Massachusetts Estate Planning & Asset Protection Blog

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

The High Cost of Seniors Living Longer

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Fri, Sep 05, 2014

 

The Cost of Living Longer | Massachusetts Eldercare Attorney

 

 planning, estate, eldercare

 

A Pachyderm of Problems

Every day, we see clients for whom long-term care is the elephant in the room. They feel they can’t afford the costs, but they also feel they can’t afford not to have it either. So their solution is to pretend they don’t see the elephant and try to ignore the problem until it goes away on its own. This unfortunately often leads to our metaphorical elephant trampling their life savings and any future inheritance they are trying to leave behind. The older you are, the more expensive a long-term care policy gets and if you get sick before you have long-term care protection in place, it’s too late. Insurance companies are looking out for their bottom line, and an already ill senior will scare them off.

The costs for these policies are rising faster than inflation too. Therein lies the conundrum for Boomers and seniors: They’re living longer than their parents did but that means they need more money to make it through “old age”. Finding long-term care is a tough and complicated process. You’ll need to find a place that cares for people with your (or your loved one’s) circumstances. You need to find a place with the right facilities and staff, a place that leaves you with a good, safe feeling. And you have to be able to afford it too. This is not any sort of one-size-fits-all situation. Everyone has their own specific services and conditions that they or their loved ones will need met. Remember, what we call “long-term care” is a broad category, with options ranging from live-in facilities to your own home.

Lurking Complications With Long Term Care

The greatest threat to the financial security of Boomers and seniors is the cost of long-term care (and Obamacare will not assist with this). Assisted-living facilities are now climbing toward the $7,500-a-month mark. Many have started bundling more services together, rather than charging for each individually. Bundling might be a good idea from the nursing home’s perspective, but just like pre-packaged cable TV you will wind up paying for a lot of services you don’t need and don’t want. A private room at a nursing home will range from $500 - $600 a day.

The cost of home healthcare is rising, too. Some people choose independent-living apartments. These facilities typically don’t require lump-sum payments, and residents can contract with home health-services independently. Medicaid may be there for those who qualify but if you ever want to learn the true meaning of “jumping through hoops” just try qualifying! The best thing, of course, is long-term care insurance, but that’s getting more expensive too as companies raise their rates while cutting back on their coverage. In addition, this insurance is getting more complicated, now encompassing aspects such as protection of the surviving spouse, caregiver issues, scams/ID theft, and making sure you have an advocate to fight for your rights in a system that’s slanted against you.

In short, we’re living longer, and unlike previous generations, people are generally not living with or even near their children. Seniors are going to need more money for this longer life and for any unforeseen medical problems that may arise.

A Magic Trick No One Wants to See

Do you know the fastest way for a Boomer or senior couple to become an impoverished Boomer or senior couple is? Simple, one of them just needs to become ill before they get long-term care insurance. We see it every day, people who’ve worked hard and saved money all their lives are forced to see it wash away in a flood of medical bills as they age. It is truly heart-breaking, because, if you’ve managed to squirrel some money away, you could probably have afforded long-term care. 

The Downside to Living Longer

Our life expectancies are going up these days and so is the cost of healthcare, the distance seniors are living from their children and families, and the financial pressures on Medicare and Medicaid. The new Affordable Care Act, in fact, stipulates $500 billion in Medicare cuts over the next decade! Where do you turn if you or your spouse gets ill? Home health care? Adult day-care? Assisted-living? A nursing facility? Respite-care services, which allow the caregiver to drop off the senior for a limited period? Who’s going to pay for it? And for how long?  These are the questions to ask now, while you still have time to plan. If you haven’t purchased long-term care before you or your spouse become ill…forget about it. No one will insure you once you’re sick! If this happens to you, you’re going to be out of time, out of options, and very quickly out of money. And if you’ve planned to leave something for your heirs, there may be nothing left to leave to them other than a pile of bills. 

 

It’s an old (but true) cliché: those who fail to plan, are planning to fail. When it comes to healthcare expenses as you age, you fail to plan at the risk of yourself and those you love.  

 

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: living will, Estate Planning, Estate Planning, asset protection, Massacusetts Estate Tax, long term care, life insurance, Medicaid, MassHealth, in-home care, marriage, Estate Planning Tip, seniors, assisted living, life-care plan, hospice, Massachusetts, assets, in home, incapacity, asset, home, surviving spouse, Estate Planning Recommendations, in-home care, long term care insurance, Inheritance

For Seniors Who Are Betting on Getting to 80

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Thu, Aug 28, 2014

Betting on Getting to 80 | Massachusetts Elder Care Attorney

 

outliving, eldercare, savings, estate, nursing home 

For Those Who Are Concerned About Outliving Their Money

According to research for our book The Seniors and Boomers Guide to Health Care Reform and Avoiding Nursing Home Poverty, outliving one’s life savings is a top concern for many people. One possible solution to this is what the US Treasury is pushing many baby boomers to do: start writing checks to their insurance companies for products that won’t be a financial benefit for them until they’re 80. The Treasuries new rules on annuities known as longevity insurance could allow millions of Americans fresh options for their retirement accounts and 401(k) plans. This is according to Bloomberg Personal Finance.

