Will Medicare pay for any of my mother’s nursing home costs?

Question:  Will Medicare pay for any of my mother’s nursing home costs?

Answer:  Medicare has provisions that if you are in the hospital and you are transferred out of the hospital directly to a nursing home facility to receive rehabilitation for whatever medical condition you have that Medicare will pay for the nursing home care up to a limited number of days as long as you are making progress under Medicare rules. So it is possible for Medicare to pay for part of your mother’s nursing home care when she leaves the hospital and needs rehabilitation.

If you need help with this or other elder care / senior care matters, you can find thousands of Elder Care Professionals from across America on ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Resources for Families.

You can also find Elder Law Attorneys on ElderLawAttorneys.us and Estate Planning Attorneys on EstatePlanningAttorneys.us – 2 additional websites sponsored exclusively by the national ElderCare Matters Alliance.

whesch Will Medicare pay for any of my mother’s nursing home costs?
William E. Hesch, Esq., CPA, PFS
William E. Hesch Law Firm, LLC
Cincinnati, Ohio
An ElderCare Matters Partner

Most Common Types of Senior Scams

Question:  Would you please provide us with some information about the most common frauds / scams that are being performed on seniors?

Answer:  There are a variety of scams that people perpetrate on seniors. Most are geared towards draining them financially or to secure their information for identity theft. Below are some of the most common types of Senior Scams:

  • Medicare and Healthcare Scams: Also known as a Medicare discount-drug card scam, these people will call, email, or even go door to door selling fraudulent discount Medicare drug cards. It is important to note that any situation like this is always a scam – legitimate prescription drug benefit companies are not allowed to make unsolicited sales pitches.
  • Free Contests and Magazine Subscriptions: This type of scam is one of the oldest in the book. Almost always done by mail, and now sometimes through email, a scammer will claim that the senior has won a free contest or can have a free subscription to a magazine if they provide enough personal information to verify that it is them.
  • Grandparent/Grandchild Scam: This type of scam is done over the phone or through an email. A scammer will pretend to be the senior’s grandchild, asking for money. Usually the “grandchild” is in some dire or embarrassing situation and asks the grandparent not to tell the grandchild’s parents. This prevents the grandparent from checking on the situation first before sending the money.
  • Charity Email: This scam tends to be more prevalent during the holidays. Scam artists send out emails soliciting contributions, usually using the name of a legitimate charity, with a link to send money. Seniors will give out their bank account information and other personal information through the link.

How to Prevent Senior Scams

The best way to help prevent someone from scamming your elderly loved one is to have a conversation with them about the risks and warning signs of fraud. For seniors that are less capable of making sound decisions, it is up to family members to be more vigilant in their watch for scams.

Sadly, seniors in the early stages of dementia or Alzheimer’s are more likely to become the target of fraud. It is difficult because the senior still believes that they are capable of making financial decisions even though they may no longer be able to do so on their own. An easy way to protect your loved one from scams is to add an adult child to the senior’s bank accounts to help look for suspicious withdrawals or payments.

If there is a concern that your elderly loved one has been taken advantage of in a scam, the first thing you should do is call a credit reporting agency and put a freeze on any compromised accounts. Adding a lock to the mailbox and taking the senior’s name off of subscription lists can also decrease the chances of a scam.

If you need help with this or other elder care / senior care legal matters, you can find thousands of Elder Care Professionals from across America on ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Resources for Families.

You can also find Elder Law Attorneys on ElderLawAttorneys.us and Estate Planning Attorneys on EstatePlanningAttorneys.us – 2 additional websites sponsored exclusively by the national ElderCare Matters Alliance.

mettinger Most Common Types of Senior Scams
Michael Ettinger, Esq.
Ettinger Law Firm
Albany, New York
An ElderCare Matters Partner

New York Elder Law Attorney Answers Today’s Question on ElderCareMatters.com about Power of Attorney

Question:  Would you please provide us with some information about Powers of Attorney?

Answer:  

  1. What is a Power of Attorney?

A Power of Attorney is a document in which you can appoint an agent to make financial transactions on your behalf if you are not present to make these transactions.

