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incapacity

What is the Process to Declare Someone Incapacitated or Incompetent in Florida?

What is the Process to Declare Someone Incapacitated or Incompetent in Florida?

The process for declaring someone incompetent or incapacitated begins with filing a Petition to Determine Incapacity with the court (Fla.Stat. §744.331(1)).

The Court will then appoint an examining committee to assess the mental and physical condition of the person who is allegedly incapacitated (Fla.Stat. §744.331(4)).

Depending on the report presented to the Court, a hearing will be conducted wherein testimony and other evidence is heard, and the Court decides if the alleged incapacitated person is actually incapacitated and then whether a guardian is necessary.

How Do Courts Decide Who to Appoint as a Guardian?

When a person is declared incompetent by a Florida court, the judge often is presented with conflicting applications by different persons, often family members of the incompetent person, who propose to be the guardian and look after the financial and medical affairs of the incompetent.

Although Florida judges are afforded wide discretion in these difficult decisions, there are some statutory guidelines regarding the considerations in the appointment of guardians.

Florida law directs that a person related by blood or marriage receives preferential treatment.

The law also directs courts to consider the following:

  • “(1) Subject to the provisions of subsection (4), the court may appoint any person who is fit and proper and qualified to act as guardian, whether related to the ward or not.
  • (2) The court shall give preference to the appointment of a person who:
  • (a) Is related by blood or marriage to the ward;
  • (b) Has educational, professional, or business experience relevant to the nature of the services sought to be provided;
  • (c) Has the capacity to manage the financial resources involved; or
  • (d) Has the ability to meet the requirements of the law and the unique needs of the individual case.
  • (3) The court shall also:
  • (a) Consider the wishes expressed by an incapacitated person as to who shall be appointed guardian;
  • (b) Consider the preference of a minor who is age 14 or over as to who should be appointed guardian;
  • (c) Consider any person designated as guardian in any will in which the ward is a beneficiary.
  • (4) If the person designated is qualified to serve pursuant to s. 744.309, the court shall appoint any standby guardian or preneed guardian, unless the court determines that appointing such person is contrary to the best interests of the ward.” Fla. Stat. § 744.312.

Even though the statute directs that “a person who is related by blood or marriage to the ward” receives preference in the appointment; the inquiry does not end there. The court also has the discretion to give preference to a non-relative who possesses particular experience or ability to serve as guardian. See, e.g., Treloar v. Smith, 791 So. 2d 1195 (Fla. 5th DCA 2001) (finding that while next of kin are given first consideration, the statute does not mandatorily require that such an appointment be made; rather, the statute specifically provides that court may appoint any person who is qualified, whether related to the ward or not).

Moreover, it is the best interest of the ward that trumps other considerations in the appointment of a guardian. See, e.g., In re Guardianship of Stephens, 965 So. 2d at 852 (“The best interests of the Ward — which include choosing a qualified guardian for the Ward — come first. Family member preference in and of itself is secondary, regardless of how well qualified the family members are.”).

Third District Upholds Palm Beach Probate Court’s Appointment of Guardian Not Related to the Ward by Blood or Marriage

These principals were recently examined by the Florida Third District Court of Appeals when it reviewed the decision of a Palm Beach County Probate Judge in Morris v. Knight, 34 Fla.L.Weekly D321a; –So.2d–; 2009 WL 321586, February 11, 2009 (Fla.3rd DCA) which involved an appeal of Judge Karen Martin’s decision to appoint a guardian over Estelle Pratt Barker, a ninety-seven-year-old woman who was found to be incapacitated.

Judge Martin of the Palm Beach County Probate Court was faced with three individuals who petitioned for guardianship and control of Ms. Barker’s person and property: Ms. Glinton, who is Barker’s first cousin; Ms. Morris, whose mother is Barker’s first cousin; and Mr. Knight, who is a neighbor and friend of Barker. A hearing was held on the three competing petitions.

The testimony revealed that Glinton and Morris were related to Ms. Barker, however, there was also testimony from Barker’s attorney that in the thirty years that he served Barker, she never talked about or came in with any family member except Ms. Morris.

Regarding Knight, Glinton asserted that he used Barker’s money to purchase a new car for himself and that he had been Baker Acted for mental illness. Glinton, however, could not offer any evidence of such allegations during her testimony, and the court thus found them to be false. The court also determined that Glinton made other representations not supported by evidence and ultimately found her unfit to serve as guardian.

The testimony revealed that Mr. Knight had known Barker since he was a child visiting his grandmother who lived across the street from Barker in the 1960s. “Knight is a former U.S. Marine and retired sanitation worker for the City of West Palm Beach. He has also worked as a mental health technician and as an aide in a nursing home. He now receives both Veteran’s Administration benefits and a pension from the City of West Palm Beach. At trial, Knight stated that from about 1999 to 2002, Barker’s family did not visit her much. Knight would see Barker come out on the porch of her home around 7:00 a.m. each day and sit alone all day. Knight began stopping by to bring Barker coffee and food, to visit with her, and to wash her clothes and clean her house. When Barker’s doctor made the decision to place Barker in a nursing home, Knight continued to visit her there six days a week for two hours each day. Knight testified that he intends to continue visiting Barker, washing her clothes, and bringing her snacks whether he is appointed guardian or not.”

