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.
New POLST Raises Awareness About End-Of-Life Decisions
March 26, 2011
A recent article in the Wall Street Journal shines the light on a new program being instituted by a growing number of states called “Physician-Orders for Life Sustaining Treatment,” or POLST. “A POLST, which is signed by both the patient and the doctor, spells out such choices as whether a patient wants to be on a mechanical breathing machine or feeding tube and receive antibiotics.” In current medical practice, it is usually discussed and signed in a hospital or long term care setting, when a patient’s health is fragile but the patient is still able to give meaningful direction to his or her physician. However, we see no reason that it cannot be discussed and signed at an earlier time, say, when you and your attorney are discussing your estate plan and your end-of-life wishes.
It is different from an Advance Health Care Directive, in that the POLST is an actual medical order from your physician.
Creating a POLST is an important step toward getting the care and medical treatment you want at a time when you may no longer be able to communicate those wishes to your family or medical staff.
Keep in mind that although the POLST is an important step in making your wishes known, the POLST is not intended to replace an Advance Directive. The POLST programs “are meant to complement advance directives, sometimes known as living wills, in which people state in broad terms how much medical intervention they will want when their condition no longer allows them to communicate.”
The WSJ article states that “A study supported by the National Institutes of Health last year found that patients with POLST forms were more likely to have treatment preferences documented than patients who used traditional documents such as living wills and do-not-resuscitate orders.“ This comes as no surprise, considering that executing a POLST includes getting the document signed by your doctor, thus ensuring that you doctor is not only aware that you’ve expressed your wishes for end-of-life care, but has also likely had a part in helping you understand exactly what your options are. A short audio recording is available in the WSJ site.
Our office recommends that our clients go one step further—in addition to having your doctor sign your POLST, give your doctor a copy of your Advance Directive as well. Once you have things squared away with your doctor we also recommend giving a copy of your POLST and your Advance Directive to the person you’ve named as your healthcare agent.
For more information, including the April, 2011, update to the POLST form used in California, visit the site of the Coalition for Compassionate Care at http://www.capolst.org/
The more informed you doctors and family are about your wishes for end-of-life care, the more likely it is that you will receive the treatment you prefer.
Long-Term Care; Be Prepared in an Area of Uncertain Options
February 17, 2011
It’s flu season again, and the strain going around this year has been a difficult one, mainly because of how long it keeps its victims out of commission. So the article we recently found on Time.com about Long-Term Care seems particularly timely and relevant, if only because this year’s flu could be seen as an omen of what’s to come as Baby Boomers age into their golden years.
According to the article, “A huge wave of baby boomers may need long-term care in their golden years — and yet fewer than half have taken steps to prepare for it… two-thirds of Americans believe it’s important to plan for long-term care, but only 44% have taken steps to protect themselves.” Part of the reason for this lack of preparedness is that Baby Boomers underestimate the likelihood that they’ll need long-term care, or they overestimate the likelihood that their children or families will be able (or willing) to provide that care.
But there’s another reason why Baby Boomers are statistically unprepared for the crisis of old age; to put it simply, there aren’t any clear avenues to solid and reliable financial preparedness. “While it’s clear that not enough people are thinking about preparing for their long-term-care needs, it’s not at all clear what, if any, the best solutions are.”
Some think that extra savings in the bank will cover the cost of long-term care; others believe that government programs such as Medi-Cal or Medicare will take care of them. Unfortunately, both of these beliefs are mistaken. “The average cost of a nursing home ranges from $85,000 to $120,000 a year, while hiring an aide to spend six hours a day on average in the home starts around $40,000 a year… Medicare, meanwhile, only covers up to 100 days of long-term care and often involves co-payments. Medicaid [Medi-Cal in California]will cover long-term nursing-home care but only after the person has drained his or her savings account.”
Another solution is long-term care insurance; but even with long-term care insurance, nothing is clear cut, and too many people have found themselves paying into a policy and ending up with no return on their investment. You also need to be healthy enough to qualify for the policy. Long-term care insurance is still one of the best options out there, but “There have been horror stories of people paying premiums on long-term-care insurance policies for years, only to find the benefits won’t cover their needs 20 or 30 years down the road when health care and long-term-care costs are significantly higher.”
Another option may be Medi-Cal for those who need nursing level care. Our firm has been a leader in assisting clients with qualification, and with helping them plan their estates to enable qualification when need later arises. There are many myths associated with Medi-Cal. For more information, we invite you to download a free copy of our “Consumer’s Guide To Medi-Cal Planning“.
