Answer:   Helping a parent move can be stressful, especially if that move is long distance. The job can be made less overwhelming by good planning. The big decision to move will be made easier by turning the process into a series of smaller decisions and tasks. Teaming up with senior service providers will make the physical and emotional tasks easier.

PLANNING should be your first step.  Develop a timeline. Decide which parts of the move you will do,   and which parts you need help with.  Decide where she will move to.  If  you need help, a geriatric social worker or a Senior Placement Counselor can help you locate an assisted living facility that is appropriate for her needs and resources. Talk to the Move-In Coordinator to find out the rules and schedules for moving in. You may also want to obtain a floor plan of her new apartment to help you decide which furniture to move and where it will  be placed within her room.

Another aspect of planning is to decide how you will move your mom's furniture and possessions. You can rent a van and drive it yourself. You can use a U-pak service like PODS who will transport your items after you pack them into a container (which they provide and deliver.) If you are moving a small amount you may choose to send it via a freight company or UPS. Finally, you can schedule a move with an interstate mover.  How you choose to move her things will be determined by what she is moving, your time availability, physical ability, and financial resources. Schedule your mover as soon as you are sure about the date and location. Sometimes it takes awhile to get on a schedule.

PACKING You didn't say the degree to which you are able to be involved in the your mother's relocation.  Are you planning to go there and help her organize, downsize, and pack?  If so, allow enough time that you and she are not rushed.  It is always a good idea to use new boxes and packing paper, not salvaged boxes. Boxes need to be of a uniform size,  taped closed, and strong enough to stack.  If you are not able to do the packing yourself, you may want to hire a professional move manager,  who specializes in working with older adults.  A move manager understands the  needs and limitations of elders. They will also know the local moving resources. Typically a move  manager will provide boxes.  Some will be able to help you load a van or pod if you choose that route.  A move manager knows how to downsize with sensitivity;  in all probability they have a working relationship with the facility where your mom is now living.  Another benefit of using a move manager is that she will know how to contact other move managers who service the residence where your mom is moving into.

It is a good idea to take with her valuables like jewelry, keys, eyeglasses, medicine, personal phone book, and anything she will need as soon as she arrives. In some cases there will be a difference in time between her arrival and the delivery of her things. Most assisted living communities have furnished rooms for short term occupancy.

Don't forget to file a change of address with the Post Office, arrange to change her bank accounts and any automatic deposits. Notify her doctors, dentist, caregivers, and other service providers.

RELOCATING YOUR MOTHER Your mother may be able to travel alone, if not you will need to drive her or fly with her.  Consult her doctor for advice and any needed medications. If you are unable to travel with her, you can hire a travel companion. Some move managers provide that service. Caregivers services can drive her to the airport and, if you want, fly with her. Airlines offer limited companion services similar to those provided to unaccompanied minors.

UNPACKING will take the same amount of time as packing. Your mom will adjust to her new residence faster if her things are put away where she is used to finding them.  A move manager in your area can help you unpack, set-up her new apartment and remove the boxes.

ATTITUDE is as important as logistics to a successful move. Listen to your mom and let her express her   preferences about where she will live, what to take or leave, and how her new residence will be set up. Treat her with respect and tact. Recognize the difficulty of moving away from familiar surroundings and routines. Avoid becoming critical or impatient. Be realistic about the time needed to accomplish a move. Remember the most important thing is to accomplish her move with minimal disruption to your lives and your relationship.

Jamie Wasson, CRTS, Managing Partner
easyMove, LLC
Pleasant Hill, California
Member of the national ElderCare Matters Alliance, California chapter

Answer:  It is great to hear that you are in good health, but your finances may not be as healthy as you are.

The good news is that your estate is under the current $5 million limit, so there are no estate tax issues.

The bad news is that, based on your information, you have very limited liquidity, and liquidity is the secret of financial survival.  In my opinion, you need to have $1 million in liquidity, that is cash, stocks, or a pension plan, so that you are financially secure during retirement.

Also, there is a real concern about Medicare.  Will it be around in 10 years and will it pay the lion's share of your medical expenses in the future, and if not, will you be able to afford these medical expenses? 

