Avoid Family Disagreements over Caregiving

June 2, 2022

Taking care of a loved one can be all consuming and taxing to family relationships. According to the “Caregiving in the U.S. 2020” report by AARP and the National Alliance for Caregiving, “about one in five caregivers report experiencing high financial strain as a result of providing care.” This is especially true for those involved in high-intensity caregiving for over 21 hours a week, who often deplete their savings and go into debt. However, there are steps you can take to avoid family disagreements over caregiving.

AARP’s recent article entitled “How Caregivers Can Stop Arguing About Money” says caregiving-related money conflicts are only partially about dollars and cents. Some are predicated on differences in priorities:

Should the family’s finite resources be directed to the care recipient or spread among all family members?
Should the cost of something like a front door ramp for a parent’s house be borne equally by all the adult siblings or solely by the primary caregiver who lives with that parent?
Should a declining parent give all her assets to the adult child committed to caregiving or divide them among her children?

Caregivers, care recipients and other family members may have different answers to such questions and then can get into heated discussions. This can mean hard feelings that can destroy family relationships during the caregiving years and beyond. Here are a few ideas on how to avoid such conflicts:

One strategy to help caregiving families avoid constant financial conflict is to handle little and big questions differently. For the little decisions that need to be made every day, such as which pharmacy to use, family members should defer to the primary caregiver’s judgment. However, for more consequential decisions like selling the family home to help pay for a parent’s nursing home care, all family members should feel their opinions are sought out and respected. It is typically the family members who feel like their voices aren’t heard, who protest the most loudly and cause the fiercest debates.

If caregiving family members still can’t find a way to stop arguing about money, then they should consider meeting with a member of the clergy, a family therapist, or elder mediator. A pro is trained to manage emotions, clarify points and frame acceptable compromises. They can help avoid further disagreements over caregiving that can cause damage to already damaged family relationships. If you would like to learn more about caregiving, or long-term care facilities, please visit our previous posts.

Reference: AARP (Feb. 8, 2022) “How Caregivers Can Stop Arguing About Money”

Photo by Kampus Production

Caring for sick Parent can be Challenging

March 24, 2022

Caring for a sick parent can be challenging and emotional time. It’s not uncommon for adult children to have to face a parent’s decline and a stay in hospice at the end of their life. The children are tasked with trying to prepare for his passing. This includes how to handle his financial matters.

Seniors Matter’s recent article entitled “How do I handle my father’s financial matters now that he’s in hospice?” says that because of this major task, it is easy to put financial considerations on the back burner. Nonetheless, it is important to address a few key issues with your family.

If a family member is terminally ill or admitted to hospice – and you are able to do so – it may be a good idea to start by helping to take inventory of your family member’s assets and liabilities. A clear idea of where their assets are and what they have is a great starting point to help you prepare and be in a better position to manage the estate.

An inventory may include any and all of the following:

Real estate
Bank accounts
Cars, boats and other vehicles
Stocks and bonds
Life insurance
Retirement plans (such as a 401(k), a traditional IRA, a Roth IRA and a SEP IRA);
Wages and other income
Business interests
Intellectual property; and
Any debts, liabilities and judgments.

Next, find out what, if any, estate planning documents may be in place. This includes a will, powers of attorney, trusts, a healthcare directive and a living will. You will need to find copies.

Caring for a sick parent while also managing their financial affairs can be challenging, but it can make the aftermath easier and less stressful for you and your family. If you are interested in reading more about elder care issues, please visit our previous posts.

Reference: Seniors Matter (Feb. 22, 2022) “How do I handle my father’s financial matters now that he’s in hospice?”

Photo by Kampus Production from Pexels

Advance Care Planning a Benefit to Seniors

March 23, 2022

Advance care planning (ACP) is an ongoing discussion that involves shared decision-making to clarify and document an individual’s wishes, preferences and goals regarding their medical care. This is extremely important to making certain that they get the medical care they want, if they become incapacitated and unable to make their own decisions. Advance care planning is a major benefit to seniors. Despite the importance of ACP, most Americans don’t have their medical wishes documented, according to Medical Life Sciences News’ recent article entitled “Comprehensive approach may promote Advance Care Planning for elderly adults.”

In the pandemic, too many families exhausted themselves attempting to address this issue, agonizing over what their loved one might have chosen for their care if they had been given the chance.

