An Advance Healthcare Directive Can Make a Difficult Conversation a Little Bit Easier
August 13, 2012
Does your family know your preferences for end-of-life care in case of emergency? Are you sure? If you haven’t created an Advance Healthcare Directive or spoken to your loved ones specifically about this issue, then chances are they don’t know your wishes, no matter how close you believe you are.
Our firm understands that opening up a conversation about DNR directives or end-of-life care can be difficult and awkward. Thinking about your own death, or the death of someone you love is painful. But the arguments—and potentially lengthy court battles—that can occur between caring relatives when these issues are not discussed will be even more painful. If the tragic Terri Schiavo case taught us anything it should have taught us that a difficult conversation now can save our loved ones years of pain and hardship later on.
We may not be able to save you from a difficult conversation, but this article from ABC News might help you get the conversation started. The first suggestion is to put your wishes in writing and then mail a copy of those wishes to your loved ones or to your healthcare agent. The article suggests a resource workbook which can be found online, but an even better option would be to execute an Advance Healthcare Directive with your estate planning or elder law attorney.
Executing and Advance Healthcare Directive not only provides you with an opportunity to say to your loved ones “I want to talk about this;” it also ensures that there will be no legal obstacles if tragedy should strike and you are unable to make your own healthcare decisions.
Once your loved ones know your preferences for end-of-life care this opens the door for them to ask questions if they have any, and even perhaps express their own views and preferences. Your primary care physician should receive a copy of your Advance Healthcare Directive as well. Confirm that your physician will be able to honor and respect your wishes if and when the time comes.
For more information about Advance Healthcare Directives, or talking to your family and friends about end-of-life decisions, please contact our office.
Prudential to Stop Offering Group Long-Term Care Insurance, Giving Buyers One Less Option
July 25, 2012
If you have been thinking about investing in long-term care insurance when planning for the future, you now, unfortunately, have one less option to consider. Recent news reports that as of August 1 of this year, Prudential Financial Inc will stop selling group long-term care policies in all but five states. According to news sources this makes Prudential the latest in a line of insurers to stop selling the product.
While the growing inevitability of the need for long-term care and how to pay for it is a rising concern for the American public, offering long-term care insurance has not been a profitable practice for insurers. “Most insurers that offer [long-term care insurance] have suffered through sizeable losses. In the early days of the product, insurers underestimated the size and length of claims, and more recently the rate environment has exacerbated the problem.”
If you already have long-term care insurance through Prudential don’t panic, “Prudential said coverage under existing policies would not change, and would remain renewable.” It will be in your best interest to be vigilant, however, considering that Prudential “cautioned that premiums could change, subject to regulatory review.”
If you do not yet have long-term care insurance, never fear, there are still plenty of companies you can turn to for coverage. The National Care Planning Council has an excellent online guide to many aspects of long-term care, but your options and requirements will vary depending on your health, your age, your state of residence, and other factors. Please contact our office for the most up-to-date and relevant options for your family.
Affordable Care Act Likely to Improve Situations of People with Disabilities
July 23, 2012
The Affordable Care Act (ACA) is a hot topic lately, and of great concern to people of all walks of life; but people with disabilities, or who rely on government benefits to help them pay for health care and living expenses, have even more at stake in the game and more reason to be concerned. It is this population of elderly or disabled individuals who, according to this recent article in Forbes, have had to (in some states) limit their income in order to continue receiving affordable health insurance through federally funded programs. But hopefully, the ACA is about to change all that.
“The most obvious and most significant health industry reform important to [elderly or disabled individuals] is the elimination of pre‐existing conditions as a bar to purchasing private health insurance. However, ACA also eliminates annual or lifetime caps, rescission of insurance policies, non‐renewability, and higher premium costs for persons with pre‐existing conditions.”
