Massachusetts Estate Planning & Asset Protection Blog

The Costs of Dementia: For the Patient and the Family - Part II

Posted by Dennis Sullivan & Associates on Wed, Apr 05, 2017

In Part II of our three-part blog on the Costs of Dementia, we discuss the Financial, Emotional and Physical Costs of caring for someone with dementia.

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Financial Costs for the Family

Women routinely serve as caregivers for spouses, parents, in-laws and friends. While some men do serve as caregivers, women spend approximately 50% more time caregiving than men.

The financial impact on women caregivers is substantial. In a Genworth study, Beyond Dollars 2015, more than 60% of the women surveyed reported they pay for care with their own savings and retirement funds. These expenses include household expenses, personal items, transportation services, informal caregivers and long-term care facilities. Almost half report having to reduce their own quality of living in order to pay for the care.

In addition, absences, reduced hours and chronic tardiness can mean a significant reduction in a caregiver’s pay. 77% of those surveyed missed time from work in order to provide care for a loved one, with an average of seven hours missed per week. About one-third of caregivers provide 30 or more hours of care per week, and half of those estimate they lost around one-third of their income. More than half had to work fewer hours, felt their career was negatively affected and had to leave their job as the result of a long-term care situation.

Caregivers who lose income also lose retirement benefits and social security benefits. They may be sacrificing their children’s college funds and their own retirement. Other family members who contribute to the costs of care may also see their standard of living and savings reduced.

 Emotional and Physical Costs to Caregivers

In addition to the financial costs, caregivers report increased stress, anxiety and depression. The Genworth study found that while a high percentage of caregivers have some positive feelings about providing care for their loved one, almost half also experienced depression, mood swings and resentment, and admitted the event negatively affected their personal health and well-being. About a third reported an extremely high level of stress and said their relationships with their family and spouse were affected. More than half did not feel qualified to provide physical care and worried about the lack of time for themselves and their families.

Providing care to someone with dementia increases the levels of distress and depression higher than caring for someone without dementia. People with dementia may wander, become aggressive and often no longer recognize family members, even those caring for them. Caregivers can become exhausted physically and emotionally, and the patient may simply become too much for them to handle, especially when the caregiver is an older person providing care for his/her ill spouse. This can lead to feelings of failure and guilt. In addition, these caregivers often have high blood pressure, an increased risk of developing hypertension, spend less time on preventative care and have a higher risk of developing coronary heart disease.

At the Estate Planning & Asset Protection Law Center, we have helped many clients plan for caring for loved ones with dimentia. To learn more,we encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

 

Tags: dementia, care costs, seniors, alzheimers care, Alzheimers Disease

Be Prepared Before Alzheimer’s Strikes

Posted by Dennis Sullivan & Associates on Fri, Apr 03, 2015

Be Prepared Before Alzheimer’s Strikes | Massachusetts Elder Care Attorney

 

dementia-2

 

One of the problems we see in clients with early stages of dementia is trouble managing their personal finances. This can often lead to costly financial mistakes before there are signs that something is wrong.

No one knows exactly what the future holds for us, so early planning for potential late-in-life health issues is essential, as is keeping an eye open for any potential warning signs in loved ones.

If you notice that a loved one seems more disorganized than usual (bills are piling up, they have a hard time remembering names and words, or if things are in strange places throughout their home), it is a good idea to contact a doctor. Alzheimer's and most forms of dementia are progressive, this means it will get worse over the next few years.

Even before a diagnosis, it is important for people to discuss with their families how they would like to be helped. This includes deciding who will be the primary caregiver and who will be in charge of finances. According to a recent USA TODAY article, titled "Financial planning for dementia," a person with dementia often feels insecure that he or she will lose control and everyone else will tell him what to do. This is why conversations are so important to have before there is a problem in order to make sure your loved one’s wishes are carried out as well as avoiding confusion and misunderstandings later on.

We strongly recommend that everyone should have a will, power of attorney, medical directive, as well as a living trust set up before they have a problem. Without these important documents, the courts may need to become involved and appoint someone to oversee the care and finances, possibly someone with no connection to the family involved. This can be frustrating, time-consuming, and expensive.

