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What Is the VA’s Plan for Long-Term Care for Baby Boomers?

What Is the VA’s Plan for Long-Term Care for Baby Boomers?  Teresa Boyd, Assistant Deputy Undersecretary for Health at the Veterans Health Administration recently told House Veterans Affairs Subcommittee on Health members they would have to wait another few weeks before the VA’s “Elderly Strategic Plan” will be ready for release. Even so, lawmakers asked the VHA official about issues found in a recent Government Accountability Office report.

Military.com’s recent article entitled “Lawmakers Scrutinize VA’s Plans to Provide Long-Term Care for Aging Baby Boomers” reports that there are currently about 3.2 million veterans aged 65 years or older using VA health care services. The GAO found that the VA anticipates the amount of long-term care provided to veterans with service-connected disabilities will increase by 18% from fiscal 2017 to 2037, plus another 5% to provide the services to post-9/11 veterans.

The government watchdog report identified three issues facing the VA, as it prepares for a generation of aging Baby Boomers:

  1. Staffing shortages
  2. Access to specialized providers; and
  3. Trouble getting to vets in rural areas.

Boyd said that the VA’s plan will address the concerns listed by the GAO.

Despite the VA’s ongoing improvements to scholarship and student loan payback programs to attract more staff, Representative Conor Lamb, D-Pennsylvania, wasn’t as optimistic. He’s concerned the current administration’s actions against VA unions will detract those the VA is trying to court. The Trump administration had cut a type of pay union representatives receive, while pursuing grievances on behalf of bargaining units and requiring union staff to pay for office space.

“The type of people who are going to take a home health aide or assistance job are often the people who need that sort of protection and support the most,” he said. “And I think for us to recruit the best of the best in that category for the next generation, you want the people who are already there telling their friends, ‘Hey, VA’s a great place to work. They stick up for us; they pay us well; they take care of our needs if we get sick … ‘”

Lamb asked the VA to consider this, as it looks at the obstacles found in the GAO report.

Meanwhile, Brownley and other lawmakers advocated for more investments in the VA’s in-home, long-term care programs.

“In recent years, stakeholders have largely focused on VA’s community care and caregiver programs. While these are essential areas for VA to get right, the scale of the silver tsunami is something VA cannot afford to get wrong,” Brownley said. “Millions of veterans and their families are relying on us to ensure their later years are as dignified and healthy as possible.”

Boyd agreed that many seniors want to remain in their own homes as long as possible, rather than moving to a facility for their long-term care. Boyd reported that the results of one of the VA’s in-home programs, Choose Home, have played a role in developing the strategic plan to be released in the next few weeks.

Reference: military.com (March 9, 2020) “Lawmakers Scrutinize VA’s Plans to Provide Long-Term Care for Aging Baby Boomers”

Check out more related articles at :

The 2030 Problem: Caring for Aging Baby Boomers

Long-term Care Planning for Baby Boomers: Addressing an Uncertain Future

You can also read one of our previous Blogs at :

Do I Need Long-Term Care and Why?

POA COVID

C19 UPDATE: If You Have Not Yet Named Someone with Medical Power of Attorney, Do It Now

C19 UPDATE: If You Have Not Yet Named Someone with Medical Power of Attorney, Do It Now!  Stop procrastinating and get this crucial planning in place now.

What is a Medical Power of Attorney?

A medical power of attorney is a legal document you use to give someone else authority to make medical decisions for you when you can no longer make them yourself.  This person, also known as an agent, can only exercise this power if your doctor says you are unable to make key decisions yourself.

Other Terms for Medical Power of Attorney

Depending on the state where you live, the medical power of attorney may be called something else. You may have seen this referred to as a health care power of attorney, an advance directive, advance health care directive, a durable power of attorney for health care, etc. There are many variations, but they all mean fundamentally the same thing.

Be aware that each state has their own laws about medical powers of attorney, so it’s important to work with a qualified estate planning attorney to ensure your decisions will be enforced through legally binding documents. Also, some states may not honor documents from other states, so even if you made these decisions and created documents in another state, it’s wise to review with an estate attorney to ensure they are legally valid in your state now.

What Can My Medical Agent Do for Me?    What Is a Health Care Agent?

