Estate Planning Blog Articles

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State Bolsters Nursing Home Oversight

The New York State Assembly recently gave final legislative approval in a unanimous vote to a bill requiring the Long-Term Care Ombudsman Program (LTCOP) to publicize, as part of its annual reports, the kinds and patterns of complaints received by its regional offices and the number of ombudsman visits to each long-term care facility.

Harlem World Magazine’s recent article entitled “NYS Lawmakers Move To Strengthen Nursing Home Oversight From Care, To Complaints And More” reports that the New York State Senate passed the companion bill on May 24 with a strong, bipartisan vote.

The move follows a $2.5 million increase in state funding in the 2022 state budget for the federally-required program – more than doubling its previous state-funded budget.

LTCOP has lagged in other states’ programs, while more than 15,000 people have died in New York nursing homes since the start of the COVID-19 pandemic.

“This bill would arm policymakers with the information they need to ensure the Long-Term Care Ombudsman Program is as effective as possible in advocating for and speaking on behalf of our society’s most vulnerable population: nursing home residents,” said AARP New York State Director Beth Finkel.

“After over 15,000 deaths in New York nursing homes and counting since the start of the pandemic, we need a strong advocate. AARP New York thanks Senator Rachel May and Assembly Member Sarah Clark for steering this bill through their respective houses, and we strongly urge Governor Kathy Hochul to sign it into law.”

The New York Ombudsman Program is an advocate and resource for seniors and people with disabilities who live in nursing homes, assisted living and other licensed adult care homes. Ombudsmen help residents understand and exercise their rights to good care in an environment that promotes and protects their dignity and quality of life.

The legislation was supported by the Center for Elder Law & Justice in Buffalo, New York.

Although LTCOP can’t sanction long-term care facilities, it’s the only agency authorized to visit facilities on a regular basis to observe conditions, monitor care and help residents and families resolve problems.

In addition to helping individual residents and families, LTCOP is required by federal rules to act as an independent voice for residents with respect to laws and policies that impact their care.

Reference: Harlem World Magazine (June 4, 2022) “NYS Lawmakers Move To Strengthen Nursing Home Oversight From Care, To Complaints And More”

Elderly Woman Thanks Firefighters for Ride to Visit Husband at Nursing Home

An senior in San Diego was so grateful for the help of local firefighters, she wanted to thank them in person with a big bag of sweets, reports NBC San Diego’s recent article entitled “Stranded La Jolla Woman, 87, Brings Treats to Firefighters Who Gave Her a Lift.”

“It was a long time I was waiting for that cab. If it wasn’t for you, I’d be there all night,” La Jolla resident Sandy Lightman recalled telling San Diego Fire-Rescue Department Captain Jordan Buller on May 10, the night of her “rescue.”

The article said that Mrs. Lightman may have needed a fire engine to haul the three dozen cookies and four cheesecakes to Captain Buller and the Station 35 crew.

The 87-year-old explained that she’d just ended one of her daily trips to a nursing facility, where she cares for her husband who’s living with dementia.

She started requesting a cab around 8:20 p.m., but it didn’t show. So, she kept calling.

Hours later at 11 p.m., while on another call to the facility, Captain Buller and his crew recognized Lightman’s distress.

“She was frantically trying to call family and call a cab and we could tell she was distraught,” he said.

“I can’t walk that well, and I was only two-and-a-half blocks from where I live but I was afraid to go on the street by myself. I didn’t know if I’d make it home,” she said.

Since the cab wasn’t coming, the San Diego fire firefighters loaded Lightman into the cab of their engine.

They strapped her into the jump seat—and even gave her headphones to wear for the trip.

“It felt so secure, it made me feel so good because they were helping me and I knew I was safe, because I was afraid,” said Mrs. Lightman.

Back home safely, the grateful woman says she’s thankful to the local news outlet that was able to help track down the station who treated her with such kindness, so she could spoil them with some sweet treats.

Lightman and her husband will celebrate 40 years of marriage next week.

Reference: NBC San Diego (May 24, 2022) “Stranded La Jolla Woman, 87, Brings Treats to Firefighters Who Gave Her a Lift”

Who Is the Best Choice for Power of Attorney?

