Upcoming Long-term Care Planning Presentation at Dodge Park Rest Home

Fall Prevention in the Aging Population

From time to time I like to feature local experts with tips and advice for improving senior’s lives. This week’s blog is written by my colleague, Dr. Don Pelto of Central Massachusetts Podiatry. Dr. Pelto specializes in many foot ailments and writes about how you can be proactive by avoiding falls among elders.

Falls are a  major causes of injury in elderly people.  Hip fractures account for approximately 25 percent of injury deaths among those 65+, and 34 percent of injury deaths among those 85+.

Most falls happen in or around your house and can be life threatening.  For example, Mary Smith was seen in my office for a footcare visit.  I asked her, “Mary have you fallen recently?”  She said, “Well in fact I was walking around my house and was only going a short distance and not using my walker and I fell and hurt my hand but thankfully nothing was broken.” Mary said that she lost her balance quite frequently and that she had nearly fallen a number of times.

Mary’s situation is very common. Many times a fall can cause other problems that lead to problems that can be fatal over time.  There are many devices such as canes and walkers that can help the elderly live safer at home.  However, a new fall-prevention device has been developed that can be worn in regular shoes has been shown to decrease falls by 30-60 percent in the elderly.  It is typically covered by Medicare and Medicaid and is light weight.

If you would like to learn more about these braces visit www.fallpreventionbrace.com or if you would like to make an appointment to see a physician regarding obtaining these braces please contact Dr. Donald Pelto at Central Massachusetts Podiatry at 508.757.4003 or www.drpelto.com.  Dr. Pelto is a podiatrist working in Worcester, Massachusetts.

Grandparents Raising Grandchildren- Legal Options and Financial Support

With the decline of the traditional nuclear family, individuals over 50 are increasingly vested with responsibility for the caretaking of young children and adolescents. Financial problems are the primary cause of seniors having to assume more “traditional” child-rearing duties. Whether due to a divorce, military service, substance abuse, mental illness or other secondary issues, some adults may be unable or simply unwilling to be good parents themselves.

After suffering ten years of domestic abuse at the hands of her husband, Jennifer finally filed for divorce and moved herself and her daughter in with her parents, Gerry and Donna Daly. Although the relocation was supposed to be temporary, Jennifer has exhausted her bank accounts, refuses to obtain employment, and has sunk into a deep depression. Gerry and Donna are proud, retired grandparents who want to ensure that their grandchild is raised with love, discipline, and opportunity. They have been expensing the household’s grocery bills and clothing for the child, as well as toting her from play-dates to extracurricular activities. The Dalys’ other children have begun to voice concern over their parents’ spending, noting that their income is supposed to sufficiently cover a two-person household and not be stretched to support a four person family. While Gerry and Donna understand their concern, they don’t believe in asking Jennifer and her daughter to leave and have the utmost confidence that Jennifer will get back on her feet. What are their legal and financial options?

Many times, the child-rearing duties that grandparents assume will cause a real strain on seniors’ budgets. Child care costs can grow exponentially dependent on the length of time a grandparent will be asked to assist in raising his or her grandchild. Given this responsibility, these seniors might consider obtaining legal authority to make decisions for that child – on important issues such as healthcare and schooling – and financial assistance from the State.

In Massachusetts alone, 67,781 children reside in grandparent-headed households. Although the Daly’s granddaughter is physically living in their home and they are raising her, Gerry and Donna do not have any legal rights or authority to make decisions on behalf of the children. Jennifer could sign a form giving her parents ‘caregiver authorization.’  This is a caretaking option provided by the Massachusetts Uniform Probate code and allows parents to authorize a designated caregiver to exercise “concurrent parental rights” on healthcare and schooling matters. Provided that the caregiver lives with the child, the authorization is valid for two years and does not require court approval. Caregiver authorization is an alternative to filing for Guardianship of a Minor, a court decree effectively suspending the rights of the parents and transferring them to a guardian entrusted with caretaking responsibility. Depending on Jennifer’s state, this may be necessary for the Dalys.

If you are on a fixed income and unable to get help from a child’s parents, the child may be eligible for payments from Massachusetts’ Transitional Aid to Families with Dependent Children and medical coverage through MassHealth. For further information on assistance through these and similar programs, consider reviewing the Massachusetts “Resource Guide for Grandparents Raising their Children.”

