Question of the Day: "I have Power of Attorney for my elderly mother's affairs, but as she becomes increasingly mentally unreliable, what are the pros and cons of becoming her guardian? She lives in WV; I live in another state."

Answer:  Thanks for your question. Guardianships are very expensive, time consuming, and supervised by the courts.

The advantage of having a valid power of attorney is that you have the power to act quickly without court involvement.

The court system in Florida (where I practice) will not usually allow a guardianship when estate documents have been prepared to avoid being declared incompetent.

To locate experts in your state who can help you with this elder care matter, go to: www.ElderCareMatters.com/statechapters.htm

Joseph F. Pippen, Jr., Attorney at Law
Law Office of Joseph F. Pippen, Jr. & Associates

Largo, Florida  33771
727-586-3306

Member of the national ElderCare Matters Alliance, Florida chapter


Question of the Day: "Do testamentary trusts avoid probate?"

Answer:  No!  All wills are probated and testamentary trusts are created within wills; thus assets devised in a will to a testamentary trust would have to be probated.  The fact that a testamentary trust has been created has not accomplished any avoidance of probate.

Testamentary trusts serve a useful purpose in that they can be used as a tax-saving tool to divide large estates, and they can be a useful tool to keep persons from receiving an estate in one lump sum.  Testamentary trusts are also useful when beneficiaries are to receive “income only” monies.

If one has an interest in setting up a trust that has all of the advantages of a testamentary trust plus avoid probate, then an exploration of the “living trust” should take place.  Living trusts are also known as revocable trusts, family trusts, and a grantor’s trust.

Living trusts differ from testamentary trusts in that living trusts are established now while you are living, and you go through a personal (probate) proving process of your estate yourself without using the court process.  This process is accomplished by keeping a Schedule “A” or inventory list of the items you have registered to the trust.  You never lose any power or control over any assets that you own in the trust and you, yourself, serve as “trustee” of the trust.

 A common myth about living trusts is that you lose control of your own property or that the trust needs a tax number.  Neither is true, as no tax number is required and you don’t lose any control of the assets.

The decision concerning whether one would want a living trust versus a testamentary trust will probably center around whether one would want his estate to be probated through the court system or whether one would rather bypass the probate system.

This discussion often centers around who the beneficiaries and successor trustees are.  For example, if the successor trustees and beneficiaries are children, then many people desire to avoid probate and leave their entire estate probate-free.

For those persons who had testamentary trusts drawn into their wills before December of 2009, a thorough review of their documents should be analyzed by an attorney, as the many tax changes that have taken place may have necessitated revisions to their documents.

For a thorough discussion of your estate planning needs, you should ask your attorney about trusts for your estate.

To locate experts in your state who can help you with this elder care matter, go to: www.ElderCareMatters.com/statechapters.htm

Joseph F. Pippen, Jr., Attorney at Law
Law Office of Joseph F. Pippen, Jr. & Associates
Largo, Florida  33771
727-586-3306

Member of the national ElderCare Matters Alliance, Florida chapter


Question of the Day: "We’ve had recurring problems handling my mother’s prescription medications. She takes about 10 prescriptions every day, and often she takes the medications in error, i.e., too many, not enough, etc. Last week we had to rush her to the ER because of an unintentional overdose of these prescription medications. What would you recommend we do to resolve this potentially dangerous problem?"

Answer:  There are a number of different solutions, depending on her medication routine, what is causing the difficulties, etc.  When we do a geriatric care assessment, this is often one of the areas explored and it is not unusual to find problems, which as you well know can be very adverse.  We tailor recommendations to the solutions that fit for the individual.

A couple of resources I can share that might work.  First, you’re probably aware of simple pill boxes, where medications are laid out as to when to be taken.  A family member or a R.N. from a home care company can do this.  If your Mom can handle taking the medications from the pillboxes correctly, this can work.  Some clients need additional reminders, and maybe it is feasible for someone in the family to call and help with this.  Some pharmacies and services also package pills in easy-to-use dosages (one of our local pharmacies delivers them right to the client, packed in easy to tear off packets with all the pills for a specified time).

