Options to Consider When Planning for Long-Term Care Expenses

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Photo via Pexels

The need for long-term care is shared by as many as 12 million Americans today. Many of these seniors find it difficult to finance the high costs of long-term care, particularly in nursing homes or assisted living facilities. Although Medicare can help seniors pay for expensive medical services and treatments, it does little to help cover the expenses of daily living assistance. Even if you never anticipate needing long-term care, it’s an excellent idea to be prepared. Plan ahead to cover the costs so you can support a high quality of life for you or your loved one.

Aging in Place Safely

The majority of seniors who receive assistance choose to remain at home rather than in an institution. This can easily be managed by making some simple home upgrades to increase the safety and functionality of your space. This might mean installing grab bars in bathrooms to reduce the risk of falls or widening doorways to accommodate walkers and wheelchairs. You should consider removing loose carpeting to prevent trips and slips. Adding extra lighting to entrance ways and staircases will also help prevent falls by increasing the visibility of steps and other hazards. If you can, move your essential rooms to the ground floor of your house to minimize the number of times you need to use the stairs. Installing railings on both sides of staircases can also make a huge difference when it comes to safety. The idea here is to make your home safe, more enjoyable and easier to live in.

Understanding Your Insurance Options

Long-term care insurance is invaluable to seniors who end up requiring assistance with daily tasks. You have a couple of different options for this. Long-term care insurance will cover the costs associated with care that are not covered by Medicare. For many, however, the premiums required by long-term care policies are too high, causing Americans to look elsewhere for help with coverage. Another, newer option is to get a hybrid life insurance policy with a long-term care option. If you end up needing long-term care, this policy will help you cover the expenses. If you don’t, your family will receive your death benefit. Just note that these hybrid policies are often more expensive than traditional long-term care insurance.

Government Programs That Can Help You

Although Medicare does not cover the costs of ongoing personal care, Medicaid may be able to help you out if you’re a low-income family. Your eligibility for Medicaid will depend on your assets and the specific requirements of your state, but the program generally covers costs for nursing homes, assisted living, and care at home. Some states have PACE, a program that can provide at-home care to people who would otherwise have to move into a nursing home. You should also take advantage of any veterans benefits or Social Security disability income that you may be eligible for. Check out Benefits.gov for more information.

Receiving Income from Your Investments

Another option is to supplement your retirement pension by using your assets to produce an income. PayingForCare recommends seeing if you can fund long-term care yourself to avoid paying insurance premiums. For example, if you’re moving to a nursing home or assisted living facility and your house will remain empty, you can rent it out to help pay for your care. If you choose to sell your home, you can invest the money into bonds and shares that pay out regular returns. Both of these options allow you to hold onto your assets while using the money they generate to fund your care. This may not be able to cover the full expense of long-term care, but it can certainly help you out.

Seniors can still have a meaningful life regardless of any decline in their physical or mental functions. Long-term care allows people to receive the individualized support they need to retain their dignity and age with grace. Since long-term care can be quite costly, anyone over 50 should seriously consider planning for the expense, even if you don’t think you’ll need it.

Source: Marie Villeza of ElderImpact
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Like Prince, Aretha Franklin Died Without a Will

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Aretha Franklin, Queen of Soul, died August 16 at the age of 76 – without a Will. Her four sons and niece have already filed papers in Court, which means there will be public proceedings over her estate and possibly court battles, depending on who claims what. Aretha is not the first celebrity to die without a Will. Prince also died without a Will, as did Amy Winehouse. Since they died without a Will, no one knows what they would have wanted to happen to their assets. For Amy, her parents inherited her estate and her ex-husband got nothing.

Other celebrities had a Will but it wasn’t updated, like Philip Seymour Hoffman, James Gandolfini, and Heath Ledger. For example, Philip Seymour Hoffman had three children with Marianne O’Donnell but only mentioned one child in his Will. Heath Ledger did not update his Will to include Michelle Williams or their child; instead, his $20 million estate went to his parents and sisters. And James Gandolfini’s outdated Will sent $30 million of his $70 million estate to the IRS.

