Elder Law Attorney

Protect A Life of Saving from Long Term Care Costs

Every month, Lawrence Cappiello writes a check to a nursing home for $12,000 to pay for his wife’s nursing home and long term care costs. Two years ago, his net worth was $500,000. In less than two years, the Cappiello’s savings will be gone. This unsettling story is explained in the article “How to Keep LTC Costs From Devouring Your Client’s Life Savings” from Insurance News Net. He is suffering from nursing home sticker shock and says he should have known better.

With proper planning, long term care costs won’t take your life’s savings

Cappiello was a professor at the University of Buffalo for 25 years. During that time, he taught an introductory course on health care and human services that touched on the costs to consumers. He said it was clear even then, that the cost of long term care was going to escalate out of control.

To qualify for Medicaid payments of nursing home care in New York State, residents are permitted to own no more than $15,450 in nonexempt assets. However, elder law attorneys, whose practices focus on these exact issues, say that the way to protect the family’s assets, is to take steps years before nursing home or long term care is needed. Some general recommendations:

  • Signing over the deed of the home to children or any others who would otherwise inherit it from you in a will. The transaction would need to stipulate that you have life use of the home.
  • Establishing an irrevocable trust, that upon death, transfers the house to the beneficiaries. There must be language that ensures that you have life use of the house.
  • Giving away savings and other financial assets.

Transfers of any assets must take place more than five years before applying for Medicaid nursing home and long term care coverage. If they have been given away or transferred within the five year “look-back” period, then there is a chance that they may still qualify, or they may have to wait five years.

That is why planning with an experienced estate planning attorney is so critical for families, especially when one of the spouses is facing a known illness that will get worse with time. There are steps that can be taken, but they must be done in a timely manner.

Many older people are not exactly jumping with joy at the idea of handing over their assets, even when relationships with adult children are good. The idea of giving up assets and the family home is a marker of the passage of time and the inevitability of one’s own passing. These are not things that we enjoy considering. However, taking steps in advance, can make a huge difference in the quality of the well spouse’s life.

It should be noted that a sick spouse can move assets to a healthy spouse, to make the sick spouse lawfully poor and eligible for Medicaid. There is no look back period or penalty relating to long term care for interspousal transfers. This may sound like a very simple solution. However, these are complex matters that need the help of an experienced attorney. If it were so easy, countless spouses would not be facing their own impoverishment because of an ill spouse’s long term care needs.

Reference: Insurance News Net (Feb. 4, 2019) “How to Keep LTC Costs From Devouring Your Client’s Life Savings”

300,000 Americans to Gain Medicaid Benefits

Most of those who will be eligible in 2019 are over age 50 and would otherwise have no healthcare.

Ballot measures in three states—Idaho, Nebraska, and Utah—will extend the federal- and state-funded healthcare program to allow access to approximately three hundred thousand low-income Americans.

MP900398819AARP’s recent article, “Medicaid to Expand in 3 States,” reports that with the passage of ballot measures in those three states, 37 states, including DC, have now expanded the Medicaid program, since the Affordable Care Act (ACA) created the opportunity to offer more people coverage.

The success of the three ballot measures “is a recognition that Medicaid plays an important role in our society for those who are in need and that it’s an issue that has changed a great deal over the past five or six years from a political standpoint,” says John Hishta, AARP senior vice president for campaigns. “I think the voters have led the way in some of these states.”

Montana voters rejected a measure that would have increased tobacco taxes on cigarettes and taxed other tobacco products to pay for the state’s share of Medicaid expansion, veterans’ mental health, and home- and community-based services. Nearly 130,000 low-income residents in that state may now lose their Medicaid eligibility in 2019, if the state Legislature doesn’t act.

The mid-term election results in three other states could have implications for their Medicaid programs as well. Maine’s Democratic Governor-elect Janet Mills supports expanding Medicaid. The state’s voters decided in 2017 to expand the program, but the current governor, Republican Paul LePage, refused to implement the expansion.

