Long-Term Care Costs and Your Estate Plan
A Good Estate Plan Takes Into Account Long-Term Care Costs

Long-Term Care Costs and Your Estate Plan

There are many misunderstandings about long-term or nursing home care and how they impact your estate plan. A good estate plan will factor in the financial and legal impacts of long-term care costs. The article “Five myths about nursing home costs and estate planning” from The Sentinel seeks to clarify the facts and dispel the myths. Some of these estate planning truths may be a little hard to hear, but they are important to know.

Myth One: Before any benefits can be received for nursing home care, a married couple must have spent at least half of their assets and everything but $120,000. If the person receiving nursing home care is single, they must spend almost all assets on the cost of care, before they qualify for aid.

Fact: Nursing homes have no legal duty to advise anyone before or after they are admitted about this myth.

Several opportunities to spend money on items other than a nursing home, include home improvements, debt retirement, a new car and funeral prepayment. An elder law attorney will know how to use a Medicaid-compliant annuity to preserve assets, without spending them on the cost of care, depending on state law.

There are people who say that an attorney should not help a client take advantage of legally permitted methods to save their money. If they don’t like the laws, let them lobby to change them. Experienced elder law and estate planning attorneys help middle-class clients preserve their life savings, much like millionaires use CPAs to minimize annual federal income taxes.

Myth Two: The nursing home will take our family’s home, if we cannot pay for the cost of care.

Fact: Nursing homes do not want and will not take your home. They just want to be paid. If you can’t afford to pay, the state will use Medicaid money to pay, as long as the family meets the eligibility requirements. The state may eventually attach a collection lien against the estate of the last surviving homeowner to recover funds that the state has used for care.

A good elder law attorney will know how to help the family meet those requirements, so that the adult children are not sued by the nursing home for filial responsibility collection rights, if applicable under state law. The attorney will also know what exceptions and legal loopholes can be used to preserve the family home and avoid estate recovery liens.

Myth Three. We’ve promised our parents that they’ll never go to a nursing home.

Fact: There is a good chance that an aging parent, because of dementia or the various frailties of aging, will need to go to a nursing home at some point, because the care that is provided is better than what the family can do at home.

What our loved ones really want is to know that they won’t be cast off and abandoned, and that they will get the best care possible. When home care is provided by a spouse over an extended period of time, often both spouses end up needing care.

Myth Four: I love my children equally, so I am going to make all of them my legal agent.

Fact: It’s far better for one child to be appointed as the legal agent, so that disagreements between siblings don’t impact decisions. If health care decisions are delayed because of differing opinions, the doctor will often make the decision for the patient. If children don’t get along in the best of circumstances, don’t expect that to change with an aging parent is facing medical, financial and legal issues in a nursing home.

Myth Five. We did our last will and testament years ago, and nothing’s changed, so we don’t need to update anything.

Fact: The most common will leaves everything to a spouse, and thereafter everything goes to the children. That’s fine, until someone has dementia or is in a nursing home. If one spouse is in the nursing home and receiving government benefits, eligibility for the benefits will be lost, if the other spouse dies and leaves assets to the spouse who is receiving care in the nursing home.

A fundamental asset preservation strategy is to make changes to the will. It is not necessary to cut the spouse out of the will, but a well-prepared will can provide for the spouse, preserve assets and comply with state laws about minimal spousal election.

When there has been a diagnosis of early stage dementia, it is critical that an estate planning attorney’s help be obtained as soon as possible, while the person still has legal capacity to make changes to important documents.

The important lesson for all the myths and facts above: see an experienced estate planning elder law attorney to make sure you are prepared for the best care and to preserve assets.

Learn more about long-term care asset protection planning.

Reference: The Sentinel (May 10, 2019) “Five myths about nursing home costs and estate planning”

Should You Get Personal Care Agreement to Care for Mom?
Personal Care Agreement for Mom

Should You Get Personal Care Agreement to Care for Mom?

Using a personal care agreement to care for a loved one is a great way to get compensated for the effort while at the same time preserving the loved one’s assets. Families often expect to care for relatives, thinking that it is part of their duty as a daughter or son, niece or nephew. Using a personal care agreement often makes sense, says AARP Bulletin’s article “Creating a Personal Care Agreement as a Family Caregiver,” if the amount of care is a few hours here and there, or paying a bill or running an errand or two.

