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.

Placing a loved one in a nursing home is bad enough without having to worry about the tremendous expense involved with it. Oftentimes, these costs are significant enough to deplete most, if not all, of the assets of the individual. When a nursing home is the only option, the extra expense has to be met somehow. So what can you do to keep these expense down?

It is tempting to allow the nursing home staff to attend to your loved one’s every needs. But this is the same as employing a full-time assistance to take care of your every desire. If you take some of these duties on yourself, you can lower the excess fees that are being charged for performing additional duties above and beyond their normal responsibilities.

It is quite possible that your family qualifies for a type of government assistance, including Medicare or Medicaid. You will want to consult with the human resources office of the nursing facility to see what the qualifications are. These programs are largely based on the assets and any income that the individual receives.

Having supplemental insurance in place will greatly reduce the cost of the facility. Many of these policies are designed to pay the monthly bill , regardless of how much it is. The key is to lock in these policies early on before they are needed. The cost of the policy might seem wasteful while it is not being used, but once it is enforced you will see a dramatic savings.

Your loved one could qualify for another type of assistance. If they have served in the military during wartime, they could be eligible for assistance through the VA for the duration of their stay. The Veterans Administration has supplement payments available for those who served this country during a period of conflict. Monies are paid directly to the facility to ensure that they are being utilized for the intended need. The filing process requires proof of their service through proper documentation, but the payout could be enough to make up the difference that you are lacking in income each month.

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

Finding a nursing home for a loved one can be a very difficult situation. After all, not many people have a long-term goal of moving into a nursing home when they get older. Many times, the search for a nursing home happens after someone is unable to live in a different setting such as at a rehab center or an assisted living home. That means that the search is often done under the gun which makes it very difficult to choose the right place. For that reason, it makes sense to investigate the options in advance so that you have more choices. Here are some tips to remember.

First, make sure that the location is convenient to that you can frequently check in on your loved one. One of the biggest issues with nursing homes is that family and friends have to come to visit often enough to make sure that the person is getting high-quality care. Plus, your loved one certainly doesn’t want to be dropped off at a nursing home and rarely visited.

If you can get references from friends and family that you trust, that is a great way to start your search for a good nursing home. Ask around and see what locations people think are great as well as the ones they would stay away from.

Do some online searching to see what other people have thought about particular nursing homes. There are many different sites which offer reviews done by real people who have had interaction with particular nursing homes.

You should tour the nursing home so that you can see how the staff is treating the residents. You should also speak with the nursing home administrator to find out how things are done and get a good feel for their quality of care. It should be very simple to drop in unannounced in the middle of the week and be able to take a look around so that you get a much more objective view.

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

John’s mom, Mary, had always been fiercely independent. In the years since John’s dad passed away, Mary had insisted on living on her own, and had maintained a very active lifestyle. However, as she entered her eighties, John started noticing some changes.

For one thing, his mom’s house started looking a little shabby. Nothing shocking or unsanitary, but the house was no longer as spic-and-span as she’d always kept it. Plus, the laundry started piling up, and John noticed that food was staying in Mary’s kitchen for a suspiciously long time – she wasn’t cooking for herself like she used to.

John finally grew concerned enough to talk to his mother, and found out that she was getting tired much more easily than before, and she just wasn’t physically able to keep up with all of her household tasks. John explored the options, and the solution was rather simple – a home health aide was hired to come into Mary’s house and take care of the cooking, cleaning, and laundry for several hours each week.

As our parents age, the potential need for long-term care becomes more of a reality. It’s easy to see that prospect as scary and unsettling, but it doesn’t have to be. Long-term care does not necessarily mean nursing home care. It actually encompasses a range of options, from in-home care to assisted living facilities to nursing homes.

What’s important is to be aware of changes in your aging parent’s health and lifestyle, to educate yourself about the different types of long-term care that are available, and to be ready to step in and help your mom or dad make the transition to whatever form of care is needed when the time comes.

If you’re concerned that your parent or another loved one is facing the need for long-term care, consider talking to an elder law attorney. He or she can help you understand the options and help you address another potentially daunting issue – paying for care.

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