You have Options For Your or Your Loved One’s Long-Term Care Needs

As life expectancy continues to rise, so does the possibility that an individual will require long-term care at the end of his or her life. A recent article states that 7 in 10 Americans will require long-term care at some point in their lives. Unfortunately, as life expectancies rise, so do the costs of long-term care.

ElderlyWomanInGlasses
(Photo credit: Wikipedia)

Many families do not realize how high the costs of care are until they are trying to place a loved one in a facility.  Many studies estimate the cost to range from $8,000 per month to $13,000 per month.  At that point, it is too late to utilize any sort of planning or saving and the financial reality can be devastating. Therefore, it is important to have a plan to cover your long-term care costs. Below are three of the most common ways that people plan to pay for their long-term care.

1. Save and pay out of pocket: If you believe that you will be able to pay for your long-term care costs out-of-pocket, be sure to conduct some research to predict how much money you will need to save and account for contingencies.
2. Purchase long-term care insurance: Long-term care insurance is becoming a more popular method through which individuals pay for their long-term care costs. Importantly, be sure to purchase this early for the best rates.
3. Spend down your assets so that you apply for Medicaid: Medicaid is a needs-based program. Therefore, your assets must be below a specific threshold in order to qualify for benefits. If you are above the threshold, you may be able to carefully spend your assets down until you qualify for coverage.

Which is right for your family?

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Planning Now for the Potential of Alzheimer’s Later

More and more senior Americans are forced to deal with the devastating diagnosis of Alzheimer’s. Without planning, an Alzheimer’s diagnosis can be a devastating financial blow to an individual and his or her family. A recent article discusses how individuals can take control of their financial futures by planning now for the potential of an Alzheimer’s diagnosis later.

One potential way through which a person can get funds to pay for medical care is through Medicaid. Medicaid is a need-based program, so a person must meet certain income requirements to apply. If a person is above the threshold to receive Medicaid, he or she must spend-down assets in order to qualify. However, the spend-down of assets must be done carefully,with the oversight of an estate-planning attorney. Importantly, Medicaid employs a look back provision that will disqualify certain distributions of wealth if they occur within five years of a person’s application for Medicaid.

Often, Alzheimer’s patients require more care than Medicaid will cover. One option to fill the gap is through long-term care insurance. These insurance policies provide broad coverage for care received in a patient’s home, assisted living facility or nursing home. It is important to get long-term care insurance early, as rates go up as a person ages. Additionally, it may be difficult to find an insurer after a diagnosis of Alzheimer’s.

Give Serious Consideration to End of Life Decisions

One major part of estate planning is determining what kind of care, if any, you would like to receive at the end of your life. Although most people would rather not think about the end of their life, a recent article explains the importance of giving serious consideration to end-of-life care.

If you have thought about what type of care, if any, you would like to receive at the end of your life, it is important to complete an advanced medical directive and a medical power of attorney. These documents will allow you to put these desires in writing so that medical staff will be aware of your wishes when you cannot otherwise communicate with them. Additionally, they allow you to select the person who you trust to make medical decisions on your behalf.

Sample Virginia Durable Do Not Resuscitate Ord...
(Photo credit: Wikipedia)

One common type of advanced directive is a do not resuscitate order (“DNR”). A DNR advises medical staff not to take life-saving measures in the event that death is imminent. If you have a DNR, it is important to keep it in an easily accessible location, and inform your family and doctors of its existence. Importantly, an advanced directive that directs medical staff not to prolong the dying process does not withhold medicine and other procedures meant to keep you comfortable during the dying process.

Conversely, you could also complete a prolonging procedure declaration. This document instructs medical staff to do everything they can to delay death, even when it is imminent.

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Long Term Care Planning: Understanding the Medicaid Look-Back Provision

For those engaged in the process of Long Term Care Planning, perhaps the most intimidating proposition is Medicaid’s look-back provision. This provision provides that certain assets that a person no longer owns will still count toward the calculation of his or her total assets to determine whether he or she qualifies for Medicaid coverage. A recent article discusses the look-back rules.

The Medicaid look-back period is the five years prior to that date upon which an individual applies for Medicaid benefits.  All transfers made during this period are subject to scrutiny by Medicaid officials. For the purposes of calculating benefits, it is as though all gifts made during this period never occurred. For example, if an individual gave his or her child $20,000 the year before he or she applied for Medicaid coverage, the government would likely count that $20,000 towards the person’s assets to determine whether he or she qualifies for Medicaid.

