Tailoring a Caregiving Plan to Your Family

Tailoring a Caregiving Plan to Your Family: If you have a family member who needs ongoing assistance because of a disability, severe medical issue, or a chronic illness, you might need to create a schedule within the family for providing care to that loved one. Few of us can afford to hire a private nurse for a family member. Many people who need caregiving need someone available 24 hours a day, even if some of that time is watching over the person rather than providing medical attention.

Public assistance programs provide limited, if any services, so most families have to figure out who can pitch in and help care for the loved one. If you are like most people, you could use some suggestions on tailoring a caregiving plan to your family. Recent legislation could make that task easier.

The Inherent Problems of Caregiving

People who are already working full-time and raising their families, often end up taking shifts, along with other relatives. The situation can go on like this for years. The caregivers become exhausted, physically, emotionally and financially.

Resentment can build, if some of the family caregivers feel they are doing more than their share, while others are not doing their part. Years later, the primary caregivers can get accused of undue influence, if the person who received help gives a larger portion of the estate to the primary caregivers out of gratitude.

Why Congress is Paying Attention to the Challenges of Family Caregiving

Our population is aging. By 2026, the baby boomer generation will start to turn 80 years old. Many people in their eighties need long-term care, either in the home or a facility. The high numbers of baby boomers and the declining birthrates mean there will be more people needing family caregiving and fewer relatives available to provide those services.

Family caregiving takes a massive chunk out of our economy each year. Experts say 40 million people in the United States provide unpaid caregiving services to their adult loved ones, who have limitations in their daily activities. The experts on aging value these services at around $470 billion a year.

Another 3.7 million Americans take care of a disabled child under the age of 18. Some people have to provide caregiving for both an older adult and a child. People in the field estimate that about 6.5 million people in our country fall into this category.

The caregivers face immediate and long-term financial crises, because of the time they devote to the needs of their vulnerable loved ones. In the moment, the caregiver might have to cut back on work hours or leave a paying job to be there for the family member in need. Losing a paycheck and benefits, can put a caregiver into economic hardship. Many caregivers live in poverty in the future, because it was impossible to contribute to retirement savings or the Social Security system during the long years of caregiving.

Congress is working on measures to provide more public resources for family caregivers. The “Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act” contains strategies for state and communities to support caregiving families. Increased assessments and service planning dovetailed with education, supports and respite options can impact financial security and workplace issues of caregivers. The new law centers on both caregivers and people receiving the care.

It is our goal to provide our clients with the highest level of legal services in the areas of Last Will and Testaments, Living Trust, Irrevocable TrustsEstate Planning, Probate, Asset Protection, and complete Business Planning. If you or someone you know needs information on Florida estate planning, please contact us today at 239-418-0169 to schedule your free consultation.

References:

AARP. “Building a Family Caregiving Strategy to Align with the Real Needs of Families.” (accessed October 31, 2019) https://blog.aarp.org/thinking-policy/building-a-family-caregiving-strategy-to-align-with-the-real-needs-of-families

 

Don’t Let Medicare Open Enrollment Go by without checking your benefits

Don’t Let Medicare Open Enrollment Go without checking your benefits: Medicare’s Open Enrollment Period, during which you can freely enroll in or switch plans, runs from October 15 to December 7. Don’t let this period slip by without shopping around to see whether your current choices are the best ones for you.

During this period you may enroll in a Medicare Part D (prescription drug) plan or, if you currently have a plan, you may change plans. In addition, during the seven-week period you can return to traditional Medicare (Parts A and B) from a Medicare Advantage (Part C, managed care) plan, enroll in a Medicare Advantage plan, or change Advantage plans. Beneficiaries can go to www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to make changes in their Medicare prescription drug and health plan coverage.

According to the New York Times, few Medicare beneficiaries take advantage of open enrollment, but of those that do, nearly half cut their premiums by at least 5 percent. Even beneficiaries who have been satisfied with their plans in 2019 should review their choices for 2020, as both premiums and plan coverage can fluctuate from year to year. Are the doctors you use still part of your Medicare Advantage plan’s provider network? Have any of the prescriptions you take been dropped from your prescription plan’s list of covered drugs (the “formulary”)? Could you save money with the same coverage by switching to a different plan?