In the course of the disease, a person may need help with the actions of daily living and may have trouble communicating. At this point, someone else should be designated to take care of all financial matters, and it might be time to start looking into an assisted living facility.

Healthcare costs for dementia patients can be substantial, and it is very important to provide for the financial security of a healthy spouse. If you would like to being the review process, please contact our office.

 

For additional guidance, please see The Seniors and Boomer's Guide to Health Care Reform and Avoiding Nursing Home Poverty the book provides important information for families on resources for quality care and protection for loved ones.

At the Estate Planning & Asset Protection Law Center, we provide a unique education and counseling process which includes our unique 19 Point Trust, Estate and Asset Protection Review to help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones, click here for more information. We provide clients with a unique approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

 

Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

Tags: assisted living, power of attorney, trust, Wills, Alzheimers Disease, 2015

Can Your Will Protect You When You Don't Die?

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Thu, Aug 07, 2014

 

What Happens When You Don’t Die?

medicare, medicaid, wills, spouse

 

Is your “I love you” will capable of protecting you or your spouse from long-term care costs?

You know the kinds of wills we’re talking about: The husband leaves everything to the wife, the wife leaves everything to the husband and after they both die, everything goes to the kids. This works well in situations where the spouses are healthy one day and are deceased the next. 

However, as most of us know, life usually doesn’t work that way very often. Research indicates that nearly 70% of individuals over 65 will require some kind of long-term care in their lifetimes.

Thus, many spouses worry that if they predecease an ill spouse who is currently in a nursing home or will require long-term care at some point in the near future, there will be insufficient funds available to provide for their institutionalized spouses’ needs. This is an especially relevant concern for expenses that are not covered under Medicaid such as: care managers, private nurses, single rooms, as well as certain therapies and drugs.

Another concern is that the availability of funds from “I love you” wills and trusts will disqualify the surviving ill spouse from eligibility for Medicare benefits. As you know from prior articles, Medicare (MassHealth in Massachusetts) is the only long-term-care governmental program in the United States and does not cover long-term custodial care.

To solve this problem many of our clients rely on a “testamentary trust”. This is a trust built into the will of each spouse. For many estate planners, this is counterintuitive because much of the estate planning occurs within the context of a revocable living trust. In order to preserve access to Medicaid eligibility without requiring that the surviving spouse spend down the assets and lose the chance to maintain a “rainy day fund”, creating a testamentary trust in the will of the pre-deceasing spouse is essential.

What this means is that around age 55, you have to completely revise your wills and trusts to accommodate a different paradigm of thought. The thinking process is no longer “What happens when I die?” Now the question becomes “What happens if I don’t die and live a long time with expensive long-term care?”

The new paradigm requires a new estate plan. If you consider yourself middle-class (meaning that your net worth will be significantly impacted by the cost of long-term care for you and/or your spouse) and are over age 55, we suggest that you revise and update your estate plan to reflect your current and future needs as soon as possible.

At the Estate Planning & Asset Protection Law Center, we help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones.  We provide clients with a unique educational and counseling approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

 Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

Tags: will, living will, Estate Planning, Estate Planning, Alzheimer's Disease, Elder Law, asset protection, long term care, Medicaid, in-home care, Health Care, estate reduction, estate, elder care journey, hospice, Alzheimers Disease, medicaid qualification, Wills, assets, Medicaid penalties, alzheimer's activities, in home, incapacity, Elder Law, Attorney, myths, Alzheimer's, alzheimers, financial, Attorney, income, Alzheimer's, federal, health, surviving spouse, in-home care, long term care insurance

Early Signs That You May Be Getting Alzheimer's | Massachusetts Alzheimer's Attorney

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Mon, Jan 13, 2014

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Alzheimer's: Just hearing the word strikes fear into anyone over 50.

 The statistics are chilling. Already, more than five million Americans have Alzheimer's. And by the time the last Baby Boomer passes away, that figure will be over ten million.

Prior to the past few decades, it was simply called dementia. It wasn't until recent years that Alzheimer's became classified as a disease in itself...and as just one of a number of forms of dementia.