Dr. Angelo Volandes, MD, MPH, physician and researcher, Division of General Internal Medicine at Massachusetts General Hospital, and colleagues started the Advance Care Planning: Communicating with Outpatients for Vital Informed Decisions (ACP-COVID) pragmatic trial. This experiment was designed to see if ACP participation during the pandemic would increase following implementation of video decision aids and clinician communication skills training. They also looked at how these interventions would affect ACP documentation among patients from ethnic and racial minority groups, specifically African Americans and Hispanics.

The trial included a large, diverse patient population aged 65+ from 22 outpatient clinics at Northwell Health, the largest healthcare system in New York State. ACP documentation from three six-month time periods was compared:

Pre-COVID-19
The first wave of COVID-19; and
An intervention period.

The findings showed that ACP documentation was significantly greater among all groups during the intervention period, with African American and Hispanic patients showing the most significant increases.

“The stark disparity in COVID-related outcomes for African American and Hispanic patients highlights a reality already known by many: our healthcare system routinely fails to meet the needs of minority patients. No one intervention or initiative is going to correct all those failings though advance care planning, through engaging and empowering patients, is one of the most effective, immediate ways to address disparities in care,” adds Volandes, who is also an Associate Professor of Medicine at Harvard Medical School.

“Fundamentally, advance care planning aims to empower patients. The results of our study demonstrate the importance of meeting patients where they are,” adds Volandes. “Whether that means providing information in their native language or sharing educational material via text rather than a patient portal, if advance care planning is to be about the patient and we need to find ways to ensure that they feel they have the knowledge and ability to make decisions alongside their clinicians when they deem the time is right. COVID-19 has made ACP more important than ever, and especially in communities that have been hardest hit by the pandemic.” The bottom line is that advance care planning can be a huge benefit to seniors and their caregivers. Work closely with an elder law attorney to begin the planning process. If you would like to learn more about long-term care and nursing home planning, please visit our previous posts.

Reference: Medical Life Sciences News (Feb. 28, 2022) “Comprehensive approach may promote Advance Care Planning for elderly adults”

Photo by RODNAE Productions from Pexels

Medicaid Annuity might be an Option

March 7, 2022

What happens when one spouse needs nursing home care? Medicare typically does not cover long-term care. The current median monthly cost of a private room at a nursing home is about $8,000, according to the recent article “A ‘Medicaid annuity’ may be a useful option when your spouse needs nursing home care” from CNBC. For people with limited assets and income, Medicaid will pay. However, what about families who have some assets but are not wealthy enough to be able to pay for their care without leaving the well spouse impoverished? It is a common situation, which requires advance planning. A Medicaid annuity might be an option for your family to consider.

For some families, spending down assets by paying off debt or making purchases to qualify is one way. For others, buying a Medicaid Compliant Immediate Annuity is another. This allows the couple to convert countable assets for Medicaid purposes into an income stream for the well spouse.

Medicaid Compliant Annuities are complex financial instruments and are not for everyone. They are often used in a crisis situation, when there are no other options.

Medicaid has a five-year look-back period in most states. The program reviews all assets and transactions from the prior five years to make sure assets were not transferred out of ownership solely so the person can qualify for Medicaid.

All assets are counted, whether they are owned by the ill spouse or the well spouse. The limits on assets, which include cash, investments and bank accounts, among others, vary slightly by state. However, they can be as low as $2,000. An experienced elder law attorney helps to navigate this process.

For a married couple, in some states, the healthy spouse may have up to $137,400 in total assets. Anything above that is considered available to use for long-term care. Some states have limits on income, while other states do not count the healthy spouse’s income.

If a couple has $100,000 above the state’s asset cap, they can purchase an annuity payable to the well spouse, based on their own life expectancy. For the annuity to be Medicaid compliant, it must meet several requirements. The state has to be named the remainder beneficiary for at least the amount Medicaid paid for the sick spouse’s nursing home care. The annuity must be an immediate annuity, meaning the income stream begins immediately, and it must be irrevocable.

Medicaid programs are run by the state, so each state has its own rules, asset limits, etc. A detailed conversation with a local elder law attorney with experience with Medicaid will be helpful in deciding of a Medicaid annuity might be an option for you. There are some states that do not allow the use of annuities for Medicaid planning. If you would like to learn more about Medicaid planning, please visit our previous posts.

