Elder Law / Medicaid Planning

A Pooled Income Trust is a special type of trust that allows individuals of any age (typically over 65) to become financially eligible for public assistance benefits (such as Medicaid home care and Supplemental Security Income), while preserving their monthly income in trust for living expenses and supplemental needs. All income received by the beneficiary must be deposited into the Pooled Income Trust which is set up and managed by a not-for-profit organization.

In order to be eligible to deposit your income into a Pooled Income Trust, you must be disabled as defined by law. For purposes of the Trust, "disabled" typically includes age-related infirmities. The Trust may only be established by a parent, a grandparent, a legal guardian, the individual beneficiary (you), or by a court order.

Typical individuals who use a Pool Income Trust are: (a) elderly persons living at home who would like to protect their income while accessing Medicaid home care; (2) recipients of public benefit programs such as Supplemental Security Income (SSI) and Medicaid; (3) persons living in an Assisted Living Community under a Medicaid program who would like to protect their income while receiving Medicaid coverage.

Medicaid recipients who deposit their income into a Pool Income Trust will not be subject to the rules that normally apply to "excess income," meaning that the Trust income will not be considered as available income to be spent down each month. Supplemental payments for the benefit of the Medicaid recipient include: living expenses, including food and clothing; homeowner expenses including real estate taxes, utilities and insurance, rental expenses, supplemental home care services, geriatric care services, entertainment and travel expenses, medical procedures not provided through government assistance, attorney and guardian fees, and any other expense not provided by government assistance programs.

As with all long term care planning tools, it’s imperative that you consult a qualified estate planning attorney who can make sure that you are in compliance with all local and federal laws.

Kerry Hannon (NYTimes.com) has recently published an article entitled, An Aging Population Also Poses Opportunities for Retirement Careers (March 7, 2014). Provided below is the abstract to the article from NYTimes.com:

An Aging Population Also Poses Opportunities for Retirement Careers

As the population ages, jobs like massage therapist and others like senior fitness trainers, dietitians and nutritionists, personal assistants, handymen, drivers and caterers who prepare meals for shut-ins are on the upswing.

"It's no secret that retirement is a very diverse process for older Americans, with some combination of phased retirement and bridge jobs being the norm among older career workers," according to Kevin E. Cahill, an economist with the Sloan Center on Aging and Work at Boston College.

"About 60 percent of the career workers take on a part-time job after exiting their main career," Mr. Cahill said.

As a result, more and more jobs and businesses are being created to satisfy not just the growing number of people living healthier and longer lives, but this "Aging in place" market.

FINANCIAL PLANNER Not surprisingly, as retirees fear outliving their money, jobs for personal financial advisers are expected to be one of the faster-growing occupations over the next decade, with a projected growth rate of 27 percent by 2022, according to the Labor Department.

TRAVEL GUIDE When Judi Bonilla, 56, was laid off from her job as a logistics subcontractor for the military, she did some soul-searching and came to the conclusion that she enjoyed working with older adults.

What ties these jobs together? At a time of life when someone's world begins to narrow, these services all offer a kind of independence - whether it's a way for clients to stay active socially and physically, to not worry about finances, or to get relief from the aches and anxiety of aging with a human touch.

For more information on this topic, continue reading the article "An Aging Population Also Poses Opportunities for Retirement Careers" by Kerry Hannon (NYTimes.com). 

Individuals who are beginning the estate planning process may assume it's best to have their adult child(ren) join them in the initial meeting with an estate planning attorney, but this may cause more harm than good.

This issue comes up often in the estate planning and elder law field, and it's a matter of client confidentiality. The attorney must determine who their client is- the individual looking to draft an estate plan or their adult children- and they owe confidentiality to that particular client.

The client is the person whose interests are most at stake. In this case, it is the parent. The attorney must be certain that they understand your wishes, goals and objectives. Having your child in the meeting could cause a problem if your child is joining in on the conversation, which may make it difficult for the attorney to determine if the wishes are those of your child, or are really your wishes.