Another concern that you should have is that California is bankrupt.  What affect will this have on its ability to provide California residents with Medi-Cal benefits?

If you have not done so already, I would suggest that you do the following:

1. Meet with a financial planner to develop a financial "road map".
2. Meet with an attorney to have the following legal documents prepared:  Power of Attorney for Health, Power of Attorney for Finances, and a Living Trust (which can help your estate avoid the high cost of Probate)  

Finally, regarding your daughter.  I would suggest that at 50 years of age that she assume responsibility for herself–that she find a job, and perhaps start thinking about taking care of you and your elder care needs.

Hope this helps.

Orlando J. Antonini, CPA/PFS, CFP, QFP, RIA, NCG
Antonini CPAs LLP
San Francisco, California
Member of the national ElderCare Matters Alliance, California chapter

Answer:  Once the durable Power of Attorney for health care or finance is in place, the designated person who holds the Power of Attorney should keep as much documentation about the person as possible, including a list of their medications, physician's report including diagnosis, allergies, etc., advanced healthcare directive, POLST (physician's orders for life sustaining treatment), DNR (do not resuscitate) , family history, medical history, copy of the Will, bank information, mortuary information, etc. The Power of Attorney is authorized to make decisions re: the care of that person in an assisted living facility or nursing home even if the person is still in his/her right mind.

My answer to your question is based on my many years of being a long term care Administrator.  If you need more specific information about these legal documents, I would suggest you contact an Elder Care Attorney in California, which can be found on ElderCareMatters.com.

Daniela Berindei, Administrator
Elite Elder Care
El Dorado Hills, California
916-267-1346
Member of the national ElderCare Matters Alliance, California chapter

Answer:  The state of California offers a program called In-Home Supportive Services (IHSS), which is paid for by Medicaid funds (MediCal, in California).  The program, administered by each county, does provide a certain number of home care hours, based upon an assessment by a county social worker.   

The care may be provided by a family member, who is paid by IHSS, if the recipient qualifies for MediCal and the caregiver is acceptable to IHSS.   

There is a Website with links to each of the counties’ offices: http://www.cdss.ca.gov/agedblinddisabled/pg1785.htm 

If your mother does not qualify for MediCal, you can talk to a reputable employer-based home care agency about the possibility of working for that company.  The care will not be free to your mother, of course, and you would have to pass the agency’s background screening, but you would be legally employed.

Bert Cave, President
Support For Home
Sacramento, California
916-482-8484
Member of the national ElderCare Matters Alliance, California chapter

Answer:  Daily Money Managers help people handle their daily finances and, depending on their individual practice, a variety of other administrative tasks.

There are 2 different daily money management programs at Diablo Valley Foundation for The Aging: AARP Volunteer Money Management Program and Fee for Service Money Management Program. 

The AARP Volunteer Money Manager Program offers money management service to help low-income older and/or disabled adults who have difficulty budgeting, paying routine bills, and keeping track of financial matters. An AARP Money Manager can also help deal with some debt problems, help obtain credit report/score. Organizations like Diablo Valley Foundation (DVFA) supervises volunteers and monitors all accounts. AARP recruits volunteers for the program and provides general guidelines. 

Within AARP Volunteer Money Management Program, there are 2 programs: Representative Payee and Bill Pay. 

When someone becomes the Representative Payee, he or she will set up a new bank account which is accessible only to the Representative Payee. A volunteer is assigned who will visit the client, work out a budget, and pay the bills. Clients must be 60 years old and older, and have a qualifying annual income limit of $35,298 for a single person and $49, 947 for the couple, assets under $35,000 (excluding home and car). AARP requires a medical verification of client’s inability to manage his/her own finances. 

A monthly fee for Representative Payee Program may be charged depending on income and other expenditures 

If someone becomes Bill Payer, all of the above applies, except the client retains control over his/her accounts, and medical verification is not required. 

A monthly fee for Bill Payer Program may be charged on case-by-case basis. 

A Fee for Service Money Manager will research all financial documents to determine the clients’ financial position and assets, sets up a Quicken or other financial software program that will track assets, expenses, and income. The Fee for Service Money Manager also writes client’s checks upon receipt of bills, reconciles all accounts monthly to statements, and sends reports to family when requested. 