Kansas’ Democrat Governor-elect Laura Kelly stated in the campaign that she’d push for legislation to expand Medicaid during her first year in office. In 2017 the Republican-controlled Kansas House of Representatives and Senate passed legislation to extend Medicaid, but the current Governor Sam Brownback vetoed it. The Legislature couldn’t override his veto.

Wisconsin’s Governor-elect Tony Evers says he wants to expand Medicaid, which would provide coverage to at least an additional 80,000 people in that state.

Most of the people who apply for Medicaid work but do not earn enough to cannot afford health insurance. The program allows people between 50—64 years of age to get health care coverage.

Reference: AARP (November 8, 2018) “Medicaid to Expand in 3 States”

Preparing for the Realities of Aging

A healthy life where you retain all your faculties and enjoy yourself, is definitely preferred to decades of dementia. We don’t get to choose, but we can plan.

As Baby Boomers continue to change the face of aging, and so many embrace the idea of genetic testing, many are confronted with a harsh picture of what their future may bring. If that includes dementia, there are facts you need to know and myths that need to be uncovered.

MP900439289The (Bryan TX) Eagle’s recent article, “Alzheimer’s disease: Five common myths, busted,”reports that, according to the Alzheimer’s Association, one in three seniors dies with Alzheimer’s or another type of dementia. There are up to 5.7 million individuals who live and die with the disease, which makes it the sixth leading cause of death in the United States. The article provides five common myths about Alzheimer’s disease.

Myth # 1: Memory loss is a normal part of growing older. A slip of the memory may well be a normal part of growing older. While these forgetful moments may cause a bit of frustration and embarrassment, they don’t affect our ability to live an independent life. However, if a loved one has trouble remembering commonly used words or loses the ability to communicate, it could be a potential symptom rather than a natural senior side-effect.

Myth # 2: Alzheimer’s can be reversed if it’s diagnosed early.No. Unfortunately, there's no treatment that will reverse the progress of Alzheimer’s disease. However, although there are therapies and drugs that can slow down the neurodegeneration associated with Alzheimer’s, there is no known cure. Even so, early diagnosis has its benefits, like better symptom management, a safer patient environment and the ability to plan for the future.

Myth # 3: Alzheimer’s just affects older people. Some Alzheimer’s patients can get diagnosed in their 40’s or 50’s. The early onset Alzheimer’s is uncommon (just 5% of patients are diagnosed before age 65); an accurate diagnosis is important to help the family cope with the realities of the disease.

Myth # 4: A diagnosis of Alzheimer’s means your life is over. Many people live years or even decades, before the disease claims their lives. Alzheimer’s effects each patient differently. The disease is commonly divided into three stages. The first or “mild” stage is where the patient is able to live a mostly normal life. The middle or “moderate” stage requires more extensive care. And in the late or “severe” stage, the patient needs 24/7 supervision and medical assistance. Life many never be the same with an Alzheimer’s diagnosis, but it’s far from over.

Myth # 5: There’s little you can do to protect yourself financially, if you are diagnosed with the disease. A serious diagnosis of any type can drastically impact a family, but it’s important to understand that there are things you can and should do to help your loved ones manage what comes next, emotionally as well as financially. Look at these ways you can help:

  • Create a list of all financial accounts;
  • Review the titles and names on each account;
  • Look at your options for paying for medical care, such as existing insurance policies, Medicare coverage, or other sources of funding;
  • Consider designating a Durable Power of Attorney for Healthcare, so that a trusted person can make decisions for the patient if there’s an accident or incapacitation;
  • Communicating preferences for living arrangements, medical assistance, and end-of-life care; and
  • Be sure your will is up to date.

Speak with an elder law attorney, who will be able to help you and your family navigate this process. He or she will also be able to recommend local resources that will help make this journey as good as it can be.

Reference: The (Bryan TX) Eagle (October 4, 2018) “Alzheimer’s disease: Five common myths, busted”

Are You or Will You Become a “Solo Ager”?

“Solo agers face unique challenges, as their needs begin to change.”

Did you know that a study from the Pew Research Center says about 20% of the 75 million baby boomers don’t have children—a figure that’s double what it was in the 1970s and one that’s expected to keep rising.

MP900427632We mention this because these people need someone to count on to always be there, if they need help making decisions and managing their affairs as they get older.