The challenge: convincing savers to choose that option. The annuities thrill retirement experts and policy makers who see them as a way to ensure workers don’t end up impoverished in old age. Just about everyone else ignores the products, which make up less than 1 percent of all annuity sales.

It can be a great investment too. With $125,000, a 60-year-old man can buy a policy from New York Life that guarantees an income of almost $45,000 a year starting at age 80. The same $125,000 in a regular retirement account would need to grow at the unlikely rate of 11 percent a year from age 60 to 80 to provide that income, assuming 4 percent is withdrawn annually after age 80.

Planning for the Future

Since women live longer than men, their longevity policies are more expensive, and more valuable. Millions of widows in their 80s and 90s end up living on Social Security alone. A 60-year-old woman who puts $125,000 into one of these annuities could get an annual payout of $35,268. For women with a husband and no children, a longevity benefit is a comforting buffer against long-term care costs.

Dollars in longevity policies go farther for those who buy earlier than 60 or start the benefit later than 80. If the insurance becomes common in retirement plans, the cost of policies should fall. To maximize her payout, Carson decided against buying inflation protection and a provision that refunds all the money she put in if she dies early.

Indeed, the oft-repeated big risk with longevity insurance is that buyers could die before they collect. But that chance is what allows the policies to be so lucrative for the long-lived. Those who die early help pay for those who live into their 90s and later. And even if you die at 75, the guarantee of income at 80 means you can tap the rest of your nest egg earlier without worrying so much about running out of money.

How It Works

For longevity insurance to catch on, it needs to gain a foothold in retirement plans. The Treasury rules let workers devote as much as 25 percent of their 401(k) to the products, up to $125,000. That doesn't mean employers will offer the option or that workers will choose it though.

Employers face legal liability for their retirement plan options, making them cautious about relatively unproven products. Insurance companies may need to come up with new kinds of longevity annuities that are more transparent and are geared more towards women since they tend to live longer.

Adding to the resistance is a widespread assumption that Americans don't want to lock up their cash in insurance products. They'd rather get big eventual lump sum payouts, even if they have no idea how to turn that into an income that will support them in their old age.

What the Experts Think

If longevity insurance takes off, it will be a real victory for the experts who have been striving to change that mindset. This may also provide a solution for many boomers and seniors for whom outliving their life savings is a major concern. For more information about these and other concerns see the report from the Seniors and Boomers’ Guide to Health Care Reform and Avoiding Nursing home Poverty.

Seniors, boomers, guide, poverty, nursing home,

Everyone would love 401(k) plans to look more like traditional pensions or Social Security, so savers can put less focus on the balance in their account rather than on the income it will eventually produce. That's an outlook your 100-year-old self may well appreciate.

At the Estate Planning & Asset Protection Law Center, we provide a unique education and counseling process which uses a 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: Elder Law, annuity, Baby Boomers, family, elder care, assisted living, elder care journey, assets, care, Elder Law, senior, insurance, surviving spouse, family

Estate and Long Term Care Planning for Women

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Mon, Aug 18, 2014

 

The Unique Challenges in Women Face with Estate Planning

Estate planning for women

Estate and Long Term Care Planning for Women can be different and full of confusing choices. Women are living longer today than ever before, and you will need an estate plan that can protect you from the new challenges arising daily. Let’s look at some of the more common situations below:

Married women tend to be younger than their husbands and tend to be on their own once their husband passes. Many married women let their husbands do all the financial planning, including their estate planning. Unfortunately this leaves many of them confused, or even blindsided by the oncoming costs that can appear with their estate and long term care options. Second marriages can create a whole new set of issues to deal with as well. Children from both marriages must be accounted for and must know what their responsibilities are going to be as well as fairly dividing their inheritance. For your own sake it would be best if you chose exactly who you would want to have power of attorney as well as whom you wish to have as your healthcare proxy. It is also important to update these documents regularly as many institutions do not accept them if they are more than a year old.

Single or childless women may choose to leave their possessions to close friends, relatives or charities. Without a good, up-to-date estate plan however, that won’t happen. Instead a bureaucrat appointed by the state will decide where your worldly goods will go when you’re gone. And for women living with a partner whom they are not legally married to, their partner won’t see one red cent of your estate unless you have an ironclad estate plan stipulating who gets what.

Your documents cannot do you much good unless they have been updated to reflect your current needs and situation. If you have gone through a separation or divorce you probably do not wish for your former partner to inherit your things or be making medical decisions about you. We have seen many cases where this has happened, and it is too late to change anything. Fortunately situations like this can be avoided by simply updating your documents regularly. At the Estate Planning & Asset Protection Law Center of Dennis Sullivan & Associates we provide clients with a unique Lifetime Protection Program to help keep their documents and plans up to date with any changes in their personal, family and health situations.

