Young adults are often urged to plan ahead and take control of their future; whether that means getting good grades and planning for college, searching for internships in their career area of interest, or saving money for the day when they are out on their own. Older adults, on the other hand (aside from being advised to save for retirement) may not know that there is one very important way to plan for their own future: choosing a guardian or conservator.

As the elderly population moves into their 70s, 80s and 90s it is not unusual to lose the ability to drive, manage their own finances, or even care for their own daily physical needs. When this happens, and the ability to care for yourself is lost, the courts will often give care over to a guardian or conservator—someone who will manage your money, medication, household tasks (or all of the above) for you.

If you have not taken steps ahead of time to name the person or people you trust to serve as your guardian or conservator then the courts will name one for you. Often the person named as guardian or conservator is the first person to petition the court for the job—although this may not be the person you would choose to manage your money or your care.

The best way to ensure that you have the right person managing your finances or your health care when the time comes is to plan ahead and execute a Nomination of Conservator, a Healthcare Directive, and a Durable Power of Attorney. Together these three documents let the courts know who you trust with your physical or medical care, and who you feel is qualified to properly manage your money without taking advantage. These three documents will help you take control of your own future, even at a time when losing some of that control may seem inevitable.

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One of the primary concerns of the aging population is long-term care. As the life expectancy of Americans goes up so does the expectation that they will someday need some form of long-term care. You may not know whether that care will happen in a hospital, a nursing home, or in your own home, but you can be sure that it will be expensive.

How expensive will long term care be? It turns out the answer to this question depends a great deal on where you live. The AARP, The Commonwealth Fund, and The SCAN Foundation recently released a report which they call “The Long Term Scorecard,” which compares states and ranks them according to categories. The website Web MD has an article explaining how to use the scorecard and what it means.

The article in Web MD states that “Long-term care is unaffordable for middle income families, according to [The Long Term Scorecard report.] Even in states where nursing home care is most affordable, such care averages 171% of an older person’s household income. The national average is 241%.”

Some states, however, have been making the issue of long-term care a priority, and have been wrestling with questions such as how to make it more affordable to residents and how to provide support to family caregivers. According to the article in Web MD, they’ve broken down the information in “The Scorecard” to help readers understand which states provide the best support (either financial, social, emotional or legal) for the elderly and their caregivers.

The article “ranks states’ performance according to four categories: 1. Affordability and access, 2. Patient choice of both provider and setting, 3. Quality of life and care, and 4. Support for family caregivers.” The states ranked highest overall were Minnesota, Washington, Oregon, Hawaii and Wisconsin; while the lowest ranking states turned out to be Mississippi, Alabama, West Virginia, Oklahoma and Indiana. (For more information on how the states were ranked and what each ranking means please read the article here.)

Perhaps the most important lesson to take from all this is that no matter where you live, or what your health is like right now, it is very likely that you will need some kind of long-term care in the future, and that that care will be expensive. Burying your head in the sand or choosing to “think about it when the time comes” will only make things worse for you and for your family. Call our office and let us help you prepare now for whatever the future may bring.

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Last month saw some good news for seniors and their families in the state of New York. State Governor Andrew Cuomo announced on his website that he “signed a law to create a statewide alert system for missing vulnerable adults, similar to the nationwide Amber Alert program, which will help authorities locate cognitively impaired persons who go missing.” By signing this law Governor Cuomo added New York to the growing list of states with similar programs in place to help find and protect seniors with Alzheimer’s who may wander away from their homes in confusion.

The first state-wide public notification system for vulnerable adults, sometimes called “Silver Alert” programs, was passed in Oklahoma in 2006. Since then 28 states have joined Oklahoma in passing Silver Alert legislation (or something similar) and five states have some kind of vulnerable adult alert legislation pending.

According to Governor Cuomo’s announcement, New York’s new Amber Alert for Seniors program “provides for the rapid public dissemination of information regarding adults with dementia, Alzheimer’s, or other cognitive impairments who go missing. Under the new law, the same Amber Alert mechanisms used to find missing children will be activated for missing vulnerable adults, including the printing and distribution of photographs and posters, a toll-free twenty-four hour hotline, a curriculum for training law enforcement personnel, and assistance for returning missing vulnerable adults who are located out of state.”

New York’s program—and the similar programs in all participating states—are a comfort to the families of seniors afflicted with Alzheimer’s or dementia. Too often we read news stories about seniors who have wandered away from their homes and are not found until it’s too late. If you worry that your elderly relative may be at risk for wandering, check the laws of your state to find out which programs are available to you and how to enroll (if necessary).

