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Eldercare and Paid Family Leave: Love and the Bottom Line

Eldercare and Paid Family Leave: Love and the Bottom Line

Article Originated from: standard.com



Growing Older — Help Wanted

Here’s a snapshot of current and future caregiving needs for the elderly:

  • The average care recipient is 69.4 years old — a member of the 80-million-member baby boom generation.
  • About 66% of older adults with disabilities get all their care and assistance from their family members.
  • Half of Americans who reach 65 will need long-term care, typically for two years, according to government projections.

These statistics and others paint a picture of a crisis that’s unfolding fast — even though many boomers are still rock ‘n’ rolling. Overall, they’re healthier than previous generations. And advances in medical treatments may help them live longer.

But as they reach their 80s, 90s and beyond, boomers are seeing more medical problems and frailty, and may require more care.

Weighing Workers Down — Career and Income Impacts

The impacts of this demographic shift are already falling heavily on mid-life adults, especially women. You may see them as co-workers, employees or neighbors — but they also serve as nurses, cooks, drivers, organizers and more for their loved ones.

These competing demands can have devastating effects on working caregivers’ careers and earnings. Studies show that 70% suffer work-related difficulties due to their dual roles.4 And about six out of 10 workers experience at least one change in their employment due to caregiving. Negative impacts include rearranging work schedules, cutting back hours, taking a leave of absence or receiving a warning about performance or attendance.

Employee Challenges and Costs

  • 40% of caregivers for elderly relatives work in inflexible environments and have been forced to reduce their work hours or quit.
  • Only 53% of employers offer flexible work hours or paid sick days.
  • Only 22% allow telecommuting regardless of employee caregiving burden.

Adding to Employer Costs — Lost Time and Talent

Paychecks or Parents?

That’s a choice millions of people have to make when an elderly parent or relative becomes dependent. Whether it’s dementia, an injury or just “old age,” parents’ needs can put their adult children’s careers and lives on hold.

What happens when someone drops out of the workforce and loses two, five or even 10 years of experience and earnings? Their own health and financial security may be at risk.

Why Aren’t More Women Working? They’re Caring for Parents, New York Times, Aug. 29, 2019, nytimes.com

Caregiver absenteeism costs the U.S. economy an estimated $25.2 billion in lost productivity, according to a 2011 report. That’s based on an average of 6.6 workdays missed per working caregiver per year, averaging $200 in lost productivity per day.

The costs of losing talent add up, too. Among workers who provide care for an elderly relative, seven in 10 have had to cut back on hours — and wages — or drop out of the workforce altogether.15 In another study, one-third reported leaving a job during their careers due to caregiving responsibilities.12 That can create a high turnover rate. And as HR managers know, hiring and training new people can be a big expense!

Eldercare is also unpredictable, even more so than child care. Parents can plan for constant child care in the early years and less as children grow more independent. With the elderly, it’s the opposite. Their needs tend to be intermittent, changing and increasing. That unpredictability can put a big strain on employees and their managers.

Looking Up — New Awareness and Resources

While news articles tend to focus on the lack of support for eldercare, a positive shift is underway. In the last decade, the share of employers providing eldercare resources and referral services increased from 29% in 2005 to 46% in 2016. What’s more, 78% of employers say that they provide paid or unpaid time off for employees to provide eldercare — without putting their jobs at risk.

There’s also growing awareness coming from the top down. More and more CEOs and organizational leaders are struggling to care for aging parents. That gives them the first-hand experience, perspective and incentive to help employees manage these challenges. Forward-thinking employers understand that the costs of losing talent and productivity can outweigh the costs of support for caregivers.

Paying It Off — Benefits of Paid Family Leave, Including Caregiving

Here’s a rare consensus: Most Americans agree that paid family leave is a good thing. When asked what the consequences would be if all Americans had access to paid leave for family or medical reasons, about 90% say it would have a very or somewhat positive impact on families, women and men. And about two-thirds (65%) think the impact on the economy would be positive as well.

What’s the track record for PFL? One study of paid leave in California found that giving workers some time off increases the likelihood that workers — particularly if they’re low-income — will stay in the labor force following personal and family health events.

In most other states, Paid Family and Medical Leave laws are relatively new, not in force yet or nonexistent, so stay tuned for future results.

Interested in more information on caregiving and the aging population? Check out this post that answers the question: Why Is Paid Family Leave So Important for All Generations?

It’s also important to us at The Standard, both as a leading insurance carrier and as a national employer with offices across the country. Helping families take care of their loved ones is at the core of what we do.

Read more related articles at:

The Importance of Paid Leave for Caregivers

Older Adults & Family Caregiver Need Paid Family and Medical Leave

Also, Read One of our previous Blogs at:


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


Why Estate Planning Is Crucial When Reaching End Of Life

Why Estate Planning Is Crucial When Reaching End Of Life

Why  is Estate Planning Crucial When Reaching End Of Life ? People would strive to look for high-paying jobs in order to provide a better life for their families. These people would continually invest time and effort to improve their skills and work for longer hours to ensure that their families can experience the best in life.

But earning a high salary from a stable job isn’t enough for you to achieve these goals. If you want to make sure that everything you’ve worked for actually goes to your family, include estate planning in your to-do list. Estate planning is important as this allows you to decide who will receive the things you’ve worked for the moment you die.

To paint a clearer picture of why estate planning is crucial when you’re reaching the end of life, consider the points below:

1.         Continually Provide For Your Family

No amount of exercise and diet can make you immortal. Even with a healthy and active lifestyle, you will still age and eventually die. This period can be very challenging for your family, especially if you’re the breadwinner. But estate planning can make a lot of difference.

When you work with professionals, to plan for your estate, you can have peace of mind because you know that can always provide for your family. Estate planning can ensure that your family will continue to get their benefits, and they’re getting it in the easiest way possible, even in your absence.

Since estate planning allows you to turn over all of your assets before you die, this process can save your family from experiencing any financial stress. None of your family members will have to worry about how they’re going to pay their bills or provide food on the table because you already arranged all of these things when you were still alive.

2.         Save Your Family From Making Difficult Decisions

Your family will usually make tough decisions as you’re reaching the end of your life. When you’re in a coma, should they let you die naturally or spend money on equipment to let you live? What will they do with your body when you die? These are very difficult decisions to make because a lot of emotions are involved.

