Massachusetts Estate Planning & Asset Protection Blog

The Costs of Dementia: For the Patient and the Family - Part III What Can be Done

Posted by Dennis Sullivan & Associates on Mon, Apr 17, 2017

In the last installment of our three-part blog on the Costs of Dementia, we discuss the steps you can take to help alleviate the burden of caring for someone with dementia.

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What can be done?

Planning is important. Challenges that caregivers face include finding relief from the emotional stress associated with providing care for a loved one, planning to cover the responsibilities that could jeopardize the caregiver’s job or career, and easing financial pressures that strain a family’s budget. Having options—additional caregivers, alternate sources of funds, respite care for the caregiver—can help relieve many of these stresses. In addition, there are a number of legal options to help families protect hard-earned assets from the rising costs of long term care, and to access funds to help pay for that care.

Plannng ahead is the best way to ensure you have options if a loved one has dementia or any long term illness. Unfortunately, most people fail to plan ahead. According to the Genworth survey, the top reasons people fail to plan are they didn’t want to admit care was needed; the timing of the long-term care need was unforeseen or unexpected; they didn’t want to talk about it; they thought they had more time; and they hoped the issue would resolve itself.

Waiting too long to plan for the need for long-term care, especially for dementia, can throw a family into confusion about what Mom or Dad would want, what options are available, what resources can help pay for care and who is best-suited to help provide hands-on care, if needed. Having the courage to discuss the possibility of incapacity and/or dementia before it happens can go a long way toward being prepared should that time come.

Watch for early signs of dementia. The Alzheimer’s Association (www.alz.org) has prepared a list of signs and symptoms that can help individuals and family members recognize the beginnings of dementia. Early diagnosis provides the best opportunities for treatment, support and planning for the future. Some medications can slow the progress of the disease, and new discoveries are being made every year.

Take good care of the caregiver. Caregivers need support and time off to take care of themselves. Arrange for relief from outside caregivers or other family members. All will benefit from joining a caregiver support group to share questions and frustrations, and learn how other caregivers are coping. Caregivers need to determine what they need to maintain their stamina, energy and positive outlook. That may include regular exercise (a yoga class, golf, walk or run), a weekly Bible study, an outing with friends, or time to read or simply watch TV.

If the main caregiver currently works outside the home, they can inquire about resources and accomodations at work that might be available. Depending on how long they expect to be caring for the person, they may be able to work on a flex time schedule or from home. Consider whether other family members can provide compensation to the one who will be the main caregiver.

Seek assistance. Find out what resources might be available. A local Elder Law attorney can prepare necessary legal documents, help maximize income, retirement savings and long-time care insurance, and apply for VA or Medicaid benefits. He or she will also be familiar with various living communities in the area and in-home care agencies.

Conclusion

Caring for a loved one with dementia is more demanding and more expensive for a longer time than caring for a loved one without dementia. It requires the entire family to come together to discuss and explore all options so that the burden of providing care is shared by all.

We help families who may need long term care by creating an asset protection plan that will provide peace of mind to all. Attend one of our free educational workshops 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: Alzheimer's Disease, alzheimers care, caregiver, caretaker, care costs, dementia, seniors, costs of dementia

What Is Hospice|Massachusetts Elder Law Attorney

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

Hospice, Estate Planning, Elder Care

 

Certain topics such as death and hospice can be uncomfortable to talk about.  The fact is that death is a natural part of life and hospice is a service that can provide support and comfort to people who have been given time to prepare for death and their families.  Unfortunately, there are a lot of myths circulating about hospice that cause some people to be hesitant to even ask questions about it.  A better understanding of what hospice is, and what it is not, can help alleviate the sense of dread that often is felt when this word is mentioned.

What is hospice?

Many people think that hospice is a place, and though there are facilities that you can go that provide hospice services, that is not what hospice is.  Hospice means a philosophy of care.  Hospice will provide care to a client at their home, whether that is a private home, personal care home, nursing home, etc. 