While it may be your desire to become legally and financially responsible for your grandchildren, you are not required to as a matter of law. It is ultimately up to the Commonwealth to assign custody to a suitable individual. However, if circumstances have placed your grandchildren in your home, it is helpful and oftentimes necessary to review your present legal options and to adapt an existing estate plan to ensure that the unique challenges of caring for grandchildren are addressed. Contact Vickstrom Law to your situation and get informed on your options.

What Really Happens to Your Estate if You Die Without a Will in Massachusetts?

Dying without a Will is called dying “intestate”. What this means is that your intentions as to who inherits your assets, who administers your estate, and who acts as guardians for any young children are determined by the Commonwealth of Massachusetts. It is often said that if you don’t have an estate plan, the Commonwealth has one for you. And as of January 2^nd, 2012, the Commonwealth has an updated plan for you! That’s when the last phase of the Massachusetts Uniform Probate Code (MUPC) takes effect.

It’s estimated that nearly 65% of Americans don’t have a Will. Fred is a healthy, vibrant sixty-five year old man. He exercises three times and week, and has made a conscious effort to eat well since his recent diagnosis of diabetes. After speaking with many close friends, Lenore, Fred’s wife, insists that they both create Wills. Fred insists that he is perfectly healthy, wishing to leave the issue of estate planning until he experiences further health problems. What if Fred was to die without a Will?

If Fred dies in 2012, or later, without creating a Will or using some legal method to transfer his assets, Massachusetts law, specifically, the rules of intestacy, determine what happen to your property. After payment of debts, expenses, administration and funeral costs, your property will be distributed to your heirs according to a predetermined legal formula. The problem is that the formula that the Commonwealth uses may not end up being how you would like your estate divided. If no relatives can found to inherit your assets, they are taken by the State.

Intestacy distribution, under the MUPC, specifies that if Fred dies leaving a spouse with no children and his parents are also deceased, his spouse receives everything. But, the same scenario if Fred’s father is still alive at his passing, Fred’s wife and father will each inherit from Fred’s estate.

What if Fred passed with a spouse and minor children? Then his spouse would inherit everything, regardless of whether his parents were still living. However, if one of his children was from a previous relationship, the current spouse and ALL of Fred’s children are heirs together and inherit a portion of his estate.

Despite the changes under the MUPC, Massachusetts Wills still have a spousal elective share clause, which means you can’t disinherit your spouse in your Will. In most cases the surviving spouse can elect to get the first $100,000 or $200,000 of the estate, plus a portion of the remaining property, instead of what their spouse left in their Will.

The rules of intestacy may appear confusing and difficult to apply given your unique situation. It is always best to determine how you would like your assets to pass through a properly executed Last Will & Testament, or even a Trust. In this way, you can ensure that family members you are not close with do not end up inheriting through your estate. You may also provide for step-children in the case of blended families.

The best way to truly ensure that your family is protected and that your estate is distributed the way you want it is to consult with a knowledgeable attorney’s office, like Vickstrom Law, who specializes in Estate Planning.

Marrying Later in Life: Do I Need a Prenup?

Welcome to the new singles scene. With the average life expectancy in the United States about 78 years old, people are living longer and healthier lives than ever before and more and more seniors are falling in love. However, what can be a thrilling and romantic time for an older couple can also be an anxious time for family members that have expectations regarding inheritance. It is worth noting that once married, a spouse will automatically inherit, at the very least, a portion of deceased partner’s estate, unless measures are taken to avoid this.

After her husband of 49 years passed away, Louise never thought she would remarry. After six months she met Frank, a man fifteen years younger, who occasionally accompanied Louise to dinner and church. About a year and a half after her husband died, Louise called her daughter, Emily, saying she’d been scoping out wedding venues. Prior to the wedding, Emily pushed that the couple sign a prenuptial agreement. Her mother had considerable assets and she worried that Frank might be after her money. Louise brought the concerns to Frank, who balked at the idea, declaring that their marriage would endure forever. After some discussion, Louise became adamant, wanting to preserve some assets and family property for her children as a condition of the marriage. Ultimately, the prenup was a deal-breaker; Frank was either interested in little more than her wealth or was too hurt to come to turns with the reality of their relationship.

Without a prenup in place, your new spouse could invalidate your previously existing estate plan. For example, suppose Louise intended her home to pass to Emily. With improper estate planning and no prenup, Frank could inherit her house and pass it on to his heirs when he dies. Disinheriting her children would probably not have been Louse’s intention.