Most of us tend to think of memory loss as the chief distinguishing characteristic of Alzheimer's. And, realistically, it probably is. But it's often not the first way in which Alzheimer's manifests itself. In fact, there are a number of signs - prior to any noticeable memory loss - which could indicate the onset of this disease.

Unfortunately, most of us (and, often, even doctors) miss these early signs - because we're too focused on memory loss as the most significant indicator.

 In 2011, research in Spain indicated that more than a third of adults who go on to develop early-onset Alzheimer's (before age 65) display a number of other symptoms, before memory loss becomes obvious. Interestingly, they're also the same symptoms that often appear first in patients who develop the disease after 65.

 In Part 2, we'll give you the list of early symptoms which could possibly indicate the onset of Alzheimer's.

 With all this talk about Alzheimer's and dementia, it's wise to remember that estate planning isn't something you do after you become sick. It's something to do before you ever get sick!

 

We can help. We've been planning Massachusetts families' estates for the past 25 years.

 

We can help your family, too. We're just a phone call away.

To gain free online access to our Senior and Boomers Guide to Healthcare Reform and Avoiding Nursing Home Poverty, which contains care tips as well as other useful information , please Click the link here:

Seniors and Boomers Guide 

At the Estate Planning & Asset Protection Law Center of Dennis Sullivan & Associates, we help people and their families concerned with losing their homes and life savings to increasing medical and nursing home costs, taxes and the costs and time delays of probate. We also protect clients from losing control of their own health and financial decisions.

We encourage you to attend one of our free educational workshops to learn more about our process and what you can do to enhance the security of your spouse, home, life savings and legacy. To register for a seat at an upcoming workshop call (800) 964-4295 (24/7) or register online at www.SeniorWorkshop.com

Tags: Alzheimer's Disease, Alzheimers Disease, alzheimer's activities, Alzheimer's, alzheimers, Nursing Home, 2014

Happy Thanksgiving From Dennis Sullivan & Associates | Massachusetts Alzheimer's Attorney

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Tue, Nov 26, 2013


Thanksgiving

HAPPY THANKSGIVING FROM OUR FAMILY TO YOURS!  

Turkey Thanksgiving

Thanksgiving is a time for family, friends, and food. This year we thought we would mention a concern that may affect some families and friends whose loved ones are suffering from Alzheimer’s Disease.  In an article by CNN, it was reported that “Alzheimer’s ‘will become the defining disease of the Baby Boomer Generation.’” This is a difficult disease to live with and watch people live with. Below are some facts about the disease and some tips on how to celebrate this joyous holiday with the ones you love.


The Facts:
Alzheimer’s disease is the sixth leading cause of death in the United States and the fifth leading cause of death for those 65 and older. This disease is the only one in the top ten causes of death in America that has no way to prevent it, cure it, or even slow its progression.
Alzheimer’s takes a devastating toll not only on those with the disease, but also on their caregivers. In 2012, 15.4 million family and friends provided 17.5 billion hours of unpaid care to those with Alzheimer’s and other dementias; this care valuing at $216.3 billion... 

Thanksgiving Tips:

  • While preparing the food, reminisce about past Thanksgivings. But don’t ask, “Do you remember when…” something happened, since you don’t know how much has been forgotten. Instead, try starting your memories with “Wasn’t it fun when we…”

  • Limit the number of people you invite this year. Too many people may overwhelm someone with Alzheimer’s. Also make sure that there is a place for them to rest when things get to be a little too hectic.

  • Fill your home with familiar holiday scents, such as vanilla, which is considered to be calming. The smell of cooking food may also trigger memories and put them at ease.

  • Allow the person with Alzheimer’s to participate in cooking, but make sure that it is in a safe environment. Maybe stirring batter or mashing potatoes (See recipe below) at the kitchen table would be a good idea.

  • Sing or play familiar music. Music has a unique place in the human memory.

  • Watch TV or a movie together. You could watch a Football game, a Thanksgiving Day parade, or the Westminster National Dog Show.  