If your state does NOT have a program in place you may want to consider enrolling your elderly loved one in the MedicAlert® + Alzheimer’s Association Safe Return® program. To learn more about this nation-wide emergency response service click here.

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The “golden years” are supposed to be a time to retire and relax after a life of working hard for yourself and your family, but according to a recent story on NPR, Baby Boomers have some big financial concerns about the future, many of which involve how they will pay for health care in their golden years.

“The struggling economy, a longer life expectancy, ever-increasing health care costs and challenges facing Social Security are putting added pressure on the boomers, those born between 1946 and 1964.”

An Associated Press LifeGoesStrong.org poll questioned almost 1,500 adults, over 1,000 of whom were Baby Boomers, and found that while ALL Boomers had some concerns about financial comfort and survival as they aged, the younger Boomers in particular (those born in the ‘60s) had the strongest—and the most all-encompassing—concerns.

This discrepancy in fear makes sense when you consider that “Many older boomers still have a defined benefit pension plan, probably some decent retiree medical insurance and Social Security,” whereas “the youngest boomers… face more uncertainty about their pensions, their Social Security, their housing and their medical care.”

The NPR article does not offer any easy fixes or instant comforts to these financial concerns—indeed there are no easy fixes—but it does offer a few suggestions to help Boomers ease their minds about those things that worry them the most:

* Push retirement back as long as you can to put off drawing on your savings until absolutely necessary.

* Start investing in long term care insurance, and do so as early as possible. “Costs for long-term care insurance can range from $1,000 to $8,000 a year, depending on age, health conditions, policy term and other factors.” As you get older the cost goes up—sometimes very steeply.

* Don’t neglect your estate planning. According to the poll, “Forty-percent of the boomers polled said they had a legal will to spell out how their possessions should be distributed after death,” and even fewer had health care directives, proxies, or living wills. A health care directive “allows people to document their wishes concerning medical treatment, and the proxy is a medical power of attorney that allows for the appointment of a trusted person to make medical decisions in case an individual is unable to do so.”

Our office can help you address any concerns you might have about your own (or a loved one’s) golden years. Don’t hesitate to contact us.

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One of the services Elder Law and Estate Planning attorneys often provide is helping clients navigate the application procedures and bureaucratic systems for the various state and federal medical insurance programs; and one thing that remains a surprise throughout the years is how many people forget about the VA Aid and Attendance Program for war veterans.

According to the Department of Veterans Affairs website, VA Aid and Attendance is “a benefit paid to wartime veterans [or their spouses] who have limited or no income, and who are age 65 or older, or, if under 65, who are permanently and totally disabled.” Unfortunately, too many veterans and their spouses are unaware that they qualify for this benefit, or even worse, have never been informed that the program exists.

An informative article in the Washington Post quotes the VA’s deputy undersecretary for disability assistance as saying that he believes they are only reaching “about one in four eligible veterans.” Part of the reason for this is that “there are a lot of veterans where it’s been 40 years or more since they’ve been on active duty. It just doesn’t occur to them there may be a benefit from the VA.”

If you are a war veteran over the age of 65 it is very likely that you and/or your spouse qualify for Aid and Attendance Benefits. Eligibility requirements include:

• You served at least 90 days of active military service 1 day of which was during a war time period. (If you entered active duty after September 7, 1980, generally you must have served at least 24 months, or the full period for which called or ordered to active duty.)
• You were discharged from service under conditions other than dishonorable.
• Your countable family income is below a yearly limit set by law (The yearly limit on income is set by Congress.)
• You must need help with at least one activity of daily living: dressing, eating, walking, bathing, adjusting prosthetic devices or using the toilet. Those who are blind, living in nursing homes or require in-home care may also be eligible.

For many veterans and their families the financial assistance they receive from their VA Aid and Attendance benefits can be an incredible help. Unfortunately, the application process required to receive the benefits can be daunting. “It’s not a simple process. A&A applicants must mail the forms, copies of service records, marriage certificates, proof of insurance and medical records to the regional VA office. If a third party is making the application, an additional form, 21-22-a or 21-0845, must be completed.”

This is why many veterans ask a knowledgeable Elder Law or Estate Planning attorney to help with the application process. The right attorney can help you find and fill out the correct forms, gather the necessary records and materials, and keep track of progress throughout the entire process. If you think you may be eligible for VA Aid & Attendance Benefits please don’t hesitate to contact our office.