Picking a person to serve as your Power of Attorney is an extremely important part of your estate plan, although it is often treated like an afterthought once the will and trust documents are completed. Naming a POA needs to be given the same serious consideration as creating a will, as discussed in this recent article “Avoid powers of attorney mistakes” from Medical Economics.

Choosing the wrong person to act on your behalf as your Power of Attorney (POA) could lead to a host of unintended consequences, leading to financial disaster. If the same person has been named your POA for healthcare, you and your family could be looking at a double-disaster. What’s more, if the same person is also a beneficiary, the potential for conflict and self-dealing gets even worse.

The Power of Attorney is a fiduciary, meaning they are required to put your interests and the interest of the estate ahead of their own. To select a POA to manage your financial life, it should be someone who you trust will always put your interests first, is good at managing money and has a track record of being responsible. Spouses are typically chosen for POAs, but if your spouse is poor at money management, or if your marriage is new or on shaky ground, it may be better to consider an alternate person.

If the wrong person is named a POA, a self-dealing agent could change beneficiaries, redirect portfolio income to themselves, or completely undo your investment portfolio.

The person you name as a healthcare POA could protect the quality of your life and ensure that your remaining years are spent with good care and in comfort. However, the opposite could also occur. Your healthcare POA is responsible for arranging for your healthcare. If the healthcare POA is a beneficiary, could they hasten your demise by choosing a substandard nursing facility or failing to take you to medical appointments to get their inheritance? It has happened.

Most POAs, both healthcare and financial, are not evil characters like we see in the movies, but often incompetence alone can lead to a negative outcome.

How can you protect yourself? First, know what you are empowering your POAs to do. A boilerplate POA limits your ability to make decisions about who may do what tasks on your behalf. Work with your estate planning attorney to create a POA for your needs. Do you want one person to manage your day-to-day personal finances, while another is in charge of your investment portfolio? Perhaps you want a third person to be in charge of selling your home and distributing your personal possessions, if you have to move into a nursing home.

If someone, a family member, or a spouse, simply presents you with POA documents and demands you sign them, be suspicious. Your POA should be created by you and your estate planning attorney to achieve your wishes for care in case of incapacity.

Different grown children might do better with different tasks. If your trusted, beloved daughter is a nurse, she may be in a better position to manage your healthcare than another sibling. If you have two adult children who work together well and are respected and trusted, you might want to make them co-agents to take care of you.

Your estate planning attorney has seen all kinds of family situations concerning POAs for finances and healthcare. Ask their advice and don’t hesitate to share your concerns. They will be able to help you come up with a solution to protect you, your estate and your family.

Reference: Medical Economics (Feb. 3, 2022) “Avoid powers of attorney mistakes”

Can Elder Financial Abuse Be Stopped?

The numbers are chilling. One in ten Americans age 60+ has experienced elder abuse. One of the most common forms of elder abuse is financial, says a recent article from Forbes titled “What Is Elder Financial Abuse—And How Do We Prevent It?”

Financial elder abuse is defined as when someone illegally or improperly uses an elderly person’s money for their own use. Elderly people are easy victims for obvious reasons. They may be mentally vulnerable, suffering from Alzheimer’s or other form of dementia. They may also be lonely and find the company of a new “friend” is so delightful that it impairs their judgement.

Financial elder abuse occurs most often from adult children, but also in nursing homes and assisted living facilities. Be on the watch for those new friends who enter senior’s lives, especially if they seek to limit contact with family members.

Caregivers or nursing staff have access to resident’s possessions, including checkbooks, ATM cards and credit cards. Monitoring an aging parent’s bank accounts on a regular basis should be part of caregiving by adult children. Unusual transactions, large withdrawals or unlikely purchases by credit card should immediately be reported to their bank or credit card company.

Less obvious and harder to track, is when someone forces a nursing home resident to sign legal documents transferring ownership of homes, cars, bank accounts and even investment accounts. They may also be pressured into creating a new will.

Here are some red flags to watch for:

  • New names being added to bank accounts or on credit cards.
  • Finding unpaid bills, letters from collection agencies or past due notices from creditors, especially when the person has sufficient funds.
  • Relatives who suddenly show up and want to be involved with an aging senior, including estranged children.
  • The unexpected transfer of any kind of asset to someone who is not a family member.
  • Any change in habits concerning money, including someone who was never worried about money suddenly being concerned about paying bills.

