Category Archives: Health

Should I be Paid to Care for My Parents?

By Attorney Elizabeth Durnell

Have you ever considered paying your children to care for you?  Have you ever considered being paid to care for your parents?

There is a new trend in Nursing Home Medicaid planning, in which parents pay their children to care for them, even after they enter a Nursing Home.

In 2009, the Wall Street Journal published an article by Victoria E. Knight entitled “Relative Can Be Paid To Look After Elderly”.  Following is an exerpt from that article:

Caring for a family member is a responsibility many people bear. It can also be a source of income.

So-called “caregiver agreements” — formal contracts under which relatives are hired to care for elderly family members — have been around for a while. But with the economic downturn, more families may be open to entering into such arrangements, some attorneys and caregiver advocates say.

Financial transfers made under a caregiver agreement generally aren’t considered gifts, an important consideration if an elderly person later hopes to qualify for Medicaid, the joint federal/state program that covers nursing-home care. The contracts can also provide assurances to other family members about the cost and quality of care being delivered and reward caregivers for the long hours they put in. The agreements need to be carefully crafted, and there are tax consequences.

To an aging parent, the idea of being cared for by a trusted family member may be appealing. And for those who want to stay in their own homes, or need to because they can’t sell their property to fund entry into a continuing-care retirement community, hiring a relative can be a money-saving strategy.

For adult children who have more time to devote to mom or dad, such arrangements can provide a modest source of income — or at least cover expenses they incur in providing care — at a time when many families are struggling.

In recent years, caregiver agreements have grown in popularity as a Medicaid planning tool because they can reduce the size of an estate, according to Louis Jay Ulman, a senior principal at Offit Kurman, a law firm with offices in the Baltimore-Washington corridor. That’s because a rule change extended the look-back period for making gifts to family members to five years from three.

If properly set up, transfers made under a caregiver agreement aren’t considered gifts but rather compensation because they are payments made in return for a service, lawyers say.

Please note the beginning of the last paragraph: “If properly set up.”  There are many specific and complex legal requirements to set up these arrangements.  If done incorrectly, it could cost you and your family time, money and added risk that your loved one will not qualify for benefits as an improper transfer.  If you are interested in learning more about caregiver agreements, it is imperative you contact an Elder Law Attorney.

Disabled Children and Government Benefits: What is so special about Special Needs Trusts?

Do you have a disabled child (under 65) who is receiving government benefits, such as Medicare or Medicaid? If so, you need to know about some important scenario’s that could affect your child’s government benefit eligibility.

In your will, have you named your disabled child as a beneficiary of certain items?  If so, upon your death, you may have just made your child ineligible for government benefits such as Medicaid, as he may no longer meet the financial criteria.   What if someone else names your child as the beneficiary of their will or gives them an extravagant gift if money? That is right, someone else has made your child Medicaid ineligible.

What if your child was involved in a terrible car crash or medical malpractice situation and he or she was to receive a settlement check after they had already been on Medicaid for several months? You guessed it, your child would no longer be eligible for Medicaid.

Without a special needs or supplemental needs trust in these situations, your child will become ineligible for Medicaid, have to “self-pay” the nursing home out of pocket from the money they just received, and go through the whole Medicaid process again once the nursing home, hospital, doctors, and government have taken all of their newly acquired money.  In reality, the money coming to the disabled individual is just going straight in the government’s pocket.

With special planning, these situations can be remedied.

A Special Needs Trust, also called a (d)(4)(a) trust, is setup with the disabled person’s assets by the disabled individual’s parent, grandparent, guardian, or court, and is designed to take the disabled individual’s incoming assets (such as a settlement check or retirement account) into the trust before it goes to the individual. No other person may put assets into this trust besides the disabled individual.  The money can be used for the special needs of the individual (luxuries and care) above and beyond what government benefits provide for such as: Medical and dental expenses beyond what third parties pay for; Clothing; Electronic Equipment (such as radio, recording and playback, television and computer equipment); Programs of training; Education; Treatment and rehabilitation; Transportation (including vehicle purchases); Vacations; Participation in hobbies; Companionship; and so forth. In the eyes of the government, the money is not considered to belong to the individual.  Upon death, any remaining money will first payback the government for the amount of benefits they provided, then the rest of the money goes to anyone the parent, grandparent, court, or guardian designates.

A Supplemental Needs Trust, also called a Third Party Trust, is set up with assets other than the disabled person’s.  It can be set up by anyone, except the disabled individual, and anyone can add items to this trust except the disabled individual.  These types of trusts are designed for times when you would like to name the disabled child as a beneficiary of a will.  They may be used for the same luxuries and care items as set forth above, but at death, the money goes straight to the remainder beneficiaries that the third party named, instead of going to the government.

There are several types of trusts for a disabled person and each is designed to meet a different goal.  While this article only outlines two types of trusts, each trust is complex should not be attempted without experienced legal advice.  Please call or office if we can assist you.  You will need the help of a qualified elder law professional to help you identify your options.

What If You Can’t Make Your Own Medical Decisions?

