Massachusetts Estate Planning & Asset Protection Blog

Checklist for Families With Loved Ones Who Need Nursing Home Care

Posted by Wellesley Estate Planning Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Fri, May 11, 2012

If you have a loved one with Alzheimer’s, he or she may eventually need nursing home care. The challenge is in finding the right facility not only for your loved one, but also for the family.

Below is a sample checklist that has been developed to help you and family members make these important decisions. Make copies, and compare different homes. Don’t expect every facility to score well on every question; simply consider which items are most important to you. But, don’t rely only on a number. Ask to speak to family members of other residents. Also, contact the local or state ombudsman, and get a copy of the state inspection report.

Sample Nursing Home Evaluation Form
Name of Nursing Home: ________________________________________
Date Visited: __________________________

  • First impression? 1 2 3 4 5

  • Exterior: paint, gutters and trim? 1 2 3 4 5

  • Are the grounds pleasant and well kept? 1 2 3 4 5

  • Views from residents’ rooms and other windows? 1 2 3 4 5

  • Alzheimer’s Special Care Unit? 1 2 3 4 5

  • Secure outdoor area? 1 2 3 4 5

  • Secure area with walking paths? 1 2 3 4 5

  • Appropriate areas for physical and occupational therapy? 1 2 3 4 5

  • Are barber or beauty salon services available? 1 2 3 4 5

  • A well-ventilated room for smokers? 1 2 3 4 5

  • General cleanliness? 1 2 3 4 5

  • Clean smell? 1 2 3 4 5

  • Enough space for residents? 1 2 3 4 5

  • How noisy are hallways and common areas? 1 2 3 4 5

  • Is the dining area clean and pleasant? 1 2 3 4 5

  • Is there room at tables for both residents and aides, if necessary? 1 2 3 4 5

  • Are residents using common areas? 1 2 3 4 5

  • Can residents bring furniture and personal items for their rooms? 1 2 3 4 5

  • Does the administrator know residents by name, and speak to them in a pleasant manner? 1 2 3 4 5

  • Does staff speak to residents with cheerful, respectful attitudes? 1 2 3 4 5

  • Do staff and administrators work well together? 1 2 3 4 5

  • What special training has the staff received for Alzheimer’s residents? May I observe a training session? 1 2 3 4 5

  • Do nursing assistants participate in the resident’s care process? 1 2 3 4 5

  • Employee retention? 1 2 3 4 5

  • Does a state ombudsman visit regularly? 1 2 3 4 5

  • How likely is an increase in private pay rates? 1 2 3 4 5

  • Any additional charges not included in the daily or monthly rate? 1 2 3 4 5

  • How are roommates selected? 1 2 3 4 5

  • Describe a typical day? 1 2 3 4 5

  • Can residents choose when to go to bed and wake up? 1 2 3 4 5

  • Are meaningful activities available for Alzheimer’s patients? 1 2 3 4 5

  • If activities are in progress, what’s the level of resident participation? 1 2 3 4 5

  • Can Alzheimer’s patients continue to participate in interests like gardening or contact with pets? 1 2 3 4 5

  • Is there safe, well-lighted parking? 1 2 3 4 5

  • Are hotels/motels nearby for out-of-town family members? 1 2 3 4 5

  • Area restaurants suitable for taking residents out with family members? 1 2 3 4 5

  • How convenient will care planning conferences be for family members? 1 2 3 4 5

  • Is an effective family council in place? 1 2 3 4 5

  • Can meetings be scheduled to discuss any problems? 1 2 3 4 5

Putting your loved one in a nursing home can be a very traumatic process. But it doesn’t have to be. We can help.Nursing Home, Alzheimer's, dementia, family guide, long term care

At The Estate Planning & Asset Protection Law Center, we’re Elder Law attorneys. We have walked families through this process successfully before. In fact, we have helped several families with estate planning, wills, trusts, powers of attorney, long-term care planning, asset protection, isses qualifying for Veteran’s Benefits and MassHealth.

To learn more about how the Estate Planning & Asset Protection Law Center can help you register online to attend one of our upcoming Trust, Estate, and Asset Protection Workshops or register by calling (800) 964-4295 (24/7).  You will discover why traditional estate planning may not work and the Life Care Planning steps you should be taking instead so you will not outlive your savings, the asset protection language that most people don't have in their power of attorney documents which can help protect their life savings, how to qualify for the hidden Veteran's benefits that most people know nothing about, and How Medicaid works...and the steps you need to take now to protect yourself and your family under the new rules. 

