States with Most Affordable Long-Term Care?

Seven in 10 people 65 and older will require some type of long-term care during their lifetime. This expense will vary based on the patient’s required level of care, care setting and geographic location, says Think Advisor’s recent article entitled “15 Cheapest States for Long-Term Care: 2020.”

A recent study by Genworth found that the cost for facility and in-home care services increased on average from 1.9% to 3.8% per year from 2004 to 2020. That amounts to $797 annually for home care and as much as $2,542 annually for a private room in a nursing home.

At the current rate, some care costs are more than the 1.8% U.S. inflation rate, Genworth said.

These findings were taken from 14,326 surveys completed this summer by long-term care providers at nursing homes, assisted living facilities, adult day health facilities and home care providers. The survey encompassed 435 regions based on the 384 U.S. Metropolitan Statistical Areas, as defined by the U.S. Office of Management and Budget.

In a follow-up study, Genworth also found that these factors are contributing to rate increases for long-term care:

Labor shortages
Personal protective equipment (PPE) costs
Regulatory changes, such as updated CDC guidelines
Employee recruitment and retention issues
Wages demands; and
Supply and demand.

Here are the 15 cheapest states for long-term care, according to Genworth with their average annual cost:

15. Utah: $59,704

14. Kansas: $57,766

13. Iowa: $57,735

12. Kentucky: $57,540

11. South Carolina: $57,413

10. Tennessee: $56,664

9. North Carolina: $56,512

8. Georgia: $53,708

7. Mississippi: $52,461

6. Arkansas: $50,835

5. Oklahoma: $50,641

4. Texas: $48,987

3. Missouri: $48,753

2. Alabama: $48,240

1. Louisiana: $44,811

Reference: Think Advisor (Dec. 14, 2020) “15 Cheapest States for Long-Term Care: 2020”

What Do I Need to Know as a Caregiver for the Elderly?

Not everyone is cut out for assisting older people because the job requires a unique skillset and, more importantly, empathy.

Big Easy’s recent article entitled “6 Things to Consider as a Caregiver for the Elderly” says it can be hard to understand that a senior has become dependent on others, and being assisted in everyday tasks may even lead to compromises in their privacy. This can put a senior in stressful conditions that lead to anxiety. In that case, hiring a professional caregiver for the elderly may be the best option.

However, no matter your training, caring for an older person can still be challenging. Consider these six things to develop the best possible relationship with the elderly and to provide the best care.

Compassion. Being compassionate helps develop a better connection to the elderly person. This can frequently solve many behavioral problems and can make for a pleasant caregiving environment. Most older people have some physical or mental disability that keeps them from being independent. In some situations, being abandoned by their loved ones creates even more emotional damage. To help, be empathetic and kind to them in these difficult times. This can significantly help to decrease the emotional pain that accompanies old age and illness. Being compassionate is one of the most effective ways of delivering the best care possible in these situations.

Communication. If you have the ability to have natural and comfortable conversations with elderly patients, you can develop a tighter emotional bond with them. Healthy communication and conversations also can distract a senior from things that may be troubling them, which will not only benefit the patient but will also help you carry out your tasks more easily. You may also be called upon to interact with other family members or doctors, so good communication skills are required.

Safety. Safety is vital for the elderly, and the slightest negligence can become a matter of life and death for them. The most common types of injuries for older people are attributed to falls. It is also even more dangerous because their bones are weak and don’t heal quickly. Use extreme care when assisting seniors in slippery areas, like the bathroom. Take precautions, such as de-cluttering the house and eliminating tripping hazards. Most importantly, keep them under constant observation, especially those with mental illnesses.

Hygiene. Maintaining quality hygiene can be a challenge, especially if people are shy or want their privacy. Take bathing as an example: it’s not surprising that the elderly are embarrassed, when caregivers have to bathe them. Even so, you are tasked with maintaining their hygiene. If you don’t, it can lead to more health-related issues.

Medications. Most seniors take medication, some of which produce side effects, such as nausea or dizziness. As a caregiver, you should make certain that they are taking their medicines on time and watch for side-effects in the case of an emergency. Review their medications and administer the prescribed dosage at the right times yourself. This will also help those who forget to take their medicines without prompting.