For other clients, especially with cognitive deficits, a more extensive solution may be needed.  There are some wonderful technologies, such as electronic pill dispensers that are pre-loaded and dispense the meds. at the scheduled time.  They typically sound a reminder and have different settings to help avoid missed dosages turning in to overdoses.  Additionally, some of the emergency response systems (fall buttons) have options for medication reminders.  Some clients may need more hands-on, personal assistance.  A home care aide trained in medication assistance can be there to serve as a personal reminder.  You may want to talk to a home care agency about your Mom’s specific needs and see if a reasonable plan can be worked out…with 10 prescriptions, timing may be tough so it may require some creativity or a combination of options.

I always like to go back to the basics too.  I would suggest bringing this up with your Mom’s doctor (or doctors?) and asking if there are any ways to streamline the medication routine.  When pills are prescribed over time (and sometimes by different specialists), the doctor doesn’t have a really good picture of how complex this can be, and obviously at this point there have been adverse effects which make this a priority.  Can any of the pills be eliminated?  Can some of them be taken at the same time, or a larger dosage be taken less frequently?  If a review hasn’t been done recently, it is probably a good idea anyway with such a large # of medications.  There are consultant pharmacists who specialize in medication reviews.

To locate experts in your state who can help you with this elder care matter, go to: www.ElderCareMatters.com/statechapters.htm

Shannon Martin, M.S.W., CMC
Aging Wisely, LLC
Clearwater, Florida  33756
727-447-5845

Member of the national ElderCare Matters Alliance, Florida chapter


Question of the Day: "What is a Geriatric Care Assessment, what does it usually include and what does it usually cost?"

Answer:  A geriatric care assessment is a useful tool for any family caring for an aging loved one (for an overview of components & the process you may wish to read http://www.agingwisely.com/the-positive-results-of-a-comprehensive-geriatric-assessment/). 

What outcomes can one expect from an eldercare assessment?

  • A comprehensive picture of the situation and a solid understanding of current status, future needs and things to anticipate.
  • A road map for moving forward, with very specific recommendations that can be carried out by family/responsible party, or with a care manager’s assistance if desired.
  • Cost projections, budgets and means of assistance with various recommendations and needs.
  • Alternatives so that clients and their responsible parties can prioritize and direct the goals and future care planning.

How does a family or client benefit from a professional geriatric assessment?

  • COST SAVINGS: expertise to help clients access services and benefits, find less costly options and avoid costly mistakes.
  • TIME & STRESS SAVINGS: benefit from the professional’s knowledge of resources & systems, unique solutions to your concerns.
  • IMPROVED FAMILY RELATIONSHIPS/CAREGIVING EXPERIENCE:  an objective picture helps families to come to agreement and makes caregiving easier.
  • CONFIDENCE:  knowing they understand the options and can make the best choices armed with all the information.

The cost of an assessment will vary as care managers set their rates independently.  Prices vary by area of the country, expertise/experience and scope of services.  At Aging Wisely, for example, we offer clients a flat rate, comprehensive assessment which covers diverse areas and provides a complete set of recommendations.  At times, we do an even more in depth assessment for legal cases which involved extensive research and confirmation of information from various parties.  However, we also offer families the opportunity to do a more limited assessment of a particular area if that is appropriate to their situation. 

A brief, introductory type of assessment may be offered for a rate of $200-300 whereas a more comprehensive assessment may include many hours of work and can be a great value at $500 or more.

To locate experts in your state who can help you with this elder care matter, go to: www.ElderCareMatters.com/statechapters.htm

Shannon Martin, M.S.W., CMC
Aging Wisely, LLC
Clearwater, Florida  33756
727-447-5845

Member of the national ElderCare Matters Alliance, Florida chapter


Question of the Day: "What exactly is a Geriatric Care Manager (Care Manager) and why would my family consider using one? My mother is 81 years old, my father is deceased and my sister and I live several hundred miles away from my mother, who still lives in her home."

