Question:  Would you please provide me with some information re: gifting as it relates to VA planning for Aid & Attendance.  It is my understanding that there are no penalties involved for gifting assets in order to reduce resources to approved levels.  Mom’s income is less than the medical expenses that she will pay in the assisted living facility, but her assets are a bit too high.

Answer:  At this time, gifting does not create penalties (or periods of ineligibility) for the purposes of VA pension benefits.  That being said, gifting for VA purposes may create penalties (periods of ineligibility) for the purposes of future applications for Medi-Cal for skilled nursing facilities.  Any time you do gifts for VA purposes, you should be structuring a plan that ensures that you will not be creating periods of ineligibility for future Medi-Cal applications.  Often a stroke, hip fracture, heart attack, or some other unexpected medical hospitalization and subsequent discharge to a skilled nursing facility will create a need for Medi-Cal benefits within the look-back period (currently 30 months after the gift was made, or 60 months in the case of gifts to irrevocable trusts, and 60 months for all gifts in the future when the Deficit Reduction Act is implemented with filing of final regulations with the Secretary of the State of CA).  If you have not structured the gifts to create either no period of ineligibility or very minimal period of ineligibility, then you will have shot yourself in the Medi-Cal foot when you do your VA pension gifts.  Because the gifting rules for Medi-Cal are complicated, see an experienced California attorney who knows the current rules about gifting.  Be sure to ask the attorney if they are experienced in the laws governing gifting under Medi-Cal and if they can structure a gifting program that will not create a period of ineligibility, or that will greatly minimize any gifting period of ineligibility.  Also, if you are thinking of gifting real estate, the rules are even more complicated for purposes of VA pension or Medi-Cal, and you will need an attorney with experience in both areas of law.  Any time you gift an asset that has appreciated in value since purchase, there will be tax issues to evaluation, discuss, and account for—income tax issues, capital gains step-up issues, 121 exclusions, property tax reassessment issues, so do not try to do this on your own.  Lastly, when someone needs VA pension now, it is not unlikely that they will need Medi-Cal within a matter of months or a few years, so always consider that VA gifts may create Medi-Cal penalties if not structured properly.   The area of gifts for VA and Medi-Cal is not a do-it-yourself proposition.  Get good legal advice and guidance. 

Dallas Leigh Atkins, Esq.
Law Offices of Dallas Atkins
Santa Barbara, CA  93101
805-687-8782
www.AtkinsElderCareLaw.com
Member of the national ElderCare Matters Alliance, California chapter

Answer:  The fact that your mother granted you and your brother her power of attorney is a good indication that she trusts the two of you (and is, perhaps, relying on you) to step in to protect her interests when you think protection is warranted.  You should look into her situation and her finances as far as your power of attorney allows, while at the same time respecting whatever level of autonomy your mother is capable of exercising.  It might be appropriate to enlist the input of her physician or other medical providers who are in a position to shed light on her medical condition.  Hopefully, your mother has given her medical providers her written permission to share her health information with you.  She may have done this in her advance health-care directive, her "HIPAA authorization," or other estate planning or health care documents.  If she has not done so, her medical providers will probably decline to talk with you.

POSSIBLE ACTION STEPS:  (1) Get clear with your brother on your specific concerns.  (2) Agree with your brother on who (if anyone) should be consulted concerning your mother's medical condition and her finances.  (3) Approach your mother with your concerns and let her know that you are there to make sure her interests are protected.  If you can involve your mother’s physician or other family members or trusted individuals, that will probably promote her comfort level.

If your mother clearly understands that you are endeavoring to act in her best interest, she will probably appreciate the attention that you are focusing on her. 

Scott Makuakane, Esq., CFP
Founding Partner, Est8Planning LLLC
Honolulu, Hawaii  96813
www.est8planning.com
Member of the national ElderCare Matters Alliance, Hawaii chapter, State Coordinator

Answer:  If you are a professional who helps families plan for or deal with ANY of their elder care matters, then you owe it to yourself to be listed on America's #1 online source for "Elder Care Experts"….

ElderCareMatters.com

ElderCareMatters.com is where you will find more than 2,000 competent, caring elder care experts located across America, including:

• Elder Law Attorneys
• Estate Planning Advisors
• Financial Planners
• Investment Advisors
• Geriatric Care Managers
• Insurance Professionals
• Life Care Planners
• Professional Organizers
• Reverse Mortgage Lenders
• Senior Move Managers
• Senior Real Estate Professionals
•  Tax Advisors
• Aging in Place Professionals
• Daily Money Managers
• And other elder care experts with long and successful careers working with seniors and their families

This is also where you will find some of America's best:

• Assisted Living Communities
• Alzheimer's / Memory Care Communities
• Continuing Care Retirement Communities
• Home Care Agencies

Together, we provide families across America with:

• Unparalleled professional expertise
• Up-to-date elder care information & answers to your elder care questions
• Competent, caring assistance with a wide range of elder care services

So if you are a competent, caring elder care professional who helps families with ANY of their elder care matters, then request today an Application for Membership in the national ElderCare Matters Alliance and get listed on ElderCareMatters.com - America's #1 source for "Elder Care Experts" plus information and answers about a wide range of elder care matters.

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO
ElderCare Matters, LLC
ElderCareMatters.com

Answer:  Assuming you have a valid financial or general power of attorney that complies with state law, you need to check the document.  When does the document say the power is effective?  Some are effective immediately upon signing it.  In that case, you can use the power right now.  She may, however, try to revoke it. 

Most powers of attorney, however, are considered “springing.”  That means the power of attorney is effective upon some triggering event, usually incapacity.  The document should say how incapacity will be determined.  For example, some say that the principal (the person who signed the power of attorney) must be determined to be incapacitated by two physicians.  If such a requirement is in the document, then you will need written statements from the physicians stating that she cannot manage her financial affairs.  Those statements should be kept with the power of attorney and made a part of it.