If you don’t want your family members to come up with answers for these challenging questions, plan your estate. Aside from deciding who will get what, estate planning also gives you the opportunity to choose disposal arrangements for your remains.

3.         Plan Better For Incapacity

It’s common for people to suffer from incapacity due to a severe accident or sudden medical issue. And when any of these happen, you won’t have the mental capacity to properly manage your financial affairs and turnover your assets.

With estate planning, you can better prepare for incapacity as this allows you to utilize the power of attorney in order to handle your healthcare and financial decisions. This will give you peace of mind knowing that even when you’re incapacitated, all of your assets are handled properly, and your demands are met accordingly.

4.         Protect Young Children

No single parent would want to leave their children alone, but death is unpredictable. As mentioned, accidents and chronic illnesses can happen in an instant and will force you to leave your children.

If you truly want your children to get the best in life, it’s best if you plan your estate as soon as possible. Estate planning allows you to name the guardians of your minor children the moment you die. This means that you get to decide who will look after your children if they haven’t reached 18 years old.

Without estate planning, the courts will have to step in, and they will decide who will raise your children after you’re gone.

5.         Easier Transition For The Business

Running your own business isn’t easy, but when handled properly, this endeavor can significantly improve your own and your family’s quality of life. A thriving business can be your ticket to earn a steady income and even expand your business opportunities.

But all of these can go to waste without estate planning. How can your business continue to operate if you die? Who will take your position and oversee the operations? Not having any answers to these questions can eventually put your business in trouble.

Estate planning is a necessity for small business owners. With estate planning, you can give your position to another person early and ensure that there is a proper transition in the business. Taking this step can guarantee that your business continues to operate even when you die or become disabled.

Ask Help From The Professionals

Contrary to popular belief, estate planning isn’t only for the rich; it’s basically for anyone who wants to turn over their investments to the right members of the family. Estate planning is also best if you want to enhance family values and protect assets for future generations of the family.

For you to effectively and easily plan for your estate, don’t hesitate to ask for help from the professionals. You can now hire lawyers who specialize in estate planning to ensure that all of your hard work won’t go down the drain even after you die.

Read more related articles at:

Not all end-of-life decisions are covered in a will. Here’s what else you need

Why having an end-of-life plan in your 30s makes sense

Also, read one of our previous Blogs at:

How Do I Plan for End-of-Life Measures for a Loved One?

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

Nursing home costs

Nursing Home Costs And Ways to Pay

Nursing Home Costs And Ways to Pay


By Merritt Whitley
June 7, 2021
Nursing Home Costs And Ways to Pay.  Your loved one is at a point in their life when they need help with day-to-day activities and functions, and you want to secure the best possible care to support their health and well-being.

Nursing homes — sometimes called skilled nursing facilities or convalescent homes — are one senior care option to explore. Nursing homes offer the highest level of care to adults who have chronic, debilitating physical or mental health conditions and require round-the-clock supervision. They provide more specialized resources than assisted living or memory care communities, typically administered by licensed professionals. These services include wound care, feeding assistance, injections, and physical therapy. In addition to meeting medical needs, nursing home staff also provide help with activities of daily living (ADLs), such as bathing and grooming, and activities to promote social interaction.

Because nursing homes provide this high level of care, they tend to cost more than other senior care types. As of January 2021, the average cost of a shared room in a nursing home was $255 a day, or $7,650 a month, according to the American Council on Aging. If your loved one’s doctor has determined they require nursing home care, you’ll want to start planning how your family will cover nursing home costs.


Paying for nursing home care through federal and state programs

Who pays for nursing home care? While most families use a combination of personal savings, private insurance, and assets to cover senior living, some federal and state programs offer assistance to seniors paying for nursing homes. Resources vary by location, care needs, and financial eligibility.

Medicare. Nursing homes often offer short-term inpatient rehab in addition to longer-term senior housing and care. Medicare — a federal program that provides health coverage to seniors age 65 and older — covers short-term stays. It doesn’t cover long-term care.

This is helpful for older adults recovering from an injury or other health event, but it’s not a lifelong solution.

“Medicare pays full coverage for the first 20 days and partial payment for days 21 to 100,” says Michael Leitson, senior data manager at the American Health Care Association. “After day 100, they don’t pay anything.”

Learn more about Medicare’s coverage and some additional benefits of the program.

One of our expert Senior Living Advisors will be reaching out to support your search. Need urgent assistance? Call us at (866) 205-8671.

Most, but not all, nursing homes accept Medicaid. To learn more about how to pay for nursing home care with Medicaid benefits, contact your state’s Medicaid office.

VA benefits. The U.S. Department of Veterans Affairs does provide senior care to veterans who require long-term medical assistance. Senior living covered by the VA is often determined by a senior’s individual health care needs and may include paying for nursing homes. Veterans and their spouses must already be signed up for VA health care and meet enrollment and eligibility requirements based on income, disability level, and location. Learn more about how to secure nursing home payments through the VA here.


Paying for nursing home care with private pay options

In addition to state and federal programs, many families pay for nursing homes using personal resources. Consider the following options, and consult your loved one about their savings and funds.

Savings. Personal savings, or out-of-pocket payments, are the primary way seniors fund nursing home care, according to the National Institute on Aging.

Pensions. A pension is a sum of money paid monthly by a retiree’s former employer. Pension amounts are generally based on position, years of service, and age of retirement.

Retirement income. Retirement income can include social security benefits, benefits from annuities, retirement or profit sharing plans, insurance contracts, or IRAs. Retirement income is often taxable. Speak with an accountant about potential tax breaks and credits for using retirement income to pay for nursing home care.

Stocks. Stock portfolios can be sold to pay for nursing home care. Speak with your loved one’s portfolio advisor to determine the best course of action.

Read more related articles at:

Nursing Home Costs and Ways to Pay

How to Pay for Nursing Home Costs

Also, read one of our previous Blogs at:

Protect Your Estate from Nursing Home Costs

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

Baby Boomers



Written By: The American Academy of Estate Planning Attorneys

The Baby Boomer generation – the largest generation in American history to date – is heading into retirement, but are they prepared? More importantly for their children and grandchildren – and possibly the economy as a whole – will there be anything left to bequeath when they pass away? It appears some Baby Boomers have planned for their retirement, however, estate planning is not a priority for many. As a result, this may be the first generation where the transfer of wealth cannot be predicted.

