Massachusetts Estate Planning & Asset Protection Blog

Understanding Long Term Care Planning

Posted by Dennis Sullivan & Associates on Fri, Jan 19, 2018

Facing the enormity of long term care, whether it is the financial, healthcare, emotional or psychological issues, it is so overwhelming. 

It's needs a team effort!  With the help of family, friends and our team here at Dennis Sullivan and Associates you can make the enormity of long term care manageable 

 

What exactly is "Long Term Care Planning" ? 

Here's one way to look at long term care planning: 

In today’s world, the question is no longer only, “What happens when I die?, but now we need to plan for “What happens if I live?” An estate plan covers the scenario of, What happens when I die.  But long term care covers a large variety of other factors and scenarios that sometime families forget to consider such as what happens if I live but am not healthy and have increased health-care costs and need to rely on others for assistance, either temporarily or on a permanent basis. The estate plan does not address this need. An estate plan can help you answer the first question, but a long-term care plan can help you answer both the first and second questions. Let’s put it another way. An estate plan insures that if you have assets when you die they will be passed in the manner you wish. The key word is “if.” The plan will not, however, guarantee that there will be anything left at that time to pass. Your assets could be mostly or entirely wiped out by a lengthy illness, hospital, and/or nursing home stay, leaving your spouse and other heirs with nothing.

 long Term Care and Medicaid:

I had a conversation last week with a married couple for whom we are preparing a Medicaid application. John is in a nursing home, and Mary is healthy and living at home. I explained to them that Mary can keep half of their countable assets, in their case $75,000, but that they must spend down to below that dollar amount by the last day of the month directly preceding the month we want to qualify John for Medicaid. I have had this conversation numerous times with clients in John and Mary’s situation, and know all too well that this simple instruction is not always followed. The largest part of most spend downs typically goes to the nursing home. But, as most people do, myself included, we wait until we get a bill before we pay it. If I owe you money, I’m not going to chase after you for a bill. Whenever you get around to it and invoice me, then I’ll pay it. The longer the money stays in my bank account, the happier I am. However, this can get you into big trouble and cost you tens of thousands of dollars if you wait for the nursing home bill. If we want John to be eligible for Medicaid next month and we know that he owes the nursing home $20,000 for the past two months of care, but the nursing home hasn’t yet presented Mary with a bill, it does not matter that Mary and John legitimately owe the facility the money. If that $20,000 is still sitting in their bank account next month, causing their account balance to exceed $75,000, John cannot qualify for Medicaid. Even worse than that, he can’t even qualify for next month. He has to wait until the following month, which means they will owe the facility another $10,000, leaving Mary with $65,000 to live on.


So Much to Discuss

For more information on Long Term Care Planning we encourage you 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. January sessions are filling up fast call or register on line to reserve your seat today.  

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


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

Tags: Dennis Sullivan, Elder Law, Estate Planning, Estate Planning Recommendations, Estate Planning Tip, Financial Planning, Retirement, coverage, senior, Attorney, Baby Boomers, Capital Gains Tax, GST tax, Massachusetts, New estate tax law, IRS, Massacusetts Estate Tax, Tax Savings, federal, new regulations, tax, tax reform, tax deductions, taxes, tax liability, tax exemption, New Tax Bill, Tax Bill, 2018 Tax Bill

New Tax Bill: What you need to know

Posted by Dennis Sullivan & Associates on Fri, Jan 05, 2018

How does the new tax bill affect you and your family now and in the future?

The new tax bill has officially been passed by Congress and signed by President Trump, what does this mean for us?  The answer to this depends on many variables discussed here. 

 

First of all, these changes don’t apply until you file your 2018 taxes, meaning that you won’t have to worry about the new law when filing your 2017 income tax returns this spring.  That being said, still we will be experiencing the greatest overhaul of the tax laws in more than 30 years.  The last major changes having been made under President Reagan in 1986. 

One change you can expect to see is that both corporate tax rates and personal income tax rates will drop.  There are also other changes which limit or eliminate personal deductions.   The changes that affect corporate tax rates are permanent, and the changes that affect individual tax rates and deductions are not.

Also in the new tax bill you will find a “sunset” provision, meaning that the new law – as it applies to individuals – will expire on December 31, 2025.   That is, unless Congress agrees to extend the law.  That, of course, will depend on the political and economic climate 8 years from now, including whether the economy responds the way Republicans say it will

       Now let’s take a look at the changes that are likely to affect the average senior.  Good news, the tax rates have been lowered a bit.  There are still 7 tax brackets but the rates have changed with the top rate lowered from 39.6% to 37% and the threshold at which each rate is reached has been altered. (The corporate rate reduction is much greater, from 37% to 21%).