You must also consider what will happen if you require long term care and make sure there is going to adequate funding for what you may need in the future. Many people have made the mistake of giving away their savings in order to qualify for Medicaid without consulting a professional first. Not only was this unnecessary, they often still do not qualify because they did not plan for their situation ahead of time. Giving away their assets can even create large penalties if you ever need a nursing home. To learn more about some of the other mistakes to watch out for take a look at The Ten Biggest Estate and Asset Protection Mistakes People Make and How to Avoid Them! For a free report based on the book click here.

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: health care proxy, Estate Planning, Elder Law, asset protection, long term care, Charitable Giving, Nursing Homes, marriage, Beneficiary, elder care, assisted living, estate, assets, coverage, death benefit, surviving spouse, Estate Planning Recommendations

Do You Have A Support System?|Massachusetts Elder Law Attorney

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Fri, Feb 21, 2014

Support, Estate Planning

It’s a growing epidemic, the number of aging Americans who have no one who would naturally be their support system as their health declines and they need assistance.  A New York Times article the other day, titled “The Childless Plan for Their Fading Days”, highlights this problem and what some seniors are doing about it.

In our practice, we’ve seen an increase in single and/or childless seniors who need assistance.  According to a recent  AARP report, nearly 12% of women between 80 and 84 in 2010 had no children.  Coupled with the fact that many of these women are widowed, divorced or never married, they have no natural support system.  Who will step into the roles of financial and healthcare decision makers, when they need it?

This problem will become even more acute when we consider that the baby boomer generation, Americans between the ages of 50 and 68, who make up the largest percentage of the caregivers right now, will themselves need care in the next 20 years.  Here are some numbers to consider.

According to the same AARP report, the number of people ages 45 to 64, the peak caregiving years, is expected to increase 1% between 2010 and 2030.  At the same time, the population of over 80 Americans will increase 79%.  This means the number of potential caregivers per senior who needs care will drop from over 7 to 1 down to 4 to 1.  Add to that statistic the fact that baby boomers, on average, have fewer children than their parents and higher divorce rates.  Many won’t have that “natural” support system.

Where will the replacement come from?  Some will look to nieces and nephews.  But, being more distant relatives, that is often not a suitable solution.  Some will look to ex-spouses.  We’ve seen a number of clients who, while divorced, still live with their ex-spouses and have an emotional and/or financial attachment similar to a married couple.

But, what if that isn’t the case?  According to the New York Times article, some people are looking to communal or co-housing arrangements.  One woman looked to friends in her apartment building and designated them as her agent under power of attorney and health care representative.  Another man is taking the drastic step of moving from his home in California to a kibbutz in Israel that he has visited for years.  A kibbutz is a collective community in which the group cares for the individuals within it as a Socialist type society.

In some cases, people will look to professionals.  Geriatric care managers and daily money managers can be an excellent solution.  Longtime trusted advisors, such as attorneys and accountants are also an option for others.

One thing, however, is clear.  While it is always best to put a plan in place before a crisis hits, it is even more critical for those who don’t have any “natural”  support system.  No one will know what you want and if you don’t have the mental capacity any longer to say, then the legal system, ie. guardianship process, will determine what happens.  And that is not likely to be what you want.

This article can be found here

The New York Times article can be found here

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: health care proxy, HIPAA, durable power of attorney, Beneficiary, assisted living, caregiver, 2014, Single

Massachusetts Estate Planning Lawyer | Jill Saved $30,000 - Part Two

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Mon, Feb 04, 2013

Medicaid, Medicare, Fiscal Cliff, Seniors, Estate Planning, MassachusettsLast week we were talking about Jill, who tried to apply for Medicaid for her grandfather, but ran into a snag. She provided the Medicaid caseworker with 5 years of financial records and was told that Granddad still had to spend down another $30,000 from accounts that Jill never knew existed.

When we looked at the statements Jill gave to Medicaid, it was clear that the $30,000 in question was in two Uniform Gift to Minors Act accounts, for which Granddad was acting as custodian for Jill.  We asked her why she gave those documents to Medicaid and Jill didn’t have a good answer. “I just figured I would give them everything and they would tell me when he would be eligible and what I needed to do”, she replied.

It’s a very common response. Many people are under the erroneous belief that the Medicaid application process is a simple one. They know there is a penalty if they gift money but, Jill’s Grandfather hadn’t done that.  He legitimately spent down all the assets so she thought she would just walk into the Medicaid office and tell them that, hand over everything and it would all be fine.  Unfortunately, it rarely works out that way and what you don’t know can really hurt you. You can’t rely on the state Medicaid caseworker because so often they are wrong. That was the case here.

You see, when Granddad set up the UGMA accounts 30+ years ago, when Jill was a young child, he irrevocably transferred the money into those accounts for Jill’s benefit. He remained a custodian of those accounts until Jill reached 21, entrusted to manage those funds for her benefit. We explained to Jill that for Medicaid purposes those funds were no longer Granddad’s so they shouldn’t be counted as his. The caseworker was wrong to tell her to cash out the accounts and spend down the funds for Granddad.

