Estate Planning

 

Getting Help When You Need It

 

Jeff Mascitelli is the owner of CarePatrol, a senior placement agency located in Escondido here in San Diego County.  This week, Jeff submitted an article for our Southern California Legal Center newsletter, as a guest writer.  See below for some great information from Jeff and CarePatrol:

Most people tend to wait too long to arrange for support in the care of a loved one with dementia. For many families, support services are sought at the point where the primary caregiver has reached the end of their abilities to cope with the mental stress or physical demands, or at the point at which the primary caregiver’s own health is in jeopardy.

The energy it takes to care for someone with dementia creates both a physical and emotional drain; the caregiver must be diligent in monitoring the needs of someone with memory loss, and the job can quickly take a heavy toll. The underlying stress of not knowing what to expect and not knowing what may happen next erodes the caregiver’s ability to cope with the multiple physical demands of care giving.

Many people find it difficult to ask someone outside their immediate family to assist in providing the necessary care. By transferring some of the care responsibilities to professional caregivers, the family finds that this is exactly what they need in order to be of continued emotional support to their loved one.

There comes a point where one person may not be able to provide all the care needed by someone with Alzheimer’s disease. It may take an additional person, or even a group of people to meet the personal care needs of your loved one.

Learning to place your trust in other people takes time; learning to place your loved one in the trust of caregivers also takes time. No two caregivers will extend care in exactly the same way; being open to allowing care to be provided in a different but appropriate way will let you become comfortable with the new situation as well as helping the person with dementia to make a smooth transition.

Once the transition occurs, it is common for family members to have feelings of guilt. These feelings are a natural progression from being fully responsible to being only partially responsible. The beneficial trade off is that it becomes possible to meet the person’s physical and emotional needs by sharing the responsibilities.

Being committed to this change is essential in helping this transition to occur. It won’t be a perfect situation, but it is a situation, which is necessary to bring enough balance back into life to allow people to function.

The very best providers don’t always have availability, so planning ahead and knowing the various available options is the best way to plan for the future. Arranging for care while the person with memory loss is still able to integrate into their new lifestyle and routines is helpful. Taking a proactive approach to arranging for care is wise. If you’re caring for someone with dementia, chances are you need support. At the very least, you need a scheduled and specific break to care for your own, personal and emotional needs.

Pre-screening and monitoring every assisted living home and assisted living community’s latest Department of Health Services survey is important to finding a safe environment for a loved on.  This also helps assure you that your loved one is receiving the highest quality of care.

Gaining as much knowledge as possible about your current situation, such as healthcare needs, social activities, memory care, location and financial features, to evaluate and discuss available options is a critical part of a placement service.

Jeff Mascitelli can be reached at (760) 494-7800 or via email at jeffm@carepatrol.com if you have any questions about the topics in this article, or if you would like to learn more about care placement and caregivers for your family.

I Am A Published Author!

 

After watching thousands of clients struggle through a journey they are often severely unprepared for, and following my own experiences when caring for my own aging parents, I created the ElderCare Ready series as a step-by-step guide for family caregivers.  The ElderCare Ready Book explains the importance of being prepared emotionally, physically, and legally, and describes what needs to be done to prepare.  The ElderCare Ready Pack is a 200+ page step-by-step guide, and once completed by the reader, it packs the necessary information for your eldercare journey.

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In my 34-year practice in elder law, I have found that the need to care for an aging family member often sneaks up on everyone involved, and procrastination exaggerates the problem exponentially.  Both adult children and their parents tend to avoid thinking about getting sick or old.  But when the crisis eventually occurs, as millions of families have already discovered, it is more difficult to cope with the uncertainly, stress and confusion of eldercare due to a lack of clear understanding and preparation.  Sadly, by the time people call me, they are usually in crisis mode.  I created the ElderCare Ready Book and ElderCare Ready Pack so people can prepare for their eldercare journey and alleviate the accompanying stress as much as possible.

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The ElderCare Ready Book and ElderCare Ready Pack teach readers what to expect, help them to prepare ahead of time, demystify the confusing process of eldercare, and provide a clear path forward.

The Book and Pack are broken down into 10 categories: Personal Information, Contacts, Medical Information, Current Living Situation, Desired Facilities, Pets, Financial, Estate Plan, Service Providers, and Miscellaneous.

The importance of collecting this information cannot be overstated.  You need information when you have to act for your elder, especially if they are not mentally capable of making legal decisions.  I advise clients to collect this information NOW when there is no crisis at hand and while your elder is as mentally competent as possible to assist you.

To keep everyone updated on eldercare issues, I also created an eldercare website at www.eldercareready.com.  Comments on the posts are always welcome.

My ElderCare Ready Book and ElderCare Ready Pack are available at Amazon.com.  Enjoy!

New Programs May Help Elders and Their Families Detect and Prevent Financial Ruin

It is common knowledge that the elderly are most at risk for financial scams and abuse. Families often forget, however, that sometimes the biggest financial threat to elders is actually their own decreasing financial acuity and competency. In addition to the aging factor, many elderly persons (although certainly not all, or even the majority of elders) do not have a great deal of financial literacy to begin with, when considering the increasing complexity of today’s investment and financial systems.

In January, Anne Tergesen of MarketWatch.com commented on a relevant story by the Wall Street Journal, and provided a few tips for families who are worried about elders who may be at risk for financial abuse or simply at risk for falling behind in keeping track of their financial health.

In Tergesen’s article, she acknowledges the basic fact (that most families are already aware of) that elders often have trouble keeping track of their financials due to the natural aging process, but she also introduces a new program that is aimed at seeking out cognitive changes in elders early on, to prevent financial issues in the future.