  1. What is the difference between a Power of Attorney and an Executor?

A Power of Attorney is in effect only during your lifetime. An Executor takes over the management of your estate upon your death. You name the Executor in your Will.

  1. What is a durable Power of Attorney?

A durable Power of Attorney states that the Power will be in force even if you become subsequently become disabled.

  1. How do I appoint an agent?

The Power of Attorney form is a form that must be signed before a Notary Public.

  1. What powers can I give to my agent in the Power of Attorney?

The form lists the areas of authority that you delegate. These include real estate transactions, banking transactions and insurance transactions, to name a few. However, the Power of Attorney does not in itself authorize the agent to make unlimited gifts.

  1. How can I authorize my agent to make gifts?

A Power of Attorney can be personalized to indicate the authority to make gifts and the limits, if any, on this authority.

  1. My bank has its own Power of Attorney Form. Do I need it?

A general Power of Attorney must be honored by banks. However, they sometimes are reluctant to honor them, so if you can sign the bank form, it is often easier for the agent to make transactions later on.

  1. Whom should I appoint as my agent?

You should appoint only someone whom you trust explicitly. You may also appoint two people acting together as an additional safeguard.

  1. If any accounts and house are all jointly held, do I need a Power of Attorney?

The joint accounts should be able to be accessed without the Power, but for real estate, a Power of Attorney will be needed.

10. Can I appoint my agent so that he or she has authority only if I become incapacitated?

The Power of Attorney is not valid for an agent appointed until he or she has signed the Power of Attorney before a Notary Public. You may execute the Power of Attorney but not have your agent sign until you are incapacitated.

If you need help with this or other elder care / senior care legal matters, you can find thousands of Elder Care Professionals from across America on ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Resources for Families.

You can also find Elder Law Attorneys on ElderLawAttorneys.us and Estate Planning Attorneys on EstatePlanningAttorneys.us – 2 additional websites sponsored exclusively by the national ElderCare Matters Alliance.

jrobert New York Elder Law Attorney Answers Todays Question on ElderCareMatters.com about Power of Attorney
Joan Lensky Robert, Esq.
Kassoff, Robert & Lerner, LLP
Rockville Centre, New York
An ElderCare Matters Partner

Difference between Mild Cognitive Impairment (MCI) and Dementia

Question:  What is the difference between “Mild Cognitive Impairment” (MCI) and Dementia?

Answer:   The distinction between mild cognitive impairment and dementia can get a bit blurry. In California, Residential Care for the Elderly (RCFE) facilities can accept people with varying degrees of memory loss. Once a person is diagnosed with dementia, there are additional licensing requirements a facility in California must meet.

The definitions that follow are from the Community Care Licensing regulations:

Mild cognitive impairment” (MCI) refers to people whose cognitive abilities are in a “conditional state” between normal aging and dementia. Normal age-related memory changes can include:

  • forgetting a person’s name
  • location of an object

Individuals with MCI have difficulty with short-term memory loss. MCI is a state in which at least one cognitive function, usually short-term memory, is impaired to an extent that is greater than would be anticipated in the normal aging process. MCI is characterized by short term memory problems, but no other symptoms of dementia (e.g., problems with language, judgment, changes in personality or behavior) that affect a person’s daily functioning. Individuals with MCI may experience some difficulty with intellectually demanding activities, but lack the degree of cognitive and functional impairment required to meet diagnostic criteria for dementia.

Dementia” means the loss of intellectual function sufficient to interfere with an individual’s ability to perform activities of daily living or to carry out social or occupational activities, such as:

  • thinking
  • remembering
  • reasoning
  • exercising judgment
  • making decisions
  • other cognitive functions

Dementia is not a disease itself, but rather a group of symptoms that may accompany certain conditions or diseases, including Alzheimer’s Disease. Symptoms may include changes in personality, mood, and/or behavior. Dementia is irreversible when caused by disease or injury, but may be reversible when caused by depression, drugs, alcohol, or hormone/vitamin imbalances.

Someone meeting with Mr. Sweetbriar might wonder why his family is so concerned about his memory. He is alert and focused and answers your questions with reasonable clarity. However, his family describes his difficulty remembering his grandchildren’s names, dialing wrong numbers, and losing his sunglasses twice in the last month.   The key to providing care for Mr. Sweetbriar is in the diagnosis from his physician. His doctor has diagnosed mild cognitive impairment.