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It is common knowledge in our society of aging Baby Boomers that many adult children end up taking months or even years off from their lives and careers to provide care for their elderly parents. Most children do this out of love and a sense of duty, but even in the closest of parent-child relationships there may be an unspoken expectation that appreciation for the caregiving child’s time and effort may be reflected in the parent’s will or trust. After all, professional caregivers demand a salary, is it too much to expect that a relative serving as caregiver should be compensated as well?

Take as an example the case of Anthony Olivo, who this article in Forbes describes as “a tax lawyer who ended up providing nearly full-time care for his mother and father.” Anthony “worked in law firms from 1976 to 1988 and then opened his own practice. Yet by 1994, given all the time he was devoting to his parents and their health problems, he found it hard to maintain his practice. He lived with his parents and gave them round-the-clock care from 1994 through 2003, during which he earned no significant income from his law practice.”

Now Mr. Olivo is asking that the U.S. Tax Court deduct $1.24 million from the estate of his parents for fees it paid to Anthony while he was serving as caregiver. Mr. Olivo is not challenging his parents’ wishes, he is not asking for more of the estate than his parents bequeathed to him; rather, he is asking that a “salary” for caregiving be deducted from the taxable portion of his inheritance.

Unfortunately, in the absence of a legal agreement, the tax court is unable to rule in Mr. Olivo’s favor: “The court was careful to note that Anthony rendered extraordinary care and that his efforts were commendable. However, the court ruled that his mother’s estate did not establish that Anthony was entitled to that pay. There were no written agreements and scant evidence the family agreed to pay him.” Furthermore, “There was no contract and no firm evidence of how much Anthony’s services were worth.”

We sympathize with Mr. Olivo, and hope that our firm can help save our clients from ending up in a similar situation. Simply leaving the caregiving relative “a little extra” in a will or trust is not enough, we cannot stress enough the importance of a legal caregiver agreement if a family member is providing caregiver services—especially if that family member is giving up time from his or her own career to do so.

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“Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.”

-Dylan Thomas, Do Not Go Gentle Into That Good Night

The Dylan Thomas poem from which the above lines are taken fairly accurately expresses the American view of death. Even after a long and satisfying life we tend to think of death as something to be fought against with all of the tools at our disposal. We struggle to keep parents, grandparents, or patients alive for just one more week, one more day.

But the new film Consider the Conversation suggests that a natural death after a long life may not be a single event to struggle against, but rather a process to be faced with as much grace and comfort as possible. Created by Mike Bernhagen, a business development specialist turned hospice advocate after watching the slow physical and cognitive decline of his elderly mother; and Terry Kaldhusdal, a teacher and filmmaker; the documentary is a labor of love.

“Consider the Conversation does not seek to hand down answers. Rather, it provides something far more important – the questions all of us need to contemplate. That being said, the producers have three goals for this film: 1) to change the current American attitude from one that predominantly views end-of-life as a failed medical event to one that sees it as a normal process rich in opportunity for human development, 2) to inspire dialogue between patient and doctor, husband and wife, parent and child, minister and parishioner, and 3) to encourage medical professionals, healthcare organizations and clergy to take the lead in counseling others.”

The film brings up issues that every adult child should be talking about with their elderly parent, and that every elderly patient should be having with their doctor. These are also issues that you should be discussing with your estate planner as you create your Living Will or Advance Healthcare Directive.

The film Consider the Conversation is being shown on public television stations around the country. Check the website for an updated screening schedule, or to purchase the DVD.

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Trudy Lieberman has had plenty of experience with Medicare—of course up until now most of it was from the outside looking in. As a journalist for more than 40 years specializing in insurance, health care, health care financing and long-term care, one would think that when the time came this year for her to enter the Medicare system herself she’d be an old pro. Unfortunately, as Ms. Lieberman discovered—and shared with the readers of her exceptional five part article series in Time Magazine’s Moneyland—entering the Medicare system as a patient can be confusing for even the most knowledgeable of inside reporters.

While her experience as a reporter may not have made signing up for Medicare any easier for Ms. Lieberman, her willingness to share her entrance into Medicare with readers may make the process easier for the rest of us. Here are just a few of the issues Lieberman has written about thus far:

Sorting through Medicare information and choosing a plan: “Brochures and ‘lead cards’ for Medicare Advantage plans and Medigap policies began flooding my mailbox in January. This stuff can be a real burden, but some of it’s worthwhile – some even important – so you can’t just throw it all away…Hopefully, my sorting system (partly informed by decades of reporting on Medicare, partly by common sense) will make the task easier for you.