Remember that financial institutions may not accept the power of attorney.  Some will not accept a power that is a certain number of years old.  Others will look for certain clauses that may or may not me in your document.  And some financial institutions seem to give people a hard time just because.  It is very difficult to try to force a financial institution to accept a power of attorney.

If your power of attorney turns out to be ineffective for whatever reason, you may need to petition the court for a conservatorship.

Ronald Zack, Esq.
Tucson, Arizona
520-331-3232
www.TucsonEstatePlanning.com

Answer:  The correct answer is "It depends". It depends on your unique family, health, and financial situation. Tax consequences also have to be considered. In the event you need long-term care, there is a five year look-back period that applies to gifts (transfers of assets without consideration). Thus, if you are faced with a chronic or catastrophic illness within five years after you transfer the home to your children; such transfer may impact your ability to obtain Medicaid (Title 19) benefits. This is a very complicated area of the law and requires careful consideration.

If it makes sense to transfer the home to your children, there are several ways to structure the transfer. The first is an outright gift to your children. This is generally not advisable for tax reasons and asset protection purposes. The second is by completing the transfer but retaining a life estate. While generally superior to an outright gift, this is also not without problems. However, the retained life estate does give you some legal control over the property and also preserves some tax benefits associated with inherited property versus gifted property. The third is a transfer of your home to an irrevocable trust. This is usually the preferred method of protecting the home as it balances tax benefits with asset protection issues and also protects the home from your children's creditors or in the event they should predecease you.

As you can see, the transfer of your home is something that requires careful consideration and sound legal counsel.

Paul T. Czepiga, Esq., CELA
Czepiga Daly Dillman, LLC
Newington, CT  06111
860-597-7995
www.CtSeniorLaw.com
Member of the national ElderCare Matters Alliance, Connecticut chapter

Question:  “I have a potential concern for my recently widowed 84 year old mother, a Massachusetts resident who requires home care.  Mom is independent, still has all her intellectual faculties, and has a great memory, but has some physical limitations, so she requires home care assistance.  I visit Mom every few weeks to help her pay her bills.
 
Mom recently disclosed to me, that she recently gave money to one of her home care aids.  My mother says she gave her the money, in cash, and told her it was a gift. I know that my mother would never complain about this woman as she would not want to lose her care. 
 
I feel my mother has been taken advantage of financially, and am concerned it will happen again.  As her daughter, what can I legally do?"

Answer:  You're in a difficult situation and there's no easy answer. It's good that your mother is mentally sharp but she may well be feeling vulnerable because of her physical limitations. I have seen quite a few cases where normally financially astute elders make unwise decisions because of these changes.

Since you are  with your mother regularly and help her pay her bills, you should be able to keep on eye on things and be alerted if she starts withdrawing more cash then usual from the bank. If you are named as the agent under your mother's power of attorney you many also speak with the people at her bank to be on the alert for unusual activity.

Dagmar M. Pollex, Esq.
Law Offices of Dagmar M. Pollex, P.C.
Braintree, Massachusetts  02184
781-535-6490
www.PollexEstatePlanning.com
Member of the national ElderCare Matters Alliance, Massachusetts chapter

Answer:  With Reverse Mortgages, it doesn’t matter how many mortgages have previously been placed on the property.  The couple must be at least 62 years old.  Actually, the amount of money you might get extended as a reverse mortgage is based upon the age of the couple and the value of the home.  The older you are, the more money you can qualify for.  This is because you can continue to live in the home for the rest of your life and never have to make a mortgage payment.  So, if the elderly couple in the question are more advanced in age, it greatens the chance that the amount they qualify for can pay off both of the two prior mortgages.  It needs to because a reverse mortgage won’t be extended unless it will occupy a “first” position. 

One of the best things about reverse mortgages is that they are non-recourse. The concept began in 1988 under Ronald Reagan, an oldster himself.

Russell Hodges, Esq., Managing Partner
Hodges Law Firm, LLC
Atlanta, Georgia  30040
404-824-4225 or 770-888-0015
www.RHodgesLaw.com
Member of the national ElderCare Matters Alliance, Georgia chapter

Answer:  Wow, I would be worried also, without any assurances in writing.  Please understand that there are a number of issues in your question, all rolled into one.  First, when your mother entered the assisted living facility, she or, perhaps a family member acting on her behalf, probably signed a contract.  It is important to know what provisions are contained in the contract to see if, in fact, what you have been told verbally is in the written agreement.  Second, you said your mother moved into assisted living.  However, unless it is a continung care community or one of the few supportive living facilities in Illinois that take Medicaid, most assisted living facilities do not accept Medicaid, so more information is needed. Third, you don't mention how your mother is paying for the assisted living facility and what other assets she may have, so it's difficult to asses how soon she may need assistance paying for care.  The house presents a trickier issue.  Is there a possibility your mother intends to return to her home?  If so, the home may not be considered an available asset for purposes of qualifying for Medicaid.  The home may also be exempt if a "qualifying family member" is living in the home.  She may be allowed to transfer the home to a qualifying family member.  However, if she does not intend to return home, if there is no qualifying family member living in the home, and the home is sold, there may be planning strategies that could preserve some of the funds for her use, rather than to spend them all down before qualifying.  Bottom, line, it is not a simple question, and you would be well served by seeking the advice of an experienced elder law attorney in your area who could sort out all the issues and recommend planning strategies rather than rely on verbal assurances of the facility representative.

Teresa Nuccio, Esq.
Teresa Nuccio & Associates, P.C.
Park Ridge, Illinois  60068
847-823-9576
www.teresanuccio.com
Member of the national ElderCare Matters Alliance, Illinois chapter

Answer:  Georgia Medicaid policy, found at Section 2332 et seq. of VOLUME II/MA, MT 39-08/10 titled “Retirement Funds”, expressly exempt retirement funds, including, Individual Retirement Accounts (IRAs) Keogh plans, and some retirement profit sharing plans are “exempt” or non-countable resources for Aged, Blind, or Disabled classes of Medicaid, including Long-Term Care (Nursing Home) Medicaid if owned by the applicant/recipient if the applicant/recipient applies for “periodic” distributions.  To be eligible for ABD Medicaid, the individual must apply for periodic benefits.  If s/he has the choice between periodic payments and a lump sum, the individual must apply for periodic payments. 