Just like there are many different terms for the medical power of attorney, there also are different terms for the medical agent – this person may be referred to as an attorney-in-fact, a health proxy, or surrogate.

Some of the things a medical POA authorizes your agent to decide for you:

  • Which doctors or facilities to work with and whether to change
  • Give consent for additional testing or treatment
  • How aggressively to treat
  • Whether to disconnect life support

We are ready to help walk you through these decisions, understand the ramifications of your choices, and memorialize your plans in binding legal documents. We are currently offering no-contact initial conferences remotely if you prefer. Book a call now and let us help you make the right choices for yourself and your loved ones.

Read other related articles at :  Power of Attorney/AmericanBarAssociaton

Powers of Attorney: Crucial Documents for Caregiving

Also view our previous Posts at : 

What to Know About a Power of Attorney?

Why Is a Power of Attorney Important?

What is the Difference between Guardianship and Power of Attorney?

What is the Difference between Guardianship and Power of Attorney? Protecting yourself or a loved one can take many different forms, since aging takes a toll on the ability to handle financial and medical decisions. In most situations, guardianship or a power of attorney does the trick, says the article “Guardianships vs. Powers of Attorney” from the Pittsburgh Post-Gazette.  How to know which is the best one to use?

A guardianship is a court-authorized assignment of surrogate decision-making power for the benefit of a person who has lost the ability to make informed decisions on their own, often described as a person who has become incapacitated. The decisions that another person can make on their behalf can be very broad, or they can be very specific.

If a person becomes incapacitated, either through a slowly progressing illness like dementia or quickly, as the result of an accident, a judge will appoint a person or sometimes an organization to handle health care and financial decisions. The court-appointed guardian or organization could be a person or agency you have never heard of and would not know your family or anything about you.

Yes, that is scary. However, guardianship takes place when families do not plan in advance to appoint a surrogate decision maker, also known as an “agent.”

Here’s even more scary news: once the court has appointed a guardian, that relationship may continue for the rest of the incapacitated person’s life. That means annual accountings and involvement with the court, legal fees and other professional fees the guardian or court deems necessary.

There are some guardians who have made headlines for stealing money and making care decisions that the individual and their families did not want.

Meeting with an estate planning attorney to prepare for incapacity as part of an overall estate plan is a far better way. Why don’t more people do it?

  • They aren’t aware of the importance of power of attorney.
  • They don’t want to spend the money.
  • They don’t know who to choose as their power of attorney
  • They don’t want to think about incapacity or death.

In contrast to a court-supervised lifetime guardianship, a properly drafted power of attorney can provide for an agent to make a variety of financial and medical decisions. The person named as a power of attorney (the agent) can serve for the person’s lifetime, just like a guardian.

This is the most fundamental estate planning document, after the last will and testament. Once it’s prepared, you can always change your mind and you or your agent never need to go to court. Hopefully this shed some light  on what the difference between a Guardianship and a Power of Attorney is.

Reference: Pittsburgh Post-Gazette (Feb. 24, 2020) “Guardianships vs. Powers of Attorney”

Read other articles pertaining to this subject at : THE DIFFERENCE BETWEEN POWERS  OF ATTORNEY AND GUARDIANSHIPS/AARP

                                                                                                          Power of attorney and guardianship: What’s the difference?/care.com

You can also read some of our previous Blogs at :

Will Florida’s New Legislation Help Seniors in Guardianships?

When Do I Need a Power of Attorney?

Alzheimer’s

New Blood Test May Make Alzheimer’s Diagnosis Easier

New Blood Test May Make Alzheimer’s Diagnosis Easier.  Researchers at the University of California – UC San Francisco have analyzed the blood test in more than 300 patients and believe that they will see such a test available in doctor’s offices within five years, according to a press release from The University of California- San Francisco’s entitled “New Blood Test Could Make Alzheimer’s Diagnosis Easier Than Ever.”

“This test could eventually be deployed in a primary care setting for people with memory concerns to identify who should be referred to specialized centers to participate in clinical trials or to be treated with new Alzheimer’s therapies, once they are approved,” said Adam Boxer, MD, PhD, neurologist at the UCSF Memory and Aging Center and senior author of the study published in Nature Medicine. Boxer also is affiliated with the UCSF Weill Institute for Neurosciences.