“Grace Morrow (“Morrow”), an adult protective investigator with the Department of Children and Families, described Barker and Knight’s relationship as being “like a mother-son relationship.” Morrow also added that Knight was always there for anything that she or Barker needed and that Barker was happy with Knight’s care and companionship.”

Judge Martin of the Palm Beach County Court denied Morris and Glinton’s petitions for guardianship and appointed Knight as Barker’s guardian. The court considered the fact that Morris and Glinton are related to Barker, but did not find that fact to be dispositive. Instead, based on Knight’s fitness to serve as guardian and Barker’s demonstrated wish to entrust her care to Knight, the court determined Knight to be the most appropriate person to serve Barker’s best interests.

The Court of Appeals agreed with Judge Martin. Applying the abuse of discretion standard of review, the appellate court confirmed Judge Martin’s decision.

Read more related articles at:

How to Get Power of Attorney for Your Elderly Parents in Florida

Guardianship in Florida

Also, read one of our previous Blogs here:

No One Knows The Time Or Hour…Incapacity Planning

Click here to check out our On Demand Video about Estate Planning.

Click here for a short informative video from our own Attorney Bill O’Leary.

prince phillip

What Prince Philip’s Death Shows Us About The Importance Of End-Of-Life Planning

What Prince Philip’s Death Shows Us About The Importance Of End-Of-Life Planning

What Prince Philip’s Death Shows Us About The Importance Of End-Of-Life Planning Since his death , Prince Philip has been remembered around the world as a model of service and a loyal and loving husband. His over 70 years in the public arena as a member of the Royal Family has many feeling that a beloved member of their own family has passed.

While memorials and tributes continue to pour in, one thing is clear:  Prince Philip had clearly defined wishes regarding how he wished to pass as well as his funeral plan. In his case, as an important state figure, it was a requirement. In many ways the ritualistic nature of that plan is allowing many to remember the Prince and all he accomplished.

While this type of planning might only seem fit for royalty, it is actually something that all of us can accomplish with our estate planning documents. Specifically, our health care directives can help us with end-of-life planning and funeral planning, and the process is quite simple.

Despite the importance of these documents, The Palliative and Advanced Illness Research Center at Penn Medicine found in a 2017 study that only one-third of all Americans have such a document for end-of-life care. Further, there is a higher level of engagement for older Americans versus younger individuals. For such an important decision, there is room for greater improvement in obtaining these documents.

A health care directive is a legal document that allows an individual to name an agent to make medical decisions for them if incapacitated. Upon death, it gives the agent the ability to manage the decisions regarding the body.

When most people think of health care directives, they typically think of pain relief and interventions. The circumstances of Prince Philip’s passing serve as an example of additional features that can be added to a health care directive.

Prince Philip was able to pass away at home in Windsor Castle. In the final two months of his life, he spent a significant amount of time in hospital. After his death, it was revealed that his final wish was to die at home. Fortunately, that wish was fulfilled.

But Philip’s wish is not unique to royalty. Many do not want to end their lives in hospital if it can be avoided, and the health care directive is a powerful way to express this. An individual can add to their directive that they wish to die in their home rather than in the hospital. While fulfilling this wish might not be possible depending on the circumstances, for the agent, it is helpful to have a clear directive about what an individual wants as they pass away.

Creation of A Funeral Plan

Further the health care directive can help design a funeral plan. Funeral planning has been around for centuries, but in modern day estate planning, one’s wishes have often been relegated to a simple directive of burial or cremation within the health care directive.

For many people, these directions are not adequate. Today, individuals are embracing the idea of giving more detailed plans for their funeral. These directions can include a variety of instructions. Some  people may choose to identify the type of religious service, hymns and speakers at the funeral. Others may choose to lay out details for the final event they will plan for their loved ones. As a result, funeral plans can consist of elaborate parties and ceremonies that an individual would want to have as their final goodbye.

Finally, for those who are socially conscious, funeral plans can be the last chance to embrace their ideals. From being buried in an environmentally friendly mushroom suit that will disintegrate back into the earth to having ashes spread among the trees in a beautiful setting, many are choosing these more thoughtful funeral arrangements.

Regardless of the wishes, having these detailed plans can help the family grieve and honor the deceased’s last wishes. They can also alleviate potential family tensions about what the plans should be.

Straightforward Process

Obtaining a health care directive is a straightforward process. Since groundbreaking cases in the 1990s and 2000s, all fifty states offer a form for residents to fill out to state their wishes for end-of-life planning. They are often downloadable from the state website.

As the pomp and pageantry of Prince Philip’s funeral unfold over the next week, it might be a good time to complete and sign a health care directive to help detail how you’d like your end-of-life and funeral plans to play out.

elderly and money

Social dissatisfaction predicts vulnerability to financial exploitation in older adults

Social dissatisfaction predicts vulnerability to financial exploitation in older adults

Researchers at the Keck School of Medicine of USC led the first study linking interpersonal problems to financial vulnerability over time.

Researchers who study elder abuse have long believed that when older adults face loneliness or relationship problems, they are more likely to fall victim to monetary scams and exploitation. But the field has only studied the link retrospectively, looking back in time to see whether a connection exists, and has yet to establish a firm link.