       Some of the most significant changes relate to deductions.  The standard deduction has been doubled to $12,000 for a single person and $24,000 for married couples but personal exemptions have been eliminated.  The deduction for state and local taxes will be capped at $10,000, something that could hurt many Massachusetts residents and especially homeowners because we have high real estate and state income taxes.  


So Much to Discuss:

For the first time in decades major overhauls to the tax system are happening! This is an enormous change that can affect your estate planning and asset protection as well. Be sure to stay tuned as we will discuss more about this new tax bill in our next blog post!    

For more information 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. January sessions are filling up fast call or register on line to reserve your seat today.  

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


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

Tags: Dennis Sullivan, Elder Law, Estate Planning, Estate Planning Recommendations, Estate Planning Tip, Financial Planning, Retirement, coverage, senior, Attorney, Baby Boomers, Capital Gains Tax, GST tax, Massachusetts, New estate tax law, IRS, Massacusetts Estate Tax, Tax Savings, federal, new regulations, tax, tax reform, tax deductions, taxes, tax liability, tax exemption, New Tax Bill, Tax Bill, 2018 Tax Bill

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

Massachusetts Elder Law Attorney | The Fiscal Cliff & Its Impact on Medicare

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Sun, Feb 17, 2013

As you have likely hear by now, the fiscal cliff deal passed by Congress on January 1, 2013 (the American Tax Payer Relief Act) has made a number of changes to a number of important laws and programs in this country

While the deal itself does not contain significant changes or cuts to traditional Medicare, serious and fundamental threats to the Medicare program are expected to arise in the coming months as Congress grapples with broad budgetary issues. As a result, programs like Medicare, Medicaid, and Social Security are poised to take center stage in discussions about Sequestration, the debt ceiling, and decreasing the national debt.

Important Medicare-Related Provisions of the Deal

  • Sustainable Growth Rate (SGR) – Physician Payment

The Sustainable Growth Rate, also known as the "doc fix", is a formula created in 1997 to control the rate of Medicare cost growth by setting targets for expenditures on physician services. Despite being law, Congress has not followed the SGR formula and has voted each year to override the SGR formula in order to avoid steep cuts in provider reimbursements. The Relief Act once again pushes back the application of SGR for another year. Another round of discussions over SGR is expected as part of efforts to replace the formula.

  • Outpatient Therapy Caps

Current Medicare law places a yearly dollar amount cap on all outpatient physical and speech therapy services ($1,900 in 2013).  Beneficiaries and their providers, however, have been able to file for an exception when the provision of additional therapy services is determined to be medically necessary. This exceptions process was set to expire on December 31, 2012, but the fiscal cliff deal extended the exceptions process to December 31, 2013.

  • Medicare Private Health Plans

The authority of Medicare Advantage Special Needs Plans (SNPs) to restrict enrollment to specified groups of beneficiaries (for example, dual eligible individuals) was extended until January 1, 2015.

The authority for Medicare Cost Plans, a type of Health Maintenance Organization (HMO) through which Medicare beneficiaries may choose to receive their benefits, was extended until January 1, 2014. These plans are only authorized to operate in certain regions of the country.

  • Outreach to Enroll Medicare Beneficiaries in Low-Income Programs

Funding to improve enrollment in programs for low-income Medicare beneficiaries was reauthorized for another year. This funding is allocated to State Health Insurance Programs (SHIPs), Area Agencies on Aging (AAA), Aging and Disability Resource Center (ARDCs), and the National Center for Benefits Outreach and Enrollment. The money is intended to help eligible individuals enroll in Medicare Savings Programs, the Part D Low Income Subsidy, and other programs.

  • Commission on Long Term Care

The Relief Act established a fifteen member commission to develop a plan for implementing and financing a comprehensive, coordinated and high quality system that ensures the availability of long term services and supports (LTSS). Efforts in the Affordable Care Act to enact such a system, known as the CLASS Act, were repealed in the Relief Act.

Commission members will be appointed this month by House and Senate leaders as well as the White House. The Commission will be tasked with producing a comprehensive and detailed report with recommendations for legislative or administrative action within 6 months. If approved by a majority of the Commission members, this report will be introduced as a Senate bill.

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The Relief Act also included a number of provisions adjusting how Medicare providers are paid. Many affect how certain Medicare hospitals are paid. There are also provisions affecting Medicare payment of radiology services, ESRD treatment, diabetic supplies and ambulance transportation, among others.

