Question of the Day on ElderCareMatters.com: "I am eighty years old and in excellent health. I have family and friends who can act as executors of my Will and Living Trust. I also have a power of attorney and a Health Care directive However, I don't feel that they would have the expertise to administer my estate (modest though it is). Do I need an Elder Care Lawyer or an Estate Planning Lawyer to help my executors in the case of a serious illness or my demise? What is the cheapest way to get the service that I need?"

Answer:  It is a great idea to have a relationship with an elder law attorney so that your family and friends know who to turn to if something were to happen.  The attorney can help them with decisions if you have a serious illness or require extended care.  The attorney can also help them through the estate administration process after you pass away.  Creating a relationship with a good elder law attorney does not have to be expensive.  Many attorneys either charge a fixed fee for their help or charge hourly only for the work they do for you.  When you meet with an attorney, he or she can talk about how they charge and help work with you to make sure that you are comfortable with how things would be handled.

To locate competent elder care professionals who are located near You and can help you with this type of elder care matter, go to: www.ElderCareMatters.com – A FREE online source to find elder care experts plus information & answers about a wide range of elder care matters.

Angela N. Manz, Attorney at Law
The Law Firm of Angela N. Manz
Virginia Beach, VA  23452
757-271-6275
Member of the ElderCare Matters Alliance, Virginia chapter


Question of the Day on ElderCareMatters.com: "An acquaintance, an 86 year old veteran, has become frail and unsafe in his home. His exploration into a retirement / nursing home facility is beyond his financial ability to pay. The VA has turned down his request for financial assistance because his Social Security and retirement puts him in the "too much income" bracket. What can be done to help this gentleman?"

Answer:  Although I don’t know exactly what benefit this gentleman applied for through the VA, I would highly recommend that he look into the Aid and Attendance pension to help pay for assisted living.  Aid and Attendance is available for veterans (or their widowed spouses) who served at least 90 days of active duty, with one day during a period of wartime.  They do not have to have been in combat.  

To be eligible, the veteran (or his widowed spouse) must have recurring medical expenses or care costs such as the Medicare premium, supplemental insurance premiums, prescription drugs, etc.  The VA also allows the monthly rent at an assisted living community as a medical expense if the veteran’s doctor states that he needs assistance with some of his daily activities, such as making meals, driving, bathing, dressing, taking medications, or if he needs a protective environment due to dementia. 

If the veteran moved to assisted living, that monthly cost may lower his income enough for him to qualify.  I would recommend that your acquaintance contact an attorney who is accredited with the VA and talk with that attorney about how to qualify. The maximum pension for a married veteran is $1949 per month and the maximum for a single veteran is $1644 per month.   If he obtains this pension, these tax-free benefits will help pay for his assisted living so that he can get the care that he needs.

To locate competent elder care professionals who are located near You and can help you with this type of elder care matter, go to: www.ElderCareMatters.com – A FREE online source to find elder care experts across America plus information & answers about a wide range of elder care matters.

Angela N. Manz, Attorney at Law
The Law Firm of Angela N. Manz
Virginia Beach, VA  23452
757-271-6275
Member of the ElderCare Matters Alliance, Virginia chapter


Question & Answer of the Day on ElderCareMatters.com for Thursday, July 7, 2011

Question:  I recently relocated my elderly mom from New York to Virginia. She is living in an assisted living facility by me. She still has her home in NY where two apartment rents help to pay for her assisted living room rent, prescriptions, incontinence care, etc. The rest of her care fees come out of her savings. Is her assisted living rent deductible on her tax return?

Answer:  Although I am not a CPA, my understanding is that the IRS may allow her to deduct the cost of assisted living rent as a medical expense if your mother needs assistance due to a chronic illness.  IRS publication 502 defines chronically ill as being unable to perform 2 or more activities of daily living without substantial assistance or if the person needs substantial supervision due to a cognitive impairment.  From what you described, it appears as though she would be able to deduct her assisted living costs as a medical expense. However, her total medical expenses must exceed 7.5% of her adjusted gross income in order to be deductable. 

I would recommend that you keep all receipts from the assisted living community, as well as receipts for all other medical expenses that your mother incurs during the year.  Then talk with your tax preparer to make sure that you take advantage of all the available deductions.