The best advice we can give is to do your research and ask for the help of an advisor with experience in elder law, elder care, and senior financial planning. Be prepared.
Minnesota Health Care Dispute Raises Fears for Everyone
February 5, 2011
As estate planning attorneys we help our clients plan ahead. We help them create the documents and take the legal action they need to protect themselves and those they love. We help them talk through painful possibilities, and support them as they make difficult decisions. We work to ensure that our clients and their families will be prepared for any eventuality—but deep down we hope that they will never really need to rely upon some of the documents we prepare in order to “trump” familiy consensus and reasonable decisions.
One of the situations that estate planners (or any compassionate advisor) dread is the family conflict that is happening right now in Minnesota. According to the Minneapolis Star Tribune the family and friends of 85 year old Al Barnes are struggling to make a difficult decision about his end-of-life care—a decision made no easier by the fact that not all family members (or Mr. Barnes doctors and health care providers) can agree on the next course of action.
“Numerous doctors have assessed Barnes in the past year, and agree on his prognosis. According to court records, Barnes suffers from a level of dementia so profound that doctors believe it is pointless to treat his kidney failure and respiratory failure.” But this isn’t the whole story. Al Barnes’ wife Lana Barnes believes that “her husband suffers from chronic Lyme disease, and that antibiotic treatment of the tick-borne bacterial infection would reverse his dementia — and necessitate treatment for his other conditions as well.”
Mr. Barnes does have a Health Care Directive which lists his wife Lana as his agent, but it apparently goes no further than that, giving no specific instructions or information about what his wishes for end-of-life care would be. And herein lies the dispute. “A Methodist Hospital doctor wants to take decisionmaking rights from [Mrs. Barnes] because he believes she is demanding hopeless and painful treatments. The 56-year-old wife is accusing the doctor and others of misdiagnosis that has left Barnes substantially — but not irreversibly — incapacitated.”
The Minneapolis Probate Courts temporarily took away Mrs. Barnes’ authority over her husband’s care earlier this month after the disagreements between wife and doctors came to a head. “Lana and doctors from Methodist Hospital [are] due to resume arguments over his medical care Wednesday in Hennepin County Probate Court… After Wednesday’s hearing, a judge will decide whether Lana Barnes remains in charge.”
This is exactly the kind of situation we hope to help our clients avoid by encouraging a little bit of forethought, conversations between family members and loved ones, and by preparing a thorough, decisive, and well-thought-out health care directive.
Government Rescinds Medicare Coverage of End-Of-Life Planning
January 15, 2011
Apparently the suspicion surrounding end-of-life planning is not as far in the past as we might have hoped. The recent Medicare regulation which would have allowed the government to pay doctors who advise patients on options for end-of-life care was rescinded only days after it was enacted.
Why such an abrupt turnaround? The reason is probably not too difficult to guess. Most people know that Medicare-covered end-of-life planning has a tempestuous history both in politics and in the media. This article in the New York Times stated that “while administration officials cited procedural reasons for changing the rule, it was clear that political concerns were also a factor.”
The alteration of the rule may be disappointing, but it shouldn’t stop you from thinking—or talking to your doctor—about your choices for your own end-of-life care. After all, this administrative change of heart does not alter the fact that having these discussions with your doctor (as well as with your health care agent and loved ones) preserve patient autonomy at a time when events may seem to spiral out of control. As National Public Radio pointed out in their article, “it remains perfectly legal for physicians to talk with patients during annual visits paid for by Medicare about how much or little care they want when facing a terminal illness.”
Media firestorms and political debate notwithstanding, your decisions about your end-of-life care are important. When you have these discussions with your doctor and loved ones, and when you have a living will or healthcare directive in place, you are far more likely to get the care you want at the end of your life, regardless of how invasive or restrained you want that care to be.
If you have reservations about what a health care directive might mean to your future medical care, or if you have any questions about this issue, you should discuss your concerns with both your doctor and your elder law or estate planning attorney. Appropriate legal documents can be drafted that will address your wishes and be clear to your physician.
Estate Planning Through the Ages
December 5, 2010
Can you remember what you were doing in your early 20s? Can you imagine what kind of life you’ll be living in your 70s or 80s? We experience incredible changes as the decades roll by—not just to ourselves, but in the world at large. With our lives changing so much, our estate planning documents and strategies should hardly remain static. Here is a guide to how your estate plan may or may not evolve through the decades.