A “lump” sum is a liquidation of the retirement fund.  There’s no requirement in the Medicaid plan that payments be taken monthly; payments can be made annually.  The Medicaid policy states “[p]eriodic retirement benefits are payments made to an individual at some regular interval (e.g. monthly).  The signal, “e.g.” means “for example”.  As a result, the use of “monthly” in the policy is intended only as an example of what “periodic payments” means.  

The caseworker is directed to determine if the applicant for Nursing Home Medicaid is eligible for periodic payments from the IRA.  If not, can the individual make a lump sum withdrawal.  If the individual is eligible and receiving periodic payments, the payments are treated as “income” only; the fund is disregarded as an asset. 

A retirement fund belonging to an applicant/recipient’s spouse is disregarded, regardless as to whether periodic payments are made. 

The income is budgeted with other sources of income the applicant receives.  For example, if she has Social Security retirement and the IRA distributions, these amounts make up her income.  Once Medicaid eligibility is established, Medicaid calculates a “patient liability” or cost-share which is her contribution toward the costs of her long-term care.  Patient liability is paid over to the nursing home each month.  

The IRA does not designate the State as the beneficiary upon death; she can designate whomsoever she wishes. 

It sounds like the Medicaid caseworker communicating with this family is confusing the treatment of an “annuity” with the treatment of “retirement funds” for Nursing Home Medicaid eligibility purposes.

David Paul Pollan, Esq.
The Pollan Law Firm
Atlanta, Georgia  30309
678-510-1358
www.PollanLawFirm.com
Member of the national ElderCare Matters Alliance, Georgia chapter

Answer:  If you have a loved one living in a nursing home, it is important for you to understand what constitutes abuse and neglect, and how to recognize the warning signs.  Abuse and neglect comes in many different forms and may affect a resident physically, mentally and emotionally.  The most important things to look for if you suspect abuse or worry about the welfare of your loved one include: falls, cuts and bruises, the development of bed sores, sudden weight loss, anxiety or agitate behavior, overmedication, poor hygiene, unsanitary conditions, or a sudden change in the resident’s disposition or behaviors. Residents and their families have a right to question a nursing home's care decisions. If you believe a loved one is receiving substandard care in a nursing home, you should discuss their care plan with staff.  If you suspect that your loved one has been seriously injured as a result of nursing home abuse or neglect, you should contact a nursing home lawyer who can help you determine if you have a case against the facility.

Steven M. Levin, Esq., Co-Founder & Senior Partner
Levin & Perconti
Chicago, Illinois  60654
312-332-2872
www.LevinPerconti.com
Member of the national ElderCare Matters Alliance, Illinois chapter

Answer:  In Massachusetts and probably other states, if  married couples do not have  a health care proxy (HCP) in place and one of them needs hospital care the other will have no rights with respect to his or her spouse's health care needs.
 
In circumstances where the hospitalized spouse loses competency to decide an emergency, guardianship will be required. The cost will then become large because court action will be required. If these people are hesitant they can name each other as health care agent followed by a trusted child as an alternate. Also they should think about a durable financial power of attorney  because a health care proxy only addresses health issues, and if one of them becomes incompetent the other can take over with the financials. Without that document financial institutions would require a Conservatorship– again an expensive proposition. Every person needs to have these 2 documents in place. The fiscal and emotional costs to the family would be far greater than the actual legal costs to retain an attorney to draft them.

Susana Lannik, Attorney at Law
Law Office of Susana Lannik, LLC
Newton, Massachusetts  02458
617-658-2980
www.LannikLaw.com
Member of the national ElderCare Matters Alliance, Massachusetts chapter

Heather R. Chubb, Attorney at Law
The Chubb Law Firm
Gold River, CA  95670
916-635-6800
www.ChubbLawFirm.com
Member of the national ElderCare Matters Alliance, California chapter

Answer:  If you have an account that is set up with a beneficiary, that is payable on death to a particular person, it is not necessary for this account to be included in your revocable living trust.  The premise behind the payable on death account is that when the account holder dies the account will legally belong to the beneficiary.  This is one way to avoid the probate process for an individually owned account.  Presumably, one of the reasons you would create a trust is also to avoid probate of your assets upon your death. 

If the account is owned by your revocable living trust, because the trust does not “die,” the pay on death feature will never be triggered.  In any event, I’m not certain that bank would allow an account owned by a trust to also carry a payable on death designation. 

Although not absolutely necessary, including this account in your trust is a good idea and will help centralize the management of all your assets in the event of your incapacity or death and make life easier for your family.  If the account is in your trust you can use your trust distribution instructions to indicate that this account go to a specific person.  This is called a specific distribution.

Answer:  Starting in October, ElderCareMatters.com will feature each week 1 of the 81 different elder care services that are provided by the members of the national ElderCare Matters Alliance, experts who help families across America plan for and deal with their elder care matters. 

For example, during week 1 we will showcase members of the national ElderCare Matter Alliance who provide "Aging in Place Services". 

During this week our "Premium" and "Lifetime" members who are experts in helping families "Age in Place" will provide us with:

1) Actual Q&As taken from their practices,
2) Original articles written by them about this important elder care service,
3) Answers to your questions about Aging in Place.

So if you would like to ask one of our elder care experts a question about "Aging in Place",  just send a short email (a few sentences only please) to: questions@ElderCareMatters. com.

And remember to bookmark ElderCareMatters.com and check back often to see if your question is our Elder Care Question of the Day.