 

Tags: Alzheimer's Disease, Nursing Home Guide, Nursing Homes, Estate Planning, Estate Planning, Elder Law, assisted living, elder care journey, durable power of attorney, Health Care, health care proxy, elder care, family, veterans benefits

Common Myths of Medicaid Qualification

Posted by Wellesley Estate Planning Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Fri, May 11, 2012

Is it true you can give $10,000 to each child without penalty? Can't you just put your kids' names on your accounts? Is it true there's an annuity that allows you to "flip the switch" and solve all your payment problems?

The answers? NO! NO! NO! The $10,000 is now $13,000... and it's an IRS rule, not a Medicaid rule. Putting your children's names on your accounts protects none of the money. Annuities? The laws have changed - and there is no magic switch.

Medicaid Qualification, Massachusetts, MA Estate Planning

Often, out of sheer frustration, retirees tell us they're going to solve the problem of qualifying for MassHealth by just giving it all to their kids. But that opens up the possibility of your kids' problems - with their spouses, for example - impacting your money.  In addition, most retirees have no idea about the tax implications. For instance, transferring a house to a child changes the property tax classification to non-owner-occupied - and property taxes will go up.

To qualify for MassHealth, you do have to “spend down” your assets. Each state has different rules; but, generally, you're allowed to keep around $2,000 if you are single and $113,640 if you are married.

The only exempt assets are:

  • Home equity up to $750,000

  • Personal belongings, household goods

  • One car or truck

  • Burial spaces and certain related items for applicant and spouse

  • Irrevocable pre-paid funeral contract

  • Up to $1,500 of face value life insurance; if the face value exceeds $1,500, the cash value is considered a means of payment

All other assets are generally non-exempt - any item that can be turned into cash is a countable asset.  Non-exempt items would include:

  • Cash, savings and checking accounts

  • Credit union share and draft accounts

  • Certificates of deposit

  • U.S. Savings Bonds

  • IRAs, 401(k)s, Keogh plans, 403(b) and all other defined compensation plans

  • Pre-paid funeral contracts that can be canceled

  • Trusts (depending on the terms and conditions of the trust)

  • Real Estate (other than primary residence)

  • More than one car

  • Boat or recreational vehicles

  • Stocks, bonds and mutual funds

  • Land contracts or mortgages held on real estate sold

Sound confusing? It is!  The Elder Law Journey can be very complex and no one should try to navigate this road alone. It's too easy to crash and burn. The Estate Planning & Asset Protection Law Center can help. We practice Elder Law, and we've walked a number of families through the Elder Care Journey by providing them with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset protection programs, and assistance acquiring Veteran’s Benefits.

To learn more about how the Estate Planning & Asset Protection Law Center can help you register online to attend one of our upcoming Trust, Estate, and Asset Protection Workshops or register by calling (800) 964-4295 (24/7).  You will discover why traditional estate planning may not work and the life-care planning steps you should be taking instead so you will not outlive your savings, the asset protection language that most people don't have in their power of attorney documents which can help protect their life savings, how to qualify for the hidden Veteran's benefits that most people know nothing about, and How Medicaid works...and the steps you need to take now to protect yourself and your family under the new rules.

Tags: Alzheimer's Disease, Medicare, Medicaid, MassHealth, Estate Planning, Estate Planning, Elder Law, HIPAA, elder care journey, health care proxy, elder care, family, power of attorney, 401(k)

The Realities of Long-Term Care

Posted by Wellesley Estate Planning Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Tue, Apr 24, 2012

Carla called me only after much urging from her friend.  Carla’s husband, David, had lung cancer and it had spread throughout his body.  The end of his battle was nearing and he had been approved for placement on hospice, an approach to medical care where the goal is to enhance the quality of life for patients with terminal illness but who are likely to die within 6 months.  It appeared that David only had weeks to live and a long term nursing home stay wasn’t a likely scenario. So, why was she calling me?  Let’s take a closer look.

 Carla told me the last several years have really taken a toll on her health.  She is 70 but starting to slow down physically.  She said she has put knee replacement surgery on hold.  It was clear that Carla’s focus was completely on David but her friend recognized that she also needs to focus on “life after David”.  That’s why Carla was calling, although I don’t think she realized it entirely.