Family Thanksgiving

Recipe:

Kraft’s Whipped Sweet Potato Bake

what you need:
3 cans  (15 oz. each) sweet potatoes, drained
¼ cup  butter or margarine, melted
1 tsp.  ground cinnamon
1 tsp.  ground ginger
¼ tsp.  ground nutmeg
3 cups  JET-PUFFED Miniature Marshmallows  
make it:
HEAT oven to 350°F.
BEAT potatoes, butter and spices with mixer until blended.
SPOON into 1-1/2-qt. casserole sprayed with cooking spray; top with marshmallows.
BAKE 15 to 20 min. or until potato mixture is heated through and marshmallows are lightly browned.
kraft kitchens tips:
SIZE-WISE
Enjoy this classic side dish on special occasions, but keep portion size in mind.
USE YOUR MICROWAVE
Mix all ingredients; spoon into microwaveable 1-1/2-qt. dish sprayed with cooking spray. Do not top with marshmallows. Microwave on HIGH 8 to 10 min. or until heated through, stirring after 5 min. Top with marshmallows; let stand 2 to 3 min. or until marshmallows begin to melt.
SUBSTITUTE
Substitute 2 tsp. pumpkin pie spice for the cinnamon, ginger and nutmeg.

At the Estate Planning & Asset Protection Law Center of Dennis Sullivan & Associates, we help people and their families concerned with losing their homes and life savings to increasing medical and nursing home costs, taxes and the costs and time delays of probate. We also protect clients from losing control of their own health and financial decisions.

We encourage you to attend one of our free educational workshops to learn more about our process and what you can do to enhance the security of your spouse, home, life savings and legacy. To register for a seat at an upcoming workshop call (800) 964-4295 (24/7) or register online 

Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

CNN Artcle: Here Tips: Here Recipe: Here

Tags: Alzheimer's Disease, Alzheimers Disease, alzheimer's activities, Alzheimer's, Alzheimers Disease. Massachusetts, Thanksgiving, Recipes, family

Massachusetts Elder Law Lawyer | Alzheimer's vs. Dementia: Do You Know the Difference?

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Fri, Feb 15, 2013

Alzheimer's, Dementia, Lawyer, Massachusetts, Elder LawWe recently saw a large-type headline about a woman who was supposedly "cured" of Alzheimer's. There is of course, no cure for Alzheimer's. As it turns out that this woman had been misdiagnosed with Alzheimer's.  She actually had a rare thyroid condition that can sometimes mimic the characteristics of Alzheimer's.  

Alzheimer's now affects nearly 6 million Americans, some of them at surprisingly-young ages (like University of Tennessee Women's Basketball Coach Pat Summit, who was diagnosed at 59). And experts are saying that, by the year 2030, the number of people with the disease will double.  

Did you know, Alzheimer's accounts for only 70% of dementias...not all of them!  

Some forms of dementia, believe it or not, can be caused by physical illness, such as vascular dementia, strokes, Parkinson's, medications that don't interact well together, urinary tract infections, fluid on the brain, thyroid or other endocrine illnesses, or metabolic problems.  There may also be other hidden villains as well, that only a series of extensive and invasive medical tests can reveal. If a doctor diagnoses you or a loved one with dementia, perhaps you should consider a having battery of tests conducted just to make sure. Misdiagnoses can result in tragedy, especially for seniors.  

For more information on Alzheimer’s and Dementia, we encourage you to visit

At the Estate Planning & Asset Protection Law Center, we help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones.  We provide clients with a unique educational and counseling approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

Alzheimer's Care, Demetia Care, Lawyer, Elder LawTo gain free online access to the Complete Alzheimer's Resource Kit, which contains care tips as well as other useful information on Alzheimer’s disease, please visit www.BostonMemoryLawyer.com.  We also invite you to visit (insert domain name from list below) for more information on (pick one of three topics).

