Adult Children and Elderly Parents: Caring for Each Other
December 24, 2010
The idea of adult children caring for aging parents or grandparents is not a new one. In fact, with the aging Baby-Boomer population, adult children giving up free time or extra hours at work to care for relatives is a growing trend. But recently families have begun creating “caregiver compensation agreements,” something which can end up benefiting both parties in a number of ways.
According to a recent article in the Wall Street Journal, “the high unemployment rate, the rising cost of nursing-home care, an aging population, and a 2006 change in Medicaid law that makes it harder for people who wish to qualify to give away assets” are all contributing factors to the growing trend of these compensation agreements among family members. Note: Medicaid is called “Medi-Cal” in California.
How can it help you?
If you’re a caregiver the benefits of a caregiver compensation agreement are fairly self explanatory. “Some 37% of caregivers surveyed by the NAC in 2007 said they had quit a job or reduced their hours to accommodate their responsibilities,” some kind of compensation seems only fair. And if you feel uncomfortable taking “wages” from your parents, there are other ways to arrange for compensation. “Attorneys say many families pay an hourly wage. As an estate-planning tactic, others opt for annual gifts or a lump-sum payment designed to cover services over an extended period. Some arrange for the caregiver to receive a larger inheritance.” It will all depend on what works best for your family.
If you’re the one receiving the care, compensation agreements can benefit you as well. Paying a family caregiver can help you deplete your savings and qualify for Medi-Cal, which might then help if you later need a nursing home subsidy. Doing so can also help you reduce your taxable estate, as well as give a gift of sorts to younger family members who may be in need. Remember the Medi-Cal rules are tricky, so best to enlist the help of an Elder Law attorney before creating any care contracts.
However you may decide to structure your compensation agreement, disclosure can be of the utmost importance. Make other family members aware of the agreement up front to avoid suspicion or hurt feelings later on.
Just Say No? Medical Marijuana in Nursing Homes
October 30, 2010
The legalization of marijuana is on the ballot in California this November, but California isn’t the only part of the country where marijuana is making news. The use of marijuana for medical purposes is being debated around the nation—especially as concerns elderly patients in nursing homes which receive federal funding through Medicare or Medicaid.
This article on the New York Times’ New Old Age Blog reports on this issue, and just how concerned and confused nursing home facility administrators are about what their options are and how to proceed. “Any patient using medical marijuana breaks federal law. Marijuana is listed as a Schedule 1 drug, which means the federal government considers it to have no medicinal value. Despite this, physicians in 14 states and the District of Columbia are allowed to recommend it. . . Many facility administrators wonder how they can comply with federal law and preserve their reimbursements and at the same time permit residents to medicate with marijuana.”
Federal funding isn’t the only conflict attached to the medical marijuana issue. Nursing homes in New Mexico (a state where marijuana was legalized for medicinal purposes in 2007) report that “the lack of dosing direction has caused problems. . . Pills in nursing homes are in what they call vacuum packs: you have to pop a pill out one at a time. They don’t do that with marijuana. It’s an amount of marijuana in a small plastic bag, so there is no way to track if someone took one or two pinches.”
Another issue to consider is the stigma attached to marijuana use, and complaints from other patients or residents.
Medical marijuana is generally prescribed to seniors to help them deal with chronic pain. Oregon’s long-term care ombudsman, Mary Jaeger, asks in the article above “Wouldn’t any one of us, in our own homes, feel that we have the right to live our lives by our own values and choices, to preserve our own dignity and, frankly, to live pain-free?” Will seniors moving to federally supported nursing homes have to find other ways to deal with chronic pain? And more importantly… will they be willing to do so?
Caregiver Compensation Agreements Benefit Elders AND Caregivers
September 1, 2010
Caring for an aging relative is hard work. Many of the people who serve as caregivers admit that they often feel as if they have two jobs—their day job, and the part-to-full-time job of caregiver. If you consider that in our fast-paced society time is money, then most of these caregivers are not only giving up their time, but also their potential income. Caregivers need to know that it doesn’t have to be this way; caregivers can be compensated according to mutually agreed upon terms of a Caregiver Agreement, or Personal-Care Contract.
Elder law attorneys have known about Caregiver Agreements for a long time, but a recent article in the Wall Street Journal will hopefully raise caregiver awareness of this useful contract; especially, as the article mentions, given the “still-fragile” state of the economy. A Caregiver (or Employment) Agreement “should document a caregiver’s responsibilities and hours and set a rate of pay that’s in line with local practices. Both the caregiver and care recipient should sign the contract and disclose it to the rest of the family.”
