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CARING FOR LOVED ONES

More and more, as our population ages, many of us are taking care of aging spouses or parents. According to the Mayo Clinic, 33% of adults provide such care. Most caregivers feel an obligation to do so out of love.

However, caregivers often find that providing that care is emotionally and physically, and often financially, draining. It is essential that caregivers know their limits. The danger is that the everyday stresses and challenges of providing such care often lead caregivers to forget about themselves, which can lead to depression, social isolation, financial difficulties, stress, fatigue, loss of interest in activities, frequent pain or headaches, and other effects.

 

When we get on an airplane before we take off the flight attendants always instruct passengers that, if the oxygen masks drop down, be sure to place them on you before you help others. Why? If you pass out from lack of oxygen, you cannot help anyone else, so by taking care of yourself you are in a position to care for others. This is not selfishness – it is a necessity. 

 

When “Mary” first came to see us, her husband of over 40 years had advanced Alzheimer’s and other physical conditions, and qualified for skilled nursing level care. Caring for him was a 24-hour job – he would wander off at all hours of the day and night, and other behaviors and

Mary needed to dispense his medications throughout the day and evening. We immediately sensed that Mary was on the verge of a nervous breakdown, but this was her husband, her love, to whom she had pledged herself in sickness and in health. She could not imagine abandoning her “obligation” to him by placing him in a nursing home, and, sadly, they did not qualify for Medicaid Waiver for in-home care.

We worked hard to make her understand that caring for her husband was killing her. As we talked, it became ever clearer that she could not keep up her current pace. I asked Mary how caring for her husband was affecting her; she admitted that she was under constant stress, was depressed, didn’t have any social life, and was generally wearing down. I then asked her what would happen if she were to wear down so much that she died from overwork while caring for her husband. She was startled – she hadn’t considered that. The answer was, there would be no alternative – he would have to go to a nursing home.

 

It took a couple of meetings with her, but she finally came to realize that in the long run, she was not doing her husband any favors by keeping him at home; her best course of action would be to find a great nursing home for him, and visit him frequently and get stronger physically and emotionally herself so she could continue to play an important role in her husband’s life for a long time to come.

 

If you are going to care for a loved one in the twilight of his/her life, then there are things which you should do to maintain your physical and mental health, such as:

 

  • Seek and accept help from family and support groups, including online.
  • Keep connected with family, friends, even clergy.
  • Find out from your loved one’s medical staff, or others, what resources are available to you and your loved one.
  • Give yourself permission to spend “me time” to rejuvenate your physical and mental conditions – then do it! Even a short time for yourself each day can make a huge difference.
  • Maintain good, healthy habits.
  • Exercise – it improves your mood and reduces stress.

 

You should consider all of your options, but always consider your needs as well as your loved one’s. Remember, to be an effective resource for your loved one, you need to put the oxygen mask on first before you can help others!

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Caregiver Agreements and Considerations.

Caregiver agreements are often used in the Medicaid context so that a family member can be paid for their services to a loved one and the payment would not be considered a gift.

In the Medicaid context, payments to family members are considered to be a gift for love and affection, unless there is a clear agreement written prior to services being rendered, preferably signed by the parent receiving the care as well as the child giving the care.

The caregiver agreement will set forth all of the terms of the transaction, including what services will be provided, where will they be provided, how will they be provided, and other typical contract languages.

The significance of this agreement is that the Department of Human Services (DHS) will look at the transaction as an arms-length transaction between third parties and not among family members.

This means that the payments to the child will not be considered a gift, and, therefore payments will be allowed to be counted as a “for value” transfer as part of a legitimate spend-down and not a gift that will trigger a penalty period for Medicaid purposes.

The biggest question that arises in regards to caregiver agreements is what the parent should pay for services. This is often a very difficult question because there are certainly competing interests at stake. For the parent receiving the care, they genuinely would like to pay full market value and as much as they can without there being a penalty created. This will legitimately reduce the value of their estate, but benefit the child who is providing services for their care on a daily basis.

On the other hand, if there are other children who are not providing the care they often feel slighted or that the other sibling is receiving more than their fair share.

This is very difficult because the children who are not providing the care want the amount to be paid to be the least amount possible to potentially raise the amount that will be left for them and their siblings to share.

However, if the parent does not spend down their assets legitimately, the money can be lost to long-term care costs, and there may not be anything left for anybody.

This inheritance rub is one of the most difficult things involved with a family caregiver because of the potential conflict that it may create among the family members.

At the end of the day, fair market value is generally set in, in this context, by what other professionals and people are charging for similar services. As long as you can stay within the realm of what others are charging for similar services, the Department of Human Services will not raise a red flag. However, that does not mean that other children or other family members may not question the motives of their family member providing the services and the amount of the payment.

We believe it is important to have all parties abreast of the information and informed so that we can potentially avoid unwanted conflict in the future. We always advise the advice of a professional to assist with these potential implications, and ensuring that the agreements are written properly to comply with DHS and Medicaid standards.

If you are looking for advice in regards to estate planning, please call our office at 717-845-5390 or click the link here and we will contact you.

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Now is a Good Time to Review Your Estate Plan.

It has certainly been a strange year and it feels as though we are finally heading out of it and things are “getting back to normal”. It makes me very happy to hear everybody talking about all of their upcoming plans for travel and trips to visit family because they missed out on a lot of planned events this past year.

Let me tell you what has really hit home for me, is how painful lack of planning can be and how it can affect your family in many ways. There are far too many lessons that we have learned from the past year, but one, in particular, is how a lack of planning can devastate a family.