At the Estate Planning & Asset Protection Law Center, we help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones.  We provide clients with a unique education and counseling approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

 

Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

 

Nursing home care is more than $140,000 per year! Attend this FREE educational seminar to learn:

  • How to protect your home and assets from the costs of long-term care

  • How to stay out of the nursing home and access in-home care

  • How to make sure your spouse is not left financially ruined if you need nursing home care

  • How to access Veterans benefits to pay for long-term care

Tags: Elder Law, Medicaid, dementia, Alzheimers Disease, Alzheimer's, Alzheimers Disease. Massachusetts, adult day center

Massachusetts Estate Planning Tips | The Impact of the Fiscal Cliff Deal on Seniors and Boomer

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Mon, Jan 21, 2013

The American Tax Payer Relief Act: It's complicated but It Affects Everyone - Especially Boomers and Seniors  

The American Taxpayer Relief Act of 2012 was actually passed by the Senate in at 2:00 am on January 1, 2013. After speculation on whether Speaker Boehner would bring the bill to a vote or if the House would add amendments likely be rejected by the Senate, the House eventually passed the bill at 10:45 p.m. President Obama signed it the next day.  

The bill addresses the Bush-era tax rates, estate and gift tax rates, Medicare reimbursement, among numerous other issues.

TAX RATES 

The bill permanently extends current tax rates for individuals earning less than $400,000 and couples earning less than $450,000. Those earning more will see an increase from 35% to 39.6%. Wealthy folks will see an increase from 15% to 20% on capital gains and dividends. Individuals earning above $250,000, and married couples earning more than $300,000, will see a phase-out of the personal exemption.     

ESTATE TAX 

The estate tax exemption will remain $5.12 million per person, but will be adjusted for inflation. The top rate will grow from 35% to 40%. Portability's extended, as well, and the gift tax exemption will remain at $5 million.   

PAYROLL TAX  

This tax, which funds Social Security, has been at 4.2% since 2011, but will now revert back to the previous of 6.2%.  

OLDER AMERICAN FUNDING 

Funding has been increased for the Older Americans Act and similar programs. This year only, Area Agencies on Aging will receive an additional $7.5 million, and Aging and Disability Resource Centers an additional $5 million.  

The National Center for Benefits and Outreach Enrollment will receive an additional $5 million, and Medicare State Health Insurance Programs will receive an additional $7.5 million.  

There is also a provision that prevents the scheduled 27% reimbursement cuts to Medicare physicians this year.  

At the Estate Planning & Asset Protection Law Center, we help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones.  We provide clients with a unique education and counseling approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops. Call 800-964-4295 to learn more about what you can do to enhance the security of your beneficiaries, digital assests, Estate Plan and legacy

 

Click Here to Register For Our Trust, Estate & Asset  Protection Workshop
.

Tags: Massacusetts Estate Tax, Health Care, family, seniors, estate tax, health Care act, Alzheimers Disease, tax, Attorney

Massachusetts Alzheimer's Attorney | Caring for Your Loved One With Alzheimer's

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Fri, Oct 26, 2012

I'm The Only Family Member Doing Caregiving. How Do I Deal With That... And With Them?

If you think the Hatfields and McCoys went at it, you should see what happens in some families when a loved one is diagnosed with Alzheimer's or dementia. It can make that "other" feud seem like child's play!
caregiver, Alzheimer's, attorney
Additionally, it can give rise to tremendous resentment on the part of those who do the care-giving for those who don't.

When this happens, there's only one thing to do: Recognize that there's absolutely nothing you can do. And - even harder - let it go!

You have enough to handle. Any additional family matters will only weigh you down even more. Sometimes, family members may be afraid to see their loved one in such a state...or they may be in denial. But that's their problem. You can only do what's necessary to take care of yourself.

Care-giving is the toughest job in the world. And it can get even the strongest person down. So your personal priority should be to seek help - from people who can give it to you, rather than those who can't. Some people seek professional counseling. Others join support groups, where you'll quickly learn that you're hardly "the only person" who knows what you're going through. And, if your family can't be there for you, maybe a good friend can.

You may want to keep your family in the loop, about the condition, and how your loved one is doing. But don't harbor false expectations. For the most part, nothing you do or say to your family is going to motivate them to help, if they're not already motivated.

Even if they can't help, though...we can!