One common perception of a prenup is that the agreement entails fear that a marriage will fail. Why draft a prenup if two individuals love and trust one another? Frank may have had these concerns. While a premarital agreement might feel unsatisfying, over one-quarter of senior marriages do end in divorce. With accumulated resources and descendants, a prenup can ensure that a spouse’s separate assets will pass to his or her own loved ones upon marriage dissolution. Though it may not seem fitting with the romance of a wedding, think of a prenup as an open and honest disclosure of both parties’ assets and agreement as to their distribution.

A prenup is not an estate-planning tool and may not take precedence over a will or trust. The married later in life couple must also be sure to implement a solid estate plan to ensure their joint wishes are not undermined by the surviving spouse. To ensure that your prenuptial agreement is valid, it must be in writing, signed voluntarily, read and understood by both parties, disclosures must be open and honest, and the agreement must be fair and not contain illegal provisions. If you have already remarried and did not negotiate a prenuptial agreement, these issues may be resolved with a post-nuptial agreement and through proper estate planning.

Contact Vickstrom Law for more information concerning prenuptial or postnuptial agreements as well as proper estate planning for later in life marriages.

Protecting the Family Cottage from a Medicaid (MassHealth) Spend Down through an Irrevocable Trust

An irrevocable trust is an excellent tool when preplanning for Medicaid benefits.  Anything that is put into the irrevocable trust is protected from a Medicaid spend-down if five years pass from the date of the transfer.

For example, Alice Smith, a 77-year-old widow, wants to protect her family cottage from potential long-term care nursing home bills and preserve it for the benefit of her four children and their immediate families.  To do so she would need to establish an irrevocable trust, fund it with the cottage property, and have five years pass from the date of the transfer.  Additionally, to ensure her children have sufficient funds to maintain the family cottage, Alice also simultaneously transferred $250,000 of cash assets into the trust.  Finally, in order to bullet-proof the plan in the event of an accident, Alice purchased a traditional long-term care insurance policy which will provide her with five years worth of long-term care benefits, including home health, assisted living, and nursing home care.  The long-term care insurance policy also offered a full return of premium rider in the event that she passed away without using any of the coverage.  After such an event, the annual premiums would be refunded to her revocable living trust.

With the above plan in place, Alice was confident that her wish to have the family cottage remain in the family for many years to come would be long lasting.  Notwithstanding the above, Alice understood that when the maintenance funds ran out that a financial problem may soon develop.  However, to avoid a point of impasse among her children, Alice designed the trust so that if a financial problem persisted for more than 90 days, the trustee was directed to sell the property, giving each child an equal share of the sale proceeds.

This week’s blog originally appeared in a blog from Kraus Financial Services and can be viewed here.

When Should I Update My Estate Plan?

An estate plan that was suitable a few years ago may no longer be suitable today. One should look to update their estate planning every three to five years or even sooner if you experience a dramatic change in life circumstances.

John and Laura had estate plans created shortly after their marriage in 2002. After learning of Laura’s infidelity, John undertook divorce proceedings but failed to update his estate plan to remove Laura. For the past five years John has had a serious girlfriend. Last week John was diagnosed with prostate cancer and wants to ensure his girlfriend gets his estate in the event of his death. Laura has an adult special needs son, Bill, and John would like some of the assets to go to Bill for his care. He feels that his family is aware of such intentions and that hiring an attorney is an unnecessary cost. Is John right?

A change in your marital status should be followed by a change in your estate plan. It is important to note that in Massachusetts, marriage voids a will executed prior to the marriage, unless the will appears as though it was made in contemplation of marriage. Divorce may also necessitate modifying an existing estate plan to disinherit an ex-spouse. Contrary to conventional wisdom, just because you’re divorced does not automatically remove your ex-spouse as a beneficiary of an account such as an IRA. Consider the revision or replacement of your estate plan as a part of the divorce process, which will look at all the pieces of your estate to make sure you are not overlooking something.

If your named executors, beneficiaries under your will/trust, or other beneficiaries are no longer in your life, you definitely want to update your documents to reflect a new beneficiary or executor. You may also want to include a new child, grandchild, niece or nephew who has been born after your last will was signed. John should make sure that his ex-wife is removed from all of his assets.

If a beneficiary becomes disabled, or has special needs, you may wish to update your estate plan to accommodate the increased needs of that individual by creating a Special Needs Trust (SNT). A SNT will allow assets to be protected for the disabled beneficiary without disqualifying him or her from receiving government benefits when you pass. A SNT within John’s estate plan would ensure that any funds left to Bill did not effect his benefits.