What Jill needed to do now was to transfer those accounts to her name. She was now 45 so that should have happened 24 years ago. I told her that under the UGMA law she was entitled to access those accounts. And if you’re wondering whether the transfer to an account in her name will cause a Medicaid penalty, the answer is no!  The money was transferred out of Granddad’s name more than 5 years ago when he made the irrevocable transfer, so it wouldn’t fall within the Medicaid look back period.

In fact, Granddad was taking the interest all these years, some of which went towards paying for his long term care in his later years. In other words, some of what was legally Jill’s money went towards Granddad’s care already so Medicaid shouldn’t complain about that.

Jill understood what we were saying but asked if we would step in and assist her to complete the process.  Several months later we received a favorable decision.  Jill was able to keep the $30,000 and Granddad was approved for Medicaid.

Jill was appreciative and understood the mistake she made.  We told Jill that her mistake was in relying on the state to steer her in the right direction. Luckily, we were there to save the day and save Jill $30,000.

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 assets, Estate Plan and legacy.

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

Tags: long term care, Medicare, Baby Boomers, Medicaid, Health Care, assisted living, medicaid qualification, Elder Law, Attorney

Warning: Congressional Budget Office Considering Medicaid Changes That Will Cost You Hundreds of Thousands in Long Term Care Costs

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Fri, Jan 04, 2013

The Congressional Budget Office (CBO) is reviewing a new proposal to increase the look back period for Medicaid from 5 years to 10 years.  This would mean that you may end up paying more from your savings if you need nursing home care.  The CBO is also reviewing the impact of decreasing the home equity exemption from $750,000 to $50,000, which means your home will be at risk if you or your spouse go to a nursing home.  It is more important than ever that you take the important steps now to protect your spouse, home and life savings before it's too late.  You can protect your home and life savings by taking action now, before these new rule changes take effect.  If you do not, you could end up costing your family its life savings. 

For more information attend one of our Trust, Estate & Asset Protection Workshops by calling (800) 964-4295 (24/7) or visiting www.SeniorWorkshop.com.


You can also download a new report on the Biggest Mistakes in Estate & Asset Protection Planning...and How to Avoid Them by clicking here.  The report covers how you and your loved ones can avoid costly mistakes in this post-fiscal cliff enconomy. 

Tags: trusts, Elder Law, asset protection, long term care, Nursing Homes, assisted living, assets, alzheimer's activities, Attorney

Massachusetts Estate Planning Attorney | Last Mintue Planning to Avoid Nursing Home Poverty

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

Lawrence Case Study

The Lawrence Family initially contacted our office looking for help upon getting referred by their financial advisor.   They were confused because they were told that they should deed their home to the children.  Like many people we have helped, their home was their largest asset.  When asked if they liked the idea of their children paying $150,000 in unnecessary capital gains on the sale of the home, they said of course they did not.  With our advice,  Mr. & Mrs. Lawrence decided not to transfer their home to the children, avoiding that expensive MISTAKE.  Instead, when they sold the home, the sale was tax-free and the proceeds were added to their life savings.asset protection, estate planning

Failure to Act Costs Thousands:

Plan Ahead to Protect Your Life Savings

Unfortunately for the family, they did not follow our other strong recommendation at the time and for a number of years thereafter to protect their life savings from being spent down on long term care costs.  As a result of their failure to plan ahead, their life savings had to be used to pay $16,000 a month to a care facility, a cost that Mr. Lawrence and Mrs. Lawrence incurred when they both ended up in the same long term care community.  Mr. Lawrence was in the nursing home and Mrs. Lawrence was across the courtyard in assisted living. 

The Lawrences incurred these costs 6 years ago.  If the care had been for two people it would have been much higher.  At todays rates, nursing home care for one person costs and average of $12,000-$15,000 per month.  That's $144,000-$180,000 per year.  The cost is completely avoidable however, and could have been avoided if Mr. & Mrs. Lawrence had come to us in advance. They could’ve protected everything and even passed the Medicaid 5 year look back period.

It’s Never Too Late, Emergency Planning is Possible

All was not lost for Mr. & Mrs. Lawrence.  Fortunately their son and daughter came to us in time to help the family with some advanced asset protection planning. Both children lived out of town, one in Oregon and the other in Europe. But we had a chance to meet with the family before Mr. Lawrence passed away.  Our teams of professionals were able to help protect $500,000 for Mrs. Lawrence from being forced to be spent on her long term care costs. Because of our successful advanced planning to help the family, we enabled Mrs. Lawrence to remain in assisted living, which is not paid for by Medicaid, AND she was able to keep additional funds for living expenses and medical expenses, which would otherwise have been paid to the nursing home for Mr. Lawrence’s care.   Needless to say at this time of crisis when Mr. Lawrence was in his last days, the family was relieved with the results they accomplished.  The planning even survived review by the Medicaid Board as qualified long term care costs to be paid for when the time came.

Are Increased Medicaid Look-Back Periods on the Horizon?