To locate competent elder care professionals who are located near You and can help you with this type of elder care matter, go to: www.ElderCareMatters.com – A FREE online source to find elder care experts plus information & answers about a wide range of elder care matters.

Angela N. Manz, Attorney at Law
The Law Firm of Angela N. Manz
Virginia Beach, VA  23452
757-271-6275
Member of the ElderCare Matters Alliance, Virginia chapter


Question of the Day on ElderCareMatters.com: "I have Power of Attorney and a Health Care Proxy for my mother. It was done while she lived in NY. She now lives in Georgia by me, so do I have to have a new POA and Health Care Proxy prepared by a Georgia attorney?"

Answer:  Generally, a POA or Health Care Proxy does not necessarily need to be redone simply because your mother moved to another state.  However, I recommend that you have them reviewed by an elder law attorney who practices in Georgia to make sure that they comply with Georgia law and to make sure that they have all of the necessary powers needed to make decisions for your mother.  For instance, if Georgia law requires that the health care proxy be notarized and New York does not, then you may need a new one prepared or it won’t be accepted.  Or if your mother’s POA does not have certain powers which may be necessary for asset protection planning, then you may want to have a new one prepared. If the attorney in Georgia does recommend that your mother sign new documents, he or she should also tell you the specific reasons why that recommendation was made. 

To locate competent elder law attorneys who are located near You and can help you with this type of elder care matter, go to: www.ElderCareMatters.com – A FREE online source to find elder care experts plus information & answers about a wide range of elder care matters.

Angela N. Manz, Attorney at Law
The Law Firm of Angela N. Manz
Virginia Beach, VA  23452
757-271-6275
Member of the ElderCare Matters Alliance, Virginia chapter


Question of the Day on ElderCareMatters.com: "I need to get a power of attorney and I was wondering if it would be okay to just use one from the internet instead of going to an attorney?"

Answer:  A power of attorney is one of the most important documents that you can execute. It allows you to appoint an agent to manage your financial affairs if you become unable to do so. Without a power of attorney, if you become incapacitated your family will have to go to court to have a judge determine who will manage your financial affairs.  That can be both costly and time consuming and is easily avoided by having a comprehensive power of attorney. 

Many people use the internet to obtain a power of attorney in order to avoid going to an attorney. These internet forms seem simple to complete and are not expensive.  The biggest problem though is that these forms are not tailored to your specific family’s needs and are often missing many important powers that your agent should have. 

The most important function of a power of attorney is that it sets out the specific powers that your agent will have if you become unable to make financial decisions on your own. These powers generally include buying or selling property, managing your bank accounts, paying bills, investing money, cashing checks, and collecting debts. 

In many states your agent only has the powers that are specifically listed in the power of attorney.  This means that a broad statement that your agent can do anything you can do is simply not enough.  Your power of attorney must list out each power you want your agent to have.  

The powers stated in your power of attorney can vary greatly depending on your wishes and your family’s situation.  Some powers are typically not included on an online power of attorney, and therefore it is important to consult an attorney rather than filling out a premade form. For example, the power to transfer money to your children, or to create and fund an irrevocable trust, is generally not included in an online power of attorney, but these can be extremely important powers for your agent to have if you need to do Medicaid or Veterans benefits planning in the future.   

By having a power of attorney, your family can avoid the court process and feel secure about your future. While it is tempting to avoid legal fees by completing an online premade form, I recommend that you seek the advice of an experienced attorney. With your attorney’s help, you can rest assured that your wishes will be carried out should you become unable to manage your finances in the future.

To locate competent elder law attorneys who are located near You and can help you with this type of elder care matter, go to: www.ElderCareMatters.com – A FREE online source to find elder care experts plus information & answers about a wide range of elder care matters.

Angela N. Manz, Attorney at Law
The Law Firm of Angela N. Manz
Virginia Beach, VA  23452
757-271-6275
Member of the ElderCare Matters Alliance, Virginia chapter


Question of the Day on ElderCareMatters.com: "I have seen a big change recently in my Mother’s ability to take care of herself. I'm not sure how serious the situation is but I know she may need some help. Is this something that a Geriatric Care Manager can help me with?"