Now, a team of researchers at the Keck School of Medicine of USC has collected longitudinal data showing that an increase in interpersonal dysfunction, defined as loneliness or dissatisfaction with relationships, predicts subsequent vulnerability to financial exploitation. The results were just published in the journal Aging & Mental Health.

“To our knowledge, this is the first study showing that the quality of older adults’ interpersonal relationships has an impact on their financial vulnerability at a later time,” said the study’s senior author, Duke Han, PhD, director of neuropsychology in the Department of Family Medicine and a professor of family medicine, neurology, psychology and gerontology at the Keck School of Medicine.

The findings underscore that social connectedness, which is already known to enhance physical health and psychological wellbeing among older adults, may also be a key protector against financial abuse.

“This study points to a specific factor—social functioning—that could allow us to predict, and ultimately prevent, vulnerability to financial exploitation before it happens,” said Aaron Lim, PhD, a postdoctoral fellow in Han’s research lab and first author of the study.

A spike in vulnerability

The participants included 26 adults, aged 50 and older, with an average age of 65. At the beginning of the study, researchers evaluated each participant’s overall health, cognitive functioning, depression and anxiety symptoms and prior history of financial exploitation and controlled for these factors in their statistical analyses.

Then, for six months, the researchers collected data at two-week intervals. They measured each participant’s interpersonal dysfunction by asking how frequently they had argued with someone, felt rejected, felt lonely, wished their relationships were better and wished they had more friends. They also assessed participants’ vulnerability to financial exploitation during the past two weeks with questions such as “how confident are you in making big financial decisions?” and “how often has someone talked you into a decision to spend or donate money that you did not initially want to do?”

“When a person reported a spike in problems within their social circle or increased feelings of loneliness, we were much more likely to see a corresponding spike in their psychological vulnerability to being financially exploited two weeks later,” Lim said.

In addition to the effects within individuals, there was also a significant effect between participants: Those who had higher interpersonal dysfunction compared to other participants tended to report greater vulnerability to financial exploitation.

Preventing exploitation

The study’s results offer insight into how to counteract common financial scams that target older adults, including phishing emails, investment schemes and the “grandparent scam,” where an older adult receives a call from someone about a grandchild in urgent need of money.

At the individual level, Lim suggests that people watch for social upsets in their parents’ and grandparents’ lives—such as the death of a close friend or an argument with a family member—as risk factors for financial vulnerability in the immediate future. At the community level, organizations that support seniors can also provide additional opportunities for social connection.

Because the study’s sample was small, the results need to be replicated in larger and more diverse samples, Han said. The research team also plans to build on the findings with a follow-up study to investigate the connection between social dysfunction and actual incidents of financial exploitation, not just vulnerability.

About this study

In addition to Han and Lim, the study’s other authors are Laura Mosqueda and Annie L. Nguyen from the Department of Family Medicine, Keck School of Medicine of USC; Tyler B. Mason from the Department of Population and Public Health Science, Keck School of Medicine of USC; Laura Fenton from the Department of Psychology, USC Dornsife College of Letters, Arts and Sciences; Gali H. Weissberger from the Interdisciplinary Department of Social Sciences, Bar-Ilan University; and Peter Lichtenberg from the Department of Psychology, Wayne State University.

This work was supported by the National Institute on Aging [1RF1AG068166, T32AG000037, K01AG064986] and the Elder Justice Foundation.

Read more related articles at:

Interpersonal dysfunction predicts subsequent financial exploitation vulnerability in a sample of adults over 50: a prospective observational study

Loneliness, social isolation, and financial exploitation can go hand in hand for older adults

Also, read one of our previous Blogs at:

Social Interaction Study Highlights Loneliness and Isolation as Heath Risks for Elders

Click here to check out our On Demand Video about Estate Planning.

Click here for a short informative video from our own Attorney Bill O’Leary.

 

 

dementia

When Your Loved One Has Dementia: 3 Questions For Family Caregivers

When Your Loved One Has Dementia: 3 Questions For Family Caregivers

Here are three important questions to ask if your aging loved one has been diagnosed with a form of dementia.

What Training Do I Need?

When a loved one in your care is experiencing dementia, the first thing to do is reach out to local healthcare resources for education and training. The temperament of people suffering from a form of dementia can change very quickly, turning hurtful or even violent. But there are ways to interact with them to help keep them calm. Contact their healthcare provider for suggestions or referrals.

Do I Have the Legal Standing to Care for Them?

Does your loved one have a will or living will in place? Do you have a healthcare power of attorney for them? These are documents that must be created and signed before their dementia progresses to the point where it totally distorts their thinking. The documents will allow you to care for them according to their original wishes and avoid strife within the family should disagreements arise. Contact an Elder Law attorney as soon as possible to craft these documents.

How Can I Get Help?

Caring for an aging loved one can be exhausting, but an aging loved one with a form of dementia is an even greater challenge. Start planning now for self-care. You can’t care for someone else if your physical and mental health are depleted. Find out about respite care options in your area to give yourself the rest you’re going to need.

Putting these measures in place now can ensure that you are prepared for the road ahead. You’ll create a support net for the future. Often, the entire family is in a more peaceful and understanding position emotionally, mentally and physically for the well-being of all with these areas of advance planning in place.