Long term care planning is a very confusing area, especially with the new health care reform, but all families’ have an opportunity to plan ahead and beat the Medicaid program’s 5 year look back. It should be noted that it is critically important for people to get their planning done now.  The look back period was increased from 3 to 5 years a short time ago, and many are now speculating that another increase somewhere in the neighborhood of 8 to 10 years is coming some point down the road.  The good news is that everything can be protected well in advance so families are not forced to spend their life savings, lose their home, and impoverish the spouse to pay for a nursing home.  In every scenario, planning ahead to defeat the five-year look back is much more effective. 

New Guide Reveals How Health Care Reform Impacts You

The stock market, investment, and retirement accounts have fallen in recent years, but medical and long term care costs continue to rise.  In Massachusetts, one-month in a nursing home costs an average of $12,000-$15,000 per month.  Additionally, as a result of the Supreme Court’s decision upholding the Affordable Care Act as there will be a number of significant changes to the health care system in the United States.  Seniors and Boomers, are concerned about how the Affordable Care Act will impact their lives, future, finances, and health care. Because health care reform and increasing long term care costs are on the minds of so many we have written a new book called the Senior & Boomers’ Guide to Health Care Reform and Avoiding Nursing Home Poverty.  The guide contains hidden benefits on how new healthcare laws will affect your family, healthcare, Medicare and Medicaid coverage as well as little known secrets many smart families are already using to avoid nursing home poverty.     

While the boomers are in their 50’s and 60’s now, before you know it, they’ll be moving on to thier 70’s and 80’s. The senior segment of the population is growing five times faster than the rest of the population. Just like the seniors that we serve today, many Boomers have these same concerns.  It is so important for us all to pay attention to what’s going on with health care reform.  This guide was written to be a helpful resource to navigate and understand some of the changes brought about by the Health Care Reform.  With or without health care reform, we all need to take responsibility for our own savings and planning.  People need to be smart about how to protect what is most important to them. At the Estate Planning & Asset Protection Law Center, our professional team has helped many families in Massachusetts protect their home, spouse and life savings, so if and when the time comes to go to a nursing home, people are not forced to spend their life savings down. 

Unfortunately many learn too late that Medicare will not pay for nursing homes.  Medicare only pays for diseases for which there is a cure and the patient can recover.  If you want to learn more, you can read about it in the Seniors & Boomers Guide to Health Care Reform and Avoiding Nursing Home Poverty.

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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.

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Tags: Estate Planning, assisted living, Wellesley, Massachusetts, Nursing Home, case study, asset, protection

Massachusetts Elder Law Attorney | Medicare Disenrollment

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Wed, Oct 31, 2012

Earlier in the week we covered the timelines and procedures for Medicare Enrollment.  Today we will focus our blog on the timelines and procedures for disenrolling from Medicare Advantage Plans.

Voluntary Disenrollment

A person may choose to end his or her membership in a Medicare Advantage plan for any reason, but only during one of the election periods- annual, MADP, or special. Beginning in 2012, a person may disenroll from an MA plan to enroll in one of the Medicare-rated "five-star" plans at any time of the year. An individual who wishes to voluntarily disenroll should write a letter or complete a disenrollment form and send it to 'his or her plan's customer service department. The date of one's disenrollment depends on when the plan receives the written request to disenroll. In general, written requests to disenroll must be received by the Medicare Advantage pl an no later than the tenth of the month to be effective the first of the following month. Written requests to disenroll that are received after the tenth of the month will be effective the second month after the request is received.

An exception to this general rule is that disenrollment requests received between November 1 and November 10 are usually effective ·December I. However, because the month of November is also the annual election period, one can ask for a January I effective date.

Even though a person has requested disenrollment, he or she must continue to receive all covered services from the plan's contracting medical providers until the date the disenrollment is effective. The individual will be covered by Original Medicare after this, unless he or she has joined another Medicare Advantage plan.

Note that other factors are also involved in voluntary disenrollment. For instance, consider a Medicare beneficiary whose first Medicare enrollment was in a Medicare Advantage program, and within the first 12 months of coverage, decides to disenroll from the program and enro ll in Original Medicare. In this situation, he or she has 63 days to purchase any Medicare supplement plan (within the scope of the plans that the carrier offers) on a guaranteed basis.

Also, a person may have originally enrolled in Original Medicare and a Medicare supplement program, then decided to switch to Medicare Advantage- and then decided to switch back to Original Medicare. In this case, the individual may, within 12 months after that decision, go back to Original Medicare and the same Medicare supplement offered by the same MS carrier as before, if he or she has been in the Medicare Advantage plan for less than a year. A problem that may arise involves Part D coverage. If an enrollee decides to use the one-year guarantee to switch out of Medicare Advantage, CMS rules require the enrollee to complete a standalone Part D application and mark the "Special Election Period" box that appears in the "Office Use Only" portion of the application to disenroll from the prescription drug program. CMS will then use the SEP on the Part D application to begin the process for the MA disenrollment and return the applicant to Original Medicare. (This SEP procedure is also available when enrolling into an MA plan when receiving Medicaid assistance or when applying for Medicare disability at any time during the year.)

