Question of the Day on ElderCareMatters.com: “My 93 year old grandfather from North Carolina who is in good health moved in with my family 9 months ago. My (absentee) brother and I are the only heirs. My husband and I are purchasing a new home to increase space for our new family. My grandfather wants to give us $200k toward the house in order to spend down a portion of his cash savings. Should we include him on the deed and homestead him in the new state of Florida or simply receive the money as a "gift"? My husband and I are financially independent and while we appreciate the gift, we do not need the gift to purchase the new home.”

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

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

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

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

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

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

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


Question of the Day on ElderCareMatters.com: "I’m the trustee on my parent’s trust. Parts of the trust’s assets are held in the stock market. With the recent market fluctuations, can I be held responsible for any losses the trust’s stock may have sustained?"

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

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

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

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

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

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

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

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


This Week’s Featured Elder Care Expert on ElderCareMatters.com is Dennis B. Sullivan, Esq., CPA, LLM

Dennis B. Sullivan, Esq., CPA, LLM
888 Worcester Street, Suite 260
Wellesley, Massachusetts  02482
781-237-2815
www.EstatePlanandAssetProtection.com
Member of the national ElderCare Matters Alliance, Massachusetts chapter

This week’s Featured Elder Care Expert is Dennis B. Sullivan, Esq., CPA, LLM, Member of the Massachusetts chapter of the national ElderCare Matters Alliance (a network of  1,500+ elder care experts across America). 

Mr. Sullivan has over 25 years of experience helping individuals and families with tax, estate, and asset protection planning. 

Every day this week (M-F), Attorney Sullivan will answer one of your questions about his areas of expertise (Tax, Estate Planning, Asset Protection Planning), and this selected question along with Mr. Sullivan’s answer will be posted on the Featured Elder Care Question of the Day section of ElderCareMatters.com.

So if you would like to ask Mr. Sullivan a question about your elder care matter, 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 Featured Elder Care Question of the Day.


Question of the Day on ElderCareMatters.com: "Help! I hired an independent home care provider several months ago and now I am literally fearing for my safety. Many of my treasured items from my home have been taken and money has been taken from my purse as well. The care that I was supposed to be given is almost non-existent and I dare not complain. How do I go about getting rid of this person without fearing that she will harm me afterwards? Whom should I contact?"

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

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

Bart Delsing, Owner & Chief Operating Officer
FirstLantic Healthcare, Inc.

Delray Beach, Florida  33445
561-243-7979
Member of the national ElderCare Matters Alliance, Florida chapter 


Question of the Day on ElderCareMatters.com: "My mother is 79 years old and suffers with Alzheimer’s Disease. She and my Dad, who is 81 years old, live by themselves with Dad now providing all of her elder care, which simply cannot continue because Dad is showing signs of “burning out” both mentally and physically. My question is: Can you please provide me with a series of questions that I could ask when interviewing home care agencies so that I will have a better chance of hiring the right home care company for my elderly parents? This hiring decision is simply too important to leave to chance. Thank you."

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

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

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

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

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

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

Bart Delsing, Owner & Chief Operating Officer
FirstLantic Healthcare, Inc.

Delray Beach, Florida  33445
561-243-7979
Member of the national ElderCare Matters Alliance, Florida chapter 


Question of the Day on ElderCareMatters.com: "I'm trying to manage my mother’s doctor appointments, health insurance and everyday needs from another state, but this is becoming overwhelming. Is there a service that I could rely on to provide my mother with the care she needs while I am so far away?"

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

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

–          Client advocacy

–          Comprehensive evaluations and assessments

–          Special needs trust and disability management

–          Crisis intervention

–          Supportive counseling

–          Medication management

–          Budget preparation

–          Attendance at appointments

–          Coordinating care and community services

–          Residential placement assistance

–          Guardianship monitoring and/or avoidance

–          Legal support through complementary documentations

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

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

Bart Delsing, Owner & Chief Operating Officer
FirstLantic Healthcare, Inc.

Delray Beach, Florida  33445
561-243-7979
Member of the national ElderCare Matters Alliance, Florida chapter 


Question of the Day on ElderCareMatters.com: "When you need an answer to one of your elder care questions, who can you ask?"

Answer:  Ask the experts of the national ElderCare Matters Alliance, 1,500 of America’s top elder care experts with years of experience in helping families plan for and deal with their elder care matters. 

Every day one of our elder care experts will answer your family’s important questions about elder care matters – from legal, financial, housing, healthcare, etc.

If you would like to ask one of our Elder Care Experts a question about his/her areas of expertise, just send a short email (a few sentences only please) to: questions@ElderCareMatters.com.

Every day we will post one of your questions along with an answer provided by our Featured Elder Care Expert of the Week on the homepage of www.ElderCareMatters.com (which is currently visited by thousands of families each week).  Yours may be one of the questions posted.  Of course, we’ll keep your question anonymous and generic so that every family may benefit.  Not to worry.

So bookmark www.ElderCareMatters.com and visit us daily as questions about a wide range of elder care matters are answered FREE of CHARGE by some of America’s top elder care professionals with years of experience helping families plan for and deal with the issues of aging.

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


Question of the Day on ElderCareMatters.com: "What exactly is Medication Therapy Management? Mom’s primary care physician mentioned this briefly at our last doctor’s appointment as an option for my mom who has had several “close calls” recently with overdosing on prescription drugs. Please advise."

Answer:  Medication Therapy Management (MTM) is a process that reviews and evaluates how each senior is responding to their unique group of medications—prescription, non-prescriptions, over the counter and natural medications, supplements, vitamins, minerals…any item that is in use to improve health.  It also evaluates food intake, how the medications are taken or used.   