Read more related articles at:

20 Things to Remember If You Love Someone With Dementia

Also, read one of our previous Blogs at:

Do Seniors with Dementia Show Signs of Financial ‘Symptoms’ Years before a Diagnosis?

Click here to check out our On Demand Video about Estate Planning.

Click here for a short informative video from our own Attorney Bill O’Leary.

apply for medicaid

How to apply for Medicaid

Below is a general guide to the Medicaid application process. Be sure to contact your local Medicaid office for state-specific rules.

Note: Your Medicaid office may be called the Department of Health, the Department of Social Services, the Department of Insurance, or by another name.

  • Contact your local Medicaid office to ask how you need to submit your application. Some states require you apply in person, while others may allow you to apply by mail, online, by telephone, or at locations in the community, such as health centers and community organizations.
  • Find out which documents and forms of identification you may need in order to apply. Your Medicaid office may ask you to show the following:
    • Proof of date of birth (e.g., birth certificate)
    • Proof U.S. citizenship or lawful residence (e.g., passport, drivers license, birth certificate, green card, employment authorization card)
    • Proof of all types of income, earned and unearned (e.g., paycheck stubs, retirement benefits, Supplemental Security Income)
    • Proof of resources (e.g., bank or stock statements, life insurance policies, property)
    • Proof of residence (e.g., rent receipt, landlord statement, deed)
    • Medicare card and any other insurance cards (you can also provide a copy of the insurance policy)

Note: Medicaid coverage is available, regardless of citizenship status, if you are pregnant or require treatment for an emergency medical condition. A doctor must certify that you are pregnant or had an emergency, and you must meet all other eligibility requirements.

Troubleshooting

  • If you have any problems applying at a Medicaid office, ask to speak with a supervisor.
  • If you do not receive a timely decision on your Medicaid application or are turned down for Medicaid, you can appeal by asking for a state fair hearing (not a city or local one). Check with your Medicaid office to learn more about requesting a fair hearing.
  • Once you have Medicaid, you must recertify (show that you remain eligible for Medicaid) to continue to get Medicaid coverage. When you submit your Medicaid application, be sure to ask when and how you will need to recertify. In many states, recertification is an annual process.

Read more related articles here:

Florida Medicaid

New to Medicaid? How It Works

Also, read one of our previous Blogs here:

What It Means to Need ‘Nursing Home Level of Care’ for Medicaid Eligibility

Click here to check out our On Demand Video about Estate Planning.

Click here for a short informative video from our own Attorney Bill O’Leary.

medicaid house

Is Prior Occupancy Required to Have Home Excluded, When Qualifying for Long-Term Medicaid?

Is Prior Occupancy Required to Have Home Excluded,When Qualifying for Long-Term Medicaid ?

When qualifying for long-term Medicaid, there are asset and income restrictions. In many states, the applicant cannot have more than $2,000 in assets and receive benefits. Luckily, the equity in the applicant’s home is an excluded asset, up to a certain amount. But in order to have the home’s equity excluded, must the applicant have occupied that home prior to applying for benefits? This issue was recently litigated in Texas.

Clyde and Dorothy owned a home and lived in it until late 2010 when they sold it to Linda and Robby. Clyde and Dorothy moved into a rental property that was owned by Linda and Robby. In 2017, both Clyde and Dorothy moved into a nursing home. A week or so later, they purchased a one-half interest in the home they sold. They filed a Commission form stating that the home was their place of residence and indicated an intent to return there. About a month later, Clyde and Dorothy applied for Medicaid benefits. Their respective applications were denied, due to being over-resourced because the state counted the equity in the home as a countable resource.

Clyde and Dorothy appealed the decision; the Commissioner agreed with the state. Clyde and Dorothy appealed again. The trial court agreed with Clyde and Dorothy. The state appealed and now we have this case out of The Texas Court of Appeals, Third District.

The state argued that a Medicaid applicant must live in the home prior to applying for Medicaid, in order for the equity of the home to be excluded for Medicaid-eligibility purposes. Since Clyde and Dorothy did not live in the home before they entered the nursing home, the home’s equity should not be an excluded asset. In turn, Clyde and Dorothy argued that the home should be an excluded asset because they had an ownership interest in it, they both considered it to be their principal place of residence, and they intended to return there.

The list of excluded assets for Medicaid eligibility is enumerated in 42 U.S.C. § 1382b. Therein, the “home (including the land that appertains thereto)” is listed as an excluded asset.

In turn, 20 C.F.R. § 416.1212(a) defines “home”:

“A home is any property in which an individual (and spouse, if any) has an ownership interest and which serves as the individual’s principal place of residence. This property includes the shelter in which an individual resides, the land on which the shelter is located and related outbuildings.”

The state of Texas has modified this definition a bit. In 1 Tex. Admin. Code § 358.103(38), (69), it states:

“Home–A structure in which a person lives (including a mobile home, a houseboat, and a motor home), other buildings on the home property, and all adjacent land (including land separated by a road, river, or stream), in which the person has an ownership interest and that serves as his or her principal place of residence.”

“Principal place of residence–The home where a person resides, occupies, and lives.”

Finally, in Texas’s Medicaid handbook, in Section F-3000, it states, in part:

“For property to be considered a home for Medicaid eligibility purposes, the person or spouse must consider the property to be their home and:

  • have ownership interest in the property; and
  • reside in the property while having ownership interest.”