NH Magazine’s recent article entitled “The Difficulties That Come With Solo Aging” says that, for those without children or parents who’re estranged from them, it’s frequently a tough question to answer.

Our country’s 15 million “solo agers” or “elder orphans” now comprise a demographic that’s unprecedented in American history. This relatively new segment of society has a unique set of challenges.

As your physical, intellectual, and emotional capacities diminish, a person on his own must determine how he will be able to make sound decisions on financial and legal issues, relationships, housing and healthcare. There are also more cases being reported of elder fraud, and new scams are designed to take money from seniors. An elderly person could also wind up lonely and penniless.

However, there is help. Professional guardians can assist the elderly in reviewing their financial statements, creating budgets, paying bills, keeping keep them organized and sorting mail and email to see what’s a legitimate bill or a solicitation or potential scam.

A guardianship, which is also known as a conservatorship, is a legal process that’s used when a senior can no longer make or communicate safe or sound decisions about himself person and/or his property, he’s become susceptible to fraud or undue influence. The fact that establishing a guardianship can remove substantial rights from a person means that it should only be considered after other alternatives have proven ineffective or are unavailable.

In addition to a court-ordered guardianship, there are other options. There are also certified geriatric care managers, certified daily money managers, as well as attorneys who specialize in elder law.

Solo agers should arrange a future legal guardianship for themselves, a person who will assume control in a fiduciary capacity, if they’re unable to make decisions for themselves. This may be a relative or a friend, as well as a professional fiduciary or private guardian.

In addition, everyone should have a healthcare directive and an estate plan. However, solo agers have a more urgent need to have these important documents in place, while they’re still somewhat young and healthy—because they don’t have an adult child who will fly in from the other side of the country to provide that assistance and guidance.

Talk to several potential guardians or fiduciaries and go with the one whose skills most closely fit your needs and with whom you feel the most comfortable. Check their references and credentials thoroughly. You can also select different people for different tasks, which gives you a critical system of checks and balances. Be certain that you understand exactly what services each will provide and their fees and get it all in writing.

Reference: NH Magazine(October 2018) “The Difficulties That Come With Solo Aging”

What Happens in Your World After You Die?

We’re not talking about what happens to your soul, or if you are headed to a peaceful place, or even what happens to your physical remains. Have you thought about what happens to the world you leave, your family and friends and your possessions, after you die?

Let’s say you don’t believe in anything in particular. Or you’re deeply spiritual and believe that death will be a wonderous journey. Either way, you should devote time and energy to what happens right here on earth after you die, says Forbes in the article, “What Will Really Happen After You Depart?”

31179858004_e5c33b693c_oNo, not just because it’s the right thing to do and not just because you’re curious. It’s because you want your family to remember you for the awesome legacy you plan on leaving, not because of the horrible hot mess you left behind that they spent three years trying to figure it out, while trying to live their lives.

Estate organization is not the exact same thing as estate planning. An experienced estate attorney or elder law attorney can help you draft your will, your advance directive, your power(s) of attorney and a trust, if you need it. Your attorney most likely also has a copy of those documents.

 However, the attorney has no power over what you do with your original estate planning documents, once you leave their office.

One idea is to develop a guidebook or “game plan” for your family and loved ones, while you’re alive. It’s known that there’s a strong correlation between how we face death and prepare our families—and their ability to survive, adjust and start the recovery process. Organizing your estate has been called a “gift of love” that goes far beyond when you can be around to take care of your family.

Answer these questions to start the estate organizing process:

  • Does a family member know where to find your advance directive, if you end up in the hospital?
  • Where are your legal documents and who in your family knows where to find them?
  • Who has access to your bank accounts and knows your login data?
  • Are you now caring for someone? Who’d assume that responsibility, if you’re unable to do so?
  • Have you made final arrangements for your death, funeral and burial or cremation?
  • Who knows about the plans and where the paperwork is located?
  • Where are your insurance documents, and who knows where to find them?
  • Who’ll take care of your pets, when you are no longer able?

