Are there any senior living “environments” that are designed to enable residents to age-in-place?

Answer:  Yes.  But it depends upon where you live.  In Massachusetts there are what we call Continuing Care Retirement Communities (CCRC’s).  A senior will enter in an independent situation (eg. their own apartment); then if needed move to an assisted living facility on the premises (or in some cases get assistance in living within their own apartment), and then, if needed there is a nursing facility component.  Otherwise, each state will have certain home care programs available to allow people to remain in their home and get care.  Some of these opportunities are simple private pay care management companies.  Others are part of state programs.  Each state is different.  If you are interested in home care in your state, you need to contact the equivalent of your Office of Elder Affairs, or an Elder Law Attorney, or Geriatric Care manager to find out what would be available to you.

Another source to find an elder care expert near you is this ElderCare Matters website:  www.ElderCareMatters.com/statechapters.htm.

Susana Lannik, Attorney at Law
Newton, Massachusetts  02458
617-658-2980
Member of the national ElderCare Matters Alliance, Massachusetts chapter

 


"My co-worker's father is a veteran and receives about $700/mo pension from the service as well as a social security check. He is elderly but still able to live on his own. His wife's health has deteriorated rapidly in the last (6) months and she now requires a great deal of care, is not responsible for bodily functions and has dementia. Do you think there would be any VA benefits available to help with his situation? He was told that because he receives a SS and pension check that he won't qualify for any benefits or help."

Answer:  I have had this situation in my office before.  Because your co-worker’s father already receives the $700 per month, it would not pay for him to seek what are known as “aid and attention” benefits to bring in someone to care for his wife.  The $700 would be reduced by the amount of benefits that the VA MIGHT give.  Aid and attention benefits are actually called “improved pension benefits.”  It does sound like your friend’s wife has long term care needs that would be better served in a skilled nursing facility. Some states have some home care programs that are available, but this could be a “patchwork quilt” that would not offer her appropriate continuity of care.  I realize a lot of people hate to do this, but depending upon his situation–eg. the amount of assets he has, whether or not he has made transfers etc.  his wife could be eligible for Medicaid either at home (Medicaid Waiver, Personal Care Assistant) or in a skilled facility.  I would seriously urge your friend to seek out the services of an Elder Law Attorney in your area.

You can find Elder Law Attorneys who are located near you by searching the following Elder Care Matters site:  www.ElderCareMatters.com/statechapters.htm

Susana Lannik, Attorney at Law
Newton, Massachusetts  02458
617-658-2980
Member of the national ElderCare Matters Alliance, Massachusetts chapter


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

Answer:  The experts of the national ElderCare Matters Alliance.

ElderCareMatters.com is now offering a NEW Ask an Elder Care Expert service.

Each week one of our 1,200 experts will answer your family’s important questions about elder care matters – from legal, financial, housing, health care, 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.

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 their issues of aging.

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


"How can you assure elders and family that a DNR (do not resuscitate) order will be recognized and followed by EMT’s and ambulance services when 911 is called to the home? Do patient care protocols vary by State statutes?"

Answer:  I imagine that every state is different.  In Massachusetts, the person who is appointed your Health Care Agent under a Health Care Proxy can make the DNR decision.  You can also make it yourself if you are competent to do so.  There is a form you can get to fill out from the Executive Office of Elder Affairs here, or any nursing facility or hospital. That form AND your Health Care Proxy should be in a place in your home as well as in your medical records where the ambulance service can get it.  We too have had circumstances where these wishes have been ignored, and what I’ve described above is the process to enable the ambulance service to follow a DNR instruction.  In my experience, it is still a problem because sometimes in the midst of an emergency, there is no one around to show the service the DNR, even if it is posted on the refrigerator.  It is possible to place a laminated card in one’s wallet indicating where the DNR order is. Hope this helps.

To locate attorneys in your state who can help you with this elder care matter, I would recommend that you search the ElderCare Matters listing of experts at www.ElderCareMatters.com/statechapters.htm.

Susana Lannik, Attorney at Law
Newton, Massachusetts  02458
617-658-2980
Member of the national ElderCare Matters Alliance, Massachusetts chapter


"What is a revocable trust and how does this legal instrument work?"

Answer:  A revocable trust is one type of trust.  In general, trusts present many planning opportunities.  The hallmark of a revocable trust is that it may be revoked or amended at any time.  Other trusts cannot be revoked.  These are called “irrevocable”.  In some jurisdictions the revocable trust is called a “living trust.”   Some of the purposes of a revocable trust are:  To avoid probate at death, including more than one probate if you have properties in more than one state and prevent court oversight and control of the disposition of your assets if you become incapacitated.  If your assets are held in a revocable trust, they may be more rapidly distributed to your beneficiaries than through the probate process.  A properly drafted revocable trust may reduce or eliminate estate taxes.  A revocable trust is difficult to contest and can prevent court oversight of minors’ inheritances.  In that instance, you choose who oversees the minor’s monies.  It can prevent problems that occur with joint ownership of property, and unintended results upon death.  A revocable trust is not expensive to set up.

A trust like this works when you transfer your assets from your name to the trust over which you maintain control during your lifetime.  Technically the trust owns everything you transfer into it, but YOU maintain control and can do anything you want to do with those assets during your lifetime.  If you become incapacitated, the trust and not the court will control you assets. You do not have to have a separate tax ID for a revocable trust.  There are times when a revocable trust may not  be a good idea is when you need to protect assets for long-term care needs.  This is because the assets in this type of trust are fully countable, and will have to be spent down before you may seek Medicaid benefits.  Sometimes people place their primary residence into a revocable trust.  The difficulty here is that for Medicaid purposes you have transferred an asset that is not countable when you seek Medicaid, and made it entirely countable by the transfer into the trust. 