An agreement of this sort can be useful not only for the care-giver and the cared-for; it also comes in handy if you think you may need to rely on Medi-Cal (known as Medicaid in other states) to cover nursing home costs sometime in the near future.
According to the article, “Before Medicaid will pick up the tab for nursing-home costs, it requires applicants to recoup certain payments made to relatives over the previous five years — and use the money to pay the nursing home… But if payments to relatives are made under the terms of a written employment agreement, often called a personal-care contract, the law allows it.” While the recoupmement term is different in California, the point is well-taken.
But remember, “to pass muster with Medicaid, it’s important to have such a contract in place before the services are rendered.”
This is why it is extremely important to talk to an attorney who is well-versed in elder law and Caregiver Agreements before any contracts are signed or money changes hands.
Falling Through the Cracks
July 23, 2010
Our country may be facing a simultaneous growth and recession… unfortunately, according to journalist John Leland, the two seem to be at odds. What we are referring to is the growth of the elderly population and the recession of funds available to help this aging community pay for the care they need.
The economic downturn of the past few years has hit the elderly with a double-whammy. Many of them lost close to all of their savings when the stock market bottomed out, and now budget cuts to state-funded home-care services threaten to force many of them out of their homes and into hospitals or nursing facilities.
“’I’m not getting a cost-of-living adjustment, and now I’m not getting food,’ said Joyce Plennert, 83, who is on a waiting list for Meals on Wheels in Palatine, Ill. ‘Now I’m worried my home services will be cut. Without that, I’d be in a nursing home, if I could find one with room.’”
According to the above-mentioned NY Times article, a number of states have already made cuts to home-care services, including Alabama, Arizona, California, Colorado, Florida, Kansas, Mississippi, Missouri, Nevada, New Jersey, New York and Texas. “The situation is grim, and it’s safe to say that present trends are expected to continue,”
These budget cuts impact more than just senior citizens—they affect the professional caregivers and home aides who lose their jobs when state programs are cancelled, as well as the families of the elderly. When these seniors lose their ability to live at home it’s their families who will have to pick up the slack either by contributing to the costs of care or more often by becoming the caregivers themselves.
If you or a loved one is facing a loss of benefits due to budget cuts don’t be afraid to explore your options. Geriatric care managers can help families through confusing times, and other advisors such as elder lawyers, estate planners, financial planners and others can offer valuable advice when creating your plan for the future.
Should A Bank Help You Care for Your Elderly Parents?
July 8, 2010
The influential Baby Boomer generation is aging, which means more and more of them are taking on the responsibility of caring for their elderly parents, and the Boomers are beginning to face up to the fact that they will need caregiving themselves in the not-so-distant future.
Large banks are not immune to this trend—and the potential to increase their client base by offering financial elder-care services. The question is, how effective can a bank be at helping you care for your elderly relatives?
According to this article in the Wall Street Journal banks can be helpful with certain financial issues such as helping to “sort out medical bills, hire in-home care or even manage the sale of a home.” Some of the larger banks are even beginning to offer more in-depth services such as “estate planning and setting up powers of attorney… crisis management (triggered, say, by a broken hip or a car accident); health and home assessments; Medicare-coverage selection and claims management; and evaluating retirement communities and long-term-care facilities.”
All of this sounds great, but before you get too excited our firm would like to caution you to be as careful about hiring a bank to do your estate or elder care planning as you would be with engaging any other attorney or professional advisor. After all, as the WSJ article says, “banks and trust companies aren’t doing this solely out of the goodness of their hearts. Providing extra services targeted at the elderly and their family caregivers can bump up the asset-management fees that clients pay each year. . . [or] persuade a few clients to move assets to an institution to meet its minimum deposit requirements.”
So we urge you, before you jump into anything—whether it be with a bank, an attorney, a CPA or other important advisor—do the research and ask all the questions you need to ask in order to find out whether this advisor truly knows their stuff; knows the ins and outs of the law and the care-giving industry; and most important of all, make sure the person or institution you hire will be working for you, will be your advocate and your ally during difficult and confusing times. Further, to the extent your loved one needs legal services to plan for incapacity, to implement asset preservation strategies, to design an estate plan or to plan for Medi-Cal or other public benefits, our strong recommendation is to first seek the advice and guidance of an Elder Law attorney knowledgeable in the field. In our opinion, acquiring these skills takes years of study, practice and experience.
