Hawaii State Coordinator shares article titled, “Secret Money for Senior Veterans”

Secret Money for Senior Veterans

Scott A. Makuakane, Esq., CFP
Hawaii State Coordinator, ElderCareMatters.com


Many Veterans believe that they have to have suffered an in-service disability to qualify for monetary benefits from the Veterans Administration. This is a common misconception. Depending on their health status, their income, and their assets, many senior Veterans and their dependent or surviving spouses can qualify for not only basic “Improved Pensions” based on low income, but also supplemental benefits of up to $2053 per month as of 2013. The supplemental benefits are called “Housebound Benefits” and “Aid & Attendance Benefits.”

In order to qualify for any of these pension benefits, the Veteran (or surviving spouse, based on the Veteran’s military service record), must satisfy the following general criteria:

  • · The Veteran must have served at least 90 days of active duty.
  • · At least one day out of the 90 days of active duty must have been during war time (there are defined dates for the beginning and end of World War II, the Korean War, and the Vietnam Conflict; the Gulf War, which began on August 2, 1990, is not concluded yet, and its ending date will be set by Presidential Proclamation at the appropriate time).
  • · The Veteran must have received a discharge other than dishonorable.
  • · The claimant and household must have limited income and assets.
  • · The claimant must have a permanent and total disability at the time of application (note that a surviving spouse can qualify for a basic low income pension without being disabled, but the Veteran must be disabled—although the disability does not have to be related to war time or military service).
  • · The disability must have been caused without the willful misconduct of the claimant and must not have been due to the abuse of alcohol or drugs.

As the name implies, Housebound Benefits are payable where the claimant is substantially confined to his or her home because of permanent disability. In order to qualify for Aid & Attendance benefits, the claimant must:

  • · Require the aid of another person in order to perform personal functions required for everyday living (such as bathing, feeding, dressing, toileting, transferring from bed to a wheelchair, or dealing with incontinence) OR
  • · Be bedridden, in that he or she must remain in bed apart from any prescribed course of convalescence or treatment OR
  • · Be a patient in a nursing home due to mental or physical capacity OR
  • · Be blind or have very poor vision.

Applying for these supplemental benefits is not a quick or simple process, and if you decide to apply, you may want to enlist the help of a Veterans’ assistance organization or a specially-trained individual. Note that whoever assists with the application cannot charge a fee for that service. However, if the individual or organization performs other services, fees may be chargeable for those other services.

To find professionals across America who can help you plan for and/or deal with your family’s elder care matters, go to: ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Resources for Families.

Today’s Elder Care Article: Paperless World Can Leave Heirs in the Dark

Paperless World Can Leave Heirs in the Dark

Build a roadmap to your assets

As people increasingly go “paperless” – using the online features of banks and brokerages to manage their accounts – it’s complicating the process of helping your heirs sort out your finances once you’re gone.

The problem: If you don’t keep careful records, your family might not even know where to start looking for accounts. In a worst-case scenario, some assets may never be found.

But at the same time, you don’t want to recklessly list all your private financial-account passwords somewhere for a bad guy to find. That would be an invitation to theft.

There are several smart steps to take to build a roadmap to your assets. The five key components: information about your assets, names of advisers, details about safe-deposit boxes, your estate-planning documents, and a few other important documents.

For starters, provide details about banking and brokerage accounts, insurance policies, real-estate and retirement plans, and list account numbers.

Explain where to find your will, trust, power of attorney and other estate documents. If you have a safe-deposit box, give the bank’s name and address, and where you keep the keys. If you have a life-insurance policy, provide the name and phone number of the agent and a copy of the policy or its number.

Consider listing all the people your heirs will need to contact, including lawyers, accountants, executors or guardians you’ve named to care for any minor children.

Here’s what not to include: Your passwords to online accounts. Listing all your passwords in one place — no matter where it’s stored — is risky. And anyway, your heirs won’t need them. For instance, with some assets like bank accounts, heirs can sometimes gain access by showing a copy of a death certificate and proof of designated beneficiaries.

Another important, but often overlooked, item to include: computer passwords, if you keep back copies of potentially important financial paperwork (like old tax returns) on your PC.

Your financial planner or estate-planning attorney can provide additional guidance in putting together a file meeting your particular needs.

Lastly, think carefully about how to store the list. Heirs need to be able to locate it when needed (and you need to be able to update it with a minimum of hassle) but it shouldn’t be generally accessible. One option: a fire-resistant home safe, where you should also be keeping, say, your passport or other items you may need to access more quickly than things in a safe-deposit box. You might also give a copy to your lawyer to keep with other estate-planning documents.