Workers include nurses, nurses’ assistants, social workers, and chaplains.  They provide care depending on the individual’s needs; visits can be daily to once or twice a week and usually last no more than a couple hours.  They work to find the correct combination of medications in the lowest possible doses.  The goal is to control an individual’s symptoms without undesirable side effects.  While hospice tries to care for the patient in their home, if a short hospitalization is needed to keep them comfortable that is possible, as the treatments will be to provide comfort as well.

Hospice does not mean that a person is “giving up” or that death is imminent.  Hospice is designed to maximize the quality of life.  It is designed for someone who has six months or less to live and the care goals are changed from trying to find a cure to trying to find comfort and acceptance.  Hospice is not only for cancer patients, in fact; more than 60 percent of hospice clients have a diagnosis other than cancer.

How expensive is hospice?  That depends on the insurance plan.  Medicare and Medicaid plans cover the full benefits of hospice 100 percent.  For an individual with private insurance a hospice staff member will help you review your plan and determine how much your out-of-pocket costs will be. 

The more you know about hospice the easier the process can be.  A physician’s order is required for hospice, but that doesn’t mean you can’t start asking the questions.  The hospice staff is also available to speak with you about the process and provide as much information as possible. 

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

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

 

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

Tags: massachusetts estate planning strategies, hospice, caregiver, caretakeer, care, Massachusettes

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 One

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Wed, Jan 23, 2013

Medicaid, Medicare, Fiscal Cliff, Seniors, Estate Planning, MassachusettsJill needed help. 

She had cared for her grandfather for years.  When he needed nursing level care she found a nursing home nearby, arranged for him to be admitted and, as agent under his Power of Attorney, spent down his remaining assets.  Jill then scheduled an appointment with a Medicaid caseworker to file a Medicaid application on his behalf.   It seemed to be pretty simple, but problems quickly arose.

Jill gathered her grandfather’s financial records together and turned them over to the Medicaid caseworker at the first interview.  The caseworker completed the Medicaid application with her right there, printed it and had her sign it. She left the office thinking everything would proceed smoothly – that is until she got a letter from the same caseworker telling her that her grandfather still had $30,000 in assets remaining to be spent down.

Jill was confused by the letter.  She was positive that her grandfather had only a few hundred dollars left in his checking account, the only asset he had remaining.  That’s when she called our office for help.  Jill provided us with copies of everything she gave to the caseworker, and upon reviewing everything, we found 2 accounts that were titled in the name of her grandfather, custodian for Jill, with the initials UGMA at the end.

I explained to Jill that UGMA stands for Unified Gift to Minors Account.  Jill said she didn’t even know those accounts existed.  She just gathered together whatever paperwork she could find for her grandfather and turned it all over to the caseworker.   The caseworker insisted that Jill needed to cash those accounts in and pay the nursing home, then her grandfather would qualify for Medicaid.

Next week we’ll reveal why the Medicaid caseworker was wrong and what we did to fix Jill’s problem and get her grandfather 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 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.

 Elder Law Attorney, Estate Planning Lawyer, Massachusetts

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

Tags: Nursing Home Costs, asset protection, Medicaid, Nursing Homes, advanced directives, caregiver, transfer of assets, caretakeer, Medicare

Massachusetts Elder Law Attorney | More on Massachusetts’s Transfer of Home to Caregiver Child Exception

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Fri, Dec 28, 2012

The child caregiver exception to MassHealth transfer rules is one that many people focus on in an effort to protect the home and transfer it from parent to child.  It is also one that MassHealth scrutinizes very closely.  Massachusetts has rejected this exception where the child had a full time job and was therefore unavailable to assist the parent most of the day.  The care provided by the child must be such that if he/she was not providing it the parent would have needed nursing home level care.  Leaving the parent unattended for long stretches of the day while the child is working suggests that a 24/7 level of care is not necessary and so would not count towards the 2 year requirement.describe the image

Another issue is documentation of the need for care.  Typically, the child will come upon this exception as a solution in retrospect. MassHealth will require some verifiable proof that Mom needed nursing home level care at the beginning of the 2 year time frame.  We tell our elder law clients the best way to do that is with a doctor’s examination and documentation for that purpose.

