What Documents are Included in Advance Care Planning?

Starting discussions earlier helps ensure that a person with dementia stays involved and understands the planning process. In the same fashion, regular reviews of plans over time are beneficial for ensuring that their wishes are carried out.

Health News’ recent article entitled “Can Someone With Dementia Sign Legal Documents?” cautions that, when family members don’t know the preferences of their loved one, they have difficulties and stress in making decisions. Family members may also have feelings of guilt, self-doubt and stress while making advanced care decisions.

Laws in each state may differ. Working with an experienced elder law attorney can help seniors interpret state laws, plan how wishes should be carried out and understand financial options.

Geriatric care managers, trained social workers, or nurses can also offer support to those living with dementia, as well as their families.

While advance care planning, families and their loved ones with dementia should create a plan for long-term care and plan for funeral arrangements in advance.

Advance care planning documents commonly include the following:

A durable power of attorney for healthcare names someone to function as a proxy for the person with dementia, when he or she may be unable to make healthcare decisions for themselves.
A living will includes an individual’s wishes for end-of-life treatment. This can concern specific procedures such as dialysis, tubal feeding, or blood transfusion. If the person becomes permanently unconscious (coma), families can make treatment decisions based on wishes expressed in a living will.
A do-not-resuscitate order (DNR) is put with a patient’s chart when the patient doesn’t want to receive cardiopulmonary resuscitation (CPR) if their heart stops or breathing ceases. A doctor needs to sign these DNR orders before they can be placed in the patient’s charts.

Advance care planning can be a sensitive topic for families and those with dementia.

Getting medical and legal advice early is helpful in planning advance care. Involving the person with dementia in the planning process also helps families ensure that the wishes of the patient are respected.

Reference: Health News (Jan. 11, 2023) “Can Someone With Dementia Sign Legal Documents?”

What Is ‘Food Insecurity’?

“The pandemic has exacerbated existing trends in food insecurity,” Cindy Leung, ScD, MPH, assistant professor of public health nutrition at the Harvard T.H. Chan School of Public Health, in Boston, said in an email. “People who were already experiencing food insecurity found themselves at more severe levels, and other people were experiencing food insecurity for the first time. Older adults were no exception, on top of a higher risk of COVID-related disease burden and hospitalizations.”

MedPage Today’s recent article entitled “Food Insecurity Among Older Adults Remains a Problem” explains that food insecurity, which is defined as a lack of access to a sufficient amount of nutritious foods, was an issue in the U.S. even before the pandemic started.

Leung and her then-colleagues at the University of Michigan conducted a survey of about 2,000 older adults in 2020 that found that 14% of those ages 50-80 had experienced food insecurity in 2019. This appeared to be connected to worse physical and mental health, the researchers reported.

“Nearly half of adults aged 50-80 who were food insecure rated their physical health as fair or poor (45%), compared to 14% of those who were food secure,” while “almost a quarter of those who were food insecure reported fair or poor mental health (24%) compared to 5% of those who were food secure.”

The researchers also found that about 54% of food-insecure respondents had multiple (two or more) chronic conditions, compared to 41% of food-secure individuals. Food-insecure individuals were more likely than food-secure individuals to report having these conditions than food-secure respondents:

Asthma
Chronic bronchitis or chronic obstructive pulmonary disease
Chronic pain; diabetes
Kidney disease; or
A sleep disorder.

There were no significant differences in cancer, heart disease, high blood pressure, high cholesterol, or non-alcoholic fatty liver disease by food security status, however, they noted.

“Food insecurity is actually a really big problem among older adults,” Nicole Heckman, vice president of benefits access at the AARP Foundation, said in a phone interview at which a press person was present. “Nearly 9.5 million adults ages 50 and older are food insecure.”

Heckman gave several reasons for the problem. “One is obviously a lack of income,” she said. “Those that are at or below the poverty line struggle to afford the food they need, especially when we think about the inflation and just the crazy food prices and how much they have gone up over the last 2 years.”