An individual may voluntarily disenroll during the MADP period (January I through February 14) by writing or calling his or her plan (or calling 1-800-Medicare), but a written request for disenrollment may be required. The MA company must provide a disenrollment notice within seven days of receiving the request. If the (dis)enrollee wants to return to Original Medicare and obtain a Medicare supplement policy, the Medicare supplement company will require that the new applicant complete the MA questions on the Medicare supplement application and that he or she send a copy of his or her MA plan disenrollment notice, a copy of the letter that he or she sent to his or her MA plan requesting disenrollment, or a signed statement verifying that he or she has requested to be disenrolled from his or her MA plan. If an individual is disenrolling after the February 14 date, a copy of the applicant's MA plan disenrollment notice will be necessary.

Involuntary Disenrollment

A Medicare Advantage plan cannot disenroll a member for any health-related reasons. However: a member in a Medicare Advantage plan may be, or must be, disenrolled from the plan for any of the following reasons:

  • permanently moving out of the service area;

  • temporarily moving out of the service area for an uninterrupted absence of more than six months;

  • losing entitlement or discontinuing enrollment in either Part A or Part B Medicare benefits or failing to pay Part B premiums as required;

  • filing false or deliberately misleading information during enrollment;

  • exhibiting disruptive behavior (the plan must first receive permission from CMS to disenroll for this reason);

  • allowing someone other than the enrollee to use the plan membership card;

  • failing to pay plan premiums after the plan has notified the enrollee that he or she has a 90-day grace period during which the enrollee can pay the premiums; or

  • dying.

To learn more about protecting your home, spouse, and life savings from increasing medical and nursing home costs register to attend one of our free, educational workshops by clicking the image below or by calling (800) 964-4295.  Seating is limited and workshops do fill, registration is required.

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You can also learn more by reading our new Seniors Guide to Health Care Reform & Avoiding Nursing Home Poverty.  This guide reveals crucial information smart Americans must know regarding health care reform and how to protect what matters most, your spouse, home, and life savings.  The guide also includes secret steps being taken by families all over the country to avoid nursing home poverty.  Request your copy while supplies last by click the image below!

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Tags: asset protection, Health Care, elder care, assisted living, health Care act, dementia, care, Attorney, Alzheimer's, disenrollment

Massachusetts Elder Care Attorney | 10 Things Assisted-Living Homes Won't Tell You

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Wed, Oct 17, 2012

10 Things Assisted-Living Homes Won't Tell you

by Jim Rendon of Smartmoney.com

Link: www.smartmoney.com/article

Moving to a residential-care facility is difficult enough -- even before you account for the hidden fees, untrained caretakers and misleading marketing.

1. We’re a short-term solution

Since 1981, when assisted-living homes first made their debut as a sort of midpoint between home and a nursing home, they've only grown in popularity. Meanwhile, as the number of facilities and residents served has ballooned, so has the diversity of needs. Some homes cater to those who have trouble cooking or doing their own laundry; others, to those with dementia, loss of mobility and even more serious issues. But government regulations that could help protect families with a loved one in an assisted-living facility who is suffering from a chronic or degenerative illness are still few and far between.assisted-living, elder law, attorney, Massachusetts

Existing rules vary immensely from state to state, and even within a given state. In Florida, for instance, there are four different types of licenses for varying levels of care. There is no national standard for training: While some states require upwards of 25 hours of training for staffers, others have no minimum, only requiring that certain topics be covered. Furthermore, cautions Eric Carlson, directing attorney with the National Senior Citizens Law Center, though most facilities are required to keep at least one person on site overnight, in some cases that person may not be required to be awake.

Still, many people choose assisted-living facilities over nursing homes precisely because they offer residents more freedom in a less institutional and far less expensive setting. Indeed, residents who value their independence are often loath to give it up: People with severe health problems who in the past would have been moved to nursing homes are now staying longer in much less expensive assisted-living facilities, says Brian Lee, executive director of Families for Better Care and former director of Florida's long-term-care ombudsman program. And since the staff isn't required to be trained to handle these health issues, he says, "assisted-living facilities can be more dangerous than nursing homes."

2. It we don’t like you, you’re out.

Knowing the limits of the care a facility can provide -- and the thresholds of behavior or health that will lead to eviction -- is as simple as looking at its contract, says Dave Kyllo, executive director of the National Center for Assisted Living. But who decides when those thresholds have been met? Not residents or their physicians. Management. People may be asked to leave because they are disagreeable, their health needs have become unpleasant, or they are transitioning to a less lucrative payment source (read: Medicaid), says Carlson. In those cases, it's easy for a facility to claim that they can no longer care for an individual, whether or not that is actually true.

Unlike nursing homes, assisted-living facilities don't have an industrywide process for appealing such decisions. California is one of a handful of states that require facilities hoping to evict someone to go to court (most states are silent on the process for eviction). But residents do have protections, even in states that do not have laws that pertain directly to evictions from assisted-living facilities, says Rajiv Nagaich, an elder-law attorney in Washington state. Local landlord-tenant laws and the Americans With Disabilities Act can be used to fight an unwanted eviction.

3. Ailing residents are cash cows.

Three-quarters of facilities charge residents extra for a variety of services -- from bringing meals and delivering packages to making the bed and administering pills. "There is no limit on what you can charge for," says Jody Spiegel, director of the Nursing Home & Assisted Living Advocacy Project.