Let’s also keep in mind that getting all these plans and documents in place is just the first step. They don’t do anyone any good, if you don’t talk with your family and loved ones about them. You have to make sure that they understand your wishes to avoid misunderstandings or family feuds, after you’re not around to correct them. The more you can discuss these matters in a calm, caring fashion, the better their grief process will be. Think of this as your opportunity to show how much you care about them. You want them to remember you with love, grieve in a healthy manner and be able to incorporate your loss, as their lives continue. Memories are a powerful force, and how you prepare for your passing, will also be a memory for them.

Reference: Forbes (September 13, 2018) “What Will Really Happen After You Depart?”

Buzz Aldrin’s Capacity Case Illustrates Need to Plan for Aging Issues

The case of Buzz Aldrin, who is taking his son and daughter to court on charges of fraud, conspiracy and exploitation of the elderly, is a tough one.

Even when planning for competency issues is in place, there can still be problems. When a highly-intelligent public figure makes decisions his kids thinks are wrong, who is right?

Buzz AldrinThe case of Buzz Aldrin, who is taking his son and daughter to court on charges of fraud, conspiracy and exploitation of the elderly, is a tough one. He’s accusing his adult children and his longtime manager of slandering him, by telling others he has dementia and Alzheimer’s diseases, using his money for their own gain and undermining romantic relationships.

The 88-year-old astronaut’s lawsuit illustrates the reason it's important for families to plan ahead for an aging parent. However, cases like Aldrin's can be hard, because it can be difficult to determine when someone has a deteriorating mental capacity, explains Good 4 Utah in the recent article,“Buzz Aldrin lawsuit shows need to plan for aging parents.”

Aldrin's children deny the claims in the lawsuit, which was filed just weeks after they petitioned for partial guardianship over their father.

An elderly person who doesn't think they need a guardian should contest it. If someone brings a guardianship case against an elderly person who believes he still has capacity, then that senior shouldn't be afraid to push back.

In Utah, any elderly person who’s being partitioned for guardianship must be given an attorney to make certain their rights are being protected. If you have a plan in place regarding your choice of guardian, it can help.

Here are a few tips for dealing with this issue, whether you are the aging parent or the adult child.

  • Make sure your planning is in place. Decide for yourself who you want to take responsibility for your affairs if you cannot, and make sure that an elder lawyer documents your wishes.
  • If you have many children, or children from multiple marriages, you may want to select a third party to become your guardian. Children often fight over care and financial decisions.
  • Work with an experienced elder law attorney to get all of the necessary documents prepared well in advance.
  • If your family has a history of Alzheimer’s, Parkinson’s or dementia, don’t wait. Do this now.

Reference: Good 4 Utah (July 3, 2018)“Buzz Aldrin lawsuit shows need to plan for aging parents”

Finding the Right Assisted Living Facility for Now and the Future

People moving into an assisted living facility should do a lot of research to make sure they get the quality care and the services they need.

People moving into an assisted living facility should do a lot of research to make sure they get the quality care and the services they need. Their lives may depend on it.

MP900407501Life in an assisted living facility is a welcome alternative to aging seniors who are no longer able to remain in their own homes, but don’t want or need to live in a nursing home, which often feels like living in a hospital. They can receive the services they need, while enjoying a full roster of activities and the companionship of their peers. It sounds like a good plan, and in many cases, it is.

However,Consumer Reports’recent article, “5 Steps for Choosing the Right Assisted Living Community”says that finding the right residence can be a huge challenge.

Right off the bat, the cost is high. In 2017, the median fee for a private one-bedroom was $45,000 a year, according to Genworth, a long-term care insurer. Most residents pay out of pocket, although some qualify for Medicaid. Medicare generally does not cover long-term care services.

In addition, shortfalls in caregiving can be a problem for assisted living residents. A 2017 survey of state long-term-care ombudsmen conducted for Consumer Reports, which monitors senior living facilities nationwide, found the most common complaints dealt with understaffing and delays in response to calls for assistance. Ombudsman data show that complaints about assisted living have gone up 10% in recent years.

