the Consumer Financial Protection Bureau released four helpful guides on the topic of “Managing Someone Else’s Money.” In addition, for some short tips on the subject you can review the “4 rules for managing parents’ money,” a MarketWatch article released on Veterans Day.

The four tips – paraphrased – include:

1. Understand the power, meaning you have to understand what you can and cannot do under a power of attorney document.
2. Keep accounts separate, even if it can be a pain to moderate so many accounts, avoid the temptation to commingle funds that are not yours.
3. Document everything, even if it means doubling down on the bookkeeper.
4. Be watchful for exploitation by others, because being in charge of the finances does not mean you are the only one who exerts some financial control or influence. Those seeking to take financial advantage of the elderly include strangers and loved ones themselves.

In reality, there is much more to know and follow when managing other people’s money. Nevertheless, you certainly will be held to the basics. Remember to keep the CFPB guides and the MarketWatch article available for handy reference.

In truth there are many little rules for managing finances, but these are the basics that you need to accomplish to do the job. If there is time, you and your elderly loved one ought to plan now so you are prepared to fulfill your management role and the challenges ahead.Reference:

MarketWatch (November 11, 2013) “4 rules for managing parents’ money”

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Social Security Likes Diet COLA

According to the numbers recently released by the Social Security Administration, 2014 will be a “diet COLA” year. That means the Cost Of Living Adjustment (COLA) made to Social Security payments will only be a 1.5% increase. ElderLawAnswers weighed in on the news in an article titled “Social Security Benefits to Rise Only 1.5 Percent in 2014,” while the SSA has issued its own COLA Fact Sheet. The COLA is an important adjustment for many Social Security beneficiaries, especially those on a fixed income. These can be very important dollars and cents. If costs of living go up on an annual basis, then Social Security beneficiaries would be left with fewer dollars to purchase more expensive goods (and services) without the COLA increase. On a positive note, this COLA increase is welcome. Historically, there have been years without any COLA increase. That noted, at 1.5% the 2014 COLA is still less than the 1.7% COLA in 2013, which some regarded as too low. The math, as summarized by ElderLawAnswers, works out like this: Starting in January 2014, the average monthly Social Security retirement payment will rise from $1,275 to $1,294 a month for individuals and from $2,080 to $2,111 for couples. The 1.5 percent increase will apply to both elderly and disabled Social Security recipients, and individuals who receive both disability and retirement Social Security will see increases in both types of benefits. The maximum Social Security benefit for a worker retiring at full retirement age, which is age 66 for those born between 1943 and 1954, will be $2,642 a month. The good news is that it is not all bad news. While the SSA is seeing a lower COLA, it is worth noting that Medicare Part B will not be seeing an increase from the 2013 standard monthly premium of $104.90. In the end, then, for many beneficiaries 2014 might not be too unreasonable.

Reference: ElderLawAnswers (October 31, 2013) “Social Security Benefits to Rise Only 1.5 Percent in 2014”

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Social Security Likes Diet COLA in Virginia

Appealing Denial Of Medicare Treatment Saginaw, MI

Medicare Advantage plans can make certain decisions regarding their plans and what will be covered, as they should. After all, this discretion is what keeps them in business and from being “gamed” by scammers. That noted, the plans are not always right when exercising their discretion to deny doctor-prescribed treatments or procedures. If you (or a loved one) have a Medicare Advantage plan, then it is important to be prepared should the plan itself overrule your doctor and deny you coverage. That certainly would be an unfortunate turn of events! Fortunately, you can seek to overrule coverage denied by your Medicare Advantage plan, but you must know how. While you can be denied coverage, it is important to remember that the Medicare Advantage plan is not the final arbiter and you can appeal their decision. This is an important right built into the very structure of Medicare. A timely article in ElderLawAnswers.com titled “Appealing Medicare Advantage Plan Decisions” provided some insights into this process. Did you know that above every Medicare plan is the judicial oversight of an Administrative Law Judge (ALJ)? When the plan makes an adverse coverage decision, first you should appeal to their better judgment. If you are unsuccessful, then you can go over their heads and appeal to the ALJ. But wait, there is more. If you are unsuccessful before the ALJ, then go even higher to the Medicare Appeals Council (MAC). Be aware, however, that at this level the process becomes a matter of litigation and all that entails time and money. Nevertheless, litigation is sometimes a necessary evil to pursue necessary care (and justice). You may never need to challenge a denial of coverage. In case you do, however, it is best to be prepared and that means being well-informed regarding your rights.

Reference: ElderLawAnswers.com (last modified September 26, 2013) “Appealing Medicare Advantage Plan Decisions”

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Related articles

Appealing Denial Of Medicare Treatment in Virginia

Medicaid Eligibility When The “Community Spouse” Dies First Mid-Michigan

When one member of an elderly couple moves to a nursing home, even as a Medicaid beneficiary, proper estate planning must be done for both spouses. Failure to plan for the “community spouse” can have unintended consequences. It is not uncommon. One spouse, the institutional spouse, is in a nursing home and is qualified to receive Medicaid benefits to pay for their care. The other spouse, the community spouse, remains at home. Typically, the institutional spouse dies first, but not always. The issues arising when the community spouse dies first was the subject of a recent article in ElderLawAnswer.com titled “Staying Eligible for Medicaid after the Death of a Spouse.” When one spouse passes away, especially the one not receiving benefits, it affects the surviving spouse in many financial ways that can jeopardize the very benefits keeping them in the nursing home and receiving the care they need.