There are a considerable number of additional requirements for a RCFE to be approved to provide care and supervision to people with dementia. A person with dementia will be considered “non-ambulatory” (even if he/she walked into the doctor’s office unassisted) because he or she would need assistance in leaving the facility in an emergency. The local fire authority must approve the beds for non-ambulatory residents.   There are some common sense requirements for safety – to address behaviors such as wandering, aggressive behavior and ingestion of toxic materials. All staff are required to receive training when they begin work on specific issues for people with dementia, as well as eight continuing education hours on dementia each year.

It is wise to ask if a facility is approved to care for people with dementia (it was referred to in the past as having a “dementia waiver.”) These homes are approved by Community Care Licensing for dementia services, if they can show adherence to the licensing requirements.

If you need help with this or other elder care / senior care matters, you can find thousands of Elder Care Professionals from across America on ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Resources for Families.

You can also find Elder Law Attorneys on ElderLawAttorneys.us and Estate Planning Attorneys on EstatePlanningAttorneys.us – 2 additional websites sponsored exclusively by the national ElderCare Matters Alliance.

rmayer Difference between Mild Cognitive Impairment (MCI) and Dementia
Rhonda Krantz Mayer
Community Training Connection, Inc.
Chatsworth, California
An ElderCare Matters Partner

Pennsylvania Elder Law Attorney Answers Today’s Question about Using Trusts to Plan for Long Term Care

Question:  Why would one use a Trust to help plan for long term care?

Answer:  Planning for long-term care involves the consideration of many factors. There are a number of reasons that trusts can be used as part of an individual’s long-term care plan. Sometimes an individual may place assets inside of a revocable living trust. If the individual becomes incapacitated, the trustee will have the ability to manage the trust assets immediately, and those assets can be used for the care of the individual. Revocable trusts are more commonly used as part of planning for an individual’s death to deal with issues such as probate (or multi-state probate), or privacy.

Irrevocable trusts are more commonly used in planning for an individual’s long-term care. If an individual does not have a long-term case insurance policy, they are self-insured for any long-term care needs they may have. That means it is up to the individual to pay for all of the costs associated with long-term care. Medicaid is the federally-funded, state-implemented program which pays the costs of long-term care for individuals who qualify. To qualify for Medicaid, an individual must generally have a very limited amount of assets in his or her name.

Irrevocable trusts can be used, either alone or in conjunction with other planning strategies, to reduce the amount of assets in an individual’s name for Medicaid purposes. By transferring assets into an irrevocable trust, that individual may qualify for Medicaid sooner; and at 5 years after the time of the transfer into the irrevocable trust, those assets are protected from having to be spent on long-term care. The Medicaid rules are very complex, and implementing a planning strategy using trusts should only be done with a qualified elder law attorney to avoid any potential planning failures or pitfalls.

If you need help with this or other elder care / senior care legal matters, you can find thousands of Elder Care Professionals from across America on ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Resources for Families.

You can also find Elder Law Attorneys on ElderLawAttorneys.us and Estate Planning Attorneys on EstatePlanningAttorneys.us – 2 additional websites sponsored exclusively by the national ElderCare Matters Alliance.

jruggiero Pennsylvania Elder Law Attorney Answers Todays Question about Using Trusts to Plan for Long Term Care
James J. Ruggiero, Jr., Esq.
Ruggiero Law Offices, LLC
Paoli, Pennsylvania
An ElderCare Matters Partner

Senior Move Manager Answers Today’s Question on ElderCareMatters.com about Downsizing

Question:  We are about to move Mom from her home in which I was raised to an Assisted Living facility. What are some of the things we should consider during this “downsizing” process?

Answer:  The first step in downsizing is to choose the furniture going to the assisted living community. Use the floor plan from the community to decide what fits. You will need to visit the apartment that is being rented, measure the walls, locate the light switches, the cable TV outlet, the air registers, and the windows and mark these items on the floor plan. Once that’s done you can measure the furniture that you’d like to take and make sure it safely fits in the apartment. You do not want to make the space seem any smaller than it is.