Thank you for your support of ElderCareMatters.com - America's #1 online source for Elder Care Experts, Information & Answers About a Wide Range of Elder Care Matters.

Phillip G. Sanders, MBA, MSHA, CPA
Founder of ElderCareMatters.com
1-877-379-4500

Answer:  What a great idea!  Yes, we can make this happen.

In fact, I am pleased to announce that starting Monday, October 3rd, ElderCareMatters.com will "Feature" every week one of our 80 different elder care services.  For example, during one week we may showcase Elder Law or Geriatric Care Management or perhaps Elder Abuse Litigation Services.  And during this week, families are encouraged to send us their questions about this specific elder care service.  Then every day we will post an answer to one of your questions in the Question of the Day section of  ElderCareMatters.com, an answer provided by one of our Elder Care Experts who practices in this specific elder care service area.  Additionally, we will post during this week one or several original articles about this service, written by members of the national ElderCare Matters Alliance who practice in this specific service area.

And, yes, ElderCareMatters.com would be pleased to provide a link each week to ALL of our elder care experts, by state, who provide this "Featured" Elder Care Service. 

Thank you again for this great idea.

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO, ElderCareMatters.com
1-877-379-4500

Answer:  No, we have not designated a maximum # of elder care professionals that we will include on ElderCareMatters.com.  Our criterion for including professionals on this wonderful online elder care resource is:

1. All elder care professionals included on this site must complete an Application for Membership to the national ElderCare Matters Alliance and must demonstrate that they are actively involved in helping families plan for and/or deal with the issues of aging.

The bottom line is that we want ElderCareMatters.com to be a resource that families across America can use that will help them plan for and/or deal with their elder care matters.  Soon this website should include most (if not all) of the competent, caring elder care professionals across America.

So if you know of some competent, caring elder care professionals who are not yet listed on ElderCareMatters.com, encourage them to become a part of this wonderful online elder care resource for families  across America.

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO, ElderCareMatters.com
1-877-379-4500

Answer:  It is my pleasure to provide you with the following list of the 87 different elder care services that are currently provided by the members of the national ElderCare Matters Alliance on ElderCareMatters.com:

1. Accounting Services
2. Adult Day Care
3. Advance Medical Directives
4. Aging in Place Services
5. Alzheimer's / Memory Care Communities
6. Annuities
7. Arbitration
8. Asset Protection Planning
9. Assisted Living Communities
10. Assisted Living Referral Services
11. Bankruptcy
12. Bill Paying
13. Budgeting
14. Caregiving Education
15. Companion Care
16. Conservatorship
17. Consumer Law
18. Continuing Care Retirement Communities
19. Cremation Services
20. Crisis Intervention
21. Daily Money Management
22. Dementia Care
23. Disability Income Insurance
24. Disability Planning
25. Elder Abuse Litigation Services
26. Elder Law
27. ElderCare Planning
28. Estate Administration
29. Estate Liquidation
30. Estate Planning
31. Family Law
32. Financial Planning
33. Funeral Services
34. Geriatric Care Management
35. Guardianship
36. Health Insurance
37. Hoarding Clean Up and Coaching Services
38. Home Care
39. Home Downsizing Services
40. Home Health Care
41. Home Modifications
42. Hospice Care
43. Independent Living Communities
44. Investment Services
45. Life Care Planning
46. Life Insurance
47. Litigation
48. Long Term Care Insurance
49. Long Term Care Planning
50. Medicaid Planning
51. Medical Services
52. Medical Alert Systems
53. Medical Claims Processing
54. Medical Equipment & Supplies
55. Medical Malpractice Litigation
56. Medicare Consulting
57. Medicare Supplemental Insurance
58. Medication Management Services
59. Moving Services
60. Nursing Homes
61. Personal Finance
62. Powers of Attorney
63. Probate
64. Professional Organizing
65. Public / Non-Profit Resources
66. Real Estate Services
67. Rehabilitation Services
68. Residential Psychiatric Care
69. Respite Care
70. Retirement Planning
71. Reverse Mortgages
72. Securities Arbitration & Litigation Services
73. Senior Housing
74. Senior Move Management
75. Senior Move Planning
76. Senior Relocation Services
77. Social Security Disability Services
78. Special Needs Planning
79. Tax Law
80. Tax Planning
81. Tax Preparation
82. Transportation Services
83. Trustee / Fiduciary Services
84. Trusts
85. VA Benefits
86. Wills
87. Wound Care

The goal of ElderCareMatters.com is to provide families across America with the help they need to plan for and deal with their elder care matters.  Let us know if there are other elder care services that you would like to have us list on ElderCareMatters.com – America's #1 source for Elder Care Experts plus information & answers about a wide range of elder care matters.

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO, ElderCare Matters, LLC
ElderCareMatters.com
1-877-379-4500

Answer:  Thank you for your kind comments.  This is exactly what we at ElderCareMatters.com are trying to accomplish, i.e., to become a trusted resource to ALL families across America regarding elder care matters. 

We continually strive to make it easier for families such as yours to locate ElderCareMatters.com via ALL the major internet search engines, and we will continue to improve our search engines rankings for key words related to elder care matters.

In addition to our improved internet ranking, ElderCareMatters.com now has more than 1,600 professional members who provide 72 different elder care / senior care services to help families across America plan for and deal with their elder care matters. 

The # of professionals listed on ElderCareMatters.com is increasing daily; however, there are still many professionals across America who are not yet listed on this national elder care matters resource. 

If you know of elder care providers near YOU who are not yet on our list, encourage them to join the national ElderCare Matters Alliance and to be listed on ElderCareMatters.com - America's #1 source for Elder Care Experts plus information and answers about a wide range of elder care matters.

Thank you for your support of Elder Care Matters and for your help in increasing the # of professionals listed on ElderCareMatters.com - a resource to help families across America plan for and deal with their elder care matters.

