Estate Planning Blog Articles

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Can I Restructure Assets to Qualify for Medicaid?

Some people believe that Medicaid is only for poor and low-income seniors. However, with proper and thoughtful estate planning and the help of an attorney who specializes in Medicaid planning, all but the very wealthiest people can often qualify for program benefits.

Kiplinger’s recent article entitled “How to Restructure Your Assets to Qualify for Medicaid says that unlike Medicare, Medicaid isn’t a federally run program. Operating within broad federal guidelines, each state determines its own Medicaid eligibility criteria, eligible coverage groups, services covered, administrative and operating procedures and payment levels.

The Medicaid program covers long-term nursing home care costs and many home health care costs, which are not covered by Medicare. If your income exceeds your state’s Medicaid eligibility threshold, there are two commonly used trusts that can be used to divert excess income to maintain your program eligibility.

Qualified Income Trusts (QITs): Also known as a “Miller trust,” this is an irrevocable trust into which your income is placed and then controlled by a trustee. The restrictions are tight on what the income placed in the trust can be used for (e.g., both a personal and if applicable a spousal “needs allowance,” as well as any medical care costs, including the cost of private health insurance premiums). However, due to the fact that the funds are legally owned by the trust (not you individually), they no longer count against your Medicaid income eligibility.

Pooled Income Trusts: Like a QIT, these are irrevocable trusts into which your “surplus income” can be placed to maintain Medicaid eligibility. To take advantage of this type of trust, you must qualify as disabled. Your income is pooled together with the income of others and managed by a non-profit charitable organization that acts as trustee and makes monthly disbursements to pay expenses on behalf of the individuals for whom the trust was made. Any funds remaining in the trust at your death are used to help other disabled individuals in the trust.

These income trusts are designed to create a legal pathway to Medicaid eligibility for those with too much income to qualify for assistance, but not enough wealth to pay for the rising cost of much-needed care. Like income limitations, the Medicaid “asset test” is complicated and varies from state to state. Generally, your home’s value (up to a maximum amount) is exempt, provided you still live there or intend to return. Otherwise, most states require you to spend down other assets to around $2,000/person ($4,000/married couple) to qualify.

Reference: Kiplinger (Nov. 7, 2021) “How to Restructure Your Assets to Qualify for Medicaid”

Should I Get a Medical Alert System?

Many seniors live on their own without grown children nearby to assist them when they have a medical emergency. These individuals can really benefit the most from a medical alert system.

Know Techie’s recent article entitled “Should every senior citizen own a medical alert system?” gives us some reasons why every senior citizen should have a medical alert system.

A medical alert system is a simple device that monitors a person in their home and sends an electronic signal, if the emergency button is pressed. At the call center, a medical professional responds to the call. If the person can’t talk, help is sent.

Alert System Features. A medical alert system for seniors should have the following features:

  • Ease of use
  • It should be comfortable to wear and water-resistant
  • Have a long-lasting battery and GPS
  • 24/7 live assistance; and
  • Automatic fall detection.

It is also important to look at the alert’s attractiveness because some elderly fear the stigma associated with the medical alert system.

Promotes Peace of Mind. A caregiver and/or a family member will have peace of mind. If anything happens, they will have access to immediate assistance. This can improve a senior’s quality of life.

Emergency Help. Every minute matters in an emergency. A medical alert system will ensure that the seniors can access medical help right away. Every call center has experienced health experts to handle any situation.

If you don’t have a caregiver, the thought of having continuous monitoring can give you peace of mind.

Reference: Know Techie (Dec. 11, 2021) 30

What Taxes Have to Be Paid When Someone Dies?

The last thing families want to think about after a loved one has passed are taxes, but they must be dealt with, deadlines must be met and challenges along the way need to be addressed. The article “Elder Care: Death and taxes, Part 1: Tax guidance for administering a loved one’s estate” from The Sentinel offers a useful overview, and recommends speaking with an estate planning attorney to be sure all tasks are completed in a timely manner.

Final income tax returns must be filed after a person passes. This is the tax return on income received during their last year of life, up to the date of death. When a final return is filed, this alerts federal and state taxing authorities to close out the decedent’s tax accounts. If a final return is not filed, these agencies will expect to receive annual tax payments and may audit the deceased. Even if the person didn’t have enough income to need to pay taxes, a final return still needs to be filed so tax accounts are closed out. The surviving spouse or executor typically files the final tax return. If there is a surviving spouse, the final income tax return is the last joint return.