The elderly are often scared to report being victimized. They may fear further loss of control over their lives or be embarrassed to have been scammed. If a caregiver is stealing, they may also be physically threatened, or frightened of losing their familiar care provider.

Talk to your estate planning attorney, speak with the local Adult Protective Services office, or contact the National Elder Fraud Hotline, if you are concerned about a loved one being financially exploited.  If you believe a loved one is in physical danger, contact the local police. Don’t hesitate to ask for help.

Reference: Forbes (Nov. 9, 2021) “What Is Elder Financial Abuse—And How Do We Prevent It?”

How to Avoid Medicaid Estate Recovery

Medicaid is a government program that helps seniors and others pay for long term care. However, it’s not always free, explains the article “What Is Medicaid Estate Recovery?” from AOL.com. The Medicaid Estate Recovery Program (MERP) is used by states to recover costs from estates with funds. The goal of Medicaid estate recovery is to make the program affordable for the government, but it can have a severe impact on the beneficiaries of Medicaid recipients. An estate planning elder law attorney should be contacted, if you believe you or a loved one may need Medicaid.

Seniors are eligible for Medicare when they turn 65. This program pays for many healthcare expenses, but not for long-term care in a nursing home. Medicaid is used when someone does not have long term care insurance or enough money to pay for long-term care out of pocket. Medicaid can also be used for long-term or nursing home care, if steps have been taken to protect assets. This usually includes strategies, like trusts and Medicaid Asset Protection Trusts (MAPT).

A federal law passed in 1993 (the Omnibus Budget Reconciliation Act) requires states to attempt to seek reimbursement from a Medicaid beneficiary’s estate after they have died. Some of the costs that the state will try to recover include:

  • Nursing home costs
  • Home and community-based services
  • Medical services received through a hospital where the recipient is a long-term care patient
  • Prescription drug services for long-term care recipient

The recovery program lets Medicaid pursue any eligible assets owned by the estate. While this depends upon where you live, any assets that are part of the probate estate could be attached, including:

  • Bank accounts
  • Your home or other real estate
  • Vehicles or other real property

In addition, some states allow Medicaid to recover assets that are not subject to probate, including jointly held accounts, Payable-On-Death (POD) bank accounts, real estate owned in joint tenancy with right of survivorship, living trusts and any other assets that the Medicaid recipient had a legal interest in.

An estate planning elder care attorney in your state will know what types of assets your state tends to pursue and will help you understand what can and cannot be used for Medicaid benefit recovery.

Note that while Medicaid cannot take the primary residence while the recipient is still living, they can place a lien on the home. If the recipient passes away and a beneficiary inherits the home, they will not be able to sell the property until the lien has been satisfied.

For beneficiaries, Medicaid recovery means a smaller inheritance. However, that’s not the only thing to be mindful of. There are laws known as “filial responsibility laws” that allow healthcare providers to sue the children of long-term care recipients to recover nursing care costs. This is not commonly done as of this writing, but the costs of COVID may change this in the near future.

Strategic planning can help you or loved ones avoid the financial impact of Medicaid estate recovery. If you are eligible and can afford to buy a long-term care policy, that may help to cover most of the cost of care. Another option is to remove as many assets from the probate process as possible. An estate planning attorney will be able to help you create a plan to protect your assets.

Reference: AOL.com (February 5, 2021) “What Is Medicaid Estate Recovery?”

 

visiting grandparent during pandemic

Visiting Grandma at the Nursing Home

In spots where visits have resumed, they’re much changed from those before the pandemic. Nursing homes must take steps to minimize the chance of further transmission of COVID-19. The virus has been found in about 11,600 long-term care facilities, causing more than 56,000 deaths, according to data from the Kaiser Family Foundation.

AARP’s recent article entitled “When Can Visitors Return to Nursing Homes?” explains that the federal Centers for Medicare and Medicaid Services (CMS) has provided benchmarks for state and local officials to use, in deciding when visitors can return and how to safeguard against new outbreaks of COVID-19 when they do. The CMS guidelines are broad and nonbinding, and there will be differences, from state to state and nursing home to nursing home, regarding when visits resume and how they are handled. Here are some details about the next steps toward reuniting with family members in long-term care.