Some individuals try to avoid the look-back provision by setting up a trust. Although Medicaid officials do not consider a trust to be a part of a person’s assets, assets moved into a trust are considered. Therefore, if assets are transferred to a trust during the five-year look-back period, Medicaid officials will take them into account.

Individuals often mistakenly believe that Medicaid has an annual gift-giving exclusion similar to that of the IRS. However, this is not true. Although the IRS allows taxpayers to give gifts up to a certain amount without invoking tax consequences, there is no parallel in the Medicaid determination.

What is an Irrevocable Funeral Trust?

One tool for those looking to spend down their assets in order to apply for Medicaid benefits is the Irrevocable Funeral Trust (“IFT”). Through an IFT, a person can set aside funds to pay for his or her funeral and burial expenses. Importantly, funds in an IFT are not considered to be part of a person’s estate for purposes of Medicaid qualification. A recent article discusses the basics of the IFT.

Importantly, an IFT should not be used by just anyone. High net-worth individuals who will not require Medicaid assistance, for example, would not use an IFT because they likely have sufficient funds or insurance policies that will cover medical expenses.

However, those who are worried about how to pay for their long-term care costs and do not have money earmarked for their funeral should consider an IFT. A person taking out an IFT will be required to pay completely in advance, and will not be permitted to take out an IFT for an amount that exceeds 125 percent of the average funeral cost.

Importantly, no medical underwriting is necessary for an IFT. Beyond the one-time payment to the insurance company, the insured party faces no expense from the trust.

Dealing with Early-Stage Alzheimer’s

Currently, the sixth leading cause of death in the United States is Alzheimer’s disease. Between 2000 and 2010, the number of deaths caused by Alzheimer’s disease increased by 68 percent. By 2050, the number of Americans with Alzheimer’s disease is set to increase to 13.8 million. As a recent article explains, Alzheimer’s could quite possibly become an epidemic, if it is not one already.

English: PET scan of a human brain with Alzhei...
English: PET scan of a human brain with Alzheimer’s disease (Photo credit: Wikipedia)

If a loved one in your family begins to display the signs of Alzheimer’s disease, the first thing a family should do (beyond medical attention) is be sure that the family member has executed a will, durable financial power of attorney, and health care power of attorney. These documents allow the person to direct how his or her assets will be distributed upon his or her death, and also to direct who should make medical and financial decisions for him or her when he or she is no longer capable.

Importantly, a person diagnosed with early-stage Alzheimer’s may still be able to sign these legal documents. When a loved one is suffering from short-term memory or vocabulary loss, but still has a grasp on reality, he or she can often show the necessary mental capacity to create legal documents.  Although it is best if these documents are created prior to the early-stage dementia, if that is not possible, have a geriatric psychologist evaluate the person immediately prior to signing.

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‘Spending Down’ for Medicaid Coverage: A Cautionary Tale

Medicaid is a need-based public benefit program that assists citizens in paying for medical care. Therefore, a person can only receive benefits if he or she meets certain income criteria. In order to meet the criteria, many people attempt to spend down their assets. However, if not done properly, a ‘Medicaid spend-down’ could have disastrous consequences. A recent article tells the story of Eugene Shipman, who ran into trouble after attempting to spend down his assets to qualify for Medicaid.

Centers for Medicare and Medicaid Services (Me...
Centers for Medicare and Medicaid Services (Medicaid administrator) logo (Photo credit: Wikipedia)

Shipman and his wife, Arline, began the spend down process in April of 2008, so that Arline would qualify for Medicaid coverage for her anticipated and impending care needs. As part of this spend-down, Eugene disinherited her in his will executed in March of 2009. Following the drafting of the will, Arline’s son, David – who exercised her power of attorney – disclaimed any inheritance from Eugene on her behalf.

Then, in 2010, Eugene unexpectedly passed away. Arline’s attorney scrambled to file a petition to claim an elective share of Eugene’s estate on her behalf. When the trial court denied the petition, Medicaid got involved and asked the court to reconsider. Luckily, the appellate court revoked the disclaimer and granting Arline the elective share.

Had the court determined that the disclaimer should not be revoked, not only would she have lost her Medicaid eligibility, but she would have also missed out on half of Eugene’s estate. The story of Eugene and Arline should remind individuals that they must seek competent counsel and take caution when involved in a Medicaid spend down.

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ALERT: New Rules for Reverse Mortgages

As the costs of long-term care continue to rise, more and more elderly Americans are turning to reverse mortgages in order to fund these costs. A reverse mortgage allows a homeowner aged 62 or older to convert his or her home equity into cash while also remaining in the home. The homeowner can choose to accept this cash through a line of credit, monthly payment, or lump sum. As a recent article explains, the rules surrounding reverse mortgages are about to change.