Unexpected celebrity deaths can make us think about what estate planning documents we have in place. Even for a normal sized estate, the hassle of probate administration and the tax implications of dying without a Will can be devastating. For most of us, a Will accomplishes what we need. You decide who gets what and who will be in charge of administering your estate. However, Wills are public documents after your death and going through probate administration can be costly and time consuming.

For some people, including Aretha, a Revocable Trust is a better way to dispose of your assets. With a Revocable Trust, you still decide who gets what and who will be in charge, but it is private. This can be advantageous for those who do not want the public knowing who benefits or does not benefit from their estate. You still have a Will when you create a Revocable Trust, but it is usually a Pour-Over Will. A Pour-Over Will says that everything you own goes into your Revocable Trust. Another advantage of a Revocable Trust is that you can change it easily at any time as your situation changes.

In all cases, you should have some sort of estate planning in place. And you should make sure it is up-to-date. Our lives change constantly – relationships change, people are born, people die, your financial status changes. Review your estate plan regularly to make sure it accurately reflects your wishes. Contact our office to create a new estate plan or update an existing one.

Source: Forbes “Like Prince, Aretha Franklin died Without a Will. Why You Should Have One” by Robert Wood

2018 Annual Guardianship Forum

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Easterseals Arc

Join us for the 10th Annual Guardianship Forum! This year’s forum will be hosted by Volunteer Lawyer Program (VLP) of Northeast Indiana and Easterseals ARC. Parents and caregivers are invited to learn more about the complex facets of guardianship related to special needs. The forum will also help attendees discover local resources for assistance. The panel will include Magistrate Phillip Houk, who often oversees guardianship proceedings; Attorney Tracy Troyer, who helps many parents and caregivers establish guardianship; representatives from VLP and Easterseals ARC; and parents with firsthand experience with the guardianship process.

This conference will be held on Tuesday, September 11 from 6:00 p.m. to 8:00 p.m. It will be held at the Allen County Public Library, 900 Library Plaza, Fort Wayne, Indiana 46802. There is no cost and no RSVP is necessary. If you need more information, please contact below:

Lynn Walker
Easterseals Arc
lwalker@esarc.org
260.456.4534 ext. 204

Hope to see you there! If you’re unable to attend but would like more information, read our blog articles:

Feel free to contact our office to speak with an attorney experienced in guardianship proceedings.

Summer Tips for Those With Dementia

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Summer is perfect for outdoor cookouts, picnics, parties, and more fun. Many families love spending time outdoors together, enjoying good food and warm weather. However, the outdoor fun can be challenging for those living with Alzheimer’s and dementia. In America, there are 5.7 million people living with Alzheimer’s and more than 15 million people caring for someone with Alzheimer’s. In Indiana alone, there are 110,000 people living with Alzheimer’s.

It can be challenging to incorporate someone with dementia into your summer plans and outdoor events. The Alzheimer’s Association has some tips that can help families to plan, adjust their expectations, and have an enjoyable summer with everyone in the family:

  • Tell people. Make sure your extended family and friends know that this person has dementia. Let them know what to expect and how they can help – such as activities they can do with the person and how to best communicate with them. Rather than having group conversations, try engaging the person with dementia one-on-one.
  • Involve the person with dementia. Keep the person with dementia involved in the activities and conversation. Avoid isolating him/her. Depending on his/her abilities and preferences, he/she may be able to help with the planning and set up.
  • Be flexible. Some situations may be less stressful to a person with dementia than others. If evenings are more difficult for the person with dementia, consider having your event earlier in the afternoon. If you are attending an event, you may arrive earlier when there are less people.
  • Plan ahead. If you are attending a gathering, talk to the host beforehand for any special needs. For example, the person with dementia may need a quiet room he/she can retire to when tired or worn out from the noise and distractions.
  • Adapt your summer holidays. Some holidays such as Memorial Day and the 4th of July can be exceptionally challenging due to the loud noises and large crowds. Be adaptable by celebrating these holidays in different ways, such as watching fireworks from indoors or watching the parades on TV.
  • Adjust your expectations. You may have many summer traditions with your family that you enjoy. Rather than expecting these traditions to remain exactly how they were before a dementia diagnosis, be open to doing less or delegating more. Save your energy for spending quality time with friends and family.
Source: Alz.org/Indiana

Case Study: Quadriplegic Sues for In-Home Care

Karen Vaughn, a 60-year old Indiana resident, has lived with quadriplegia since 1976. She requires assistance with almost all activities of daily living, including bathing, eating, and brushing her teeth. Between 1981 and 2016, Karen lived in her own apartment while receiving in-home health care through Medicaid. In January 2016, she was hospitalized with pneumonia.

