If you are the loved one of an elderly Charlton resident, you may be concerned about how your loved one will be able to pay for health care or long-term nursing care in the future. If you are concerned, you are not alone. The cost of health care and long-term nursing care in America is among the highest in the world. The majority of Americans struggle with financing routine medical care throughout their lives.

Paying for long-term care as an elderly American can result in the depletion of a lifetime of savings in a very short time. One option for your elderly Charlton loved one may be the Medicaid program. Although getting approved for the program may take some planning, if approved it may cover the cost of long-term care for your loved one.

Most people do not realize just how expensive long-term care can be. The bill for just a one year stay in a long-term care facility can easily exceed $100,000. For the average American, that may deplete their savings in the span of just a few short years, or less. Private health insurance coverage, which many people depend on, may not even cover long-term care, or may cap the coverage for long-term care, leaving the insured without coverage.

The Medicaid program may be the answer; however, applying can be like walking through a mine field. Eligibility for Medicaid is based on the applicant’s income and assets, among other things. If your elderly loved one has any assets or income, you may need to consult with your Charlton elder law attorney ahead of time in order to develop a plan that will both ensure approval, and shield the assets and/or income, of your loved one.

The Law Offices of James A. Miller is a member of the American Academy of Estate Planning Attorneys.

If you have an elderly parent who is still living in their Shrewsbury home and you are concerned that they are not able to properly care for themself, you may wish to discuss the option of moving to a retirement facility. Be prepared, however, as this may not be met with enthusiasm if not approached with care. Your parent likely feels that their home represents their independence. Moving, therefore, equals giving up their independence. Because this can be such an emotional subject, try approaching it from a non-emotional angle. What will it cost to remain in the home in the years to come? Do a little research and get estimates on the following prior to discussing the subject with your parent:

• Building ramps and opening up doorways
• Modifications to the home such as the addition of hand rails, grab bars and additional lighting
• A chair lift if the home has a second story
• Home health aids or nursing services
• Cleaning services
• Transportation
• Meal preparation

While there may be additional modifications or services needed, these can provide you with a general estimate of what it will cost to remain in the home. Sit down with your parent after you have all the facts and figures and explain what it will cost to stay in the home versus the cost of selling the home and moving to a retirement facility. When your parent sees how remaining in the home will rapidly deplete their estate assets, they may be more open to the possibility of moving from their Shrewsbury home.

The Law Offices of James A. Miller is a member of the American Academy of Estate Planning Attorneys.

If you are like many residents of Gardner, you may reach a point in your life when you are faced with the agonizing decision to step in and petition for guardianship over an elderly family member or loved one. Wanting to help is the easy part. Deciding that a guardianship is necessary is not as easy because it entails taking away your loved one or family member’s independence. Being able to make decision for ourselves is something we all cherish. Deciding to take away that ability can be a heart wrenching, but necessary, decision.

If you have a loved one who appears to be unable to make daily decisions, deciding to step in can be a matter of safety, not interference. Not only could your loved one suffer physical injuries if you do not step in, but other, less well meaning, individuals could take advantage of your loved one.

State law determines what options are available in this situation. Both guardianship and conservatorship are common options. While the names are frequently used interchangeably, they often have different legal meanings. Typically, a conservator has legal authority over the estate of the ward, or person who needs protection and assistance, while a guardian has legal authority over the person of the ward. In other words, as guardian, you would likely be able to make decisions such as where your loved one will live and which physician he or she will use. Becoming a guardian requires court approval. If you are concerned that a family member or loved one is in need of a guardian, consult with a Gardner elder law attorney right away.

The Law Offices of James A. Miller is a member of the American Academy of Estate Planning Attorneys.

Start the financial planning process now for long term care in order to offer protection to you and your family in the future. There is no single way of telling if or when long terms care is or is not going to be needed. However, it is a good idea to begin preparations now to ensure financial security and to avoid emotional heartaches. While we would like to believe our families will step up to the plate and bring us into their homes, the reality is paying for long term care is what happens.

Costs for long term care, or short term care in a nursing home, add up quickly. This is particularly true in the case of nursing home expenses. The stress associated with these costs can be averted, though, with proper financial planning in place. This allows for asset protection for you, as well as comfort for your family.

Speak to your estate planning attorney about which financial planning methods would work best for you, your current situation and your family. In some cases, it might be a good idea to start a savings account, or creating a trust might be a better idea. Keep in mind your estate planning attorney is going to go over many methods with you and they may suggest you use more than one. Avoid depending on just one option, like an insurance policy for example, because you may not qualify. Once you and your estate planning attorney have listed financial planning options, research them thoroughly to ensure they truly are good choices for your overall financial picture. During your research process, ask yourself the following questions:

• How soon do you believe you need long term care, and what would be the associated costs for home care versus nursing home care.
• What kind of assistance do you believe you’ll need?
• Have you suffered an accident or an illness that would bring up the need for long term care?
• Do you have family members living close-by that could offer help, or are your needs specially centered on professional assistance?
• Have you been diagnosed with a medical condition that may require long term care as it progresses?

