Lynn Harrelson, R.Ph., FASCP, Senior Care Pharmacist
8302 Cheshire Way
Louisville, Kentucky 40222
Member of the national ElderCare Matters Alliance, Kentucky chapter
Everyone who cares for todays’ seniors will eventually deal with the problems created by the medications that the seniors use. Some seniors have other watchful eyes on the medication they use. The general public is generally unaware that since Medicare was initiated in the mid-sixties that pharmacists have been federally mandated to review the medications of all Medicare patients residing in nursing homes or long term care facilities (LTCFs) across the country. Specially trained pharmacists review the use of each patient’s medications, how they are responding, train facility staff on proper dosing of medications, side-effect monitoring and documenting and they make recommendations to the prescriber for changes in orders or labs.
The role of the long term care pharmacist is extremely important in maximizing the benefits of the medicines that are used while avoiding or minimizing the risks from those same medicines. Today there are other pharmacists who provide that same detailed review and consults for seniors who continue to live independently in their community, in their home, at a retirement center or assisted living facility.
Today more seniors are taking increasing numbers of medications, these medications are more chemically complex. Seniors often use more than one physician and as they age, have many more medical conditions. Seniors also take non-prescription medications that a few years back required a prescription, counseling to assure better use and greater understanding of the side effects that could develop.
Studies have shown that if a senior takes 2 medications, the chances of a medication related problem is 6%, if they take 5, it’s 50%. If a senior takes more than eight medications, there is a 100% chance that they will experience a medication related problem. Eight (8) or more medications, that list of medications includes any prescription, non-prescription, over the counters, supplements, and nutritionals.
Although a medicine can make you feel better and maintain your health, we must be aware that all medicines have both benefits and risks. You are encouraged to visit my website for more details on medications related problems in the today’s seniors. Our first step in addressing this problematic issue is greater awareness of the problem.
William “Bill” Brown, Attorney at Law
2999 E. Dublin-Granville Road
Columbus, Ohio 43231-4030
How unusual family situations can be addressed by living trusts
Living (revocable) trusts can address unique scenarios for people that need to have their questions answered regarding significant issues, such as a disabled or handicapped beneficiary, a son or daughter who refuses to get a job or needs educational assistance. What if the parents own a vacation or secondary home? A properly drafted trust can address these matters.
The Spendthrift Son
The trust may be revocable, or irrevocable and funded during the parents’ lifetime. Direction to the trustee may provide that the beneficiary only receives trust funds (dollar for dollar) based on trustee satisfaction of W-2 or 1099 forms for the previous year. Distribution should be related to the amount of effort expended in the business or profession of the child’s choice.
Disabled or Handicapped Beneficiary
There are three basic types of trusts to cover this situation.
A revocable trust that contains language giving the trustee the ability to shut off distributions to a handicapped beneficiary and will not interfere with Medicaid or Social Security eligibility payments. This has been referred to as the “spigot test”. The beneficiary is to have his supplementary needs met over and above those paid for by state or federal benefits.
A second type of trust is a Supplemental Needs Trust that must be irrevocable and not terminate before the beneficiary’s death according to latest issues of the Social Security Administration Program Operation Manual (POM). In many states, law has codified the “spigot test”. See Ohio Revised Code ‘5111.151 (2004).
A third and seldom-used trust has been enacted by some states called a Supplemental Services Trust. See Ohio Revised Code ‘5815.28. There are limitations on its use. For instance the maximum trust principal must be under two hundred thousand dollars ($200,000). The trust must have a “pay back” to the state of at least 50%. This trust may be useful if the beneficiary qualifies, developmental disabilities, mental disabilities, or eligibility through the Ohio Department of Mental Health, a board of alcohol and drug addiction or mental health services. Ohio Revised Code ‘5815.28 (B.)
Finally, if a beneficiary is disabled and is under 65 years of age, a Special Needs Trust may be allowed. See 42 U.S., C.A. ‘1396p (d) (4)(A), or applicable state statues. It is a Medicaid “pay-back” trust that must guarantee that upon the death of the beneficiary all of the remaining funds (up to the amount paid by Medicaid) must be returned to the governmental agency making payments. A probate court, guardian, or parent of the beneficiary initially may set up this trust.
