Hospice provides end-of-live palliative care for those who are in the last year of their lives.  Hospice services are paid by Medicare and the goal is to provide palliative (not curative) care and support for the family.

Palliative Care

The goal of hospice is to keep the ill person comfortable.  There is no reason for anyone to die in pain.

There are no attempts to cure any illness.  Hospice services are available when no curative path is available or no curative path is chosen.

For example, a patient with advanced pancreatic cancer may choose hospice.  All attempts are made to provide medicine and care to eliminate pain.  No chemotherapy or radiation would be provided.

Stay at Home

Often, it’s a goal to keep an ill loved one at home as long as possible; so, hospice provides care at home.

If more support is required, many hospices have facilities where the ill person can stay 24/7, receive palliative care, and family can visit and receive support services such as counseling and social work support.

Examples of Care Provided

Hospice provides nurse evaluation and visits; pain control; wound care; caretakers to provide assistance with bathing, dressing, toileting, and shaving; and social worker sessions.

If you are ill and the doctor has provided a prognosis of one year or less, either the doctor or you can call a hospice for an evaluation to determine what services are appropriate for you and your family.  Most families who use hospice services rave about their experience.

If you have any questions about hospice or other elder care support services consult with a qualified estate planning attorney.

Legacy APC, A Trusts & Estates Law Firm is a member of the American Academy of Estate Planning Attorneys.

We understand that it can be overwhelming when a loved one is diagnosed with a serious illness.  There are all kind of family, financial, administrative and legal things to do and you may not be sure what to do or how to do it.  That’s why it’s in your best interest to call a qualified estate planning attorney for guidance.

Testamentary Capacity

A qualified estate planning attorney can determine whether your loved one still has legal competence.  If so, estate planning documents can be put into place so that your loved one’s wishes are carried out and your burden is reduced.

Checklist

A qualified estate planning attorney can provide a checklist of things you need to do and things to think about.  This way you won’t overlook anything.

Legal Advice

A qualified estate planning attorney can help you and your loved ones make important decisions.  Be sure not to take the advice of well-meaning neighbors, bank tellers, or loved ones.  Get good legal advice before making decisions.

Referrals

A qualified estate planning attorney can refer you to other professionals such as geriatric care managers, realtors, financial advisors, appraisers, insurance professionals, home care specialists, hospice care suppliers, etc.

Although it’s always in your loved one’s benefit to take care of these matters before serious illness strikes, it may not be too late.  Consult with a qualified estate planning attorney right away.

Legacy APC, A Trusts & Estates Law Firm is a member of the American Academy of Estate Planning Attorneys.

If you don’t immediately qualify for MediCal to pay your nursing home bills, a qualified estate planning – elder law attorney may be able to help you to qualify, so you don’t lose all of your hard earned money and so you receive the care you need.

When Should I Plan?

MediCal pays for nursing home care for those who are both medically and financially needy.  The sooner you do planning, the more options you have and the more money you can protect.  The ideal time to do MediCal planning is at least 5 years before you need it; but it’s never too late.

What are MediCal Plans?

Common MediCal planning strategies include trusts, gifting programs, and transforming non-exempt assets into exempt assets.  These strategies are used to increase your quality of life, increase the quality of life of your spouse, and protect hard earned assets.

How will an Attorney Help Me?

A qualified estate planning – elder law attorney can help you by:

• Design of a MediCal plan, specific to your individual situation.  This includes a plan to avoid MediCal recovery.
• Implementation of your MediCal plan (i.e. getting your plan in place.)
• Preparation of MediCal application.
• Handling all communications with MediCal office, during the application process.
• Preparation of basic estate planning documents.

But, What about the Legal Fees?

If you’re like most people, you are concerned about the legal fees associated with Medi-Cal planning.  Typically, fees are about equal to what it would cost you to pay one month in a nursing home, saving you and your family thousands and thousands of dollars.

