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


We Are Now Ranked #1 On Google, Yahoo & Bing

At last, families have a resource they can tap into to find “Elder Care Experts” across America…

ElderCareMatters.com

 

ElderCareMatters.com, along with the 1,300+ Lifetime Members of the national ElderCare Matters Alliance, provides families with the resources they need to plan for and deal with their elder care matters.  And now our “Elder Care Experts” are ranked #1 on Google, Yahoo & Bing. 

This is America’s online source to find elder care experts plus useful information & answers about a wide range of elder care matters. 

Here you will find professionals with years of experience in helping families with the issues of aging, including:

  • Elder Law Attorneys
  • Estate Planning Advisors
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  • Geriatric Care Managers
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  • A host of other elder care experts with long and successful careers working with seniors and their families

This is also where you will find some of America’s best:

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Together, we provide families with:

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If you and your family need help with elder care matters, this is where you will find competent, caring elder care experts located near you.  Whether you are looking for:

  • an elder law attorney in Philadelphia
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you can count on www.ElderCareMatters.com to help you find the Elder Care Experts that you will need in ALL 50 states (plus the District of Columbia).  



So why wait?  If you are an elder care professional and you would like to “get the word out” to hundreds of thousands of families across America (in a cost effective way) about how you can help them plan for and deal with their issues of aging, then you should join our 1,300+ elder care experts as a lifetime member of the national ElderCare Matters Alliance. 

And, now, if you are one of the next 200 new members, you will receive a 25% discount off the regular lifetime membership price

This 25% discount is available only to the next 200 elder care professionals who join the national ElderCare Matters Alliance. 

If you are a competent elder care professional – take advantage of this special 25% discount offer and pay only $337.50 for a “lifetime membership” (and there are no annual membership dues, ever!) to the national ElderCare Matters Alliance.

To request an Application for Lifetime Membership, send an email directly to: psanders@eldercarematters.com


Question of the Day: "When a trust is established and the assets in the trust generate income, how is this income taxed?"

Answer:  If the trust is a revocable (or living) trust, then the income that is generated is simply reported on the Settlor’s individual income tax return during his life.  Upon the Settlor’s death, the revocable trust becomes irrevocable and becomes a separate entity for tax purposes.  Once a trust is irrevocable, any income that is trapped in the trust (not distributed to a beneficiary) is generally reported on a fiduciary income tax return (Form 1041).  Generally, to the extent income is passed out to a beneficiary, that income is reported on the beneficiary’s individual income tax return.  However, if the trust is a simple trust (meaning a beneficiary is required to receive all of the income of the trust under the terms of the document), then the income is reported on the beneficiary’s income tax return.  There are other types of trusts (irrevocable trusts established during the life of a grantor/settlor, grantor trusts, etc.) which have various tax treatments.  In order to determine the proper tax treatment, the trust agreement must be reviewed.

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


Need help with your Elder Care Matters? Ask one of our 1,300+ Elder Care Experts

Question: When you need an answer about an elder care matter, who can you ask? 

Answer: The experts of the national ElderCare Matters Alliance. 

ElderCareMatters.com  is now offering an “Ask an Elder Care Expert” service.

Every day one of our 1,300+ 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 to 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 by some of America’s top elder care professionals with years of experience helping families plan for and deal with the issues of aging.


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