Phillip G. Sanders, MBA, MSHA, CPA
Founder of ElderCareMatters.com
1-877-379-4500

Answer:  ElderCareMatters.com is an elder care resource to help families across America plan for and deal with their elder care matters.  With this goal in mind, we will continue to add more elder care-related services to ElderCareMatters.com in order to make this online elder care resource invaluable for families looking for help in planning for and/or dealing with their elder care matters.

Below are the 72 different elder care services currently listed on ElderCareMatters.com (with more services soon to be added): 

1. Adult Day Care
2. Advance Medical Directives
3. Aging in Place Services
4. Alzheimer's / Memory Care Communities
5. Annuities
6. Arbitration
7. Asset Protection Planning
8. Assisted Living Communities
9. Assisted Living Referral Services
10. Bankruptcy
11. Caregiving Education
12. Consumer Law
13. Continuing Care Retirement Communities
14. Crisis Intervention
15. Daily Money Management / Bill Paying
16. Dementia Care
17. Disability Income Insurance
18. Elder Abuse Litigation Services
19. Elder Law
20. ElderCare Planning / Long-Term Care Planning
21. Estate Administration
22. Estate Liquidation
23. Estate Planning
24. Financial Planning
25. Funeral Services
26. Geriatric Care Management
27. Guardianship / Conservatorship
28. Health Insurance
29. Hoarding Clean Up and Coaching Services
30. Home Care
31. Home Downsizing Services
32. Home Health Care
33. Home Modifications
34. Hospice Care
35. Independent Living Communities
36. Investment Services
37. Life Care Planning
38. Life Insurance
39. Litigation
40. Long-Term Care Insurance
41. Medicaid / Disability Planning
42. Medical / Healthcare
43. Medical Alert Systems
44. Medical Claims Processing
45. Medical Equipment & Supplies
46. Medicare Consulting
47. Medicare Supplemental Insurance
48. Medication Management Services
49. Moving / Relocation Services
50. Personal Finance / Accounting / Tax Preparation
51. Powers of Attorney
52. Probate
53. Professional Organizing
54. Public / Non-Profit Resources
55. Real Estate Services
56. Rehabilitation Services
57. Residential Psychiatric Care
58. Respite Care
59. Retirement Planning
60. Reverse Mortgages
61. Securities Arbitration & Litigation Services
62. Senior Move Management
63. Senior Move Planning
64. Social Security Disability Services
65. Special Needs Planning
66. Tax Law
67. Tax Planning
68. Transportation Services
69. Trustee / Fiduciary Services
70. Trusts
71. VA Benefits
72. Wills

If you need help with your family's elder care matters, you can count on ElderCareMatters.com to provide you with the experts, information & answers you need to plan for and deal with your elder care matters.

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO of ElderCareMatters.com
1-877-379-4500

Answer:  Almost 1,600 professionals across America who help families plan for and/or deal with the issues of aging are now members of the national ElderCare Matters Alliance and listed on  ElderCareMatters.com - America's #1 source for Elder Care Experts plus information and answers about a wide range of elder care matters.

Listed on ElderCareMatters.com are professionals who provide a total of 69 different elder care services (and this # will continue to grow), including:

• Adult Day Care
• Aging in Place Services
• Assisted Living
• Daily Money Management / Bill Paying
• Elder Law
• Estate Planning
• Financial Planning
• Geriatric Care
• Home Care
• Life Care Planning
• Medical Equipment & Supplies
• Real Estate Services
• Senior Move Management
• Special Needs Planning
• VA Benefits
• Wills

The # of professionals listed on ElderCareMatters.com is increasing daily; however, there are still many professionals across America who are not yet listed on this national elder care matters resource. 

If you know of elder care providers near YOU who are not yet on our list, encourage them to join the national ElderCare Matters Alliance and to be listed on ElderCareMatters.com - America's #1 source for Elder Care Experts plus information and answers about a wide range of elder care matters.

Thank you for your support of Elder Care Matters and for your help in increasing the # of professionals listed on ElderCareMatters.com - a resource to help families across America plan for and deal with their elder care matters.

Phillip G. Sanders, MBA, MSHA, CPA
Founder of ElderCareMatters.com
1-877-379-4500

Answer:  Our commitment at ElderCare Matters is to provide families across America with elder care resources (Experts, Information & Answers) to help them plan for and deal with their elder care matters.  To this end, we have no set # of experts that we will showcase on ElderCareMatters.com but rather we are inviting ALL competent, caring elder care professionals across America to become a part of this phenonmenal elder care resource.

ElderCare Matters is where you will find 1,579 Elder Care Experts near YOU (and this # is growing daily) who have years of experience in helping families with elder care matters, including:

• Elder Law Attorneys
• Estate Planning Advisors
• Financial & Investment Advisors
• Geriatric Care Managers
• Insurance Professionals
• Reverse Mortgage Lenders
• Senior Move Managers
• Tax Advisors
• Daily Money Managers
• Other elder experts with long and successful careers working with seniors and their families

This is also where you will find some of America's best:

• Assisted Living Communities
• Alzheimer's / Memory Care Communities
• Continuing Care Retirement Communities
• Home Care Agencies

So if you help families plan for and/or deal with elder care matters and you are a competent, caring elder care professional, then you should be listed on ElderCareMatters.com – America's #1 source for Elder Care Experts plus information and answers about a wide range of elder care matters.

To request an Application for Membership to the national ElderCare Matters Alliance, send an email directly to: info@ElderCareMatters.com

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO of ElderCare Matters
ElderCareMatters.com
1-877-379-4500

Answer:  The more resources (Experts, Information & Answers) families have available to help them with their elder care matters, the better decisions they will be able to make when planning for and dealing with these important elder care matters.

In fact, this Labor Day weekend, my family and I are dealing with Elder Care Matters with my in-laws because my Mother-in-Law has Alzheimer's Disease with a myriad of other health issues and my Father-in-Law finally made the decision early Sunday morning to admit her to a Skilled Nursing Facility.