The federal government addressed the general issue of food insecurity during the pandemic in part by expanding access to food programs like the Supplemental Nutrition Assistance Program (SNAP), as well as expanding the dollar value of available benefits. However, Heckman said, “many older adults aren’t actually aware of the programs and benefits to help them put food on their table. Research shows there are over three million older adults that missed out on more than $200 a month in SNAP benefits” during the pandemic.

Reference: MedPage Today (Jan. 10, 2023) “Food Insecurity Among Older Adults Remains a Problem”

What’s the Most Common Debt for Retirees?

A recent survey of about 2,000 American retirees between the ages of 62 and 75 found many of them burdened with debt.

Some likely ran out of time to pay off their debts before retiring. Others may have entered the red or simply deepened their debt level after leaving work.

Money Talks News’ recent article entitled “This Is the Most Common Debt Among Retirees — by Far” provides the most common type of debt retirees report — along with other debts that are part of retirement for many people.

Credit card debt. Retirees who said they had this type of debt in 2022 was 40%, compared to 42% in 2020. Credit card debt is almost always expensive, but it’s much worse if you don’t have a regular paycheck to help you pay bills.
Mortgage. Retirees who said they had this type of debt in 2022 was 30%, with no report for 2020. A home loan is one of the few types of borrowing that can be classified as “good debt.” Many experts suggest paying off a mortgage before retirement. but others argue against such a strategy.
Auto loans. Retirees who said they had this type of debt in 2022 was 23%, and in 2020, it was 30%. Unless you saved a bunch, an auto loan is hard to avoid, retired or not. As a result, about a quarter of retirees still are paying off this type of loan.

Retirees said they also are carrying these types of debt in 2022:

Medical debt: 11%
Home equity loan: 7%
Student loan: 4%
Business loan: 1%

Reference: Money Talks News (Jan. 9, 2023) “This Is the Most Common Debt Among Retirees — by Far”

Where Should an Estate Plan Be Stored?

If you have a medical emergency or die unexpectedly, and your documents can’t be located, your family will be scrambling to give you the assistance you need or to close your final affairs, says AARP’s recent article, entitled “Storing Legal Documents in an Easy-to-Find Place for Family Caregivers.”

Security and accessibility are the two primary factors in making the decision about where to store originals. However, frequently the most secure spot isn’t always the most accessible.

Some attorneys offer to keep the originals of your legal documents for safekeeping. However, this has drawbacks. Your family would have to contact the law firm and obtain the release of the documents.

If you opt to keep your original documents at home, secure them from fire or flood. A fire-rated safe is more protective than a file cabinet.

If you lock them up, remember that someone will need to either have a key or know where the key is.

If you decide not to provide copies or originals to your future caregivers and loved ones, tell them where they’ll be able to find the documents, if they need them (and how to access them!).

If you’re reluctant to tell them in advance, leave a letter of instruction for their use if you’re incapacitated or pass away.

Inform your attorney of the location and ask them to note it in your file or perhaps provide a copy of your letter of instruction for them to keep.

If you decide to change the location, let the attorney know.

When you draft new documents, make certain you destroy or discard your now-outdated documents.

Send a notice of revocation to anyone who’s holding copies or originals. If you’ve recorded any of those documents, record the notice of revocation as well. Also, ask that anyone holding copies also destroy or discard the documents in their possession.

You don’t want your loved ones to get delayed in probate court if they can only find a copy of your documents or, even worse, no documents at all.

Organization and dialog are critical to both safeguarding your paperwork and making it easy for your loved ones to use it when the time comes.

Reference: AARP (July 27, 2022) “Storing Legal Documents in an Easy-to-Find Place for Family Caregivers”

How to Talk to Parents about Estate Planning

Research from the National Alliance for Caregiving (NAC) and AARP shows that more than 50 million Americans currently serve as unpaid caregivers. This number has increased by nearly 25% since 2015. Statistically, baby boomers and women take on the biggest caregiving burden when it comes to providing care for aging family members. As life expectancy increases, and baby boomers advance well into senior years of their own, the need for caregiving will only continue to rise.

Forbes’ recent article entitled “Holiday Season Tips For Caregivers” says that as the number of seniors in America continues to grow, we find ourselves on the verge of the largest transfer of wealth in history. It is estimated that 45 million Americans will transfer some $68 trillion over the next 25 years.