Reference: CNBC (Jan. 26, 2022) “A ‘Medicaid annuity’ may be a useful option when your spouse needs nursing home care”

Photo by RODNAE Productions from Pexels

Naming Power of Attorney is extremely important

March 3, 2022

Naming a person to serve as your Power of Attorney is an extremely important part of your estate plan, although it is often treated like an afterthought once the will and trust documents are completed. Naming a POA needs to be given the same serious consideration as creating a will, as discussed in this recent article “Avoid powers of attorney mistakes” from Medical Economics.

Choosing the wrong person to act on your behalf as your Power of Attorney (POA) could lead to a host of unintended consequences, leading to financial disaster. If the same person has been named your POA for healthcare, you and your family could be looking at a double-disaster. What’s more, if the same person is also a beneficiary, the potential for conflict and self-dealing gets even worse.

The Power of Attorney is a fiduciary, meaning they are required to put your interests and the interest of the estate ahead of their own. To select a POA to manage your financial life, it should be someone who you trust will always put your interests first, is good at managing money and has a track record of being responsible. Spouses are typically chosen for POAs, but if your spouse is poor at money management, or if your marriage is new or on shaky ground, it may be better to consider an alternate person.

If the wrong person is named a POA, a self-dealing agent could change beneficiaries, redirect portfolio income to themselves, or completely undo your investment portfolio.

The person you name as a healthcare POA could protect the quality of your life and ensure that your remaining years are spent with good care and in comfort. However, the opposite could also occur. Your healthcare POA is responsible for arranging for your healthcare. If the healthcare POA is a beneficiary, could they hasten your demise by choosing a substandard nursing facility or failing to take you to medical appointments to get their inheritance? It has happened.

Most POAs, both healthcare and financial, are not evil characters like we see in the movies, but often incompetence alone can lead to a negative outcome.

How can you protect yourself? First, know what you are empowering your POAs to do. A boilerplate POA limits your ability to make decisions about who may do what tasks on your behalf. Work with your estate planning attorney to create a POA for your needs. Do you want one person to manage your day-to-day personal finances, while another is in charge of your investment portfolio? Perhaps you want a third person to be in charge of selling your home and distributing your personal possessions, if you have to move into a nursing home.

If someone, a family member, or a spouse, simply presents you with POA documents and demands you sign them, be suspicious. Your POA should be created by you and your estate planning attorney to achieve your wishes for care in case of incapacity.

Different grown children might do better with different tasks. If your trusted, beloved daughter is a nurse, she may be in a better position to manage your healthcare than another sibling. If you have two adult children who work together well and are respected and trusted, you might want to make them co-agents to take care of you.

Naming a Power of Attorney is an extremely important part of your estate plan. Your estate planning attorney has seen all kinds of family situations concerning POAs for finances and healthcare. Ask their advice and don’t hesitate to share your concerns. They will be able to help you come up with a solution to protect you, your estate and your family. If you would like to read more about how powers of attorney work, please visit our previous posts.

Reference: Medical Economics (Feb. 3, 2022) “Avoid powers of attorney mistakes”

Photo by August de Richelieu from Pexels

Preventing Long-Term Care Abuse

January 26, 2022

Elder financial abuse is always upsetting, but it’s even worse when a parent is in a long-term care facility and adult children aren’t there to prevent it or stop it. This is especially true during the pandemic, when restrictions meant to keep residents safe from COVID make them more vulnerable to scammers. Preventing long-term care abuse should be top of mind for adult children.

The federal Consumer Financial Protection Bureau recently released a guide to prevent this very same problem, as reported in the article “Preventing Elder Financial Abuse When Your Parent Is In Long-Term Care” from next avenue.

The goal is to help professionals who work with the facilities to recognize red flags, develop policies and protocols and use technology to prevent residents from becoming victims. There’s also a lot of good information in the guide for the children of residents.

One reason elder financial abuse occurs so easily in long-term care facilities is because members of care teams can easily get access to financial records as well as medical records. Putting protections in place before financial abuse happens is the best strategy.

Banking and credit card accounts should be monitored regularly, and fraud alerts should be set up to be sent to the individual and a designated, trusted contact. An outside professional may also be hired to watch over the person’s finances.