Especially when representing elderly clients, there may be concerns that the wishes and desires of a child may be in conflict with the best interests of the parent. For example, in a Medicaid and long-term care estate planning context, the attorney may explain various options and one of those may involve transferring, or gifting, assets to children. The child's interest (purely from a financial aspect) would be to receive this gift. However, that may not be what the parent wants, or feels comfortable with. The parent may be reluctant to express those concerns to the attorney if the child is sitting right next to the parent in the meeting.

Also, the attorney will need to make a determination concerning the client's competency. Attorneys are usually able to assess a client's ability to make decisions during the initial meeting. Having a child in the room may make it more difficult for the attorney to determine competency because the child may be "guiding" the parent and finishing the parents thoughts in an attempt to help. 

The American Bar Association has published a pamphlet on these issues titled "Why Am I Left in the Waiting Room?" that may be helpful for you and your child to read prior to meeting with an attorney. 

Turning Over the Keys: Helping older drivers make the tough decision 

We all want to be in control, to go where we want at our leisure.  As we age, however, our senses and reaction times begin to slow which can make getting behind the wheel increasingly hazardous. It is important to be realistic about the driving abilities of loved ones as they reach a certain stage and to prepare accordingly. Not only will it keep seniors safe, but planning ahead will help them financially as they make other arrangements for transportation.

The first step is to reduce the need to drive. Find ways to bring the things they need right to them, like ordering groceries online for delivery and encouraging in-home appointments. Suggest that they invite friends and family over for regular visits instead of going out. They may be surprised by how many things are possible from the comfort of their own home.

For the times your loved ones need to, or want to, venture elsewhere, look into other transportation options. Although there is usually no need to quit driving all at once, look to family, friends, taxis, and public transportation when you can, especially for longer trips. Use the money you’ve been saving, along with what would have been spent on gas, on alternate modes of transportation. Their town may even have designated senior transportation services. 

The time to start making this transition may be sooner than you or your loved ones think. Don’t wait until an accident leaves them with no alternative. It may be time to start talking about limiting driving if they report noticing subtle difficulties, like trouble reading traffic signs or delayed breaking. Keep an eye out for small dings in your loved one’s car or surrounding items, like the mailbox or garage door, along with slower response time or difficulty finding their way around familiar territory. Ask them to watch for these things as well.

Asking a loved one to turn over their keys can be tough but with an open dialogue, the right support system and reasonable alternatives in place to ensure that they can continue to live an active lifestyle, a smooth transition is feasible.  

Jessica Silver-Greenberg (NYTimes) has recently published an article entitled, “Winning Veterans’ Trust, and Profiting From It” (December 23, 2013). Provided below is the abstract to the article from NY Times:

Winning Veterans’ Trust, and Profiting From It 

As you reach a certain age, retirement planning is essential. For Henry Schaffer, a World War II veteran, there was no question that he no longer could live on his own. His daughter Kristi began searching for retirement homes and the money to pay for it.

At Aspen View, a senior living complex in Billings, Mont., a lawyer accredited by the Department of Veterans Affairs, told the family Mr. Schaffer could probably qualify for a V.A discount. The problem lies after Mr. Schaffer moved in and they learned he did not qualify for a V.A discount at all. His daughter Kristi now says he worries he will be evicted as he can only afford about half of his monthly bills.

As baby boomers head toward retirement — worrying not only about their financial futures, but also their parents’ — a cottage industry has sprung up around the pension program.

Lawyers, financial advisers and insurance brokers have formed a lucrative alliance with retirement communities and assisted living facilities to extract many billions of taxpayer dollars from the V.A., according to interviews with state and federal authorities, as well as a review by The New York Times of hundreds of legal documents and client contracts.

For more information on this topic, continue reading the article “Winning Veterans’ Trust, and Profiting From It” by Jessica Silver-Greenberg. 

As a child of a senior citizen, you are faced with many choices in helping to care for your parent. You want the very best care for your mother or father, but you also have to take into consideration your personal needs, family obligations and finances.

When choosing a caregiver for a loved one, there are a number of things to take into consideration.