Do NOT Try this at Home

Just like you see on television, when it comes to MediCal planning and transfers, do NOT try this at home.   MediCal laws are complicated and they constantly change.

In addition, transfers, if done incorrectly, may disqualify you from receiving MediCal and may have serious tax consequences.

If you want MediCal to pay for your nursing home care, consult with a qualified estate planning – elder law attorney; the sooner, the better.

Legacy APC, A Trusts & Estates Law Firm is a member of the American Academy of Estate Planning Attorneys.

We can answer this common question, “Can the nursing home take my living trust assets?” in one word.  “Yes.”  Assets titled in your own living trust (or in your name) can be taken by the nursing home.  They must be spent first, before you can qualify for MediCal to pay for your nursing home care.   This means that the assets must be spent down for living expenses, nursing home care, or exempt assets before MediCal kicks in.

Nursing Home Planning Strategies

However, there are other ways to protect your assets and the sooner you meet with an estate planning –elder law attorney, the more options you have and the more money you can protect.  Common nursing home planning strategies include long term care insurance, income only trusts, gifting programs, annuities, and the purchase of exempt assets such as a new roof for the house, a television for the room, and a lift chair as well as paying off the mortgage or car.

Are You the Beneficiary of Someone Else’s Living Trust?

On the other hand, if you know you’re someone else’s beneficiary, you may want to have a chat with him or her and ask that the assets come to you in an asset protected beneficiary trust.  If you receive assets in trust, they can’t be taken by the nursing home, divorcing spouse, or another creditor.

Conversely, if you receive an inheritance or gift outright, in your individual name, it can be taken by the nursing home, divorcing spouse, car accident creditor, bankruptcy creditor, and the like.

A Loved One Can Give You Protection You Can’t Get for Yourself

While your own revocable living trust cannot protect against your creditors such as the nursing home, someone else’s can.  Consult with a qualified estate planning attorney to determine the best way to own your assets, plan for nursing home care, and give/receive an inheritance or gift.

Legacy APC, A Trusts & Estates Law Firm is a member of the American Academy of Estate Planning Attorneys.

As a loved one continues to age, it can be difficult to discuss the inevitable long term care needs.  Both you and your loved one will likely feel anxieties and denial about her needs.  It’s important to communicate effectively so that you’re able to get her the help she needs.

Take a look at the information below to learn ways to better communicate about long term care.  If you have any questions, or if you’d like to discuss long term care options, meet with an estate planning – elder law attorney.

Encourage your loved one to ask for help. It’s important that your loved one feels comfortable asking for help and discussing her needs.  This will open the door for discussions such as long term care topics.  If you and your loved one have a comfortable relationship, she will likely feel comfortable discussing difficult topics such as long term care.

Slowly ask questions and bring up conversations. It may take your loved one some time to feel comfortable talking about her needs.  Don’t try to pressure your loved one into discussing her needs in one conversation.  It’s a good idea to spread out the discussions. You will be able to accomplish more over a more lengthy time period than in one afternoon.

Communicate with your loved one about the many options. Most seniors have fears of long term care because they assume there is only one way to get care:  the nursing home.  There are many ways to get the care that is needed such as home care and assisted living facilities.  It’s a good idea to communicate all of your loved one’s options so that she has a better understanding of her choices.

Take the time to carefully discuss this difficult topic with your loved one.  If you have any questions, or if you’d like help choosing a long term care option, consult with a qualified estate planning – elder law attorney.

Legacy APC, A Trusts & Estates Law Firm is a member of the American Academy of Estate Planning Attorneys.

Elder abuse runs rampant in our society.  You can help to prevent and stop financial elder abuse by being aware that it exists and of its signs.

MetLife Mature Market Institute and the Center for Gerontology at Virginia Tech just released a study indicating that the elderly are victims to financial abuse by close family members, friends, neighbors, and strangers. 