One Los Angeles assisted-living facility began charging a resident, Carmen Lashley, extra fees when her health began to decline in 2011: $500 a month for administering her medication, dressing her, bathing her, wheeling her to meals -- on top of rent, and she was on a fixed income, says her daughter Maxine St. Prix. In January, Lashley was rushed to the hospital with a breathing problem; a physician recommended she move to a nursing home, so St. Prix notified the assisted-living facility. Still, the facility tried to collect one last month's rent and the extra $500 in fees, even though the contract indicated that in the event of a medical emergency, she did not have to give 30 days' notice. "A collections agency even called my daughter," says St. Prix.

Such charges are usually detailed in the contract. But families facing an important and often emotional decision don't always read the agreements carefully. That's why some insiders recommend consulting an eldercare lawyer before signing on the dotted line. Facilities aren't trying to deceive prospective residents though, says Greg Crist, a spokesman for the American Health Care Association: If someone asks about a charge, it will be explained, and residents should expect increases in charges as labor, food and fuel costs rise.

4. Our rates aren’t set in stone.

The housing crisis and the recession have had a significant impact on the assisted-living business. According to the National Investment Center for the Seniors Housing & Care Industry, occupancy rates are at 88.7 percent for 2012, down from their peak of 90.6 percent in 2006. Often, seniors move into assisted-living facilities after selling their homes, but with housing prices down -- especially in retirement hot spots like Florida, California and Arizona -- fewer seniors have the money to move. And in some of the softer markets, overbuilding too has taken a toll on the industry: The Chicago area's vacancy rate is down to 83.7 percent, with 453 units under construction; St. Louis, with 84.7 percent vacancy, saw inventory grow by 8.2 percent last year, according to the National Investment Center.

Eager to lure potential residents, some places have begun enlisting marketing firms to help seniors sell their homes. Others have begun offering bridge financing to help people move into a facility while they wait for their house to sell, says Suzanne Modigliani, a Brookline, Mass., geriatric care manager.

Furthermore, some communities are more competitive now than they were prior to the recession, and more are offering incentives such as discounts off the community fee or off the first few months' rent. "Don't assume that the listed rates are the rates they charge everyone," says Nagaich. Depending on how many open spots a facility has, he says, potential residents may be able to negotiate the base rent down, or include a clause that bars raising prices for several years or even eliminates some of those pesky charges altogether.

5. Did we say we would lock the doors?

From a business perspective, Alzheimer's and dementia sufferers are a huge market: More than 40 percent of assisted-living residents have the diagnoses. Many facilities advertise specially trained staff, customized activities and locked floors for those who wander. But critics say it can be hard to differentiate a sales pitch from a real service, and government regulations of dementia care tend to be minimal. "The law has not kept up," Spiegel says.

Susan Dukow placed her mother in multiple assisted-living facilities in Los Angeles that promised specialized Alzheimer's care. But her mother got repeated urinary tract infections, she says, because facility staffers did not clean her properly. Furthermore, she says, at one facility, patients could get out of the locked ward, and scheduled activities rarely occurred as advertised. "They sold you on these incredible activities going on, and it was a joke," she says. (The facility replies that while the doors do open if pressure is applied for more than 15 seconds, staff is notified automatically, and that not every activity was appropriate for every resident.)

Beth Kallmyer, vice president of constituent services with the Alzheimer's Association, advises potential residents concerned about such issues to ask specific questions about the type of care and activities available and to look for competitive staff-to-patient ratios.

6. Advertised amenities are a red herring.

Everyone wants to believe that they will age well -- that dementia, broken hips, and other debilitating elements of aging will not happen to them, says Carlson. To cater to that image of an idyllic, healthy, comfortable retirement, many homes spend money creating a beautiful atmosphere -- expensive carpet in the common areas, trees in the courtyard, flowers in the dining room.

While that has value, says Los Angeles geriatric-care manager Bunni Dybnis, it can keep people from making a clear-eyed assessment of the level of care offered. Compared with providing top-level care and a high staff-to-resident ratio, carpeting and paint are cheap. "Don't be fooled by the decor. There is so much denial and such an appeal to that psychology," says Charlene Harrington, a professor emeritus at the University of California, San Francisco. Harrington advises potential residents and their families to talk to staff and other residents, eat a few meals to assess the quality of the food and take time to get a feel for the community.

7. We're not running a charity here.

A whopping 82 percent of assisted-living residences are for-profit -- owned by publicly traded companies, individuals or private-equity -- compared with 68 percent of nursing homes. Though nursing homes get the majority of their income from very low-paying Medicaid recipients (for assisted-living homes, the proportion is 19 percent), profit margins have been increasing in recent years for those that are privately held, according to research firm Sageworks. In 2006, profit margins were just 3.5 percent. But by 2011, they had nearly doubled to 6.4 percent -- slightly less than average for all privately held companies, but far above the 1.5 percent average for publicly traded nursing homes -- and they're rising again this year.

