Prepare to Care for Aging Parents & Loved Ones
November 23, 2012
If you are the child of parents who are currently over the age of 65 you’ve probably given a little bit of thought to the day when one (or both) of your parents may need Long Term Care. Understandably, most adult children prefer not to think about the day when their parents may not be able to care for themselves, but in some cases it simply cannot be avoided, especially if your parent is already showing early signs of Alzheimer’s or dementia. If you are concerned about your parent’s future, there are steps you can take now to make the transition to giving and receiving care later easier on both you and your parents:
1. Talk to your parents. Find out if your parents have already thought about the topic, if they’ve made provisions for it, or if they have any specific wishes. Furthermore, opening the lines of communication lays the groundwork for trust and cooperation in the future.
2. Encourage your parents to create an Estate Plan if they don’t have one already. An Estate Plan will be important in expressing your parents’ wishes on necessary issues such as preferred agents in case of incapacity, financial power of attorney, and health care decisions. These essential documents will not only let you and others know their wishes, it will also prevent many expensive delays and frustrating red tape in the future.
3. Make sure that long-term care planning is a part of their estate plan. When most persons prepare an estate plan, they usually think only about passing assets to loved ones upon death, avoiding probate and taxes. Often overlooked is long term care planning. Such planning should consider the need for a Medi-Cal subsidy should either parent ever need care in a nursing facility. Many middle income individuals are surprised to learn that they may qualify for a Medi-Cal subsidy in the event of need. However, this ability to qualify may depend upon whether proper planning documents are in place ahead of time.
4. Talk to trusted advisors about how to prepare for the financial burden of Long Term Care—because there will be a financial burden. Our firm can help you consider options for Medi-Cal and Long Term Care Insurance, as well as some lesser known options such as a Dependent Care Account or a Care Contract with a care-giver child.
As you think and talk about these issues with your parents, siblings, and other trusted advisors, remember that you don’t have to go through this alone. Elder Law and Long Term Care are intricate and convoluted subjects, but there are caring professionals out there whose business it is to guide you through the intricacies of Elder Care. Let us help you look into the future with confidence and clear eyes.
Personal Care Contracts: The Hidden Solution to the Elder Care Dilemma
November 19, 2012
Caring for an aging relative is difficult—and often underappreciated—work. Many people who serve as caregivers often feel as if they have two jobs—their full-time day job at the office and the part-to-full-time job of caregiver at home. As their parents age and decline, most of these caregivers end up not only giving up more and more of their time, but also, eventually, their own opportunity for more income. Caregivers need to know that it doesn’t have to be this way; that if their elderly loved one (and perhaps the rest of the family) agree, the caregiver can be compensated according to mutually agreed upon terms of a Caregiver Agreement, also known as a Personal-Care Contract.
Elder law attorneys have known about Caregiver Agreements for a long time, but very few caregivers themselves are aware of this useful contract. A Caregiver (or Employment) Agreement serves to document a caregiver’s responsibilities and hours, and to set a rate of pay that’s in line with local practices and incomes. The contract would then be signed by both the caregiver and care recipient, and eventually shared with the rest of the family.
An agreement of this sort can be useful not only for the care-giver and the one cared-for; it also comes in handy if you think you may need to rely on Medi-Cal to cover nursing home costs sometime in the future. Payments voluntarily made to a family care-giver without a written contract would likely be viewed as gifts, potentially disqualifying the parent from a later Medi-Cal subsidy should he or she later need care in a nursing home. However, if payments to relatives are made under the terms of a written employment agreement which complies with Medi-Cal rules, the risk of disqualification from a later Medi-Cal subsidy is reduced dramatically.
Caregiver Agreements are also useful in Veterans Pension planning: qualifying payments made pursuant to a legitimate care contract may count as an Unreimbursed Medical Expense, potentially qualifying the Veteran for a monthly pension to help pay for care expenses.
It is important to remember, however, that in order for government programs to recognize an employment agreement between family members the contract must already be in place before services are rendered.
This is why it is so important to have such an agreement prepared by an Elder Law attorney knowledgeable regarding Medi-Cal rules and Veterans Pension Planning before any money changes hands. If you believe that a Personal Care Contract may be a useful tool to provide for the care of your loved one, we invite you to contact us to arrange a consultation.
Supreme Court’s Ruling on Health Care Reform May Help Seniors
July 6, 2012
The recent Supreme Court ruling of the constitutionality of the new health care reforms has many seniors breathing a sigh of relief. The ruling has ensured that, at least for the time being, senior citizens will continue to receive their currently existing benefits from programs such as Medicaid and Medicare; but the ruling also paves the way for changes—some good and some not so good—in the way various home-based and long term care services are paid for and provided.