The court here affirmed the decision and sided with Clyde and Dorothy. The court reasoned that whether a home was someone’s principal place of residence is subjective, pointing to POMS SI 01130.100.A.2 which states that someone’s principal place of residence is what that person “considers his or her established or principal home”. (emphasis added)  The court looked at other relevant case law as well. In the end, it was ruled that a Medicaid applicant doesn’t have to physically live in the home that is sought to be excluded before the applicant moved to a nursing home. Indeed, it is not a requirement under federal law that the individual had occupied the property for it to be an excluded asset. If federal legislators had intended on this being a requirement, they would have written such in federal law. The court stated that it wouldn’t make practical sense or further the objectives of the Medicaid program to interpret the federal statute as having such requirement.

Read more related articles at:

Florida Medicaid (SMMC-LTC) Income & Assets Limits for Nursing Homes & Long Term Care

Medicaid Eligibility: 2022 Income, Asset & Care Requirements for Nursing Homes & Long-Term Care

Also, read more related articles at:

How Medicaid Planning Trusts Protect Assets and Homes from Estate Recovery

Click here to check out our On Demand Video about Estate Planning.

Click here for a short informative video from our own Attorney Bill O’Leary.

 

incapacity

No One Knows The Time Or Hour…Incapacity Planning

No One Knows The Time Or Hour…Incapacity Planning

No One Knows The Time Or Hour…Incapacity Planning.

“However, no one knows the day or hour when these things will happen, not even the angels in heaven” Matthew 24:36

The first thing to discuss is how to prepare for even a temporary incapacity, like creating documents to allow another to care for children and pets if you have a long stay in the hospital. You may also want someone to take over paying bills and have someone secure firearms and other tangible property in your home that might be stolen. You may even need to have someone clean out perishable food in the refrigerator.

Further, in this digital age, you will need to set up who can access your data if you are incapacitated, and provide passwords and usernames. The document to give someone the authority to act on your behalf is a durable power of attorney. This appointment of an agent to act on your behalf can be a general power or a limited power.

The second thing to do is to tell people what you would like to have done. This can be in the form of a letter, but to make your wishes legally binding it will need to be in the form of a will or a trust. Some things you can decide for yourself, such as funeral arrangements with a prepaid funeral contract. Make sure that these and other documents are held in a secure place and where someone can access them in an emergency. Here is a quick Estate Planning Document Checklist:

‡        Durable Power of Attorney

‡       Health Care Proxy

‡       Revocable Trusts

‡       Irrevocable Trusts

‡       Declaration of Homestead

‡       Beneficiary Designation Forms

‡       Retirement accounts

‡       Life insurance

‡       Annuities

In addition, you should discuss how decisions are too be made, and by whom, if you are incapacitated – even going as far as a written procedure for friends and family. Also, make a detailed outline of your wealth trasnfer wishes and then review your documents – do your documents match you estate planning desires? If so, are your assets are titled correctly and have you set up the appropriate beneficiary designation forms? If not, then consider revision of those documents. Finally, make sure current copies of those documents go to the correct people. No One Knows The Time Or Hour…Incapacity Planning.

Read more related articles here:

5 Legal Facts You Need to Know About Incapacity Planning

Legal Planning for Incapacity

Also, read one of our previous Blogs here:

How Can I Plan For Incapacity?

Click here to check out our On Demand Video about Estate Planning.

Click here for a short informative video from our own Attorney Bill O’Leary.

 

long term care

Do I Need To Think About Long Term Care?

 

Do I Need To Think About Long Term Care?

 

Many older adults and caregivers worry about the cost of medical care. These expenses can use up a significant part of monthly income, even for families who thought they had saved enough.

How people pay for long-term care—whether delivered at home or in a hospital, assisted living facility, or nursing home—depends on their financial situation and the kinds of services they use. Often, they rely on a variety of payment sources, including personal funds, government programs, and private financing options.

Personal Funds (Out-of-Pocket Expenses)

At first, many older adults pay for care in part with their own money. They may use personal savings, a pension or other retirement fund, income from stocks and bonds, or proceeds from the sale of a home.

Much home-based care is paid for using personal funds (“out of pocket”). Initially, family and friends often provide personal care and other services, such as transportation, for free. But as a person’s needs increase, paid services may be needed.

Many older adults also pay out-of-pocket to participate in adult day service programs, meals, and other community-based services provided by local governments and nonprofit groups. These services help them remain in their homes.

Professional care given in assisted living facilities and continuing care retirement communities is almost always paid for out of pocket, though, in some states, Medicaid (see below) may pay some costs for people who meet financial and health requirements.

Look up what long-term care costs in your area.

Government Programs

Older adults may be eligible for some government healthcare benefits. Caregivers can help by learning more about possible sources of financial help and assisting older adults in applying for aid as appropriate. The Internet can be a helpful tool in this search.

Several federal and state programs provide help with healthcare-related costs.

Centers for Medicare & Medicaid Services

The Centers for Medicare & Medicaid Services (CMS) offers several programs. Over time, the benefits and eligibility requirements of these programs can change, and some benefits differ from State to State. Check with CMS or the individual programs directly for the most recent information.