Once she recovered, she tried to return home but could not find a home health care provider. She was unable to find a provider for two reasons: (1) the reimbursement rate offered by the state to home health care providers was too low and (2) Medicaid required that certain tasks (like the ones Karen needed) be performed by nurses. Karen was unable to find any nurses that would provide skilled care at the state’s reimbursement rate.

Despite being cleared medically, Karen remained hospitalized for 11 months and was then moved to a nursing home 60 miles away from her friends and family. Once there, she developed a bed sore that required surgery, which had never happened in her own home. In her case, cost was not an issue- Karen had been approved for $395,000 a year  and in-home care is less expensive than a hospital or nursing home.

Karen sued under the Americans with Disabilities Act, the Rehabilitation Act, and the Medicaid Act. She argued that FSSA failed to provide her with medical assistance that she qualifies for, there by institutionalizing her against her will. Karen and her doctors contended that she did not require nurses or a skilled level of care in all areas. “Any lay person could be taught how to safely provide Ms. Vaughn’s care,” said one of her doctors.

U.S. District Court Judge Jane Magnus-Stinson ruled in Karen’s favor and ordered a remedy hearing to finalize her care. The judge found that FSSA’s administrative policy was too rigid:

“Ms. Vaughn’s request that more of her services be provided by non-nursing staff would help to alleviate the effects of a nursing shortage…For all of these reasons, the court concludes that Ms. Vaughn has established that the accommodations she requests are reasonable.”

Source: “Woman OK to get care at home” by Niki Kelly, The Journal Gazette

New Medicare Card

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Indiana is in the process of mailing out new Medicare cards. Medicare has posted this information regarding your new card:

Your new card will automatically come to you. You don’t need to do anything as long as your address is up to date. If you need to update your address, visit your My Social Security account. Once you get your new Medicare card, destroy your old Medicare card and start using your new card right away. Your new Medicare Number is a unique combination of numbers and letters. Your new number uses numbers 0 thru 9. The letters S, L, O, I, B, and Z are never used.

Make sure you watch out for scams. Medicare will never call you uninvited and ask you to give personal or private information to get your new Medicare Number and card. Scam artists may try to get personal information (like your current Medicare Number) by contacting you about your new card. If someone asks you for your information, for money, or threatens to cancel your health benefits if you don’t share your personal information, hang up and call Medicare at 1-800-MEDICARE (1-800-633-4227).

Source: Medicare

Case Study: Personal Injury Settlement Can Go Into Special Needs Trust

A (d)(4)(a) Special Needs Trust is a trust created for the benefit of a disabled individual under 65. The trust must be funded with the disabled individual’s assets. It enables the trust beneficiary to continue receiving public assistance benefits without regard to the trust property. This is because (1) the beneficiary has no control over the money in the trust and (2) the trust includes a payback provision to the state at the beneficiary’s death (up to an amount equal to the government benefits paid on his/her behalf).

Recently, Timothy Robbins (42 years old) received a $17 million settlement agreement for permanent personal injuries sustained when a semi truck sideswiped his vehicle. Timothy was in a coma for many weeks and eventually transferred to a nursing home where he will likely remain the rest of his life.  His father, Shelly Robbins, was appointed guardian of his estate.

During litigation, Timothy was receiving Medicaid and Supplemental Security Income. At the settlement agreement, Shelly asked that the trial court transfer the balance of the settlement (after fees and a Medicaid lien) to a (d)(4)(a) Special Needs Trust. The trial court disapproved because it stated that such a transfer would create a “legal fiction of impoverishment.” It ordered that only $1 million be transferred to the Trust and the remainder to Timothy’s estate.