Answer:  Here is the definition of a geriatric care manager from the NAPGCM (National Association of Professional Geriatric Care Managers): “A professional Geriatric Care Manager (GCM) is a health and human services specialist who helps families who are caring for older relatives”.  Most importantly, a geriatric care manager provides the expertise to help you and your family more smoothly navigate the path of eldercare.  An experienced care manager can assess the situation, provide recommendations that save you a lot of time, money and potential headaches and anticipate potential issues and concerns. 

The services of a geriatric care manager are especially important for families at a distance, as you mention in your case.  You can hire the care manager to be your “eyes and ears” locally and your loved one’s advocate, which provides great peace of mind.  Having someone with professional training means he or she can spot issues that, for example, a neighbor or friend may not be equipped to do.  The care manager understands local services and resources and can often identify solutions to issues which may have your family bogged down trying to solve.  Typically care managers are on call 24/7 for clients and can be there to manage a hospitalization or other urgent situations and communicate to you.

It sounds as if this could be very beneficial for your family.  You can start right here on www.ElderCareMatters.com looking up professional care managers in her local area and having a conversation with them about their backgrounds, how they would approach your situation, etc.  A consultation or assessment would be a good start to get some recommendations and consider if and how ongoing services might be worthwhile for your Mom’s continued wellbeing and your peace of mind.

Shannon Martin, M.S.W., CMC
Aging Wisely, LLC
Clearwater, Florida  33756
727-447-5845

Member of the national ElderCare Matters Alliance, Florida chapter


Question of the Day: "My mother went into the hospital from a fall. When released 4 days later, the hospital told my father that she was "not admitted" only "under observation" for the time there. Why would they do this? Is it something with the billing and Medicare coverage?"

Answer:  Unfortunately this is something more and more elders and their families are running in to.  This does relate to billing and especially the crackdown on hospitals in regards to overpayments for hospital stays.  This was never really intended to be a status for patients for more than about 24-48 hours, but increasingly families are experiencing what yours did with stays upwards of 3-10 days classified as observation status.  This is particularly problematic when a patient needs inpatient skilled nursing care afterwards, because Medicare requires a 3 day hospital stay (with admitted status) in order to cover subsequent rehabilitation or skilled nursing in a skilled nursing facility.  Additionally, the patient may be responsible for some services received during the hospital stay, which is essentially treated as an outpatient stay.

Be aware that Medicare recipients do have the right to appeal coverage decisions.  This is also an important issue for families to be aware of in order to be able to ask questions and get more details when a loved one is in the hospital.  The Medicare coverage (or non-coverage in the case of no qualifying hospital stay) of inpatient rehabilitation can be worth thousands of dollars, and may be key to a loved one’s recovery.

To locate experts in your state who can help you with this elder care matter, go to: www.ElderCareMatters.com/statechapters.htm

Shannon Martin, M.S.W., CMC
Aging Wisely, LLC
Clearwater, Florida  33756
727-447-5845

Member of the national ElderCare Matters Alliance, Florida chapter


Question of the Day: “I am concerned about my 85 year old father’s ability to drive. What can we do?”

Answer:  This is one of the more common challenges families face as loved ones age, because the car and driving symbolize independence to most people.  The best advice is to start these conversations early, when possible.  For example, discuss and make plans when a loved one gets a diagnosis of a chronic condition that may impact driving, such as Alzheimer’s Disease, Parkinson’s Disease, M.S. and conditions of visual or mobility impairment.  It may help to talk about what others have done and explore some transportation options together.

In having a conversation with your loved one, consider your approach.  Who might your loved one listen to about this issue?  You may wish to discuss an approach with your siblings and work together.  Sometimes this is best done during a transition or when something has changed, such as after a hospital stay or surgery.  Think of these as “windows of opportunity”.  A couple of good reference books about family discussions and approaching issues between the generations are: How to Say it to Seniors by David Solie and Another Country: Navigating the Emotional Terrain of Our Elders by Mary Pipher.

You may wish to talk to your loved one’s doctor about your concerns.  If you serve as your loved one’s healthcare surrogate or have been given HIPPA permission for sharing information, you can likely at least provide your observations to help ensure the doctor is aware.  Physicians will vary in their approach and involvement.