This article in Forbes explains some of the ways that the ruling on the Affordable Care Act will impact senior citizens or adults with disabilities:
According to the article, Medicaid (called Medi-Cal in California) “currently funds nearly half of all paid long-term care services.” This current coverage will continue under the 2010 health law, but states can refuse to provide new coverage to individuals if they choose.
The Medicare program is currently under some considerable financial strain, and the Affordable Care Act “includes a small increase in the payroll tax that is aimed at increasing revenues for Medicare.” This should be a great help to the program, and a relief to seniors who receive benefits from Medicare.
For seniors and adults who require long-term care services and have been frustrated by numerous roadblocks to getting that care at home instead of in a nursing facility, good news is on the horizon; the ACA “includes important new incentives for states to expand Medicaid long-term care services for people living at home.” However, it remains to be seen whether the states will accept these incentives and expand coverage. As of this writing, Republican Governors in a number of states have announced that they do NOT intend to accept the incentives and expand coverage. We find such positions to be unfortunate for the many seniors and uninsured persons who would thereby lose the opportunity for health care coverage.
And finally, the law is giving more attention to seniors and adults with chronic and long-term illnesses. The ACA “creates a new office to coordinate the health and long-term care of people who receive both Medicare and Medicaid. . . It also includes important incentives to encourage hospitals, nursing homes, doctors, and other providers to work together to improve care for people with chronic disease.”
Advice to Caregivers: Take Time For Yourself !
April 7, 2012
Many of our clients provide care for elderly loved ones; some even providing constant, around the clock care. Care giving is a demanding, overwhelming, and often grossly underappreciated job. In addition to giving up their own time and interests, caregivers have to watch someone they love slowly regress and lose the ability to do even the most basic of tasks. Often, the senior being cared for eventually loses their ability to even recognize the people around them… including the person giving constant loving care. For all of these reasons, it’s very common for caregivers to experience depression and fatigue… caregiver burnout.
Depression and burnout does not have to be the plight of all caregivers, especially if you know the symptoms and how to combat them. The good news is that there are many preventative strategies which are readily available… the hard part for caregivers is valuing their own time and mental health enough to take advantage of them.
One of the best ways to avoid caregiver burnout is by making time for yourself periodically. Adult day service centers provide personal care, social activities, therapy and meals during the day while caregivers need to be away at work or even taking a much-needed break. If you have a parent who can no longer care for themselves during the day, adult day services might be a good solution for everybody involved.
There is a saying that hardships shared are halved, and joys shared are doubled; this is as true of care giving as it is for anything else. Many caregivers are reluctant to ask for help, but sharing the burden could save you from caregiver burnout. Don’t be afraid to reach out.
Will Medicare Fully Cover You in Your Golden Years?
February 20, 2012
Many retirees (or soon-to-be-retirees) have been living and saving under the assumption that Medicare would pay for a bulk of their medical costs during retirement, but a recent article in the Wall Street Journal reveals that counting on Medicare may not be the safest bet anymore. According to the article, one of the most important facts that retirees need to understand about Medicare is that “Medicare pays for very little long-term care, and you’ll still need significant savings to cover the rest of your medical expenses.”
This statement may come as a shock to those who fall in the soon-to-be-retired category simply because they likely haven’t had to give much thought to post-retirement medical costs yet; but they may be in for a rude awakening when the time comes to rely on Medicare. “Two-thirds of those on Medicare also said they pay the same, or more, for healthcare now than when they were working. They have been unpleasantly surprised by the cost of Medicare Part B premiums, what you pay for doctor and outpatient coverage, with 44% paying more than they had expected.”
Fortunately, our readers can become aware of this need to be more proactive about their own healthcare, and can start planning now. How you should plan will depend greatly on your age, your current rate of saving, and many other factors. But becoming aware is the important first step.
How To Succesfully Choose a Nursing Home for Your Loved One
February 11, 2012
If and when the time comes to choose a nursing home—either for yourself or for a loved one—how will you know how to choose the right one? A person’s living situation often has a lot to do with how happy they are, so it is important to choose carefully and wisely. When you do begin the process of choosing a nursing home, you don’t have to go into it blind. Here are a few things to consider and questions to ask when you start your search:
A Matter of Money – Nursing care is an expensive prospect, so one of your first considerations when looking for a nursing home will be how much it will cost and how you (or your loved one) will pay for it. Fortunately, it is likely that the entire cost will not have to come out of your personal finances. The Medicare.gov website offers an overview of different strategies to pay for quality nursing care. Your elder law attorney can help you navigate these—and other—options. You may also wish to download our free guide, “Consumer’s Guide To Medi-Cal Planning”. Many middle income persons are often surprised to learn that they may be able to qualify, although often this may require planning and professional guidance from an Elder Law Attorney.
Check out the following guide published by California Advocates for Nursing Home Reform: “How to Choose a Nursing Home”.