Many people wish to set aside funds for the higher education of their children or grandchildren. An education-specific trust can restrict use of trust funds to the costs of college, university or trade school tuition, books, fees and supplies if the beneficiary is regularly enrolled, and restrict principal distribution until a baccalaureate degree is obtained. The trust should be irrevocable in order to be funded each year with the annual gift tax exclusion (currently $13,000 per person) and provide the trustee with an ability to withhold distributions if the beneficiary has a substance abuse problem, is involved with potential litigation, is attached to a questionable religious organization, or is physically or mentally impaired, affecting the beneficiary’s ability to manage a distribution.
Secondary or Vacation Homes
Occasionally on the death of a spouse, the surviving spouse will own a vacation home. The couple may have a number of children, one who doesn’t partake in the activities the secondary home was set up to offer, or can’t afford to maintain a home. A specific trust for this kind of property can avoid arguments between the children, fund the costs of maintenance for years, determine permitted use and terms of selling or buying out a sibling’s interest. Such a trust keeps peace in the family and provides direction, particularly if the secondary or vacation home has passed down through a number of generations.
Finally, there are many unique situations that may be addressed using trusts and issues solved with proper estate planning, advice and direction.
Sheri Samotin, President
LifeBridge Solutions, LLC
999 Vanderbilt Beach Road
Naples, Florida 34108
Taking Charge Without Taking Over: Five Tips For Helping Your Aging Parent
Whether you are teaching your young daughter how to knit, or helping your aging mother balance her checkbook, how do you take charge without taking over? How many times have you found yourself “showing” someone how to do something by doing it for them? It’s human nature. But while it might make sense to show by doing when you are “teaching” someone younger or less familiar with a particular topic than you are, it usually leads to anger when you do this when you are “assisting” someone with a task that he previously has been perfectly capable of handling himself.
It was probably hard enough for your mom to agree to let you help her pay her bills and balance her checkbook. And even once she agreed, it wouldn’t be surprising if she told you that she didn’t know why you were insisting on helping her since she is perfectly capable of doing it herself. The truth is that acknowledging that you need help with the business of life is really, really hard for most seniors. If they come to the point where they need your help, they are confronted with their own limitations. And those limitations won’t “get better” in most cases. Deep down, your mom knows that this is the beginning of the end of her independence as she has come to know it.
So, how do you take charge without taking over?
Sometimes, no matter how you approach the situation, you’ll find yourself in a confrontation with your Mom or Dad over how to best care for them. At these times, you and your parent might find it helpful to talk with an objective third party such as a family transition coach who can shed new light on the situation. Your job as your parent’s caregiver is to keep them safe, comfortable, and happy. As long as you keep that in perspective you should have no trouble taking charge without taking over.
John E. Settle, Jr., Esq.
John E. Settle, Jr., Attorney at Law
1915 Citizens Bank Drive
Bossier City, Louisiana 71111
Member of the Louisiana chapter of the national ElderCare Matters Alliance
The Internet and Elder Law
In the words of Charles Dinkens, “it is best of times, and the worst of times” when one thinks of using the internet to get answers to important questions on law, medicine and/or investments. The internet is one of the most important developments of modern civilization, and not a day (Q: hour?) goes by without more expansion, and sometimes invasion, by internet “tools” that are supposed to make our lives better.
As an attorney who has practiced more than thirty years, I always welcome a client who has some knowledge on the topics that are the subject of my consultation – – be it from a neighbor, his uncle Charley or a jailhouse lawyer. Generally it is fairly easy to have a client focus on my education and experience versus these “sources” of law. However when it comes to “internet law” it is often much more difficult to rebut, differentiate or explain the “real” law versus PC downloads.
Unfortunately, a false sense of authenticity is often given to internet documents – – without serious inquiry as to who put this information on the internet. Many individuals do not realize /understand that the internet is not like Encyclopedia Britannica, and that there is no scholarly screening body/agency to ensure accuracy of what can be found on the “net”.
When presented with an internet Will, Trust, Power of Attorney or any other legal document, I always ask my client the following questions:
1. Do you know if this document is drawn in accordance with the laws, and legal requirements of your state of residence?
2. How do you know if this is the document(s) you really need?
3. And who are you going to complain to if you utilize this document and it doesn’t “work” the way you intended?
It is important for all seniors to know that the laws of each State on inheritance – – with or without a Will – are generally quite different, as well as the requirements for proper execution of the Will. Furthermore, generic powers of attorneys can sometimes cause challenges, especially in the area of health care. Similarly, the so-called advantages of a Living Trust to transfer assets after death vis a vis a Will are generally overstated, and frequently do not obviate the need for succession proceedings to be instituted to transfer title to real estate.