Women are more likely to be victims than men and men are more likely to be the perpetrators than women.  Those who live alone are targeted most often.  It seems the “ideal” target for financial elder abuse is a woman in her eighties, who lives alone, but needs some help.

This financial abuse isn’t nickels and dimes.  Annually, about 2.9 million dollars are unscrupulously taken from elders each year.

Signs of Financial Elder Abuse

• Secret relationship or marriage between elder and caregiver
• A new friend separates or distances elder from family and friends
• Someone tells your elderly loved one that he’ll take care of her until she dies if she gives him all of her money
• Missing family heirlooms
• Missing money
• CDs are cashed in even though there are penalties
• Change in account beneficiary or account owners
• Change in deed or mortgage
• Numerous account withdrawals
• Sudden unexplained change in estate planning documents such as wills, trusts, or powers of attorney
• Inappropriate or unexplained gifting to friend, neighbor, family member, stranger, church, or other charity
• Missing credit card bills or unexplained credit card charges
• Elder is uncomfortable or can’t answer questions about finances
• The same telemarketer calls more than once
• Someone has an unexplained interest in your elderly loved one
• Financial activity that couldn’t have been completed by elder such as ATM withdrawal by physical or mentally impaired elder

If you suspect financial elder abuse, report it immediately.  You can make a difference.  Don’t hesitate.

Legacy APC, A Trusts & Estates Law Firm is a member of the American Academy of Estate Planning Attorneys.

If you have elderly parents, there are likely three generations in your family that all need estate planning: you, your parents, and your adult children. For those with elderly parents, there are important estate planning considerations:

• Your elderly parents may fear losing control of their finances and their lives. Proceed with caution and great respect.

• Your elderly parents may fear the onslaught of dementia. Gently support them in getting medical treatment and having open and honest discussions with the doctor.

• Sometimes, elderly parents attempt to hide symptoms of dementia because they are afraid and/or ashamed. Never shame. Always support.

• Elderly parents often deal with depression especially if they have failing health, the loss of a spouse, the loss of friends and siblings, and the loss of independence. Depression can be treated with medication. There is no reason anyone should suffer.

• Many elderly parents should not be driving, but they are hesitant to give up their driver’s license because it is the last line of defense in losing their independence. If your parents have a HIPAA release and your are authorized to do so, speak with your parents’ doctors about the driving issue.

• Talk to your elderly parents about estate planning. Gently ask what planning is already in place. If comprehensive and up to date planning is not in place, suggest that they meet with an estate planning attorney and offer to make the arrangements and drive them.

• Gently explain that if your parents don’t have powers of attorney for health care, you can’t help them with medical decisions and a court might have to intervene.

• Gently explain that if your parents don’t have powers of attorney for finances, you can’t help them with paying bills and taking care of day to day business. If they become too ill to take care of these matters themselves, the court will have to intervene.

• Court intervention is expensive, time consuming, an invasion of privacy, and public.

If you have questions about elderly parent estate planning considerations, consult with an estate planning attorney.

Legacy APC, A Trusts & Estates Law Firm is a member of the American Academy of Estate Planning Attorneys.

We have highlighted the rising costs associated with long term care recently and they are indeed considerable. To briefly recap, the average annual charge for a yearlong residence in an assisted living facility in the United States was just a tick under $40,000 in 2010. This represented a very significant 5.2% increase over the previous year, and nursing home costs rose by nearly as much.

The national average for a year in a private room in a nursing home in 2009 was $79,935, which is certainly no small chunk of change. But in 2010 that number rose to $83,585, which is a 4.6% increase. In California this average was higher, coming in at over $100,000 a year.

Statistics indicate that the average stay in a nursing home is about two and a half years, so this is a cost that is significant and needs to be budgeted for appropriately. And remember, we are seeing annual increases, so if you are planning for long term care that may become necessary 20 years down the road the costs may well be 50% higher, and perhaps even more. If you are married your projections should be double the anticipated costs for an individual.