For answers to questions like these, carefully look over the plan’s “Annual Notice of Change” letter to you. Prescription drug plans can change their premiums, deductibles, the list of drugs they cover, and their plan rules for covered drugs, exceptions, and appeals. Medicare Advantage plans can change their benefit packages, as well as their provider networks.

Remember that fraud perpetrators will inevitably use the Open Enrollment Period to try to gain access to individuals’ personal financial information. Medicare beneficiaries should never give their personal information out to anyone making unsolicited phone calls selling Medicare-related products or services or showing up on their doorstep uninvited. If you think you’ve been a victim of fraud or identity theft, contact Medicare.

It is our goal to provide our clients with the highest level of legal services in the areas of Last Will and Testaments, Living Trust, Irrevocable Trusts, Estate Planning, Probate, Asset Protection, and complete Business Planning. If you or someone you know needs information on Florida estate planning, please contact us today at 239-418-0169 to schedule your free consultation.

Here are more resources for navigating the Open Enrollment Period:

 

 

IRS Issues Long-Term Care Premium Deductibility Limits for 2020

IRS Issues Long-Term Care Premium Deductibility Limits for 2020: The Internal Revenue Service (IRS) has announced the amount taxpayers can deduct from their 2020 income as a result of buying long-term care insurance.

Premiums for “qualified” long-term care insurance policies (see explanation below) are tax deductible to the extent that they, along with other unreimbursed medical expenses (including Medicare premiums), exceed 10 percent of the insured’s adjusted gross income.

These premiums — what the policyholder pays the insurance company to keep the policy in force — are deductible for the taxpayer, his or her spouse and other dependents. (If you are self-employed, the tax-deductibility rules are a little different: You can take the amount of the premium as a deduction as long as you made a net profit; your medical expenses do not have to exceed a certain percentage of your income.)  Additionally, these tax deductions allowed by the IRS for long-term care insurance premiums are generally not available with so-called hybrid policies, such as life insurance and annuity policies with a long-term care benefit.

However, there is a limit on how large a premium can be deducted, depending on the age of the taxpayer at the end of the year. Following are the deductibility limits for tax year 2020. Any premium amounts for the year above these limits are not considered to be a medical expense.

Attained age before the close of the taxable year

Maximum deduction for year:

40 or less : $430

More than 40 but not more than 50 : $810

More than 50 but not more than 60 : $1,630

More than 60 but not more than 70 : $4,350

More than 70 : $5,430

Another change announced by the IRS involves benefits from per diem or indemnity policies, which pay a predetermined amount each day.  These benefits are not included in income except amounts that exceed the beneficiary’s total qualified long-term care expenses or $380 per day, whichever is greater.

For these and other inflation adjustments from the IRS, click here.  For tax year 2019 deductibility limits, click here.

What Is a “Qualified” Policy?

To be “qualified,” policies issued on or after January 1, 1997, must adhere to certain requirements, among them that the policy must offer the consumer the options of “inflation” and “nonforfeiture” protection, although the consumer can choose not to purchase these features. Policies purchased before January 1, 1997, will be grandfathered and treated as “qualified” as long as they have been approved by the insurance commissioner of the state in which they are sold. For more on the “qualified” definition, click here.

It is our goal to provide our clients with the highest level of legal services in the areas of Last Will and Testaments, Living Trust, Irrevocable Trusts, Estate Planning, Probate, Asset Protection, and complete Business Planning. If you or someone you know needs information on Florida estate planning, please contact us today at 239-418-0169 to schedule your free consultation.

How Will New Legislation Update Social Security?

People with disabilities who receive Supplemental Security Income would be allowed to keep a few more assets and wouldn’t be penalized for marrying under a new proposal, according to Disability Scoop’s recent article, “Lawmakers Look To Update SSI Program.”

Right now, in order to retain benefits, SSI recipients generally can have no more than $2,000 to their name at any given time. However, Congress is looking to significantly increase that ceiling, with a bill introduced this month that would increase SSI’s asset limit to $10,000 for an individual and $20,000 for couples.

