Question: “With the high price of nursing home care and assisted living, our family is considering making the necessary modifications to Mom’s home so that she can “age in place” there. Specifically, what would we need to consider in order to proceed with this elder care housing plan for our mother?”
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
Call Harry Enterprises, Inc.
Lutz, Florida 33549
Member of the national ElderCare Matters Alliance, Florida chapter
Question: “My family and I live in Alaska and we need help with a host of elder care issues, including elder law, geriatric care and senior housing. Unfortunately, in reviewing the professional listings that are found on ElderCareMatters.com for Alaska, there are many “Coming Soon” pages. Can you please tell me what this means and let me know when I can expect to see more professionals listed for Alaska. Please don’t forget about our 49th state. We too desperately need help with our elder care matters, and we thank you very much for providing us with this wonderful online elder care resource.”
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
Every day, more and more families from across America are relying on ElderCareMatters.com to help them find competent “Elder Care Experts” who are located near them and who can help them with a wide range of elder care matters, such as legal services, financial planning, home care, senior housing, adult day care, geriatric care management, money management, insurance services, aging in place services, etc.
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:
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
Question: I am a practicing elder law attorney with more than 15 years experience helping families with their elder care matters. How would I go about becoming a member of the national ElderCare Matters Alliance so that I may be listed on www.ElderCareMatters.com and so that I may be a resource for families who visit this website and need my expertise to help them plan for and/or deal with their elder care matters?
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:
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)
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
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
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 is where you will find more than 2,000 competent, caring elder care experts located across America, including:
This is also where you will find some of America’s best:
Together, we provide families across America with:
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
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.
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
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
Member of the national ElderCare Matters Alliance, Massachusetts chapter
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