1. Time. Do you require part- or full-time care for your parent? Are you looking for a caregiver to come into your home? Will your parent live with the caregiver or will you put your parent into a senior care facility? According to the National Alliance for Caregiving, 58 percent of care recipients live in their own home and 20 percent live with the caregiver. You should consider your current arrangement but also take time to identify some alternatives in the event that the requirements of care should change in the future.
2. Family ties. If you have siblings, they probably want to be involved in the decision of your parent’s care. If you have a sibling who lives far away, sharing in the care responsibilities or decision-making process may prove to be challenge. It’s important that you open up the lines of communication with your parents and your siblings so everyone is aware and in agreement about the best course of care.
3. Specialized care. Some caregivers and care facilities specialize in specific conditions or treatments. For instance, there are special residences for those with Alzheimer’s and others for those suffering from various types of cancer. If your parent suffers from a disease or physical ailment, you may want to take this into consideration during the selection process
4. Social interaction. Many seniors fear that caregivers or care facilities will be isolating, limiting their social interaction with friends and loved ones. It’s important to keep this in mind throughout the process and identify the activities that he or she may enjoy such as playing games, exercising or cooking. Make sure to inquire about the caregiver’s ability to allow social interaction. Someone who is able to accommodate your parent’s individual preferences or cultural activities will likely be a better fit for your mother or father.
5. Credentials. Obviously, it is important to make sure that the person or team who cares for your parent has the required credentials. Run background checks and look at facility reviews to ensure you are dealing with licensed, accredited individuals. You may choose to run an independent background check or check references for added peace of mind.
6. Scope of care. If you are looking for a live-in caregiver, that person is responsible for more than just keeping an eye on your mother or father—he or she may be responsible for preparing meals, distributing medication, transporting your parent, or managing the home. Facilities typically have multidisciplinary personnel to care for residents, but an individual will likely need to complete a variety of tasks and have a broad skill set to do it all.
7. Money.Talk to your parent about the financial arrangements that he or she may have in place. If this isn’t an option, you will likely need to discuss the options with your siblings or your parent’s lawyer—or check your mother’s or father’s estate plan—to find out more about available assets and how to make financial choices pertaining to your parent’s care.
8. Prepare. Upon meeting the prospective caregiver or visiting a facility, it is important to have questions prepared ahead of time so you can gather all of the information necessary to make an informed choice. Finally, be prepared to listen to your parent’s concerns or observations so you can consider their input in the decision. If he or she is able, they will likely want to make the choice themselves.

Choosing a caregiver for your parent is an important decision that weighs heavily on most adult children but with the right planning and guidance, you can make the best choice for your family. Once you find the right person, make sure to follow up as care continues and to check in with your mother or father to ensure the caregiver is the perfect fit.

For Week 3 of the National Alzheimer's Awareness Month, LegalJourney will be offering a free Power of Attorney and Declaration of Preened Guardian¹ from Wednesday November 20th until Friday November 22nd, 2013. 

Week 3: Free Power of Attorney and Declaration of Preneed Guardian¹

The first 4 individuals who contact the LegalJourney Law Firm using the "Contact the Firm" option on www.legaljourney.com will receive a free Florida Power of Attorney and a free Florida Declaration of Preneed Guardian.

The LegalJourney Law Firm’s Week 3 offer includes: an interview with an attorney, a customized power of attorney, a customized declaration of preneed guardian and notarization² of your documents.

To find out additional details, please contact the LegalJourney Law Firm PLLC

¹This offer is available until close of business November 22, 2013.

²Notarization is only available to residents of the Tampa Bay Area

Amy Feldman (Barron’s) has recently published an article entitled, “Thinking Long Term” (November 09, 2013). Provided below is the abstract to the article from Barron’s:

Thinking Long Term

Are you Skeptical of long-term care insurance? You're not alone, and more and more advisors are arguing that the benefits outweigh the costs.

The numbers for long-term care speak for themselves, what happens when you do not have money to sustain yourself and need long-term care? Most people think that Medicare or health insurance will have you covered, but in reality that only covers a very short stay if you end up needing long-term care. Even if you have saved a respectably amount for retirement, long-term care costs can exceed $100,00 a year and you may be faced with having to spend down your assets to qualify for Medicaid.

The aging of the U.S. has changed retirement planning dramatically, at some point many of us may be faced with Alzheimer’s or other forms of dementia, arthritis, diabetes, etc. due to the fact that we are living longer.