Think about purchasing smaller couches that are firm and easy to get up from, a flat screen TV to hang on the wall, a bistro kitchen set with chairs that have arms and a new bed.

Once you’ve chosen the larger items to take to the new apartment choose the items you love such as family photos, decoratives, heirlooms, etc. Whatever is left can be given to the family (if they want them), sold through an estate sale or donated. This seems like an easy process but it can be a very emotional situation and the older adult may need some time to part with their personal items. Moving out before cleaning out the house is usually easier than trying to distribute items while living there. If mom isn’t ready to part with everything yet, is a little confused on what she wants to take, is worried the new assisted living community isn’t for her or has other concerns this is a good solution. The house and the contents are still there but a timeline needs to be set to get the items out of the house and the house on the market for sale. If it’s not possible to afford assisted living without selling the house and its contents then you might need to hire a third party, such as a Senior Move Manager, to assist with the whole process. This person will help sort, distribute items no longer wanted/needed and help move your mom.

If you need help with this or other elder care / senior care matters, you can find thousands of Elder Care Professionals from across America on ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Resources for Families.

You can also find Elder Law Attorneys on ElderLawAttorneys.us and Estate Planning Attorneys on EstatePlanningAttorneys.us – 2 additional websites sponsored exclusively by the national ElderCare Matters Alliance.

jprell Senior Move Manager Answers Todays Question on ElderCareMatters.com about Downsizing
Jennifer Prell, Senior Move Manager
Paxem, Inc.
Cary, Illinois
An ElderCare Matters Partner

Elder Law Attorney Answers Today’s Question On ElderCareMatters.com About Applying For Medicaid Benefits

Question:   How would we go about applying for Medicaid benefits?

Answer:  Medicaid benefits are going to be different in every state.  The first thing you need to determine is what benefits you seek.  For instance, in Pennsylvania, if you are seeking benefits for home and community based services, you will start with the local area agency on aging.  If you are seeking benefits for nursing services provided in a nursing home, you would file the application at the County Assistance Office.  In any event, you can get this information from your local Area Agency on Aging or an experienced Elder Law attorney.

If you need help with this or other elder care / senior care legal matters, you can find thousands of Elder Care Professionals from across America on ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Resources for Families.

You can also find Elder Law Attorneys on ElderLawAttorneys.us and Estate Planning Attorneys on EstatePlanningAttorneys.us – 2 additional websites sponsored exclusively by the national ElderCare Matters Alliance.

rslutsky Elder Law Attorney Answers Todays Question On ElderCareMatters.com About Applying For Medicaid Benefits
Robert M. Slutsky, Esq.
Robert Slutsky Associates
Plymouth Meeting, Pennsylvania
An ElderCare Matters Partner

Hawaii Estate Planning Attorney Answers Today’s Question on ElderCareMatters.com

Question:  How Does a Revocable Living Trust Avoid Probate?

Answer:  Once assets are transferred to the trustee, the trustmaker no longer holds legal title to them. If the trustmaker dies, the trust continues, and the successor trustee (who is named in the trust instrument) takes over administering the trust. Since a trust can’t die the same way a person can, the trust assets will not be subject to probate upon the trustmaker’s death.

If you need help with this or other elder care / senior care legal matters, you can find thousands of Elder Care Professionals from across America on ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Resources for Families.

You can also find Elder Law Attorneys on ElderLawAttorneys.us and Estate Planning Attorneys on EstatePlanningAttorneys.us – 2 additional websites sponsored exclusively by the national ElderCare Matters Alliance.

smakuakane Hawaii Estate Planning Attorney Answers Todays Question on ElderCareMatters.com
Scott A. Makuakane, Esq., CFP
Est8Planning Counsel LLLC
Honolulu, Hawaii
An ElderCare Matters Partner

Missouri Elder Law Attorney Answers Today’s Question on ElderCareMatters.com

Question:  When does it make financial sense (if ever) for seniors to consider a reverse mortgage? My Mom and Dad have a Reverse Mortgage on their principal residence. Will we need to sell their home when they die?