These trusts should be drafted for you by a qualified estate  planning and elder law  attorney IN YOUR STATE who specializes in Elder Law and Estate Planning, following a full intake to ensure that this move is right for you.  Please note:  I am a Massachusetts elder law attorney, and the law may be different elsewhere.

To locate attorneys in your state who can help you with this elder care matter, I would recommend that you search the ElderCare Matters listing of experts at www.ElderCareMatters.com/statechapters.htm.

Susana Lannik, Attorney at Law
Newton, MA  02458
617-658-2980
Member of the national ElderCare Matters Alliance, Massachusetts chapter


"I am 64 and my husband is 70. We have been married 5 years. I have no children and he has one son. Prior to our marriage, I accumulated my retirement savings. He has none. I also recently inherited a considerable sum from my mother. If I died first, I would want my money to go to my husband to support him for the rest of his life. However, I would want the remainder, upon his death, to go to my brothers, nieces and nephews — not his son. How can I make sure this happens?"

Answer:  There are two ways to accomplish your goal.  But, if I were your attorney, I would not make any recommendations until I had a full understanding of the structure of your estate, your husband’s estate, how your retirement funds are held, and whether or not you have a taxable estate.  In Massachusetts, an estate over the threshold of $1M is taxable, and so all of this information would affect my response to you.  Another important question would be if you or your husband have any health issues at this time.  If there are no health issues, then I might recommend an Irrevocable Income only trust for some or all of the funds–again depending on your entire estate structure. This kind of trust would entitle you to income only with the remaining principal to go to your brothers, sisters, etc, on your death.  In the alternative, your attorney could draft a will for you with a testamentary trust.  Your husband would receive the income but not the principal.  The principal would go to your family.  The best advice is that you should consult with an attorney in your state on these matters and have him or her create a comprehensive plan for you and your husband.  I am a Massachusetts estate and elder law attorney, and the law may be different in your neck of the woods.

To locate attorneys in your state who can help you with this elder care matter, I would recommend that you search the ElderCare Matters listing of experts at www.ElderCareMatters.com/statechapters.htm.

Susana Lannik, Attorney at Law
Newton, MA  02458
617-658-2980
Member of the national ElderCare Matters Alliance, Massachusetts chapter


"I understand that I am legally allowed to make annual gifts valued at $13,000 (per person) and that these gifts will not be taxable. I have been making such transfers to my children each year. Do these transfers affect my eligibility for MassHealth benefits in the future?"

Answer:  Unfortunately under Medicaid regulation, it is any transfers that can disqualify you as a MassHealth applicant, even if they are legal under tax law.

Susana Lannik, Attorney at Law
Lannik Law, LLC
Newton, Massachusetts  02458 
617-658-2980
Member of the national ElderCare Matters Alliance, Massachusetts chapter


“For some reason, my aging parents are stonewalled about signing a healthcare power of attorney. They seem to think that one of them will always be available to take care of the other. As they age, it is becoming more and more apparent that this issue needs to be discussed, but they refuse any attempt on any family member's part to do this. I believe they view it as a means for someone to take control, thus losing their independence. What would you suggest?”

Answer:  Unfortunately, if they have capacity, you cannot force them to sign a healthcare power of attorney or take over their decision making authority.  Maybe the issue is simply not wanting to discuss it with you.

Is there a third person you can enlist to talk with them about this important elder care matter, i.e., member of the clergy or maybe a social worker or care manager?

To locate an elder care expert in your area, I would suggest that you go to www.ElderCareMatters.com/statechapters.htm

Sonya Mittelman, Attorney at Law
Bronx, NY  10461
718-863-4647
Member of the national ElderCare Matters Alliance, New York chapter


“If my mother, a widow in her 80s, sets up an irrevocable trust to protect her house, then needs nursing home care, how long after the trust is set up would it be before she is eligible for Medicaid. Also if she is in a nursing home, who pays for the upkeep of the house and the property taxes?”

Answer:  Medicaid will look  back  for 5 years,  but that does not mean she is ineligible for five years.   The ineligibilty or penalty period is determined  by dividing the amount transferred, which would be the assessed  value of the house,  by the average  monthly  rate  of a nursing home in  your region. The trust  is the owner of the home and would be responsible for  the bills, so when the trust  is set up, make sure  it has funds, either  in cash or  in   stocks/bonds, that can be quickly converted to cash.

If you have further questions about Medicaid, I would suggest that you locate an Elder Law Attorney in your state by going to the ElderCare Matters website at www.ElderCareMatters.com/statechapters.htm

Sonya Mittelman, Attorney at Law
Bronx, NY  10461
718-863-4647
Member of the national ElderCare Matters Alliance, New York chapter


ElderCare Matters Alliance now has 1,200 professional members

The ElderCare Matters Alliance is a national organization of 1,200 elder care experts who help families across America plan for and deal with their issues of aging, including providing families with a host of elder care resources that can be found on www.ElderCareMatters.com

If you are a competent, caring elder care professional – you need to belong to the national ElderCare Matters Alliance.

To request a Lifetime Membership Application to the national ElderCare Matters Alliance, send an email to psanders@ElderCareMatters.com

www.ElderCareMatters.com – America’s online source for elder care experts who help families plan for and deal with their issues of aging.

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO
ElderCare Matters
www.ElderCareMatters.com


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