As a result, having estate planning conversations has become more important than ever.

Discussions about money and mortality can be challenging and emotional. Here are some tips on how to broach this sensitive subject with family and loved ones.

Schedule a time: This can be an overwhelming topic, but don’t ignore it. Scheduling dedicated time to open the dialogue and creating a timeline to complete the basic estate planning documents can make the process more manageable and keep everyone involved accountable.

Share your wealth of knowledge: Share your knowledge about what the documents mean, how and when they come into play, as well as what happens if there’s no estate plan in place. Remind them that this is their chance to ensure that their wishes are carried out.

Ask questions: Provided the person is in a sound state of mind, they’re in a position to be involved in the decision-making. Ask open-ended questions like what steps have already been taken and document as much as possible without judgment.

Share your plan: Sharing your ideas and discussing your own plans can ease tension and help eliminate fears. It shows others that they’re not alone in the planning process.

Leave the conversation open-ended: The key to these planning conversations is empathy because many seniors are experiencing a variety of emotions. Reassure them that you’re available for future conversations and will plan to check back in at the times set forth in the timeline you created together.

You should also ask an experienced estate planning attorney for assistance.

Reference: Forbes (Nov. 29, 2022) “Holiday Season Tips For Caregivers”

How Will Social Security Change Next Year?

Money Talks News’ recent article entitled “5 Ways the Social Security System Will Change in 2023” looks at several ways in which Social Security will change for 2023.

The benefit increase. Social Security recipients will see their monthly payments go up by 8.7% in 2023. That cost-of-living adjustment (COLA) means an extra $146 a month. Not all retirees will see much extra Social Security income in 2023 because the Medicare Part B premium is withheld from some retirees’ Social Security payments.
The earnings limit for working retirees. If you claim Social Security retirement benefits before reaching your full retirement age (FRA) and also continue working, the SSA will withhold some of your benefits, if your income exceeds the earnings limit. This limit generally increases annually as the national average wage index increases. For 2023, it will rise from $19,560 to $21,240 if you reach full retirement age after 2023, and from $51,960 to $56,520 if you reach full retirement age in 2023. However, you don’t lose any benefits withheld due to your income exceeding the applicable earnings limit.
The tax cap on workers’ income. The maximum amount of a worker’s income subject to Social Security payroll taxes will increase from $147,000 in 2022 to $160,200 in 2023. As a result, if you’re lucky enough to earn more than $160,200 in 2023, you won’t owe Social Security payroll taxes on every dollar you earn. The Social Security payroll tax rate itself will remain the same in 2024: 6.2% for employees (employers pay another 6.2% on their employees’ behalf) and 12.4% for the self-employed.

“To receive Social Security retirement benefits, most people need to accumulate at least 40 ‘credits’ during their working lifetime, according to the U.S. Social Security Administration (SSA). Currently, you can earn up to four credits per year, if you work and pay Social Security taxes.”

The earnings required for you to get a Social Security credit, also known as one-quarter of coverage, will go up from $1,510 in 2022 to $1,640 in 2023.

The maximum benefit. There’s a limit to how much money a retiree can get in monthly benefits—the maximum Social Security benefit. Your maximum Social Security benefit is based upon the age at which you retire. The maximum benefit for a person who retires at their full retirement age will go up from $3,345 per month in 2022 to $3,627 per month in 2023.

Reference: Money Talks News (Oct. 13, 2022) “5 Ways the Social Security System Will Change in 2023”

What Is the Government Doing about Misleading Medicare Ads?

Kathryn A. Coleman, director of the agency’s Medicare Drug and Health Plan Contract Administration Group, said in a three-page letter that CMS is immediately upgrading its review of marketing materials, which must be submitted under its regulatory “File and Use” authority for Medicare Advantage and Part D drug plans, and “may exercise its authority to prohibit” their use, reports MedPage Today’s recent article entitled “CMS Puts the Kibosh on Misleading Medicare Advantage Sales Pitches.”

Medicare Advantage marketing materials can now go live five days after submission, provided the company submitting them “certifies the material complies with all applicable standards.” However, beginning on January 1, Coleman said no television advertisements will qualify to be submitted under its “File and Use” authority, meaning the ads will not run until CMS approves them.