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

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

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

Tags: MassHealth, Massachusetts, caregiver, transfer, Elder Law, Attorney

Massachusetts Elder Law Attorney | What is a "But For" Letter?

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Mon, Dec 24, 2012

We talked last week about MassHealth’s transfer penalty, but what exactly is a “but for” letter?  As I explained , the MassHealth penalty doesn’t start when the transfer of assets is made, but only after the other requirements are met, meaning the application is filed and all MassHealth, attorney, elder lawthe other MassHealth requirements are met.   A “but for” letter is the written communication from MassHealth stating that but for the transfer penalty you would have been eligible to receive benefits.  It tells you exactly when the penalty starts and how long it will be.  The State will not pay for your care during the time frame of the penalty.  You’ll need to find other means to pay for the care.

Click here to get a free sneak preview of the “Senior and Boomer’s Guide to Health Care Reform & Avoiding Nursing Home Poverty”, which contains information on how Massachusetts Seniors and Boomers will be impacted by the Affordable Care Act!

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.

describe the imageWe 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: MassHealth, Massachusetts, caregiver, Elder Law, Attorney, health, legal, home, but for, letter

Massachusetts Elder Law Attorney | Does MassHealth Permit a Family Member to be Paid to Provide Care?

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Thu, Dec 20, 2012

We tell our elder law clients that family members are allowed to receive payment for their duties as caregivers.   Family members who wish to be paid as caregivers should be conservative when determining a fee.  Fees should be less than or equal to the current fair market value of an outside aide service.  Also, family caregivers must be realistic when determining the amount of hours worked.  For example, if the family member holds a full time job, he or she may not charge for care given while at work in their full time employment.MassHealth, elder law, Massachusetts  Family members may not be paid in advance (in a lump sum) nor may they be hired retroactively for services already provided.  If there is no family caregiver agreement in place, the family member may not be paid for past services.  MassHealth presumes that the care was provided by the child “out of love” with no expectation of financial compensation.

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, which contains care tips as well as other useful information on Alzheimer’s disease, please visit www.BostonMemoryLawyer.com.

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: MassHealth, Massachusetts, caregiver, Elder Law, Attorney, health, legal, aide, home

Massachusetts Elder Law Attorney | Can Paying for Home Health Aides Cause a MassHealth Penalty? (Part 2)

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Wed, Dec 19, 2012

Can Paying for Home Health Aides Cause a MassHealth Penalty? (Part 2)

There are two components to properly paying a home health aide hired without the assistance of an agency:

1. Enter into a Caregiver Agreement with the aide – this agreement lays out the duties of the aide and the rate.  In short, it provides New Jersey MassHealth  with a record that an individual was hired to care for the eventual applicant and that the money withdrawn from the applicant’s account was used in return for a service (i.e.; transferred for value).  Some aides may be hesitant to sign due to their fear of the IRS or INS (immigration).  We explain to our elder law clients that the purpose of this agreement is to document payment for services forMassHealth, Medicaid an eventual MassHealth  filing, not to report the aide to a government authority.  This, of course, does not excuse the applicant and the aide from reporting income.  We do not provide advice on IRS and INS reporting rules, nor do we offer any guarantees that MassHealth  will not communicate with other government entities, however, we do tell clients that, to our knowledge,it has never happened and is not likely given how expansive “the government” is. 

2. Maintain receipts – simply buy a book of receipts from an office supply store.  Have the aide sign a receipt each time he/she is paid noting the dates of services for which payment is being made and the services performed

It should be noted that hiring a home health agency is never a problem for MassHealth.  The contract with the agency is proof of the services provided and payments are made to the agency, not to the aide.  A red flag for MassHealth  are checks made payable to an individual.  When they see checks to “Jenny Smith” they assume it is a gift to Jenny, who, they presume, is a family member.  You know that Jenny has been working for years taking care of Mom, but remember that MassHealth  doesn’t know that, and again, a verbal statement, unsupported by supporting documentation, will not be enough.

