Massachusetts Estate Planning & Asset Protection Blog

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

Massachusetts Elder Care Attorney | In Home, Assisted Living, or Skilled Care? What Should You Consider?

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Fri, Oct 05, 2012

How Should You Spend Your Money?
The Delicat
e Balance of Care Options: 

In Home, Assisted Living, or Skilled Care?  What Should You Consider?


Seniors all around the country are concerned about their future,especially finances and health care.  The stock market,  investments and retirement accounts have fallen in recent years, but medical and nursing home costs continue to rise. Americans today are living longer than ever before. On average, those who reach age 65 can expect to live well into their eighties. In fact, the average life expectancy in the United States recently reached an all-time high of 78.7 years and the Census Bureau estimates that in the near future the average life expectancy will be into the low 90’s. This blog discusses in home, assisted living, and skilled care to help you decide which care option is best.


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


When you or a loved one become unable to completely take care of yourself, the question, "What care option is best?" becomes important to answer. While it is important to consider one's personal  needs and desires, it is equally important to consider what the future may hold in terms of changes in the type of care needed. With care being so expensive today, you may want to look into applying for VA benefits or Medicaid or some newly available community resources to help pay for your care.  There are a number of options available so it is might be time for some careful consideration and planning for the care that may be needed at some point during your lifetime. Perhaps NOW would be a good time to consider that you may need to take personal responsibilty for some costs that may be facing you and your family at some point during your lifetimes.  The following is meant to help you understand in more detail what needs to be considered as you evaluate your options.assisted living, medicaid, in home care


In Home Care

One option people tend to start with is an in-home caregiver. You can obtain an in-home caregiver either independently, or through an agency. If you have a non-agency caregiver for which there is no record of payment, as many people do because it can be more cost effective, it is vital that you enter into a written caregiver contract with that caregiver. This will allow you to prove to VA, and eventually Medicaid, if needed in the future, that this caregiver was paid at fair market value and at a certain amount per hour. You must also obtain the necessary medical opinions indicating that the caregiver is a necessity, and then document the caregiver expenditures. Once there is a physician's opinion, a contract in place and documentation of the caregiver expenditures, a VA application or Medicaid application.  You will be better positioned to submit. 

VA Benefits May Help

It is important to know that, in order to qualify for VA Aid & Attendance benefits, your unreimbursed medical expenses must exceed your income. For example, if you have a monthly Social Security income of $1,800, and pursuant to the caregiver contract, you are privately paying a private caregiver at the rate of $15 per hour for 40 hours a week, the result is a monthly expenditure of $2,400 per month. This would more than offset your $1,800 per month Social Security income, thereby potentially enabling you to qualify for maximum VA benefits of about $1,700 per month.  It is important to note that a Bill has been proposed that would add a 3-year lookback period, making it more difficult to qualify.  The window of opportunity is closing and it is critical that you act now if you think you qualify.


How Long is Too Long to Spend Monies on In Home Care?

Let's say you have an in-home caregiver and have been paying them for a while. The question now becomes "How do I plan for the day that I run out of cash, and require either assisted living or nursing home care?" The problem with in-home caregivers is that you can expend all of your monies with them. When you run out of assets with a caregiver at home, you will not have built any goodwill with a Medicaid facility, which you are now asking to care for you for the rest of your life. It is important for you and your family to understand that at this point, while you may want to stay at home, if all of your funds are depleted from paying for an in-home caregiver and your health is declining, then you will subsequently have no money to offer as "key" money to a facility, either assisted living or skilled care, when and if you need to move from home to a higher level of care.


Can You Stay Too Long in an Assisted Living Facility?

Going to an assisted living facility may not be the answer either, though. The result can be the same in an assisted living facility as it is with the private caregiver. Once you run out of money at an assisted living facility, they will ask you to leave. All the goodwill you built with the assisted living facility becomes worthless when you then enter a skilled care facility, to which you now have no money to offer, and with which you have the eventual hope of Medicaid eligibility.


A Balanced Approach

A better approach would be to balance the situation by staying at home with a caregiver, or staying in an assisted living facility, as long as possible, but not spend down to the point where you do not have at least enough assets to cover one year of private pay at a Medicaid skilled care facility in order to make yourself an attractive candidate for the facility of your choice.


Thus, while the extra $1,700 per month from the VA may help keep you at home longer, don't stay at home or in an assisted living facility too long, putting yourself in the position to not have available monies to make you an attractive candidate for a skilled care facility. Keep in mind that a skilled care facility may eventually take Medicaid, and you may need such a higher level of care in the future, which can be very expensive.  This will require some initial "key" money payment to the skilled care facility. This is a very delicate balance that you can only achieve with your eyes wide open and with sensitivity to your wishes, while also being circumspect about protecting yourself now, as well as in the future.


At the Estate Planning & Asset Protection Law Center of Dennis Sullivan & Associates, we help people and their familes with our unique conseling & educational process.  Our process starts with a health assessment designed to help people better understand their options as well the time frame in which they'll likely need help, whether at home or in an assited living facility.  Our team of professionals then evaluates the families options based on their health needs and financial circumstances and help determine which significant resources may be available. In some cases we can even help people qualify more more resources than they thought would be available and are able to help people qualify for resources much sooner than they would otherwise have been able. 


For more information on how our team of professionals can help you, call (781) 237-2815 today.  We also invite you to attend one of our free educational Trust, Estate, & Asset Protection Workshops.  Seating is limited and registration is required.  To register Click Here or call (800) 964-4295 (24/7).

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

Tags: Estate Planning, Medicaid, Nursing Homes, elder care, assisted living, veterans benefits, VA benefit, Massachusetts, caregiver, in home, skillled care

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