Experts recommend listening to their loved ones during visits, online or in person. When a senior complains about money or personal belongings going missing, don’t assume these are part of cognitive issues. Take steps to investigate and document findings.

If an aging parent mentions a strange phone call or an unusual request by a staff member, immediately check their accounts, even if they insist no personal information was shared. Scammers are very good at what they do and can easily convince a victim nothing wrong has occurred. Even if something didn’t occur this time, a single phone call or conversation may be a warning of the parent being on someone’s radar as a possible victim.

Pay attention if small amounts of cash are missing from accounts. Scammers typically begin small, testing the waters to see if the person, their family, or the financial institution is paying attention. Banks cannot discuss your parent’s finances with their investment advisor, due to privacy rules, so the designated family member needs to be in touch with any institutions handling their money.

One of the most common ways of preventing long-term care abuse is a durable Power of Attorney. If no family member has been given Power of Attorney over financial accounts, this is a must-do, as long as the parent has legal capacity to grant this power. The POA gives the person the legal ability to manage financial accounts. If the person is incapacitated, it may be necessary for the child to be named guardian. An estate planning attorney will be able to discuss the situation and recommend the best way forward for the individual and their family. If you would like to learn more about elder financial abuse, or long-term care abuse, please visit our previous posts.

Reference: next avenue (Dec. 17, 2021) “Preventing Elder Financial Abuse When Your Parent Is In Long-Term Care”

Photo by David Henry from Pexels

Costs of Long-Term Care can be Challenging

December 30, 2021

The potential costs of long-term care be challenging for even a relatively prosperous patient if they are forced to stay for some time in a nursing home. SGE’s recent article entitled “How to Pay for Long-Term Care” explains that although long-term care insurance can be a good way to pay for long-term care costs, not everyone can buy a policy. Insurance companies won’t sell coverage to people already in long-term care or having trouble with activities of daily living. They may also refuse coverage, if you have had a stroke or been diagnosed with dementia, cancer, AIDS or Parkinson’s Disease. Even healthy people over 85 may not be able to get long-term care coverage.

However, there are a number of options for covering these expenses, including the following:

Federal and state governments. While the federal government’s health insurance plan doesn’t cover most long-term care costs, it would pay for up to 100 days in a nursing home if patients required skilled services and rehabilitative care. Skilled home health or other skilled in-home service may also be covered by Medicare. State programs will also pay for long-term care services for people whose incomes are below a certain level and meet other requirements.
Private health insurance. Employer-sponsored health plans and other private health insurance will cover some long-term care costs, such as shorter-term, medically necessary skilled care.
Long-term care insurance. Private long-term care insurance policies can cover many of the costs of long-term care.
Private savings. Older adults who require long-term care that’s not covered by government programs and who don’t have long-term care insurance can use money from their retirement accounts, personal savings, brokerage accounts and other sources.
Health savings accounts. Money in these tax-advantaged savings can be withdrawn tax-free to pay for qualifying medical expenses, such as long-term care. However, only those in high-deductible health plans can put money into health savings accounts.
Home equity loans. Many older adults have paid off their mortgages or have a lot of equity in their homes. A home equity loan is a way to tap this value to pay for long-term care.
Reverse mortgage. This allows a homeowner to get what amounts to a home equity loan without paying interest or principal on the loans while they’re alive. When the homeowner dies or moves out, the entire balance of the loan becomes due. The lender usually takes ownership.
Life insurance. Asset-based long-term care insurance is a whole life insurance policy that permits the policyholder to use the death benefits to pay for long-term care. Life insurance policies can also be purchased with a long-term care rider as a secondary benefit.
Hybrid insurance policies. Some long-term care insurance policies are designed annuities. With a single premium payment, the insurer provides benefits that can be used for long-term care. You can also buy a deferred long-term care annuity that’s specially designed to cover these costs. Some permanent life insurance policies also have long-term care riders.

While the costs of long-term care can be challenging, most people will not face extremely burdensome long-term care costs because nursing home stays tend to be short, since statistics show that most people died within six months of entering a nursing home. Moreover, the vast majority of elder adults aren’t in nursing homes, and many never go into them. If you would like to learn more about long-term care, please visit our previous posts.