Boomers Begin to Retire

The oldest of the Baby Boomer generation began to retire just a few years ago, in 2011. It is estimated that just over 65 million Baby Boomers are currently in or heading for retirement. How they will fare during their “Golden Years” remains to be seen based on evidence that indicates many failed to plan ahead for their retirement years. Worse still, those who did plan for their retirement years may not have estate planning in place.

Why Didn’t Boomers Plan for Retirement?

The obvious question is why didn’t Baby Boomers focus as much on retirement planning as generations before them did? Several factors appear to have caused this lack of planning phenomenon, the first of which is the Boomers’ spending habits. The generation that gave birth to the Boomers, lived through the Great Depression, World War II, and the Korean War. Not only was the economy far from stable, but the entire world was frequently unstable for that generation. Consequently, they learned to be frugal, plan ahead, and depend only on themselves. By contrast, the Baby Boomers grew up during the Cold War, which was a time of relative peace and a more predictable economy. The result was what is often referred to as the “Me-Generation.” Boomers embraced the idea of spending on credit and, consequently, racked up mountains of debt that many are bringing with them into retirement. Instead of saving every dollar that wasn’t absolutely needed for necessities like the previous generation, the Boomers are notorious for spending now and worrying about saving later. The problem is that later, is now.

Another reason why many Baby Boomers did not save for retirement is they are counting on a sizeable inheritance that will create the cushion they need for their retirement years. Over 20 years ago, a study compiled by Robert Avery and Michael Rendall for Cornell University, concluded the generation that gave birth to the Boomers will pass on to their children and grandchildren an inheritance worth more than $10.4 trillion. That’s a sizeable amount, however, what if that inheritance doesn’t come through as expected? Poor estate planning, long-term care costs, or simply living longer than expected could all cause a long-awaited inheritance to dwindle to almost nothing by the time it gets passed down.

The Great Wealth Transfer

Despite the lack of retirement planning, Boomers are retiring in huge numbers. They will be passing down what is left of their estates over the next several decades. Financial experts are bracing for what they predict will be the largest transfer of wealth in history. Those same experts tell us that roughly $30 trillion will change hands over the next few decades as Baby Boomers pass down their estates to Gen-Xers and Millennials. The problem, however, is that while Baby Boomers took a somewhat lackadaisical approach to retirement planning, many of them ignored estate planning altogether. A recent article by Forbes magazine suggests that 51 percent of Americans aged 55-64 and 62 percent aged 45-54 don’t have Wills. Consequently, a significant portion of that wealth could be lost prior to, or during, the wealth transfer unless Boomers start focusing on their estate plans.

Why Is Estate Planning So Important for Baby Boomers?

One of the biggest factors affecting Baby Boomers and the transfer of their wealth, is the double-edged sword of longevity. Americans are living, on average, almost twice as long at the beginning of the 21st century as they did at the beginning of the 20th century. While a longer life is certainly something to look forward to, it also raises practical and financial concerns. Baby Boomers are expected to spend considerably more time and money in long-term care before they pass. Nationwide, the average cost of a month in long-term care is over $6,800 and the average length of stay is 2.5 years. Without a plan to pay for that care, a substantial portion of a retiree’s nest egg can be lost to nursing home costs. Boomers will also waste a considerable amount of money on probate if they continue to shrug off the need for comprehensive estate planning. The end result is that unless Boomers start to pay attention to the need for estate planning, the Great Wealth Transfer might not be so “Great” after all.

The Good News – It Isn’t Too Late for Baby Boomers to Focus on Estate Planning

Although it is always best to start estate planning early on in life, it is never too late to benefit from a well-thought-out estate plan. For Baby Boomers heading into retirement, there are several important ways in which estate planning can help them hold onto their wealth. Incorporating Medicaid planning into an estate plan is imperative for anyone who is close to, or in, retirement. When added into an estate plan far enough ahead of time, Medicaid planning can protect estate assets and ensure eligibility for Medicaid benefits that will help cover the cost of long-term care. Probate avoidance strategies can also save an estate both time and money. Using a Trust instead of a Will to transfer major assets can save fees and costs associated with probate and ensure that beneficiaries have access to assets immediately after death. A Trust is also a great way to prepare for incapacity, which affects most Americans during their lifetime.

For Baby Boomers, it is not too late to protect your assets and focus on estate planning. The key is to consult with an experienced estate planning attorney sooner rather than later.

Read more related articles at:

Baby Boomers May Be the First Generation Not to Pass Wealth On to Children, Survey Says.

Millions of baby boomers are getting caught in the country’s broken retirement system

Also, read one of our previous Blogs at:

The Aging of America: Will the Baby Boom Be Ready for Retirement?

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

Medicaid Crisis

Medicaid “Crisis” Planning

Medicaid “Crisis” Planning

Medicaid “Crisis” Planning is defined as when an individual is already in a skilled nursing facility or will be entering within a short time-period and needs to qualify for Medicaid benefits immediately. This event may also involve failing to qualify for Medicaid benefits because of either too much income or too many assets, or both.

In the case of a married couple, an applicant may be able to also increase the well spouse’s Community Spouse Resource Allowance or redirect some of the nursing home spouse’s income away from nursing home costs, and back towards the well spouse, using the Minimum Monthly Maintenance Income Allowance.

A large percentage of Florida seniors will require long-term care at some point in their lives.  To be able to pay the enormous expense, most will need to rely on Medicaid for help. Unfortunately, many residents in this state did not take prior steps to ensure they will qualify for the program. In such cases, there are some Medicaid “Crisis” solutions that can be used even at the last minute to help seniors become eligible.

Nursing homes in Florida can cost up to $10,000 per month or more. And typically, Medicare will not pay for it. For most families, this means they need to either qualify for Medicaid or try to come up with the money out of their own pocket


Medicaid Crisis Planning Strategies

When a senior has an immediate need for long-term care, the government does not intend for you to transfer your assets one day, enter the nursing home the next day, and apply for Medicaid benefits the following day. Therefore, there is a five-year “look back” period for most asset transfers. If you transfer assets within the “look back” period, you are subject to a penalty.