My family and I found the help we needed (including finding the Elder Law Attorney whom my Father-in-Law hired from a small South Georgia town) through my contacts with the national ElderCare Matters Alliance, a national network of 1,576 Elder Care Experts who have "teamed up" on ElderCareMatters.com to provide families, such as ours, with the resources that they need to be able to make educated decisions about Elder Care Matters.

The purpose of ElderCareMatters.com is to provide ALL families across America with easy online access to ALL competent, caring Elder Care Experts in America, plus useful, up-to-date Elder Care Information, and answers to their Elder Care Questions.

Although ElderCareMatters.com currently has 1,576 professional members available to help families with their elder care matters, this is not enough. 

So in order to encourage ALL Elder Care Professionals across America to become a part of this online resource, we have decided that we will now offer 3 different Membership options, including a FREE Basic Membership option.

Now, there should be no excuse (including financially) why ALL competent, caring Elder Care Professionals across America should not be listed on  ElderCareMatters.com - America's #1 online source for Elder Care Experts plus information & answers about a wide range of elder care matters. 

To request an Application for any of our 3 different levels of Professional Membership (Basic, Premium or Lifetime) to the national ElderCare Matters Alliance, send an email directly to: info@ElderCareMatters.com.

Phillip G. Sanders, MBA, MSHA, CPA
Founder, ElderCareMatters.com
1-877-379-4500

Phillip G. Sanders, MBA, MSHA, CPA
Founder of ElderCareMatters.com
1-877-379-4500

This week's Featured Elder Care Expert on ElderCareMatters.com is Phillip G. Sanders, MBA, MSHA, CPA, Founder of  ElderCareMatters.com, America's #1 online source for Elder Care Experts plus information & answers about a wide range of elder care matters.

Every day this week (M-F), Mr. Sanders will answer one of your questions about this online elder care resource that helps families across America plan for and deal with their issues of aging.

One selected question along with Mr. Sanders' answer will be posted on the Featured  Elder Care Question of the Day section of ElderCareMatters.com.

So if you would like to ask the Founder of ElderCareMatters.com a question, just send a short email (a few sentences please) to: Questions@ElderCareMatters.com.

And remember to bookmark ElderCareMatters.com and check back often to see if your question is our Elder Care Question of the Day.

Answer:  The best thing to do is to get your Mother (and Dad, if possible) to sign a power of attorney form, giving you the right to handle their financial affairs. If they have a checking account, I suggest you take the executed Power of Attorney form to their bank and become a signatory on their checking account. Once both sign the POA form, there will be no need to “separate” their money.  Hope this helps.

To find  competent, caring elder care professionals across America who are located near You and can help you with your elder care matters, go to: www.ElderCareMatters.com - A FREE online resource to find elder care experts plus elder care information & answers to your elder care questions.

Gregory D. Roberts, CFP, CLU, ChFC, CLTC, EA
Life Solutions
Aiken, South Carolina  29803
803-617-9805
Member of the national ElderCare Matters Alliance, South Carolina chapter 

Answer:   Yes, there are planning steps you can take now.  First, check with your local agencies, such as the Area Council on Aging to find out what eldercare services are available in your area. You may find that there are adult day care centers that cost nothing or are very reasonably priced. Next, determine out what the cost of eldercare is in your community. These providers will include home health care agencies, nursing homes, and assisted living facilities. Prices vary, so survey the market carefully.

Involve your children and inform them of your wishes in the event you need custodial eldercare services, and write down your wishes. Name one of your children or friends that you trust as your eldercare coordinator. As an aside, it is always a good idea to consult with an attorney and have a durable power of attorney drafted, as well as a living will.

If you have assets available for possible eldercare expenses, you should designate those as being for that purpose. If you have existing life insurance or annuity policies, it may be possible to leverage those products by re-positioning them into products that can provide enhanced eldercare dollars in the event that you need them. Check with your financial advisor.

To find  competent, caring elder care professionals across America who are located near You and can help you with your elder care matters, go to: www.ElderCareMatters.com - A FREE online resource to find elder care experts plus elder care information & answers to your elder care questions.

Gregory D. Roberts, CFP, CLU, ChFC, CLTC, EA
Life Solutions
Aiken, South Carolina  29803
803-617-9805
Member of the national ElderCare Matters Alliance, South Carolina chapter 

Answer:  Whether or not your parents’ deposit qualifies as an exempt asset under Medicaid depends on whether the contract is a lease agreement or a contract to purchase a unit.  At many assisted living residences the contract is a lease agreement, not ownership, and will not qualify.  In Massachusetts, home ownership is required to qualify for the exemption for your home.  The home ownership exemption, however, is not valid if he is not able to return home.  As a result, many clients who own homes will protect them and their life-savings with an asset protection trust.  That way the deposit at an assisted living residence can be funded with home sale proceeds or other savings and continue to be protected in the trust even if they get sick in a nursing home and are no longer able to satisfy the requirement of “intending to return home.”  As a result of the asset protection trust there is more flexibility and greater protection for life savings, without the otherwise required ability to return home.

To find  competent, caring elder care professionals across America who are located near You and can help you with your elder care matters, go to: www.ElderCareMatters.com - A FREE online resource to find elder care experts plus elder care information & answers to your elder care questions.

Dennis B. Sullivan, Esq., LLM, CPA
Estate Planning & Asset Protection Law Center of Dennis Sullivan & Assoc.
Wellesley, Massachusetts  02482
781-237-2815
Member of the national ElderCare Matters Alliance, Massachusetts chapter 

Answer:   As far as the Veterans Administration is concerned, the home your father owns is considered his home whether or not he is currently living there and will not impact his eligibility for benefits.  One thing you and your family should be careful of, however, is renting the home.  If you rent the home and its classification switches from residential property to rental property, it may be considered an asset and cost your father his veteran’s benefits.