You may have several challenging times throughout your career as a caregiver for the elderly, but empathy and compassion will help you considerably. You will create a better job experience and help the elderly with a very difficult phase of their life.

Reference: Big Easy (Dec. 10, 2020) “6 Things to Consider as a Caregiver for the Elderly”

What Should I Know, If I Need to Take an Elderly Person to the Doctor?

First, know and understand the rules in the pandemic.

AARP’s August 17 article entitled “4 Things to Know When Taking a Loved One to the Doctor During COVID-19” provides four other things to consider as you plan doctors’ appointments.

Is there an urgent need for the appointment? A caregiver of a senior may be tempted to schedule some appointments. However, doctors are trying to return to normal, and even with precautions in place, they may not want to see your senior for a non-urgent visit. Right now, most doctors don’t advise patients to come into their office for routine follow-ups. See if the visit can be postponed or ask the medical office about a virtual visit on Zoom.

Do you know the office’s visitor policy? If the doctor asks you to bring your loved one to the doctor’s office, look at its visitor policy before you go. With COVID-19, most offices have very strict policies and may only permit scheduled patients in the office. Some will make exceptions for a senior’s caregiver if needed, but they may request that once the patient is checked in, the caregiver wait in the car.

What are the facility’s precautions against COVID-19? In most health care facilities, as well as in imaging centers, doctors’ offices, hospitals with outpatient services, ERs and labs, there’s intense facility cleaning and sanitizing, universal masking, physical distancing and hand sanitizing. Patients are typically met at the door with a thermometer and a COVID-19 questionnaire. Other precautions include removing magazines to protect against the risk of virus transmission and requiring all staff to wear surgical masks.

What preparation is needed for an in-person appointment? Both the caregiver and patient should wear masks and get there punctually. When you make the appointment and it is prep for a scheduled surgery or procedure, ask if the patient needs a COVID-19 test.

You should also bring a list of medications with dosages and frequencies (and the number of refills left.). It is also helpful to have on hand a medical history that includes symptoms, dates and durations. This can be valuable in completing the COVID-19 questionnaire and to get more from the appointment. You should also have a list of questions for the doctor.

When you leave the appointment, be certain: (i) all of the patient’s questions have been answered; (ii) review the instructions for home care provided in the treatment plan; and (iii) schedule the next appointment, if a follow-up is needed.

Reference: AARP (Aug. 17, 2020) “4 Things to Know When Taking a Loved One to the Doctor During COVID-19”

What Did the Supreme Court Say about Medicaid Work Requirements?

The Trump administration had asked the Supreme Court in July to reinstate its historic approvals of state work requirements waivers. It contends that these rules may assist certain beneficiaries in transitioning to private policies and may result in improved health and to help states conserve financial resources to provide coverage to others in need.

MSN’s article entitled “Supreme Court agrees to consider Medicaid work requirements” reports that lower courts have struck down the Department of Health and Human Services’ approvals, holding that Medicaid’s primary purpose is to provide health care coverage.

The National Health Law Program, one of the consumer advocacy groups that brought the original lawsuits, said it thinks it will win at the Supreme Court.

“HHS’s action was properly vacated because Secretary [Alex] Azar failed to account for the significant loss in health coverage that these approvals would produce,” said Jane Perkins, legal director at the National Health Law Program. “Tens of thousands of people would lose their Medicaid coverage and become uninsured.”

The Supreme Court’s decision to take up the cases follows a panel of federal appellate judges that struck down the Trump administration’s approval of work requirements in Arkansas in February. The unanimous decision, written by Judge David Sentelle, a Reagan appointee, affirmed a district court ruling that found the administration had failed to analyze whether these programs would “promote the primary objective of Medicaid — to furnish medical assistance.”

New Hampshire stopped its roll-out of work requirements last year after the same district judge, James Boasberg in DC, set aside the administration’s approval in that state.

In an unprecedented step two years ago, the Trump administration started granting state requests to mandate that certain Medicaid beneficiaries work to receive benefits. Republicans have long wanted to have that requirement with Medicaid, which insures more than 75 million low-income Americans.

There were 12 states that received waivers, although four were set aside in court, according to the Kaiser Family Foundation. Another seven state requests are awaiting federal approval. Work requirements are not in effect anywhere, after states stopped their efforts because of the legal rulings and the pandemic.