Before you head out on all of your great adventures and trips, please take a moment for yourself and put your own oxygen mask on. Please pull out your estate planning and take a quick look at it. Make sure that the documents read the way that you want them to read and that you understand them.

Furthermore, make sure that all of your beneficiary designations on your life insurance and retirement accounts match what you intend for them to do and do not incorrectly believe that your Will controls how those assets are distributed.

As we have stated in many other blogs and articles, the beneficiary designations on these items are the most important thing and will trump what you have in your Will. Just confirm that your plan is the way that you intend it to be and that there are no unintended consequences.

If you have not had it reviewed by a professional in the last three or four years, take the time now to bring it to someone to review to ensure that everything is the way that it needs to be.

We also encourage you to take the time, once your documents are review and updated as necessary, to talk to your family about your planning when you are on your adventures and at family gatherings to make sure that everybody knows what your wishes are and what your planning is for the future.

These simple steps will save heartache and avoid hurt feelings. The time is now to review prior to heading out. Enjoy your travels and please be safe.

If you are looking for advice in regards to estate planning, please call our office at 717-845-5390 or click the link here and we will contact you.

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With premiums increasing drastically, should I keep my long-term care insurance?

This is a question that I receive on a regular basis in my estate planning and elder law practice. By way of full disclosure, I am not a licensed insurance agent and I am not licensed to be able to sell long-term care insurance or any other insurance product. I am an attorney with approximately 20 years of experience in estate planning and elder law and I happen to be a Certified Elder Law Attorney under the authorization of the Pennsylvania Supreme Court. While I am not the person who will sell the products, I am certainly an individual who has been advising numerous clients over the years and definitely believe in the benefits of a long-term care policy and what they can provide. We have done numerous other logs about long-term care insurance and the benefits of said policies.

When long-term care insurance first gained popularity, many companies completely missed out on the actuarial tables and in predicting what people were going to need. Because of this drastic miscalculation, most of the companies who originally were in the markets for long-term care insurance are no longer there. The few standing companies that are left are trying to figure out ways to make up for the mistakes of the past. Because of that, they are often forced to increase premiums and decrease benefits. Although these companies do have to get permission from the insurance board, it is not a very difficult proposition and in most cases, they will almost always be able to receive permission. The most difficult part is that individuals have been paying into a plan for a number of years and now are learning that they’re going to have to decrease their benefits and even then they may have to increase the premiums that they are paying. It is heart-wrenching to have to provide guidance in these situations and ultimately I always encourage them to bring in their financial professionals to try to make the decisions.  This is as much about the numbers and common sense as it is about the emotion involved. This becomes very easy for us to get disgusted and upset about what is occurring, but it is a cold, harsh reality of the miscalculations that were made in the past.  In some instances increasing premiums and decreasing benefits is the only way some of these companies will survive. 

My best advice to any and all people who are faced with this dilemma is to write out the pros and cons and to try to make the evaluation and determination about numbers and as little as possible about the emotion of the situation. It is too easy to get hung up on the principle of the manner, but the truth is principals are expensive and cause wars. Make the best decision for you and your family based upon the information that you have in front of you. Long-term care is not going away and dropping the policy out of spite is not going to help anyone. 

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The Talk

No, we are not talking about the birds and the bees and how to have a conversation with your young son or daughter.  We are talking about the conversation with your parents as they age and what are their wishes in regards to caregiving, long-term care, death, and the planning associated with it.  Most families shy away from these conversations and essentially treat them as faux pas conversations and avoid them at all costs. While avoiding the conversation can make it seem like it’s going away and make it seem like everything is okay inevitably that decision will blow up and will become a very painful situation for those involved.

 

As an estate planning and elder law attorney, I cannot begin to tell you how many families avoided this conversation with their parents and regretted it later.  I have never had a family come back to me after I have suggested that they sit down and have “The Talk” and told me that they regretted it and wished they would’ve waited.  They all say that it was great to get everything out on the table.  

 

Most parents don’t talk about it with their children mainly because they don’t think that their children want to discuss it.  We often hear parents saying that my kid clams up or my kid gets very nervous and just doesn’t want to talk about me or my spouse dying.  Therefore it’s easier just not to have the conversation.  Believe it or not, most parents are open to having the conversation because they are dealing with it on a daily basis and they understand that it’s better to have the conversation or at least to think about it ahead of time.

 

Our advice is to try to start the conversation to understand what your parent’s wishes are for their golden years. Where do they want to live as they age?  Do they have an idea as to how they would like to be treated if they were ever to be in an end-of-life situation?  Where would they like to be buried?  Do they have their financial affairs in order and do they have professionals that they are working with that you could contact if something happened to them?  What is going to happen when if they have to go into a nursing home how can you assist them with their planning?  What happens when they die?

 

These are often great conversation starters.  An estate planning and elder law attorney could also assist you with filling in the details and understanding how to put these answers in legal documents to make them binding in the future.  Don’t underestimate having your parents go to a workshop on estate planning and elder law, it will get them thinking and may also provide the opportunity for the conversation to occur.

 

The holidays and times that families together often end up being the time that people get to discuss these topics and we encourage that you have “The Talk” not only for your parents but for you and your family as well.  As much as your parents will thank you for wanting to have the discussion to figure all of the information out you will also be relieved to know that they have thought a lot about it and have a lot of strong opinions and beliefs and now you know that you can carry out their wishes.  One thing that I have found is that people always want to do what’s best for mom and dad and oftentimes want to do what mom and dad intended.  If you have had the conversation and have documents in place everyone will be on the same page and no one has to speculate or argue about what was intended.

If you are interested in learning more about Medicaid crisis planning, please call our office at 717-845-5390, or click here to RSVP to our upcoming workshops.

 

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