Some communities have professional driver evaluation services available.  These may be found through local hospitals, the VA, Memory Clinics or public aging services.  A driver evaluation can be particularly useful because it is a measurable test done by a neutral party.  Evaluators may recommend modifications which will allow the person to continue driving safely.

If you reach an impasse with a loved one and have serious concerns (which most likely means there are legitimate things you have observed to cause concern), check your state’s provisions for reporting an unsafe driver.  Many states have anonymous reports that initiate a review process.  Contact the state DMV for more information. 

In some cases, your loved one may continue to drive even if legal driving privileges have been revoked.  This can be especially challenging, though local law enforcement may be able to help.  It may be necessary to remove the car, especially for someone with dementia who may forget that driving privileges have been removed.  

If a loved one is going to give up driving, it is essential to set up services so that he/she can still be involved in activities and not feel stranded at home.  Staying as active as possible helps an elder’s physical and mental health and feeling dependent on neighbors and family can be detrimental to well-being.  The services available in each community vary, but you can start with your local Area Agency on Aging or Department of Aging

Most communities have some senior transportation services and for most individuals, a combination of friends and family helping along with services such as free and low cost public options, taxis and hired drivers can provide for the range of transportation needs.  Keep in mind when looking at paid services that, according to the Dept. of Labor’s Bureau of Labor Statistics, car ownership costs are the second largest household expense in the U.S.  Owning and operating a car costs an average of $8,000/year or about $600/month.  Help make sure your loved one is comfortable with the services and make it easy for them to use them.  For example, post the phone #s and explain any rules or limitations or help with set-up and paperwork.

A geriatric care manager can help your family through this process.  From facilitating conversations to assessing the individual’s abilities, needs and options to setting up services, a care manager will have experience and resources in this area.  An elder law attorney is another valuable resource, from planning ahead so your loved one has decision making provisions in place to initiating a guardianship process or exploring legal options when needed.

To locate experts in your state who can help you with this elder care matter, go to: www.ElderCareMatters.com/statechapters.htm

Shannon Martin, M.S.W., CMC
Aging Wisely, LLC
Clearwater, Florida  33756
727-447-5845

 

Member of the national ElderCare Matters Alliance, Florida chapter


Question of the Day: "My mother died last December and left everything to her caregiver. Can I challenge my mother’s Will, and what would I need to prove?"

Answer:  Yes, heirs have a right to challenge a family member’s Will.  However, time is of the essence in these matters as a Will contest may be barred (notwithstanding the facts) if not filed in a timely matter.  The time frame to contest is extremely short.  You should contact an attorney as soon as possible for a more in depth analysis of your case as there are numerous grounds to contest a Will, which if proved could invalidate the Will, such as fraud. forgery, lack of capacity, and undue influence. 

NOTE:  The information provided above is not intended to be nor should be relied upon as legal advice.  Peck Bloom, LLC is located in the State of Illinois and the attorneys are only licensed to practice law in Illinois and Florida.  You should consult a qualified attorney licensed in your state regarding these matters.

To locate experts in your state who can help you with this elder care matter, go to: www.ElderCareMatters.com/statechapters.htm

Kerry R. Peck, Managing Partner
Peck Bloom, LLC
Chicago, Illinois  60603
1-877-845-1743

Member of the national ElderCare Matters Alliance, Illinois chapter


Question of the Day: "I’m an 85 year old female and in good health and live in my own house with my 60 yr old daughter who cares for me. What are my options if I wish to transfer or gift my home to my 2 daughters. My concerns are – Look back period, how would this affect my 60 yr old daughter’s homestead exemption, Gift taxes, etc. Is it possible for my daughters to purchase the house from me and then rent it back to me, and would this affect my Medicaid planning?"

Answer:  Most states have a look-back period of five years and any gift made in the five-year period prior to applying for Medicaid would put you in a penalty period of ineligibility for Medicaid.  This penalty period of ineligibility for Medicaid starts when you are otherwise eligible for Medicaid.  The meaning of “otherwise eligible” varies from state to state, but in Illinois this means you have $2,000 or less in assets and you are in a Medicaid facility. You should not make an outright gift or transfer of your home to your daughters.  Aside from the penalty period Medicaid will impose, there are consequences in regards to your real estate taxes as well: 1) you will lose your homestead exemption, 2) you will lose your senior exemption and possible senior freeze or deferral of taxes, and 3).  you would be transferring your basis in the property to her as a gift rather than giving her a “step-up” in basis at the time of your death.  This means, she would have to pay capital gains tax on the property based upon the difference between your original purchase price and the price she sold the home for in the future.  For these reasons, I cannot recommend you gift or transfer the property to your daughter or daughters.