In Arkansas, more than 18,000 people lost coverage in 2018, before the court intervened. Judge Boasberg had also canceled Kentucky’s approval. That move blocked work requirements from being implemented in the state. However, Kentucky withdrew its waiver request after a Democratic governor won election in 2019 and dismissed its appeal.

The judge blocked work requirements in Michigan earlier this year.

Reference: MSN (Dec. 5, 2020) “Supreme Court agrees to consider Medicaid work requirements”

What Debts Must Be Paid after I Die?

When you pass away, your assets become your estate, and the process of dividing up debt after your death is part of probate. Creditors only have a certain amount of time to make a claim against the estate (usually three months to nine months).

Kiplinger’s recent article entitled “Debt After Death: What You Should Know” explains that beyond those basics, here are some situations where debts are forgiven after death, and some others where they still are required to be paid in some fashion:

The beneficiaries’ money is partially protected if properly named. If you designated a beneficiary on an account — such as your life insurance policy and 401(k) — unsecured creditors typically can’t collect any money from those sources of funds. However, if beneficiaries weren’t determined before death, the funds would then go to the estate, which creditors tap.
Credit card debt depends on what you signed. Most of the time, credit card debt doesn’t disappear when you die. The deceased’s estate will typically pay the credit card debt from the estate’s assets. Children won’t inherit the credit card debt, unless they’re a joint holder on the account. Likewise, a surviving spouse is responsible for their deceased spouse’s debt, if he or she is a joint borrower. Moreover, if you live in a community property state, you could be responsible for the credit card debt of a deceased spouse. This is not to be confused with being an authorized user on a credit card, which has different rules. Talk to an experienced estate planning attorney, if a creditor asks you to pay off a credit card. Don’t just assume you’re liable, just because someone says you are.
Federal student loan forgiveness. This applies both to federal loans taken out by parents on behalf of their children and loans taken out by the students themselves. If the borrower dies, federal student loans are forgiven. If the student passes away, the loan is discharged. However, for private student loans, there’s no law requiring lenders to cancel a loan, so ask the loan servicer.
Passing a mortgage to heirs. If you leave a mortgage behind for your children, under federal law, lenders must let family members assume a mortgage when they inherit residential property. This law prevents heirs from having to qualify for the mortgage. The heirs aren’t required to keep the mortgage, so they can refinance or pay off the debt entirely. For married couples who are joint borrowers on a mortgage, the surviving spouse can take over the loan, refinance, or pay it off.
Marriage issues. If your spouse passes, you’re legally required to pay any joint tax owed to the state and federal government. In community property states, the surviving spouse must pay off any debt your partner acquired while you were married. However, in other states, you may only be responsible for a select amount of debt, like medical bills.

You may want to purchase more life insurance to pay for your debts at death or pay off the debts while you’re alive.

Reference: Kiplinger (Nov. 2, 2020) “Debt After Death: What You Should Know”

Is Transferring House to Children a Good Idea?

Transferring your house to your children while you’re alive may avoid probate. However, gifting a home also can mean a rather large and unnecessary tax bill. It also may place your house at risk, if your children get sued or file for bankruptcy.

You also could be making a mistake, if you hope it will help keep the house from being consumed by nursing home bills.

There are better ways to transfer a house to your children, as well as a little-known potential fix that may help even if the giver has since died, says Considerable’s recent article entitled “Should you transfer your house to your adult kids?”

If a parent signs a quitclaim to give her son the house and then dies, it can potentially mean a tax bill of thousands of dollars for the son.

Families who see this error in time can undo the damage, by gifting the house back to the parent.

People will also transfer a home to try to qualify for Medicaid, but any gifts or transfers made within five years of applying for Medicaid can result in a penalty period when seniors are disqualified from receiving benefits.

In addition, transferring your home to another person can expose you to their financial problems because their creditors could file liens on your home and, depending on state law, take some or most of its value. If the child divorces, the house could become an asset that must be divided as part of the marital estate.

Section 2036 of the Internal Revenue Code says that if the parent were to retain a “life interest” in the property, which includes the right to continue living there, the home would remain in her estate rather than be considered a completed gift. However, there are rules for what constitutes a life interest, including the power to determine what happens to the property and liability for its bills.

