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.

Every year, Genworth Financial conducts a nationwide survey of long-term care costs. The report detailing the results of the2011 survey has been released and, to no one’s surprise, the cost of care in nursing homes and assisted living facilities has increased.

The Nationwide Trend

In fact, the cost of long-term care has shown a steady increase, on a nationwide basis, since 2005. When you look at the U.S. as a whole, nursing home fees jumped 5.1% from last year to this year.

What About Massachusetts?

Here in Massachusetts, the median annual cost for a private room in a nursing home is in the six figures – $125,925, to be exact. A one-bedroom space in an assisted living facility will set you back $59,400, on average.

What’s Your Plan?

With long-term care costs high and rising, it’s smart to plan ahead for the possibility that you’ll one day find yourself in a nursing home or an assisted living facility.  The main options for paying for care are:

• To pay out-of-pocket, or with funds provided by family members
• To buy a good long-term care insurance policy
• To qualify for Medicaid

What’s the best option for you? An elder law attorney can help you assess your situation and make that determination.

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

When a loved one is diagnosed with Alzheimer’s disease, your family’s life begins to change. Because of the progressive nature of the disease, a person with Alzhiemer’s is in a unique position when it comes to estate planning. Usually, when the initial diagnosis comes in, the patient is still lucid and functioning relatively well; but, the diagnosis itself means that tough times lie ahead. The moment to plan for these tough times is as soon as possible after an Alzheimer’s diagnosis.

This is particularly true if your loved one has no estate plan, but even if there’s an estate plan in place, it needs to be reviewed and likely needs to be updated. Not only does a person with Alzheimer’s need an effective will or revocable living trust, there’s also a need for in-depth incapacity planning.

For instance, who should be in charge of financial matters when your loved one is no longer able to independently manage bank accounts, bills, and property? It’s important to have a Durable Power of Attorney for Finances in place, and it’s also a good idea to make sure the  Power of Attorney allows for Medicaid planning and gives your loved one’s agent the authority to access retirement accounts – these things are generally not included in a basic Power of Attorney.

Then there’s the question of medical care. What kinds of medical care does your loved one want, and what types of care does he or she prefer to avoid? This needs to be spelled out by way of a Living Will, plus a Healthcare Surrogate should be named to interact with doctors and make healthcare decisions for your loved one.

And what about long-term care? Now is the time to explore all the options, from in-home care to adult day care to assisted living facilities and nursing homes. Choosing facilities ahead of time, and putting a plan in place to pay for long-term care, can go a long way toward providing everyone in your family with peace of mind.

If a loved one has recently received an Alzheimer’s diagnosis, now is the time to encourage him or her to meet with an estate planning attorney and make sure all the issues are addressed.

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

We all lead busy lives, and sometimes we’re so overwhelmed just keeping up with the details of our day-to-day existence that planning for the future falls by the wayside. Maybe this is why less than half of American adults have a Will, and I’d be willing to bet that even fewer of us have given more than a passing thought to planning for long-term care. However, long-term care planning is an important concern. Here are three reasons why:

1. Americans are Living Longer than Ever.  Life expectancies have been steadily rising for many years now, but a long life does not automatically mean a healthy one. According to the National Clearinghouse for Long Term Care Information, roughly 70 percent of people over the age of 65 need some form of long-term care.
2. Planning Can Preserve Your Nest Egg. It’s no secret that long-term care is expensive. According to the 2010 Met Life Market Survey of Long-Term Care Costs, the average annual cost for a private room in a Massachusetts nursing home is $95,265. Without a plan in place for how you’ll cover long-term care expenses, it’s all too easy to dissipate your nest egg and burden your loved ones. 
3. Planning Can Provide Relief to Your Family. When someone needs long-term care, and there’s not an adequate plan in place, it’s often that person’s family members who bear the brunt of the situation, both in terms of emotional stress and financial stress. While your loved ones may be more than willing to help out, you can smooth the transition to long-term care for yourself and for them, if you have communicated your preferences for the type of care you want, as well as put in place a way to pay for that care. 

Thinking about the possible need for long-term care certainly isn’t fun, but long-term care planning doesn’t have to be torture. A qualified elder law attorney can help you explore your options and make a plan that meets your needs, as well as the needs of your loved ones.

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

Financial abuse of the elderly is among the most subtle forms of abuse and exploitation of older people, but it is far from rare – according to a recent study, up to one million elderly Americans could be victims of financial abuse each year. What’s worse, a majority of the time, the abusers are caregivers or family members.