Before the passage of the ACA many disabled persons couldn’t qualify for health insurance from private insurers, leaving public programs such as Medicaid as their only option. The problem with relying on Medicaid is that once your income reaches a certain amount you no longer qualify. For disabled persons with “pre-existing conditions,” losing Medicaid benefits while still unable to qualify for private insurance was equal to disaster, and resulted in many people self-limiting their income.
Now, however, private insurance companies will no longer be able to bar individuals with pre-existing conditions. Thankfully, this should “open the door to many more people to confidently join the workforce, knowing they will not do so at the cost of having medical needs met.”
If you or a loved one has a special needs trust, or would like to know how the ACA may affect your government provided health insurance or benefits, please contact our office.
The Pros and Cons of Long-Term Care Insurance
May 14, 2012
Do you have long-term care insurance? SHOULD you have long-term care insurance? These are questions that currently plague many forty-, fifty-, and sixty-somethings, as well as some precocious thirty-somethings. We’ve been hearing and reading more and more about long-term care insurance in recent years, but we still don’t seem to have any kind of firm consensus about whether it’s a good investment—whether it’s a necessary investment—or not.
This recent article from CBS online, entitled Why Long-Term Care Insurance Is Important, argues that “LTCI is a tool that can help preserve and protect financial assets, provide flexibility to choose the type of care, offer the ability to choose where care is received, help to ensure high-quality care, and provide financial and emotional support for the family.” This article helps readers not only understand why LTCI might be important, but what are the important questions to ask when considering whether and which long-term care insurance might benefit you and your family.
Of course, not everyone thinks long-term care insurance is necessary. Another article, this one from the Wall Street Journal, provides both sides of the argument. The pro-LTCI writer argues that “For those who buy and keep their policy it is a no-regret proposition. No one who has paid premiums and receives their benefits from the policy regrets having paid those premiums.” You pay a small regular sum over the course of a few decades, and when the time comes you are saved from bankrupting your family by paying as much as $250 a day, often for months or more.
The opposition writer against long-term care insurance argues that the likelihood that you’ll need to use the insurance policy is exaggerated. “It may be more useful to learn that 67% to 70% of seniors who do go into a nursing home are discharged within 90 days, and that after two years, less than 6% of those admitted will still be there.” This is important information to have, but $250/day for even 30-60 days can quickly wipe out a significant portion of a retiree’s savings.
Whatever you choose, make sure you account for your decision in your retirement and estate plans. Talk about the decisions with your estate planner, your financial advisor, and especially with your children. Long-term care expenses can be significant, and it’s always best to be as prepared as you can possibly be.
The High Emotional—And Financial—Cost of Alzheimer’s Disease
March 19, 2012
Alzheimer’s is a disease that affects everybody it touches—husbands, wives, children and grandchildren—they all bear witness to their loved one’s slow demise.
Sadly, emotional stress is not the only stress that accompanies Alzheimer’s disease; those loved ones serving as caretakers may carry a huge amount of financial stress as well. The cost of caring for an Alzheimer’s patient can run anywhere from $64 a day to $77,380 a year, and because Alzheimer’s disease can be such a long-lasting disease (a person can suffer from Alzheimer’s for up to 20 years) the costs of care can end up being astronomical. It’s obvious that people can’t do it alone.
Long-term care insurance can be very helpful in paying for the costs of care necessary for a loved one suffering from Alzheimer’s… if your loved one has thought ahead and purchased the policy before they or their spouse began suffering from symptoms of Alzheimer’s. Some people may not have thought ahead and hope that government programs will be able to help with the high cost of care. Medicaid can be helpful … if you fall in the right category and know how to navigate the complex system. (Medicare doesn’t cover the cost of long-term care.)
Unfortunately, learning how to navigate the system is not something you can do in an hour or two. Because your experience will depend on a number of unique factors we can’t give you an easy set of instructions to follow. The best advice we can give is to say that right now, the best way to navigate the Medicaid/Medi-Cal system is to find someone who knows the system to assist you. Most estate planning and elder law attorneys help their clients with these issues on a regular basis. If you want to ensure that you and your loved ones will be cared for no matter what the future may bring, don’t be afraid to ask your attorney for help.