The Supplemental Security Income Restoration Act would also increase the amount of disregarded income that beneficiaries can collect monthly.

The bill would also repeal penalties for marrying or receiving financial, food, and housing assistance from family members.

Supporters of the Act say it’s time to update Social Security’s SSI program, which has remained largely static since 1972.

“This issue is one I have heard about directly from autism advocates and families in our district, particularly parents preparing for children with disabilities to transition into adulthood,” said Rep. Elissa Slotkin, D-Mich., who introduced the measure along with Rep. Raúl Grijalva, D-Ariz.

“This bill brings the Supplemental Security Income (SSI) program’s outdated limits up to speed with inflation—a common-sense adjustment that will make a huge difference for individuals and families caring for someone with disabilities.”

It is our goal to provide our clients with the highest level of legal services in the areas of Last Will and Testaments, Living Trust, Irrevocable Trusts, Estate Planning, Asset Protection, and complete Business Planning. If you or someone you know needs information on Florida estate planning, please contact us today at 239-418-0169 to schedule your free consultation.

Reference: Disability Scoop (September 23, 2019) “Lawmakers Look To Update SSI Program”

 

Dark Side of Medicaid Means You Need Estate Planning

Dark Side of Medicaid Means You Need Estate Planning:  A woman in Massachusetts, age 62, is living in her family’s home on borrowed time. Her late father did all the right things: saving to buy a home and then buying a life-insurance policy to satisfy the mortgage on his passing, with the expectation that he had secured the family’s future. However, as reported in the article “Medicaid’s Dark Secret” in The Atlantic, after the father died and the mother needed to live in a nursing home as a consequence of Alzheimer’s, the legacy began to unravel.

Just weeks after her mother entered the nursing home, her daughter received a notice that MassHealth, the state’s Medicaid program, had placed a lien on the house. She called MassHealth; her mother had been a longtime employee of Boston Public Schools and there were alternatives. She wanted her mother taken off Medicaid. The person she spoke to at MassHealth said not to worry. If her mother came out of the nursing home, the lien would be removed, and her mother could continue to receive benefits from Medicaid.

The daughter and her husband moved to Massachusetts, took their mother out of the nursing home and cared for her full-time. They also fixed up the dilapidated house. To do so, they cashed in all of their savings bonds, about $100,000. They refinished the house and paid off the two mortgages their mother had on the house.

Her husband then began to show signs of dementia. Now, the daughter spent her days and nights caring for both her mother and her husband.

After her mother died, she received a letter from the Massachusetts Office of Health and Human Services, which oversees MassHealth, notifying her that the state was seeking reimbursement from the estate for $198,660. She had six months to pay the debt in full, and after that time, she would be accruing interest at 12%. The state could legally force her to sell the house and take its care of proceeds to settle the debt. Her husband had entered the final stages of Alzheimer’s.

Despite all her calls to officials, none of whom would help, and her own research that found that there were in fact exceptions for adult child caregivers, the state rejected all of her requests for help. She had no assets, little income, and no hope.

State recovery for Medicaid expenditures became mandatory, as part of a deficit reduction law signed by President Bill Clinton. Many states resisted instituting the process, even going to court to defend their citizens. The federal government took a position that federal funds for Medicaid would be cut if the states did not comply. However, other states took a harder line, some even allowing pre-death liens, taking interest on past-due debts or limiting the number of hardship waivers. The law gave the states the option to expand recovery efforts, including medical expenses, and many did, collecting for every doctor’s visit, drug, and surgery covered by Medicaid.

Few people are aware of estate recovery. It’s disclosed in the Medicaid enrollment forms but buried in the fine print. It’s hard for a non-lawyer to know what it means. When it makes headlines, people are shocked and dismayed. During the rollout of the Obama administration’s Medicaid expansion, more people became aware of the fine print. At least three states passed legislation to scale back recovery policies after public outcry.

The Medicaid Recovery program is a strong reason for families to meet with an elder law attorney and make a plan. Assets can be placed in irrevocable trusts, or deeds can be transferred to family members. There are many strategies to protect families from estate recovery. This issue should be on the front burner of anyone who owns a home, or other assets, who may need to apply for Medicaid at some point in the future. Avoiding probate is one part of estate planning, avoiding Medicaid recovery is another.