FFS Money Manager also reviews all accounts to analyze net worth, transfers funds when necessary, makes deposits/withdrawals from clients’ accounts, and prepares information for annual tax preparation. 

Basic FFS Money Management fee is around $50/hr plus mileage to client’s residence.

Robert Kain, Executive Director
Diablo Valley Foundation for the Aging
Walnut Creek, California  94595
Member of the national ElderCare Matters Alliance, California chapter

Answer:  Your situation presents an excellent example of the importance of planning before the need for care arises.  You do not indicate how old your father is or what type of illness or care he needs or his income.  I do see that he needs 24/7 care but is only paying for 8 hours per day.  I presume that since he is living with your sister she is providing some of the additional care.  If his goal is to stay with your sister as long as possible the VA pension will be a great resource for achieving this.  If he needs more care than can be provided at home for a reasonable cost then you may want to look at the available Medi-Cal benefits.  Depending on which County your father lives in (or can move to) and his income, he may qualify for Medi-Cal’s Assisted Living Waiver program (this program has an income cap) or for In-Home Operations (this program uses the same qualifiers as the Skilled Nursing facility program and there is no income cap).  Once your father qualifies for Medi-Cal the VA benefit will drop to $90/month, which he will get to keep in addition to the $35/month personal allowance provided by Medi-Cal. 

Regarding the net worth qualification for the VA pension, you are correct that the VA does not allow unsecured debts to reduce net worth.  You are also correct that the VA will exclude from net worth the portion owned by a joint owner.  Unlike Medi-Cal (Medicaid) the VA does not have a bright line rule for the amount of assets the veteran may keep and still qualify for pension.  The VA instead looks at net worth in terms of life expectancy.

You indicate your father created a revocable trust several months ago.  If he still has mental capacity several options are available to him.  He could create an irrevocable trust now and transfer his assets to it to reduce net worth.  He would need to be extremely careful how the transfers took place so that eligibility for Medi-Cal would not be jeopardized.  In addition, he would need to work with an attorney who will help him evaluate and understand all the planning and tax issues such transfers can create, and one who is well versed in both VA pension and Medi-Cal law.  While the VA does not penalize transfers or have a look back period, if he needs 24/7 care later on in a nursing home Medi-Cal will be an important tool for him. 

Outright transfers of the house and condo to his children could also be done.  There would be no VA penalties, but there will be adverse tax implications in the form of loss of basis (which creates additional capital gains tax upon sale), and Med-Cal transfer penalties if not completed the correct way.  In addition, if the recipient was sued, got divorced or passes away the assets will be lost to dad and completely out of his control.

If the condo is considered your father’s primary residence, then it is an exempt asset for both VA and Medi-Cal purposes.  He could transfer the condo to your sister (provided he has the requisite mental capacity) without suffering any Medi-Cal penalties, but that transfer will not work for VA purposes.  Under the VA rules the transfer of a primary residence to a relative already living in it will not reduce net worth.  While the condo would remain exempt during your father’s lifetime, upon his passing, if he received Medi-Cal, the State would seek reimbursement for the payment of his care from his share of the condo. 

Because the house is not your father’s primary residence it would not be exempt and could be an unavailable asset (valued at the assessed value not fair market value) due to the joint owners’ refusal to sell, but would remain subject to transfer penalties if given/transferred out of his name.

For any transfer to be valid your father must have the requisite mental capacity.  If your father does not have the requisite mental capacity, then transferring assets will not be a viable option unless he has a financial durable power of attorney that contains appropriate expanded gifting powers and public benefit planning.

The only other option, if your father no longer has mental capacity, would be for him to add someone to his bank account to turn it into a multi-owner account and reduce net worth.  This option will work only if the bank account is not already owned by his revocable trust.  While this will likely allow him to qualify for VA pension, Medi-Cal reimbursement will remain an unresolved issue.

With proper advice and counsel while he was of sound mind he could have arranged his affairs to enable easy qualification for both VA pension and Medi-Cal.  Use of an irrevocable trust would provide a means to qualify for benefits and hold the assets in a manner that would reduce capital gains, preserve the step up in basis and protect the assets from being taken away from beneficiaries due to unforeseen lawsuits, divorce or untimely death.