Fortunately, there are certain types of asset transfers that are exempt from the “look back” period, and thus can be employed as last-minute solutions to qualify for Medicaid. These include assets transferred to:

  • Your spouse (or another person if it is for your spouse’s benefit)
  • A child who is blind or disabled
  • A trust for the benefit of a child who is blind or disabled
  • A trust for the sole benefit of someone who is disabled and under age 65

If the asset you are transferring is your home, there are a few added exemptions in addition to those mentioned above, including transfers to:

  • A child who is under age 21
  • A sibling who has equity in the home and has lived in it at least a year prior to the applicant entering a nursing facility
  • A child who lived in the home at least two years prior to the applicant entering a nursing facility, and who provided care that helped keep the applicant living at home

If any of these situations apply to you, it may be possible to transfer your assets and qualify for Medicaid without penalty.

Qualified Income Trusts

Also known as a Florida Medicaid trust, Miller trust, or d4B trust, a qualified income trust is an irrevocable living trust that is set up to divert excess income and allow the creator to qualify for Medicaid. While the Medicaid recipient is alive, assets in the trust can be accumulated, invested, or spent.

Upon death, any remaining assets in the trust must be paid back to the state up to the total amount the state paid the recipient for long-term care (minus applicable taxes and trust administration fees). While this is a less than ideal scenario, a qualified income trust can help you qualify for Medicaid while giving you control of your assets while you are alive.

Other strategies that can be taken last-minute to help qualify for Medicaid include:

  • “Spend downs” of excess countable assets into exempt assets such as home improvements and automobiles
  • Medicaid pooled trusts in which excess funds are put into a group trust with leftover funds remaining in the trust after you die and being used to help others in the pool
  • Medicaid-compliant annuities that irrevocably convert countable assets into an income stream

There are several other strategies that may be available depending on your situation. A qualified Elder Law Attorney can fully review your needs to determine the best solutions for your specific circumstance.

Read more related articles at:

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

Medicaid Eligibility Test / Pre-Screen for Long Term Care

Also, read one of our previous Blogs at:


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




LTC Insurance

Pros and Cons of Long-Term Care Insurance

Pros and Cons of Long-Term Care Insurance


Pros and Cons of Long-Term Care Insurance. Is long-term care insurance a wise purchase? Here are five questions you can ask to see whether this type of insurance will benefit you.

Key Takeaways

  • Knowing the pros and cons of long-term care insurance will help you decide whether it’s a wise purchase for you and your situation.
  • Consider factors such as your lifestyle, your family health history, and what kind of care you might need in the future.
  • Think about whether you would be able to afford to pay for your long-term care in the future, or if you’d likely need the safety net of insurance.


Do You Lead a Healthy Lifestyle?

Believe it or not, being healthy may mean that you are more likely to need care. The healthiest people are often the ones who end up needing long-term care assistance later in life, whereas heart problems or cancer may take the unhealthy ones sooner. One of the benefits of long term care insurance , if you are a healthy person, is that it can allow you to stay in your home and maintain your independence longer. Most policies issued today cover the cost of in-home care, which can provide someone to help with many of the activities of daily living, such as cooking and cleaning. Usually, you must require assistance with two out of the six activities of daily living for your long-term care benefits to begin.


What Shows up in Your Family Health History?

What have longevity and health been like for your grandparents, parents, aunts, uncles, and siblings? Has anyone needed care later in life? Who was there to assist them? What if they had needed care? How would it have affected the family? Today, many families are scattered across the country, making it difficult to rely on relatives for care. It can also be physically demanding to care for someone, and your family members might not be capable of providing the help needed. Long-term care insurance helps reduce the burden of care that may otherwise fall on loved ones.


What Kind of Care Might You Need?

What if you break a hip later in life? What if your mind remains fully alert, but you need help cooking, cleaning, and dressing, and you do not want to move in with a family member? Who would help, and how would you pay for their help? Full-time, long-term care assistance can run from $6,000 to $10,000 per month, or even more if medical care is needed. If you have sufficient assets to cover these costs then you do not need long-term care insurance. If you do not have sufficient assets, without long-term care insurance, you will end up spending down the funds you have before you see whether you qualify for Medicaid. Long-term care insurance buys you time and enables you to afford quality care.


Can You Afford It, or Can You Afford Not to Have It? 

Long-term care insurance has adjustable features. Like buying a car, you can get all the extras, and pay for them, or you can buy a base model that costs less but still provides decent transportation. The major downside of long-term care insurance is the same as with any insurance: you may pay premiums for years and never use the coverage. According to the American Association for Long Term Care Insurance, the average annual premium for a long-term care policy for a 65-year-old male, in reasonably good health, runs about $1,400. That figure is based on a policy that provides a pool of benefits equal to $162,000. Depending on the level of care you require, and the state in which you live, the average cost of a stay in a long-term facility can exceed $10,000 per month, which means that the benefits from such a policy could run out in a little more than a year. You need to look at it the same way you look at any other type of insurance. After paying for homeowner’s insurance for years, are you upset that your home never burned down and that you never used your insurance? Of course not! You are happy that you never experienced such an awful event. When it comes to the amount of coverage, you may not need a “Cadillac” policy. Instead, evaluate the amount of long-term care coverage you may need by considering your other sources of income. A policy that covers $100 per day, with an inflation rider, may be sufficient once you also factor in your Social Security and pension income. If you have little income and not much in savings, you will likely need to rely on Medicaid should you need care during your retirement years. If you have a nice pension and $2 million or more saved, you may feel comfortable being self-insured, which means that you would pay out-of-pocket for care needs. If your financials are in the middle of these two scenarios, having essential coverage for a reasonable premium could be a life-saver in your later years.


What Are the Odds?

According to the American Association for Long-Term Care Insurance: “The lifetime probability of becoming disabled in at least two activities of daily living or of being cognitively impaired is 68% for people age 65 and older.” It is wise to look at the statistics, but your personal odds are either zero or 100%. You either will need care or you will not. If you need care for more than four or five months, you will be glad you have long-term care insurance.



Long -term care insurance allows you to maintain your independence and afford quality care, and it also helps you reduce the financial and psychological stress that a long-term care event can impose on your family. The cons are the cost of the premiums. Whether you buy insurance or not, you will want to have a plan in place so that you and your family will know what to do if you need care. That plan involves talking to family and friends about their ability to help, if and when help is needed. You may also want to consider alternatives to long-term care insurance, such as making arrangements to live with family or friends or moving into a continuing care community.