Advice for Executors: How to Manage Final Medical Expenses
March 14, 2012
Most people die in a hospital; sometimes after a long and slow decline, sometimes after a quick and unexpected tragedy. If you are an executor of the deceased’s estate this is significant because it means that there are usually final medical bills to be paid. What most executors do not know is that these final medical bills are not necessarily just like all the other final expenses, especially when it comes to filing a final tax return for the estate; this article from SmartMoney.com explains why.
“…When a person incurs medical expenses and dies before they are paid, the executor of the decedent’s estate can elect to treat those medical expenses as if they were paid when incurred – as long as the estate pays the expenses within one year after the date of death. In other words, this election allows those expenses to be deducted on the decedent’s final Form 1040, even though they were not paid by the date of death.”
Many executors may not think of this because medical expenses can only be deducted if they exceed a certain percentage of the deceased’s adjusted gross income (7.5% to be exact); but health care being what it is, final medical expenses can quite often reach this point.
This sounds easy, but be careful if the deceased’s estate exceeds the $3.5 million estate tax exemption—you may want to look into other options. The article suggests that in this case it might be beneficial to “forgo the election and count the unpaid medical expenses as liabilities on the estate tax return.”
As the executor of an estate you may have more options than you are aware of when it comes to taxes, probate, and achieving the best results for the beneficiaries. If you are unsure about any of these—or other—issues, please contact our office, we can help advise you on all angles of the trustee or probate process.
Elderly Daycare Can Help Prevent Caregiver Burnout
March 7, 2012
Many of our clients provide care for elderly loved ones; some even providing constant, around the clock care. Care giving is a demanding, overwhelming, and often grossly underappreciated job. In addition to giving up their own time and interests, caregivers have to watch someone they love slowly regress and lose the ability to do even the most basic of tasks. Often, the senior being cared for eventually loses their ability to even recognize the people around them… including the person giving constant loving care. For all of these reasons, it’s very common for caregivers to experience depression and fatigue… caregiver burnout.
Depression and burnout does not have to be the plight of all caregivers, especially if you know the symptoms and how to combat them. The good news is that there are many preventative strategies which are readily available… the hard part for caregivers is valuing their own time and mental health enough to take advantage of them.
One of the best ways to avoid caregiver burnout is by making time for yourself periodically. Adult day service centers provide personal care, social activities, therapy and meals during the day while caregivers need to be away at work or even taking a much-needed break. If you have a parent who can no longer care for themselves during the day, adult day services might be a good solution for everybody involved.
There is a saying that hardships shared are halved, and joys shared are doubled; this is as true of care giving as it is for anything else. Many caregivers are reluctant to ask for help, but sharing the burden could save you from caregiver burnout. Don’t be afraid to reach out.
A Difficult Decision: Choosing a Nursing Home for Yourself or Your Loved One
February 6, 2012
If and when the time comes to choose a nursing home—either for yourself or for a loved one—how will you know how to choose the right one? A person’s living situation often has a lot to do with how happy they are, so it is important to choose carefully and wisely. When you do begin the process of choosing a nursing home, you don’t have to go into it blind. Here are a few things to consider and questions to ask when you start your search:
A Matter of Money – Nursing care is an expensive prospect, so one of your first considerations when looking for a nursing home will be how much it will cost and how you (or your loved one) will pay for it. Fortunately, it is likely that the entire cost will not have to come out of your personal finances. The Medicare.gov website offers an overview of different strategies to pay for quality nursing care. Your elder law attorney can help you navigate these—and other—options.
For-Profit vs. Non-Profit – Not all nursing homes are created equal, and according to this recent article the choice between a for-profit or non-profit home can be one you’ll want to consider carefully.