Any tax liabilities should be paid by the estate, not by the executor. If a refund is due, the IRS will only release it to the personal representative of the estate. An estate planning attorney will know the required IRS form, which is to be sent with an original of the order appointing the person to represent the estate.

Depending on the decedent’s state of residence, heirs may have to pay an Inheritance Tax Return. This is usually based on the relationship of the heirs. The estate planning attorney will know who needs to pay this tax, how much needs to be paid and how it is done.

Income received by the estate after the decedent’s death may be taxable. This may be minimal, depending upon how much income the estate has earned after the date of death. In complex cases, there may be significant income and complex tax filings may be required.

If a Fiduciary Return needs to be filed, there will be strict filing deadline, often based on the date when the executor applied for the EIN, or the tax identification number for the estate.

The estate’s executor needs to know of any trusts that exist, even though they pass outside of probate. Currently existing trusts need to be administered. If there is a trust provision in the will, a new trust may need to be started after the date of death. Depending on how they are structured, trust income and distributions need to be reported to the IRS. The estate planning attorney will be able to help with making sure this is managed correctly, as long as they have access to the information.

The decedent’s tax returns may have a lot of information, but probably don’t include trust information. If the person had a Grantor Trust, you’ll need an experienced estate planning attorney to help. During the Grantor’s lifetime, the trust income is reported on the Grantor’s 1040 personal income tax return, as if there was no trust. However, when the Grantor dies, the tax treatment of the trust changes. The Trustee is now required to file Fiduciary Returns for the trust each year it exists and generates income.

An experienced estate planning attorney can analyze the trust and understand reporting and taxes that need to be paid, avoiding any unnecessary additional stress on the family.

Reference: The Sentinel (Dec. 3, 2021) “Elder Care: Death and taxes, Part 1: Tax guidance for administering a loved one’s estate”

Can Fluffy Come to the Nursing Home with Me?

Several studies show the benefits of pets, and senior care communities are increasingly adopting pet-friendly policies.

IAdvance Senior Care’s recent post, “How Senior Care Community Design is Changing to Become More Pet-Friendly,” explains that pets can provide many valuable benefits in senior care settings, particularly because of their effects on mental and physical health. One study found that the presence of dogs was linked to less agitation and fewer behavioral issues for Alzheimer’s patients. In fact, according to News in Health, pets have been shown to help decrease the stress-related hormone, cortisol and lower blood pressure in residents who interact with our furry friends. Studies have also proven that pets can boost mood, reduce loneliness and help seniors feel they have social support.

In addition to health benefits, pets can also provide an important consistency for those who may be moving into a senior care setting. Many people see pets as family members, and a pet-friendly community that permits new arrivals to bring pets with them can avoid a painful separation.

More senior care communities are adopting pet-friendly policies, which can require design changes.

According to Natalie Ruiz, AIA, LEED, AP, NCARB, CDT, associate principal at CallisonRTKL, senior care communities that adopt a more pet-friendly approach see multiple benefits. “For residents, having a pet helps combat loneliness, increases social interaction and gives a sense of purpose,” she explains. “For communities, they see their residents thrive with increased mobility resulting from walking a dog or grooming a cat. There’s also a simple uptick in the job and happiness that comes with the residents having a sense of purpose.”

Ruiz says that in addition to designs and renovations that accommodate residents’ pets, some facilities also benefit from pet therapy programs that introduce community pets for residents to enjoy. In these instances, the facility’s residents still have access to animal companionship but don’t have the time or financial commitments of pet ownership. With the benefits of pets, care communities are increasingly requesting new pet-friendly elements. Ruiz said more and more senior care communities are working to include dog parks with dog washes and pet water fountains. Dog runs are also popular requests.

Ruiz says that while facilities can easily create dog-friendly spaces, they should also give some thought to creating a space for cat lovers. She also suggests that a care center trying to become pet-friendly should designate a pet coordinator who can help the residents with pet care.

Reference:  iAdvance Senior Care (Nov. 30, 2021) “How Senior Care Community Design is Changing to Become More Pet-Friendly”

Does Lack of Clutter Help with Dementia?

Researchers in Great Britain looked at whether people with dementia were better able to carry out tasks, such as making a cup of tea, at home surrounded by their usual clutter or in a clutter-free environment. The researchers were surprised to find that participants with moderate dementia performed better when surrounded by their usual clutter.

News Medical Life Sciences’ recent article entitled “People with dementia may not benefit from a clutter-free environment” also noted that the different environments made no difference to those with mild and severe dementia. These patients were able to perform at the same level in both settings.