Logo of the Federal Housing Administration.
Logo of the Federal Housing Administration. (Photo credit: Wikipedia)

The Federal Housing Administration (“FHA”), which insures and regulates reverse mortgages, recently announced that it will modify the reverse mortgage program in order to reduce the incidence of default. Two major changes include lower caps on borrowing limits and new rules that will make it even harder to obtain a reverse mortgage.

The FHA plans to change the borrowing limits in order to reduce the cap on the amount that a borrower can receive in the first year of a reverse mortgage. After the new rules are implemented, a borrower will only be able to take up to 60 percent of the appraisal value of the home. This amount is reduced from the previous cap of 75 percent.

The FHA will also implement various rules that will make it harder to obtain a reverse mortgage. These rules will also likely reduce the size of the loan that borrowers will be able to receive. The new rules are scheduled to take effect on October 1.

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Long-Term Care for Your Cat

All too often, cats are surrendered to animal shelters because their owner either died or had to enter a long-term care facility where the cat was not allowed. In order to avoid this fate, a recent article argues that cat owners need to have a long-term care plan in place for their pet. Importantly, this care plan can be simple and easy to create.

The first step in creating a long-term care plan for your cat is selecting a trusted friend or relative who may be willing to care for the cat in your absence. Discuss your designation with that person to make sure that he or she is up for the task. If you have an estate plan, you can insert a clause that gives your cat, and some money for its care, to the designated caregiver. If you do not have an estate plan, you can simply make a care arrangement with that person.

English: Portrait of a female feral cat (Felis...
(Photo credit: Wikipedia)

In your will or care arrangement, be sure to outline your cat’s routine. This may include feeding and exercise habits. Also include all medical information, including your cat’s veterinarian, where his or her medical records are located and any current medications.

Importantly, provide the designated caregiver with a spare key to your home or apartment. This will allow the person to enter your home if you suddenly become incapacitated. Finally, be sure to set some money aside for your cat’s care. When determining how much money to provide, consider that your friend will need to pay for food, veterinarian bills and any other necessary care expenses.

Avoiding the Financial Crisis of Long Term Care

Many elder Americans are not prepared for the high costs of long-term care. This is causing a financial crisis, as too many Americans are relying on the federal and state governments in order to provide for this care. As a recent article explains, one way to avoid this crisis is by purchasing long-term care insurance.

According to the article, the two biggest fears of the baby boomer generation are (1) outliving the finances they have saved for retirement, and (2) being forced to depend on another person for care. Unfortunately, many seniors do not understand how the Medicare/Medicaid systems work, and believe that the federal programs will pay for any long-term care that becomes necessary.

In fact, Medicare has many limitations. For example, Medicare will only cover a stay in a skilled nursing facility if the stay is 100 days or less and is medically necessary. Of course, determining whether a stay is medically necessary will depend on Medicare standards that may be confusing.

Long-term care insurance, therefore, can fill in where Medicare leaves off. Long-term care insurance allows policy-holders to select which types of care they would like to receive. And what if long-term care insurance is not an option? Then it may be time to consult with an Elder Law attorney to discuss options, such as Medicaid “spend-down”, that can help with payment of long-term care.

When You Aren’t Sure Where to Start: Having an Estate Planning Discussion with an Elderly Parent

A majority of adults find it difficult to discuss financial issues with their aging family members. Although these are often difficult and uncomfortable conversations to have, they are often necessary. Moreover, it is important to have these conversations with your parents early, before they become unable to handle their financial lives. A recent article discusses how to start this conversation, and what topics to cover.

One way to ensure that you bring up this topic is to make an appointment with yourself to do so. A good idea is to plan the discussion for after a family gathering such as a birthday party. This way, other family members can join in the conversation. If you believe that your parents and family members will be receptive to the idea, select a date and time and then invite them to join in on the conversation.

During the conversation, it is important to discuss several different aspects of your parent’s estate. The first aspect is legal. Determine whether your parent has done any estate planning. If yes, ask where the legal documents are and what estate planning tools are employed, such as wills or trusts. Your parent may also wish to explain any distributions.

Another important aspect to discuss is healthcare. Determine what types of health coverage your parent has aside from Medicare. This may include long term care insurance, or simply some money set aside for anticipated health care costs. Finally, determine whether your parent has executed a health care power of attorney. If he or she has not, encourage him or her to do so. This will be an essential step should the time come when your parent is unable to make their own decisions on their healthcare.