However, what happens when a parent needs far more intensive care, like having their meals prepared, monitoring medications and help with daily activities of life like bathing, getting dressed and walking within the home?

It costs about $170 per shift for home maker or health aid services. Few of us are able to write that check.

Some children move in with their parents in an effort to make caring for them easier. That’s when the pay issue often arises. The caregiver may have to give up opportunities for their career, Social Security earnings and the chance to add to their own retirement savings. When the parent dies, the caregiver may find themselves without a home or a job. In this case, payment of some kind seems fair. That may also be true for adult children who take an ailing parent into their home.

The problem is, older people with limited income may not have the ability to pay for home care. There are public programs to pay for caregivers, including a family member, although not a spouse. Every state has different programs. Some long-term care insurance policies may cover a portion of home care costs. If these options are not available, then the family may have to decide whether to pay.

Here is one scenario where things go wrong fast: a daughter moves into her mother’s house, who pays her without discussing it with any other members of the family. When siblings find out, there’s a big family fight. If there is no written agreement, the payments may be considered gifts from Medicaid’s perspective, and could delay a parent’s eligibility for nursing home coverage.

The best option is to have a financial agreement in place. The questions to consider include:

  • Should the room and board be included as part of compensation, if the person is living with the aging parent?
  • Will the family pay for the caregiver’s health insurance?
  • Should there be time off for the sibling who takes the parent into their home?
  • What can the other siblings do to help?

The paid caregiver family member is an employee of the parent, and their income needs to be reported as taxable. The parent may need to file paperwork and pay employer taxes or hire a company that can manage the bookkeeping. The use of a contract and forms may feel overwhelming at first, but there will be many difficulties in the future avoided by doing this right the first time.

Learn more about the benefits of a personal care agreement.

Reference: AARP Bulletin (March 5, 2019) “Creating a Personal Care Agreement as a Family Caregiver”

Good Planning Avoids the Devastating Costs of Long-Term Care

If you don’t have a plan for long-term care, welcome to the club. However, you may not want to be a member of this club, if and when you need long-term care. A recent report from the U.S. Department of Health and Human Services found that people age 65 and older have a very good chance—70%—of needing long-term care. Despite this, most people are not putting plans in place, according to an article from Westfair Online titled Keybank poll reveals clients aren’t planning for long term care.”

This is true for people with assets exceeding $1 million and for people with more modest assets. In a study by Keybank, fewer than a quarter of high net-worth clients had plans in place for long-term care. This poses real financial risks, to the individuals and their families.

Consider the costs of long-term health care. One study from Genworth Financial reports that in 2017, the national median cost of a home health aide was roughly $49,000 a year, assisted living facilities could cost $45,000 (that’s not including medical services), and a private room in a nursing home came close to $100,000 annually. Costs vary by region, so if you live in an expensive area, those costs could easily go much higher.

Why don’t people plan ahead for long-term care? Perhaps they think they will never become ill, which is not the case. They may think their health insurance will cover all the cost, which is rarely the case.  They may believe that Medicare will cover everything, which is also not true.  We have seen cases come in the office where mom or dad didn’t plan and ended up spending all of their assets on long-term care.  No legacy was left to the kids.  Very sad.

Everyone’s hope is that they are able to be at home during a long illness, or during their last illness. However, that’s often not a choice we get. This is a topic that families should discuss well in advance of any illness. Talking with family about potential end-of-life care and decisions is important for setting expectations, delegating responsibilities and avoiding unpleasant surprises.

The other part of a long-term care discussion with family members needs to be about estate plans and decisions about the disposition of assets. Everyone should have a will, and all information including deeds, trusts, bank and investment accounts and digital assets should be discussed with the family. You’ll also need a power of attorney and health care proxy to carry out your wishes. An experienced estate planning attorney can help create an estate plan and facilitate discussions with family members.

Long-term planning is an on-going event. Life changes, and so should your long-term care plan, as well as your estate plan. You should also keep communications open with your family. They will appreciate your looking out for them before and after any illness.

Reference: Westfair Online (Sep. 7, 2018) Keybank poll reveals clients aren’t planning for long term care