Medicare

Medicare is a Federal Government health insurance program that pays some medical costs for people age 65 and older, and for all people with late-stage kidney failure. It also pays some medical costs for those who have gotten Social Security Disability Income (discussed later) for 24 months. It does not cover ongoing personal care at home, assisted living, or long-term care. Here are brief descriptions of what Medicare will pay for:

Medicare Part A:

  • Hospital costs after you pay a certain amount, called the “deductible”
  • Short stays in a nursing home to get care for a hospital-related medical condition
  • Hospice care in the last 6 months of life

Medicare Part B:

  • Part of the costs for doctor’s services, outpatient care, and other medical services that Part A does not cover
  • Some preventive services, such as flu shots and diabetes screening

Medicare Part D:

Call Medicare at 1-800-633-4227TTY: 1-877-486-2048 to find out what costs Medicare will cover for your situation, or visit the Medicare website for more information.

Medicaid

Some people may qualify for Medicaid, a combined Federal and State program for low-income people and families. This program covers the costs of medical care and some types of long-term care for people who have limited income and meet other eligibility requirements. Who is eligible and what services are covered vary from State to State.

To learn more about Medicaid, call 1-877-267-2323, TTY: 1-866-226-1819, or visit the Medicaid website. Or, contact your State health department. For a State-by-State list, visit Medicaid’s State Overviews page.

Program of All-Inclusive Care for the Elderly (PACE)

Some States have PACE, Program of All-Inclusive Care for the Elderly, a Medicare program that provides care and services to people who otherwise would need care in a nursing home. PACE covers medical, social service, and long-term care costs for frail people. It may pay for some or all of the long-term care needs of a person with Alzheimer’s disease. PACE permits most people who qualify to continue living at home instead of moving to a long-term care facility. You will need to find out if the person who needs care qualifies for PACE. There may be a monthly charge. PACE is available only in certain States and locations within those States.

To find out more about PACE, call 1-877-267-2323, or visit the PACE website or Medicare’s PACE page.

State Health Insurance Assistance Program (SHIP)

SHIP, the State Health Insurance Assistance Program is a national program offered in each State that provides counseling and assistance to people and their families on Medicare, Medicaid, and Medicare supplemental insurance (Medigap) matters.

To contact a SHIP counselor in your State, visit the SHIP National Technical Assistance Center website.

Department of Veterans Affairs

The U.S. Department of Veterans Affairs (VA) may provide long-term care or at-home care for some veterans. If your family member or relative is eligible for veterans’ benefits, check with the VA or get in touch with the VA medical center nearest you. There could be a waiting list for VA nursing homes.

To learn more about VA healthcare benefits, call 1-877-222-8387, or visit the Veterans Health Administration or the Veterans Affairs Caregiver Support page. You can also find more information at Geriatrics and Extended Care: Paying for Long-Term Care.

Social Security Administration Programs

Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs provide financial assistance to people with disabilities.

SSDI is for people younger than age 65 who are disabled according to the Social Security Administration’s definition. To qualify, you must be able to show that:

  • You are unable to work because of your medical condition
  • Your medical condition will last at least a year or is expected to result in death

Processing an SSDI application can take three to five months. However, Social Security has “compassionate allowances” to help people with Alzheimer’s diseaseother forms of dementia, and certain other serious medical conditions get disability benefits more quickly.

SSI is another program that provides monthly payments to adults age 65 and older who have a disability. To qualify, your income and resources must be under certain limits.

To find out more about these programs, call 1-800-772-1213TTY: 1-800-325-0778, or visit the Social Security Administration.

National Council on Aging (NCOA)

The National Council on Aging, a private group, has a free service called BenefitsCheckUp®. This service can help you find Federal and State benefit programs that may help your family. After providing some general information about the person who needs care, you can see a list of possible benefit programs to explore. These programs can help pay for prescription drugs, heating bills, housing, meal programs, and legal services. You don’t have to give a name, address, or Social Security number to use this service.

To learn more about BenefitsCheckUp®, call 1-571-527-3900, or visit BenefitsCheckUp®.

Benefits.gov

For more information about Federal, State, and local government benefits, go to Benefits.gov or call 1-800-FED-INFO (1-800-333-4636).

Private Financing Options for Long-Term Care

In addition to personal and government funds, there are several private payment options, including long-term care insurance, reverse mortgages, certain life insurance policies, annuities, and trusts. Which option is best for a person depends on many factors, including the person’s age, health status, personal finances, and risk of needing care.

Long-Term Care Insurance

Long-term care insurance covers many types of long-term care and benefits, including palliative and hospice care. The exact coverage depends on the type of policy you buy and what services are covered. You can purchase nursing home-only coverage or a comprehensive policy that includes both home care and facility care.

Many companies sell long-term care insurance. It is a good idea to shop around and compare policies. The cost of a policy is based on the type and amount of services, how old you are when you buy the policy, and any optional benefits you choose.

Buying long-term care insurance can be a good choice for younger, relatively healthy people at low risk of needing long-term care. Costs go up for people who are older, have health problems, or want more benefits. Someone who is in poor health or already receiving end-of-life care services may not qualify for long-term care insurance.

Reverse Mortgages for Seniors

A reverse mortgage is a special type of home loan that lets a homeowner convert part of the ownership value in his or her home into cash. Unlike a traditional home loan, no repayment is required until the borrower sells the home, no longer uses it as a main residence, or dies.