The same is true for Medicaid eligibility, and what the maximum reliable assets can be owned by the senior seeking Medicaid assistance and/or the senior’s spouse. There are fifty different sets of Medicaid rules – one for each of the fifty states in the union. Thus much of the “water cooler” scuttlebutt about Medicaid eligibility is just that – – misinformation.
The internet is a great tool for learning, but it should not be considered to be the expert on life and death planning documents. The one size fits all mentality of most internet articles and legal forms on the internet are trips for the unwary. Seniors should seek the advice and counsel of licensed attorneys in the state of their residences. After all, an actual dialogue with an individual is much better than reading a computer screen when making major life decisions.
Angela N. Manz, Attorney at Law
The Law Office of Angela N. Manz
Virginia Beach, Virginia 23452
There are several government benefits available to seniors who need help paying for extended care. However, the qualifications and requirements for these benefits can often be complicated and confusing, leaving many people unsure of how to qualify or whether they are applying for right benefit for their family.
When seniors and their families first meet with me, I like to find out about their current care needs, how much they are paying for care, their income, and their concerns for the future. This helps me determine whether they are eligible for the VA pension or Medicaid and allows me to focus on any future family changes or problems that we may need to plan for. After we talk about their concerns, I help the family match their care needs with their financial situation and create a plan that will preserve their assets, protect their family and get them the care that they need. Every family is unique and the plan for your family should be unique as well.
Two of the most important benefits available to seniors are Medicaid and the Department of Veterans Affairs (VA) Aid and Attendance Pension. While the programs may seem similar, the eligibility requirements and the benefits are quite different.
VA Aid and Attendance Pension
The VA pension is available for veterans and their surviving spouses. It pays a monthly dollar amount and that money can be used to help pay for a nursing home, assisted living rent, adult day care, in-home care, including when a child is caring for a parent, and other medical expenses. For a married veteran, the maximum pension is $1,949 per month. A single veteran may receive a maximum of $1644 per month and a surviving spouse may receive $1056.
In order to be eligible, the veteran must have served 90 days of active duty in the military, with one day during a period of wartime. The VA has established specific dates that constitute a “wartime period,” but generally veterans who served during World War II, the Korean War, the Vietnam War, and the Persian Gulf War will be eligible. Veterans also must not have been dishonorable discharged.
Next, the veteran or surviving spouse must show that they need the assistance of another person in order to perform daily tasks, such as eating, bathing, dressing, cooking, taking medications, or driving. Veterans and surviving spouses needing assistance or a protective environment to stay safe because of dementia may also qualify for the benefit.
Finally, in order to receive the pension, all applicants must meet the asset restriction. Unlike Medicaid, the VA does not have a set asset limit for this pension. Instead, the VA will look at many factors to determine if assets are too high. The VA does not include the value of the home or a car.
Even though there is an asset limitation, the VA does not penalize for transferring assets outside of the veteran or spouse’s name, if done correctly. This means that there are many planning options available to help families become eligible for the benefit. However, you must be careful. When assets are transferred to secure eligibility for VA benefits, the family must have a plan ready in the event that their loved one needs Medicaid in the future to pay for extended nursing care. Medicaid imposes a penalty for assets that are gifted away or moved into certain types of trusts and I strongly suggest that you work with an experienced elder law attorney before making any gifts or transfers.
When should you consider VA Aid and Attendance?
I generally recommend that families apply for Aid and Attendance when they have medical expenses that exceed a large portion of their income and using the pension would help bridge that gap. For example, if Mom and Dad have a monthly income of $2,500, and they move into an assisted living facility that costs $3,500 per month, I would recommend that they apply for the VA pension. For a married veteran, the maximum pension is $1,949 per month. Therefore, the VA pension, combined with their income, would give them enough money to pay for their assisted living community. Further, in many states there is little or no Medicaid help for assisted living, making the VA benefit even more valuable.
What if your loved one is in a nursing home? Typically, the cost of nursing home care is often so high that the VA pension does not pay enough to cover that cost, even when combined with your loved one’s monthly income. However, if your parent is going through a Medicaid penalty period or needs time to spend down assets before he can be eligible for Medicaid, the VA pension can be of great help during that transitional period.
What is Medicaid?
While Medicaid is also designed to help with the cost of long-term care, it differs from the VA pension. Medicaid does not pay a monthly pension. Instead, Medicaid directly pays the care provider, i.e. the nursing home.