As a general rule, don’t keep a copy on your computer. But if it is kept there, make sure your computer is as safe as possible from hackers, and is password-protected.

After all, you can’t take it with you — but you wouldn’t want someone else to take it from you.

If you would like to find additional information about elder care matters and/or find an elder care professional near you who can help you with your elder care matters, then go to: ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Resources for Families.

Robert M. Slutsky, Esq.
Robert Slutsky Associates
Plymouth Meeting, PA  19462
An ElderCare Matters Partner

Introduction to Elder Law for Caregivers


Article written by Don L. Rosenberg, Attorney and Counselor
The Center for Elder Law
Troy, Michigan
An ElderCare Matters Partner

Caregiving for someone with Alzheimer’s, a related dementia, or a physical illness is one of the most difficult jobs in the world. In addition to making sure that your loved one is safe and their daily needs are met, you are also faced with the fact that there are many financial and legal issues that must be addressed.  As if that were not enough, you also are trying provide the best quality of care at the least cost to the family.   Caregiving is expensive and stressful.  Hopefully, this article can provide some insight to the wisdom of consulting an elder law attorney as soon as one can.  An elder law attorney can provide the navigation one needs when confronted with the various complex laws to ensure the greatest quality of care at the least cost. 

Elder law is not just for senior citizens who are no longer independent or who are about to enter a nursing home. Elder law is for anyone who is middle aged and beyond — and sometimes even younger.  One may say Elder Law is for anyone who wants to be old one day.

There are now more than 5 million people in the United States living with Alzheimer’s and is now the 6th leading cause of death.  This is a 10% increase from 5 years ago, and clearly supports the long forecasted dementia epidemic.  One in eight persons age 65 and over have Alzheimer’s disease and nearly half of all persons over the age of 85 have Alzheimer’s.  Every 68 seconds someone develops Alzheimer’s disease; by mid-century someone will develop Alzheimer’s every 33 seconds. (Alzheimer’s Association Report, 2012 Alzheimer’s Disease Facts and Figures) In addition to the dementia epidemic there are the many millions of people that are afflicted with illness that also need care.  The fact is that for many, one day you are living a normal life and the next minute you are a caregiver.  

You are not alone. There are over 50 million caregivers in this county.  Studies show that 12 million people in this country need long term care. Twenty-one percent of American adults provide free caregiving for loved ones.   Fifty-nine percent of these caregivers either work outside the home, or have worked outside the home, while providing care. It has been estimated that the value of free services given by caregivers is in excess of $320 billion a year.  Additionally, as a result of caregivers, businesses are also effected by the caregiving epidemic.  Specifically, over 60% of caregivers work and dedicate on average 18 hours per week to provide care.  Family caregivers account for 73% of early departures and late arrivals in the workplace.  Caregiving by an employee costs the average employer $2,100 per employee or for all employers as much as $33 billion annually.  (Met Life Caregiving Cost Study Productivity Losses to USBusiness July 2006 and Caregiving in the U.S. by National Alliance for Caregiving in Collaboration w. AARP, 2005.) These services are provided by family members without regard to cost because of the love and respect they have for their loved ones. (Alzheimer’s Association Report, 2010 Alzheimer’s Disease Facts and Figures) 

These statistics only represent the economic cost of caregiving.  It does not even address the emotional and physical toll on caregivers.  The fact is that 70% of all caregivers over the age of 70 die first. (Alzheimer’s Association Report, 2010 Alzheimer’s Disease Facts and Figures)  People generally do not think about the health of the caregiver or plan for the unthinkable – the caregiver having health problems or passing away before their loved one with dementia.  It is for this reason that one must approach each situation from the worst case scenario.  The only way one can prudently plan is to plan for the worst and hope for the best.  The time to look down the road and make major decisions regarding your health and the health of your loved ones is now. 

It is important to understand the difference between an elder law attorney and an estate planning attorney. Estate planning attorneys are typically concerned with what happens to your estate upon your death and deal with disability when a person is no longer able to participate in their own decisions.  On the other hand elder law attorneys in addition to having estate planning expertise also can ensure that your affairs can be managed in the event of your disability, or even if you are competent and not disable to allow someone to become involved in your medical and financial affairs to the extent that you would want them to, as well as once you pass away.

Specifically, an experienced elder law attorney also has an special expertise in Medicaid, Veterans and Special Needs Planning and will address the following tough questions like: 

     Who will make my medical decisions when I am no longer able to make them? 

     If I am unable to care for myself, how can I achieve the greatest quality of care without bankrupting me or my family? 