Stating that “one must plan ahead” for these costs is easy, but doing so effectively is challenging. Unless you are fortunate enough to be able to say with confidence that money is no object, you need to understand the options that are available to you and act accordingly.

Medicare is not going to cover these costs; Medicaid might unless you are showing too many assets. Long term care insurance in an option, but funding the premium payments can take some planning.

Your decisions with regard to long term care have a lot to do with your estate plan, because your legacy can be severely eroded if you and your spouse should incur hundreds of thousands of dollars of expenses toward the end of your lives. The wise course of action is to discuss long term care with your estate planning lawyer and address this contingency pragmatically early on so that your needs are met and the lion’s share of your legacy remains intact.

Legacy APC, A Trusts & Estates Law Firm is a member of the American Academy of Estate Planning Attorneys.

One of the duties of an elder law attorney is to stay abreast of all the relevant trends as they are unfolding, and with each passing day the rapid multiplication of the elder population is becoming a bigger and bigger story. Senior citizens represent the fastest growing segment of the society, and in fact, 10,000 new Social Security applicants are stepping forward each and every day. This is expected to continue into the foreseeable future and experts say that the number of senior citizens in the United States will double by the time 2030 rolls around. In addition, people 85 years and older are the fastest-growing group of seniors.

This added longevity is clearly exciting on the one hand because life is precious, yet there is another side to the coin as well. The Alzheimer’s Association recently published a study titled “2010 Alzheimer’s Disease Facts and Figures” and the numbers they have come up with are telling indeed. Some 5.3 million Americans are suffering from Alzheimer’s disease, and 5.1 million of the reported cases involve senior citizens. So this means that one in eight or 13% of all people 65 years of age and older have Alzheimer’s disease. To take it a step further somewhere in the vicinity of 40% of senior citizens termed the “oldest old,” those 85 and up, are victims of Alzheimer’s disease.

To sum it up people are living longer than ever, the senior population is growing rapidly, and the oldest among us are increasing faster than any other group. At the same time, the older you get the more likely it is that you will contract Alzheimer’s disease.

The possible encroachment of Alzheimer’s disease is a reality that we all must face, and the only way to do it intelligently is by making the proper preparations. This is what incapacity planning is all about, and if you do not presently have an incapacity plan in place it would be wise to consult with an experienced elder law attorney who will assist you in making sure that you are prepared for any eventuality.

Legacy APC, A Trusts & Estates Law Firm is a member of the American Academy of Estate Planning Attorneys.

Things can sometimes move slowly, and when it comes to estate planning this is often the case. Many people put off the exercise for a couple of different reasons. For one, thinking seriously about the time when you will be passing away is not the most pleasant scenario to consider. And in addition, even if you don’t mind facing up to the reality, it is natural to put off things that seem irrelevant until well into the future. Plus, things are always changing, and you may think that if you alter your estate plan you will only have to do it again the next time something changes.

This line of thinking is perfectly understandable but tragically flawed. Estate planning attorneys always try to emphasize the fact that preparing for the end of your life is not a one-time event; it is an ongoing process, and it should be seen as such. This idea that you don’t have to think about creating or updating your estate plan “just yet” is a riverboat gambler’s approach.

Does death send a calling card? Will you get some sort of invitation that gives you plenty of advance notice, letting you know that you might want to go ahead and visit your estate planning attorney? Death often comes suddenly, and short of that serious illness can strike and either leave temporary or permanent incapacitation in its wake and make a trip to your attorney impossible.

The correct approach is to recognize the fact that you will have to update your estate plan when life changes take place. Things like changes in your marital status, new additions to the family, significant changes to your financial status, the death of a loved one, and changes in the marital status of your heirs can create the need for an estate plan update. If you procrastinate you are putting the well being of your family at risk.

Legacy APC, A Trusts & Estates Law Firm is a member of the American Academy of Estate Planning Attorneys.