To find  competent, caring elder care professionals across America who are located near You and can help you with your elder care matters, go to: www.ElderCareMatters.com - A FREE online resource to find elder care experts plus elder care information & answers to your elder care questions.

Dennis B. Sullivan, Esq., LLM, CPA
Estate Planning & Asset Protection Law Center of Dennis Sullivan & Assoc.
Wellesley, Massachusetts  02482
781-237-2815
Member of the national ElderCare Matters Alliance, Massachusetts chapter 

Answer:  There is a 5 year look back period for Medicaid.  Any asset transfers, including gifts, made within this 5 year look back window will trigger a penalty period of ineligibility to receive Medicaid benefits.  There are ways to avoid triggering these penalties but an outright gift is not one of the ways.  

As an example of the problem with making an outright gift, if your grandfather gifts to you $200,000 today and in 3 years requires skilled care, the gift of $200,000 will render him ineligible for Medicaid benefits for a significant period.  During the period of ineligibility he, or you, will have to pay for any nursing home care. 

In Massachusetts, the homestead protection will not keep your grandfather’s $200,000 from the reach of nursing homes, but a primary residence is often an exempt asset for Medicaid (Mass Health).  In Massachusetts however, the nursing home or skilled care facility will be able to put a lien on your home if you use a portion of his $200,000 gift to purchase the home and put his name on the deed.  

However, since you are buying your home in Florida, it may be to your grandfather’s advantage to have him contribute to the new house and count it as his “homestead”.  If he requires nursing home care in Florida, it is my understanding that his $200,000 would be exempt, but you should check with an attorney in Florida.  

If your grandfather is truly seeking to protect assets from the reach of nursing homes, setting up an asset protection trust is often the recommended option.  Creating an irrevocable trust starts the 5 year look back clock as soon as the trust is funded.  Once the property is in the trust, your grandfather can make any type of gift or transfer he so chooses without “resetting” the 5 year look back period.  In addition the irrevocable trust allows your grandfather to protect ALL of his assets while allowing access to income.  As another added benefit, your grandfather’s life savings will be left to his loved ones without the need for probate.

To find  competent, caring elder care professionals across America who are located near You and can help you with your elder care matters, go to: www.ElderCareMatters.com - A FREE online resource to find elder care experts plus elder care information & answers to your elder care questions.

Dennis B. Sullivan, Esq., LLM, CPA
Estate Planning & Asset Protection Law Center of Dennis Sullivan & Assoc.
Wellesley, Massachusetts  02482
781-237-2815
Member of the national ElderCare Matters Alliance, Massachusetts chapter 

Answer:  Generally, a fiduciary is a person who manages property for the benefit of another, exercises discretionary authority or control over an asset(s), and/or renders comprehensive and continuous investment advice.  When you accept the role to trustee, you are a fiduciary and accordingly you become personally liable to all trust beneficiaries.  Liability is not determined by the performance of investments but by whether you followed “prudent investment practices”.   

The Prudent Investor Act sets forth 7 Uniform Standards of Care to avoid being found liable for investments losing value:

1. Know standards, laws, and trust provisions.
2. Diversify assets to the specific risk/return profile of the trust.  Each trust and beneficiary will have specific cash flow requirements and risk return objectives.  The interests of all need to be weighed.
3. Prepare an Investment Policy Statement (IPS).  The IPS is basically a business plan for the trust’s investments.  It lays out goals and policies regarding trust investments.
4. Use “prudent experts” (lawyers, money managers, CPAs) and document due diligence.  Unless you are an experienced professional this can be a daunting task.  Any slip up and you could be paying out of your pocket.  Hiring an expert, so long as you use due diligence in determining their qualifications, and your liability is eliminated.
5. Control and account for investment expenses.  It is your role to make sure that the trust is paying a fair fee for the professional services.
6. Monitor the activity of “prudent experts”.  Monitoring the investment professional is part of using due diligence.  You, as trustee, want to be sure the money manager is not taking funds and is working toward accomplishing the goals stated in the IPS.
7. Avoid conflicts of interest and prohibited transactions.  Although this seems silly, trustees often violate this principal.  A trustee cannot use entrusted assets for personal or business gain.   

This is one of the most common areas of litigation we see today.  Especially with the market falling and stocks losing value, people are afraid to make changes and are standing still, thinking that if they do nothing they will not be liable for losses.  NOT TRUE.  Trustees do not need to personally guarantee every investment decision is successful.  What a trustee should do is follow a system that ensures you are following the Prudent Investor Act standards.  There is a 5 Step Investment Management Process you can use to be sure you are within the prudent investor standard:

1. Analyze Current Position.  This is where you review current investment activates, disbursements, investing strategies and policies, and legal constraints.  You examine what the trust’s investment picture currently looks like.
2. Design the Optimal Portfolio.  This is where you propose optimal asset allocation strategies and suggest any changes, keeping in mind the current market.
3. Formalize Investment Policy.  The policy should include investment objectives, guidelines, as well as guidelines for selecting and monitoring money managers, if you have them.
4. Implement Policy.  Here you would propose a number of alternative money manager structures, negotiate favorable fees and coordinate brokerage services.
5. Monitor & Supervise.  In monitoring the investments you would prepare detailed monthly appraisal and transaction report as well as quarterly reports that compare performance of the trust’s investments against the performance of the market and the state objectives.  

To answer your question, as long as you followed the 7 Uniform Standards of Care and the 5 step process for managing investments you will not be found liable for any investment losses. 

To find  competent, caring elder care professionals across America who are located near You and can help you with your elder care matters, go to: www.ElderCareMatters.com - A FREE online resource to find elder care experts plus elder care information & answers to your elder care questions.