Coleman said the agency is “particularly concerned with recent national television advertisements promoting MA [Medicare Advantage] plan benefits and cost savings, which may only be available in limited-service areas or for limited groups of enrollees, overstate the available benefits, as well as use words and imagery that may confuse beneficiaries or cause them to believe the advertisement is coming directly from the government.”

CMS is also looking at recordings of agent and broker calls with potential enrollees and is continuing its secret shopping of marketing events “by reviewing television, print, and internet marketing and calling related phone numbers and/or requesting information via online tools.”

CMS approved a final rule that requires all Medicare Advantage agents, brokers and third-party marketing organizations to record all their calls with potential enrollees “in their entirety, including the enrollment process.” In her letter, Coleman said reviews of recordings will continue.

“Our secret shopping activities have discovered that some agents were not complying with current regulation and unduly pressuring beneficiaries, as well as failing to provide accurate or enough information to assist a beneficiary in making an informed enrollment decision,” she wrote.

Coleman also noted that the agency will take “compliance action against plans for activities and materials that do not comply with CMS’ requirements.”

It also will review “all marketing complaints” received during the annual enrollment period, which runs from October 15 to December 7, and will target its “oversight and review on MA organizations and Part D sponsors with higher or increasing rates of complaints.”

Reference: MedPage Today (Oct. 21, 2022) “CMS Puts the Kibosh on Misleading Medicare Advantage Sales Pitches”

Can I Protect My Elderly Parents?

Estate planning requires the ability to be realistic about current health and assets, while considering the inevitable changes to come. For adults with aging parents, having a well-thought out estate plan, regardless of the size of the estate, becomes more urgent as the time to use the documents draws closer. A recent article, “Accessing needs of aging parents,” from The News-Enterprise explains the steps adult children need to take to protect their parents.

There are four key factors to consider: medical needs, housing and care needs, finances and legal needs. All require candid, non-emotional assessments.

Start with medical, housing and care needs. Consider the next five years. Is it likely their medical condition may decline? How will their present home work, if they are unable to manage steps or need to sleep and toilet on the same level? If their home is not conducive for aging in place, will they consider moving to a better situation—or can they afford to make any changes?

Next, examine health and care needs. Do they have long-term care insurance or do they expect to apply for Medicaid? If one spouse will need memory care or one spouse dies, will the surviving spouse have the resources needed to remain in home and receive the care they need? An experienced estate planning attorney will be able to evaluate their financial situation with regard to becoming eligible for Medicaid, if this will be needed. There is a five-year look-back period for Medicaid, so advance action is necessary to protect assets.

Do they have any estate planning documents in place? Is there a will, and when was it prepared? Ask any estate planning attorney how many times seniors have told their children a will exists, only for the children to learn the will is forty years old, woefully out of date and declared invalid by the probate court. Deceased individuals may be listed as agents for Power of Attorney and Medical Power of Attorney. Funds left for heirs may no longer exist. Laws for power of attorney may not include required provisions as a result of changes to the law.

More complicated issues may exist. If appreciated real estate property has been deeded to loved ones to protect the property from nursing home costs, are the beneficiaries prepared to pay the resulting taxes? If deeded real estate property was intentionally left unrecorded, transferring property could become a legal quagmire.

The best solution is to have an experienced estate planning attorney meet with the parents, review any existing documents and prepare an updated set of documents to achieve the parent’s goals, protect them in case of medical emergencies and allow parents and children to gain the peace of mind of knowing they are ready for the future. This includes a will, power of attorney, health care power of attorney, HIPAA release, living will and, depending upon the situation, may also include trusts.

Reference: The Times-Enterprise (Nov. 5, 2022) “Accessing needs of aging parents”

What’s Being Done to Help Seniors Age in Place?

Seasons’ recent article entitled “Federal grant will fund $15 million in aging-in-place home projects” provides everything you need to know about the latest on aging in place. The U.S. Department of Housing and Urban Development is making $15 million available to assist seniors with home modifications. This funding is made available through HUD’s Older Adult Home Modification Program.