Read more related articles at:

Long-Term Care Insurance – To Buy or Not to Buy?

How Hybrid Life Insurance Pays For Long-Term Care

Also, read one of our previous Blogs at:

What’s the Latest Trend in Long-Term Care Insurance?

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


Incapacity Planning

How Can I Plan For Incapacity?

Legal Planning for Incapacity

How can I plan for incapacity? As you face aging and the need to make plans for your future, you face having to make legal decisions about many aspects of your lives. These legal decisions not only protect you from others doing things you might not like to you, they also protect family and loved ones by giving them guidance in the care that you would like to receive. After completing all the legal paperwork, the next step is to sit down and talk to family about the decisions you have made and why.

What Are the Legal Documents Everyone Should Have?

Advance Health Care Directive

  • Gives power to a person you designate to make health care decisions for you ONLY IF you can’t speak for yourself
  • Also called Living Will, Durable Power of Attorney for Healthcare
  • Each state has slightly different versions of the form, but a form from one state will be honored in another state
  • Hospitals and doctor’s offices have the forms
  • Everyone over 18 should have one
  • Must be completed while you are competent to know what you are signing, i.e. without dementia
  • Often used to decide on feeding tubes, ventilators, and other treatments at the end of life or when someone is unconscious
  • Only needs to be witnessed; does not need to be notarized

What happens if you don’t have an Advance Health Care Directive?

  • Doctors will do everything to treat your condition and keep you alive
  • Family will be asked what to do
  • If they don’t know what your wishes would be, there might be family conflict and guilt over making the wrong decision
  • Physician training, hospital, and nursing home policies often dictate the use of “heroic means” to sustain life. For example, “reviving” a very ill person after a stroke, and using a respirator for someone deemed medically “brain dead,” are standard procedures in many hospitals.


  • Stands for Physician’s Orders for Life Sustaining Treatment and replaces DNR—Do Not Resuscitate
  • Allows individuals with life-threatening illnesses to decide with their doctors what treatment they would or wouldn’t want. Since it is a physician’s order, it is not open to the will of others.
  • Is helpful if you do not want 911 Emergency Responders to perform CPR (Cardio-pulmonary resuscitation) and expands on other treatments you might or might not want

What happens if you don’t have a POLST?

  • If 911 is called, EMTs are required to do everything possible to resuscitate a person and keep him/her alive until they arrive at the hospital.


Says how you want your estate (money and belongings) to be dispersed to family, friends, organizations, etc. after you die.

  • Also called Last Will and Testament
  • Each state has different laws about estates, but most states will honor an out-state will
  • Can be hand written or completed using on line forms, but necessary to be witnessed and/or notarized
  • If estate is complicated or over $100,000, it is best to have an attorney help you write the will or review what you wrote
  • Must be completed while you are competent to know what you are signing, i.e. without dementia
  • In a will, you appoint someone to be the executor or administrator who will pay your final bills and see that your wishes are carried out
  • Probate is the transferring of property when someone dies. The probate court oversees the executor to assure that the estate is divided as stated in the will.

What happens if you don’t have a will?

  • If you die without a will, the court will probate your estate, i.e., decide how your estate should be distributed.

Durable Power of Attorney for Finance

Allows someone to access your finances, including checking account, investments, and property, in order to pay your bills.

  • A Durable Power of Attorney is valid even if you are incapacitated.
  • Must be completed while you are competent to know what you are signing, i.e. without dementia.
  • Needs to be someone you trust, as this person has a lot of control over your finances. If you don’t have someone you trust, you should consult a professional.
  • Spouses might not have access to all of your funds unless everything, including investments, is held as joint property.

What happens if you don’t have a Power of Attorney for Finance?

  • If you don’t have a durable power of attorney for finance and you can’t manage your finances, a judge will have to appoint someone to do so. It may mean you will have to be conserved, e.g. someone appointed by the court will oversee your care and finances.

Final Arrangements

  • Decide whether you would like cremation or burial and let the family know. Also let loved ones know about your wishes regarding organ donation and other special arrangements.
  • Put your wishes in writing in a place family members can find them.
  • The more decisions you make beforehand, the fewer decisions family has to make during a difficult time when they are grieving.

What happens if you don’t make your wishes known about final arrangements?

  • Family can often be in conflict about what you would have wanted.
  • The law can determine who has the power to make the decision if it is unclear or there is conflict.

What Are the Other Things You Might Need?


A trust creates a legal entity that holds your assets for you so that your estate does not have to go through probate when you die.

  • Also called a Living Trust
  • You name a trustee to oversee the trust both while you are alive, and to distribute the trust to beneficiaries when you die.
  • You may be the trustee of the trust while you are alive, in which case you name a successor trustee for the trust who will manage it after you die or become incapacitated.
  • A revocable trust allows you to control everything that happens in the trust while you are alive.
  • An irrevocable trust cannot be changed without the beneficiary’s consent.
  • There are many options for trusts for specific purposes, such as:
    • Special Needs Trusts: Puts money aside to help someone who is disabled
    • Charitable Trust: Money given to a charity
    • Bypass Trust: Irrevocable trust passes assets to the spouse and then the children at death of second parent, limiting estate taxes
    • Life Insurance Trust: Removes life insurance from estate and thus estate taxes
    • Generation Skipping Trust: Allows grandchildren to directly inherit without paying taxes

What happens if you don’t have a trust?

  • Depending on the value of your assets, your estate will go through probate, which can take several months and incur costs to the court.

Beneficiary Forms

Bank accounts, investments, insurance, and retirement plans can be designated as “payable on death” to a named beneficiary, which means the funds don’t have to go through probate.

  • Allows access to funds immediately, rather than waiting for probate to close

What happens if you don’t have fund “payable on death?”

  • Unless funds are in a trust, the estate must be probated through the court, which can take several months (when the funds might not be available) and incur costs to the court.

Where to Find My Important Papers

Have a central place to keep wills, trusts, powers of attorney, etc so that family members will know where to look for these documents.

What happens if you don’t have a central place?

  • Often, particularly in times of emergency and stress, we get confused and don’t know where something important might be. Having a place to go to will reduce the possibility of forms being misplaced or lost. The legal forms are necessary to assure that the care you or a loved one might want are carried out.