To gain free online access to the Complete Alzheimer's Resource Kit, which contains care tips as well as other useful information on Alzheimer’s disease, please visit www.BostonMemoryLawyer.com

alzheimer's, caregiver, attorney, Massachusetts

At the Estate Planning & Asset Protection Law Center, we help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones.  We provide clients with a unique educational and counseling approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

Tags: dementia, Alzheimers Disease, Massachusetts, caregiver, care, Attorney, Alzheimer's, alzheimers

Massachusetts Elder Law Attorney | Effective Medicaid Planning

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Fri, Sep 21, 2012

Is it effective planning to add someone’s name to your bank account?

Consider the following situation:

Mrs. Jones’s husband was diagnosed with Alzheimer’s three years ago, and the disease has prolonged to the point where he needs long-term nursing home care.estate planning, massachusetts

At the time of the diagnosis she talked to some friends of the family who told her to go ahead and add the kid’s names to her bank accounts and mutual funds as a way to protect those assets from Medicaid. Now that her husband is in the nursing home she wonders if she did the right thing.

Medicaid says that adding someone else’s name to a bank account or mutual fund does NOT transfer the ownership on that account. If Mrs. Jones had a bank account with $20,000 and she added her daughter’s name to the account, the State would say that her daughter’s name was added for convenience purposes. In other words, the entire account still belongs to Mrs. Jones. So even though the child’s name has been added, the practical effect, from a Medicaid standpoint, is that has been no gift and the entire account still belongs to Mrs. Jones.

This is true whether we are talking about bank accounts, certificates of deposit,  and checking accounts. The law says there is no gift until, and unless, the child actually takes the money out of the account. In other words, using this same example, if Mrs. Jones added her daughter’s name to the account three years ago, there has been no gift made. If her daughter later takes some money out of the account, and moves it into her own name, then the gift is made at the time the daughter takes the money out of the account. 

When dealing with mutual funds, stocks and some other assets it is considered a gift at the time of the titling of the account. 

This general rule is not true where real estate is concerned. That’s because if someone’s name is added to real estate, at the time the deed is signed and recorded, then a completed gift has been made.

For instance, let’s say that Mrs. Thompson is a widow and she owns a house valued at $300,000. If she adds her son’s name to the house and then has the deed recorded, at that time she made a completed gift. Remember that a gift would cause her to be ineligible for Medicaid for the 60 moth lookback. At the end of that time, however, the Medicaid ineligibility would cease… and the house, by virtue of its title, would be protected.

Whether or not it makes sense to add someone’s name to real estate or financial assets depend upon the facts and circumstances of each particular case. Be sure to seek advice of a competent professional before proceeding.

At the Estate Planning & Asset Protection Law Center of Dennis Sullivan & Associates, we help people and their families concerned with losing their homes and life savings to increasing medical and nursing home costs, taxes and the costs and time delays of probate. We also protect clients from losing control of their own health and financial decisions.

For more information, you can gain free online access to the “Seniors’ Guide to Health Care Reform & Avoiding Nursing Home Poverty” which contains secret benefits revealed by the Affordable Care Act, as well as useful information about Medicaid.

Click Here to Download the Senior & Boomers Guide to Health Care Reform & Avoiding  Nursing Home Poverty

We encourage you to attend one of our free educational workshops to learn more about our process and what you can do to enhance the security of your spouse, home, life savings and legacy. To register for a seat at an upcoming workshop call (800) 964-4295 (24/7) or register online at www.SeniorWorkshop.com

Register NOW and receive a free Unique Self-Guided 19-Point Trust, Estate, & Asset Protection Legal Guide with accompanying DVD, absolutely free.

Tags: Estate Planning, Elder Law, long term care, Medicaid, Health Care, Wellesley, Alzheimers Disease, Massachusetts, Nursing Home

Massachusetts Elder Law Attorney | Long-Term Care Emerges as a Growing Cost with Medicaid

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Sun, Sep 09, 2012

"With Medicaid, Long-Term Care of Elderly Looms as a Rising Cost"

By Nina Bernstein, New York Times

medicaid

"Medicaid has long conjured up images of inner-city clinics jammed with poor families. Its far less-visible role is as the only safety net for millions of middle-class people whose needs for long-term care, at home or in a nursing home, outlast their resources.