     Who will be able to talk to my doctors and the hospital when I require guidance even though I am able to make my own medical decisions? 

     Who will make my end of life decisions? 

     What happens if I get sick, and is there a way I can stay in my home or in some least restrictive setting other than a nursing home and receive financial assistance. 

     What happens if I get sick and cannot stay in my home anymore, and how am I going to pay for this care? 

It should be obvious that for caregivers of loved ones with Alzheimer’s and related dementia or any health issue that information regarding Medicaid and estate planning is a necessity.

Today’s article on ElderCareMatters.com is about Special Needs Trusts

The Future and Security of your Son or Daughter

What Will Happen After I’m Gone?

Imagine for a moment that tomorrow evening, on your way home from a party, you and your spouse pass away in a car accident. Have you ever wondered what will happen to your child* with a disability after you are gone? Who will watch your child or who would be the guardian or trustee? Stop wondering. Through a very special planning process you can ensure that all these concerns are taken care of.

Estate and Financial Planning for a person with a disability is like no other type of planning-it is special. Imagine a process that will assure that your child with a disability will always have a friend, advocate and protector of their legal rights and insure that your child’s governmental benefits are never altered, diminished or destroyed as well as ensure that they will have a meaningful life after you are gone. This is what Special Needs Planning can accomplish.

Why a Will is NOT Enough

If you were to die with only a Will in place or no planning at all for your disabled child, any estate left to your child is, in reality, a gift to the government! Your child will lose his or her benefits and medical coverage while spending down your well-intentioned inheritance. It is a gift to the government instead of your child. Unfortunately this knowledge has led most parents to intentionally disinherit their child with a disability.

The Perfect Solution: The Special Needs Trust

There is an alternative to the harsh realities of a Will-it is the Special Needs Trust (SNT). The Special Needs Trust is the ONLY reliable method to make sure your inheritance and gifts benefit your child with a disability. The point of the SNT is to keep the assets in a form that will be available for your child but will not disqualify him or her from benefits for which he or she might be eligible

A properly drafted Special Needs Estate and Financial Plan will specify that the money is not to replace the benefits, but is to supplement them and ensure that funding is available to meet your goals. The SNT may be used for extra medical care, personal items such as TV’s, radios, computers, vacations, companionship, advocates or any other item or service to enhance your child’s self-esteem or situation-anything but food, clothing and shelter.

While government agencies recognize SNTs, they have imposed very strict rules upon them. This is why it is vital that you consult an experienced attorney-not just one who does general estate planning, but one who is knowledgeable in SNTs and current benefit law! One wrong word or phrase can make the difference between an inheritance that benefits your child and one that causes your child to lose the many services, assistance and benefits available.

The Letter of Guidance

Almost as important as the SNT is the Letter of Guidance. The Letter of Guidance helps pave your child’s transition by giving future caregivers the information about your child they so vitally need. A Letter of Guidance is based on the premise that no one knows your child better than you do. It is a document that describes your child’s history, current status and what your wishes, hopes and dreams are for him or her.

The Letter of Guidance addresses the following areas:

  • Family History
  • Medical History
  • Housing
  • Education
  • Religion
  • Rights & Values
  • Leisure & Recreation
  • Likes & Dislikes
  • Day Programs//Work
  • Daily Routine
  • Daily Living Skills

When Should I Plan?

The answer is simple. Start Now. Start Today. Procrastination is easy-when your health is good, the future looks bright and there are hundreds of other pressing tasks to be done. Yet none of us can predict the future. What will happen to your child if something happens to you? Plan NOW and say to yourself, “I know I’ve done all I can for my child’s future-something that was extremely important to do. Now I am relieved and that is very exciting!”

Special Needs Planning – With Special Needs Estate and Financial Planning you can Provide a Meaningful Life for your Loved One with a Disability After you are Gone.

  • Provides Lifetime Supervision and Care
  • Maintains Government Benefits
  • Provides Supplemental and Special Needs Benefits
  • Avoids Family Conflict

One Parent’s thoughts about Planning:

One parent shared their experience about how they felt about planning as follows:   It has been in the back of my mind for years, soon after I found my son had this lifelong disability.  What would the future hold for him when I wasn’t there anymore to be his advocate, friend and supporter?  It was both a big and little worry.  Big, because it gave me a whole in my gut whenever the question crept in.  And little in the sense that I tried not to think about it.  I’d think I’ll worry about that tomorrow, next week, when he’s older, when I’m older.