Reference: SGE (Dec. 4, 2021) “How to Pay for Long-Term Care”

Photo by Kampus Production from Pexels

When to have Healthcare conversation with Parents?

December 23, 2021

You have been noticing that your mother or father appears to be in cognitive decline. But you wonder when to have a healthcare conversation with your parents? Waiting until a senior’s decline is apparent may already be too late, says CNBC’s recent article entitled “Waiting to talk finance with an aging parent in cognitive decline is a mistake, experts say.”

Adult children should be talking to their elderly parents about this while they’re still working because they’re still competent and still able to fund long-term care and pay the premiums from income.

Some incidents that could trigger these conversations include a parent thinking about downsizing, claiming Social Security, going on an extended trip, or finding out one of their friends is going into long-term care.

Adult children should ask questions to get a clear sense of their parents’ financial situation. However, they should understand that getting this information may take several discussions.

Here are questions to ask your parents in stages, over a period of time (from least uncomfortable to most):

Where do you keep your financial and estate planning documents?
What assets do you have and what are your debts?
Is it possible to meet with your advisors to have a good understanding in the event of a crisis?
Who are your healthcare professionals?
What medications do you take and where’s your pharmacy?
Do you have long-term care insurance or other plans for long-term care?
What are your wishes as to end-of-life care and funeral plans and expenses?
If you have a medical crisis, what kind of treatment do you want?

Evaluate your parents’ responses with the help of an elder law attorney to these basic questions and plan the next steps.

There’s some paperwork that should be done at this point, if it hasn’t already. This includes a power of attorney, healthcare directive and a living will. Do not wait to have a healthcare conversation with your parents. Discuss your options and seek advice from an experienced Elder Law attorney. If you are interested in learning more about Elder Law, please visit our previous posts.

Reference: CNBC (Nov. 30, 2021) “Waiting to talk finance with an aging parent in cognitive decline is a mistake, experts say”

Photo by Andrea Piacquadio from Pexels

Ways to reduce Financial Elder Abuse

December 17, 2021

The numbers are chilling. One in ten Americans age 60+ has experienced elder abuse. One of the most common forms of elder abuse is financial, says a recent article from Forbes titled “What Is Elder Financial Abuse—And How Do We Prevent It?” There are ways to reduce financial elder abuse.

Financial elder abuse is defined as when someone illegally or improperly uses an elderly person’s money for their own use. Elderly people are easy victims for obvious reasons. They may be mentally vulnerable, suffering from Alzheimer’s or other form of dementia. They may also be lonely and find the company of a new “friend” is so delightful that it impairs their judgement.

Financial elder abuse occurs most often from adult children, but also in nursing homes and assisted living facilities. Be on the watch for those new friends who enter senior’s lives, especially if they seek to limit contact with family members.

Caregivers or nursing staff have access to resident’s possessions, including checkbooks, ATM cards and credit cards. Monitoring an elderly parent’s bank accounts on a regular basis should be part of caregiving by adult children. Unusual transactions, large withdrawals or unlikely purchases by credit card should immediately be reported to their bank or credit card company.

Less obvious and harder to track, is when someone forces a nursing home resident to sign legal documents transferring ownership of homes, cars, bank accounts and even investment accounts. They may also be pressured into creating a new will.

Here are some red flags to watch for:

New names being added to bank accounts or on credit cards.
Finding unpaid bills, letters from collection agencies or past due notices from creditors, especially when the person has sufficient funds.
Relatives who suddenly show up and want to be involved with an aging senior, including estranged children.
The unexpected transfer of any kind of asset to someone who is not a family member.
Any change in habits concerning money, including someone who was never worried about money suddenly being concerned about paying bills.

The elderly are often scared to report being victimized. They may fear further loss of control over their lives or be embarrassed to have been scammed. If a caregiver is stealing, they may also be physically threatened, or frightened of losing their familiar care provider.

There are ways to reduce financial elder abuse. Talk to your estate planning attorney, speak with the local Adult Protective Services office, or contact the National Elder Fraud Hotline, if you are concerned about a loved one being financially exploited. If you believe a loved one is in physical danger, contact the local police. Don’t hesitate to ask for help. If you are interested in learning more about elder abuse, please visit our previous posts.