There is currently no blood test for either condition. Alzheimer’s diagnoses can only be confirmed by a PET scan of the brain, which can be expensive or an invasive lumbar puncture to test cerebrospinal fluid.

If approved, the new blood test could make screening easier and help increase the number of patients eligible for clinical trials—vital to the search for drugs to stop or slow dementia. Patients who know whether they have Alzheimer’s or FTD are also better able to manage their symptoms.

In the new study, scientists collected blood samples from 362 people aged 58 to 70, including 56 individuals who’d been diagnosed with Alzheimer’s, 190 diagnosed with FTD, 47 with mild cognitive impairment, plus 69 healthy controls.

Researchers checked the blood samples for proteins that could serve as signs of dementia. One protein, called pTau181, is known to aggregate in tangles in the brains of patients with Alzheimer’s. Blood levels of pTau181 were about 3½ times higher in people with Alzheimer’s as opposed to their healthy peers. People with FTD had normal levels of pTau181, and those with mild cognitive impairment due to underlying Alzheimer’s had an intermediate increase.

When researchers followed the patients for two years, they saw that higher levels of pTau181 predicted more rapid cognitive decline in those with Alzheimer’s or mild cognitive impairment.

The researchers note the new blood test has the same degree of accuracy as current PET scans and lumbar punctures in distinguishing Alzheimer’s from FTD. It would be less expensive and easier.

Alzheimer’s impacts nearly 6 million Americans and comprises two-thirds of dementia cases. FTD includes a broad group of brain disorders often linked with degeneration of the frontal and temporal lobes of the brain. So this New Blood Test May Make Alzheimer’s Diagnosis Easier.

Reference: UCSF (March 2, 2020) “New Blood Test Could Make Alzheimer’s Diagnosis Easier Than Ever”

Read more related articles at: 

Simple Blood Test May be Able to Diagnose Alzheimer’s Disease

Blood test is highly accurate at identifying Alzheimer’s before symptoms arise

How to Pay for a Loved One’s Memory Care and Manage Their Finances

Also read our previous Blogs at: 

How Do I Prepare my Parents for Alzheimer’s?

How Do We Live Our Lives When A Loved One Has Alzheimer’s?

 

 

 

Kirk Douglas

The Latest on Kirk Douglas’ Estate

What is The Latest on Kirk Douglas’ Estate? Wealth Advisor’s recent article entitled “Kirk Douglas Lived Well, Died Rich And May Trigger $200M Los Angeles Range War” explains that Douglas worked steadily in a four-decade period but slowed down after the early 1980s. Since that’s almost 40 years ago, one might think that what would be considered a modest legacy by modern standards would be whittled down considerably. However, Kirk Douglas died extremely rich, despite a long life and decades of semi-retirement.

Douglas was one of the first to ask to participate in the profit of his movies and was one of the first stars to form his own production company. For example, Spartacus was big enough to gross $30 million on its $12 million budget. When he started his company, he refused to pay himself for that film. Instead he took 60% of the profit and wound up about $3 million ahead. His company owned the films and sold off distribution rights.

His widow Anne is now the only shareholder of record. She’s rolled the money into a family trust that over the decades created numerous tiers of holding companies and joint ventures. One of those joint ventures ended up owning half the land under Marina Del Rey’s high-rise Shores apartment complex, a property that cost a reported $165 million to build. The land is nearly priceless.

Now that it’s only Anne, the successor trustees will one day need to decide what to do with the land. She called the shots on the accounting side. Kirk remarked that he didn’t even know where the money was. However, when he found out, he got eager to give it all away. Tens of millions have already been committed to hospitals, schools and theaters.

Estate tax won’t be an issue because Kirk and Anne conducted thorough estate planning so that any wealth that goes to the family will transfer via a trust. That way, they’ll get a portion of the income without triggering estate tax concerns.

Thanks to all of Kirk’s films—many of which he owned like Spartacus—he compiled tens of millions of dollars in cash and stock during his lifetime. In almost 70 years of marital bliss, his planning added up to a lot of marital property. It was good life with good things yet to come.