Click the image below to read Tergesen’s article on MarketWatch.com:

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This program (which is sponsored by the Investor Protection Trust) is called the Elder Investment Fraud and Financial Exploitation Program (EIFFE). The program is a partnership between the Trust, the American Bar Association’s Commission on Law and Aging, and more than three thousand specially trained physicians around the country. The Trust is providing these professionals (attorneys and doctors) with resources to help elders and their families detect and prevent abuse, fraud, and general financial trouble within the elderly population.

The program provides these professionals with steps to take to detect cognitive impairment (such as questions to ask and behavioral signs to be aware of), and resources to be able to refer their clients and patients to family members, state and local agencies, geriatric care managers, and other professionals to prevent financial missteps and abuse.

These programs are currently being implemented in selected states, but the Trust is aiming at making these resources available to professionals nationwide in the very near future. Professionals such as doctors and attorneys are well placed to be able to detect possible cognitive issues and help elders and families to prevent possible problems for the future, and these new resources will likely prove to help more elderly persons get help sooner and avoid irreparable financial abuse and neglect.

Proposed Government Changes to VA Pension Rules

 

On January 23, 2015, the Veterans Administration published proposed rule changes for some benefit programs.  These changes, in my opinion, are designed to ebb the flow of applications and to stop the transfers of assets in order to qualify for benefits.

The rules address net worth limits, transfers of assets, medical expenses, and income deductions.  To a large extent the rules are designed to mimic the Medicaid (Medi-Cal) rules, except that California has not yet implemented the Deficit Reduction Act rules, so these rules are a bit more ominous.

Net Worth

Net worth would be limited to the spousal allowance resource for Medicaid.  However, income would be added to the net worth calculation.  So if a claimant filed a claim and had $117,240 in resources (the Medicaid limit) but also earned $10,000 in income, the net worth would actually be calculated as $127,240 and that person would be disqualified.

The assets can be reduced by spending them or as they decrease in value, or both.  The claimant can still qualify if there are additional expenses that may reduce the income calculation (such as medical expenses).

Personal residences would be excluded even if the claimant is not residing in the residence.

Asset Transfers

Transfers would be penalized if they are covered assets (assets that would exceed the allowable net worth).  The lookback period would be 36 months and there is a presumption that a transfer made during this period was done for the purpose of reducing assets to qualify for the pension.  There are some exceptions if clear and convincing evidence supports a showing of fraud, misrepresentation, or unfair business practices related to the sale or marketing of financial products or services for the purposes of establishing the pension.   Interestingly, if a true gift (unrelated to pension qualification) such as if a person gave a child a gift of a car two years ago, this may cause the claimant to be denied VA Pension.

Penalty Period

There is a 10 YEAR limit on penalties imposed but the actual period is determined in a manner similar to Medi-Cal calculations for disqualification.

The effect of these rules can be quite surprising and discriminate against a surviving spouse vs a married couple.  Innocent gifts to children can catch the parent in a disqualification.  There are many other traps for the unwary which brings to the forefront why professional assistance is needed in this highly complex area of public benefits planning.

ElderCounsel, LLC has provided this office permission to send a comprehensive analysis of the proposed changes to the VA Pension rules.  Please email me for a free copy of this white paper.

Alzheimer’s and the Arts

Researchers are finding that music, art, and dance may be the key to improving mood and quality of life for those with age-related disabilities such as Alzheimer ’s disease.

Frederick Kunkle, a writer for the Washington Post, penned this article last week which noted that recent studies are focusing on the impact of the arts on elderly persons who have cognitive disabilities. Click on the image below to read Kunkle’s article at the Washington Post:

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These studies differ from previous inquiries covering these diseases and the arts, as they are looking at the impact of the arts on the well-being, general happiness, and mood of patients, rather than simply looking at biological improvements in memory.  Kunkle also noted that previous studies were often too narrow or poorly controlled, and that these new studies were more thorough and took into account the wellbeing of the patient as a whole.

These researchers are being supported by the National Endowment for the Arts (NEA) and the National Institute of Health (NIH).   NEA department head Sunil Iyengar stated that these new studies were covering topics that researchers have tended to underplay in the last few years, such as how the arts can provide meaningful and measurable improvements in mood for both Alzheimer’s patients and their caregivers.

If you have ever had a family member who has suffered from an age related illness such as Alzheimer’s disease or dementia, you can understand how important mood and well being is for both the elderly person and their family and caregivers.   These diseases most often cause drastic changes in overall mood, making sufferers more aggressive, irritable, and hostile.  These studies are showing that exposing seniors to music, art, and dance can have a very measurable positive impact on their mood.

Kunkle’s article notes that dance and movement have been shown to help older persons avoid falls.  Reducing fall risk is hugely important for elderly persons, as a fall can put a person out of commission for a long time and have a drastic impact on their health.  The article also notes that music has been shown to help elders remember positive past experiences and to be more engaged in their communities, particularly in assisted living and other senior community settings.

In one assisted living facility in Mannassas, Virginia, resident George D. Moseley (70, suffering from paranoid schizophrenia) said that his training as an artist “…helps me to manage and cope, and have a positive attitude.”  He went on to say, “The paintbrush and the art give me an outlook and a feeling of serenity and peace, love, and joy.  The paintbrush is the treatment for all else that has failed.”  George is pictured below, next to a mural he has painted in an empty resident room:

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Many senior living communities, assisted living facilities, and memory care facilities are already putting art, music, poetry, and dance within reach for their residents.  Hopefully this trend will continue and new studies will prove that the arts can improve the well being and quality of life for those who suffer from dementia and Alzheimer’s disease.