According to Genwroth’s 2013 cost-of-care survey, a median cost of a private room in a nursing home is $230 a day, that is equivalent to $83,950 a year and if you hope to choose the nicest facility in your area, expect to pay more.

For more information on why Long-Term care planning is important, continue reading the article “Thinking Long Term” by Amy Feldman. 

When it comes to Alzheimer’s disease and other forms of dementia, more Americans fear being unable to care for themselves and burdening others with their care than they fear the actual loss of memory. Advance planning for incapacity is a legal process that can lessen the fear that you may become a burden to your loved ones later in life. For more information read our previously posted blog article "Advance Planning Can Help Relieve the Worries of Alzheimer’s Disease"

This week LegalJourney will be offering a free Declaration of Preneed Guardian¹ from Wednesday November 13^th until Friday November 15^th, 2013.

Week 2: Free Declaration of Preneed Guardian¹

The first 4 individuals who contact the LegalJourney Law Firm using the "Contact the Firm" option on www.legaljourney.com will receive a free Florida Declaration of Preneed Guardian.

When included as part of your Estate Plan, the declaration of a preneed guardianship can alleviate the stress involved with determining who will become guardian of a loved ones person and property during incapacity.

The LegalJourney Law Firm’s Declaration of Preneed Guardian free offer includes: an interview with an attorney and a customized Declaration of Preneed Guardian.

To find out additional details, please contact the LegalJourney Law Firm PLLC

Florida Statute Section 744.3045 Preneed Guardian States that “a competent adult may name a preneed guardian by making a written declaration that names such guardian to serve in the event of the declarant’s incapacity… ”

¹This offer is available until November 15^th, 2013.

As part of National Alzheimer’s Awareness Month, the LegalJourney Law Firm will be spreading the word on free services offered during the month of November 2013. 

The Byrd Institute is offering the following services:

Free Memory Screening - TUESDAY, NOVEMBER 19, 2013 8:30AM - 3:30PM

The USF Health Byrd Alzheimer’s Institute will offer free memory screenings on Tuesday, November 19th from 8:30am-3:30pm. In addition to memory screenings, guests will enjoy exhibit booths, blood pressure checks, and hearing screenings. Bring your prescription and over-the-counter medications for a consultation with a clinical pharmacist.

*Reservations required. To make an appointment, please call: (813) 974-4357

Free Tremor Screenings - TUESDAY, NOVEMBER 19, 2013 10:00AM - 12:30PM the USF Health Parkinson’s Disease and Movement Disorders Center (6th floor of Byrd Alzheimer’s Institute).

 *Reservations required. To make an appointment, please call: (813) 396-0751

The Byrd Institute is located at 4001 E. Fletcher Ave, Tampa, FL

We all want to be in control, to go where we want at our leisure.  As we age, however, our senses and reaction times begin to slow which can make getting behind the wheel increasingly hazardous. It is important to be realistic about the driving abilities of loved ones as they reach a certain stage and to prepare accordingly. Not only will it keep seniors safe, but planning ahead will help them financially as they make other arrangements for transportation.

The first step is to reduce the need to drive. Find ways to bring the things they need right to them, like ordering groceries online for delivery and encouraging in-home appointments. Suggest that they invite friends and family over for regular visits instead of going out. They may be surprised by how many things are possible from the comfort of their own home.

For the times your loved ones need to, or want to, venture elsewhere, look into other transportation options. Although there is usually no need to quit driving all at once, look to family, friends, taxis, and public transportation when you can, especially for longer trips. Use the money you’ve been saving, along with what would have been spent on gas, on alternate modes of transportation. Their town may even have designated senior transportation services. 

The time to start making this transition may be sooner than you or your loved ones think. Don’t wait until an accident leaves them with no alternative. It may be time to start talking about limiting driving if they report noticing subtle difficulties, like trouble reading traffic signs or delayed breaking. Keep an eye out for small dings in your loved one’s car or surrounding items, like the mailbox or garage door, along with slower response time or difficulty finding their way around familiar territory. Ask them to watch for these things as well.

Asking a loved one to turn over their keys can be tough but with an open dialogue, the right support system and reasonable alternatives in place to ensure that they can continue to live an active lifestyle, a smooth transition is feasible.