Of course, I’ve done things to prepare for that future he’s going to have without me, things like teaching him how to wash clothes and shop.  But should I write a will?  Make an estate plan?  No, for years, I dodged that one totally.  But you know, it’s funny.  Now that we’re finished up our estate and only need to periodically review our plans, I feel like an enormous burden has been lifted up from me.  The big, black, scary, shadow is gone.  Well, not totally gone, I suppose.  I still worry about Sam, what will happen to him in his life.  I guess every parent does that.  But now I don’t worry the same way.  I have done all I can do for that part of his future, something that was extremely important to do, and I am very relieved.  Now I feel like we can deal fully with the present day and see to see the other things that need to be done to prepare for our child as an adult.  And that is very exciting.

drosenbergDon L. Rosenberg, Attorney and Counselor
The Center for Elder Law
Troy, Michigan  48098
Premium Member of the national ElderCare Matters Alliance, Michigan chapter

"Trust Basics" by Scott A. Makuakane, Esq., CFP

Trust Basics

by Scott A. Makuakane, Esq., CFP
Counselor at Law, Est8Planning Counsel LLLC
Honolulu, Hawaii  96813
State Coordinator of the national ElderCare Matters Alliance, Hawaii chapter

A trust is the legal relationship that is created when a person transfers “stuff” to a trustee with the understanding that the trustee will manage it for the benefit of one or more beneficiaries.  We use the term “stuff” to mean any kind of property you can own.  It includes both real property—such as land and buildings—and personal property—such as bank accounts, stocks and bonds, and personal effects.  The person who transfers the stuff to the trustee is called a trustmaker.  This person is also known as a settlor, grantor, or trustor.  Usually, the trustmaker is also the trustee (or perhaps co-trustee) and the initial beneficiary of the trust.  It is not uncommon for husbands and wives to create two separate trusts and to be the co-trustees of both of their trusts during their joint lifetimes, and then, after the death of one spouse, to have the survivor serve either as sole trustee or co-trustee with one or more other individuals or a trust company.

A trust is controlled by a document called the trust agreement (sometimes called the trust instrument).  The trust agreement sets out the rules about how the trust will be run.  We often refer to a client’s set of estate planning documents as their “rule book,” and the trust agreement is the part of the rule book that controls the trust.

If the trust agreement says that the trustmaker can revoke it or change it, the trust is what we call a revocable trust.  If the trust agreement does not allow the trustmaker to change or revoke it, we have what is called an irrevocable trust.  Irrevocable trusts are used in many estate plans.  They allow trustmakers to make gifts but keep the recipients from having complete control over the gifted assets.  Irrevocable trusts play an important part in many estate plans.  They can help provide tax savings, creditor protection, and expert management of assets.

A living trust is one that you create and fund (transfer stuff into) during your lifetime.  It can be revocable or irrevocable, depending on how much control you want to maintain over the trust and its assets.  A revocable trust gives you complete control, whereas an irrevocable trust gives you limited or no control.  A testamentary trust is one that goes into effect and is funded following your death because it is governed by your last will and testament.

You remain in control of your trust assets as long as your trust is revocable.  The trustee is bound by the trust agreement.  You have final say over what the trust agreement says, and failure to abide by the trust agreement can make the trustee personally liable to the beneficiaries, including yourself.  This means that if the trustee messes up, that person may have to pay for the mess out of his or her own pocket.  Most often, the trustmaker of a revocable living trust is the initial trustee.  In that situation, the trustmaker does not have to worry about anyone questioning his or her management of the trust.  In fact, potential beneficiaries have a vested interest in not doing anything that might cause the trustmaker to revoke the trust or change the trust agreement in order to exclude a troublemaker.  This is a simple demonstration of the “golden rule” of estate planning:

      The One who hath the Gold maketh the Rules

 If your kids are good kids, they won’t stick their noses into what you do with your trust.  If they are bad kids, hopefully they are smart kids and will at least act like good kids as long as you’re alive because they won’t want to be disinherited.  If you do not have any children—or don’t have any that you like—don’t assume that revocable living trusts are not a good idea for you.  There are many good reasons for creating trusts, and some of them may apply to your situation.  One reason that many people create revocable living trusts is so that their stuff will not go through probate after they are gone, or through conservatorship if they become incapacitated.

Once assets are transferred to the trustee, the trustmaker no longer holds legal title to them—even if the trustmaker and the trustee are the same person.  Thus, if the trustmaker dies or becomes incapacitated, the trust continues, and the successor trustee (who is named in the trust agreement) takes over administering the trust.

Trusts are often the building blocks of effective estate plans.  They provide simplicity, flexibility, and predictability in dealing with your assets.  The also give you the peace of mind of knowing that you have arranged your affairs to ensure that your wishes will be carried out, and that future transitions (such as your incapacity or death) will be much easier on your loved ones.