Reference: ElderLawAnswer.com (October 2013) “Staying Eligible for Medicaid after the Death of a Spouse”

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Capital Gains, Gift, Charity, Estate Law, Estate Planning, Tax Law Saginaw, MI

If we live long enough, eventually we may require some form of care. That is just a fact of aging. However, with some planning in advance, we may have more options regarding where that care is given. Would you rather stay at home or be moved to an institution? If you would prefer to stay at home, then you are in good company. According to the AARP, 9 in 10 Americans say they want to grow old at home as long as possible. In-home care was the subject of a recent article in The Wall Street Journal titled “When to Consider In-Home Care.” Not everyone can find the appropriate in-home care, even while options are rapidly expanding. Depending upon the community and your needs (or the needs of your elderly loved ones), there are many creative ways to make your in-home care a reality. For example, doctors and nurses can make house calls, while personal care assistants can help with shopping, cooking, cleaning, etc. As needs increase, in-home care at the level of basic assisted-living or nursing home care can be found, and often at far less expense. None of these options come without consequences. As a result, it is worth understanding the attending challenges. Living at home, after all, will limit socialization. More to the point, if care is given directly by a family member, then there is the toll on their life and health, too. After you read the original article, spend some time looking into your own community. You might just find that your best option is more readily available than you thought. When it is all said and done, you just might be able to stay at home that much longer.

Reference: The Wall Street Journal (September 15, 2013) “When to Consider In-Home Care”

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Medicaid Eligibility When The “Community Spouse” Dies First Saginaw, MI

When one member of an elderly couple moves to a nursing home, even as a Medicaid beneficiary, proper estate planning must be done for both spouses. Failure to plan for the “community spouse” can have unintended consequences. It is not uncommon. One spouse, the institutional spouse, is in a nursing home and is qualified to receive Medicaid benefits to pay for their care. The other spouse, the community spouse, remains at home. Typically, the institutional spouse dies first, but not always. The issues arising when the community spouse dies first was the subject of a recent article in ElderLawAnswer.com titled “Staying Eligible for Medicaid after the Death of a Spouse.” When one spouse passes away, especially the one not receiving benefits, it affects the surviving spouse in many financial ways that can jeopardize the very benefits keeping them in the nursing home and receiving the care they need.

Reference: ElderLawAnswer.com (October 2013) “Staying Eligible for Medicaid after the Death of a Spouse”

For more information, see www.jerryreiflawyer.com

 

 

When There’s No One To Bat For You (Health Care Agents) Saginaw, MI

Truly, it is a blessing to have a family to share life with you. That fact is no clearer should the time come to make life-and-death health decisions on your behalf. But what if you have no “family” to name as your healthcare proxy or as the agent on your power of attorney? The New Old Age blog of The New York Times recently took up the question of “When There’s No Family.” This is an especially difficult problem for many seniors. They oftentimes need someone to wield a power of attorney and even a medical directive to go to bat in their interests with medical staff, not to mention settling aspects of the estate. While there are close friends for many seniors even in lieu of family, it is still not uncommon to be without even these. According to the American Bar Association’s Commission on Law and Aging, “perhaps 4 percent of older adults are ‘the unbefriended elderly,’ a chilling phrase referring to those who cannot make decisions for themselves, have no advance directive or surrogate decision maker, and have no family or friends able to assist.” Unfortunately, there are few easy solutions. Even engaging a professional to serve in such capacities can be a difficult road, too. The professional will be bound to certain standards and difficult legal requirements. In addition, not everyone can serve in this capacity, especially the medical staff an elderly person may have come to befriend and rely upon. Fortunately, solutions are emerging -- like the notion of a “care community” of elderly individuals looking after one another, financially, medically and often legally. Whether such a solution is open to you, it is still absolutely vital to have robust advanced directives concerning end-of-life decisions. Make sure you have appointed someone you know and trust to speak for you and do for you when you cannot. The importance of having your end-of-life wishes committed to writing cannot be overemphasized.

Reference: The New York Times – The New Old Age (September 23, 2013) “When There’s No Family”

For more information, see www.jerryreiflawyer.com

 

 

When It Is Time To Return Home From The Nursing Home Mid-Michigan

When an elderly loved one falls, or is otherwise injured, it can spark a few rough transitions: car from home to hospital for care, and from hospital to nursing home to recover. However, one of the most difficult transitions can be returning home from the nursing home, even after your elderly loved one no longer needs to be there. Every state is different, but most states sponsor a special Medicaid program paid for by federal dollars that allows a senior to transition all the way back home to receive their care there. The program is called Money Follows the Person. For a firsthand account, read a recent Kaiser Health News article titled “Moving People Home After Nursing Home Stay Is Complicated.” It is the story of Dorothy Holmes who was able to return to her home with the help of Massachusetts Medicaid. Although the Holmes story and the details of the program highlighted are specific to Massachusetts, some 45 states have adopted similar such programs. The common key is that the programs identify Medicaid patients who are and have been in nursing homes for at least 90 days, but simply no longer need to be there. Consequently, these programs help them transition home and continue the Medicaid payments for their care. Not only is there a strong legal reason and ethical motive behind helping people return home, but it makes good sense in terms of dollars and cents, too. It is less expensive to provide home care than it is institutional care. Therefore, the program is a win-win for all involved. If you have a loved one in this position, then it is worth exploring your options. Transitioning home from a nursing home can be tricky, especially since you do not want to lose the nursing home benefits just because you do not need to be in a nursing home setting. This program, if available, may find your loved one on its own or it might be something to proactively contact directly. For that matter, too, it is worth noting that there may be other options for many patients. In many instances it is merely a matter of finding and figuring them out.