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

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

 

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

Tags: MassHealth, Massachusetts, caregiver, Elder Law, Attorney, health, legal, aide, home

Massachusetts Elder Law Attorney | Can Paying for Home Health Aides Cause a MassHealth Penalty? (Part 1)

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Tue, Dec 18, 2012

Can Paying for Home Health Aides Cause a MassHealth Penalty? (Part 1)

Paying private home aides “under the table” in the years immediately preceding a MassHealth  application is a common trap for the unwary.  Without proper documentation, Massachusetts will inquire about the weekly ATM withdrawals, checks written to “cash”, or checks written to a MassHealth, elder law, attorneyperson unknown to the case worker. The burden is on the MassHealth  applicant to prove that these transfers are for fair value.  Even though your aide is “like family” or “completely trustworthy” does not excuse you from keeping adequate records for MassHealth .  MassHealth  will simply refuse to accept statements describing past transfers. Tomorrow we’ll talk about the two components to properly paying a home health aide hired without the assistance of an agency.

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 developed our Unique Self-Guided 19-Point Trust, Estate, & Asset Protection Legal Guide, so you can learn where problems may exist in your planning as well as opportunities for improvement and how to implement a plan to protect your spouse, home, family, and life savings.  

Click Here to Download our Trust, Estate, & Asset Protection  Legal Guide

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: MassHealth, Massachusetts, caregiver, Elder Law, Attorney, legal

Massachusetts Elder Law Attorney | Is Art Therapy The Answer for Dementia?

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Thu, Nov 29, 2012

Medications can’t stop the disease’s inexorable damage to the mind, and stress and agitation often remain challenging despite drug treatment. But a growing number of Alzheimer’s institutions and caregivers are realizing that a musical walk down memory lane — a dance class, storytelling session, art project, or museum tour — can do more than offer pleasant diversions. They can improve a number of disease symptoms as well as quality of life.Alzheimer's, art, therapy

The basic idea is to use art to engage and connect with people with dementia. No matter how many memories they’ve lost, an essential piece of who they always were still remains.

Even people who were not artistic or music lovers in their youth can be inspired by the sound of a song they heard on their first date, or by a painting that evokes an emotion. Writers and poets also see their art as a way to reach people, regardless of age or prognosis.

One of the key benefits of doing or appreciating art is that it challenges people who are usually doted on.When you are cared for, you lose your sense of who you are. Everybody with dementia has a lot going for them. They can experience, they can be present, and they can develop.

Robert Stern, a professor of neurology and neurosurgery at Boston University, said a growing body of research is confirming the anecdotal evidence that the arts can improve quality of life, reduce stress, and allow the person to better connect to the world. Recent research suggests music can boost recall of personal memories.

Whether it be fine arts, music, listening to music, going to museums. All those things do not have an impact on the disease per se. What they do most likely is they get through to the person with Alzheimer’s by exploiting the areas of the brain which are least impaired. Anything that can touch the patient through that network of brain areas can have a profound impact.

Medications such as cholinesterase inhibitors may be able to slow some of the memory loss of Alzheimer’s and allow people to live independently longer. But all of the efforts to develop drugs to reverse memory loss and the behavioral changes of Alzheimer’s have failed so far. Researchers think that’s because the damage of Alzheimer’s begins years, if not decades before symptoms become obvious. They are now testing drugs in people likely to develop the disease, to see if they are more effective.

Instead of just warehousing dementia patients until more effective medications are discovered or patients die, our present challenge is to provide people with a life worth living while they’re alive.

Using music and art and movements that don’t rely on verbal skills allows people to succeed. The primary language is emotion with this disease.

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.

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: Elder Law, dementia, caregiver, Attorney, Alzheimer's, alzheimers, Alzheimers Disease. Massachusetts, art, therapy, music, cargiver

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