As far as Medicaid is concerned, if you sell your property for fair market value to your daughter or another third party, this will not affect your eligibility for Medicaid.  Furthermore, this would allow your daughter who resides with you to establish her own homestead exemption.  However, if she rents the property back to you this would be rental income to her that she would have to claim on her taxes.

There is a caretaker child exemption in many states which allows the transfer of the home to a child who has cared for their parent without creating a penalty for Medicaid.  Illinois is currently in the process of changing all of their Medicaid rules to come into compliance with the Deficit Reduction Act.  Under current Illinois rules, transferring the home to a caretaker child is an exempt transfer (PM 07-02-20(b)).  To qualify as a caretaker child in Illinois, the rules state, “a person’s child who provided care (either nursing or support) for the person and who was living in the homestead property for at least two years immediately before the date they entered the facility or applied for/received [Medicaid] services.”  Under the new proposed rules from Illinois, they initially proposed rules that were hyper-technical and would effectively eliminate the possibility for this exempt transfer to occur.  I created and co-chair the Task Force for Senior Fairness with fellow elder law attorney, Diana M. Law, which has worked tirelessly to combat Illinois’s proposed rules in areas we consider to be too harsh, punitive and draconian for our Seniors.  One of our wins, is that Illinois has changed their proposed rules in the area of the caretaker child.  The rules still contain more criteria to qualify as a caretaker child, but the exemption remains and is now manageable to obtain.  Once the new rules are implemented, the caseworker will also need proof of the child’s residence and a doctor’s note stating the applicant would have had to go the nursing home earlier but for the child’s assistance they were able to stay at home.

The best advice I can give you is to see an elder law attorney in your area while you are still healthy who is familiar with Medicaid, Real Estate and Personal Care Contracts so you can establish in writing that your daughter is providing care for you.

NOTE:  The information provided above is not intended to be nor should be relied upon as legal advice.  Peck Bloom, LLC is located in the State of Illinois and the attorneys are only licensed to practice law in Illinois and Florida.  You should consult a qualified attorney licensed in your state regarding these matters.

To locate experts in your state who can help you with this elder care matter, go to: www.ElderCareMatters.com/statechapters.htm

Kerry R. Peck, Managing Partner
Peck Bloom, LLC
Chicago, Illinois  60603
1-877-845-1743

Member of the national ElderCare Matters Alliance, Illinois chapter


Question of the Day: "What provisions in a will or revocable trust are appropriate for a child or parent who is unable to care for his or her own needs?"

Answer:  A last will and testament becomes effective only upon death and does not contain provisions for planning at incapacity.  However, a properly drafted trust appoints a successor trustee to make distributions to or for the benefit of the Settlor at his incapacity (and this can be expanded to provide for others as well upon the incapacity of the Settlor (such as the Settlor’s spouse and children).  Also, a power of attorney for healthcare and property can be used which names an agent to make healthcare and property decisions for a person should they become incapacitated.  These can be drafted with very broad powers, or the powers of the agent can be as limited as desired.  Also, the power of attorney for property can include provisions which allow the agent to make gifts and other estate planning decisions on behalf of a person who has become incapacitated, if that is desired.

NOTE:  The information provided above is not intended to be nor should be relied upon as legal advice.  Peck Bloom, LLC is located in the State of Illinois and the attorneys are only licensed to practice law in Illinois and Florida.

To locate experts in your state who can help you with this elder care matter, go to: www.ElderCareMatters.com/statechapters.htm

Kerry R. Peck, Managing Partner
Peck Bloom, LLC
Chicago, Illinois  60603
1-877-845-1743

Member of the national ElderCare Matters Alliance, Illinois chapter


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