Reference: The Kaiser Health News (August 16, 2013) “Moving People Home After Nursing Home Stay Is Complicated”

For more information, see www.jerryreiflawyer.com

 

 

 

When There’s No One To Bat For You (Health Care Agents) Saginaw, MI

Truly, it is a blessing to have a family to share life with you. That fact is no clearer should the time come to make life-and-death health decisions on your behalf. But what if you have no “family” to name as your healthcare proxy or as the agent on your power of attorney? The New Old Age blog of The New York Times recently took up the question of “When There’s No Family.” This is an especially difficult problem for many seniors. They oftentimes need someone to wield a power of attorney and even a medical directive to go to bat in their interests with medical staff, not to mention settling aspects of the estate. While there are close friends for many seniors even in lieu of family, it is still not uncommon to be without even these. According to the American Bar Association’s Commission on Law and Aging, “perhaps 4 percent of older adults are ‘the unbefriended elderly,’ a chilling phrase referring to those who cannot make decisions for themselves, have no advance directive or surrogate decision maker, and have no family or friends able to assist.” Unfortunately, there are few easy solutions. Even engaging a professional to serve in such capacities can be a difficult road, too. The professional will be bound to certain standards and difficult legal requirements. In addition, not everyone can serve in this capacity, especially the medical staff an elderly person may have come to befriend and rely upon. Fortunately, solutions are emerging -- like the notion of a “care community” of elderly individuals looking after one another, financially, medically and often legally. Whether such a solution is open to you, it is still absolutely vital to have robust advanced directives concerning end-of-life decisions. Make sure you have appointed someone you know and trust to speak for you and do for you when you cannot. The importance of having your end-of-life wishes committed to writing cannot be overemphasized.

Reference: The New York Times – The New Old Age (September 23, 2013) “When There’s No Family”

For more information, see www.jerryreiflawyer.com

 

 

When It Is Time To Return Home From The Nursing Home

When an elderly loved one falls, or is otherwise injured, it can spark a few rough transitions: car from home to hospital for care, and from hospital to nursing home to recover. However, one of the most difficult transitions can be returning home from the nursing home, even after your elderly loved one no longer needs to be there. Every state is different, but most states sponsor a special Medicaid program paid for by federal dollars that allows a senior to transition all the way back home to receive their care there. The program is called Money Follows the Person. For a firsthand account, read a recent Kaiser Health News article titled “Moving People Home After Nursing Home Stay Is Complicated.” It is the story of Dorothy Holmes who was able to return to her home with the help of Massachusetts Medicaid. Although the Holmes story and the details of the program highlighted are specific to Massachusetts, some 45 states have adopted similar such programs. The common key is that the programs identify Medicaid patients who are and have been in nursing homes for at least 90 days, but simply no longer need to be there. Consequently, these programs help them transition home and continue the Medicaid payments for their care. Not only is there a strong legal reason and ethical motive behind helping people return home, but it makes good sense in terms of dollars and cents, too. It is less expensive to provide home care than it is institutional care. Therefore, the program is a win-win for all involved. If you have a loved one in this position, then it is worth exploring your options. Transitioning home from a nursing home can be tricky, especially since you do not want to lose the nursing home benefits just because you do not need to be in a nursing home setting. This program, if available, may find your loved one on its own or it might be something to proactively contact directly. For that matter, too, it is worth noting that there may be other options for many patients. In many instances it is merely a matter of finding and figuring them out.

Reference: The Kaiser Health News (August 16, 2013) “Moving People Home After Nursing Home Stay Is Complicated”

For more information, see www.jerryreiflawyer.com

 

 

When It Is Time To Return Home From The Nursing Home Saginaw, MI

When an elderly loved one falls, or is otherwise injured, it can spark a few rough transitions: car from home to hospital for care, and from hospital to nursing home to recover. However, one of the most difficult transitions can be returning home from the nursing home, even after your elderly loved one no longer needs to be there. Every state is different, but most states sponsor a special Medicaid program paid for by federal dollars that allows a senior to transition all the way back home to receive their care there. The program is called Money Follows the Person. For a firsthand account, read a recent Kaiser Health News article titled “Moving People Home After Nursing Home Stay Is Complicated.” It is the story of Dorothy Holmes who was able to return to her home with the help of Massachusetts Medicaid. Although the Holmes story and the details of the program highlighted are specific to Massachusetts, some 45 states have adopted similar such programs. The common key is that the programs identify Medicaid patients who are and have been in nursing homes for at least 90 days, but simply no longer need to be there. Consequently, these programs help them transition home and continue the Medicaid payments for their care. Not only is there a strong legal reason and ethical motive behind helping people return home, but it makes good sense in terms of dollars and cents, too. It is less expensive to provide home care than it is institutional care. Therefore, the program is a win-win for all involved. If you have a loved one in this position, then it is worth exploring your options. Transitioning home from a nursing home can be tricky, especially since you do not want to lose the nursing home benefits just because you do not need to be in a nursing home setting. This program, if available, may find your loved one on its own or it might be something to proactively contact directly. For that matter, too, it is worth noting that there may be other options for many patients. In many instances it is merely a matter of finding and figuring them out.