Many people believe that they can only get Medicaid once they have spent all of their money in the nursing home, but this is absolutely not true. To be eligible for Medicaid, the applicant may only have $2,000 in countable assets. However, not all assets are “countable” assets. In Virginia for example, non-countable assets include up to $2,000 cash, your home (under certain circumstances), one car, personal property, certain funeral and burial funds (including a pre-paid funeral or burial), certain property used in a trade or business, some life insurance (up to $1,500 cash value), and certain annuities.
Further, even though the Medicaid applicant may only have $2,000, we still have many options for legally sheltering and protecting assets. Unfortunately, Medicaid does not pay for everything that someone needs while they are in a nursing home. Therefore, it is important to be able to keep some assets for the benefit of the Medicaid applicant so that they can have what they need, as well as those things that bring them comfort and enjoyment. Typically, a married couple can protect most, if not all, of their assets and have one spouse become eligible for Medicaid. A single person can typically protect half of their assets and then become eligible Medicaid. Never assume that your parent or loved one is not eligible.
When should you consider Medicaid?
I typically recommend Medicaid when someone needs extended care in a nursing home. This is because the cost of the nursing home is generally so high that the person’s income, even coupled with the VA benefit, is not enough to pay for the care without depleting their assets.
I may also recommend Medicaid for home care when the household income is high, but the person requiring care has a low income. The VA considers the total household income, while Medicaid typically only looks at the income of the person needing care. For example, if Dad has a monthly income of $4,500, and Mom’s monthly income is only $500, it may not be wise to apply for the VA pension. To get VA benefits, Mom and Dad would have to spend a large amount of their income each month on Mom’s care. If they can’t afford that much care or if Mom doesn’t need that much care, I may recommend that Mom apply for Medicaid home care benefits. Because Medicaid only looks at Mom’s income, in many states Mom would qualify regardless of Dad’s high monthly income. However, it is important to make sure that Mom still meets the asset requirement for Medicaid, which may require sheltering assets before she could become eligible.
While these benefits are complex, they can be a tremendous help for your family and you should never assume that your loved one cannot qualify. Caring for a senior parent can be difficult, but taking the time to fully explore all of the benefit options is worth the effort so that your loved one can preserve their assets, protect their family and get the care they need.
Amy Cameron O’Rourke, MPH, CMC
The Cameron Group
Orlando, Florida 32803
Watching a parent grow older, become more frail and maybe more vulnerable can be an enriching experience when there is a framework for understanding the stage they are in. Without understanding some of the common stages, however, it can be a time fraught with frustration and anxiety. This time of life for an elder is called “late life” and one of the books that best describes and supports this time is the pioneering book, “ My Mother, Your Mother”, by Dr. Dennis McCullough.
The stage that will be the focus of this article is the crisis stage. This stage is characterized by an acute medical episode such as a fall or a stroke. It can be something non-medical but just as devastating such as loss of driving privileges, loss of memory; some life change that has begun significantly altering the elders’ lifestyle. Typically the elder is in denial of the severity of the change and the children are overly anxious as they are projecting the worst case scenario on to the elder. Communications frequently breakdown as anxieties collide. The elder does not want the children telling them what to do and the children want a permanent solution placed on their parent so they don’t have to worry anymore.
Strategies for the Crisis Stage: Bring in an objective third party to guide these communications, which are usually fraught with emotions. Professional Geriatric Care Managers are elder care experts who understand the complex systems that care for the elder (hospitals, nursing homes, assisted living facilities) and can help the family successfully resolve the immediate problem and coordinate a plan of care for after the crisis is over. They listen carefully to each family member and the elder to help the family come to a consensus.
Family meetings for are set up on a regular basis for the future with the following recommended components. First, time in the beginning of the call should be allowed for each family member’s concerns to get verbalized. Secondly, prioritize the concerns and list the responsibilities associated with the concerns. Lastly, divide the responsibilities for the care of the elder. For example, long distance siblings may be responsible for communicating to other family members via e mail, phone or Facebook. They may also take on the insurance issues, or financial issues that arise. This leaves the hands on care for the child who lives locally. The Care Manager can be on the calls to help with the decision making and also provide guidance and assistance in implementing some of the solutions the family members decide upon.
After the crisis, the family meetings should be continued to maintain continuity of communication and to maintain the plan of care for the parent.
Philip C. Benedict, CFP
Benedict Financial Advisors, Inc.
Atlanta, Georgia 30328
What would make most people happier? Better health? More friends? More time with children and grandchildren?
Most people of any age would like more of the above, but one thing that would definitely improve the financial and emotional quality of the lives of many people, especially seniors, is more monthly cash flow. Think about it.