The Medicare provisions in the Relief Act are not as harmful to the program as many of the dangerous proposals offered to Congress over the past few months.  There have been proposals made to double look back periods and decrease Medicare and Medicaid benefits.  Drastic cuts are still on the table as policy-makers seek to address the looming sequestration and debt ceiling with savings from health care programs. For real health savings that address the underlying problem of health care costs system wide, policy-makers and advocates should begin with solutions that improve the health and well-being of Medicare beneficiaries while preserving the Medicare program for those who depend on it now and in the future.

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 family and legacy.

Tags: Elder Law, asset protection, Baby Boomers, senior, Attorney, Fiscal Cliff, Massachusettes

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

Massachusetts Elder Law Lawyer | Considering Retirement or Retired?

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Wed, Jan 30, 2013

Now Is the Time to Review Your Investments

In conducting research for our upcoming book, the Senior & Boomer’s Guide to Health Care Reform & Avoiding Nursing Home Poverty we learned that many people who are still working are giving retirement a second thought.

This is because they have to make big decisions about things such as Social Security and taxes - in advance. The world as we knew it has been turned upside-down in recent years, and this decision will affect the rest of your life.  Many are not sure they are ready - emotionally and financially - to retire.

If you're considering making the break, ask yourself these questions:

AM I REALLY READY?

Because of the loss of our financial security-blankets in recent years, people are working longer. If you enjoy your job, maybe you should keep working.

Working will allow you more time to build up your savings for the day when you really do want to play golf instead of office politics, and more time to pay down your mortgage. Keep in mind, once you retire, it can be difficult to un-retire.

CAN I REALLY LIVE ON A SMALLER BUDGET?

If you think it was hard staying on a budget during your working life, you ain't seen nuthin' yet! In fact, it often gets more expensive to live after you retire. You've got less coming in. But you'll probably be spending money on things you never had the time to spend it on before.

You'll probably be traveling more. Seeing more movies or ballgames. Playing more golf. Going out with friends more. And perhaps buying more "toys."

The Web can be a resource.  Retirement and financial planning websites like Mint.com can help you figure out expenses that may end with retirement, and those that may begin.

Some experts encourage a trial run, by living on a projected "retirement budget" while you're still working. It's not a totally accurate method. But it might give you time to develop coping strategies.

CAN I PUT OFF TAKING SOCIAL SECURITY?

There's a natural instinct to sign up when you turn 62. But "full-retirement age" isn't until 66...and, if you start early, your benefits will be reduced. So, if you've got a bit of a nest egg, consider waiting a while. And if you can wait until 70, your benefits will be even higher.

For those eligible at age 66, waiting just one year will result in monthly benefits equaling 108% of the previous amount. And waiting until 70 would generate 132% of the regular monthly benefit!  In fact, you can nearly double the amount you'll get at 62 if you can wait until 70.

HAVE YOU SPOKEN WITH YOUR ACCOUNTANT?

Most of us speak with our accountant just once a year - at tax time. But don't consider retirement without discussing your finances with your accountant or asking us about how we can help you with retirement and tax planning.

Consider a financial planner, too. A big chunk of your IRA is going to Uncle Sam when you withdraw it.  Together, we can help you develop a strategy for your taxable and tax-sheltered accounts. And we can help you decide whether to convert to a Roth IRA, where withdrawals are tax-free, but conversions are not.

ARE YOUR INVESTMENTS SAFE AND PRODUCTIVE?

Many people especially those considering retirement or in retirement should review their portfolio with an eye towards age and risk tolerance, making sure they are in line with one and other.  Many people are sick of banks not only dropping their CD rates but their money market rates as well.  Many professionals are concerned that interest rates may be at a turning point and with the debt ceiling conversation being revisited, now may be a good time to review your investment options.  If you would like some information on safe investing for seniors, please let us know.

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 family and legacy.

elder law, massachusetts, estate planning, medicaid, alzheimer's

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Tags: retirement plans, Estate Planning, Elder Law, roth conversions, Retirement, Baby Boomers, 401(k), Attorney, senior, income

Massachusetts Estate Planning Attorney | Critical Planning Documents for College Students

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Mon, Jan 28, 2013

HIPPA, Health Care Proxy, College Student, Estate PlanningIs your "baby" going away to college? Have they recently gone away to college? If so, you've no doubt spent a lot of time poring over lists lately to determine what's a "want" and what's a "need."

You've been planning, and dreading, this day for a couple of years and you've most likely been saving for it for a lot longer than that.  Chances are, you're prepared.  There are however, some things for which you just can't prepare, like accidents or other tragedies.

That's why you need to have your child sign two critical documents.