Shelly appealed. The Indiana Court of Appeals reversed and remanded with instructions that the total amount of available settlement proceeds be transferred to the Trust. The court pointed out that both federal and state law allow this “legal fiction of impoverishment” to exist by placing assets into a Special Needs Trust. The State recognizes that while this provision has the potential to shift expenses to the taxpayer, the remaining funds of the Trust will be paid back to the State. The appellate court reprimanded the trial court for exceeding the scope of its authority based solely on its disagreement with the policy.

This ruling affirms the legislation in place for (d)(4)(a) Special Needs Trusts and makes it clear that any of the beneficiary’s assets can go in the Trust, including personal injury settlements.

Source: NAELA

New Indiana Law: Giving Estate Notice to Medicaid

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Beginning July 1, there is a new requirement for all estates where the decedent was at least 55 years old at the time of death: you must send Notice of Administration to Medicaid. In a probate estate, Notice of Administration must be sent to all known or reasonably ascertainable creditors. IC 29-1-7-7(d) has been amended to state that the Notice of Administration must be sent to the Indiana Medicaid Estate Recovery if the person that died was at least 55. The reason for this amendment is because Indiana Medicaid Estate Recovery is considered a reasonably ascertainable creditor for anyone 55 and older.  The address for service of notice is:

Medicaid Estate Recovery Program
Indiana Family and Social Services Administration
402 W. Washington St., W382, MS 07
Indianapolis, IN  46204

The Indiana Family & Social Services Administration (FSSA) Estate Recovery Program is the entity that administers the estate recovery process for the State of Indiana. It is used by Indiana to recover money paid by Medicaid to a qualified individual. When a Medicaid recipient dies, federal and state law requires that Indiana seek to recover from the estate an amount equal to the Medicaid benefits paid on their behalf.  The program seeks to recover the total amount Medicaid has paid on behalf of recipients after age 55 and in other certain limited circumstances. All funds recovered through this process are used to provide for future Medicaid recipients.

An estate consists of the assets and property, including real and personal property, owned by the Medicaid recipient at the time of death. It also includes non-probate assets, which are real and personal property conveyed through a non-probate transfer (i.e. jointly owned property that would normally pass to the joint owner or bank accounts with a POD provision). Indiana can seek to recover the following:

  • Real property, including property conveyed to the recipient’s survivor through joint tenancy with right of survivorship
  • Money remaining in the recipient’s bank account regardless if the account has a payable on death provision or has a joint owner
  • Money remaining in a recipient’s nursing home account
  • Funds remaining in a Qualified Income Trust (QIT), also known as a Miller Trust, as of the date of death
  • Funds remaining in a funeral trust after the funeral has been paid for in full
  • Annuities purchased after May 1, 2005, including annuities that do not designate the State of Indiana as the beneficiary
  • Assets in a revocable trust if the assets were transferred into the trust after May 1, 2002

Even if the individual was not on Medicaid, it is still required that Notice of Administration be sent to FSSA if (1) an estate is opened and (2) the individual was at least 55 years old.

Source: FSSA

 

Five Strategies to Help Your Brain

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While you can’t prevent Alzheimer’s, there are steps you can take to lower your risk of developing Alzheimer’s. “Lifestyle changes could reduce your chances of developing Alzheimer’s by 90 percent,” says Dr. Ayesha Sherzai of the Brain Health and Alzheimer’s Prevention Program. Here are five lifestyle strategies that you can take to help reduce your risk of developing Alzheimer’s.

1. Fill up on coffee, chocolate, and red wine. Coffee, red wine, and dark chocolate are high in antioxidants, which protect your cells against free radicals. Free radicals kill nerve cells which can cause changes in the brain that lead to Alzheimer’s. For coffee, enjoy three cups a day. With chocolate, look for at least 70% cacao and eat less than one ounce a day. Stick to a 5-ounce glass of red wine a day.