It’s a testament to the power of long-term thinking. Kirk Douglas’ fortune has remained intact for generations and will undoubtedly keep helping the world for many years to come.

So that is the Latest on Kirk Douglas’ Estate.

Reference:  Wealth Advisor (Feb. 4, 2020) “Kirk Douglas Lived Well, Died Rich And May Trigger $200M Los Angeles Range War”

Read these articles for more information:    Kirk Douglas gives most of $61M fortune to charity, leaving nothing for son Michael

                                                                                             Kirk Douglas leaves most of his $80 million fortune to charity

Also read one of our previous Blogs about other celebrities who left their Estate’s to charity:

George Michael’s Charity Continues

If you are interested in leaving part of your Estate to charity, we also have experience in this area. Visit our Website at:

Charitable Planning In Northeast Florida

 

long term care givers

How Can Long-Distance Caregivers Help Loved Ones?

How Can Long-Distance Caregivers Help Loved Ones? A recent article noted that long-distance caregivers have the same concerns and pressures as local caregivers, perhaps even more. They spend about twice as much on caregiving as people caring for a loved one nearby, because they’re more likely to need to hire help, take uncompensated time off work and pay for travel. A huge challenge for this group is just staying informed and assured that the person needing care is in good hands. As a result, long-distance caregivers must have good communication and a solid team on the ground.

AARP’s recent article entitled “Long-Distance Caregiving: 5 Key Steps to Providing Care From Afar” provides us with five steps to staying informed and effective as a long-distance caregiver and thoughts for implementing the measures.

  1. Be sure you have access to information. Having a means of receiving good information and possessing legal authority to make financial and health-care decisions is critical for all primary caregivers, but it’s even greater for ones caring from a distance. Arrange as much as you can during an in-person visit.
  • Start the discussion on finances and map out with your loved one how to pay for health care and everyday expenses.
  • Ask whether your parent or other senior is able to sign the forms or make the calls necessary to give doctors, hospitals and insurers permission to share information with you or another trusted family member. This should include banks and utilities.
  • Be sure the senior has designated a durable power of attorney for health care and financial decisions.
  • Know what to do in an emergency, as far as access to the home by a neighbor, if needed.
  1. Create your on-the-ground support team. Don’t try to do it all, especially if your loved one has more serious or complicated health issues. In addition to healthcare professionals, ask friends, family and community groups to join a network of caregiving helpmates. Remember to add your loved one as part of the team.
  • Assign roles and tasks, that the members of the team are willing and able to do.
  • Create a list with contact info for everyone and keep it up to date.
  1. Consider hiring a reputable caregiving professional. They’re often called a geriatric care manager, aging life care manager, or eldercare navigator or coordinator. These professionals are frequently licensed nurses or social workers who can also be valuable mediators or sounding boards, when family members disagree on care decisions.
  • Verify the person’s professional certifications, see how long the person has been in the field and request references.
  • Care managers can charge $50 to $200 an hour. Medicare doesn’t cover this service, nor do most health insurance plans. However, if you can handle it financially, an experienced manager may be able to save your family time, money and stress with even a short call.
  1. Find ways to communicate regularly with your local support group and loved one. You should leverage technology. With permission, place video monitors, wearable activity trackers, remote door locks to prevent wandering (if the care recipient has dementia) and even electronic pill dispensers that can tell you if someone has taken the prescribed medications.
  2. Leverage your visits. Nothing’s better than an in-person visit. When you can manage one, come with a list of things you need to know or discuss.
  • Interview possible home aides or house cleaners or meet with social workers or other professionals involved in your loved one’s care to discuss any concerns.
  • Look for signs of abuse, which means monitoring your senior’s checking account and see if there are any irregularities and look for red flags of physical or emotional mistreatment, like bruises, unexplained injuries, or a sudden change in personality. Note if your family member talks about a person you’ve never met who visits often and has been “very helpful.”

Although you may have several practical tasks to tick off your list, it’s important to spend quality time with your loved one. And seek the advice of a qualified elder law attorney, if you have any questions. This is some of the ways Long-Distance Caregivers can  help Loved Ones?