These are just some of the questions to address when performing your research. Discuss each of your findings with your estate planning attorney. It may be necessary to bring your primary care physician into the conversation if they are the representative eluding to the fact that long term care could become a part of your reality in the future.

The Law Offices of James A. Miller is a member of the American Academy of Estate Planning Attorneys.

Do you or a loved one need to move into a nursing  facility in the near future? If so, do you understand how much nursing home expenses are and what these expenses cover? Have you planned for long term care, to include nursing home expenses in the event that it is necessary to move into one?

These questions are difficult to answer, there’s no doubt about that. Times are changing drastically, including our life expectancies and how often family members are able to step in and offer primary care. Because we are living longer and we can’t depend on family in comparison to decades ago, nursing homes are becoming more and more of a reality in a number of households.

Because children with aging parents are not taking them into their homes as they once did so commonly in the past, nursing homes have been depended on for long term care and other rehabilitation needs. Some of these nursing homes can be quite expensive, and could go up to $10,000 per month or more. Most households cannot afford such nursing home expenses, so they must plan ahead.

The first line of defense is securing an insurance policy that will cover long term care. These policies come at a premium, though, and are often difficult to afford. You must also meet certain health requirements in order to qualify. If you are not able to afford the policy or do not meet the health requirement (or both), are there other options?

Some individuals rely upon Medicaid to cover their nursing home expenses. Individuals must go through an enrollment process where they must show a medical need, they must meet the income standards and they must adhere to the assets standards. This is tricky for those who have accumulated a lot of assets in the way of collectibles or properties, but do not have a lot of regular income coming in.

Confer with your estate planning attorney about how to meet these criteria, as well as what other options you can explore. Also, inquire regarding what is included in these costs. There are suggestions in place to start planning for nursing home expenses early on in the form of creating a trust. That way, the funds are there to cover whatever your insurance policy does not pay for. Or, if you do not have an insurance policy, there are funds available to cover the nursing home expenses.

The Law Offices of James A. Miller is a member of the American Academy of Estate Planning Attorneys.

Many senior citizens facing catastrophic nursing home expenses are often forced to turn to Medicaid, the need-based, state run program that helps pay for medical costs for those who meet asset and income limitations. But why would you need a Medicaid attorney before, during or after applying for Medicaid assistance?

1. Look-back Periods

Medicaid has rules, a statute of limitations of sorts, that prevent you from selling or transferring  assets below fair market value to qualify for benefits. It’s known as a look-back period, and in Massachusetts, Medicaid officials  look-back for a period of 60 months prior to a Medicaid application to review transfers, gifts and sales of property during this time.

A Medicaid attorney can help advise you of transfer and gifting strategies that will help you retain your family’s assets while maintaining eligibility for benefits.

2. Medicaid Planning

Massachusetts seniors have some options available to them in order to protect their assets, their estates and their loved ones. By using Medicaid planning, families can help plan for the rules and regulations of Medicaid such as look back period, ineligibility periods and more.

3. Inadvertent Ineligibility and Consequences

An action as seemingly innocuous as taking out a home equity loan to pay for a home renovation project could result in a period of ineligibility for Medicaid benefits. Why? In many cases, your primary residence may be exempt from Medicaid’s resource limits if a spouse is living in the home. On the other hand, the proceeds from the loan may not be considered exempt, and could be required to be spent on nursing home expenses.

A Medicaid planning attorney is able to help an individual maintain eligibility for Medicaid while protecting a family’s assets. Medicaid planning is a highly specialized area of the law, and using an estate planning attorney with Medicaid planning expertise is recommended to ensure the plans mesh within a comprehensive estate plan.

The Law Offices of James A. Miller is a member of the American Academy of Estate Planning Attorneys.

In part one of our two-part series on financial abuse of the elderly we talked about the warning signs that may signal that something is amiss with your elderly loved one, neighbor or friend.

Typical in such abuse cases is withdrawal from some or many of their normal social activities, a change in the way or frequency they communicate with you, maybe a change in their phone number, or not wanting to tell you much about what is going on in their life.

Con artists often try to convince their victims that “I’m the one you really need, and only me.”  Then they try to isolate their victims from the elder’s friends and relatives so they can make their moves without influence from people who truly care about the elder.

Whereas the “communications” and “social” signs may be somewhat difficult to detect, especially if they happen gradually, there are other warning signs that are much more indicative that something is really wrong:

• A change in a Will or other legal document.
• Someone poses as a caregiver and suddenly becomes involved in the elder’s life and convinces the elder that “I’m the one who needs to take care of you” or “Your family doesn’t care about you the way I do”.
• The elder suddenly has a new “boyfriend” or “girlfriend” or “best friend”.
• Someone you don’t know suddenly moves in with the elder person.

Precautions you can take

If you’re a friend or neighbor of an elder you can simply make yourself more aware of the person’s regular routine and watch for any signs that things may not be normal.