This Week’s Article on ElderCareMatters.com is about Estate Planning


jruggieroBy James J. Ruggiero Jr. Esq., AEP®
Ruggiero Law Offices LLC 

As Benjamin Franklin once said, “You may delay, but time may not.” No truer are these words than in the case of estate planning. The average person allows 10-to-15 years to elapse before revising his or her estate plan. Life’s ups and downs, and the impending estate tax law changes, present the opportunity to protect your legacy.

Unless Congress acts before the end of the year, in 2013, the estate tax rates in effect prior to the Bush tax cuts enacted in the early part of the last decade return. Although in 2012, the maximum rate was 35 percent on taxable estates in excess of $5,120,000, in 2013, the top marginal rate will be 55 percent, and the exemption rate will decrease to $1 million. For example, if your estate were worth $1.5 million, in 2012, you would not have paid federal estate tax; whereas, in 2013, you will pay federal estate tax because of the decreased exemption. With the potential impact of this in mind, don’t let the heir day of your loved one turn out to be a bad heir day, which most of us run the risk of doing by failing to implement an estate plan in the upcoming year.

By way of example, in 2006, 46 percent of the general public had a will; however, in 2007, that percentage dropped to 37.  But actually, estate planning is about more than having a will.  Four basic documents encompass a good estate plan:  a Last Will and Testament, a General Durable Power of Attorney, a Healthcare Power of Attorney, and a Living Will. 

Each of us needs an updated Living Will 

The recent celebrity case involving Gary Coleman provides a clear example of the ills that can occur without an updated estate plan. In 2006, Coleman created a healthcare directive that gave his then-wife power to make medical decisions if he became incapacitated. It apparently included a statement to prolong his life for as long as possible. After divorcing and failing to revise his healthcare directive, Coleman suffered a head injury and was admitted to the hospital, diagnosed with a brain hemorrhage.  Coleman’s ex-wife decided to take Coleman off life support only one day after he was admitted.

In some states, divorce fails to nullify a healthcare directive.  If you have been through a divorce, it is wise to review your estate documents to ensure they continue to reflect your wishes.  

Form your own dynasty

Although problems can arise due to neglecting to update healthcare directives, preserving wealth is perhaps the greatest concern. Too often, we underestimate the size of our estate, not realizing the problems this can cause after we have gone.  Trusts provide a viable option for ensuring that your heirs do not pay excessive estate taxes upon your death.  Different types of trusts are available to meet your needs and the needs of your loved ones.

A dynasty trust is one way wealth preservation can be achieved.  Despite its name, the term has nothing to do with aristocracy.  With a dynasty trust, you transfer the assets of a business, real estate, or other income-producing property to the trust. Depending on the exact terms, the income accumulates or is paid out on behalf of the trust’s beneficiaries: children, grandchildren, or even remote descendants. Assuming the assets remain in the dynasty trust, they will not be included in a beneficiary’s estate when he or she dies.  Thus, the asset values can continue to compound over several generations without any erosion due to estate taxes.  Further, because the beneficiaries do not own the assets, there is protection against loss from creditors or divorce proceedings. Wealth is preserved and remains in the hands of family–with little or no tax consequences.

Create a “heir” style that works for you 

When is a good time to update your estate plan?  While it is always good to maintain a current estate plan, significant life events mandate a revision.  If you’ve recently started a business, you may need to update your estate plan.  Crucial aspects, such as business succession planning, guarantee that the wealth you’ve worked so hard to build is passed on to those you love or designate. Additionally, our changing economy can result in loss of a job or early retirement, both invoking the need for a review.  Similarly, a spouse that is re-entering the work force or changing from full- to part-time status, necessitates re-evaluating your assets.

Changes in family may dictate a change in your estate plan. If a son or daughter should marry someone you would prefer not to include as an heir, inevitably, you would want to take a second look at your estate planning. You would find it important to avoid the risk that your wealth could end up in the hands of a former son- or daughter-in-law.

Indeed, even if you like your in-laws, other life events can trigger an update to your estate plan.  Have you recently moved into Pennsylvania? Or, are you planning a move to another state?  If so, it is good advice to learn about the laws of your new locale to make sure that your plans are protected. Even marriages, births, and other happy events in our lives should awaken the notion that our estate plans need to be re-examined.