Answer:  A reverse mortgage is not a financial solution for everyone, in fact, for most people, because there are specific rules that must be followed and very often the funds received are not ultimately worth the cost.

If however, a couple who owns their home outright, are over 62 years of age and at least one of the spouses will be able to live in the home for at least one year from the date of receiving the mortgage, it may make sense.

If a couple has few assets, and needs more income than they currently receive for on-going health or other expenses (for example, to pay for care in the home) or they need funds to pay off existing debt, reverse mortgages can be a solution in that they provide a portion of the equity in the home in the form of a monthly income, a lump sum or line of credit or a combination of all three. Often, the amount of the reverse mortgage is a far less than the actual value of the home.

A reverse mortgage is a loan, so it does not require that monthly payments be made to the lender, as with a traditional mortgage or home equity loan. . Depending on the type of plan chosen, the reverse mortgage becomes due with interest when the borrower moves, sells the home, reaches the end of a pre-selected loan period, or dies. Because reverse mortgages are considered loan advances and not income, the amount received is not taxable. Any interest (including original interest discount) accrued on a reverse mortgage is not deductible until the mortgage is actually pay it, which is usually when the loan is paid off in full.

Not infrequently, individuals who may have a beneficiary or other deed that gives the home to their children or others when they die do not realize that the beneficiary deed or designation is usually ineffective to transfer the home upon the owners’ death, because the home must be sold to re-pay the loan. If the home sells for more than the amount loaned, the additional proceeds may usually be retained by any named beneficiaries; if the home sells for less than the amount loaned, the lending company must accept the sale proceeds and cannot seek repayment for the full loan amount from any heirs, unless they do not sell the home or otherwise pay the full loan amount. Any beneficiaries of a home that has a reverse mortgage may choose to keep the home so long as they re-pay the full amount of the loan from other funds.

If you need help with this or other elder care / senior care legal matters, you can find thousands of Elder Care Professionals from across America on ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Resources for Families.

You can also find Elder Law Attorneys on ElderLawAttorneys.us and Estate Planning Attorneys on EstatePlanningAttorneys.us – 2 additional websites sponsored exclusively by the national ElderCare Matters Alliance.

dschuster Missouri Elder Law Attorney Answers Todays Question on ElderCareMatters.com
Debra K. Schuster, M.H.A., J.D.
Debra K. Schuster, P.C.
St. Louis, Missouri
An ElderCare Matters Partner

Alabama Elder Law Attorney Answers Today’s Question on ElderCareMatters.com

Question:   What is a Living Trust?

Answer:  A living trust is simply a trust that is created during your lifetime as opposed to a testamentary trust that is created after your death. And trusts, living or testamentary, can be as different as the various models of automobiles available to your parents today. Whether your elderly parents should set up a living trust depends entirely on what they are trying to accomplish because different kinds of trusts can achieve different results.

Think of the decision like this – your parents can walk, ride a bus, take a train, or perhaps even fly to their destination but they can also drive themselves. If they decide they want to drive themselves then which automobile best suits them? Will they need a van to haul a lot of people? Do they want to travel in luxury such as a Lexus would provide? Do they want reliable and cheap transportation like a Toyota Prius, or will they be carrying tools and supplies to work with them and need a pickup truck?

Just like automobiles, trusts come in many different models. A trust is simply an agreement between a trust creator and a trustee (i.e. trust manager) where the trust creator transfers assets to a trustee to hold and manage under the terms dictated in the trust agreement for the benefit of someone identified by the trust creator. Trusts have gained a lot of popularity in recent decades among the middle class who recognize that trusts can solve many everyday routine challenges even if we don’t have millions or billions of dollars to manage.

Revocable Living Trust

Revocable living trusts, typically, are established by a trust creator who may also serve as the trustee to manage the assets for themselves during their lifetime. They are revocable and changeable by the creator at any time during the creator’s lifetime.

In order to understand the advantage of this type of trust it is necessary to think about the three stages of life that most of us will progress through. First, we are fully capable and competent to mange everything our self and the management of assets in a living trust are not really much different from owning the assets outright and managing them ourselves.