Choosing a Medigap Plan to fill in the gaps of Medicare coverage: “It quickly became clear that the push to give consumers more choices and more information has actually made the job of picking a Medigap plan much harder. I ended up having to check out multiple websites, brochures, handouts and make several toll-free calls for assistance.”

Finding a plan to cover the cost of prescription drugs: “I decided to ask my pharmacy about the retail cost of the drugs I currently take. I’ve always had great drug coverage, so it was shocking to learn that my prescriptions would cost $3,131 a year if I had to pay out-of-pocket. (Of course, from interviewing seniors over the years, I know some folks actually pay four or five times that amount.)”

Part five comes out next week, and we look forward to reading the conclusion of this helpful series. We know how confusing and time consuming dealing with Medicare can be, so it’s helpful to know that many elder law attorneys specialize in helping seniors with this very process—we can help you too.

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One of the most difficult aspects of caring for an elderly parent (or helping an aging parent who lives far away) is keeping one step ahead when that parent begins to lose the ability to manage his or her own finances. Many seniors can be very resistant to discussing what they feel is an extremely private and sensitive topic. Furthermore, according to this article in AgingCare.com, “for many elders, being able to take care of their own finances is an important symbol of independence and self-worth,” and one that they are not likely to relinquish easily.

Unfortunately, an elderly parent’s ability to manage their own money may cease before they are willing to ask for help. In these cases, it may be up to their children and loved ones to step in and help as best they can. What follows is a list of some non-invasive, non-offensive steps adult children and caregivers can take to help aging parents manage their finances.

• Ask for a list of important people and information you might need in case of emergency. This list would include contact information for an attorney, financial advisor, primary care physician, and insurance agent.
• Ask where your parent keeps important documents and how an executor or advisor could access those documents upon your parent’s death or incapacity.
• If your parent is willing, discuss their estate plan with them, including who they have chosen as their agent or executor, and what you can do if something happens.
• Ask your parent to make a list of monthly bills, expenses and account numbers. Although your parent may not want to hand over this information right away, the list should be stored with other important estate planning documents so that it can be accessed in case of emergency.
• As you keep track of your own financial deadlines (tax filing deadlines and the like) set up reminders for your parent as well.
• Ask that your parent list you as an “emergency contact” with their utility services, this means that you would be informed if your parent’s service is in danger of being terminated.
• And finally, talk to your parent as often as you can. Keeping open lines of communication is the very best way to stay informed about the abilities and well-being of your aging parent.

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Alzheimer’s Disease is a devastating illness which affects families all over the country; from the adult child who fears that her father’s recent forgetfulness might be a harbinger of something more sinister, to the elderly gentleman who wonders how he will possible pay for the care his beloved wife requires.

Over the years, the treatment received by Alzheimer’s patients has depended in part on how the disease is diagnosed; and according to this article from a New York Times blog, “new criteria [for diagnosis], unveiled on Tuesday by the National Institute on Aging and the Alzheimer’s Association, will have consequences for family caregivers. Informed by research showing that changes in the brain may be under way a decade before any symptoms appear, the guidelines are likely to lead to increasingly early diagnoses.”

One of the most significant results of these new criteria is the establishment of three distinct stages of Alzheimer’s disease:

Pre-Clinical Dementia, wherein “There’s some biological or structural brain evidence that the Alzheimer’s process is under way, but the person’s not disabled and the family doesn’t notice any problem.”

Mild Cognitive Impairment, in which “someone has problems that don’t cause disability, but they’re evident enough that the patient and a family member or another observer agree, ‘Yes, it’s noticeable.’”

And finally, actual Dementia, which includes the signs and symptoms we all already associate with Alzheimer’s disease.

One of the most practical implications of these new criteria will be the early diagnosis—and thus the earlier treatment—of Alzheimer’s. The article mentions that these treatments are not yet curative, but there are medications that can help with the symptoms, and there is some evidence that “if you optimize the treatments for other diseases that make Alzheimer’s worse, like diabetes and heart disease, that increases the likelihood that Alzheimer’s will not accelerate.”

Perhaps of the most significance to elder law attorneys is the fact that early diagnosis can allow families to make the legal arrangements they need before the disease progresses to the point where it is too late. If the disease can be diagnosed in the Pre-Clinical stage, or even the stage of Mild Cognitive Impairment, the person receiving the diagnosis may have the time to consult with an attorney and put their affairs in order, helping to ensure that they—and their family—are provided for in the years ahead.

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