Evaluate Staff and Policies – Taking the time you need to evaluate the staff and the policies of the homes on your list will quite possibly be the most important part of your decision-making process. This article from the “Our Parents” website provides a comprehensive list of questions to ask yourself, the nursing home staff, the residents, and more before you make your decision.
Location, Location, Location – Finally, we all know that location is everything, and this is true of nursing homes as well. Issues of location ranging from how close the home is to family and friends, to what kind of view can be seen from the windows can all be of the utmost importance.
Choosing a nursing home may well be one of the most difficult decisions you will ever make, so it’s best to go into it prepared. Don’t be afraid to get in touch with the professionals who can help you make the best possible decision for yourself and your loved ones.
New Year’s Resolutions: Taking Control of Your Health in 2012
December 21, 2011
Without a doubt the most frequent and popular New Year’s Resolutions made each year have to do with health. People resolve to exercise more, to lose weight, to eat better, etc. But far too few people are aware that in addition being healthy in body and mind, there are steps you can (and should) take to protect your medical future and privacy as well.
1. Think about your medical future and put your wishes into writing. How would you like to be cared for in the event that you are incapacitated? How long (and by what measures) would you like to be kept alive if you were to be irrevocably injured or diagnosed with a terminal illness? Who would you like making these decisions for you if you were unable to make them for yourself? These are the issues addressed in an advanced healthcare directive or a living will—documents every adult should have not only for their own peace of mind, but for the peace of mind of their family and loved ones as well.
2. Execute a HIPAA to help protect your medical privacy. A HIPAA Authorization is the document that lets your doctors and other health care providers know who may receive information about your medical status and treatment. Not only does this protect your privacy, but it ensures that the people who should be informed about your medical status will have access to the information they need.
3. Consider your eventual long-term care needs and look into long-term care insurance as a safety net. There is no way to know for sure which of us will need long-term care, but as life-expectancy increases the chances that any of us will need long-term care increase along with it. You can plan for this eventuality and protect yourself and your family from being hit too hard by the expenses of long-term care by investing in long-term care insurance. There are a few options available for long-term care insurance, and our office can help you choose which plan might be best for you.
Who Will Be Making Your Difficult Healthcare Decisions?
December 14, 2011
A recent article in the LA Times reminds us of just how important it is to have some kind of living will or advanced healthcare directive, and that it is absolutely necessary to talk about these things with your loved ones. If you have not done these things it is your loved ones who will be left to make the painful and terrible decisions about your medical treatment and possibly even the heart-wrenching DNR determination.
The author writes of his father—chronically ill, stroke survivor, suffering from mild but advancing dementia—who is currently staying in a nursing home, “where they’ve put him on a diet of pureed foods and thickened liquids, but he often refuses to eat, demanding to be taken home and fed the home cooking he’s always loved. It’s hard to tell him that may never happen, and that his options are increasingly grim. If my dad can’t eat, a feeding tube will be his only choice. Other than giving up the fight.”
The family is now struggling to decide if a feeding tube is the right course of action, what their father would (or does) want, and how involved he should be in the decision considering his current state of mental health. “We worry… that with mild but advancing dementia, my father won’t be able to fully comprehend the implications of being fed through a tube implanted in his gut. And if he declines it, is he competent to make that decision?” These are the heart-breaking decisions that can leave loved ones asking themselves for years after, “Did we do the right thing?”
We often shy away from talking about these issues with our family members and loved ones. We think that they are too sad, too depressing, or too far into the future to worry about yet. The only thing that can make these decisions even the tiniest bit easier, however, is knowing for certain what your loved one would want; and the only way to know for certain is to talk about your feelings with your family, and to put your wishes in writing with a living will or healthcare directive. Our office can help you do this.
More often than not the best that can be hoped for in a situation like the one discussed above is that some measure of peace is attained. We wish this for the author of the article and his family, and we wish this for any of our readers involved in similarly difficult and painful circumstances.