The first important advantage of a revocable living trust arises when we become unable to handle our affairs. Traditionally, management of our assets in this situation either required a conservator or an agent under a power of attorney, neither of which is ideal. A conservatorship requires probate court intervention that means we turn over control to a probate judge who may never have even met us and almost certainly will not have any intimate knowledge of us or our families. Because of the loss of control and costs of conservatorship proceedings, many middle class families appoint an agent under a power of attorney instead. This is also not an optimum solution, however, for a couple of reasons:

  • Financial institutions are reluctant to accept a powers of attorney and many states’ laws do not require them to accept a power of attorney so they many times don’t; and
  • A power of attorney is nothing but a super blank check, it typically says whatever I can do with my stuff my agent may do also. The grant of authority does not contain any limitations, conditions, restrictions, or instructions because these provisions would insure that gun-shy financial institutions would not accept the agent for fear that they could be implicated if the agent violated any restriction or limitation.

A revocable living trust, however, is the owner of the financial account and when the trustee becomes incapacitated a successor trustee simply assumes the management responsibilities for the trust just as a new president of a corporation would when the old president retires. Banks are comfortable with this transition in management responsibilities because trusts have existed for hundreds of years and the body of law surrounding them is extensive so their perceived liability is much less than following the directions of an agent.

When we eventually depart this earth, a revocable living trust becomes irrevocable (i.e. unchangeable) and serves as a will substitute by outlining the same wishes that we would put into a will. But, a trust, unlike a will, does not have to be probated. Many people consider this an advantage and, indeed, in states such as California the probate system is so expensive and time consuming that it should be avoided but in many states probate is not very onerous. Even in these states, however, having a revocable living trust serve as a substitute will is desirable when:

  • Minor heirs exist. In probate each minor must have a separate guardian ad litem (i.e. attorney other than the one who represents the estate) appointed to protect their interests whether they are receiving any inheritance or not. As you can imagine, with multiple attorneys working, costs can mushroom; or
  • You anticipate trouble from disgruntled heirs. A probate court is a convenient forum for a disgruntled heir to cause problems. They do not have to hire an attorney or file suit in order to have their claims heard because the estate is already in court. Additionally, it is much easier to claim that you were unduly influenced or incompetent when you made your will because it may have been executed years ago and placed on a shelf to gather dust. The creator of a living trust who also serves as trustee, however, has many witnesses who can testify to capacity and influence issues because they interacted with the trustee during their lifetime.

Irrevocable Living Trust 

An irrevocable living trust can also be used advantageously but many people forego their advantages because (1) they don’t really understand how trusts operate and (2) irrevocable sounds an awful lot like cast in concrete (i.e. non-changeable) and they are afraid they will be trapped if their wishes or laws change.

Traditionally, irrevocable living trusts have been used to minimize estate taxes and had to, therefore, conform to very strict IRS rules that if not cast in concrete at least created a bog of quicksand that would be hard to slosh through to change course. But here is the good news today, an individual must have more than $5.34 million net worth and a couple $10.68 million net worth before estate taxes are relevant so most of us do not have to concern ourselves with the overly burdensome IRS rules. We can, therefore, have an irrevocable trust that is changeable and flexible.

So if we can have a flexible and amendable irrevocable trust how can we use it for middle class folks? The uses are only limited by our imaginations and some of the more popular uses include:

  • Protecting our assets from nursing homes while retaining the income from and access to the assets;
  • Qualifying for a non-taxable Veterans Administration pension of up to $25,020, indexed for inflation and guaranteed by the full faith and credit of the United State government; and
  • Protecting assets from divorce, lawsuits, and other predators.

If you need help with this or other elder care / senior care legal matters, you can find thousands of Elder Care Professionals from across America on ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Resources for Families.

You can also find Elder Law Attorneys on ElderLawAttorneys.us and Estate Planning Attorneys on EstatePlanningAttorneys.us – 2 additional websites sponsored exclusively by the national ElderCare Matters Alliance.

sbailey Alabama Elder Law Attorney Answers Todays Question on ElderCareMatters.com
Stephen J. Bailey, Esq.
Bailey Law Firm
Birmingham, Alabama
An ElderCare Matters Partner