2. Get enough deep sleep. You should get eight hours of sleep each night, but you also need to get quality sleep. Deep sleep reduces inflammation and clears out the toxins that have developed during the day.  Your body goes through several sleep cycles, including REM sleep which occurs after deep sleep. If you remember having dreams or wake up feeling refreshed, you’ve likely had deep sleep. You can improve your sleep habits by making your room dark and not using your bed to do work. Also, stop doing anything stimulating (like checking your phone or exercising) at least one hour before bed.

3. Exercise. Exercise, especially aerobic, increases blood flow to the brain, helps improve connections between neurons, and reduces inflammation. “When you’re sedentary, blood flow to the brain is reduced and other chemical processes are induced, which can affect your cognitive functioning,” Dr. Sherzai. Try to exercise for at least 30 minutes five days a week.

4. Eat more veggies. A diet focused on whole foods and plants (vegetables, fruit, whole grains, beans, lentils, seeds, and nuts) is high in antioxidants, which reduce inflammation. Try eating a veggie burger every once in a while. Or replace your sandwich with a salad. Add a serving of beans and greens to your meals. Cut out added sugar, which also contributes to inflammation. Check the label of prepackaged foods and try to choose ones that are low in grams of sugar.

5. Learn something new. Learning new skills creates new synapses (neural connections) that keep your brain functioning well. The more synapses you have, the more you can afford to lose. Learning even a small skill will help. Try enhancing one of your hobbies.

Taking steps toward including these changes in your lifestyle can go a long way in reducing your risk of Alzheimer’s. While it’s not a cure all, it can help you feel better now and healthier in the future.

Source: “Minding Your Brain” by Karen Asp

New Medicaid Service for Transportation

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Indiana Health Coverage Programs now offers a new program for all non-emergency transportation for certain Medicaid recipients. Beginning last month, a company called Southeastrans is in charge of all non-emergency transportation. If a Medicaid recipient has no way of getting to his doctor appointment, he can simply call Southeastrans to schedule his ride. For all trips covered by Medicaid, an individual must use Southeastrans. Medicaid recipients will no longer call transportation providers themselves to schedule rides.

Trip Reservation Line: 1-855-325-7586

Medicaid recipients can now call the trip reservation line during regular business hours, Monday through Friday 8:00 am to 6:00 pm, to schedule their ride. Calls must be made at least two business days before the ride is needed. Trips can also be scheduled on the online Southeastrans Member Portal. After a person registers, he can login to see his scheduled trips and schedule new trips. He can also cancel a trip or get help from a Southeastrans representative.

Southeastrans can schedule rides to non-emergency medical services covered by Medicaid, such as to the dentist, doctor, or dialysis. Medicaid will pay for 20 one-way trips per 12 month period. More trips may he provided if the doctor requests it and it is approved through Southeastrans.

When a person calls to schedule, he will need:

  • Member ID, full name, and date of birth
  • Telephone number of member
  • Pick-up address
  • Doctor or facility name and address
  • Telephone number of doctor or facility
  • Appointment date and time
  • Any special transportation needs (wheelchair, walker, vision-impaired, etc)

Once the ride is scheduled, Southeastrans will give the Medicaid recipient an estimated time to be ready for pick-up. If the ride is late, call Southeastrans at 1-855-325-7586. When the appointment is over, the Medicaid recipient can call Southeastrans to let them know he is ready to return home. Southeastrans will contact the transportation provider to arrange a ride home.

If a Medicaid recipient needs a trip with less than two days’ notice (such as for an urgent appointment that could not be scheduled in advance), the person can call Southeastrans to set that up. The urgent need must be verified by the person’s doctor. However, emergency transportation needs are not set up through Southeastrans – call 911.

If the Medicaid recipient needs to stop at a pharmacy on the way home from the medical appointment, the person or the driver can call Southeastrans to add a pharmacy stop. A pharmacy stop on the way home is not counted as a separate trip. However, if the person needs to later schedule a separate trip to the pharmacy through Southeastrans, the trip will count toward the 20-trip limit.

To learn more, visit the Southeastrans website. If you or someone you know needs help getting qualified for Medicaid, our experienced attorneys can help you get eligible while protecting your assets.