In Your 20s: You’re young, just finishing school and starting in your career, unlikely to be married yet… the last thing you’re thinking about is estate planning! At this time of life, who gets your “stuff” may not be as important as who will make your decisions. Choosing your financial and healthcare agents and creating your power of attorney and healthcare directive are the important things to do at this time.
In Your 30s: Marriage, children, home ownership—most of these things happen in your 30s, and your estate plan should reflect that. Now is the time to choose guardians for your young children, decide with your spouse how your joint property will be distributed, and get serious about life insurance.
In Your 40s: This is when your strategy may switch from simple direction of inheritance to more serious asset protection. You’ve worked hard and saved, and you’ll want to think about the best way to maximize your assets with trusts and tax planning. Consider investing in long-term care insurance.
In Your 50s: As your children start to become independent you may have more freedom with your income. Some people choose to create charitable trusts, some prefer to invest for retirement, and still others decide it’s time to take a risk and start over with a second career. Your estate planner can advise and help with all of these.
In Your 60s: Ah retirement! Making the big change from work to retirement means making changes to your estate plan as well. If you’ve been keeping up with your planning through the decades all that is required now will be some basic maintenance; changes to account for marriages of your children, the birth of grandchildren, and your own relocation to someplace warm and sunny. But beyond the basic maintenance, you may want to start doing some basic planning for long-term care —just in case.
In your 70s and Beyond: Health is the key word now. Our life-spans are getting longer, but so are our illnesses. You need to be ready. Tighten up your estate plan, and although it may sound morbid, talk to your doctors and family about your end-of-life decisions. Consult with an Elder Law Attorney about options for funding long term care expenses, and seek assistance in revising your estate plan to coordinate with those options. You may be surprised to learn that you may be able to qualify for a government subsidy under the Medi-Cal program while still preserving your assets for your loved ones, providing that appropriate authorizations are in place.
The life alterations that come over a span of decades are difficult enough; you don’t want to have to find a new lawyer every time your circumstances change. Our firm makes it our business to keep up with you at every stage.
A “Graying Trend” In Caregiving
April 28, 2010
What will you be doing when you’re 73? If you think you will have earned the right to have someone take care of you, think again; you may end up serving as a caregiver for someone else. A recent article in the New York Times describes a new trend in caregiving: the elderly are being cared for increasingly by the elderly. According to the article, “Professional caregivers — almost all of them women — are one of the fastest-growing segments of the American work force, and also one of the grayest.”
As odd as it may sound, the arrangement of 55-75 year olds caring for 85-100 year olds often works out beautifully. Older caregivers may not be able to do much heavy lifting, but what they are able to do is connect with their charges. Many older caregivers have already spent months or years caring for their parents or spouse, so they have an understanding of the fear, frustration and stress the families are going through. In addition, because older caregivers often share similar culture and experiences, the relationship can end up turning into a friendship, as with the case of Grace Jackson and Mary-Lou O’Neill:
“Grace Jackson, who is 101, said she never wanted a helper at home and resented Mary-Lou O’Neill, 73, when she arrived four years ago at Ms. Jackson’s daughters’ insistence. But as their relationship has grown, ‘It’s developed into a friendship,’ Ms. Jackson said, adding that friends who had younger aides were often offended by their manners or language.”
The down side to this “graying trend” in caregiving is that most of these elderly women—in spite of how they excel and make the best of their situation—become caregivers because they have to, they can’t afford to retire completely, even at the age of 70 or 75. The time to think about your own future is now. Talk to your advisors about planning for your own retirement; because although you may have everything it takes to be a wonderful caregiver in your senior years, the fact is that you may not want to.
One More BIG Reason to Have a Health Care Directive
April 17, 2010
Do you have a health care directive? If not, the Los Angeles Times has just given you one more reason to create one: Advance directives for end-of-life care result in preferred treatment.
That’s right, according to the recent article; those people who have recorded their wishes for end-of-life treatment have their wishes followed by agents and doctors over 80% of the time. According to a health and retirement study done between the years of 2000 and 2006, “researchers found that of the 398 incapacitated people who had used a living will to request limited care at the end of life, almost 83% received it…” and “…Of the 417 incapacitated people who had requested comfort care in a living will, 97% received it.”
Those are huge percentages, especially when you consider how easy it is to create a health care directive or living will.
There is no down side to recording your wishes and nominating a trusted agent to help ensure those wishes are followed—it brings you peace mind, it brings comfort to your family members, and our office can help you execute one quickly and easily. Knowing all this, as well as the fact that studies now show how truly effective they are in getting you the treatment you desire… there’s really no reason to delay any longer. Call our office for more information.