Reference: AARP (Oct. 30, 2019) “Long-Distance Caregiving: 5 Key Steps to Providing Care From Afar”

Read more about this topic at:

Getting Started with Long-Distance Caregiving

8 Tips for Long Distance Care Giving

You can also read one of our previous blogs at:  How your caregiver can get paid and treated fairly

Medicare Mistakes

The High Cost of Medicare Mistakes

The High Cost of Medicare Mistakes can be daunting. A 68-year-old woman knew that she had to sign up at age 65 for Medicare Part A for hospital care and Part B for outpatient care, since she did not have employer provided health insurance from an employer with 20 or more employees. She knew also that if she did not have health insurance from an employer and didn’t sign up immediately, she’d face a penalty with higher Part B and Part D premiums for the rest of her life when eventually she did sign up, reports Forbes in the article “Beware Medicare’s Part B Premium Penalty And Surcharge Traps.”

Here’s where it got sticky: she thought that Medicare provided an eight-month special enrollment period after one job ended to apply penalty free. She is employed on a sporadic basis, so she thought she had a window of time. Between the ages of 65 and 68, she had several jobs with large employers, and was never out of work for more than eight months.

She was out of work for 25 months total between ages 65 and 68, when she was not enrolled in Medicare. She thought that since she was never out of work for more than eight months, she didn’t have to sign up until she officially stopped working and would then enroll penalty free in traditional Medicare Parts A, B, and D.

She had read information on the Medicare website and her interpretation of the information was wrong. It was a costly mistake.

In determining whether you need to permanently pay a Medicare Part B penalty, Medicare counts up all the months between age 65 and the month you first enroll in Part B, even if you have a job with a large employer with no gaps in employment for more than eight months.

She got hit with a 20% lifetime Medicare Part B premium penalty. For every 12 months that you’re not covered by Medicare B after reaching 65 and before you enroll, the penalty is an additional 10%. And making things worse, she was hit with a Medicare Part B penalty based on the cumulative (not consecutive, which is an important difference) 25 months that she went without credible prescription drug coverage.

This is the sort of problem that does not self-resolve or get better over time. In this case, another mistake in timing is going to hurt her. She sold some assets and realized a capital gain in 2018, which increased her Modified Adjusted Gross Income (MAGI). In 2020, she’s going to have to pay the Income Related Monthly Adjustment Amount (IRMAA). If your MAGI, two years before the current year, is less than $87,000, you are exempt from IRMAA in the current year. Her cost: $1,735.20 more this year. Had she instead realized those capital gains over the course of several years, her 2018 MAGI might not have crossed the $87,000 threshold. Most people are not aware of the IRMAA and take capital gains in larger amounts than they need.

This is a harsh lesson to learn, at a time in life when there’s not a lot of flexibility or time to catch up. Talking with an estate planning lawyer about Medicare and about tax planning, as well as having an estate plan created, would have spared this woman, and countless others, from the harsh consequences of her mistakes.

Reference: Forbes (Jan. 29, 2020) “Beware Medicare’s Part B Premium Penalty And Surcharge Traps”

Read More about this from CNBC at: Don’t make these common, costly Medicare mistakes

And from AARP:  How to Avoid Mistakes When enrolling in Medicare

Also check out our previous Blog:  New Medicare Rule Makes it Harder to Receive Home Care

Elder Law

When Do I Need an Elder Law Attorney?

Elder law is different from estate law, but they frequently address many of the same issues. Estate planning contemplates your finances and property to best provide for you and your family while you’re still alive but incapacitated. It also concerns itself with the estate you leave to your loved ones when you die, minimizing probate complications and potential estate tax bills. Elder law contemplates these same issues but also the scenario when you may need some form of long-term care, even your eligibility for Medicaid should you need it.

A recent article from The Balance’s asks “Do You or a Family Member Need to Hire an Elder Law Attorney?” According to the article there are a variety of options to adjust as economically and efficiently as possible to plan for all eventualities. An elder law attorney can discuss these options with you.

Medicaid is a complicated subject, and really requires the assistance of an expert. The program has rigid eligibility guidelines in the event you require long-term care. The program’s benefits are income- and asset-based. However, you can’t simply give everything away to qualify, if you think you might need this type of care in the near future. There are strategies that should be implemented because the “spend down” rules and five-year “look back” period reverts assets or money to your ownership for qualifying purposes, if you try to transfer them to others. An elder law attorney will know these rules well and can guide you.