So, how do you detect this subtle form of abuse? Here are some signs to watch out for:

• Sudden changes in bank balances or withdrawals of large sums of money
• Disappearance of money or valuables
• A new, unexplained signatory to a bank account
• A sudden change in a Will or other estate planning documents
• A decline in living conditions that is inconsistent with an elder’s financial status

Even better than detecting abuse after it has started is to prevent it from happening in the first place. While there’s no foolproof way to prevent financial abuse, a senior who is isolated can become a particularly vulnerable target. So, if you have an elderly loved one, you can provide a layer of protection by encouraging friends and family members to visit regularly – and keep a watchful eye – and by helping your loved one stay as socially active as possible.

What if you notice signs of financial abuse?

You can call the Massachusetts Elder Abuse Hotline at 1-800-922-2275.

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

In order to qualify for Medicaid benefits, you as an applicant must fall below certain income and asset thresholds. However, not all your assets are taken into account when it comes to determining whether you meet the requirements.

Countable vs. Non-Countable

When you submit an application for Medicaid benefits, your assets fall into two categories: countable and non-countable. Only your countable assets are part of the equation for determining whether you’ll qualify. Medicaid planning is the process of preserving as many of your assets as possible by working within the rules to shift those assets from the “countable” category into the “non-countable” category prior to submitting your Medicaid application. In this way, you can qualify for benefits while salvaging at least a portion of your property and savings to pass on to your loved ones.

Is Medicaid Planning Legal and Ethical?

Those who don’t understand Medicaid planning often express concerns about whether it’s a legal and ethical way to qualify for benefits. The truth is, the Medicaid program itself has built-in rules that allow for the preservation of assets. Medicaid attorneys spend a great deal of time learning these rules and keeping up with changes in the law so that they can help their clients apply the rules in a way that allows clients to preserve as much of their hard-earned savings as possible. Transactions that occur as part of the Medicaid planning process are disclosed on a client’s Medicaid application, and nothing is hidden. Medicaid attorneys take care to ensure that the strategies they use to help their clients are supported by the law and are communicated clearly to all the parties involved.

For more information on Medicaid eligibility or the Medicaid planning process, you’ll want to talk to an experienced Medicaid planning attorney.

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

“Alzheimer’s is a terminal disease…If your loved one has three months to live and wants to eat chocolate for dinner or sing ‘Amazing Grace,’ or wake up when they want, why not let them?” These are the kinds of questions asked in an ongoing study by Jeannine Forrest and Dan Kuhn aimed at rethinking the care nursing homes provide to  patients with Alzheimer’s and dementia.

The authors of the study, highlighted in a recent Chicago Tribune article, advocate a shift away from traditional, restrictive enforcement of nursing home regulations and toward regulations that focus on providing comfort care to Alzheimer’s and dementia patients. Comfort care can make a positive difference in all areas of a patient’s life, from how much background noise he or she experiences to how medication is dispensed to how the patient is bathed and fed. 

For example, “If comfort is the goal, then you don’t have to put 1,200 calories of pureed food and yucky food supplements in front of a frail woman and expect her to eat that,” Forrest said. “If she gets the calories by eating macaroni and cheese and chocolate pudding, so be it. If people aren’t on a restrictive diet, giving choices and snacks as they are hungry prevents weight loss and diminishes aggressive behavior.”

The result? Improved quality of life for patients facing an impossibly difficult disease.

For more information about Alzheimer’s care in general and comfort care in particular, you can visit www.alz.org/manh.

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

Family life means adjusting and adapting to all kinds of changes.  Life changes when you get married, it alters dramatically when a new baby is born, and it shifts again in the event of a divorce or when your children go off to college.  As our parents age and become less able to care for themselves, yet another important change takes place. This time, we as adult children often take on the role of our parents’ caregivers.  This can be an uncomfortable transition, especially when it comes to finances. A recent  Bankrate feature discusses some of the steps you can take to help your parents with their finances as they  get older.  Here are a few of the highlights.

• Get involved before it’s a necessity.  The time to start talking about your parent’s finances is while they’re still healthy and functioning well. If your parents don’t have an incapacity plan or an estate plan, there’s still time to put one in place. Plus, engaging in these discussions now lays the groundwork for tackling more difficult financial issues if your parents’ health begins to decline. 
• You should have Power of Attorney for your parent. In case of a temporary (or a permanent) health issue, you’ll want to be able to make sure your parents’ bills are paid and that their finances are taken care of.  As agent under a Durable Financial Power of Attorney, you’ll have the authority to do this. Your parents might also want to consider naming you co-trustee of their revocable living trust. This gives you the flexibility to help manage their finances, even if it’s not necessary for them to completely relinquish control of their finances. 
• Court intervention should be a last resort. What if you have a mom or dad who wants to remain in control, but they are beginning to make financial decisions that are detrimental? You might want to employ a strategy like making sure there’s a limited amount of funds in your parent’s checking account, or try other non-legal strategies before seeking guardianship or conservatorship.

For more information on how you can help your aging parents, you can talk to an experienced elder law attorney.

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