Since the laws are state-specific, consult an elder law attorney in your state.

Reference: The Atlantic (October 2019) “Medicaid’s Dark Secret”

 

What Types of Senior Care is Available for Veterans?

What Types of Senior Care is Available for Veterans?     The U.S. Department of Veterans Affairs offers some funding programs that can help offset the cost of some types of senior care.

U.S. News & World Report’s recent article, “Veteran Benefits for Assisted Living,” explains that many senior living companies try to help many veterans maximize their benefits, which in some cases can significantly reduce the cost of senior living.

Note that the VA won’t pay for a veteran’s rent in an assisted living facility. However, VA benefits may pay for some of the extra services required, like nursing assistance, help with bathing and toileting, and possibly meals.

There are a variety of benefits that may help, based on a vet’s specific service history and eligibility. The most commonly used benefits are the Aid & Attendance Pension. Another common benefit is the Survivor’s Pension for spouses of a deceased veteran with wartime service.

The VA’s Aid & Attendance and Housebound program is part of the pension benefits paid to veterans and survivors. The VA says these benefits are paid, in addition to monthly pension. A vet must satisfy one of the potential conditions, including:

  • Requiring the aid of another person to perform personal functions, like bathing, dressing, eating, toileting, or staying safe from hazards;
  • Being disabled and bedridden, above what would be thought of as recovery from a course of treatment, such as surgery;
  • Being a patient in a nursing home due to physical or mental incapacity; and
  • Having very poor eyesight (5/200 corrected visual acuity or less in both eyes) or a field of vision limited to five degrees or less.

Vets may qualify for these benefits, which are added to the standard monthly pension, when he or she is “substantially confined to your immediate premises because of permanent disability,” the VA says. Eligibility for the program is based on a case by case basis and involves a review by the VA.

It’s important to begin the application process early, rather than waiting for a crisis to occur. Ask an experienced estate planning or elder law attorney to help you and to discuss your options.

It is our goal to provide our clients with the highest level of legal services in the areas of Last Will and Testaments, Living Trust, Irrevocable Trusts, Estate Planning, Asset Protection, and complete Business Planning. If you or someone you know needs information on Florida estate planning, please contact us today at 239-418-0169 to schedule your free consultation.

Reference: U.S. News & World Report (August 12, 2019) “Veteran Benefits for Assisted Living”

 

4 Estate Planning Steps to Protect Assets from a Dementia Diagnosis

It is estimated that 1 in 8 Americans will suffer from some form of dementia after the age of 65; here are 4 estate planning steps that can help protect assets in case you or someone you love becomes incapacitated:

Assemble a team of elder care experts – this can include an elder law and/or estate planning attorney, a financial planner, a CPA, etc.  A team of trusted advisors is essential to help you plan for how your assets will be managed and how decisions will be made about your care in case of
incapacity.

Establish advance directives – advance directives – including a living will, financial power of attorney, health care power of attorney, and medical health care power of attorney – provide for the seamless transfer of decision-making abilities for your care.

Establish a revocable living trust – this will allow your assets to be managed by who you want and how you want without the court getting involved in your affairs.

Have a long-term plan – the time to create a long-term plan is before you need it. People with dementia can live for many years, and the cost to maintain a good quality of life can be a heavy financial burden for a family.   A long-term plan may include funding a long-term care insurance policy, or strategies for spending down assets to qualify for state or federal assistance programs.

If you would like more information on how estate planning can help you protect your assets from incapacity or other threats, contact our Fort Myers law firm to schedule your free consultation. 239-418-0169.

 

Making Sure Your Aging Parent has the Correct Estate Plan in Place

It’s a delicate discussion, but when parents are aging, their children should find out if their parents have several basic estate planning documents in place and talk about their final wishes. If they have not done any planning, now is the time—before a crisis occurs.  Here at The Dorcey Law Firm, our goal is to transform families for generations to come; something we can only do through proper proactive planning.