If you have plenty of monthly cash flow you can hire people to do the things you can no longer do. If you have insufficient monthly cash flow you are dependent on family, friends and government programs.
I don’t know about you, but, I want to be able to control my own financial destiny as much as humanly possible.
The time to act to create a higher monthly cash flow isn’t when you are elderly, it is right now. Right now, no matter what your age. It isn’t when interest rates are higher, it isn’t when the stock market is higher, it isn’t when Congress finally does something right, it is RIGHT NOW.
Every person and every family that dreams of a retirement of leisure and a dignified ending needs to start creating their future monthly cash flow today.
At the core of creating this future monthly cash flow is the strategy of investing in dividend paying common stocks of globally dominant companies. Of course everyone needs some savings in the bank and maybe some interest paying bonds, but it is getting comfortable with investing in dividend paying stocks and doing it that will potentially give you the cash flow you want during your retirement years.
What? You say owning common stocks are too risky to count on during retirement. Maybe that is because you are focused on the daily share price movements of the stocks rather than the cash flow the stocks are expected to generate. You have to learn to differentiate between the stock price and the underlying value of the operating company.
For a simple example, let’s take a look at a giant consumer products company’s actual history and see if we can focus on the company and not the stock.
Let’s look at the COMPANY over the last ten years:
Let’s look at the STOCK:
This company has been very successful. Management has done about everything an owner (shareholder) could expect it to do. It has increased revenues, profits and the amount of benefits to the shareholder (dividends).
What can corporate management NOT control? It cannot control the share price, which is a function of the euphoria-and-panic of the financial marketplace.
If you are retired or planning to retire, your investment accounts are probably an important source of your retirement income. And, what do you really need in retirement? For most people it is the monthly cash-flow.
What has this company done for shareholder cash-flow (dividends) since 2000? It has more than tripled.
There are no guarantees in the world of investing but IF this company can triple it’s dividend over the next ten to twelve years, then the shareholder will be earning about 9% to 10% annually based on today’s investment. That will be a nice retirement cash-flow.
Own the company and not the stock.
I realize we can only own the “stock” of a publicly traded company, so it is more accurate to say FOCUS on the company and not the stock price.
But, you may be saying, “This country is in a giant mess and the mess seems to be getting worse every day.”
The original roots of this company go back to the year 1837. It has survived the war-between-the-states, two world wars, various terrorist attacks, and all sorts of natural disasters and the leadership of a lot of inept politicians over the years. It was able to prosper during the terrible inflation years of the late 1970’s and early 80’s. Today, most of its revenues are earned outside of this country, thus it is not overly dependent on the domestic economy.
However, despite this resilience, the share price of this company has declined in value rather dramatically many times during its history. And we would expect the same in the future. Own the company and not the stock; it is the key to your financial contentment during your retirement years.
Even a great company can stumble, so you need to consider owning a group of stocks similar to the one above and enjoy the quarterly dividends. We believe no other asset class is likely to adapt to the rapidly changing and challenging world economic environment as well as these globally dominate international companies. They need to be a core part of almost every investor’s retirement income.
J. Michael Bishop, JD
Smiley Bishop & Porter, LLP
1050 Crowne Pointe Parkway
Atlanta, GA 30338
Interest rates on bank CDs and money market funds have been at historic lows over the last several years. Sure, everyone wants to make more income from their assets. But always remember there is no free lunch. No matter what a salesman might tell you, with bigger returns come bigger risks.
In an effort to attract seniors’ retirement funds, Wall Street has introduced an array of increasingly complex products that promise investors higher yields than are available from CDs or government bonds. Unfortunately, most of these products carry the danger that an investor can lose most or all of his or her principal investment. In many instances, higher yielding investments are simply inappropriate for seniors seeking to preserve their assets and should not be recommended by stockbrokers, financial advisors or investment advisors. (more…)
You helped your veteran client obtain eligibility for veterans pension with aid and attendance. The application was filed, all verification materials were submitted, and you wait for an answer. The good news is, your client was awarded with benefits. You feel really good about helping veteran clients. You feel even better when the Veterans Administration approves a claim for one of your clients.
But then the call comes in. The client is calling to ask you why they haven’t received any money. (more…)
Callie Rogers, age 16, won $3.1 million in a British lottery. By the age of 22, the unwed mother of two, having attempted suicide twice, and having spent over $400,000 on cocaine alone (in addition to more conventional luxuries), was broke, living with her mother, and working three cleaning jobs. She described her sudden windfall as having ruined her life, and she was looking forward to finding happiness once her winnings were gone. (more…)
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