There are other ways to avoid probate. Many states and DC permit “transfer on death” deeds that let homeowners transfer their homes at death without probate.

Another option is a living trust, which can ensure that all assets avoid probate.

Many states also have simplified probate procedures for smaller estates.

Reference: Considerable (Sep. 18) “Should you transfer your house to your adult kids?”

How Do I Tell Fact from Fiction with the Flu?

Flu season officially spans October to May. That makes now an opportune time to get the real facts about the virus that claims tens of thousands of lives — a majority of them older adults — every year.

AARP’s recent article entitled “7 Flu Myths Debunked” sets the record straight on seven common flu myths to help you strengthen your defenses.

Myth No. 1: Cold weather is the cause of the flu. Wrong. Viruses cause flu, not cold weather. However, the influenza virus survives better in colder environments. In colder weather, individuals also tend to gather inside with less air circulating, causing a higher risk of flu spread. Lower temperatures may also negatively impact the immune response, which makes us more susceptible to flu. It spreads via droplets as people around us talk, sneeze, or cough.

Myth No. 2: Flu is merely a bad cold. Not every respiratory ailment is the flu. Influenza and the common cold can have similar symptoms, but they are caused by different viruses and each has distinct symptoms. A cold may give you a runny or stuffy nose, but the flu typically doesn’t. A cold can make you feel crummy, but the flu can make you feel like you were hit by a Mack truck. Colds also rarely lead to dangerous complications. However, a bad case of flu can move to the lungs and cause serious infections.

Myth No. 3: Antibiotics will help treat flu. Not true. The flu is a viral infection, and antibiotics only treat bacterial infections. Sometimes complications from flu, like pneumonia, are treated with antibiotics, but flu itself is not. To treat influenza, in addition to over-the-counter drugs for cough and stuffy nose, there are approved antiviral drugs, such as Tamiflu (which should be taken early in the onset of flu symptoms to be effective).

Myth No. 4: You don’t need a flu vaccine if you don’t get sick. Influenza is very contagious. Even healthy people can get it. A flu shot is the very best intervention we have to prevent flu infections and, sometimes, the serious complications it can cause. Everyone should get a flu shot every year—and in the middle of the pandemic, it becomes even more important. The flu virus can also mutate from season to season. As a result, if a strain circulates that your immune system doesn’t have experience fighting, you can be more susceptible to getting sick. Getting a flu shot will help because the shot will build immunity to the specific strains circulating in a given season.

Myth No. 5: A flu shot can make you sick. There’s no active virus in the flu vaccine, so it can’t cause the flu. Your body may hurt because it’s building up immunity. According to the Centers for Disease Control and Prevention (CDC), the flu vaccine stopped about 4.4 million influenza illnesses in the especially severe 2018-2019 flu season. It stopped 2.3 million flu-related medical visits, 58,000 flu-related hospital stays and approximately 3,500 deaths.

Myth No. 6: You might get a “stomach flu.” The word “flu” is often used incorrectly for several unrelated viruses and other illnesses. Although the flu can cause gastrointestinal symptoms, a stomach bug that causes nausea, vomiting, or diarrhea isn’t the flu.

Myth No. 7: If you get a flu shot, you won’t get the flu. After you get the shot, it can take up to two weeks for immunity to be built up in the body, but it’s not 100% effective at preventing the flu. That said, the flu shot will make any symptoms you do get less severe. It’s also especially important to help lessen the strain on the health care system during the COVID-19 pandemic.

Reference: AARP (Oct. 22, 2020) “7 Flu Myths Debunked”

Scottish Actor Sean Connery May Have Had Dementia

The famous screen actor, Sean Connery, who was famous for portraying the original on-screen James Bond, passed away at his home in the Bahamas.

Yahoo News’s recent article entitled “Sean Connery widow reveals he had suffered from dementia” reported that Connery died peacefully in his sleep surrounded by family members, according to his widow Micheline Roquebrune.

“I was with him all the time and he just slipped away,” the 91-year-old told the London Daily Mail.

“He had dementia and it took its toll on him. He got his final wish to slip away without any fuss. It was no life for him. He was not able to express himself lately.”