There are no income or medical requirements to get a reverse mortgage, but you must be age 62 or older. The loan amount is tax-free and can be used for any expense, including long-term care. However, if you have an existing mortgage or other debt against your home, you must use the funds to pay off those debts first.

Life Insurance Policies for Long-Term Care

Some life insurance policies can help pay for long-term care. Some policies offer a combination product of both life insurance and long-term care insurance.

Policies with an “accelerated death benefit” provide tax-free cash advances while you are still alive. The advance is subtracted from the amount your beneficiaries (the people who get the insurance proceeds) will receive when you die.

You can get an accelerated death benefit if you live permanently in a nursing home, need long-term care for an extended time, are terminally ill, or have a life-threatening diagnosis such as AIDS. Check your life insurance policy to see exactly what it covers.

You may be able to raise cash by selling your life insurance policy for its current value. This option, known as a “life settlement,” is usually available only to people age 70 and older. The proceeds are taxable and can be used for any reason, including paying for long-term care.

A similar arrangement, called a “viatical settlement,” allows a terminally ill person to sell his or her life insurance policy to an insurance company for a percentage of the death benefit on the policy. This option is typically used by people who are expected to live 2 years or less. A viatical settlement provides immediate cash, but it can be hard to get.

Using Annuities to Pay for Long-Term Care

You may choose to enter into an annuity contract with an insurance company to help pay for long-term care services. In exchange for a single payment or a series of payments, the insurance company will send you an annuity, which is a series of regular payments over a specified period of time. There are two types of annuities: immediate annuities and deferred long-term care annuities.

Trusts

A trust is a legal entity that allows a person to transfer assets to another person, called the trustee. Once the trust is established, the trustee manages and controls the assets for the person or another beneficiary. You may choose to use a trust to provide flexible control of assets for an older adult or a person with a disability, which could include yourself or your spouse. Two types of trusts can help pay for long-term care services: charitable remainder trusts and Medicaid disability trusts.

Read more related articles at:

What Is Long-Term Care?

How long-term care planning can help your loved ones

Planning for Long-Term Care Your Resource Guide

Also, read one of our previous Blogs at:

How Do I Protect Property If I Need Long-Term Care?

Click here to check out our On Demand Video about Estate Planning.

Click here for a short informative video from our own Attorney Bill O’Leary.

 

end of life planning

End-Of-Life Planning Is A ‘Lifetime Gift’ To Your Loved Ones

End-Of-Life Planning Is A ‘Lifetime Gift’ To Your Loved Ones

Talking about death makes most of us uncomfortable, so we don’t plan for it.

That’s a big mistake, because if you don’t have an end-of-life plan, your state’s laws decide who gets everything you own. A doctor you’ve never met could decide how you spend your last moments, and your loved ones could be saddled with untangling an expensive legal mess after you die.

Betsy Simmons Hannibal, a senior legal editor , puts it this way: Planning for the end of life isn’t about you. “You’re never going to really get the benefit of it. So you might as well think about how it’s going to be a lifetime gift that you’re giving now to your parents or your partner or your children. It really is for the people you love.”

Here are some simple, practical steps to planning for the end of life. These tips aren’t meant to be legal or medical advice, but rather a guide to ease you into getting started.

1. Name an executor.

If you’re an adult, you should have a will, says Hannibal. Estate planning is not just for the rich. “It’s not just about the value of what you own. It’s also the feelings that you and your loved ones have about what you own.” If you own lots of valuable stuff — real estate, trust funds, yachts — you probably need a lawyer.

She says the first thing you do is name (in writing) a person whom you trust to take care of everything when you die. In most states that person is called an executor; in some they’re called a personal representative.

Hannibal says it’s a good idea to choose someone from your family. “The most important thing is that you have a good relationship with them — and also that they have a good attention to detail, because it’s a lot of work to be someone’s executor.”

An executor would have to, for example, find all your financial assets and communicate with everyone you’ve named in your will. It’s a big ask, so Hannibal says just be upfront. She suggests asking the person directly, “Would you be comfortable wrapping up my estate when I die?”

2. Take an inventory.

List everything you own, not just things that are financially valuable — such as your bank accounts, retirement savings or car — but also those things that have sentimental value: a music or book collection, jewelry, furniture. Then list whom you want to leave what to.

If you have young children, name a guardian for them. Choose carefully, because that person will be responsible for your child’s schooling, health care decisions and value system.

Hannibal says pets are considered property under the law, so she suggests naming a new owner so that the state doesn’t do it for you.

Digital accounts are also part of your property. This includes social media accounts, online photos, everything in, say, your Google Drive or iCloud, online subscriptions, dating site profiles, credit card rewards, a business on Etsy or Amazon. Hannibal suggests keeping a secure list of all those accounts and the login and password details. Let your executor know where the list is.

Just as you write out specific instructions about your physical belongings, be clear about what you’d like to happen with your online information.

She says it’s better not to have a handwritten will, because proving you wrote it will require a handwriting expert. So keep it simple. Just type out your wishes and have two witnesses watch you sign and date it. Then have them do the same. Hannibal says by signing it, “they believe that the person who made the will is of sound mind, and that’s a pretty low bar.”

You don’t need to file your will anywhere; neither do you need to get it notarized for it to be legally binding. And don’t hide it. Hannibal says just tell your executor where you’ve kept a copy.