Will You Be Able To Afford Old Age?
April 8, 2010
Are you ready for the financial implications that come with growing older? As the average American lifespan grows longer the cost of aging becomes more and more prohibitive.
A recent segment on NBC’s The Today Show takes a close look at long-term care and the price individuals and couples are required to pay as age related illnesses make it more and more difficult for senior citizens to live at home without care.
The show tells the story of “Roberta” and her husband, a couple married for 44 years, who felt there was no choice but to divorce after Roberta’s husband was diagnosed with dementia and the subsequent nursing home bills quickly depleted their assets. After paying no less than $75,000 in care costs, Roberta was advised by her attorney that one of the only ways to conserve her remaining assets for her own support would be to divorce her husband, allowing him to qualify for Medicaid coverage. As an Elder Law firm, we frankly wonder whether that was the only option for Roberta. In California, at least, there may have been other options that might avoided the tragedy of divorce.
With growing numbers of senior citizens being diagnosed with debilitating elderly illnesses, and the cost of nursing care on the rise, more and more couples are finding that without some kind of long term care insurance, or a Long Term Care Estate Plan, they simply can’t afford the cost of aging. Medicaid (called “Medi-Cal” in California) can help, but planning is the key to avoiding the tragedy of Roberta and her husband.
Plan ahead for your own old age by talking to your advisors about Medi-Cal, your options for long-term care insurance, and whether your existing estate plan should be re-designed. Most have been designed with death in mind, rather than with extended long term care needs in mind. Our firm has specially designed a Long Term Care Estate Plan for couples in just the situation above, and we have been able to help couples avoid the dreaded option of divorce. See the following links, one for healthy couples and one for a couple with an incapacitated spouse.
The IRS Provides One More Reason to Consider Long-Term Care Insurance
October 23, 2009
In the estate planning business we help people plan for the future, not only for their children and heirs but for themselves as well; which is why we are pleased to share the news that it just got a little bit easier to plan for your own financial future, because according to this article on Emax Health the IRS has just approved higher tax deductions for long-term care insurance.
Advancements in health care and our standard of living mean that Americans are living longer than ever before, but that doesn’t mean they’re living better in their old age. Very few of us are able to remain healthy and hearty until our dying days; rather, most aging Americans will experience a slow decline in their mental and physical health, and require some kind of nursing care, either at home or in a nursing facility. Unfortunately, the cost of that care is prohibitively expensive, and once a patient’s own financial resources have been exhausted the burden then falls on their family, or they end up relying on government benefits.
Long-term care insurance is one way of planning ahead to pay for the nursing care that most of us will almost assuredly need. The higher tax deductions approved by the IRS offer one more reason to consider long-term care insurance: by planning for your future you can save on your taxes right now. But do your research and consult with a professional before you jump in, because the deductions are available only on “qualified” policies, and there are limits on the amount of the premium deduction, depending on the age of the taxpayer at the end of the year.
Medicaid Fact and Fallacy: Shouldn’t You Know the Truth?
July 28, 2009
Health Care is one of the Obama Administration’s pet projects, and ever since President Obama took office there has been a lot of media attention and speculation about the national health care system and what changes (for good or ill) may be in store. Of course, the backbone of our national health care program is Medicaid, known as “Medi-Cal” in California. It is funded by the state and federal governments, and managed by the states, Medicaid is “the United States health program for eligible individuals and families with low incomes and resources.”
Of course we’ve all heard about Medicaid, and most people know the very basics of what Medicaid is and what it does; but when questioned further, how many people actually know the difference between fact and fallacy? Do you know which services Medicaid will pay for? Or if Medicaid covers parents and their children? These questions and more are answered in this article from Kaiser Health News—Medicaid: True Or False? The article gives the opportunity to test your assumptions about Medicaid and improve your factual knowledge at the same time.
As the Baby-Boomer population ages, nursing home and elderly care is becoming the fastest-growing aspect of Medicaid. This means that we’re all likely to have to have dealings with Medicaid—either for ourselves or for someone we love—at some point in the future. Shouldn’t you know as much as you can about the program before that time comes? For more California specific information in an easy to understand format, download our firm’s “Consumer’s Guide To Medi-Cal Planning”.
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