When will visits resume? As of mid-July, 30 states permitted nursing homes to proceed with outdoor visits with strict rules for distancing, monitoring and hygiene. The CMS guidelines suggest that nursing homes continue prohibiting any visitation, until they have gone at least 28 days without a new COVID-19 case originating on-site (as opposed to a facility admitting a coronavirus patient from a hospital). CMS says that these facilities should also meet several additional benchmarks, which include:

  • a decline in cases in the surrounding community
  • the ability to provide all residents with a baseline COVID-19 test and weekly tests for staff
  • enough supplies of personal protective equipment (PPE) and cleaning and disinfecting products; and
  • no staff shortages.

Where visits are permitted, it should be only by appointment and in specified hours. In some states, only one or two people can visit a particular resident at a time. Even those states allowing indoor visits are suggesting that families meet loved ones outdoors. Research has shown that the virus spreads less in open air.

Health checks on visitors. The federal guidelines call for everyone entering a facility to undergo 100% screening. However, the CMS recommendations don’t address testing visitors for COVID-19.

Masks. The federal guidelines say visitors should be required to “wear a cloth face covering or face mask for the duration of their visit,” and states that allow visitation are doing so. The guidelines also ask nursing homes to make certain that visitors practice hand hygiene. However, it doesn’t say whether facilities should provide masks or sanitizer.

Social distancing. The CMS guidelines call on nursing homes that allow visitors to ensure social distancing, but they don’t provide details. States that have permitted visits, state that facilities enforce the 6-foot rule.

Virtual visits. Another option is to make some visits virtual. Videoconferencing and chat platforms have become lifelines for residents and families during the pandemic. Continued use after the lockdowns can minimize opportunities for illness to spread.

Reference: AARP (July 22, 2020) “When Can Visitors Return to Nursing Homes?”

caregiver for family member

Can I Get Paid to Be a Caregiver for a Family Member Who’s a Vet?

AARP’s recent article entitled “Can I Get Paid to Be a Caregiver for a Family Member?” says that you may be able to get paid to be a family caregiver, if you’re caring for a veteran. Veterans have four plans for which they may qualify.

Veteran Directed Care. Similar to Medicaid’s self-directed care program, this plan lets qualified former service members manage their own long-term services and supports. Veteran Directed Care is available in 37 states, DC, and Puerto Rico for veterans of all ages, who are enrolled in the Veterans Health Administration health care system and require the level of care a nursing facility provides but want to live at home or the home of a loved one. A flexible budget (about $2,200 a month) lets vets choose the goods and services they find most useful, including a caregiver to assist with activities of daily living. The vet chooses the caregiver and may select any physically and mentally capable family member, including a child, grandchild, sibling, or spouse.

Aid and Attendance (A&A) Benefits. This program supplements a military pension to help with the expense of a caregiver, and this can be a family member. A&A benefits are available to veterans who qualify for VA pensions and meet at least one of the following criteria. The veteran:

  • Requires help from another to perform everyday personal functions, such as bathing, dressing, and eating
  • Is confined to bed because of disability
  • Is in a nursing home because of physical or mental incapacity; or
  • Has very limited eyesight, less than 5/200 acuity in both eyes, even with corrective lenses or a significantly contracted visual field.

Surviving spouses of qualifying veterans may also be eligible for this benefit.

Housebound Benefits. Veterans who get a military pension and are substantially confined to their immediate premises because of permanent disability are able to apply for a monthly pension supplement. It’s the same application process as for A&A benefits, but you can’t get both housebound and A&A benefits simultaneously.

Program of Comprehensive Assistance for Family Caregivers. This program gives a monthly stipend to family members, who serve as caregivers for vets who require help with everyday activities because of a traumatic injury sustained in the line of duty on or after Sept. 11, 2001. The vet must be enrolled in VA health services and require either personal care related to everyday activities or supervision or protection, because of conditions sustained after 9/11. The caretaker must be an adult child, parent, spouse, stepfamily member, extended family member or full-time housemate of the veteran.

Reference: AARP (May 15, 2020) “Can I Get Paid to Be a Caregiver for a Family Member?”