Massachusetts Estate Planning & Asset Protection Blog

An Explanation of Palliative Care and How it Affects You

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Fri, Mar 25, 2016

alzheimers_patient.jpg

     Human life expectancy in the past 100 years has been substantially lengthened as a result of advances in medical science.  However, as we know, the quality of an extended life span isn’t always great.  Many people live with serious illnesses such as COPD, Heart Disease, Cancer, Parkinson’s Disease etc. for many years, often spending those years suffering extreme physical and emotional pain.

     While the medical community continues to focus on finding cures for these illnesses and conditions, an important part of administering medical care is easing a patient’s pain.  This is what is known as palliative care and only recently – within the last 10 years or so – has palliative care become a new discipline of medicine.

     What is palliative care?  It is specialized medical care for people with serious illnesses.  It focuses on providing patients with relief from the symptoms and stress of a serious illness.  The goal of palliative care is to improve the quality of life for both the patient and the patient’s family.

     Palliative care is provided by a specially trained team of doctors, nurses and other specialists such as social workers and chaplains, who work together with a patient’s other doctors to provide extra support.  Palliative care specialists undergo additional training and certification in order to provide palliative care services.

     Palliative care is often coupled with hospice care, however, they are not the same.  Hospice care is for patients who are terminally ill, and have an expected lifespan of less than six months.  Palliative care is available for any patient with a serious or advanced disease who needs the added support that it care can provide.

     Palliative care specialists can play an important role in helping patients and their families discuss and make important and difficult decisions about their medical care.  That could include evaluating the different treatment options presented to the patient, weighing the pros and cons of each.  They can also assist in focusing on the future, on what the patient may or may not want as his/her condition declines.

     The palliative care team can facilitate this discussion well ahead of an acute medical crisis.  Knowing what the patient wants or doesn’t want helps to reduce the stress level of all involved when that medical crisis does arrive.

     Navigating the waters of palliative care and hospice care can feel overwhelming.  Let us help you to make that trip easier with a Health Care Proxy and Living Will and a Release of Protected Health Information (HIPAA, commonly).

     Learning more about Estate Planning and Asset Protection can protect you now and in the future. Call us or register for one of our workshops today to make your life a little easier down the road.  

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Tags: long term care, Estate Planning, palliative, hospice

The High Cost of Seniors Living Longer

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

 

The Cost of Living Longer | Massachusetts Eldercare Attorney

 

 planning, estate, eldercare

 

A Pachyderm of Problems

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

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

Lurking Complications With Long Term Care

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

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

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

A Magic Trick No One Wants to See

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

The Downside to Living Longer

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

 

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

 

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

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

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

 

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

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

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

 

What Happens When You Don’t Die?

medicare, medicaid, wills, spouse

 

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

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

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

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

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

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

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

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

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

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

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

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

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

Massachusetts Elder Law Attorney | Palliative Care

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Tue, Aug 07, 2012

Palliative care is basically the prevention and treatment of pain. It does not aim for a cure, per se; it aims, instead, for relief. And - although anyone suffering from any disease can receive palliative care - it's most often associated with hospice.palliative care

Hospice, of course, is different than hospital. People go to hospitals, generally, in search of a cure. People go to hospice when there's no hope of a cure, so they can die in a comfortable, homier atmosphere.

Palliative care, in a very real way, helps ease the process of dying... which, of course, is a part of life. It doesn't postpone death, by causing people to linger with untreatable illness. But it doesn't hasten it, either.

Palliative care in a hospice setting usually involves a team of specialists, ranging from doctors to clergy, to treat pain and its symptoms, and to provide a psychological or emotional approach when warranted. And it works; most families who experience the death of a loved one in hospice say it's better than passing away in a hospital.

Yet, many people don't take advantage of hospice - even though it's paid for by Medicare.

We often tend to think of a loved one's death as the worst thing that could happen. But I would suggest that there's one thing even worse - a loved one dying badly. What do we mean by "badly?"

According to Dr. Ira Byock, director of Palliative Medicine at Dartmouth-Hitchcock Medical Center in New Hampshire, dying badly is "Dying while suffering, dying connected to machines." Dr. Byock believes that, if we deny an imminent death, we can become delusional, and can start acting in ways that can actually harm our loved one.

These are very difficult questions. But we can help.