Perhaps you have a domestic partner who you would wish to one day become your heir. Pennsylvania does not recognize same sex or common law marriages. Thus, in this Commonwealth, a same sex or opposite sex non-related individual inheriting from you will be taxed at a rate of 15 percent. Don’t let him or her experience a bad heir day. Trusts and other estate planning, such as beneficiary designations on financial accounts, can play an important role in preserving the assets of your domestic partnership.

Most of us put estate planning on the back burner. It’s easier to choose to wait for tomorrow. By contrast, we go to the barber or beauty salon on a regular basis because we defy being caught having a bad hair day! Applying mousse, gel and spray guarantees we will have a good hair day.  Similar protection in the form of a good estate plan can be applied so that a bad heir day is likewise avoided.

Have your estate plan updated today, and do wonders for your heir!

The Importance of Providing Clear Direction in Your Advance Health-Care Directive

smakuakaneScott A. Makuakane, Esq., CFP
Est8Planning Counsel LLLC
Honolulu, Hawaii
Member of the national ElderCare Matters Alliance, Hawaii chapter

The national press has picked up several reports in the Honolulu Star-Advertiser about the plight of Karen Okada.  Karen is a 95-year-old woman who signed a “Death with Dignity Declaration” and a “Durable Power of Attorney for Health Care Instructions” back in 1998.  Both documents purport to control “in all circumstances.” 

The Queen’s Medical Center, where Karen was hospitalized for pneumonia, determined that Karen was essentially brain dead, or, in any event, had “permanently” lost the ability to participate in medical treatment decisions, and that the provisions of her Death with Dignity Declaration required that her feeding tube be withdrawn.

On the other hand, Karen’s health-care agent, in consultation with doctors who are not associated with Queen’s, disagreed with the conclusions reached by the Queen’s physicians.  What the agent knew, and the Queen’s physicians discounted, was that just before she was hospitalized at Queen’s, Karen was conscious and able to interact meaningfully with her family and caregivers.  During the time she was at Queen’s, on the other hand, Karen was for the most part unresponsive when doctors examined her, but her family reported that she smiled at least twice at her adult grandchildren and nodded to her grandson in response to his question of whether she was able to breathe freely.

The policy of Queen’s was to give precedence to an advance health-care directive over a durable power of attorney in all events, and without inquiring into why a person may have signed apparently contradictory documents.  Accordingly, Queen’s took the unusual step of suing Karen’s health-care agent in order to get a court order forcing him to direct Karen’s physicians to remove her feeding tube.

Of course, no one would want to be part of this kind of drama.  So what can you do to make your wishes clearly known so there will be no questions about how to carry them out?

  1. If you do not have an advance-health care directive in place, get one.  Make sure your loved ones—including your children over the age of 18—have advance health-care directives too.
  2. Learn all you can about the options that can be written into your advance health-care directive.  These are not “one size fits all” documents.  Your wishes may differ greatly from those of your friends and family members, and the document you sign should express your particular desires.
  3. If you have an advance health-care directive that is more than 5 years old, there is a good chance that it will not accomplish what you think it will.  Review it right away with your legal counsel.  Make any appropriate changes and updates.
  4. If you want to give a trusted family member or friend the power to make health-care decisions for you, make sure the power of attorney meshes well with any other instructions you may want to provide.
  5. Be sure to give your health-care providers your permission to give your medical information to your family members or other trusted decision makers.  Federal and State privacy laws can restrict your doctor from talking with your health-care agent unless you specifically grant that permission.
  6. Review your advance health-care directive periodically to make sure it accurately states your current wishes.  Once per year is not too often.
  7. Make sure you have a mechanism in place for giving you access to your advance health-care directive, no matter when or where an emergency might occur.  Not all health problems happen in the home, and if you have a crisis situation while you are travelling, you will need a way to make your health-care documents accessible to your caregivers.
  8. Talk with your family about your wishes BEFORE a crisis arises.  Make sure everybody is on the same page.  If your chosen decision makers indicate hesitation about carrying out your wishes, think about naming someone who will.  Your assurance to your loved ones of how seriously you intend your instructions to be taken will give them the courage to carry them out. 

Knowledge is power.  The more you know about advance health-care directives, and the sooner you act on that knowledge, the more likely it will be that your wishes will be carried out.

In case you were curious about what happened to Karen, her family was successful in gaining her release from Queen’s and placing her in a care home.  Since then, Karen has gained 20 pounds and has regained her ability to interact meaningfully with her family.