Reference: Forbes (Nov. 9, 2021) “What Is Elder Financial Abuse—And How Do We Prevent It?”

Photo by Greta Hoffman from Pexels

Divert Assets to maintain Medicaid Eligibility

December 8, 2021

Medicaid is not just for poor and low-income seniors. With the right planning, assets can be protected for the next generation, while helping a person become eligible for help with long-term care costs. There are strategies to divert assets to maintain Medicaid eligibility.

Medicaid was created by Congress in 1965 to help with insurance coverage and protect seniors from the costs of medical care, regardless of their income, health status or past medical history, reports Kiplinger in a recent article “How to Restructure Your Assets to Qualify for Medicaid.” Medicaid was a state-managed, means-based program, with broad federal parameters that is run by the individual states. Eligibility criteria, coverage groups, services covered, administration and operating procedures are all managed by each state.

With the increasing cost and need for long-term care, Medicaid has become a life-saver for people who need long-term nursing home care costs and home health care costs not covered by Medicare.

If the household income exceeds your state’s Medicaid eligibility threshold, two commonly used trusts may be used to divert excess income to maintain program eligibility.

QITs, or Qualified Income Trusts. Also known as a “Miller Trust,” income is deposited into this irrevocable trust, which is controlled by a trustee. Restrictions on what the income in the trust may be used for are strict. Both the primary beneficiary and spouse are permitted a “needs allowance,” and the funds may be used for medical care costs and the cost of private health insurance premiums. However, the funds are owned by the trust, not the individual, so they do not count against Medicaid eligibility.

If you qualify as disabled, you may be able to use a Pooled Income Trust. This is another irrevocable trust where your “surplus income” is deposited. Income is pooled together with the income of others. The trust is managed by a non-profit charitable organization, which acts as a trustee and makes monthly disbursements to pay expenses for the individuals participating in the trust. When you die, any remaining funds in the trust are used to help other disabled persons.

Meeting eligibility requirements are complicated and vary from state to state. An estate planning attorney in your state of residence will help guide you through the process, using his or her extensive knowledge of your state’s laws. Mistakes can be costly—and permanent.

For instance, your home’s value (up to a maximum amount) is exempt, as long as you still live there or will be able to return. Otherwise, most states require you to divert other income to $2,000 per person or $4,000 per married couple to qualify.

Transferring assets to other people, typically family members, is a risky strategy. There is a five-year look back period and if you’ve transferred assets, you may not be eligible for five years. If the person you transfer assets to has any personal financial issues, like creditors or divorce, they could lose your property.

Asset Protection Trusts, also known as Medicaid Trusts. You may transfer most or all of your assets into this trust, including your home, and maintain the right to live in your home. Upon your death, assets are transferred to beneficiaries, according to the trust documents.

Right of Spousal Transfers and Refusals. Assets transferred between spouses are not subject to the five-year look back period or any penalties. New York and Florida allow Spousal Refusal, where one spouse can legally refuse to provide support for a spouse, making them immediately eligible for Medicaid. The only hitch? Medicaid has the right to request the healthy spouse to contribute to a spouse who is receiving care but does not always take legal action to recover payment.

Talk with your estate planning attorney if you believe you or your spouse may require long-term care. Consider the requirements and rules of your state. Keep in mind that Medicaid gives you little or no choice about where you receive care. Planning in advance to divert assets to maintain Medicaid eligibility is the best means of protecting yourself and your spouse from the excessive costs of long term care. If you would like to learn more about Medicaid and how it works, please visit our previous posts.

Reference: Kiplinger (Nov. 7, 2021) “How to Restructure Your Assets to Qualify for Medicaid”

Category: Long Term care facility

Avoid Family Disagreements over Caregiving

Caring for sick Parent can be Challenging

Advance Care Planning a Benefit to Seniors

Medicaid Annuity might be an Option

Naming Power of Attorney is extremely important

Preventing Long-Term Care Abuse

Costs of Long-Term Care can be Challenging

When to have Healthcare conversation with Parents?

Ways to reduce Financial Elder Abuse

Divert Assets to maintain Medicaid Eligibility

Categories

View Blog Archives

Watch the

Estate Of The Union

Join Our

eNewsletter and Blog Digest List

Listen to the

Estate Of The Union

Texas Trust Law

Quick Links

Connect With Us