Reference: The Kaiser Health News (August 16, 2013) “Moving People Home After Nursing Home Stay Is Complicated”

For more information, see www.jerryreiflawyer.com

 

 

Watch Your Language – End-Of-Life Health Care Great Lakes Bay Region, MI

Words are important. Use them carefully, especially when preparing your estate planning documents. When it comes to your health care directives, the words you choose can be a matter of life and death. A recent post over at The New Old Age Blog in “DNR by Another Name” illustrates the importance of words and their legal import. It is worth reading the original article (and perhaps even the study it discusses). Consider this: how a doctor presents a medical choice can lead a caregiver or patient in one direction or the other. For example, as taken from the title of the article, DNR, or “Do Not Resuscitate” is a medical term of art. However, it often means the same as “please allow for a natural death” depending upon the medical situation, the decisions of the patient, and even (or often exclusively) the very word choices and/or mood of the doctor themselves. As one planning your own late-in-life decisions, language is a topic worthy of your careful consideration. Additionally, if you are caring for an elderly loved one, then be sure both of you understand your loved one’s advance health care wishes and take steps to clearly articulate them in proper medical directives. Do not assume anything when it comes to the ultimate health care decisions. Make sure the patient, their appointed health care agent and the physician are all speaking the same language. Communication and documentation are essential.

Reference: The New Old Age Blog – The New York Times (May 22, 2013) “DNR by Another Name”

For more information, see www.jerryreiflawyer.com

 

Promissory Notes and Medicaid Qualification Saginaw, MI

Medicaid can mean a world of difference when it comes to ensuring proper care for your elderly loved ones, especially when they are running out of assets. When their major remaining “countable” asset is an illiquid asset, what are their options short of depleting it or risking a fraudulent transfer? As you may well know, Medicaid is the source of nursing home care for many indigent Americans. Still others are caught in a netherworld of being above the minimum asset threshold for qualification, but having too few assets to realistically pay for their care. It’s a sticky situation. A promissory note may be one alternative to explore, as noted in a recent article at ElderLawAnswers.com titled “How Can Promissory Notes Be Used in Medicaid Planning?” The focus of the article is a recent federal case out of Oklahoma, but the basics apply generally. Essentially, an elderly woman transferred her farm and accounts to her son in exchange for a promissory note. A note is a legally binding contract to repay as fixed sum and so it clears the Medicaid hurdle in question. In this instance, this approach indeed saved the farm and the elderly woman received her nursing home care through Medicaid. Nevertheless, a promissory note is not a full-proof plan. For one, many states reject the idea and refuse to recognize promissory notes. For another, the plan can only work because promissory notes are legally binding contracts, and so if the note cannot be repaid there are potential tax burdens that may be triggered. The article also points out there are several tools, like the promissory note, that can prove useful when seeking legitimate Medicaid qualification. This especially is true if you plan well in advance. Danger! The Medicaid qualification rules vary from state to state. This is not a self-help project, as you may find yourself (and your elderly loved one) in a tricky financial and legal purgatory if you make any missteps.

Reference: ElderLawAnswers (May 15, 2013) “How Can Promissory Notes Be Used in Medicaid Planning?”

For more information, see www.jerryreiflawyer.com

 

Recordkeeping Key When Caring for Senior Parents

Are you spending any time and money taking care of your parents? Do you intend to take any tax deductions for your assistance? If yes, then mind your recordkeeping or you may forego the deductions. The case of Estate of Olivo v. Commissioner is most instructive. Forbes examined the Olivo case in an article titled “Mother's Day? Son Claims $1.2M Tax Write-Off For Helping Mom.” From the title of the article, it is clear that the son may have been a bit generous in his claim. To make matters even more interesting, the son was a tax attorney. Background: Anthony Olivo was the son/tax attorney. He took nearly ten years away from his law practice to care for his parents. Accordingly, Anthony lost his law practice income. However, he did collect fees from his parents for managing their estates. When Anthony’s mother died, he sought to deduct $44,200 in administrator’s fees, $55,000 in accountant’s and attorney’s fees, and a whopping $1,240,000 for a near-decade’s worth of lost wages (he did manage his own firm, after all). The IRS raised an eyebrow, and then raised it further when they took a look at his documentation of all of these fees and amounts. Problem: there was no contract, no invoice, and no evidence. Not good. Even when Anthony was handling the estate and filing the tax return he didn’t keep track of his time and just estimated. Also, not good. In reality, not everything claimed may have been deductible. Nevertheless, the lack of recordkeeping killed any chance for success. If you and your loved ones are entering a period of caregiving, then a little forethought and planning can go a long way. In the end, a little recordkeeping can be the deciding factor in making your claim.

Reference: Forbes (May 8, 2013) “Mother's Day? Son Claims $1.2M Tax Write-Off For Helping Mom”

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When Having “The Talk,” Experts Advise Going to Mom First

Have you had “the talk” with your senior parents? You know, the one about their finances? According to experts, ask Mom first. Fidelity Investments specifically suggests that moms are the best source of open dialogue, even when it comes to the “money talk.” In fact, MarketWatch recently considered this in an article titled “In family-money talks, start with mom.” A summary of the numbers from that article: In the survey of 975 parents and 152 adult children, 64% of mothers said it was “not at all difficult” to start a conversation with an adult child about their finances; only 54% of fathers felt the same way. In addition, 79% of women, versus 69% of men, reported having had “comprehensive discussions” with their adult children about estate planning or wills. The same was true of 66% of women vs. 56% of men about health and elder-care topics and 70% of women vs. 55% of men about running out of money in retirement. Although there are many reasons why moms might be the best to approach, most of them are mere conjecture. More important, however, is the reality that senior parents really do not enjoy talking about their finances. That is understandable. All that noted, “the talk” needs to be had, sooner rather than later.