I hope that this information is helpful and wish you the best of luck in helping your father obtain the help he needs.

Heather R. Chubb, Attorney at Law
The Chubb Law Firm
Member of the national ElderCare Matters Alliance, California chapter

Answer:  "Aging in Place means that residents don't need to move from their homes in order to accommodate their changing needs. When surveyed, over 85% of the older population say that they would prefer to stay in their homes rather than relocate to assisted living or nursing homes if possible. Major life changes in our Senior years such as moving away from friends and neighbors is very stressful and disorienting. Staying in one's home is a lot less expensive than being institutionalized and can contribute to longer, happier lives. In California, it can cost up to $100,000 per year to live in Assisted Living. For less than that amount, modifications can be made for safety and ease allowing Seniors to stay at home for perhaps 10-20 years.Children of Seniors  can show great care and compassion for Mom and Dad by spending a little in advance to make their homes safe and accessible through minor modifications.

Is it better to spend $80,000 – $100,000 per year (15 x $100,000 = $1,500,000) at Assisted Living or spend $80,000 x 1 = $80,000 and live at home for another 15 years? 

As an Aging in Place Specialist (CAPS certification by the National Association of Home Builders), we are able to recommend and offer attractive design solutions that create a safe and comfortable environment for individuals who want to age in place…but are not experiencing health issues that require constant medical care, or have progressive or other conditions that require home modifications/equipment, or are dealing with an abrupt or traumatic health-related change. 

At that time "Adaptable" and "Accessible" Design may become necessary. Then a team of experts including patients P.T.and O.T. offer their recommendations to guide your interior designer and contractor to make more extensive modifications including special medical equipment. Depending on the progression and longevity, these major modifications may or may not be the best solution. 

I encourage all my clients who want to stay in their homes to plan ahead now when remodeling their home. Well-designed kitchens and baths, wider hallways and door openings, and open floor plans that offer "Universal Design" elements can provide multi-generational access and even increase the value and saleability of ones home. Aging in Place Design really is valuable for anyone at any age – we are all aging every day.

Kathy Bate, ASID, CID, CAPS
Designs for Independent Living
The national ElderCare Matters Alliance, California chapter
ElderCareMatters.com

All next week, the members of the California chapter of the national ElderCare Matters Alliance (who are some of America's top Elder Care Experts) will answer your questions about a wide range of elder care matters (from legal, financial, caregiving, housing, etc.), and their answers to your questions will appear on ElderCareMatters.com.

So if you have questions about elder care matters, send us an email at Questions@ElderCareMatters.com, and one or several of our Elder Care Experts from the California chapter of the national ElderCare Matters Alliance will answer them on the homepage of ElderCareMatters.com.  (Please include your name and email address)

Thank you for your interest in Elder Care Matters.

Phillip G. Sanders, MBA, MSHA, CPA
Founder & Chief Executive Officer
ElderCare Matters, LLC
ElderCareMatters.com

Answer:  What a great idea!  It is our pleasure to be able to financially sponsor another elder care resource for families across America to use to make better elder care decisions.

In fact, several weeks ago we launched www.ElderCareWebsites.com, a FREE, secure online elder care resource that includes many of America's top elder care websites.  This is where families can find an alphabetical listing of company websites that have information about a wide range of elder care / senior care services, including Elder Law, Estate Planning, Financial Planning, Daily Money Management, Geriatric Care Management, Home Care, Long Term Care Insurance, Senior Housing, etc.

Feel free to bookmark this online listing of elder care websites, and don't forget to check back often for additional websites that soon will be listed on www.ElderCareWebsites.com, an elder care resource that includes many of America's top elder care websites.

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

A POA is an extremely powerful document that your agent can use for a variety of Medicaid, estate and long term care planning needs, both foreseen and unforeseen.  Once you choose your agent – someone you have full, total and complete trust in – your POA authorizes that agent to act on your behalf to perform such functions as drawing checks on your bank accounts for specific purposes, append signatures to routine correspondence, act as a signatory to real estate closings and buy and sell financial securities. 