By Angie Hall

Just as we create estate plans for our eventual demise, it’s also important to plan ahead for the possibility that we will become sick or unable to make medical decisions for ourselves. Medical science has created the technology to keep patients alive longer, sometime indefinitely. So, if an individual becomes incapacitated, its important to give someone legal authority to communicate a person’s wishes regarding medical treatment. The Durable Health Care Power of Attorney accomplishes this very thing. By appointing an agent through your Health Care Power of Attorney, you can ensure that someone is able to speak for you when you are unable to do so. Also, within the Living Will, you can provide your agent instruction in regard to your treatment if you are terminally ill or in a persistent vegetative state.

Keep yourself organized: How to Deal with a Healthcare Crisis

Webster’s definition of organize is “to arrange by systematic planning and united effort”.  I like to think that having a system and making an effort helps keep my cases organized.  And it helps when our clients think the same way.  I realize that many times Mom, Dad or your spouse didn’t tell you where they keep their important documents, their bills, or even their identification.  So when it comes time to help them out in a crisis, you are now in the middle of “Hide and Seek”.

In planning ahead, it is always a good idea to let a loved one know where you keep your ‘stuff’.   There are several documents that you will need in a time of crisis, so why not be prepared now and save yourself the aggravation; you will already have enough to worry about.

Here are some items that you may need to get your hands on:  Social Security cards, health Insurance cards, military discharge records, deeds to properties, cemetery lot records, stock certificates, vehicle titles, bank statements, life insurance policies, tax returns, and any and all legal documents that have been created.

Of course, there will always be that one thing that is needed that you cannot find, but it will make life easier on yourself if you start getting this information in a location that can be found.  It’s pretty hard to win the game of Hide-and-Seek if you don’t’ even know where to start looking.

Worried about taking care of aging parents?

Over half of all Americans say they worry about taking care of their aging parents. Katie Couric says both parties should sit down and have an honest talk about the future.

Navigating Medicare and Medicaid options are mind-numbing and helping our parents live out their lives can be completely overwhelming. Don’t bare the financial burden of your parents medical expenses. A consultation with an Elder Law attorney can help you and your parents plan for the future.

Gracious Dependence: Do We Have What It Takes?

by guest blogger Gail McConnon
imgEvery year medical science comes up with new ways to help us live longer – for good or not so much. We seem to think that’s what we want, don’t we?

But what are we really getting in the bargain for longer life . . and do we have what it takes to graciously accept what we get?

Where am I heading, you ask? I’m inviting you for a short stroll down the road of scientifically-assisted longevity, and the dependence that’s bound to follow . . upon family . . friends . . strangers.

I’m asking you to take a quick look at how “prepared” you are to become dependent on others to care for you while you’re doing all that aging through all the extra years you asked science to give you. You certainly don’t think extra time comes without a price?!

And even if you don’t buy into the scientific enhancement of your years, you know you can’t escape the indulgent lifestyle you’ve been leading all these years.

Let’s face it: If science doesn’t kill you, your habits most likely will.

In any case, chances are fairly good that few of us will make it to the end of our years as the independent creatures we see ourselves to be. Most of us are going to end up dependent – to some degree or other – on the good will and caring of someone else.

Start Getting Acquainted With Dependence

Be it short of long term . . assisted living . . LTC . . with family involvement or not . .it’s going to behoove us to get acquainted the better side of dependence.

What’s that?! What better side?! I’m sorry for the confusion. What I’m saying is that we’ll be doing ourselves a real favor by learning to open the gifts of gracious dependence (i.e., discovering the grace to be gained in being dependent on others).

Okay, you think I’m loopy, right? That’s fair. After all, everything up through life’s first half is focused on you as an individual . . standing on your own two feet . . making a name for yourself . . being in total control.

Now, here I am, telling you the real grace to be gained in life’s second half comes from the inside.

Let’s face it: Unplanned and unplanned for things happen as we get older.

The lifestyles we flaunted up till now are starting to turn on us.

The multitude of stresses we swallowed as we climbed that corporate or professional ladder . . and raised families . . and piled our plates higher and higher with the stuff we had no business biting into a few years back . . have been waiting patiently all this time to teach us the lessons we pretended we’d never have to learn.

Let’s be honest with ourselves, though. Those lessons are starting to come home. And some of us – or at least some of our middle-aged friends and family members – are learning hard lessons as bodies and finances and marriages and all the rest start to break down.

And even though we watched as our parents aged through life’s second half, we kept believing we were immune. Or, maybe we just kept wishing we were immune.

While it is never too early to be prepared, putting things off can have very unintended results that can cause serious anxiety, family feuds, and significant monetary losses. Seek out the advice from an Elder Law Attorney today and make sure your goals and your plan are in sync so you can rest assured that you are prepared!

Nursing homes are not the only option

Elderly manIn working with many of our clients, they are sometimes surprised to learn that there are benefits that help pay for in-home care. Even though a person may need nursing needs or skilled therapy, it does not mean that they have to go to a nursing home.  Home and Community-Based Waivers are programs of in-home and community care, helping those who are eligible to remain at home instead of a hospital, a nursing home, or a facility for those with developmental disabilities.