Professor Eneida Mioshi, from the University of East Anglia’s School of Health Sciences, said: “The majority of people with dementia live in their own home and usually want to remain living at home for as long as possible. So it’s really important to know how people with dementia can be best supported at home – one possible route would be by adapting the physical environment to best suit their needs.”

He also noted that as dementia progresses, seniors will gradually lose their ability to carry out daily tasks due to changes in their cognitive, perceptual and physical abilities. The professor went on to say that participation in daily tasks could then be improved, by adapting the individual’s environment.

“To this end, we wanted to investigate the role of clutter in activity participation, given the potential to use de-cluttering to support people with dementia to continue to be independent,” Professor Mioshi explained. “Environmental clutter has been defined as the presence of an excessive number of objects on a surface or the presence of items that are not required for a task.”

Mioshi also said it’s generally assumed that an individual suffering from dementia will be better-able to carry out daily tasks, when their home space is tidy and clutter free. However, he noted that there’s been very little research on this hypothesis.

Occupational therapist and PhD student Julieta Camino carried out the study with 65 participants who were grouped into those with mild, moderate and severe dementia. The participants were asked to carry out daily tasks, including making a cup of tea and making a simple meal, both at their own home and at UEA’s specially designed NEAT research bungalow – a fully furnished research facility that feels just like a domestic living space.

The researchers looked at their performance of activities in both settings, and also measured the amount of clutter in the participants’ homes. The NEAT home setting, however, was completely clutter free. They believed the complete absence of clutter in the research facility would play a beneficial role in helping people with dementia with daily living activities. However, we were wrong. Overall, those with moderate dementia, in particular, performed daily tasks better at home, despite the fact their homes were much more cluttered than the research bungalow.

Moreover, it didn’t seem to make any difference how cluttered the participant’s home was. The only factor that contributed to how well they could carry out tasks at home was their level of cognition – with those with severe dementia encountering the same difficulties to perform the tasks at home and in the research facility.

Sian Gregory, Research Information Manager at Alzheimer’s Society, said: “We can sometimes make assumptions about what might help someone with dementia who’s living at home, like de-cluttering so they can concentrate on tasks like making a cup of tea. But, as this study shows, our ideas might not always be right.

“Challenging assumptions is so important for careers to understand how to help someone with dementia to live well in their environment. That’s why the Alzheimer’s Society funds a variety of studies like this one to evaluate what actually works for people living with dementia today, as well as finding treatments for the future.”

Reference: News Medical Life Sciences (Nov. 26, 2021) “People with dementia may not benefit from a clutter-free environment”

Alexa, How Can You Help Seniors

Amazon’s new programs run through Alexa Smart Properties, which allows organizations to control a centralized Alexa system, according to MSN’s recent article “Amazon announces Alexa program for hospitals and senior care.”

“Early on in the pandemic, hospitals and senior living communities reached out to us and asked us to help them set up Alexa and voice in their communities,” Liron Torres, global leader for Alexa Smart Properties, said in an interview with The Verge.

“Hospitals wanted ways to interact with patients without using protective equipment, and senior living communities wanted to connect residents with family members and staff,” Torres says.

The program allows senior living facilities to employ Amazon Echo devices to send announcements or other messages to residents’ rooms. During the COVID-19 pandemic, many facilities relied on printed out sheets of paper slipped under resident doors to communicate changes in protocols, like around meals or quarantines. However, the Alexa program now lets them send messages immediately into patient rooms.

“Staff can be more available for other tasks,” Torres says.

Senior facility residents can also place calls through Alexa to family members or friends, without having to rely on a staff member. Approved contacts would also be able to call in through Alexa. The facility could enable calling for a list of contacts approved by the resident and family members when they arrive.

Two networks of senior living communities, Atria (which is nationwide) and Eskaton (based in California), are adding Alexa to some facilities, Amazon announced.

In hospitals, the Alexa Smart Properties program allows nurses to speak with patients through the calling and intercom-type drop-in features without having to enter patient rooms. Patients could ask questions, or nurses could see how a patient is feeling with this feature.

“This enables hospitals to increase productivity and be able to save on medical supplies,” Torres says.

Hospitals can also send information and announcements to patients through Alexa.