After your possible incapacity, your agent will be empowered to sign your name and is obligated to act in your best financial interest at all times and in accordance with your wishes.

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

Answer: Perhaps you’ve noticed memory loss, a decline in what your loved one is able to physically do or increased medical issues. This can be frightening, whether you live out-of-state, or nearby. Sometimes we think that having them move into some type of assisted living situation is the best or only solution, but that isn’t always the case. You and your parents can benefit greatly from the services of a geriatric care manager who can help you sort through appropriate options while considering your parents’ and family’s values. A geriatric care manager (Care Manager) is a health care professional who strives to offer objective information and alternatives to support the well-being, safety and independence of your loved one.

Care Managers help elders and their families by:

• Providing a comprehensive assessment to determine if living at home is a safe option. If not, care managers can offer professional, objective opinions to assist families as they sort through the decision process for elder care residential options;
• Arranging and managing in-home services to assist with health, home and personal needs;
• Providing short and long-term support to families engaged in local or long-distance care giving;
• Coordinating health care appointments and necessary medical follow-up;
• Preventing unnecessary or repetitive medical care;
• Helping to navigate complex medical systems, diseases and insurance issues;
• Assisting primary caregivers in the home, across town or at a distance, in coping with emotional stress caused by elder care;
• Offering education and support to manage the disease process (Alzheimer’s, Cancer, etc.);
• Giving caregivers the information necessary to make early informed decisions about health care needs before an acute situation arises;
• Supplying an extra pair of eyes and hands to help with the care of a loved one.

Gina Fisher, LCSW
Executive Director of Clinical Operations
University of Oklahoma College of Nursing – Life Stage Solutions
Member of the national ElderCare Matters Alliance, Oklahoma chapter

Answer:  The surviving spouse of a veteran who served at least 90 days of consecutive active duty service, at least one day of which was during wartime, may qualify for a non-service connected pension from the Veterans Administration.  The surviving spouse must have been married to the veteran for at least one year (or have had children by the veteran if married less than one year) and been living with the veteran throughout the marriage and at the time of the veteran’s death. 

If your mother has limited assets, and if the cost of assisted living, combined with her other out-of-pocket medical expenses, will exceed or come close to her total annual gross income, she should be eligible for a widow’s pension.

Debra A. Robinson, Esq.
Robinson & Miller, P.C.
Alpharetta, Georgia  30005
770-817-4999
Member of the national ElderCare Matters Alliance, Georgia chapter

Answer:  To initiate a guardianship or conservatorship, an interested party must file a petition to the court. The petition will state the petitioner's relationship to the prospective ward. The petition also will state facts that show that the proposed ward is incapacitated, and the need for a guardian. The petition should detail the ward's property and assets. The judge will examine the petition and hold a hearing that the proposed ward must attend. After the hearing, the judge will decide if the proposed ward needs a guardian, conservator or both. Wards have the right to appeal a guardianship or conservatorship determination.

Once appointed, a guardian or conservator must be discharged by the judge to end the guardianship or conservatorship. Reasons for discharge include the death of the ward or conservatee, the ward's return to capacity or the guardian or conservator's inability to fulfill his or her duties.

Stephen O. Allaire, Esq.
Partner in the Law Firm of
Ruggiero, Ziogas & Allaire
Bristol, CT  06010
860-584-2384
Member of the national ElderCare Matters Alliance, Connecticut chapter

Answer:  It sounds like your mother needs a daily money manager (DMM).  DMM’s help people handle their daily finances and, depending on their individual practice, a variety of other administrative tasks.  Rates will vary based on the tasks they handle as well as geographic area and other factors.  Whatever the rate they charge, any potential DMM should thoroughly discuss the scope of the work you need and agree on a price before any work is done.  Be sure you understand how the DMM bills and what charges you will be billed for. 

Be sure you hire someone who has experience in handling personal financial matters as well as being insured.  This is not a time to hire the cheapest person you can find.  You want to be sure your mother’s affairs will be handled correctly and ethically. 

Although there is no licensing for Daily Money Managers, many are members of The American Association of Daily Money Managers and are members of the national ElderCare Matters Alliance. 