Libby Bierman, an analyst with Sageworks who conducted the research, says that much of that profitability is due to decreases in staff. Payroll fell from more than 45 percent of sales in 2004 to 38 percent of sales this year. And often those payroll cuts can quickly translate into deficiencies in care, says Lee, the former director of Florida's ombudsman program. In a study conducted by Harrington, the top 10 for-profit chains had 41 percent more serious deficiencies -- such as failure to prevent bedsores, weight loss, falls and infections -- than government facilities. Deep cutbacks in staff only add to the problem, says Harrington: "When they have really sick people, it is a disaster."

Crist, of the American Health Care Association, says the number of government five-star rated nursing homes is up and the number of one-star facilities is down, and that profits are not always wrung from staff cuts but can come from ancillary businesses. "Residents by and large still get care, regardless of the ownership structure," he says.

8. We pay people to put you here.

With so much to know about these facilities, two types of consulting business have sprung up: One that you pay for, and one that is paid for by the facility you move into. The differences aren't insignificant.

Among free referral services are outfits like A Place for Mom, the country's largest referral service, now majority owned by private-equity firm Warburg Pincus, which has 250 agents that contract with more than 18,000 facilities across the country. If one of its agents places a senior in a facility, the facility will pay the company close to a month's rent. But placement services generally won't recommend a facility that won't pay that finder's fee -- even if it may be a better fit for the client. More troubling, as long as the facility will pay that fee, agents at A Place for Mom will only stop referring patients to a facility if it receives a stop-placement order -- the harshest regulatory penalty a state can impose short of revoking a license.

After a Seattle Times investigation into widespread problems with these free referral services, including many at A Place for Mom, Washington state enacted regulations designed to curb some of the worst practices. Now, such services are required to disclose their commissions and the last time they visited a facility, and they're not allowed to refer people to facilities that are in violation of the state's licensing laws. A Place for Mom CEO Sean Kell, a former executive with Expedia.com and Hotels.com, says the company worked with lawmakers on the reform bill, that the company is in full compliance with the law, and that some of its regulations are more comprehensive than those now required. He says the firm's agents are most knowledgeable about the facilities it contracts with, and notes that the company is always trying to add partners.

Placement services paid for by the consumer, on the other hand, can recommend any facility they see fit, as well as offer additional services. The National Association of Professional Geriatric Care Managers certifies people who assess a senior's health and lifestyle needs, develop care plans and help find financing options, such as veterans' benefits. But a basic assessment can be $500 or more, and managers charge $100 to $200 an hour. Modigliani, the Massachusetts-based care manager, argues that direct payment by the client ensures that she is working only in the client's best interest. Geriatric-care managers don't just place people in homes, she says, but continue to work for them after placement, and they are in and out of the facilities they recommend on a regular basis.

9. Ratings? What ratings?

Good luck finding out whether or not assisted-living facilities provide good care. Only a handful of states post records online. And state inspections can be rare. California, for one, inspects every five years and doesn't put results online. Kyllo, of the National Center for Assisted Living, says consumers should ask an assisted-living facility for its record of fines and violations, which should be on file and available to view in person.

Nursing home ratings are transparent by comparison. There are uniform national rules, and there's plenty of centralized information that consumers can look at. The federal website Medicare.gov allows consumers to look at ratings and deficiencies at every facility in the country. Unfortunately, says Lee, even that system has flaws. The records that consumers see are not the violations that inspectors saw; often, they're less severe ones -- that have been reduced through a standardized dispute-resolution process.

10. We take Medicaid, but we'd rather not.

When a resident at a nursing home or assisted-living facility runs out of money, the government will sometimes pay for his or her care, through Medicaid. But the facilities receive far less compensation per patient from Medicaid than from those paying privately. In fact, says the American Health Care Association, the homes usually lose money, or just break even, on Medicaid residents.

But since about 19 percent of assisted-living residents and 70 percent of nursing home residents pay with Medicaid, facilities do whatever they can to maximize their revenue. For instance, says the National Senior Citizens Law Center's Carlson, though nursing homes are barred from making private payments an outright requirement, they screen applicants, looking for those that have the money to pay for a few months of care out-of-pocket before they transition to Medicaid. With assisted-living facilities, this can be an outright requirement -- as in Ohio, where facility residents are actually required to pay their own way for six months.

And that's not the only way homes try to increase private payments: Some facilities, primarily nonprofit ones, do not take Medicaid at all (an important distinction because once a nursing home is Medicaid-certified, it cannot refuse someone just because they are on Medicaid; however, an organization can decide that its facility will not enroll in Medicaid at all). Complicating matters, a few states allow nursing homes to set aside only a certain number of beds for residents on Medicaid. The problem with this structure, Carlson says, is that self-paying residents sometimes discover that when their funds run out, the facility suddenly has no more Medicaid beds available. "Providers have carte blanche to turn down people -- it is a huge problem," he says. Adds Nagaich, the elder law attorney: If a facility won't give you a written agreement that you can stay on Medicaid, don't move in.

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

Click Here to Download  The Alzheimer's Resource Kit

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.

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