Connery will be remembered at a private funeral ceremony, with a memorial event to be held later, according to a publicist. He was knighted in 2000 and won many awards during his decades-spanning career, including an Oscar, three Golden Globes and two Bafta awards.

However, it was his smooth, Scottish-accented portrayal of the suave licensed-to-kill spy 007 that earned him lasting worldwide fame and adoration. He was the first actor to say the unforgettable “Bond, James Bond.”

He made six official films as novelist Ian Fleming’s spy, giving what many still consider to be the definitive portrayal.

Former 007 actor Pierce Brosnan joined the flood of weekend tributes to the Scottish actor, who he said, “led the way for us all who followed in your iconic footsteps.”

“You were my greatest James Bond as a boy, and as a man who became James Bond himself, you cast a long shadow of cinematic splendor that will live on forever,” Brosnan added.

Connery was born in Edinburgh in 1930. He married French artist Roquebrune in 1974 after they met in Morocco in 1970.

They lived outside his native Britain for decades, previously owning a home in the Spanish resort of Marbella and then in the Bahamas.

“He was gorgeous, and we had a wonderful life together,” the Tunisian-born widow said. “He was a model of a man. It is going to be very hard without him. I know that. But it could not last forever and he went peacefully.”

Reference: Yahoo News (Nov. 1, 2020) “Sean Connery widow reveals he had suffered from dementia”

Should I Delay in Claiming Social Security?

Kiplinger’s recent article entitled “Waiting to File for Social Security Benefits Is Hard, but Payoff Is Sweet” asks you to imagine if, when you were a child, your mom baked your favorite pie and made you an offer. She could serve you a piece of pie right then and let you eat it. Alternatively, if you waited until after dinner, you’d get a bigger slice. Or, if you could wait until bedtime, your piece would be even larger. And not just that day, but for the rest of your life.

Every time you had pie for dessert, the size of your piece would be based on the decision you made that one day.

There are many justifications for taking the smaller piece of pie right away, when offered. Many people want to begin their retirement as soon as possible, and they want or need the Social Security income to do so. Some want to claim their benefits and invest the money to further grow their nest egg. Many people are concerned that the Social Security trust fund will be depleted before they get their share. Finally, there are some who just aren’t aware of how much bigger their monthly payment could be if they waited.

While you can get your benefits as early as 62, that choice, can mean a permanent reduction in benefits of up to 30% less than what you could receive by filing at your full retirement age (FRA). Retirees who file after their FRA receive a delayed retirement credit of 8% per year until they turn 70.

Admittedly, eight years (from 62 to 70) is a long time to wait to tap into this significant income stream. Most seniors would jump at the chance for more money, particularly as many baby boomers face these challenges that could put even the best-laid income plans to the test in retirement:

Longevity. The longer you live, the greater the chance that your savings will have to endure multiple financial storms, such as increased taxes, inflation and costly health care issues as you get older. The Social Security Administration estimates that the average 62-year-old woman born in 1958 can expect to live another 23½ years, and a man with the same birthdate can expect to live another 20⅔ years. That’s a long time to have to make your money last. However, if you maximize your Social Security benefits by earning delayed retirement credits, you’ll always have that guaranteed income.

Low interest rates. In the current low-interest environment, the return on “safe” investments, such as CDs, bonds, and money market accounts, won’t protect you from inflation. Thus, one of the best investments that retirees can make right now isn’t really an investment at all, but rather it’s growing their Social Security payments by delaying to take them.

Decline in employer pensions. The retirement savings system in the United States traditionally has been built on three pillars: Social Security, a workplace pension and individual savings. However, over the past two decades, many employers have stopped offering pensions. As a result, the full responsibility for retirement investing has been shifting to employees with defined contribution plans. However, 40.2% of older Americans now depend on Social Security alone for income in retirement. Only 6.8% receive income from a defined benefit pension, a defined contribution plan, and Social Security. Fidelity Investments also reports that the median 401(k) balance in the first half of 2019 was $62,000 for savers in the 60 to 69 age group.

Ask an elder law attorney who practices in Social Security matters to help you make some calculations to determine your “break-even” age, which is when you’d come out ahead by waiting instead of claiming early. If you haven’t already, sign up with the Social Security Administration to get an estimate of your retirement benefits at 62, 67, and 70, using their online benefits calculator.