 I asked her about her finances.  David had a pension of $2500 and Social Security of $1500.  Carla, who didn’t work outside the home during the years she raised their 3 children, only received Social Security of $750 and no pension.  She also told me that David’ pension would stop once he died.  She remembered that he took the maximum pension option when he retired a few years ago but that there would be no survivor option if she outlived him.  I told her that she would lose one Social Security check as well, keeping the larger one.

 I asked Carla about their assets.  She and David owned their home which she estimated to be worth approximately $300,000 with no mortgage.  They also had savings totaling $250,000.  They had no life insurance and no long term care insurance.  I asked about their legal documents.  Carla said she and David had both executed powers of attorney and health care directives several years ago.  Their wills she estimated to be about 20 years old, prepared when her children were of school age.  Their wills left everything to the surviving spouse and then alternatively to the children.

 Long Term CareAs I mentioned, David was now on hospice.  Carla had set up a hospital bed on the first floor and brought David home.  At this point he was bedridden.  A hospice nurse was coming to the home several times a week.  Although very tired, Carla said that David was completely lucid.  She then asked me what exactly I could do to help her.

 It was clear from her question that her focus was on David.  She wasn’t thinking about her own needs but I was.  Although not easy for her to do, I asked Carla to shift her focus for a few minutes.  I asked her about her own health and long term care needs.   She again told me she would address it after David’ passing.

 “Who will care for you”, I asked, “if you need long term care in the future.”  Carla told me her children don’t live nearby and she never really thought about it.  She wants to be cared for at home, just as she is doing for David, but she recognized that it won’t be easy.  I then told Carla that we could help her try to accomplish that but there are steps that we need to take immediately, without delay.  Next week I’ll give you the details.

For more information on how to effectively plan for you and your spouse's trip on the elder care journey visit www.MASeniorWorkshop.com.  There you will find dates and times for upcoming workshops on estate planning, elder law, and veteran's benefits hosted by the team of professionals at The Estate Planning & Asset Protection Law Center of Dennis Sullivan & Associates. 

Tags: asset protection, long term care, Medicaid, MassHealth, in-home care, Estate Planning, Lifetime Protection Program, Elder Law, assisted living, elder care journey, durable power of attorney, Health Care, health care proxy, elder care, family, living will

Special Legal Documents for The Alzheimer's Patient

Posted by Dennis Sullivan & Associates on Tue, Jul 19, 2011

Planning ahead is important for everyone to ensure our wishes are met in the event of death or incapacity.  For families coping with Alzheimer's disease and other kinds of dementia planning is even more important because of the uncertainty of your loved one's capacity prognosis.

Power of Attorney.  A general, durable power of attorney is a legal document which lists the person or persons authorized to make decisions on behalf of another when that other person has reduced mental capacity.  The extent of the power given to the authorized person/s is up to the individual on whose behalf the document is being created.  An appropriately designed and executed power of attorney provides great peace of mind to the individual in question as well as to his/her family.  With this tool in place, there will always be someone to pay bills, withdraw funds, process any income, etc. on your loved one's behalf, according to their plan.

In some cases, people choose to establish separate powers of attorney - one for finance and another for health care. The two or more people would have authority to make decisions in different areas, financial and health care.

The person/s with the power of attorney for health care, for example, would make choices regarding treatment changes, continuation of life support, etc. The person with this power of attorney also has access to the medical records of the person with Alzheimer's. The person with power of attorney for finances usually has access to the person's bank accounts and ensures that his/her bills, including medical bills are paid.

In situations where the power of attorney is not provided ahead of time, the person who will have power of attorney must go to court to establish guardianship, which can be a lengthy and costly process for the family.

Who Decides Whether You're "Competent"?

There are various competency tests like the Hopkins Competency Assessment Test.  However, in many cases, this decision is made within families, when a loved one agrees or asserts that their ability to think clearly and make good decisions is impaired.  This revisits the need to begin to talk about this kind of planning early in the Alzheimer's diagnosis.  Once dementia-like symptoms become more severe, it becomes more difficult to broach topics like competency with your loved one.

What is an Advanced Directive?

An advanced directive, or living will, states your health care/disability instructions. Advanced directives can provide the following information:

  • The individual's wishes regarding life support and other life-lengthening measures;
  • The role of the power of attorney for health care;
  • The individual's wishes regarding his or her death.

Wills/Trusts

A will is a legal document that lists your wishes regarding the distribution of your property and the care of any minor children after your death.  