Reference: MarketWatch (May 7, 2013) “In family-money talks, start with mom”

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Hospice Not Feeling the Love from Medicare

Healthcare in the U.S. has been in a state of transition since 2010. Unfortunately, many of the most important aspects of healthcare reform, those promising to protect the elderly and those in end-of-life care, have yet to take effect. As reported quite recently through the Kaiser Health News, hospice care has yet to be expanded under the Medicare project set out three years ago. The article titled “Medicare Lags In Project to Expand Hospice” examines the very real conflict between “curative” treatment and “palliative” treatment. The former is meant to cure a condition and thereby prolong life, and the latter is meant to ease the pain caused by a condition without a focus on effecting a cure. Naturally, the curative and palliative treatments are often considered opposites. In fact, choosing palliative care would mean giving up all hope on curative care. Consequently, it is only natural that rapidly declining patients delay their entry into palliative hospice care. The 2010 law was to begin inroads into exploring combined care, the possibility of both curative and palliative concurrently. Logically, this should ease transitions without forsaking hopes, likely reducing costs in the process. To date, however, this has not happened. Health care planning is complicated, and since so much is at stake be sure to consult a professional when exploring your options.

Reference: Kaiser Health News (May 9, 2013) “Medicare Lags In Project to Expand Hospice”

For more information, see www.jerryreiflawyer.com

 

When HIPAA Happens

No one likes hospitals, except when you need one. Unfortunately, families caring for their elderly loved ones are finding hospitals and other care facilities full of legal red tape that is increasingly difficult to navigate. Sometimes the red tape is simply hospital policy gone too far. Regardless, navigating the maze requires doing your homework ahead of time. For example, what do you know about HIPAA? HIPAA is the “Health Insurance Portability and Accountability Act of 1997.” The title of a recent article in the New Old Age Blog of The New York Times summarizes the issue well: “A Privacy Law Often Misinterpreted.” One purpose of the law is to ensure the privacy of medical data. Nevertheless, this doesn’t mean the hospital is intended to protect the privacy of the patient from their loved ones, especially when that loved one is present during an examination! In fact, HIPAA does not prevent health care providers from sharing relevant information regarding a patient with their family members, unless the patient objects. The original article is a worthy and enlightening read, whether you are a patient, a family member or even a medical professional. Apparently, there is a lot of misinformation leading to misinterpretation when it comes to HIPAA. Bottom line: make sure you have up-to-date Advance Health Directives that specifically provide your designated agents with current and future access to all of your medical information, verbal and written, with specific authority to execute HIPAA releases on your behalf.

Reference: The New York Times – The New Old Age Blog (March 27, 2013) “A Privacy Law Often Misinterpreted”

For more information, see www.jerryreiflawyer.com

 

When HIPAA Happens Saginaw, Michigan

No one likes hospitals, except when you need one. Unfortunately, families caring for their elderly loved ones are finding hospitals and other care facilities full of legal red tape that is increasingly difficult to navigate. Sometimes the red tape is simply hospital policy gone too far. Regardless, navigating the maze requires doing your homework ahead of time. For example, what do you know about HIPAA? HIPAA is the “Health Insurance Portability and Accountability Act of 1997.” The title of a recent article in the New Old Age Blog of The New York Times summarizes the issue well: “A Privacy Law Often Misinterpreted.” One purpose of the law is to ensure the privacy of medical data. Nevertheless, this doesn’t mean the hospital is intended to protect the privacy of the patient from their loved ones, especially when that loved one is present during an examination! In fact, HIPAA does not prevent health care providers from sharing relevant information regarding a patient with their family members, unless the patient objects. The original article is a worthy and enlightening read, whether you are a patient, a family member or even a medical professional. Apparently, there is a lot of misinformation leading to misinterpretation when it comes to HIPAA. Bottom line: make sure you have up-to-date Advance Health Directives that specifically provide your designated agents with current and future access to all of your medical information, verbal and written, with specific authority to execute HIPAA releases on your behalf.

Reference: The
New York Times – The New Old Age Blog (March 27, 2013) “A Privacy Law Often Misinterpreted”

For more informaton, see www.jerryreiflawyer.com

 

Tax Savings for Supporting Your Elderly Parent Saginaw, Michigan

It’s officially tax time, and if you have been caring for an elderly parent you may find that Uncle Sam can help with some of those costs through favorable tax treatment. Depending upon your circumstances, you may be able to claim your parent as a dependent, take a dependency care tax credit, deduct a portion of their medical expenses or get some combination of these tax breaks. Forbes offers guidance on whether you might qualify in a recent article “How To Claim Tax Breaks For Supporting Your Parents." If you think you may qualify, consult an accountant or tax professional to maximize your tax savings. Sadly, caregiving frequently also means managing end-of-life care ... and the attendant expenses. While it may be difficult to focus on financial matters during these stressful times, tax breaks can help extend available resources. Of course, the first step is to determine which expenses qualify and to what extent. Expenses that frequently apply to people with advanced illness include health insurance premiums not paid through work, deductibles, co-pays, medication, alternative care, medical supplies such as bandages, dental care, Medicare B premiums, lodging while traveling for care, and transportation costs. The IRS has a very detailed list of what is and isn’t deductible in Publication 502. You can refer to this publication for details, as well as to another excellent Forbes article, “Save Money On Taxes At The End Of Life -- How And Why It Matters.” Again, be sure to consult your accountant or tax professional if you think you may have qualifying expenses. The tax savings could be significant, and could help ease an otherwise difficult burden.