Reference: MSN (Oct. 25, 2021) “Amazon announces Alexa program for hospitals and senior care”

Talk to Parents about Estate Planning without Making It Awkward

If you don’t have this conversation with parents when they are able to share information and provide you with instructions, helping with their care if they become incapacitated or dealing with their estate after they pass will be far more difficult. None of this is easy, but there are some practical strategies shared in the article “How to Talk to Your Parents About Estate Planning” from The Balance.

Parents worry about children fighting over estates after they pass, but not having a “family meeting” to speak about estate planning increases the chance of this happening. In many cases, family conflicts lead to litigation, and everyone loses.

Start by including siblings. Including everyone creates an awareness of fairness because no one is being left out. A frank, open conversation including all of the heirs with parents can prevent or at least lessen the chances for arguments over what parents would have wanted. Distrust grows with secrets, so get everything out in the open.

When is the right time to have the conversation? There is no time like the present. Don’t wait for an emergency to occur—what most people do—but by then, it’s too late.

Estate planning includes preparing for issues of aging as well as property distribution after death. Health care power of attorney and financial power of attorney need to be prepared, so family members can be involved when a parent is incapacitated. An estate planning attorney will draft these documents as part of creating an estate plan.

The unpredictable events of 2020 and 2021 have made life’s fragile nature clear. Now is the time to sit down with family members and talk about the plans for the future. Do your parents have an estate plan? Are there plans for incapacity, including Long-Term Care insurance? If they needed to be moved to a long-term facility, how would the cost be covered?

Another reason to have this conversation with family now is your own retirement planning. The cost of caring for an ailing parent can derail even the best retirement plan in a matter of months.

Define roles among siblings. Who will serve as power of attorney and manage mom’s finances? Who will be the executor after death? Where are all of the necessary documents? If the last will and testament is locked in a safe deposit box and no one can gain access to it, how will the family manage to follow their parent’s wishes?

Find any old wills and see If trusts were established when children were young. If an estate plan was created years ago and the children are now adults, it’s likely all of the documents need to be revised. Review any trusts with an estate planning attorney. Those children who were protected by trusts so many years ago may now be ready to serve as executor, trustees, power of attorney or health care surrogate.

Usually, a complete understanding of the parent’s wishes and reasons behind their estate plan takes more than a single conversation. Some of the issues may require detailed discussion, or family members may need time to process the information. However, as long as the parents are living, the conversation should continue. Scheduling an annual family meeting, often with the family’s estate planning attorney present, can help everyone set long-term goals and foster healthy family relationships for multiple generations.

Reference: The Balance (Oct. 15, 2021) “How to Talk to Your Parents About Estate Planning”

What are Latest Trends in Senior Care Facility Design?

iAdvance Senior Care’s recent article entitled “The Newest Trends in Senior Care Facility Design” interviewed Christine Cook, NCARB, principal with the Dallas-based design boutique three. She explained that she’s seeing several new trends that are shaping the industry.

“Owners and operators are working to connect through lifestyle choices, in combination with a healthcare amenity, to reach the target pool of prospective residents. ‘Active aging’ and ‘purposeful lifestyles’ resonate favorably with both residents and their families. This shifts the perception away from residency as need-based or compelled to a feeling of joining the community by choice,” she remarked.

Other design trends include more tailored residential apartments and cottages. There is also an increased demand for amenities, both on-site and within walking distance.

“Also, it is foundational to ensure consistency of the design aesthetic and quality of materials across the continuum-of-care, from independent living to assisted living and memory care,” says Cook.

Cook also said that many existing communities are decreasing their skilled nursing offerings. They’re customizing assisted living and memory care environments, tailoring them to the residents’ needs. “Most new communities are not incorporating skilled nursing at all.”

The COVID-19 pandemic has also prompted an increased focus on cleanliness and practical material selection. “Escalating cleaning protocols are demanding increased attention to the selection of finishes,” says Cook.

“Materials must be durable and resilient, otherwise replacing them when they wear out will have to be cost-effective — think modular cabinetry or tile flooring. We have also had to address plans for processional arrival sequences at entryways, modifying and limiting them to ensure there will be no security breaches with respect to disease migration.”

She’s also seen an uptick in requests for no-touch access controls for resident and staff-only areas. Cook notes that there’s also a market preference for larger balconies and full-height windows to allow for more natural daylight. Designs that reinforce healthy connections to nature, like balconies doubling as outdoor great rooms, can prompt residents to be more inspired and engaged.

However, Cook says that owner-operators frequently describe two common challenges: Keeping occupancy rates high and attracting and retaining high-quality, mission-focused staff.