Evaluate Staff and Policies – Taking the time you need to evaluate the staff and the policies of the homes on your list will quite possibly be the most important part of your decision-making process. This article from the “Our Parents” website provides a comprehensive list of questions to ask yourself, the nursing home staff, the residents, and more before you make your decision.
Visit the Nursing Home: Visit and Talk to Families of Residents. You can get a real inside feel for the facility in this manner.
Location, Location, Location – Finally, we all know that location is everything, and this is true of nursing homes as well. Issues of location ranging from how close the home is to family and friends, to what kind of view can be seen from the windows can all be of the utmost importance.
Check out the Guide on the website of California Advocates for nursinNursing Home Reform:
sing a nursing home may well be one of the most difficult decisions you will ever make, so it’s best to go into it prepared. Don’t be afraid to get in touch with the professionals who can help you make the best possible decision for yourself and your loved ones.
Off to College? Don’t Forget Your Health Directive!
August 25, 2011
The hot and lazy days of summer are almost over; parents are thinking about back-to-school sales, kids are making the most of their final days of freedom, and college freshmen are getting ready to embark on their first year of adult-hood. Most of these college students have a list (whether mental or physical) of all the things they’ll need as they leave the nest for the first time, but most of these lists will be missing two key items: A Healthcare Directive and a HIPAA Form.
You may be wondering why a college student needs estate planning documents—aren’t those just for older, established people? Not at all.
Most incoming college students are now (or will soon be) 18, and considered adults under the law. This means that hospitals and medical personnel are no longer required to ask the parent’s permission before performing medical procedures. In fact, once your child is 18 health care providers are no longer required to share information with the parents at all.
Most college students (and parents) are unaware of this side-effect of turning 18, and parents and children alike can run into frustrating roadblocks should an accident occur. You can avoid these roadblocks by simply having your young adult execute the two simple documents mentioned in this blog post.
A Healthcare Directive can be an in depth document or a very simple one, but the most important part for your new 18 year old will be the nomination of a healthcare agent. A healthcare agent is the person who will make medical decisions for your child if he or she is unable to make them alone.
A HIPPA Authorization Form addresses the issue of security and privacy of health data. In a HIPAA form your child can list the people who have permission to receive information about his or her medical records and status.
For a fledgling 18 year old these two documents are of the utmost importance, and with the right help, they are very easy to execute. Don’t wait until it’s too late; make sure your young adult has these documents completed before they leave the nest.
War Veterans May Be Unaware They Qualify For VA Aid and Attendance Benefits
August 4, 2011
One of the services Elder Law and Estate Planning attorneys often provide is helping clients navigate the application procedures and bureaucratic systems for the various state and federal medical insurance programs; and one thing that remains a surprise throughout the years is how many people forget about the VA Aid and Attendance Program for war veterans.
According to the Department of Veterans Affairs website, VA Aid and Attendance is “a benefit paid to wartime veterans [or their spouses] who have limited or no income, and who are age 65 or older, or, if under 65, who are permanently and totally disabled.” Unfortunately, too many veterans and their spouses are unaware that they qualify for this benefit, or even worse, have never been informed that the program exists.
An informative article in the Washington Post quotes the VA’s deputy undersecretary for disability assistance as saying that he believes they are only reaching “about one in four eligible veterans.” Part of the reason for this is that “there are a lot of veterans where it’s been 40 years or more since they’ve been on active duty. It just doesn’t occur to them there may be a benefit from the VA.”
If you are a war veteran over the age of 65 it is very likely that you and/or your spouse qualify for Aid and Attendance Benefits. Eligibility requirements include:
- You served at least 90 days of active military service 1 day of which was during a war time period. (If you entered active duty after September 7, 1980, generally you must have served at least 24 months, or the full period for which called or ordered to active duty.)
- You were discharged from service under conditions other than dishonorable.
- Your countable family income — after subtracting care and medical expenses — is below a yearly limit set by law (The yearly limit on income is set by Congress.)
- You must need help with at least one activity of daily living: dressing, eating, walking, bathing, adjusting prosthetic devices or using the toilet. Those who are blind, living in nursing homes or require in-home care may also be eligible.
For many veterans and their families the financial assistance they receive from their VA Aid and Attendance benefits can be an incredible help. Unfortunately, the application process required to receive the benefits can be daunting. “It’s not a simple process. A&A applicants must mail the forms, copies of service records, marriage certificates, proof of insurance and medical records to the regional VA office. If a third party is making the application, an additional form, 21-22-a or 21-0845, must be completed.”
This is why many veterans ask a knowledgeable Elder Law or Estate Planning attorney to help with the application process. The right attorney can help you find and fill out the correct forms, gather the necessary records and materials, and keep track of progress throughout the entire process. If you think you may be eligible for VA Aid & Attendance Benefits, check out the information on VA Pension Benefits by clicking this link: VA Pension Benefits.