If you’re a son, daughter or relative, here are some steps you can take to prevent financial abuse of your elderly loved ones:

• Assign a family member or close friend to learn about their financial affairs: what assets they have; whose name is on titles and deeds; who has signing authority on checking and savings accounts, what retirement accounts they have, etc.
• Educate the elder on what to watch for, perhaps with a case study of elder financial abuse.  Make sure that he or she knows the warning signs, especially if someone makes an investment offer that is too good to be true, or if someone offers to be their caregiver or to help them with financial matters.
• If there is a Will or other legal Estate Planning documents, make an agreement with the elder that you will review these documents on a regular basis.
• Re-visit the above matters on a regular basis: every six months or so.
• Visit the person regularly (or have someone you trust do so) and keep in touch by phone, always asking if anything is new or exciting in their lives.

As we stated in part one, the best deterrent is vigilance: always being aware.

The Law Offices of James A. Miller is a member of the American Academy of Estate Planning Attorneys.

Many of us approach the idea of aging with the assumption that our children will be there to provide support and care in case our health declines. But what if you don’t have children – or it has become clear that you might not be able to rely on your children as you age?

Nearly twenty percent of baby boomers are childless, and having children does not necessarily guarantee that they’ll be there to help with healthcare concerns, household tasks, decision making, and all the other areas in which you might need assistance as you age.

If you won’t have children to lean on and to handle care giving responsibilities as you age, it’s essential that you surround yourself, as much as possible, with friends and loved ones you can rely on. And it’s a good idea to include some trustworthy friends from younger generations. When you rely on a “chosen family” such as this to help you meet your needs as you age,  a well-thought-out incapacity plan is all the more important. At the very least, you’ll need:

• A Durable Power of Attorney for Finances that allows a trusted agent, chosen by you, to make financial decisions on your behalf in case you can’t do so yourself.
• A Healthcare Proxy that allows you to choose someone you can rely on to direct your medical care if you’re incapacitated.
• A HIPAA Release that allows the person you put in charge of your health care to access your medical records and communicate with your doctors.
• A Living Will with which you communicate your preferences when it comes to end-of-life care.

In addition to these documents, you may want to consider a living trust. And you’ll also want to look into your options for long-term care (and for paying for care), so that you and those close to you know your preferences if the need arises for such care.

A qualified elder law attorney can be a valuable resource when it comes to preparing for the needs you’re likely to have as you age.

The Law Offices of James A. Miller is a member of the American Academy of Estate Planning Attorneys.

Has your aging mom or dad extracted “the Promise” from you? This is the topic of a recent New York Times The New Old Age blog. What is “the Promise”? It’s swearing that you’ll never put your parent in a nursing home – no matter what.  As parents age, this can turn out to be a difficult, if not impossible, vow to keep.

With the bad reputation nursing homes have acquired, there’s been a rise in the popularity of assisted living facilities. However, these facilities are geared toward providing minimal support and assistance to elders who are still mostly able to be independent. For example, as a rule, staff can hand out medication at the appropriate time, but can’t actually administer medication – a problem for a resident with dementia who then forgets to take the medication.

The blog points out that, just as an assisted living facility might not be the right fit for every elderly person, not every nursing home is a nightmare. There are good nursing homes, and nursing home care is appropriate for some seniors.

So, how do you figure out whether your mom or dad needs an assisted living facility, a nursing home, or some other form of care? There are a few things you can do:

• To the extent possible, keep in touch with your parent’s doctor, and make sure you have accurate information on their medical condition.
• Thoroughly investigate your options and ask detailed questions about the exact type of care that’s provided at each facility you’re considering.
• Check with an elder law attorney, who can give you solid information on the realities of different types of care, and who can help you and your parents position yourselves to pay for care when the time comes.

The Law Offices of James A. Miller is a member of the American Academy of Estate Planning Attorneys.

An incapacity plan accomplishes a lot of things.

• With a living trust and/or a durable power of attorney, you can appoint someone you trust to be in charge of your finances in case you become disabled.
• With a Medical Directive you can choose which courses of treatment you want and refuse those you do not want.
• With a healthcare proxy, you can name a reliable friend or family member to make medical decisions on your behalf if you’re not in a position to make those decisions yourself.

However, unless your incapacity plan includes certain specific language, your agent or trustee won’t be able to perform one important function – engaging in Medicaid planning on your behalf. This language identifies “Medicaid triggers,” certain events let your agent or trustee shift assets out of your name and into forms of ownership that aren’t counted for Medicaid qualification purposes.

Without an incapacity plan that anticipates the need for Medicaid planning, you could be forced to dissipate your property to pay for nursing home care instead of qualifying for Medicaid coverage. The result is that your life savings could go to a nursing home rather than being used to provide for your spouse’s financial independence or being preserved for your children or grandchildren.

Make sure you have an incapacity plan that anticipates all your needs: meet with an estate planning attorney sooner rather than later.

The Law Offices of James A. Miller is a member of the American Academy of Estate Planning Attorneys.