References: Forbes (January 29, 2013)
“How To Claim Tax Breaks For Supporting Your Parents”

Forbes (February 4, 2013) “Save Money On Taxes At The End Of Life -- How And
Why It Matters”

Fosr more information, see www.jerryreiflawyer.com

 

Tax Savings for Supporting Your Elderly Parent Saginaw, Michigan

It’s officially tax time, and if you have been caring for an elderly parent you may find that Uncle Sam can help with some of those costs through favorable tax treatment. Depending upon your circumstances, you may be able to claim your parent as a dependent, take a dependency care tax credit, deduct a portion of their medical expenses or get some combination of these tax breaks. Forbes offers guidance on whether you might qualify in a recent article “How To Claim Tax Breaks For Supporting Your Parents." If you think you may qualify, consult an accountant or tax professional to maximize your tax savings. Sadly, caregiving frequently also means managing end-of-life care ... and the attendant expenses. While it may be difficult to focus on financial matters during these stressful times, tax breaks can help extend available resources. Of course, the first step is to determine which expenses qualify and to what extent. Expenses that frequently apply to people with advanced illness include health insurance premiums not paid through work, deductibles, co-pays, medication, alternative care, medical supplies such as bandages, dental care, Medicare B premiums, lodging while traveling for care, and transportation costs. The IRS has a very detailed list of what is and isn’t deductible in Publication 502. You can refer to this publication for details, as well as to another excellent Forbes article, “Save Money On Taxes At The End Of Life -- How And Why It Matters.” Again, be sure to consult your accountant or tax professional if you think you may have qualifying expenses. The tax savings could be significant, and could help ease an otherwise difficult burden.

References: Forbes (January 29, 2013)
“How To Claim Tax Breaks For Supporting Your Parents”

Forbes (February 4, 2013) “Save Money On Taxes At The End Of Life -- How And
Why It Matters”

For more information, see www.jerryreiflawyer.com

 

Health Care Costs – Location, Location, Location Saginaw, Michigan

A cup of coffee will cost you just a bit more or a bit less depending on where you get it. Interestingly, however, the cost isn’t necessarily dependent on how good the coffee tastes. No, when it comes to geography and what you pay for something, remember the three things that determine real estate prices: location, location and location. And the effect of location on medical care and old-age expenses can be significant. Planning for your old-age, or for the needs of an elderly loved one, is partly a test of geography in the health care economy. In fact, it’s more important to understand this fact of life now more than ever. For some fresh analysis of this familiar topic, you might want to take a look at a recent Morningstar article titled “Health-Care Costs: Why Your Location Really Matters.” The article speaks to the “numbers” and to international comparisons. Regardless, the key for you to note is not the economics or even the politics behind this issue, but rather the very real circumstances you and your loved ones may be facing now or in the future. So, how will you plan for the geography of medical expenses?

Reference: Morningstar (January 11, 2013) “Health-Care Costs: Why Your Location Really Matters"

For more information, see www.jerryreiflawyer.com

When It’s Time To Take Dad’s Car Keys Saginaw, Michigan

Some life transitions are easier to accept, and some are momentous. Remember the freedom you felt as a teenager when you learned to drive? If yes, then you can appreciate how difficult it is for elderly loved ones to relinquish that sense of freedom. For so many who have stepped in to oversee or care for an elderly loved one, the most dreaded transition that is so often fought is from driver to passenger: how do you make mom or dad give up the car?

For some guidance on handling this common, but difficult life transition, read a recent Forbes article titled “True Story: The Prominent Dad With Dementia Who Refused to Stop Driving.”

Reference: Forbes (January 7, 2013) “True Story: The Prominent Dad With Dementia Who Refused to Stop Driving”

For more information, see www.jerryreiflawyer.com

 

Can You Appeal a Denied Medicare Claim? Saginaw, Michigan

A doctor’s note can sometimes be a golden ticket – the proof you need to obtain the care for your health needs. But what happens when those needs are denied by Medicare? Roughly 10 percent of all Medicare claims are denied, which can be defeating for those who are in need of care. But don’t fret; you have the right to fight for your coverage. Reuters recently published an article explaining “How to appeal when Medicare won't pay.” It is not an uncomplicated process, but if Medicare refuses to pay for services your doctor recommends it’s certainly worth your while to fight. The numbers are fairly enlightening: In 2010, 40 percent of Part A appeals and 53 percent of Part B appeals were granted, according to the Centers for Medicare & Medicaid Services, which administers Medicare (CMS). Even in the case of big ticket durable medical equipment appeals, 44 percent of appeals were successful. More than half of appeals to Medicare Advantage and prescription drug plans are successful, too. Medicare consumer advocates offer these tips for filing an appeal: 1. Send a letter. Your paper trail starts with the summary notice of coverage you get in the mail. Take this notice, circle the erroneous denial, and write out why you think it should be covered. Make a copy, and mail one. 2. Don’t waste time. You have 120 days to file an appeal for Medicare Part B claims, and only 60 days for Medicare Advantage or Part D. If you filed for pre-approval and were denied, you have only 14 days to initiate your appeal. 3. Be persistent. You have a right to four levels of appeal, so don’t quit until you have exhausted all of your options. 4. Get help. For appeals beyond the first level, you may want to seek help from an elder law attorney. If you have questions about your Medicare claims and rights to appeal, seek appropriate counsel to assist in the process.