If your child is already 18 you already know that, legally, they are an adult.  As a result of federal privacy laws, the college they attend generally can not divulge medical information to you.

This is why every child going away to school should sign a Health Care Proxy and HIPAA Authorization.  This way, if tragedy or illness strikes, you'll be able to get the information you need. It doesn't matter if you gave birth to that child.  You won't be able to get any information on his health status unless there's a signed HIPAA authorization.

What happens if there's an accident, and your child ends up in a coma? Who's going to mnake necessary medical decisions? If there's no Health Care Proxy, you may have to go to court to get a guardianship designation so you are in control.

Tragedy has its own timetable however, and going to court could cost you more than just financially if it takes too much time.  Remember Terry Schiavo?

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.

estate planning, elder law, massachusetts

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


Tags: health care proxy, HIPAA, Baby Boomers, college planning, Estate Planning Tip, Attorney

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

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

Massachusetts Elder Law Lawyer | Can Keeping a Journal Help Me Deal With My Feelings About Dad's Alzheimer's?

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

The answer to this question is simple: Yes!!

elder law, massahusetts, estate planning, alzheimer's We've had people tell us, "At this time in my life, I just can't afford the time to journal." Our answer is often, "At this time in your life, you can't afford not to journal!"

Keeping a journal can be therapeutic for a caregiver. It's intensely personal. It's not meant for anyone else to see. But - time and time again - we hear from those who've tried it that it helps them express their feelings, and serves as a relief valve for some of the built-up stress.

Journaling isn't a drain on your time. Quite the contrary. While you're doing it, it often slows down time, allowing you to put things into perspective. It doesn't have to be done every day. But it should be done at least several times a week. And it doesn't have to be done for an hour a day. Even 15-20 minutes will be helpful.

It enables you to deal with the guilt, anger, fear, frustration, resentment, and any other emotion. There are no bad emotions during this time. But there are emotions that can hurt you if you don't deal with them.

There are no rules. Some people write to themselves. Others write to the disease... for example, saying how much it's destroyed their plans and dreams, etc. Journaling helps to straighten out jumbled thoughts, and make things clearer.

Journaling should be only one part of your "program," however. Talk to your friends and family. And consider joining a support group. This will help address your feelings of isolation - because, in that room, everyone knows what you're going through.

This may be the hardest period of your life. But we can help.

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.

To gain free online access to the Complete Alzheimer's Resource Kit, sold nation wide for $197, which contains care tips as well as other useful information on Alzheimer’s disease, please visit www.BostonMemoryLawyer.com.  There you will find a number of helpful secrets, tips, and tools, including the Caregiver's Journal.

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: trusts, Alzheimer's Disease, Elder Law, asset protection, Baby Boomers, Health Care, elder care, dementia

Long Term Care and College Debt | Boston Elder Law Attorney

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Thu, Aug 16, 2012

There are many dangers associated with grandparents paying for a grandchild’s college education if they haven’t planned for long term care first.  That payment may not be subject to gift tax laws but will be subject to a Medicaid transfer penalty. senior, student

However, there is another disturbing trend that is hitting seniors hard and it is a growing problem. As the cost of college education continues to soar so does the amount of student loan debt, now totaling over $1 trillion.  Almost 90% of that is from federal student loans and the federal government is getting more aggressive in pursuing repayment.  Changes in the laws have given the government more ability to collect from defaulting borrowers.  Student loans are not dischargeable in bankruptcy, unlike credit card debt, for example.


The government, under a 1996 law, has the ability to collect the debt from Social Security retirement and disability checks and it is doing just that with increasing frequency.  In the year 2000 there were 6 cases in which Social Security recipients checks were reduced to cover college loans on which they were delinquent.  In 2007 that number was 60,000 and in the first 7 months of 2012 that number was up to 115,000.


For many seniors on fixed incomes reducing their Social Security checks, which in many cases are already meager, will have a devastating impact.  In many cases parents and grandparents have cosigned loans for their children and grandchildren.  If the primary borrower defaults on the loan, the lender can collect from the cosigner.


With statistics showing that many baby boomers are not saving enough for retirement and the cost of long term care continuing to climb, adding college debt to the equation just adds to the complexity of the problem.  This is yet another example of why you can’t wait until a medical crisis hits to figure out how you will pay for long term care - Your physical and financial well being depend on it.

Gain instant free online access to “Seniors’ Guide to Health Care Reform & Avoiding Nursing Home Poverty”, which contains information on how Massachusetts Seniors will be impacted by the Affordable Care Act.

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

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: long term care, Baby Boomers, gift tax, social security, Medicaid, Retirement, health Care act, student loans

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