With baby boomers and their parents living longer than ever, few families can count on their own money to go the distance. So while Medicare has drawn more attention in the election campaign, seniors and their families may have even more at stake in the future of Medicaid changes — those proposed, and others already under way.

Though former President Bill Clinton overstated in his convention speech on Wednesday how much Medicaid spends on the elderly in nursing homes — they account for well under a third, not nearly two-thirds, of spending — Medicaid spends more than five times as much on each senior in long-term care as it does on each poor child, and even more per person on the disabled in long-term care.

Seniors like Rena Lull, 92, who spent the last of her life savings on $250-a-day nursing home care near Cooperstown, N.Y., last year, will face uncharted territory if Republicans carry out their plan to replace Medicaid with block grants that cut spending by a third over a decade.

The move would let states change minimum eligibility, standards of care, and federal rules that now protect adult children from being billed for their parents’ Medicaid care.

Now, like a vast majority of the nation’s 1.8 million nursing home residents, Mrs. Lull, a retired schoolteacher with dementia, counts on Medicaid to cover most of her bill. But her daughter Rena, 66, also a retired schoolteacher with a lifetime of savings, no longer knows what she can count on in her own old age.

“I get choked up thinking about this,” she said, recalling how her widowed mother had depleted $300,000 on five years of care in the community and one year in the Otsego Manor nursing home, before qualifying for Medicaid. “I’m so scared about what’s going to happen to me.”

The presidential election may decide Medicaid’s future. But many states faced with rising Medicaid costs and budget deficits are already trying to cut the cost of long-term care by profoundly changing Medicaid coverage, through the use of federal waivers.

Waivers sought or obtained by 26 states, including New York, California, Illinois and Texas, would affect some three million people, most of them eligible for both Medicaid and Medicare. Plans vary, but typically they try to cut costs by giving private managed-care organizations a fixed sum for a lifetime of care, from doctor and hospital visits to help at home to nursing home placement, expecting that more care will take place in less expensive settings.

Over all, 31.5 percent of Medicaid’s $400 billion in shared federal and state spending goes to long-term care for the elderly and the disabled. That ranges from less than 8 percent in Hawaii, where nursing home use is low, to more than 60 percent in North Dakota.

Many people assume that Medicare will cover long-term care, but at most it covers 100 days of rehabilitation, not so-called custodial care — the help with activities of daily life, like eating and bathing, that the aged can need for years.

To be eligible for Medicaid, however, a person typically can have no more than $14,800 in assets, and though some lawyers specialize in setting up trusts that shelter certain assets, the federal government has periodically closed loopholes that allowed it.

Mrs. Lull, who married her Ithaca College sweetheart, also a teacher, when he was in the Air Force in 1944, and carried their twin girls home in a laundry basket, is required to pay all but $50 a month of her $969 income from Social Security and a pension toward the Medicaid cost of her shared room. Her case is typical, in that she cared for her husband before his death at home at 83.

Few Americans buy private long-term care insurance, and such insurance was dropped from the Affordable Care Act last year as actuarially unsound or unaffordable.

'More than $80,000 a year on average for a nursing home — who can sustain that?' said Robyn Grant, director of public policy and advocacy for the National Consumer Voice for Quality Long Term Care. 'We’re forced, most of us, to go onto Medicaid. People don’t realize this.'

No state has a more ambitious plan to overhaul Medicaid than New York, which has the biggest Medicaid budget in the country — $54 billion — and spends about 41 percent of it for long-term care, almost half on nursing homes. Jason A. Helgerson, the state’s Medicaid chief, calls the redesign 'a multiyear march away from fee-for-service' that he says will flatten the spending rate even as the population ages.

By 2015, New York will start requiring some 78,000 nursing home residents to choose one of several managed care plans or be enrolled randomly. The plans are already enrolling tens of thousands of elderly and disabled New York City residents who now receive more than 120 hours a week of government-paid help at home, with those in other downstate counties next.

'We in New York are committed to using this as a force for good,' Mr. Helgerson said, noting that such services, including the largest home care program in the country, have long been exempted from managed care. 'By keeping people healthy, by keeping them out of unnecessarily restrictive, institutional settings, we can keep the program sustainable in the long run.'