In a recent survey, 81% of the people said they think about these issues, however only 33% said they had completed the necessary forms. Although it is hard to talk about and think about, it is important to take care of these matters for your own sake and for the sake of your family.


Family Caregiver Alliance
National Center on Caregiving

(415) 434-3388 | (800) 445-8106
Website: www.caregiver.org
Email: [email protected]
FCA CareNav: https://fca.cacrc.org/login
Services by State: https://www.caregiver.org/connecting-caregivers/services-by-state/

Family Caregiver Alliance (FCA) seeks to improve the quality of life for caregivers through education, services, research and advocacy. Through its National Center on Caregiving, FCA offers information on current social, public policy and caregiving issues and provides assistance in the development of public and private programs for caregivers. For San Francisco Bay Area residents, FCA provides direct family support services for caregivers of those with Alzheimer’s disease, stroke, ALS, head injury, Parkinson’s disease, and other debilitating health conditions that strike adults.

Read more related articles at: 

Incapacity Planning

Creating a Caregiving Plan When You Have No One to Take Care of You

Also, read one of our previous Blogs at:

What Can I Do to Plan for Incapacity?

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

medicaid 5 year lookback


Understand Medicaid’s Look-Back Period; Penalties, Exceptions & State Variances
Last updated: January 07, 2021

Medicaid’s Look-Back Period Explained
When a senior is applying for long-term care Medicaid, whether that is for services in one’s home, an assisted living residence, or a nursing home, there is an asset (resource) limit. In order to be eligible for Medicaid, one cannot have assets greater than the limit. Medicaid’s look-back period is meant to prevent Medicaid applicants from giving away assets or selling them under fair market value in an attempt to meet Medicaid’s asset limit.

All asset transfers within the timeframe of the look-back period are reviewed, and if an applicant is found to have violated this rule, a penalty period (a period of Medicaid ineligibility) will be established. This is because had the assets not been gifted, sold under their fair market value, or transferred, they could have been used to pay for the elderly individual’s long-term care. If one gifts or transfers assets prior to this look-back period, there is no penalization.

The date of one’s Medicaid application is the date from which one’s look-back period begins. In 49 states and D.C, the look back period is 60 months. In California, the look back period is 30 months. New York will also be implementing a 30-month look-back period for their Community Medicaid program, which provides long-term home and community based services. (At the time of this writing, NY has a 60-month look-back for nursing home Medicaid, but no look-back for Community Medicaid). As an example of the look back period, if a Florida resident applies for Medicaid on Jan. 1, 2021, their look-back period extends back 60 months to Dec. 31, 2015. All financial transactions during that timeframe will be subject to review.

Examples of the type of transactions that could result in a penalty include money that was gifted to a granddaughter for her high school graduation, a house transferred to a nephew, collectors’ coins sold for half their value, or a vehicle donated to a local charity. Even payments made to a personal care assistant without a formal care agreement or assets that were gifted, transferred, or sold under fair market value by a non-applicant spouse can violate the look-back period and result in a period of Medicaid ineligibility.

Even after the “initial” look back period, if a Medicaid beneficiary comes into some money, say for example, via an inheritance, and gives all (or some) of the money away, he / she is in violation of the look back rule. Said another way, despite an initial determination that one has not violated the 60-month (or 30-month in CA and soon for NY Community Medicaid) look back period and is receiving long-term care Medicaid, he / she can violate this rule, and hence, be disqualified for Medicaid benefits.

The American Council on Aging now offers a free, quick and easy Medicaid eligibility test for seniors.

For Which Medicaid Programs is Look-Back Relevant
Medicaid offers a variety of programs and the look-back period does not necessarily apply to all of them. This article is focused on elderly care and Medicaid benefits for long-term care, and these programs consider the Medicaid look-back period. Therefore, if one is applying for nursing home Medicaid or for a Home and Community Based Services (HCBS) Medicaid Waiver, the state’s Medicaid governing agency will look into past asset transfers.

Medicaid programs such as those for pregnant mothers and newborn children do not have a look-back period.


How Look-Back Varies by State
While the federal government establishes basic parameters for the Medicaid program, each state is able to work within these parameters as they see fit. Therefore, all 50 states do not have the same rules when it comes to their Medicaid programs nor do they have the same rules for their look-back period. As of 2021, every state, but California, has a Medicaid Look-Back Period of 60 months (5 years). California has a much more lenient look-back period of 30 months (2.5 years), and New York will be phasing in a 30-month look back for their Community Medicaid beginning April 1, 2021.

The “penalty divisor”, which is used to calculate the penalty for someone found in violation of the look-back period, also varies by state. The penalty divisor is tied to the average cost of nursing home care in a specific state. For instance, a state may use a daily average penalty divisor or a monthly average penalty divisor. Penalty divisors by state can be found here.

Some states may not implement the look-back period for community / in-home care. One such example is New York, which only uses the look-back period for nursing home care. However, as mentioned above, a 30-month look-back period will be phased in for home and community based services. In addition, some states might allow applicants an exception for small gifts. Pennsylvania is one such state and allows Medicaid applicants to gift as much as $500 / month without violating Medicaid’s look-back period.

The Medicaid look-back period is complicated, especially since the rules that govern it vary by state. Therefore, it is best to contact a professional Medicaid planner to learn more about the Medicaid look-back period in the state in which one resides.


Unintentional Violations of Look-Back Rules
IRS Gift Tax Exemption – The IRS allows an annual estate and gift tax exemption. This means, as of 2021, an individual in the U.S. can gift up to $15,000 per recipient without paying taxes on the gift(s). However, one may not realize this federal tax exemption does not extend to Medicaid’s rules. Said another way, if one gifts $10,000 to a daughter or son, this gift is not exempt from Medicaid’s look-back period. As mentioned above, even a cash gift to a family member for graduation can be in violation of the look-back rule. It’s also important to note, the rules that govern gifting vary by state, further complicating this possible violation. More.

Lack of Documentation – Another way one may unknowingly violate Medicaid’s look-back rule is by not having sales documentation for assets sold during the look-back period. While the assets may have been sold for fair market value, if documentation is not available to provide proof, it may be determined one has violated the look-back period. This is particularly relevant for assets, such as automobiles, motorcycles, and boats, that have to be registered with a government authority.

