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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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Do You Need a Trust?

This question is by far the most asked question that we receive in our office. However, there is absolutely no standard or right answer for everyone. Trusts are typically used for either probate avoidance purposes, tax avoidance purposes, or asset protection. Trusts are often used for disability planning but generally, that is not the sole reason for people’s use of trusts.

Currently, the federal estate tax limit provides an $11.7 million exemption per person. This means that an individual currently will not pay federal estate tax unless their estate, per person, goes over $11.7 million or $23.4 million for a husband and wife. This law is set to go back to $5 million in 2025, set for inflation which predictions are that it will end up being around $5.8 million. Even with the reduction in 2025, most people in our local community will not need to do a trust for tax purposes. Certainly, there are rumors each and every day about Congress changing the laws and lowering the exception amounts, but until that happens, I would not make plans for something that may or may not occur. History tells us that all of the rumors that we are hearing, probably none of them will actually look like the actual law if it is ever enacted, and we have always taken the position to plan for the law as it is in effect, and if and when it changes, then we can pivot. With that said, there is not a high percentage of people who will need to do trusts for tax purposes as we sit here today in May of 2021.

Probate avoidance is usually a situation where there are properties in several different states across the country. While every state has different laws as to whether a person needs to open an estate in their specific state, generally speaking, if the property is in a person’s name alone at the time of their death, the state will require them to go through that state’s probate process. We find that many people like to avoid probate in these situations so that they do not have to hire attorneys in each state to finalize for their families. In a situation where a family does not have properties in multiple states, generally, probate avoidance is not something that people are overly concerned about unless they’re in a state that the probate process is very burdensome and overwhelming, which currently, it does not happen to be in the Commonwealth of Pennsylvania.

Asset protection is one reason that people will often do trusts in the Commonwealth of Pennsylvania, to avoid potential creditor issues and long-term care costs. These are a very specific animal of trusts and the rules are very unique to these trusts alone since they are not being set up for tax purposes. It is our recommendation that you speak to a professional well-versed in these types of trusts before completing one. They are very unique and there are very simple rules; however, it is very easy to make mistakes in this area. An elder law attorney well versed in these types of trusts will be able to provide advice as to whether this type of trust makes sense for you. There is no one size fits all answer to the question of “do I need a trust?”. It is important to get very clear on your personal goals and what your goals are for your family. Once you have a very clear picture of that, then a professional will be able to advise you, based upon your current situation, as to whether it makes sense. We would certainly be honored to assist you through this process, and we offer weekly workshops which will give you insight into the thought process in regards to whether trust is right for you. We look forward to seeing you in the future.

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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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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What is the difference between a living will and a healthcare power of attorney?

This is the question that I receive at least once a week in my estate planning and elder law practice.  Taken together, a Living Will and a Healthcare Power of Attorney, are an Advanced Healthcare Directive.  Taken individually a Healthcare Power of Attorney allows an individual to make healthcare decisions on another person’s behalf.  A Living Will is a document that only kicks in when a person is “end-stage medical” which means that two qualified physicians have put in writing that the individual has no realistic hope of recovery.  That they will always remain permanently unconscious, vegetative, comatose, and/or terminally ill.  If the document has both of these items in them together, then it is considered an Advanced Healthcare Directive.  

I am always urging people to ensure that they have these documents in place.  My main reason for feeling that way is that I believe that it is imperative to take the burden off a loved one, to spare them from having to “pull the plug” on their loved one.  My experience at my law practice is that when a person’s wishes are in writing regarding what they want or do not want should something to happen, that others are much more comfortable in allowing that decision to stand if they don’t personally have to make it. 

 I remember several years ago a spouse who recently lost her husband came into my office sobbing because her husband did not have an Advanced Healthcare Directive and she did not know exactly what he wanted.  I reminded her that he repeated numerous times in my office in front of her that he did not want to live that way, and that if there is no hope there is no reason to live.  However, all that she could know or remember is that she pulled the plug.  She conveniently did not remember all of those conversations because, in her mind, she told the doctor to pull the plug, and within seven minutes her husband was no longer with her.  There was absolutely no consoling or helping her feel better about her choice.  And, although I am 100% confident she did exactly what her husband wanted because she was the one who had to make the decision she always wonders and always regretted it.  Putting your wishes in writing will allow your family members to be 100% certain that they were your wishes and that they are merely following through on what you wanted, not what they think you want, or making them play “God”.  It is imperative that everyone over the age of 18 have a Healthcare Power of Attorney as well as a Living Will.  

If we can be of any assistance or answer any questions while you make decisions about yourself and your family, please give us a call at 717-845-5390 or click the link here and we will contact you.

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