Around the country, however, some health policy analysts doubt that managed care will save money, and advocates for the aging and disabled worry that the sickest and most vulnerable people may be hurt in the process.

'Managed care isn’t going to help — it’s just more money going off the top,' said Toby Edelman, senior policy attorney in the Washington office of the Center for Medicare Advocacy who has written on the importance of Medicaid to Medicare beneficiaries and their middle class relatives. 'The managed care company has to take its cut.'

There is too little evidence available to evaluate whether managed care itself really saves money in long-term care, said H. Stephen Kaye, a professor at the Institute on Health and Aging at the University of California, San Francisco.

'One of the problems with the rush to do this is there isn’t a lot of knowledge about what measures should be used or how to track this,' Dr. Kaye said, noting that his analysis of 15 years of data from many states concluded that the gradual expansion of home and community services saves modest amounts, but that a rapid expansion can actually cost a state more.

While home care is generally much cheaper than nursing homes, Dr. Kaye said, states may wind up unleashing a pent-up demand for home care from eligible people who would never have entered a nursing home anyway. And, he added, the financial incentives for home care do not guarantee quality.

'It needs to be monitored with a lot of oversight,' he said.

In July, John D. Rockefeller IV, the Democratic senator from West Virginia who came up with the language allowing some of the most ambitious waivers, wrote Kathleen Sebelius, the secretary of health and human services, asking her to 'take immediate steps to halt this initiative.' He complained that instead of rigorous demonstrations aimed at improving care, some states were shifting whole populations into untried programs.

A spokeswoman for the federal Center for Medicare and Medicaid Services said it was 'working carefully to develop new ideas to better coordinate care with appropriate safeguards to protect beneficiaries.'

Under the block grant vision of Medicaid, that federal role in oversight would end. Richard J. Herrick, president of the New York State Health Facilities Association, a trade group, says that since Medicaid rates have been cut well below cost, he would welcome a change in rules that would let nursing homes bill families for their elders’ care, in addition to what Medicaid pays.

Advocates for the elderly say that such a change would increase the burden of care already carried by many families.

Wendy James spent nine years and thousands of dollars struggling to keep her mother safe at home with her in Yonkers, in Westchester County. Her big mistake, she says now, was not filing a Medicaid application sooner.

Her mother, Elaine, 76, formerly a secretary in a doctor’s office in Manhattan, had to quit work when she developed symptoms of Alzheimer's disease. As the illness worsened, Ms. James’s father, now 80, retired from his job in a department store to help care for his wife. When she needed an adult day program in a nursing home, which rose to $2,400 a month, the family paid out of pocket. And Ms. James, 37, who works for a medical billing company, paid up to $1,000 a month for her mother’s medications when she hit her Medicare prescription 'doughnut hole.'

A 2009 analysis by the Kaiser Family Foundation found that direct, out-of-pocket spending by individuals and families accounts for 22 percent of the $178 billion spent on nursing homes.

Mrs. James is now in a New Rochelle nursing home, where Medicaid pays the bill. Her husband travels daily to spoon-feed lunch to her in the nursing home’s chaotic day room. Ms. James feeds her mother every evening after work, rubbing her cheek to remind her to swallow.

'I did what I had to do for her,' said Ms. James, the youngest of three siblings. 'She was the best mom before she got sick.'"

Article Reference: "With Medicaid, Long-Term Care of Elderly Looms as a Rising Cost" by Nina Bernstein

Link: http://www.nytimes.com

To gain free online access to the Complete Alzheimer's Resource Kit, which contains care tips as well as other useful information on Alzheimer’s disease, please visit www.BostonMemoryLawyer.com.

 

The Lowell’s are a couple from Newton who were concerned about estate planning, taxes, and losing their life savings to nursing home. Read our case study to learn how we assisted them in starting the five-year look back period required to protect assets from being spent down on a nursing home if either got sick.

Newton Couple Discovers Secret Protect Their Home & Life Savings  While Avoiding Payment  of Unnecessary Taxes

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Tags: Nursing Home Costs, Elder Law, long term care, Medicare, Baby Boomers, Medicaid, Nursing Homes, elder care, Alzheimers Disease

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