Irrevocable Trusts (also called Medicaid Qualifying Trusts) – One might assume that these type of trusts are exempt from Medicaid’s look-back period, but this is not always true. The term, Medicaid Qualifying Trust, can create confusion, as the name suggests it is used to qualify for Medicaid. Unfortunately, if the trust is created during the look-back period, it is considered a gift, and therefore, is in violation of the look-back period. In simple terms, a Medicaid Qualifying Trust is a legal arrangement where assets are transferred from an individual, called the grantor, to a third party, called the trustee. The trustee becomes the owner of the assets and holds them for the named beneficiary. A variety of assets can be transferred via a trust and may include a Certificate of Deposit (CD), stocks, property, cash, and annuities. The term, irrevocable, means that the grantor cannot amend or cancel the trust.

Paying a Family Member to Provide Care – while it is acceptable under Medicaid rules to pay family members for providing care, doing so without proper legal documentation and caregiver agreements is a very common cause of Medicaid penalties. More information is provided below on how to do this without breaking Medicaid’s rules.


Look-Back Rule Exceptions & Loopholes
There are several exceptions and loopholes to Medicaid’s look-back rule. For instance, certain transfers can be made without violating Medicaid’s look-back period in order to protect an applicant’s family from having too little from which to live. These exceptions allow asset transfers without fear of penalty. To ensure they are done correctly and to avoid penalization, it is highly recommended one consult with a Medicaid planning professional prior to making any asset transfers.

Joint Assets of a Married Couple
For Medicaid eligibility purposes, all assets of a married couple, which are considered jointly owned, are calculated, and a portion is allocated to the non-applicant (community) spouse in order to prevent spousal impoverishment. This is called the Community Spouse Resource Allowance (CSRA), and as of 2021, may be as high as $130,380. The federal government sets this figure, and states may elect to use a lower figure. For example, South Carolina has a maximum CSRA of $66,480.

Each state is either a 50% or 100% state. For 50% states, a community spouse can keep half of the couple’s joint assets, up to $130,380, or in the case of South Carolina, up to $66,480. For example, a couple has assets equal to $300,000 in a state that has a maximum CSRA of $130,380. In a 50% state, this means that $150,000 in assets belongs to the applicant spouse and $150,000 in assets belongs to the non-applicant spouse. The non-applicant spouse can keep up to $130,380 of those assets. (The non-applicant spouse is generally only able to retain $2,000 of those assets). In a 100% state, a community spouse can retain 100% of the couple’s assets, up to the allowable $130,380, or again, in South Carolina, up to $66,480. Therefore, if a couple has $120,000 in assets in a state that has a maximum CSRA of $130,380, the non-applicant spouse is entitled to all $120,000 in assets. (To see CSRA and applicant asset limits by state, click here).

When there are excess assets, they must be “spent down” in order to meet Medicaid’s asset limit for qualification. It is not unusual that they be spent on the cost of long term care, whether that be nursing home care or in-home care, until the spouse in need of long-term care meets the asset limit. Other ways in which excess assets can be “spent down” are discussed further below in this article.

Asset Transfers to Minor Children
Transfers for the benefit of one’s child(ren,) given the child(ren) are under 21 years old, are disabled, or are legally blind. In addition to the transfer of assets, this includes the establishment of trusts.

Asset Transfer of a Home
One can transfer a home to a sibling. The sibling to which the home is being transferred must have ownership in it and must have lived in it for at least one year prior to the Medicaid applicant relocating to a nursing home. A home can also be transferred to an adult child who has served as a caregiver for their parent(s). This is called the caregiver child exemption. In order to be eligible for this exemption, the adult child must have been the primary caregiver of their aging parent(s), preventing the parent(s) from having to relocate to a nursing home or assisted living, and lived in the home with their parent(s) for at least two years prior to the parent(s) entering a nursing home.


What to Do When You’ve Violated Medicaid’s Look-Back Rules?
If one is in the unfortunate position of having violated Medicaid’s look-back period, there are ways in which one can still gain Medicaid eligibility. Usually the best course of action is to work with a professional Medicaid planner, as this is a precarious situation, and if not handled correctly, will result in a penalization period.

Free initial consultations with Medicaid planning professionals are available. Get started here.
Asset Recuperation
If one has gifted assets or transferred them for under fair market value and is able to recuperate the assets, the penalization period will be reconsidered. Therefore, if there has been any violation of the look-back period, it is extremely important to try to recover all assets. In some states, all assets transferred must be recuperated or the penalization period will remain the same. Other states might allow for partial recuperation of assets and adjust the penalty period accordingly.

Undue Hardship Waiver
If one has tried to recover assets they have gifted or transferred, but were not able to do so, they can apply for an undue hardship waiver. The Medicaid applicant must prove recuperation of assets failed, and if not granted Medicaid benefits, they will face significant hardship. This means they won’t be able to provide food, clothing, or shelter for themselves. It is very hard to be granted an undue hardship waiver unless it is very clear that the individual will suffer significant hardship without it.


Spend Down Assets Without Violating the Look-Back Period
There are ways for one to spend down excess assets without violating Medicaid’s look-back period, and hence, avoid penalization. (Calculate your total spend down amount here.) While the following strategies are all ways in which one can do so, the look-back period is extremely complicated. Therefore, it is highly recommended one contact a professional Medicaid planner prior to using one of the following strategies. Read more.

Life Care Agreements
Life care agreements, also called caregiver agreements or elder care agreements, are a great way for seniors who require a caregiver to spend down extra assets without violating Medicaid’s look-back period. In simple terms, caregiver agreements, which generally last for the duration of the care recipient’s life, are legal contracts between a caregiver, often a relative or close friend, and an elderly individual who requires care. Often life care agreements remain in effect even after the senior care recipient moves into a nursing home, as the caregiver can serve an advocate role for the senior. The contract needs to include the date care services are to begin, the type of care that will be provided, such as personal care assistance, light housecleaning, and preparation of meals, the frequency / hours the care will be provided, and the rate of pay. The pay rate must be reasonable for the area in which one lives. (If not, one may be in violation of the look-back period.) Life care agreements should make it very clear that payments to a caregiver are not simply gifts. That said, it’s best to also have supportive documentation, such as a log of executed caregiving duties, the days and number of hours worked, and written invoices for payment.