Reference: Reuters
(November 13, 2012) “How to appeal when Medicare won't pay”

For more information, see www.jerryreiflawyer.com

 

Can You Appeal a Denied Medicare Claim? Saginaw, Michigan

A doctor’s note can sometimes be a golden ticket – the proof you need to obtain the care for your health needs. But what happens when those needs are denied by Medicare? Roughly 10 percent of all Medicare claims are denied, which can be defeating for those who are in need of care. But don’t fret; you have the right to fight for your coverage. Reuters recently published an article explaining “How to appeal when Medicare won't pay.” It is not an uncomplicated process, but if Medicare refuses to pay for services your doctor recommends it’s certainly worth your while to fight. The numbers are fairly enlightening: In 2010, 40 percent of Part A appeals and 53 percent of Part B appeals were granted, according to the Centers for Medicare & Medicaid Services, which administers Medicare (CMS). Even in the case of big ticket durable medical equipment appeals, 44 percent of appeals were successful. More than half of appeals to Medicare Advantage and prescription drug plans are successful, too. Medicare consumer advocates offer these tips for filing an appeal: 1. Send a letter. Your paper trail starts with the summary notice of coverage you get in the mail. Take this notice, circle the erroneous denial, and write out why you think it should be covered. Make a copy, and mail one. 2. Don’t waste time. You have 120 days to file an appeal for Medicare Part B claims, and only 60 days for Medicare Advantage or Part D. If you filed for pre-approval and were denied, you have only 14 days to initiate your appeal. 3. Be persistent. You have a right to four levels of appeal, so don’t quit until you have exhausted all of your options. 4. Get help. For appeals beyond the first level, you may want to seek help from an elder law attorney. If you have questions about your Medicare claims and rights to appeal, seek appropriate counsel to assist in the process.

Reference: Reuters
(November 13, 2012) “How to appeal when Medicare won't pay”

For more information see www.jerryreiflawyer.com

 

The Holidays: A Time To Check On Your Elderly Loved Ones Saginaw Michigan

The holiday season is upon us! Turkey, pumpkin pie and all the trimmings are making their way to the family dinner table and guests are arriving to spend quality time with their loves ones. As you settle in with your family to express your thankful thoughts of the year, take the time to check in with your elderly loved ones to make sure they are supporting themselves and assess any care needs they may have. It’s an unfortunate burden of thought during the holidays, but that doesn’t mean it isn’t an important one to bear in mind: as written by the Wall Street Journal not too long ago, you’ve got to ask, is it “Time for Elder Care?” And then there’s the other half of it: you’ve got to observe, understand, and react in such a way as to truly help the situation. It’s easy to over-react when the well-being of your loved ones is at stake. Take the opportunity this holiday season to assess their needs and then, if something is amiss, work to find specific solutions. Your loved ones might not need full-time care, but perhaps a housekeeper or even gift cards for a few restaurant meals might help. If additional assistance is needed, assess the situation and look for the most appropriate benefits – local, state, veteran, or specific group benefits are important first steps – and be careful in your timing. Refer to the original article for more advice on this important topic. As you check in with your loves ones, make the most of your time with them and enjoy the wonderful holiday season ahead!

Reference: The Wall Street Journal (November 4, 2012) “Time for Elder Care?”

 For more information see www.jerryreiflawyer.com

 

Intentionally Defective Grantor Trust (IDGT)

When it comes to transferring real estate, you have many options. However, one you ought to investigate is the Intentionally Defective Grantor Trust (IDGT). The ins and outs of the venerable IDGT was explored recently in a Forbes article titled “Reduce Estate Taxes Without Reducing Your Liquidity.” It’s better not to wade too deeply into what makes an IDGT “intentionally defective,” except to say it creates a unique tax situation. Moving the real estate (perhaps your personal residence) into the IDGT will count as a gift in the year you make the transfer, even though you’ll still be living in the house. Effectively, you are setting up your own trust as a landlord, and yourself as tenant, complete with rent payments into your own trust. Properly done, in the process you will enjoy a great number of tax advantages. Employing an IDGT to transfer the family home may be a perfect technique to maximize your wealth transfers, particularly in a soft real estate market with an uncertain estate and gift tax future. Could an IDGT be a clever estate planning move for you? Seek professional counsel to find out more.