Dennis B. Sullivan, Esq., LLM, CPA
Estate Planning & Asset Protection Law Center of Dennis Sullivan & Assoc.
Wellesley, Massachusetts  02482
781-237-2815
Member of the national ElderCare Matters Alliance, Massachusetts chapter 

Answer:  You should contact the local authorities immediately, report the theft, and ensure they understand that you’re fearful for your safety. In addition, I would terminate the services of your current caregiver and contact a local licensed home health agency.

To find  competent, caring elder care professionals across America who are located near You and can help you with your elder care matters, go to: www.ElderCareMatters.com - A FREE online resource to find elder care experts plus elder care information & answers to your elder care questions.

Bart Delsing, Owner & Chief Operating Officer
FirstLantic Healthcare, Inc.
Delray Beach, Florida  33445
561-243-7979
Member of the national ElderCare Matters Alliance, Florida chapter 

Answer:   This is a great question. Choosing the home health agency that is best-suited for your needs is essential, but the most important selection is the caregiver. Selecting a caregiver that understands the specific needs and dynamics of an Alzheimer’s patient is critical and will determine the success of a strong relationship between your parents. Here are the questions I suggest you ask: 

1. Is the home health agency licensed? If so, request a copy of their license. This will insure that the agency is operating under the regulations of the state.
2. How long has the agency been in business? It is best to choose a well-established agency. They generally  offer more experienced, trained caregivers.
3. Are the caregivers licensed, insured and supervised? You want an agency that has professional, general liability and workers compensation coverage. If the caregivers are going to drive your parents, you should inquire about non-owned auto insurance. If caregivers are transporting patients and utilizing their own vehicle, this is a must. If they’re going to use your parents’ auto, call your parents’ insurance carrier and inquire about adding them to coverage. Moreover, if driving is required, ask the agency if they run a DMV check on the caregiver.
4. Does the agency do an Assessment Visit? If so, is this done by a Registered Nurse and is there a cost ? This is another significant step in the process for a number of reasons. You might feel that your mother needs four hours per day, but after assessing her, the opinion of the licensed professional might be considerably different. A clinically trained expert can determine if other services are needed, e.g. physical therapy. In addition, a better understanding of the home surroundings will ensure a safer environment for your parents.
5. How often is the caregiver supervised and by whom? Look for a RN supervision answer here. If not, that’s a concern.
6. What type of background screening is required of the caregiver? You should focus on a criminal background, abuse registry and reference checks. For me, the criminal background and reference checks are the most important.
7. Can I/we interview the caregiver(s)? If so, is there a charge? Either way take advantage of it.
8. If we’re not satisfied with the current caregiver, what’s the agency policy on providing a replacement?
9. Does the agency have a minimum amount of hours that are required? Although this varies agency by agency, most require a four hour minimum.
10. What are the rates?
    1. Hourly
    2. Daily: This is typically a live-in case where the caregiver is present in the home for 24 hours per day. This practice varies agency by agency based on the availability of live-in caregivers.
    3. How often do they bill and are you required to pay in advance? If they request advanced payment, it is typically for two weeks.  See if you can pay this on a credit card. The credit card will offer some safeguard to you if you’re not happy with the agency and want to make a change. 

Another aspect of selection is whether or not your parents have Long Term Care insurance (LTC). If they do have coverage, here are some questions. 

1. What LTC carriers do they accept?
2. Do they accept Assignment of Benefits (AOB)? If so, this allows the agency to bill the LTC carrier directly.
3. Does the policy have an Elimination Period? If so, how long? If the policy does, which most do, you’re required to pay for services within the Elimination Policy. An Elimination Policy can range from 30 to as many as 120 days. 

I hope that I’ve given you a starting point for discussions with prospective home health agencies. I would shop  a minimum of three agencies and dig as much as possible.

To find  competent, caring elder care professionals across America who are located near You and can help you with your elder care matters, go to: www.ElderCareMatters.com - A FREE online resource to find elder care experts plus elder care information & answers to your elder care questions.

Bart Delsing, Owner & Chief Operating Officer
FirstLantic Healthcare, Inc.
Delray Beach, Florida  33445
561-243-7979
Member of the national ElderCare Matters Alliance, Florida chapter 

Answer:  Meeting the needs of your loved one from hundreds of miles away is no easy task. Increasingly, as the population ages, many families are finding themselves in similar situations. Professional geriatric care management specializes in the challenges associated with long distance care giving. This service is designed to ensure peace-of-mind when it is neither feasible nor realistic to be hands-on and act as a locally-based caregiver.  A professionally trained care manager specializes in caring for the aged, injured and disabled, and acts as a consultant and advocate for your loved one, ensuring the integrity of care you demand.  

For instance, at FirstLantic Healthcare, we conduct a thorough assessment of the client’s needs, evaluate his or her ability to function independently, review his or her physical, emotional, and social well-being, as well as financial viability and medical condition. We develop and discuss a plan of care, arrange for the appropriate services, and fully implement the plan, which can be as extensive or as minimal as the situation warrants. Services include:

-          Client advocacy

-          Comprehensive evaluations and assessments

-          Special needs trust and disability management

-          Crisis intervention

-          Supportive counseling

-          Medication management

-          Budget preparation

-          Attendance at appointments

-          Coordinating care and community services

-          Residential placement assistance

-          Guardianship monitoring and/or avoidance

-          Legal support through complementary documentations

Care managers are nurses or social workers, specialists that understand the intricacies of the healthcare system.  If and when you make the decision to hire a professional management company, be sure they deliver the right combination of service, professionalism and kindness. It makes all the difference in providing you a sense of security and alleviating the anxiety and concerns of taking care of your loved one in the best possible manner.

To find  competent, caring elder care professionals across America who are located near You and can help you with your elder care matters, go to: www.ElderCareMatters.com - A FREE online resource to find elder care experts plus elder care information & answers to your elder care questions.

Bart Delsing, Owner & Chief Operating Officer
FirstLantic Healthcare, Inc.
Delray Beach, Florida  33445
561-243-7979
Member of the national ElderCare Matters Alliance, Florida chapter