Today's Elder Care Article on ElderCareMatters.com: "Keeping Our Seniors Safe From Scams"

hchubbHeather R. Chubb, Esq.
The Chubb Law Firm
Fair Oaks, California
Member of the national ElderCare Matters Alliance, California chapter

Keeping Our Seniors Safe From Scams

Our seniors are a charitable bunch, but sometimes that can get them into trouble.  And the scammers out there know it.  The scammers know that our seniors are often isolated and being a friendly bunch are willing to talk to a friendly voice.  They also know the mail is the highlight of the day for many seniors.  Seniors are also inclined to provide information via surveys.  And everyone likes to think they could win it big with the lottery or sweepstakes.

Take my father in law.  He has always been charitably minded, but when the stack of donations threatened to topple off the kitchen counter we knew there was a problem.  This is a smart man who had a very successful career in sales, but now he was exhibiting signs of short-term memory loss and reduced executive function.  We learned soon thereafter that he did indeed have all the hallmarks of Alzheimer’s disease.

The charitable snowball was a wake up call for my family. It was really scary when we started digging into things.  At one point, we made a list of all the “charities” he donated to and it topped 100.  Fortunately, it wasn’t big amounts, $15 – $30 at a pop, but that added up quickly to hundreds of dollars a month.  Not surprisingly, in researching these “charities” we determined that some of them were not  non-profit 501(c)s and many of them used the majority of the money they received not for their charitable purposes, but rather for administration and obtaining more donations.

We found the following resources to be very helpful in wading through this mess.

Check out the credentials of a potential charitable organization before you make a donation.  Charity Navigator – www.charitynavigator.org – is a great site to gather information.

You can also confirm charitable status of an organization through the IRS web site- www.irs.gov/app/pub-78/– remember that some organizations (like churches) may not be listed, so ask the organization for more information if you’re not sure.

Charity Watch (formerly American Institute of Philanthropy)  www.charitywatch.org rates many organizations and provides copies of their annual reports.  This is where you can find information about how they are using the funds, especially the amount spent on administration i.e., fundraising.

The Better Business Bureau Wise Giving Alliance—www.bbb.org/us/charity/ – publishes the Wise Giving Guide three times a year.  The Guide summarizes the results of the Alliance’s latest national charity evaluations and features a cover story, usually with giving tips, on charity accountability issues or other topics of interest to donors.

The more difficult item that we also dealt with was surveys.  My father-in-law received surveys from all sorts of groups, many with often polar opposite political slants, and he felt compelled to fill them out and return them, sometimes with a donation.  This only served to get his name on more lists and create more mail.

Finally, and most dangerously, there were the “sweepstakes” and “lottery” winner letters.  Hundreds of them.  You know the ones . . . “you may be a winner”. . .  just send in $$ to pay for the tax, insurance, or handling.  In some instances what you are actually doing in returning the response form and fee is agreeing to allow the company to take a monthly amount out of your checking account or credit card to keep you informed of upcoming lotteries, etc.  In other instances they use the information to hound you for more money and will even arrange to come to your house to pick up the insurance and handling fee.

We saw this first hand as well.  We’re sure it started with sending in a response and check, but it ended with a series of increasingly harassing phone calls and his consent to allow someone to come to the house to pick up the insurance fee.  Fortunately we were able to head off the in-person visit and the wiping out of his bank account, but just barely.  It gave us a terrific scare.  No sooner had we closed his bank account and opened a new one, the very next day he received a call from some outfit requesting his bank account number to set up an account to prevent identity theft of his internet accounts!  Sadly, and in this case fortunately, his short-term memory allowed him to give out the old bank account number and no further damage was done.

Three key things to remember when it comes to lotteries or sweepstakes:

No legitimate lottery or sweepstakes will ask you to pay the taxes in advance of receiving your winnings.

If you don’t remember entering, it’s likely a scam.

If it sounds too good to be true, it probably is.

If you have a senior in your life you can do them a world of good by just checking in and taking a look at the mail.  If something seems out of order it may be time for a tough conversation and someone to provide a little more oversight.  Communication with compassion is the key since no one wants to think they can no longer be independent.  But that conversation may lead in interesting directions.  I have a number of clients that were grateful when their loved one offered to help with the everyday financial management such as bill paying.

Here are some ways to prepare for and start tough conversations:

If charitable contributions are getting out of control checking out the charities using the above resources can be a great starting point.

The Federal Trade Commission, among other helpful information for consumers, has a terrific Consumer Alert regarding scams.  You can find it here http://www.ftc.gov/bcp/edu/pubs/consumer/alerts/alt099.shtm

If you have never heard of the “Lottery” organization and/or never entered a drawing this is a big clue that it is a scam.

Read the fine print to see what you are really paying for with the lottery.  No legitimate lottery will make you pay insurance, shipping, or handling, and taxes are not paid up front.

