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Alzheimer’s Disease: The Game Changer

In the mid-90’s, my grandpa Bellomo was diagnosed with Alzheimer’s Disease, and I remember watching him progress through the stages of this disease and thinking how horrible it was and that he was no longer my grandfather. I remember being very optimistic that there would be a cure for this disease in the very near future. Here we are in 2022 and there are no cures to this difficult disease. 

In my practice as an estate planning and elder law attorney, we have answers to just about every question and solutions to just about every problem. The one constant difficult issue that arises on a regular basis is a client who is diagnosed with Alzheimer’s Disease and how to provide the care that they need to keep them safe as long as possible. Certainly, keeping somebody at home is a much better option than taking them out of their environment into another situation but as this disease progresses, the individuals will often get combative and violent and oftentimes cannot remain in the home. There are several wonderful care options at assisted living facilities that are called memory units. Unfortunately, these are private pay situations with no ability for government funds to help assist or pay for this type of living. Oftentimes, memory care units can cost somewhere between $7,000 and $9,000 a month which often becomes cost prohibitive. In many cases, the individual ends up being placed in a nursing home not because a nursing home is the right place for the client, but rather because there are ways to have the government assist with the funding of the approximate $12,000 to $13,000 a month of care. 

Whether or not this is the best place for the individual is certainly debatable but for some families it is simply not an option. Alzheimer’s is a very difficult disease and our hats off to all caregivers out there who are assisting to the best of their ability. 

Please feel free to give us a call if you have any questions or comments at 717-845-5390.

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Why You Should look at LTC Insurance

The bottom line is that LTC (long term care) insurance has come a long way.  There are new types of LTC insurance and even a PA Partnership Care Plan.  We encourage our clients to talk to an agent to determine if it is right for them.  Specifically, we like the riders that keep our clients in their home and in an assisting living facility as long as possible.

I am not a financial advisor, nor am I licensed to sell insurance, nor can I receive any commission from anyone who does. Thus, I have no incentive to say that I think long-term care policies are important; the reasons may be different than what you might expect.  

I always hear the push-back that long-term care insurance is very expensive, and that, in many cases, if you don’t use it, you lose it. Since approximately 2009 Pennsylvania has become a part of something called a partnership care plan.

Essentially, for example, if you have $200,000 of long-term care insurance that pays out, the state will allow you to exempt an additional $200,000 of assets at the time that you enter a nursing home, and still qualify for Medicaid. When the plan first came out, the concern was that the state would take over long-term care insurance, but so far that has not occurred.

I believe the reason is because these are still traditional long-term care policies that, if you don’t use it during your lifetime, you lose its value at your death.

However, more recently long-term care insurance companies have come out with what is called a hybrid policy, which is a life insurance policy that has a rider for long-term care insurance. The main reason that I like long-term care policies, specifically the ones that have riders to provide for care in the home or in the personal care home, is because more and more, people want to live at home as they age and until they die.  

In all of my years of practice, no one has ever told me that they want to go into a nursing home. I often hear that they want to stay home, or they want to stay in a personal care home, but unfortunately, it is too expensive, or the assets will become completely depleted.

Although I understand that long-term care insurance or a long-term care hybrid policy may seem expensive now, trust me, the peace of mind that it will provide later when you or a loved one wants, and is able, to stay home or go to a personal care home, the money spent on the policy which allows you to do so is small compared to the out-of-pocket cost of that care, and, at least as importantly, your peace of mind.  

Although we are fortunate in the state of Pennsylvania to be able to assist people in crisis, we are not as easily able to help people to stay in their homes or in a personal care home.  Do yourself and your family a favor, and if at all possible secure your long-term care insurance now for peace of mind later; the earlier the better.  

If you want to talk about this or any other estate planning matter your wanting more information about, contact us!  

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Keep Our Loved Ones at Home

I have never had a client tell me that they want to go to a nursing home. Almost daily in my practice I hear that my clients want to remain in their home as long as possible. Unfortunately, some clients do not want to bring outside caregivers into the home for a myriad of reasons. The old days of the children taking care of the parents needs to make a comeback. Caring for parents to keep them home is extremely rewarding for both the child and the parent.

Being a family caregiver is one of the most rewarding, amazing experiences that children can provide to their loved ones. I have heard time and time again from children who are able to provide caregiving how rewarding it is, particularly in cases when it keeps their loved ones out of a nursing home.

For a number of reasons, children who provide caregiving should enter into a written caregiver agreement with their parents.

First, it is the best way to ensure that there are not mis-expectations and hurt feelings later.

Second, if done properly, it will actually provide, for both VA purposes Medicaid purposes, a legitimate spend-down of resources which would otherwise go to the government, and the monies paid will not be considered a gift. Therefore, no penalty will be assessed for the money paid to the child.

The one thing to remember is for the child caregiver monies that are received will be income taxable to the child; it is very important that the child claim those monies as income on their tax return so that it clearly shows that it was not intended to be a gift.

However, family caregiving is certainly not without its downsides to caregivers. In most cases the caregivers could make more money if they stayed in the workforce and did not leave to provide care. In a situation where they are trying to continue to work and provide care, the increased stress added to the caregivers can be detrimental their physical and/or emotional health.

There are often cases where family dynamics become an issue, either because one child is doing the caregiving and that child feels like they’re being taken advantage of, or others feel as though that child is taking advantage of Mom and Dad because they are getting paid.
Either way, a lot of times it provides an additional stress to family members that they weren’t expecting. There are times where a caregiver will be out-of-pocket as well for certain costs, and getting reimbursed may surely be an allowable thing under the law, but having other children understand why money is being distributed to one child versus them is often not an easy conversation.

There is no doubt that for those people who are able to provide care to their loved ones, care in the home it is a wonderful gift. However, I highly recommend that everything be put in writing for all of the reasons stated above, but mostly so that there are no missed expectations among the people receiving the care, the people providing the care, and the other family members.

To those who have been able to keep their family members home, thank you for everything, all that you do is appreciated. To those who are considering it, give it a try. It could be the best decision you have ever made.

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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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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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