The Monterey Herald’s recent article, “Financial planning: Making sure Mom is taken care of,” says to first make sure that they have their basic estate planning documents – a will or trust, power of attorney, and advanced healthcare directives – in place. It is important to be sure these documents fully reflect your parent’s desires. An advanced healthcare directive lets them name a person to make health care decisions on their behalf, while a power of attorney allows a named person to make financial decisions.

Based on the way in which the forms are written, the agent or surrogate can have broad authority, including the ability to access bank accounts, consent to or refuse medical treatment, or to leave instructions for health care.  Big decision, such as whether or not to be resuscitated or have life prolonged artificially, can also be put in writing, thus removing this tough choice from a child or other loved one. To limit these instructions in any specific way, it is important to talk with an experienced attorney, and have these wishes in writing.

Another key document to have is a last will & testament or living trust.  When determining if a trust is advisable, there are many factors to consider, particularly when the goal is to avoid probate after passing away.  These factors include the type of assets, and whether they are held jointly or allow for beneficiary designations; the beneficiaries ages and financial stability; whether planning for future divorce or creditor is a concern; and many more. You should conduct a full inventory of your parent’s accounts, including where they are held and how they are titled, as well as gathering the named beneficiaries on all accounts and policies.

It is also important not to make any major changes without consulting your attorney first.  For example, if your parent has a brokerage account with low-cost basis investment, you will not want to change this to a joint ownership account. The step-up in cost basis that assets receive at the time of death makes it better for the account to remain in their individual name. While you may gain control of the asset doing that (something that can also be accomplished through the power of attorney), you will lose the step up in basis.  A beneficiary designation may suffice.

To inquire more on how our law firm helps families plan for their long-term care needs, whether years in advance or after a health care crisis has occurred, please contact our office for a free consultation at (239) 418-0169.

Family Caregivers and Home Care

Caring for an ailing family member is difficult work, but it doesn’t necessarily have to be unpaid work.  Traditionally, Medicaid has paid for long-term care in a nursing home, but because most individuals would rather be cared for at home and home care is cheaper, all 50 states now have Medicaid programs that offer at least some home care. In some states, even family members can get paid for providing care at home.  The programs vary by state, and also include some non-Medicaid-related programs.

Medicaid’s program began as “cash and counseling,” but is now often called “self-directed,” “consumer-directed,” or “participant-directed” care.  The first step is to apply for Medicaid through a home-based Medicaid program.  Medicaid is available only to low-income seniors, and each state has different eligibility requirements.  Medicaid application approval can take months, and there also may be a waiting list to receive benefits under the program.

The state Medicaid agency usually conducts an assessment to determine the recipient’s care needs—e.g., how much help the Medicaid recipient needs with activities of daily living such as bathing, dressing, eating, and moving.  Once the assessment is complete, the state draws up a budget, and the recipient can use the allotted funds to pay for goods or services related to care, including paying a caregiver.  Each state offers different benefits coverage.  Some services that Medicaid may pay for include the following:

  • In-home health care
  • Personal care services, such as help bathing, eating, and moving
  • Home care services, including help with household chores like shopping or laundry
  • Caregiver support
  • Minor modifications to the home to make it accessible
  • Medical equipment

The Medicaid applicant must apply for Medicaid and select a program that allows the recipient to choose his or her own caregiver, often called “consumer directed care.”  Recipients can choose to pay a family member as a caregiver, but states vary on which family members are allowed.  For example, most states prevent caregivers from hiring a spouse, and some states do not allow recipients to hire a caregiver who lives with them.  Most programs allow ex-spouses, in-laws, children, and grandchildren to serve as paid caregivers, but states typically require that family caregivers be paid less than the market rate in order to prevent fraud.

In addition to Medicaid programs, some states have non-Medicaid programs that also allow for self-directed care. These programs may have different eligibility requirements than Medicaid and are different in each state. Family caregivers can also be paid using a “caregiver contract,” increasingly used as part of Medicaid planning.

To inquire more on how to utilize family caregivers for long-term care needs, whether for yourself or for an aging parent or relative, please contact our office for a free consultation at (239) 418-0169.