You can find many Daily Money Managers on ElderCareMatters.com - America's #1 source for Elder Care Experts, Information & Answers.

Cindy Lail, DMM
Checks & Balances, Personal Financial Services, LLC
Lawrenceville, GA  30044
404-663-9777
Member of the national ElderCare Matters Alliance, Georgia chapter

Answer:  The first step should be to have an assessment done on Mom. This should include the Aging In Place Specialist (AIPS), the family members involved, and any doctors or health care professionals that may be needed. This will inform the AIPS if there are any current health issues or if there are progressive or other conditions that require home modifications. The assessment would also tell the AIPS the wants and wishes of the client, along with a time frame for completing the modifications. 

Details of the physical structure of the existing home will be needed. If blueprints are not available, the AIPS or contractor should make detailed drawings of  the room sizes and layout. 

Determine who the "decision maker" is.  Is it mom, the children, a spouse or a combination? 

A budget is important to all parties concerned. Are the modifications being done strictly for health care reasons specifically designed for one person, is it more of a universal design in general that is wanted, and are we trying to upgrade the home at the same time? These factors will help determine what can be done in the budget, and the priorities. 

When these steps are completed, specific recommendations can be made about modifying Mom's home so that she can Age in Place there.

Harry Felsenthal, Certified Aging in Place Specialist
Licensed Contractor
Call Harry Enterprises, Inc.
Lutz, Florida  33549
813-505-3329
www.CallHarryEnterprises.com
Member of the national ElderCare Matters Alliance, Florida chapter

Answer:  We at ElderCareMatters.com realize that there are many families like yours across America who rely on us to help them locate competent, caring elder care experts who are located near them and can help them plan for and deal with their elder care matters. 

With this in mind, we are reaching out to ALL competent, caring elder care experts across  America and encouraging ALL of them to join ElderCare Matters and to be listed on ElderCareMatters.com - America's #1 online resource for "Elder Care Experts", Information & Answers about a wide range of Elder Care Matters.

Simply put, our goal at ElderCareMatters.com is to be able to provide your family (in Alaska) and ALL families (across America) with a comprehensive list of America's top elder care experts in 83 different elder care service categories. 

Soon this will be a reality as more and more Elder Care Experts from across America continue to join ElderCare Matters and actively participate on our elder care website, ElderCareMatters.com.

Thank you for your support of ElderCareMatters.com.

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

Below are just a few of the many emails that ElderCareMatters.com receives daily from families across America requesting help with their elder care matters:

• I am looking for help for my 77 year sister who lives in Louisiana and has been abandoned by her children.  Can you help me? 
• I need to locate someone to provide home care for my wife.  We live in New Jersey.  Can you help us? 
• We need to find senior transportation services in the Miami area.  Can you help us? 
• My mother has been injured in an Assisted Living Home in Arizona and we need an attorney with whom to discuss this legal matter.  Can you help us? 
• Can you help me locate elder care experts in the Jacksonville, Florida area?

If you are a competent, caring professional who helps families plan for and/or deal with elder care matters, then you should definitely become a professional member of the national Elder Care Matters Alliance and you should be listed on ElderCareMatters.com – America's #1 source for Elder Care Experts, Information & Answers about Elder Care Matters.  Professional membership is just $15/month.

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

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

Answer:  ALL competent, caring elder care professionals across America are invited to apply for membership to the national ElderCare Matters Alliance and to be listed on www.ElderCareMatters.com – America's #1 online source for "Elder Care Experts", information & answers about elder care matters.

There are currently more than 2,000 professional members of this national Elder Care Alliance, including the following:

• Elder Law Attorneys
• Estate Planning Advisors
• Financial & Investment Advisors
• Geriatric Care Managers
• Long-Term Care Insurance Professionals
• Daily Money Managers
• Seniors Real Estate Specialists
• Home Care Agencies
• Assisted Living Communities
• and many other elder care experts

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

I look forward to your participation in Elder Care Matters!

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO of ElderCare Matters, LLC
ElderCareMatters.com (America's #1 source for "Elder Care Experts", Information & Answers about Elder Care Matters)

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

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

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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