Families, caregivers and other loved ones also share their insights about how the senior is responding to the “medications”, as many of them are with the senior at various time of the day.  An action plan is developed to address these issues or concerns.  There are many things that the senior and/or their family can do to improve the benefits of the “medications” in use and to minimize the side effects or other problems.  Prescribers are also contacted for changes in medications orders, provided with information about the use of multiple medications and changes made in medication dosage, and frequency of dose. 

Having one person organize such reviews and provide information to other members of the healthcare team can be very successful in avoiding the “close calls” that cause seniors end up in the emergency room, admitted to the hospital or even subsequently moved to the nursing facility. 

Medication Therapy Management may also be known by another name…Comprehensive Medication Review (CMR) which is defined as a systematic process of collecting patient-specific information, assessing medication therapies to identify medication-related problems, developing a prioritized list of medication-related problems, and creating a plan to resolve them with the patient, caregiver and/or prescriber. A CMR is an interactive person-to-person consultation conducted between the patient and/or caregiver and the pharmacist and is designed to improve patients’ knowledge of their prescription, over-the-counter (OTC) medications, herbal therapies and dietary supplements, identify and address problems or concerns that patients may have, and empower patients to self-manage their medications and their health condition(s).  

I hope this helps…

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

Lynn Harrelson, R.Ph., FASCP, Senior Care Pharmacist
8302 Cheshire Way
Louisville, Kentucky  40222
502-425-8642
Member of the national ElderCare Matters Alliance, Kentucky chapter 


Question of the Day on ElderCareMatters.com: "My husband and I are both in our 80s and take a lot of prescription medicines. My question is whether there are any programs in place (nationally or in our state of Kentucky) that help seniors get their prescription drugs at a discount. We are spending far too much of our monthly income paying for prescription medicine. Please help."

Answer:  The first option is to always ask your prescriber for samples.  While this may work earlier in the year, as many seniors enter the donut hole, the demand for certain medications may far exceed the supply that prescribers have to share with their patients.   Always have your “next option” underway. 

In my locale, we have KIPDA (Kentuckiana Regional Planning and Development Agency) and similar regional agencies can be found throughout the country.   Many offer community outreach programs covering qualified Medicare beneficiaries under the “Extra Help with Prescription Drug Costs.”  This program is funded by the Social Security Administration, the Extra Help program provides premium, deductible, and co-payment subsidies for Medicare Part D using new 2011 Federal higher income levels.

Qualified individuals must meet the specific criteria to receive a full or partial subsidy:  they must be entitled to, or enrolled in, Medicare Part D; reside in one of the 50 states or the District of Columbia; and meet annual income guidelines.  I would suggest that you contact the Social Security office; they should be able to provide a phone number for a similar agency in your region.  Ask that office if they provide a similar service. Also, you can go online to www.socialsecurity.gov and click on “Get extra help with Medicare prescription drug costs” located in the left hand column; or call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).  

Rx Help at 1-800-760-7616 is an organization that provides drug discount cards services.  Share the following with your pharmacy (most national pharmacies participate) and this organization offers 10-85% on all FDA approved brand-name and generic medications (ID# National 001/RX Bin# 014582, Grp NDC707).  Another option is Rx Assist (www.rxassist.org or 401-729-3284) that also has information about patient assistance programs and drug discount cards. 

Benefits Check Up Rx is sponsored by the non-profit National Council on the Aging.  This web site checks the potential eligibility of adults age 55 and over for more than 260 public and private prescription drug programs. After completing a questionnaire, the user receives a confidential, personalized report. The entire process typically takes five to seven minutes to complete.  (http://www.benefitscheckup.org/before_you_start.cfm?screen=BenefitsCheckUpRx) 

Pharmaceutical Patient Assistance Programs where several pharmaceutical companies feature programs to help eligible applicants reduce their medication costs. These programs are usually limited to the company’s brand-name medications, and will most likely have specific requirements including age and income. 

Partnership for Prescription Assistance (info@pparx.org or 800-477-2669) is an organization that researches the various drug assistance programs currently available and provides access to more than 275 public and private patient assistance programs, including more than 150 programs offered by pharmaceutical companies.  

NeedyMeds (www.needymeds.org) is a web-based service that shares information on cost saving ideas and includes drug coupon programs, disease-specific assistance programs, information about discount drug cards and more. 

TogetherRx (www.togetherrxAccess.com or 800-444-4106) is a pharmaceutical sponsored program offers a 40-60 percent discount on certain brand name and generic medications for those who do not have prescription coverage. 

I hope that this helps….

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

Lynn Harrelson, R.Ph., FASCP, Senior Care Pharmacist
8302 Cheshire Way
Louisville, Kentucky  40222
502-425-8642
Member of the national ElderCare Matters Alliance, Kentucky chapter 


Question of the Day on ElderCareMatters.com: "What are the training requirements for the staff of Assisted Living Facilities as it relates to administering medications to residents?"

Answer:   Training requirements  for Assisted Living Facilities (ALFs) are regulated by each state, and educational and training requirements vary among the states to address the specific requirements of the state. Additionally, not all ALFs allow staff to administer medications, these facilities are often referred to as a social model, there are 5 or 6 in this classification. 

To better understand the regulations for an individual state, you may find the specifics on each state’s ALF association website, or staff within that association may assist you or clarify your questions.  Also, ALFs may develop their own training that may exceed state requirement to address the special needs of the residents within the facility.

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

Lynn Harrelson, R.Ph., FASCP, Senior Care Pharmacist
8302 Cheshire Way
Louisville, Kentucky  40222
502-425-8642
Member of the national ElderCare Matters Alliance, Kentucky chapter 


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