For families looking at into assisted living facilities for a family member, there are ways to find a facility that delivers quality care in a comfortable setting. The key is to conduct thorough research. You should egin by asking these five key questions:

  1. What Kind of Care is Required?Remember that different facilities offer varying levels of care. Is there a registered nurse on staff? Without this basic level of care, your loved one might end up going to the ER more often.
  2. What is the Quality of Care?Look at the residence’s licensing and inspection records, to see if there are any issues. To get a feel for the way things work, make several visits to the facility. Go for meals and during the weekends, when fewer staff are on duty. You should also talk to residents and their families about their experiences.
  3. Uncover the Real Costs of the Care. Get a written list of fees and charges from the residence and be sure that they’re included in the contract. It is recommended that you hire an elder law attorney, who’s familiar with local facilities, to review the terms of the contract.
  4. Can Your Parent or Family Member Age in Place? Find out what scenarios might trigger a discharge, and whether you could hire private aides, if more care is required. You should also ask what assistance the facility would be able to provide, if a move is needed.
  5. Is an Advocate Available? If family and friends are not able to visit on a frequent basis, the potential for problems increases. Care issues, from cleanliness to patient treatment, may not be readily apparent to an elderly resident, especially if they are suffering from dementia. Consider hiring an aging life-care expert or social worker to make frequent visits, if you are unable to. If the facility’s management knows someone is keeping a watchful eye, the quality of care will be better.

Reference: Consumer Reports (April 16, 2018) “5 Steps for Choosing the Right Assisted Living Community”

Guardianship Nightmares Surge in Unregulated Environment

With a growing population of elderly, the lack of regulations and oversight has led to a disastrous situation for adults who lose civil liberties via guardianship proceedings.

With a growing population of elderly, the lack of regulations and oversight has led to a disastrous situation for adults who lose civil liberties via guardianship proceedings.

MP900442275A review by the Reading Eagle of court documents in three Pennsylvania counties show that when it is necessary for Adult Protective Services to intervene, agencies prefer having professional guardians rather than family members.

The story, “Finding solutions to Pennsylvania's troubled system of naming guardians,” reports that over the past two decades, filings statewide have risen 28%, faster than the increase of people 60 and older—the demographic most likely to be in a guardianship. In fact, the system in Pennsylvania already shows signs of strain: the Philadelphia Orphans Court is willing to retain a felon convicted of financial fraud as guardian to dozens of incapacitated adults, because of a shortage of professionals able to assume her caseload.

Advocates for reform say that finding solutions is critical, because of the explosive growth in a cottage industry of paid professionals that has supplanted roles traditionally held by family members.

"You can lose your civil rights," said Sam Brooks, senior attorney for Community Legal Services of Philadelphia, one of the leading advocates for the elderly in the state. "There needs to be some sort of system that ensures less invasive steps are taken."

Advocates call it supported-decision making, the process of accommodating individuals with disabilities or cognitive deficits (the most common justification for guardianship) by including family, friends, and other social support to enable life decisions without restricting the adult's autonomy.

 However, in many cases, the adult who’s alleged to be incapacitated is not present or not represented by an attorney in many of these proceedings. In many instances, judges will waive the attendance requirement with a doctor's testimony on behalf of the petitioner, that being present would be harmful to the senior in the guardianship proceedings. When counsel is appointed, Pennsylvania doesn't require attorneys to resist a guardian appointment and instead allows them to decide what is in their client's best interest.

Many adults in guardianship without resources are put in nursing homes and other facilities. However, advocates say that reform might save the state money because of the institutional costs.

Advocates also want standards established that would professionalize the industry and create a post-appointment monitoring system to filter out bad actors. For example, Philadelphia judges repeatedly appointed Gloria Byars, a convicted felon, to serve as guardian to vulnerable adults. This wasn’t against the law, because Pennsylvania doesn't have any standards for becoming a guardian. The state also doesn’t require a background check.

A statewide system to manage the industry is hoped to be in place by the end of this year. The hope is that this system will be able to effectively flat unscrupulous guardians, whether they are family members or professionals.

Reference: Reading (PA) Eagle (March 6, 2018) “Finding solutions to Pennsylvania's troubled system of naming guardians”

Scroll to Top