For more information, we encourage you to download our FREE "Consumer's Guide to Hospice Care", which reveals answers to some of the most frequently asked questions concerning Massachusetts hospice care.

hospice

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: Estate Planning, Elder Law, Medicare, Health Care, elder care, hospice, Wellesley, palliative, palliative care

How Can Hospice Benefit Your Loved One? | Massachusetts Estate Planning Attorney

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Wed, Aug 01, 2012

"Hospice," first of all, has nothing to do with "hospital." A hospital strives to cure sick people... and, often, to keep them from dying. The mission of hospice, on the other hand, is to help terminally-ill patients die with dignity, on their own terms. Hospice is a place where the environment is warm and loving, and staff members have time - and compassion - not only for the patients, but also for their families.
hospice, hospice care
 
At hospice, there's a holistic approach to pain management, which includes emotional and spiritual care. These facilities provide a warm, home-like atmosphere where patients can spend their final days without being poked, prodded, and MRI'ed when virtually no hope of a cure.
 
Hospice care doesn't even have to be in a hospice facility and often is not. Staff can often come to the patient's home or long-term care facility.
(Some long-term care facilities even have their own hospice programs.)
 
Hospice may be called in by one's doctor when he is determined to probably have no more than six months to live. This is when the goal of "cure" is replaced by "comfort," and a team of a chaplain, certified nursing assistants, a doctor, registered nurse, and social worker is put together.
 
Hospice is also concerned with survivors. Grief counseling is available on both individual and group levels. And it's helped many a person get back to living again.

Unfortunately, too few of us actually take advantage of hospice, because too few of us really understand what it is... and what it isn't.

WHAT IT IS

"Hospice" is derived from the Latin word "hospitium" - guest house. Of course, it's not exactly a place you'd go on vacation.

It is, however, a place in which to die with dignity. A place in which the patient is enveloped in a loving, warm atmosphere, in which the emphasis is on pain-relief, rather than cure.

Hospice is simply an approach to caring for patients at the end of their lives. It's focused on improving remaining life, rather than prolonging it. And on the patient's - and the family's - emotional needs.

Hospice can be provided in a local facility... or in the patient's home. And there's no cost; it's provided under Medicare.

WHAT IT ISN'T

Hospice is not a place to go a day before you die. And it's not, unfortunately, a place recommended by enough physicians.

It's simply a place in which you can leave this life with dignity and with peace.

Hospice also offers another big advantage. It's a final opportunity (for both patient and family) to tie up any loose ends in their estate planning... and to make sure the patient's wishes are honored.

For more information, we encourage you to download our FREE "Consumer's Guide to Hospice Care", which reveals answers to some of the most frequently asked questions concerning Massachusetts hospice care, including:
  • What is hospice?
  • Who is eligible?
  • Is the decision to receive hospice care permanent?
  • Does hospice pay for the cost of a nursing home?
  • How can I qualify for financial assistance to help cover the high cost of my loved one's care?
  • The hospice benefit that could help save your family a tremendous amount of money...and the new benefit that can help your family gain peace of mind
  • The basics of Massachusetts Medicaid, and how you can protect your eligibility...without selling your home or leaving your family without a dime
  • How gifting money to your children can disqualify you from receiving financial assistance...unless it's done just right
  • Find out how you may be able to protect your home from an estate recovery claim by the state
  • What are the Massachusetts probate laws...and can you avoid probate?
hospice

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 invite you to 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. Call 800-964-4295 to register or visit www.SeniorWorkshop.com.

Tags: Estate Planning, Medicaid, Nursing Homes, Health Care, hospice

What Exactly Does Hospice Do? | Boston Alzheimer’s Attorney

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

What exactly does hospice do? When and how do you call in hospice?

hospice, elder care

Hospice is an organization that serves individuals with a terminal illness and their families. Hospice provides a holistic approach to pain and symptom management through physical, emotional, and spiritual care and support. The main focus is to maintain dignity and quality of life.The care provided is not meant to cure the person. It is palliative care which is aimed at relieving or reducing discomfort.

When the primary care physician determines that the patient has six months or less to live, the physician can call in hospice. Whether your loved one is at home or in a long term care facility, hospice will go there. Some facilities have their own hospice programs, so if your loved one lives in a facility, check with staff about their services.

Once hospice is called in, the current plan of care for your loved one usually stops. For example, treatments like radiation would stop, and palliative care would take over. The hospice team then develops a new plan of care for your loved one. Your physician coordinates care with hospice.

The hospice team generally consists of a chaplain, certified nursing assistants, a medical director, registered nurse, and social worker. Some hospice agencies provide bereavement care to the family for several months following death.

Hospice is a wonderful service and is highly recommend for the care of your loved one when that time comes.

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.

Tags: Estate Planning, Alzheimer's Disease, Elder Law, Nursing Homes, assisted living, elder care journey, hospice

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