Answer:  I just met with a son and his mother to review the change she has experienced with the ability to care for herself. It was a great meeting in that his mother expressed to me where her concerns were and the son expressed his concerns. Together we came up with a plan to help with meals, assistance with her bath, some brain fitness activities and a weekly jaunt to the local pool! She wants to stay at home as long as possible and needs more support to stay safe. 

What you are experiencing with your mother is at the heart of what Professional Geriatric Care Managers do. We evaluate the status of the elder, listen to their needs and coordinate a plan of care for them with the support and understanding of the family. 

A good first step would be to call a Geriatric Care Manager for an initial evaluation of your mother ideally with her support and approval.

To locate competent geriatric care managers who are located near YOU and can help you with these types of elder care matters, go to: www.ElderCareMatters.com – A FREE online source to find elder care experts plus information & answers about a wide range of elder care matters.

Amy Cameron O’Rourke, MPH, CMC
The Cameron Group
Orlando, Florida  32803
1-888-896-2010
Member of the ElderCare Matters Alliance, Florida chapter


Question of the Day on ElderCareMatters.com: "What exactly can a care manager do for my elderly mother who lives alone in her home? Our family is considering hiring a geriatric care manager for Mom, but we aren’t sure of the benefits or the costs for these services. Please advise."

Answer:  We educate, evaluate, navigate, advocate–

We are very good at preventing complicated crisis that can create an unnecessary decline in function for the elder. So many older adults want to stay in their home and with various levels of support this is achievable. In fact, many older adults do well with “Assisted Living at Home”-which is what the Care Manager creates with the family and the elder as part of the team. 

If the finances do not allow the elder to remain at home with health care, the Care Manager can help select a community for the elder and teach the family how to secure the best and most appropriate services within the facility. We can also file for appropriate benefits that will assist in paying for that care. 

We teach families how to “navigate” the health care system—It is widely believed that the health care system is fragmented-hospital care, nursing home care, assisted living care, home care—so many systems to understand and effectively navigate. We help select facilities and then help the family work within the system for the benefit of their loved one. An important component is what services are covered by Medicare and what services become the responsibility of the parent. 

Some families can’t agree on what to do for their parent. Care Managers provide an objective view and help the families come to an agreement on a plan of care. 

Some families simply don’t know what to do and need advice, guidance and direction throughout this stage of their parent’s life. 

It’s hard to put this into words, but there is frequently a level of anxiety that is present in a child with an aging parent. There are so many unknowns, and uncertainty in helping the parent.  We are able to help lower anxiety by providing helpful information and resources that make this a meaningful time for both the child and the parent. 

There is more—Let me list other services Care Managers offer: 

  • Accompany on Dr. appointments providing the physician a written summary of the status of the elder;
  • Help ensure compliance with Drs. Orders (Changes in medication, labs needed etc.);
  • Communicate with family members after a Drs. Appointment;
  • Make appropriate Drs. Appointments-streamline appts for the elder;
  • Securing services at home when requested or desired-physician care, lab, x-ray, podiatry-;
  • Prevent hospitalizations-frequent hospitalizations can often be caused by poor nutrition, hydration, non compliance with medications, falls—all preventable situations;
  • Communicate with families at a distance as to how things are going with parent;
  • Conduct family meetings via conference calls;
  • Twenty four hour emergency support-if something happens to a parent, we meet at the hospital and advocate for the elder in the hospital;
  • If a move to a facility is needed-can help select a facility appropriate to the elders’ budget, location and personality;
  • Help the elder stay at home and stay independent as long as possible with the coordination and supervision of companion or home health aide staff;
  • Secure benefits to pay for care;
  • Understanding Medicare, Medicare HMO’s, Medicare D, Long Term Care Insurance, and discovering other little known benefits that help pay for care. 

I hope this isn’t overwhelming, but I believe we provide such a valuable supportive service to the elder and their families it is difficult to stop with one line or two.

Hourly fees range from $85.00 – $250. per hour depending on the area of the country. Assessment fees range from $450.00-$1,200.