If your objective is to land the biggest possible piece of pie — and you can manage it — waiting is the name of the game.

Reference: Kiplinger (Oct. 21, 2020) “Waiting to File for Social Security Benefits Is Hard, but Payoff Is Sweet”

What Changes are Happening to Social Security in 2021?

The Social Security program undergoes a number of changes every year. Fox News’s recent article entitled “7 changes to Social Security in 2021” looks at the updates unveiled by the Social Security Administration (SSA) last week.

More money. The SSA recently announced a 1.3% COLA for the upcoming year. That means an extra $20 a month for the average retired worker. It is an estimated monthly payout of $1,543 a month by January 2021. With prices for goods and services dropping between March and May because of the coronavirus pandemic, a 1.3% COLA is a win for the program’s 64.8 million recipients.

Full retirement age going up. There’s an increase in the full retirement age (FRA), which is the age when they can receive 100% of their monthly payout, as determined by their birth year. In 2021, the full retirement age is going to go up by two months, to 66 years and 10 months for people born in 1959 (i.e., beneficiaries who can become newly eligible next year). Remember that claiming benefits at any age before your FRA results in your taking a permanent reduction to your monthly payout. The Social Security FRA will peak at age 67 in 2022 for anyone born in 1960 or later.

High earners will pay more taxes. A big change next year is an increase in the payroll tax earnings cap. The payroll tax generated $944.5 billion of the $1.06 trillion collected by Social Security. In 2021, all earned income up to $142,800 will be taxable, representing an increase of $5,100. For the roughly 6% of workers who are expected to hit this cap, it’s an increase in payroll tax of up to $632.40 next year.

Wealthy can get a larger monthly benefit. After the SSA capped monthly retirement benefits at $3,011 for persons of full retirement age in 2020, the maximum payout at full retirement age is going up to $3,148 a month in 2021. That’s an extra $1,644 a year for wealthy workers.

The disability income thresholds increase. About 9.7 million beneficiaries are receiving a monthly payout from the Social Security Disability Insurance Trust. In 2021, the income thresholds where benefits cease to disabled beneficiaries will be higher.

Withholding thresholds for early filers gets a bump. Social Security has a number of ways it penalizes early filers, one of which is the retirement earnings test. This lets the SSA withhold some or all of an early-filer’s benefit, if they earn more than a preset income threshold. In 2021, these income thresholds will be higher. Early filers who will reach full retirement age in 2021 will also see a bump in the withholding threshold. Next year, early filers who attain FRA at some point during the year will be allowed to earn up to $50,520 ($4,210 a month) before $1 in benefits is withheld for every $3 in earnings above this threshold. That’s an increase of $160 a month from this year’s levels. (The retirement earnings test isn’t applicable when you hit your full retirement age, no matter when you claimed benefits, and withheld benefits are returned as higher monthly payouts after hitting full retirement age.)

Must earn more to qualify for a retirement benefit. To qualify for a retirement benefit, you’ll need to have earned 40 lifetime work credits, of which a maximum of four credits can be earned each year. These credits are awarded according to an individual’s income in a given year. (Workers received one lifetime work credit in 2020 with $1,410 in earned income, so if a worker nets at least $5,640 in earned income or $1,410 X 4 this year, they’ll get the max of four credits). Next year, it’ll take $1,470 in earned income to earn one lifetime work credit, or $5,880 for the full year to maximize your Social Security work credits.

Reference: Fox News (Oct. 19, 2020) “7 changes to Social Security in 2021”

Estate Planning Blog Articles

Estate & Business Planning Law Firm Serving the Providence & Cranston, RI Areas

States with Most Affordable Long-Term Care?

What Do I Need to Know as a Caregiver for the Elderly?

What Should I Know, If I Need to Take an Elderly Person to the Doctor?

What Did the Supreme Court Say about Medicaid Work Requirements?

What Debts Must Be Paid after I Die?

Is Transferring House to Children a Good Idea?

How Do I Tell Fact from Fiction with the Flu?

Scottish Actor Sean Connery May Have Had Dementia

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What Did the Supreme Court Say about Medicaid Work Requirements?

What Debts Must Be Paid after I Die?

Is Transferring House to Children a Good Idea?

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Scottish Actor Sean Connery May Have Had Dementia

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