Cook thinks that several trends will continue to define the senior care market in the future. These include increased demand for pocket-park communities, which usually consist of 10 to 12 cottages that are organized around or near an activity center. These communities are often developed in association with a larger senior care community or health provider.

Reference: iAdvance Senior Care (Oct. 12, 2021) “The Newest Trends in Senior Care Facility Design”

How Does Medicaid Count Assets?

For seniors and their families, figuring out how Medicaid works usually happens when an emergency occurs, and things have to be done in a hurry. This is when expensive mistakes happen. Understanding how Medicaid counts assets, which determines eligibility, is better done in advance, says the article “It’s important to understand how Medicaid counts your resources” from The News-Enterprise.

Medicaid is available to people with limited income and assets and is used most commonly to pay for long-term care in nursing homes. This is different from Medicare, which pays for some rehabilitation services, but not for long-term care.

Eligibility is based on income and assets. If you are unable to pay for care in full, you will need to pay nearly all of your income towards care and only then will Medicaid cover the rest. Assets are counted to determine whether you have non-income sources to pay for care.

Married people are treated differently than individuals. A married couple’s assets are counted in total, regardless of whether the couple owns assets jointly or individually. The assets are then split, with each spouse considered to own half of the assets for counting purposes only. Married couples have some additional asset exemptions as well.

Not all resources are considered countable. Prepaid funeral expenses, a car used to transport the person in the care family and qualified retirement accounts may be exempt from Medicaid’s countable asset limits.

For married couples, their residence for a “Community Spouse”—the spouse still living at home, and a large sum of liquid assets, are also excluded. Many non-countable assets are very specific to the individual situation or current events. For example, stimulus checks were exempt assets, but only for a limited time.

Medicaid sets a “snapshot” date to determine asset balances because some assets change daily. For unmarried individuals, all asset protections and spend-downs must happen prior to submitting the application to Medicaid. A detailed explanation must be included, especially if any assets were transferred within five years of the application.

For married couples, a Resource Assessment Request should be submitted to Medicaid before any action is taken. This document details all resources Medicaid will count and specifies exactly how much of these resources must be “spent down” by the institutionalized spouse for eligibility.

In many cases, assets are preserved by turning the countable asset into a non-countable income stream to the spouse remaining at home.

Medicaid application is a complicated process and should be started as soon as it becomes clear that a person will need to enter a facility. Understanding options early in the process makes it more likely that property and assets can be preserved, especially for the spouse who remains at home.

Reference: The News-Enterprise (Oct. 5, 2021) “It’s important to understand how Medicaid counts your resources”

How Do I Hire an Elder Law Attorney?

Elder law attorneys are lawyers who assist the elderly and their family members, and caregivers with legal questions and planning related to aging.

These attorneys frequently are called upon to assist with tax planning, disability planning, probate and the administration of an estate, nursing home placement, as well as a host of other legal issues, says Forbes’ recent article entitled “Hiring An Elder Law Attorney.”

In addition, there are some elder law attorneys who have the designation of Certified Elder Law Attorney (CELA), a certification issued by the National Elder Law Foundation. A Certified Elder Law Attorney must meet licensing and other requirements, including specific experience in elder law matters and continuing education in elder law. However, note that an elder law attorney does not need to have the CELA certification to be an experienced elder law attorney.

There are many elder law attorneys who specialize in Medicaid planning to help protect a senior’s financial assets, if they suffer from dementia or another debilitating illness that may require long-term care. Elder law attorneys also prepare estate documents, such as a durable power of attorney for health and medical needs and a living will. As you age, the legal issues that you, your spouse, and/or your family caregivers must address can also change.

If you are a senior, then you should have durable powers of attorney for financial and health needs, in the event that you or your spouse becomes incapacitated. You might also need an elder law attorney to help you transfer assets if you or your spouse move into a nursing home to avoid spending your life savings on long-term care.

Healthy people over 65 are in the best spot to do more than having estate planning documents prepared. That’s because they have the opportunity to develop a holistic strategy beyond the legal documents. This can give assurances that the family members and professionals they’ve assembled understand the principle of supported decision-making and how it will be implemented.

For example, an elder law attorney may focus on finding the least restrictive residential environment and making other health care and financial choices. An elder law attorney can also protect seniors with diminished capacity, who are being victimized by personal and financial exploitation.

An initial consultation with an elder law attorney will help determine the types of legal services they can offer, and the fees associated with these services.

Reference: Forbes (Oct. 4, 2021) “Hiring an Elder Law Attorney”