“The funding opportunity … will assist experienced nonprofit organizations, state and local governments, and public housing authorities in undertaking comprehensive programs that make safety and functional home modifications, repairs and renovations to meet the needs of low-income elderly homeowners,” HUD officials said in a statement.

The goal of the program is to assist low-income and older adult homeowners (at least age 62) to remain in their homes by providing low-cost, low barrier and high-impact home modifications to reduce their risk of falling, improve general safety, increase accessibility and to improve functional abilities in the home.

“This is about enabling older adults to remain in the comfort of their family home, where they have made their life,” the spokesperson said, “rather than having to move to a nursing home or other assisted care facilities.”

With an estimated 20% of the population reaching age 65 by 2040, the home modification program aims to assist older adults who remain in their homes safely with honor and respect.

“We must allow our nation’s seniors to age-in-place with dignity,” said HUD Secretary Marcia L. Fudge in a statement. “This funding will give seniors the flexibility to make changes to their existing homes—changes that will keep them safe and allow them to gracefully adjust to their changing lifestyle.”

Eligible applicants include experienced nonprofit organizations, state and local governments and public housing authorities that have at least three years of experience in providing services to the elderly. Individuals, foreign entities and sole proprietorship organizations are not eligible to apply or receive funds, according to HUD. As a result, there’s no individual application homeowners or family members need to fill out to receive funding. Homeowners, family members, caregivers and other interested parties who want to get help and receive home modifications need to apply through a certain institution by contacting organizations in their area in the process of applying for funds or that have already received funds.

“Caregivers can contact the local organization that has a home modification grant, and let the grantee know that they are caregivers for a family with a family member that is age 62 and older, who owns the home they live in and are interested in having the family’s home modified under HUD’s Home Modification grant program to help them age in place,” a HUD spokesperson said.

Reference: Seasons (Sep. 19, 2022) “Federal grant will fund $15 million in aging-in-place home projects”

How to Manage Aging Parent’s Finances

A day will come when age begins to catch up with your parents and they will need help with their finances. Even if your parents don’t want to feel dependent, when you think they need your assistance, you can approach the issue with sensitivity and extend your support for the management of their finances, says Real Daily’s recent article entitled “5 Tips to Manage an Aging Parent’s Finances.” Here are some tips:

Start the conversation early. Your parents may not need your help with the handling of their financial matters right away. However, it is smart to begin the conversation early. Approach the issue of who will manage the financial responsibilities when they’re no longer able to do it. Parents should select a trusted family member by providing their advance written consent. This will let you to talk about your parents’ financial issues with financial advisors, doctors and Medicare representatives and carry out timely financial planning.
Create a list of all pertinent legal and financial documents. Prepare a list of your parents’ important contacts, bank account details and locations of any stored documents, like wills, property deeds, insurance policies and birth certificates. Make certain all information and documentation is accurate and up to date. If information needs to be modified because of a change of circumstances, this is time to apprise them of it and help them do what’s needed.
Consider executing a power of attorney. A competent adult can sign a power of attorney to authorize another person to make decisions on their behalf. A power of attorney for a specific purpose may cover medical, financial, or other decisions, and it may be designed to give limited or more sweeping powers. When your parents sign a power of attorney with you named as their attorney in fact, it will legally empower you to make key decisions when they can’t. An elder law attorney can help you draft an appropriate power of attorney according to your situation.
Document your actions and keep others in the know. Transparent communication will help you avoid misunderstandings or controversy within your family. Keep your parents, siblings and any other loved ones involved with your family informed about your actions. No matter how noble your intentions may be, if others are kept in the dark, it can raise questions about your motives. Managing the finances of aging parents is a lot of work, and you can ask for the support of family members or at least keep the lines of communication open.
Don’ comingle your finances with your parents’ plans. While it may look to be a convenient or cost-effective thing to do, it’s never a good idea to combine your parents’ finances with your own. Keep them separate. Using your parents’ money for your purposes or your own money to help them out is usually a slippery slope that should be avoided. Don’t forget about your own financial goals and retirement savings while you focus on helping your parents.

Reference: Real Daily (Sep. 9, 2022) “5 Tips to Manage an Aging Parent’s Finances”

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