Medicaid Exempt Annuities
Medicaid exempt annuities, sometimes called Medicaid compliant annuities, are another way one can spend down assets without violating Medicaid’s look-back period. Annuities convert a lump sum of cash into a monthly income stream for the Medicaid applicant or their spouse, effectively lowering one’s countable assets for Medicaid eligibility. Annuity payments can be for the duration of the recipient’s life or for a set period of time. It’s important to note, each state has its own rules for Medicaid annuities, and not all annuities may be Medicaid compliant. In addition, if one purchases a deferred annuity, which means payments are delayed until a date in the future, this violates Medicaid’s look-back period. When considering an annuity, one must proceed with caution.

Paying Off Debt
Paying off debt, such as a mortgage or credit cards, is not in violation of Medicaid’s look-back period and effectively lowers one’s assets.

Home Modifications
One can also use assets in excess of Medicaid’s eligibility limit for home modifications and reparations without violating the look-back period. This includes replacing old plumbing systems, updating electrical panels, adding first floor bedrooms and / or bathrooms, installing wheelchair ramps, chair lifts, widening doorways to allow wheelchair access, and replacing carpet with more wheelchair friendly surfaces.

Irrevocable Funeral Trusts
Irrevocable funeral trusts, which pay for funeral and burial costs in advance, provide a way to spend down excess assets without violating Medicaid’s look back rule. The term, “irrevocable”, meaning the trust cannot be changed or terminated, is extremely important, as funeral trusts that are revocable violate the look back rule. More.

Determine Your Medicaid Eligibility


Read more related articles at:

Five year rule for Medicaid is often misunderstood

The Medicaid Look Back Period Explained

Also, read one of our previous Blogs here:

Protect Assets from Medicaid Recovery


Hiring an Elder Law Attorney



An elder law attorney helps seniors and families

Having the essential legal documents in place gives you the necessary legal rights to provide the best care for your older adult, now and at the end of life.

That’s why it’s so important to find an expert lawyer that you trust to draw up the right documents.

We explain what an elder law attorney does and how they help seniors and caregivers.

We also share two ways to find an elder law attorney in your area and 5 smart tips for hiring someone who’s reputable and experienced.


What does an elder law attorney do?

Elder law is a specialized legal area focused on older adults and their adult children.

This legal specialty focuses on specific needs, including:


2 ways an elder law attorney helps seniors and family caregivers

1. Plan for the future and protect assets
An elder law attorney has the expertise to make recommendations on how to plan for future care needs.

They often answer questions like:

  • How can I qualify for Medicaid so it will pay for nursing home care?
  • How do I protect mom’s house and assets, but still afford the care she needs?
  • How do I make sure my wife will have money left after all my care expenses are paid?
  • What to do if I need to become dad’s guardian or conservator?
  • After I pass away, will Medicaid try to get money from my estate for the medical bills they paid and cause problems for my spouse or kids?

These are complicated questions and the answers will be different for each person.

A reputable elder law attorney helps protect your senior’s legal and financial situation and helps you figure out how to pay for the care they’ll need.

The fees are well worth it if they can save your family thousands of dollars and avoid future legal headaches.

2. Ensure all the legal documents are correct for your state
Laws are different (and very specific) for each state, so it’s important that the documents are prepared correctly.

This is especially true for documents like a Power of Attorneyliving will (aka advance directive), and will.

A local elder law attorney can make sure that your older adult has completed all the important legal documents and that they’re compliant with state and local laws.


2 ways to find an elder law attorney

1. Get a referral from someone you know
Getting a referral from family or a friend is a great way to find a lawyer.

If they have a lawyer they’re happy with and would work with again, that’s a good sign.

It’s best to get a referral from someone whose legal needs were similar to yours. But even if you need an elder care lawyer and your cousin worked with an excellent civil attorney, that referral is still useful.

Also, good lawyers typically know other good lawyers and will probably be able to refer you to a colleague they respect.

Similarly, financial advisors, accountants, and fiduciaries (someone legally appointed to manage money) are professionals who often work with elder law attorneys.

If you know and trust one of these professionals, ask them for a referral.

2. Check the National Academy of of Elder Law Attorneys
The National Academy of of Elder Law Attorneys (NAELA) is the professional organization for attorneys who specialize in elder law and special needs planning.

Their website includes an attorney finder to help you find an elder law attorney in your area.


5 smart tips for hiring a good elder law attorney

After getting referrals, you’ll still need to choose an attorney.

Don’t make up your mind about hiring a lawyer until you’ve met them, discussed your older adult’s needs, and checked their credentials.

1. Meet for an initial consultation 
An in-person meeting helps you get a feel for how they work and if their style works for you.

If you summarize your needs in advance, many lawyers will be willing to meet for 15 to 30 minutes at no charge. If there is a fee for a consultation, find out how much it will be.

If you can, meet with a few lawyers and present the same situation to each. Then, you can compare their responses.

That helps you confirm that the overall approach is legitimate and prompts you to ask questions about any differences in advice.

2. Find out how much experience they’ve had with issues similar to yours
Experience comes with years in practice and with how many of those types of situations they’ve dealt with.

So, it’s a good idea to look for a lawyer with experience handling matters similar to your older adult’s.

For example, if they need a Power of Attorney, long term care planning, and estate planning, ask prospective attorneys to describe their experience with those matters.

3. Evaluate their customer service
Working with someone who is professional and responsive is important.

After speaking with a lawyer, ask yourself:

  • Are they polite and professional?
  • Do they return calls or emails in a timely manner?
  • Do they take time to explain things to make sure you have a good understanding?
  • Do they follow through with things they’ve said they’ll do?

4. Take plenty of notes
To help you remember what each lawyer said and how you felt about them, be sure to take notes during and after each meeting.

Later, review your notes to help you make the final decision.

5. Check their credentials
Before hiring any lawyer, check the State Bar Association website for your state.

Look up the attorney’s name or Bar number to make sure they’re actively licensed to practice law in your state. This will also show if they’ve ever been publicly disciplined.

Read more related articles at:

6 Things an Elder Law Attorney Can Do to Help Family Caregivers

Things to Consider if You Need an Elder Law Attorney

Also, rad one of our previous Blogs at:

How Do I Find a Great Elder Law Attorney?

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



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