Both a will and a living trust can transfer assets, but each has unique uses. For example, a living trust can hold assets for your benefit while you are alive, as in the event you lose mental capacity.  A will only goes into effect after death, while a revocable living trust goes into effect as soon as it is signed. 

A will only governs the disposition of property owned in the deceased's sole name, while a revocable living trust only handles the distribution of property that has been transferred into it. 

A will does nothing to plan for mental disability, while a disability plan can be written right into a revocable living trust. Property passing under the terms of a will goes through probate, while property passing under the terms of a revocable living trust avoids probate.

If you are concerned about people knowing your net worth or your beneficiaries, you might decide to transfer your assets through a trust, which, unlike a will, is not a public document. If a person wanted to leave assets to a domestic partner, for example, might use a revocable trust, because it is harder for family members to challenge a trust than a will.

A living trust is also useful if you own real estate in a state that is not your primary residence. Real estate is governed by the probate rules of the state in which it is situated. Unless the property is in a living trust, a Massachusetts resident, for example, who owns a home in Florida would need to probate the property separately there.

For more information about estate planning and the different documents at your disposal, watch our Estate & Retirement Planning videos.  To learn firsthand about these documents and other issues surrounding an Alzheimer's diagnosis call our office at 781-237-2815 or register online to attend one of our Trust, Estate and Asset Protection workshops.  For more information about dealing with all the various intricacies of Alzheimer's, please also visit us online to read the valuable information in our Alzheimer's Resources Kit.

Tags: Alzheimer's Disease, durable power of attorney, health care proxy, living will, trusts, will

How To Make Sure Your Final Wishes Are Carried Out

Posted by Dennis Sullivan & Associates on Fri, Mar 11, 2011

Retaining control and dignity as the end of life approaches is an often overlooked aspect of comprehensive estate planning. Regardless the size or value of your “estate,” proper planning should address these difficult issues.

US News & World Report ran an article last week, How to Ensure Your Last Wishes Are Carried Out. As they outline, there are two primary ways to ensure your final wishes are followed: one is through legal documents, and the second is by communicating your wishes to those who may be involved in carrying them out should you become incapacitated.

As regards legal documents, you’ll need a power of attorney for healthcare, also known as a healthcare proxy. Your health care power of attorney allows you designate the person you want to be your health care decision-maker in the event you cannot make decisions for yourself.

You also may want to consider a Living Will. A Living Will is the document that helps guide the health care decisions made on your behalf. This is the document that allows you to spell out what types of medical care you would, or would not, want to receive in various situations.

The most important piece of advice? Make these decisions now, while you are able. Record them in valid legal documents, and communicate your wishes to those who may be carrying them out.

You can read more about Powers of Attorney and Health Care Documents (or Advance Directives) in the Estate Planning Strategies page on our website.

  For more information on crafting a legal plan to maintain control over your assets and life decisions, attend a free Estate Planning and Asset Protection Workshop.

Tags: Estate Planning, Estate Planning, Elder Law, health care proxy, living will, massachusetts estate planning strategies, trusts, will, Metro West Estate Plan

How To Craft, Revise and Maintain A Well-Thought-Out Estate Plan

Posted by Dennis Sullivan & Associates on Wed, Mar 09, 2011

"Because there is no April 15th for Estate Planning and Asset Protection, many people try to procrastinate or avoid it.  However, there can be grave consequences to neglecting it." --Dennis Sullivan, Esq. CPA, LLM

It certainly is understandable that no one enjoys a conversation about death – especially their own! And, with the estate tax exemption now set at $5 million for an individual and $10 million for a couple, many people may believe they have no reason to consult an attorney about their estate planning.

Massachusetts will assess a tax on estates over $1 million. Without proper planning a married couple will have only $1 million between them.  See a lawer to be sure that you and your spouse get the $2 million exemption available to you.

Also, Massachusetts clients and taxpayers need to watch out for estate plans created based on maximum federal applicable exclusion planning, common for many estate plans prior to 2003. Now with the $5 million federal exempt amount, there could be a COMPLETELY AVOIDABLE Massachusetts estate tax triggered at the first death. The cost to your spouse and family could be as much as $400,000 in unnecessary estate taxes.

But avoiding the topic of estate planning can mean unnecessary expense, confusion and conflict.  Why do you need an estate plan? A comprehensive estate plan ensures that your estate is distributed according to your wishes, provides protection for you in the event of your own disability, and allows you to plan for your family. 