Reference: Forbes (September 4, 2012) “Reduce Estate Taxes Without Reducing Your Liquidity

Avoiding the (Medicare) “Doughnut Hole”

Even with the Affordable Care Act (ACA) – Obamacare by any other name – well in place and affirmed by the Supreme Court, the costs paid and lifestyles lived by many is being tied to the “doughnut hole.” This especially is true for seniors taking depression medications. As recently reported in Med Page Today, a new study by Yuting Zhang, PhD, of the University of Pittsburgh, Medicare may not fully cover depression medications for seniors, despite the ACA. The article is titled “Antidepressants 'Fall' Through Doughnut Hole.” If you are unfamiliar with the “doughnut hole” issue, you are not alone. It is the coverage gap created by Medicare Part D. For those whose income is at the lower end, there tends to be coverage. Likewise, for those who have an upper-end income, there is still coverage… with a gap in between. According to the new study, and sheer intuition, patients that fall within the doughnut hole are associated with a significant drop in medication use – 12% on average. That is always relevant, but perhaps especially so in the case of depression medication. While discontinuing any prescribed medication is never advisable, it is often easier to justify foregoing depression medication than other medications. I certainly recommend reading the original article for more details regarding this study, should this issue be relevant to you or someone you love.

Reference: Med Page Today (July 5, 2012) “Antidepressants 'Fall' Through Doughnut Hole”

Your Gait Could Be A Key Leading Indicator of Alzheimer’s Disease

Early diagnosis of Alzheimer’s is key to planning for and managing the disease. More treatment options are available when the diagnosis is made sooner, and certainly more estate planning options remain open with earlier diagnosis. Of course, Alzheimer’s and dementia are difficult to diagnose, but recent studies suggest that changes in a person’s walking gait can provide striking early evidence of cognitive impairment. Cognitive disease symptoms steadily destroy our ability to plan for the disease itself. This troubling fact carries over to the legal issues of “mental capacity” when it comes time to plan your estate. So, what are the outward warning signs of present or future issues? Some new studies have come to light about walking and dementia. The New York Times recently addressed this connection in an article titled “Footprints to Cognitive Decline and Alzheimer’s Are Seen in Gait.” According to recent findings, a person’s gait – the way he or she walks – can be an early indicator of oncoming impairment for some. It seems the more difficulty a person has walking, the more difficult it is to process certain information. In fact, the results of testing were even more dramatic when persons where required to engage in various mental exercises while walking. Although neither conclusive nor confirmed, there seems to be a link between exercise and cognitive impairments.

Reference: The New York Times (July 16, 2012) “Footprints to Cognitive Decline and Alzheimer’s Are Seen in Gait”

Avoiding the (Medicare) “Doughnut Hole”

Even with the Affordable Care Act (ACA) – Obamacare by any other name – well in place and affirmed by the Supreme Court, the costs paid and lifestyles lived by many is being tied to the “doughnut hole.” This especially is true for seniors taking depression medications. As recently reported in Med Page Today, a new study by Yuting Zhang, PhD, of the University of Pittsburgh, Medicare may not fully cover depression medications for seniors, despite the ACA. The article is titled “Antidepressants 'Fall' Through Doughnut Hole.” If you are unfamiliar with the “doughnut hole” issue, you are not alone. It is the coverage gap created by Medicare Part D. For those whose income is at the lower end, there tends to be coverage. Likewise, for those who have an upper-end income, there is still coverage… with a gap in between. According to the new study, and sheer intuition, patients that fall within the doughnut hole are associated with a significant drop in medication use – 12% on average. That is always relevant, but perhaps especially so in the case of depression medication. While discontinuing any prescribed medication is never advisable, it is often easier to justify foregoing depression medication than other medications. I certainly recommend reading the original article for more details regarding this study, should this issue be relevant to you or someone you love.

Reference: Med Page Today (July 5, 2012) “Antidepressants 'Fall' Through Doughnut Hole”

Government Now Tracks Time Spent Providing Elder Care

There’s rarely a shortage of personal stories about giving care to an elderly loved one. While there has been some private sector data on the subject, now there is official governmental information directly from the Bureau of Labor Statistics. The Bureau is the very same agency that publishes information on the Consumer Price Index, the Producer Price Index, and just about every government statistic, including the American Time Use Survey. This survey works to quantify how much time Americans devote to various tasks – and have to devote to those tasks in the first place. Interestingly, the survey has begun to include the activity of providing unpaid care to someone over age 65 “because of a condition relating to aging.” As reported in a recent post in The New York Times - The New Old Age Blog in an article titled “New Numbers on Elder Care,” the Bureau has wanted to track this activity since 2003. Nevertheless, the addition is fairly recent and the results for 2011 have been published. The summaries shed light on the experiences of many Americans. One of the key lessons to learn is that it is never too early to plan for the caregiving of elder ones loved ones.

Reference: The New York Times – The New Old Age Blog (July 5, 2012) “New Numbers on Elder Care”

Art Therapy for Alzheimer’s Patients

Caring for an elderly loved one with dementia or Alzheimer’s is a difficult thing, often both for the caregiver and the patient. This is especially true when it comes to effective communication. Enter “art therapy.” According to a recent article in The New York Times (The New Old Age Blog) titled Art Therapy For Alzheimer's Patients, art helps to comfort and often even invigorate a patient by giving them “something” with which to associate that does not require verbal interaction. As a result, various museums have begun programs with care professionals to provide guided tours for patients. These tours through exhibits offer patients the opportunity to associate with and discuss the art on display. According to the article, the experience also has proven to be a pleasurable activity for the caregivers, even if neither the caregiver nor the patient was an art-buff beforehand. So, if you have a loved one who has Alzheimer’s or dementia, then you might check with your local art museum and inquire about an art therapy program. Who knows, perhaps your suggestion just might initiate a similar program in your hometown.

Reference: The New York Times – The New Old Age Blog (April 13, 2012) “Reconnecting Through Art”