It’s a jungle out there and we all need to do our homework and be safe when it comes to our hard earned money.

Today's article on ElderCareMatters.com is about Veterans Benefits for Long Term Care

drobinsonDebra A. Robinson, Esq.
Robinson & Miller, P.C.
Alpharetta, Georgia  30005
Member of the national ElderCare Matters Alliance, Georgia chapter

Don’t Overlook Veterans Benefits for Long Term Care 

Veterans or widow(er)s of veterans may be entitled to a non-service connected  monthly pension to offset long term health care costs such as home health care, assisted living or nursing homes.  Many veterans are unaware of this benefit or assume they don’t qualify because they didn’t retire from the military. 

Who Qualifies? 

The main requirements for a pension for a veteran or widow(er) are:                                

  • the veteran served at least 90 days of consecutive active duty         service, one day of which was during a war-time period;
  • the veteran’s discharge was not dishonorable;
  • the claimant’s income and assets are under certain limits; and
  • the claimant has a permanent and total disability. 


There is no specified limit on the amount of assets, but the VA will look at whether a claimant has sufficient means to pay for health care, taking into account the annual health care costs, and the claimant’s life expectancy.  Assets that will not be counted in the analysis are the home, car and personal belongings. 


 The claimant’s annual medical expenses should exceed or be close to the amount of annual income.  Medical expenses include health insurance premiums, prescription costs, caregivers, home health aides and the cost of an assisted living facility or nursing home.  If the claimant is a married veteran, the medical expenses of both the veteran and the spouse will be counted. 


 To meet the disability requirement, the claimant’s doctor must confirm that the claimant is housebound and in need of assistance from another individual.  The disability does not have to be service related.  People aged 65 or older are presumed to be disabled and are not required to be rated as disabled under the VA schedule. 


 There are three types of tax free pensions available, each with different eligibility requirements and each paying different amounts.  The maximum non-service connected pension is called Aid and Attendance, and is available to a veteran or widow(er) who is either blind, living in a nursing home, or in need of assistance to  manage the activities of daily living. 

2012 Maximum Pension Rates for Aid and Attendance

Single Veteran         $1,703 per month
Married Veteran       $2,019 per month
Widowed Spouse     $1,094 per month

A veteran who qualifies for a non-service connected pension can also apply for benefits through the VA health care system, such as prescriptions, medical equipment, glasses, hearing aids and incontinence supplies. 

In these difficult economic times, an extra $1,094 to $2,019 a month in tax free income is not something to ignore.  If you are a veteran or widow(er) who might qualify, or if you have a family member who might qualify, now is the time to get started gathering the necessary information and filing a claim.  It can take six months or longer for a claim to be processed, but once a claim is approved, payments will be retroactive to the month after the claim was filed.

This Week's Article on ElderCareMatters.com: "Aging in Place Means Aging in Your Home"

hfelsenthalHarry Felsenthal, Certified Aging in Place Specialist
Licensed Contractor, State of Florida
Call Harry Enterprises, Inc.
Lutz, Florida  33549
Member of the national ElderCare Matters Alliance, Florida chapter

Aging in Place Means Aging in Your Home

This ultimately applies to everyone on the planet, as we are all aging and will eventually need changes to our home to make life easier and safer.  The best plan for making Aging in Place modifications to your home is, do a little at a time.  Many areas of your home may need adjustments, but if you focus on one area at a time you will be better able to devise a plan for your long-term goal of staying in your home. 

Although we all age, Aging in Place doesn’t mean the same thing to everyone.  For some, making adjustments to their home is planning for the future.  For some, making adjustments to their home is a more immediate need.  If you are limited physically in some way due to a birth defect, illness, or injury, the Aging in Place home modifications can be a more urgent matter.  However, this still is an individual need for each persons’ individual situation. 

Making a list of priorities is a great place to start.  Your Aging in Place professional can inspect your home, and help you decide what areas of your home should be addressed first.  From there, you will experience a more comfortable lifestyle and ultimately a safer environment.  Each step you take to make your home work better for you will alieviate stress, and give you peace of mind.  If wheelchair access is your primary issue, then building ramps will give you the freedom of entering and exiting your home, or wider doorways can allow you to move throughout your home without assistance.  Adding shower rails, seats, or easy-access stalls can add much needed safety, while alterations to light switches or your kitchen design could just make life more fulfilling.  How wonderful would it feel to get that independence back? 

After you can perform simple tasks around the home by yourself, you will be able to easily prioritize other areas of the home to help your home once again be a sanctuary of peace and safety.  Your high quality of life is the most important goal to achieve, and your Aging in Place specialist will get you there.

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