Can I write my own will? You certainly can; however, improperly drafted or last-minute,wills frequently are contested and invalidated in court. Massachusetts does NOT recognize handwritten wills. If you don’t know what you’re doing, the outcome could be much different than you expect. 

What should every estate plan have?  The list should include a will, powers of attorney for financial affairs and for health care, and a living will along with appropriate trusts.  Trusts not only reduce estate taxes, but they also help their heirs to avoid probate. Trusts also can shield assets from nursing home and medical expenses, loss due to unforeseen circumstances, such as bankruptcy, divorce or lawsuits of your heirs.

Two common mistakes people make in their estate planning: failure to plan for their personal effects and failure to review and update their plans over time. You can learn more about comprehensive estate planning by attending one of our Trust, Estate & Asset Protection Workshops and also by downloading our Unique Self-Guided 19-Point Trust, Estate & Asset Protection Legal Guide on our website.  Once you become a client, we have a Lifetime Protection Program to ensure that your planning stays up to date with the changes in law, fincial, health and family situations.

Tags: Protective Trusts, Estate Planning, Estate Planning, Mistakes, HIPAA, health care proxy, estate tax, estate tax savings, Massacusetts Estate Tax, living will, massachusetts estate planning strategies, trusts, power of attorney, Massachusetts estate tax, will, New estate tax law

Careful Planning Can Protect Assets For Surviving Spouse

Posted by Dennis Sullivan & Associates on Fri, Jul 30, 2010

What happens if your parent dies after a long nursing home stay, for which Medicaid paid benefits?  This is the question that was posed recently by a reader to The Commercial Appeal:

My friend's mother died.  She recently received a letter from the state requesting repayment of the Medicaid benefits paid to the nursing home for her mother.  Does she owe this money?

MA Medicaid Eligibility

The short answer to the question is...well...there is no short answer.  Medicaid is a joint federal-state program, administered by each state with its own rules, but within federal guidelines.  Each state has an Estate Recovery Program to recoup money paid out for nursing home care.  While it is now common for the state to contact surviving relatives and demand repayment, the state has a right to reimbursement only from the probate assets of the deceased, and not directly from family members.  There also are limitations to the state's rights to recover even from the probate estate.

Of course, if you receive a letter from Medicaid demanding repayment, you are well-advised to consult qualified counsel before responding.  Having said that, however, the best course would be prior Medicaid eligibility planning.  There are perfectly legal ways to protect significant assets as well as speed the Medicaid eligibility process.  Additionally, certain types of transfers are permitted under federal law, and these opportunities should be explored prior to Medicaid eligibility.

You can learn more about Medicaid and long-term care planning on our website and by attending a complimentary Trust, Estate and Asset Protection workshop.  We recently added informative videos on how to protect your home and other assets for your family and you can also request a free Consumer's Guide to Medicaid, Nursing Homes and Asset Protection Planning.

Tags: Nursing Home Costs, asset protection, Estate Planning, Elder Law, health care proxy, living will, power of attorney

Massachusetts Estate Planning Strategies for Life's Changes

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Tue, Jul 28, 2009


Over time, your family will face a number of changes. From when you purchase your first home and your children are born to the time they leave for college and you plan for retirement and beyond, new issues and concerns arise. With proper planning your family will be prepared for life’s changes and challenges.

If you ask yourself questions about what you want and what is important to you, you can develop a clear and coherent plan to protect your family and lifestyle. You can even accomplish retirement planning to maximize retirement benefits, save significant income taxes, review investment performance and insurance protection and plan for a successful transfer of assets and/or business.  

Have you planned to protect your family and take control of health and financial decisions if you or they were to become disabled?  Disability is far more likely than death in any given year and if you have not planned ahead, your family may need to apply for a court conservatorship or guardianship to be able to effectively care for you and manage family finances.  

Especially with the new HIPAA laws, health care professionals will not discuss your children’s medical condition with you, once your child reaches eighteen.  This can cause problems, especially as your children head off to college.  Learn more about what you can do in next month’s column.

Have you planned to get the most income and estate tax benefits available so that you can enjoy a comfortable retirement and leave a legacy for your family that will not be consumed by taxes, sometimes exceeding 70% of IRAs and Retirement Plans?

Our legal, tax and asset protection experts can help you design a plan to meet your goals and protect your family.  For more information and to attend an upcoming workshop, please call (800) 964-4295.

Tags: HIPAA, health care proxy, living will, massachusetts estate planning strategies, power of attorney, will

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