Amy Cameron O’Rourke, MPH, CMC
The Cameron Group
Orlando, Florida  32803
1-888-896-2010
Member of the ElderCare Matters Alliance, Florida chapter


Question of the Day on ElderCareMatters.com: "I took care of a 77 year old woman for 8 months because her own family could not or would not care for her. We agreed she would pay me to take care of her fully, including bathing, shopping, cooking, and cleaning. Now, her family refuses to pay me. Who do you suggest I talk with in order to force this family to pay me for the care I rendered to this elderly woman?"

Answer:  How fortunate for your friend that she had you to provide care for her when she needed it. I have seen many situations like this and I find them so sad. I am not an attorney, so please know that my advice to you comes from experience only and not a license to help with legal issues. My general advice to you is to seek an attorney who would be willing to communicate with the family for you. I work with attorneys certified in elder law and would start there. If this is the wrong area of law, these attorneys can point you in the right direction. 

If there was anything in writing from her to you, this would help your cause. If there were any witnesses to your conversations or to your working relationships, this would also help you. If she is aware and alert, you might consider having another conversation with her. If she has any friends that knew the two of you maybe one of them would advocate for you. 

I hope this helps, good luck and many blessings to you for reaching out to help an elder.

Amy Cameron O’Rourke, MPH, CMC
The Cameron Group
Orlando, Florida  32803
1-888-896-2010
Member of the ElderCare Matters Alliance, Florida chapter


Question of the Day on ElderCareMatters.com: "Is the ability for the aged to stay in an Assisted Living Facility being abolished? My mother lives in an ALF in Florida and when the time comes, I would like her to receive hospice services. But, I do not want her to necessarily leave the assisted living facility that she currently resides in. However, I understand that no person who is bedbound is allowed to remain in an assisted living facility. This certainly affects my mother's ability to remain at the facility and receive hospice services."

Answer:  No, the ability to stay in Assisted Living in Florida has not been abolished. If an elder wants to die in their home (Assisted Living is classified as home) they have the right to stay in Assisted Living. As her need for care increases (i.e. she becomes dependent or “bed bound”) she can remain in Assisted Living; however, she must pay privately for the extra care she needs. 

Assisted Living facilities are licensed to provide assistance with care. When an elder needs total care Assisted Living facilities are required to discharge the elder to a more appropriate setting, usually a nursing home; the only exception to this rule is when the elder is on hospice. When an elder is on hospice and needs total care they are allowed to stay in the facility but must pay extra for the care needed. Assisted Living facilities are not licensed or staffed to provide total care.

I hope this answers your question!

Amy Cameron O’Rourke, MPH, CMC
The Cameron Group
Orlando, Florida  32803
1-888-896-2010
Member of the ElderCare Matters Alliance, Florida chapter


Question of the Day on ElderCareMatters.com: "How do I keep my elderly parent out of the hospital?"

Answer:  Keeping an elder out of the hospital while dealing with their multiple pathologies and can be challenging. Elders are frequently admitted to the hospital for the following preventable reason:  falls, undiagnosed infection, dehydration, and non-compliance with medicine. 

Once an elder is hospitalized, a rapid decline in health can occur. The old adage, “an ounce of prevention is worth a pound of cure” is so true in the too-often occurring syndrome of frequent hospitalization and rehabilitation stays for an elder. With careful monitoring of fluid and food intake, daily exercise and a closely supervised medication regime, hospitalizations can be prevented. 

These interventions can be implemented daily or every other day, depending on the elder’s need, by family members, professional staff, or a combination of both.  Adult children of an elder might say “My Mom or Dad won’t accept help.”  This is a natural response for a frail elder faced with losing some independence. We would advise bringing in an objective third party (professional care manager) to assist in these discussions and the implementation of care to achieve the desired outcome which, for most elders, is to stay at home and out of the hospital for their remaining days.

To locate competent geriatric care managers who are located near YOU and can help you with these types of elder care matters, go to: www.ElderCareMatters.com – A FREE online source to find elder care experts plus information & answers about a wide range of elder care matters.

Amy Cameron O’Rourke, MPH, CMC
The Cameron Group
Orlando, Florida  32803
1-888-896-2010
Member of the ElderCare Matters Alliance, Florida chapter


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