Remember that your decisions will change over time. So if you have a child, buy a house or fall out with a family member, update your will.

3. Think about health care decisions.

Your will takes care of what happens after you die. An advance directive is a legal document that covers health care and protects your wishes at the end of your life.

There are two parts to an advance directive. The first is giving someone your medical power of attorney so the person can make decisions for you if you can’t. The other part is called a living will. That’s a document where you can put in writing how you should be cared for by health professionals.

She has seen thousands of situations of loved ones making difficult and emotional decisions around a hospital bed. It’s worse when family members disagree about a course of action.

You know the saying “The best time to plant a tree was 20 years ago. The second best time is now”? Zitter says with the coronavirus in the news every day, more people are realizing that these end-of-life conversations are important. “That tree was always important to plant. But now we really have a reason to really, really plant it. … That time is now.”

4. Name a medical proxy.

Pallavi Kumar is a medical oncologist and palliative care physician at the University of Pennsylvania. Kumar says the most important medical decision you can make is to choose a person who can legally make health care decisions for you if you can’t. This person is sometimes called a medical proxy or a health care agent. Naming the person is the first part of the advance directive.

“Think about the person in your life who understands you, your goals, your values, your priorities and then is able to set aside their own wishes and be a voice for you,” she says. You want someone you trust who can handle stress, in case your loved ones disagree on what to do.

5. Fill out a living will.

After you’ve chosen your medical proxy (and named a backup), you need to think about what kind of care you want to receive. There’s no right or wrong; it’s very personal. The document that helps you do that is called a living will. It’s part two of the advance directive.

A living will addresses questions such as “Would you want pain medication?”; “Do you want to be resuscitated?”; and “Would you be OK being hooked up to a ventilator?”

Kumar says she asks her patients what’s important to them and what their goals are. For some with young children, it means trying every treatment possible for as long as possible, no matter how grueling.

Other patients might want the exact opposite. “They would say, ‘I’ve gone through a lot of treatments and I … feel I’m not having as many good days with my kids. So if the disease gets worse, I want to spend that time at home.’ ”

Kumar says even among patients who are very sick with cancer, fewer than half have had conversations about how they want to die. So talk about your wishes. Once you’ve filled out the advance directive forms, share your decisions with your medical proxy, your loved ones and your doctor.

6. Don’t forget the emotional and spiritual aspects of death.

How you want to die is personal and about much more than just the medical aspect. For some, it’s about being at peace with God; for others, it’s being kept clean. Still others don’t want to be left alone, or they want their pets close by.

Angel Grant and Michael Hebb founded the project Death Over Dinner to make it easier for people to talk about different aspects of death as they eat. “The dinner table is a very forgiving place for conversation. You’re breaking bread together. And there’s this warmth and connection,” says Grant.

Grant says reflecting on death automatically forces you to think about your life. “That’s the magic of it,” she says.

“We think it’s going to be morbid and heavy. But what these conversations do is they narrow down our understanding of what matters most to us in this life, which then gives us actionable steps to go forward living.”

Grant doesn’t believe a “good death” is an oxymoron. “A good death is subjective, but there are some things that I have heard over and over again for many years at death dinners. … A good death is being surrounded by love, knowing you have no emotional or spiritual unfinished business.”

Read more related articles at:

Hard Conversations About End Of Life Wishes: Should Young Adults Be Included?

Getting Your Affairs in Order

Click here to check out our On Demand Video about Estate Planning.

Click here for a short informative video from our own Attorney Bill O’Leary.

chronic care

Planning For Chronic Illness Is Not Just For The Elderly

Planning For Chronic Illness Is Not Just For The Elderly

Planning For Chronic Illness Is Not Just For The Elderly. A common misconception is that estate and financial planning for chronic illness is an elder law or elder abuse issue. This myth is not true. Martin Shenkman explained in an e-mail, “Sixty percent of those living with chronic illness are age 18-64. The characterization of all this planning as elder law or elder abuse makes it harder for those who are young and have chronic health issues to find help. Our society doesn’t focus on this situation.”

While some elderly experience chronic illness, it is not exclusive to them. Chronic illness can happen to any one of any age and proper estate planning just makes sense to protect you or a loved one now and in the future. With chronic illness somestimes comes incapacity, the inability to make decsions on ones own. In the case of becoming incapacitated, one will need a trusted representative to handle their financial and healthcare affairs. Proper estate planning can ensure that a persons wishes are met provided they become incapacitated and unable to decide for themselves.

Whether a person with a chronic illness is young, middle aged, or elderly, there is a need for proper estate planning at least at the simplest of levels. Powers of attorney can help one establish trusted personal representatives to help administer their affairs in case of incapacity. Because laws vary from state to state and upon different circumstances, it is wise to seek legal counsel when trying to establish powers of attorney and other estate planning documents.

Read more related articles at:

Estate Planning Musts When You Or A Or A Loved One Has A Chronic Illness

Supporting Older Patients with Chronic Conditions

Also, read one of our previous Blogs at:

WHY ESTATE PLANNING IS CRUCIAL WHEN REACHING END OF LIFE

Click here to check out our On Demand Video about Estate Planning.

Click here for a short informative video from our own Attorney Bill O’Leary.

 

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