Many times in talking to clients they are very worried about sending Mom, Dad, Husband, Wife or Child to a nursing facility. With this program, there may be ways to help keep them in the comforts of home.  Let us know if you would like more information or to find out if you may be eligible for this program.

How Obama’s New Healthcare Reform Affects Veterans

HealthcareThis week I have already met with more than a handful of clients and while the complexities of their cases are different, they have consistently asked the same question:  ”how will the new health care bill affect our situation”.  To most Americans, since nothing has been finalized, the answers are still unknown, but the Department of Veterans Affairs has weighed in on the matter, explaining that regardless of the pending health care reform, TRICARE will remain unchanged.  Please visit the following website and check out the attached article to see the comments of Defense Secretary Robert Gates.

http://www.military.com/news/article/officials-reassure-troops-on-tricare.html?col=1186032310810

AARP’s Conflict of Interest In Health Care

aarpknife

Below is link to an article by Carol Costello of CNN about AARP’s endorsement of the recent House health bill.  As she points out AARP is currently a large health insurer and has it’s own agenda in mind… not necessarily the interests of its senior members.  She points out that AARP generated over 3 times the revenue from insurance sales as what it took in from membership dues.  Clearly there is a potential conflict here.  If this bothers you as much as it bothers me, please write AARP or don’t renew your membership next time.  Perhaps they will get the message.

How Can I Prepare Myself and My Family for a Medical Emergency?

by Kathy Cooper

emergency2I sometimes describe my mother as a cat.  I am sure she has gone through at least ten lives since I was a teenager.  She’s passed out at the mall and fallen down the stairs at the at West Point Cadet Chapel during my cousin’s wedding.  We’ve had to call the emergency squad to an untold number of restaurants when she’s had a mini stroke and slipped off her chair.  It seems like she’s had an operation on most of her internal organs and I know she’s had pneumonia at least five times in my memory.  Nevertheless, she continues and most of the time she scoots around our house with her walker with little trouble or fuss.

The reason I share this with you is to remind you about the importance of being ready for an emergency with your loved ones.  Don’t let them go out without important contact information and make sure you have the authority required to access to their medical records and to make decisions in a critical situations.  Having a lot of experience with emergencies, I can tell you that you will need at least the following:

Emergency Contacts Information

What is it? Names and phone numbers of your emergency contacts

Why do you need it? If you pass out at the mall or have an accident on the freeway, you will want to have your representatives ready to provide information and decisions.

What do you do with it? Carry it with you at all times, in your wallet or purse.

Don’t forget … Check the phone numbers periodically to make sure they are up to date.  Also, remember to include cell phones which are often the best way to reach your loved ones.

Healthcare Power of Attorney

What are they? A legal document naming the person or persons who can make healthcare decisions for you if you cannot.  This is normally a family member or friend.

Why do I need them? If you are unconscious and cannot tell your doctor what you want done when a decision needs to be made , the hospital can only take direction from the person you have designated as your Healthcare Power of Attorney.

Where should I keep them? Keep your original Healthcare Power of Attorney with your important legal papers.  Give a copy of your Healthcare Power of Attorney to the person or persons who will act for you.  They should keep a copy in a location where they can get to it easily in an emergency as they will need them at the hospital to prove that they can speak for you.

HIPAA Authorization

What is it? A legal document authorizing a person you choose to have access to your medical records.

Why do I need them? Your Healthcare Power of Attorney will need your  HIPAA Authorization to prove to the hospital or medical emergency personnel that they have the right to look at your medical records to help them make medical decisions on your behalf when you are unable to do so.

Where should I keep them? Keep your original  HIPAA Authorization with your Healthcare Power of Attorney in your records for safekeeping and give a copy to the person you have designated to act as your Healthcare Power of Attorney.

Living Will

What is it? A legal document that whether you want heroic efforts to keep you alive to be taken if you are in a permanent coma or at end of life and cannot express your wishes.  This is the document that Terry Schiavo did NOT have.

Why do I need them? The Living Will indicates whether or not you will be kept alive with a feeding tube giving you food and water if that is the only thing keep you alive.

Where should I keep them? Keep the original Living Will with your important papers and give a copy to your Healthcare Power of Attorney.

Prescription Information

What is it? A list of current medications, dosages and the doctors who prescribed them along with their phone numbers. Also, note any alergies, believe me, you will forget them in an emergency.  If you are in an emergency you can  simply take the prescription bottles in a plastic bag.

Why do I need them? This is one of the first questions they ask you at the hospital.  They do not have this information there and it can delay treatment if they don’t have it.

Where should I keep them? If you keep a list, it should be easily accessible so that you can take it to the doctor to update it when your prescriptions change.  You will need it with you in an emergency.

A good elder law attorney will prepare these documents for you as part of your overall estate plan.  Call or email us if we can assist you in getting your affairs in order.



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