You’ll need the help and advice of an experienced elder law attorney to assist with your future plans, if one or more of these situations apply to you:

  • You’re in a second (or later) marriage;
  • You’re recently divorced;
  • You’ve recently lost a spouse or another family member;
  • Your spouse is incapacitated and requires long-term care;
  • You own one or more businesses;
  • You have real estate in more than one state;
  • You have a disabled family member;
  • You’re disabled;
  • You have minor children or an adult “problem” child;
  • You don’t have children;
  • You’d like to give a portion of your estate to charity;
  • You have significant assets in 401(k)s and/or IRAs; or
  • You have a taxable estate for estate tax purposes.

If you have any of these situations, you should seek the help of an elder law attorney.

If you fail to do so, you’ll most likely give a sizeable percentage of your estate to the state, an ex-spouse, or the IRS.

State probate laws are very detailed as to what can and can’t be included in a will, trust, advance medical directive, or financial power of attorney. These laws control who can and can’t serve as a personal representative, trustee, health care surrogate, or attorney-in-fact under a power of attorney.

Hiring an experienced elder law attorney can help you and your family avoid simple but expensive mistakes, if you or your family attempt this on your own.

Reference: The Balance (Jan. 21, 2020) “Do You or a Family Member Need to Hire an Elder Law Attorney?”

Read more at:

What Does An Elder Law Attorney Do?

What is Elder Law and How Can an Elder Law Attorney Help Me?

Also read one of our previous blogs at :

Elder Law Attorney Can Help Plan for Long-Term Care Costs

elder financial abuse

Elder Financial Abuse Is Increasing

Elder Financial Abuse Is Increasing. A September 2018 Forbes report said that elder financial abuse would only get worse as we age. With 10,000 people turning age 65 every day for the decade, the demographics include a growing pool of potentially fragile retirees and the elderly, many of whom are susceptible to financial exploitation.

alphabetastock.coms recent article entitled “Elder Financial Abuse Is Rising” says that, although the criminals are out there, a lot of elder financial abuse actually begins in the retirement system, because individuals must accumulate and handle a large amount of money designed to last an entire lifetime. With $14.5 trillion in self-directed retirement accounts in the U.S., it’s a big, enticing target for financial predators.

Elder financial abuse includes all of the frauds and scams targeting seniors and because it’s a hidden crime, many victims opt not to report it. Those that do report the crimes, frequently don’t prosecute.

However, when it comes to trying to promote real changes that will provide some material protections, the investment, insurance, and financial services industries directly or indirectly have been showing some reticence about the potential compliance expense. Some of these companies are lobbying to maintain a status quo—one that’s on a course to see a steady rise in elder financial exploitation.

Many retirement investors think their professional financial advisors are fiduciaries who are legally bound to act in their best interests. However, that’s not always so. Many professional financial advisors need only adhere to a lower legal standard of behavior. They can’t outright tell you a lie—but they can make recommendations that don’t put the customer’s best interests as a top priority.

A GAO study found elder financial abuse to be a growing epidemic. Rather than being able to live out their golden years in safety and financial security, the lack of financial safeguards are leaving an entire (and growing) group of older Americans at risk. These seniors are often left on their own and confused as to how the advisors they entrusted with their financial security are permitted to make moves that are motivated by high commissions and self-interest. These so-called professionals aren’t required by the law to place interests of their clients ahead of their own.

Theft and illegal behavior is one small component of the elder financial exploitation. A bigger part comes from abusive financial practices, such as higher fees and complex and unsuitable advice and recommendations from professional financial advisors who aren’t fiduciaries.

Be sure that you are working with a financial professional who is a fiduciary. Ask your elder law attorney for recommendations.

Reference: alphabetastock.com (January 11, 2020) “Elder Financial Abuse Is Rising”

Read more :   The Rising Menace of Elder Financial Abuse

 Analysis: Financial Elder Abuse is on the Rise

For a longer read an Extensive PDF Pamphlet:  Elder Financial Exploitation

And read one of our previous Blogs:   How to Combat Elder Financial Abuse

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