You might not be aware of all of the changes in estate-planning law, but new cases or statutes might have an impact on the structure of your individual estate plan. Have your attorney revisit your estate plan every few years to ensure its compliance with the current law. For example, John doesn’t know that the Power of Attorney statute changed in Massachusetts recently. He should ensure that his document complies with the new law.

Documents that need to be included in an estate plan and the manner of signature may vary on a state-by-state basis. Some states require more written witnesses and others do not recognize hand-written wills. Upon relocation to another state, review your estate-planning documents to ensure their validity in your new state. This is another example of why you should not look to make your estate plan yourself or use pre-printed forms. John’s original Will was drafted in Rhode Island. He’ll need a Massachusetts document now that he lives here and is looking to make changes anyway since his divorce.

Your estate plan is not something that should be executed once and placed in a safety deposit box. Make sure that you review it at least every few years and whenever your life changes OR the life of your beneficiary changes. If your life has changed significantly since you last did your estate planning, or it’s been more than five years since you executed your documents, be sure to consult with a qualified estate planning attorney, like Attorney Kristina Vickstrom, that can perform an estate plan review to let you know your plan is all set for a few more years or recommend any proper updates and changes.

Legislature Set to Abolish 10-Day Bed-Holds for Nursing Home Residents Temporarily Discharged or under Hospitalization

For many years, the Massachusetts Legislature has provided funding for MassHealth to keep a nursing home resident’s bed empty for up to ten days during a period of hospitalization or temporary discharge- “bed-hold”. In 2010, the benefit was used in Massachusetts 28, 854 times. However, the State Senate recently concluded that Massachusetts cannot afford to maintain this policy.

The MassHealth bed-hold-policy now permits an individual in receipt of MassHealth to leave a nursing home to seek outside medical treatment or time with family and friends for a period of ten consecutive days without incurring any private pay cost. The policy also assures that if a MassHealth recipient returns to a long-term care facility within ten days, their own bed and room will be held free until their return.

Cuts would most significantly affect persons suffering from dementia and other cognitive impairments. For these individuals, a certain routine and comfort with the attending staff and surrounding residents are particularly significant. People with advanced dementia may suffer fright, disorientation and distress with any move – they have lost their home and may have trouble processing why.

Young people in nursing homes would also be seriously affected. The Boston Globe  remarked on the case of a 31-year-old man who needs round-the-clock care after being permanently disabled in a car accident. Without bed-hold funds he will be unable to attend a summer camp without losing his place.

Although the Patrick administration has publicly declared that an average of 10 empty beds are present in a facility on any given day, so that a nursing home is usually able to retain an individual’s bed following a hospitalization or temporary illness, residents that live in homes specializing in a specific type of care face a greater amount of competition for beds.

Significantly, the financial limit for a single MassHealth recipient is $2,000. Given that private nursing home rates differ between $250-$350 per day, if recipients want their bed to be held by the facility, they will be expected to pay out of pocket.

The current MassHealth bed-hold policy also provides for non-medical leaves of absence for up to 10 days per year. Generally, this allows a recipient to leave a nursing home to attend family gatherings without putting his or her bed in jeopardy. Eliminating the bed-hold policy would force individuals to pay privately for their beds if they wish to temporarily leave the facility for a wedding or holiday function.

Disallowing residents the financial freedom to attend such events would undoubtedly result in compounded isolation from family members and the outside world.

Fortunately, advocates for upholding the MassHealth bed-hold policy have persuaded the postponement of the elimination of the policy from July 8, 2011 until July 22. Elder law advocates seek to secure the signatures of as many legislators as possible in opposition to the policy to dissuade the Executive Office of Health and Human Services Secretary, Judy Ann Bigby, from abolishing existing policy. If you are interested in fighting to maintain the 10 day bed-hold policy, contact your local legislature.

What Do You Mean Medicare Won’t Pay for Dad’s Nursing Home Stay?!

A three-day hospitalization often serves as a gateway for a senior citizen’s transition into a skilled care facility. When the patient is discharged to a skilled care facility for occupational, physical, or speech therapy, the patient’s health insurance (Medicare) will continue to finance treatment for up to 100 days per stay (as long as the person continues to benefit from rehab). Medicare coverage ultimately ends, and when it does, the patient must pay from income, savings, long-term care insurance, Medicaid, or a combination of these resources.

Jo-Ann’s ninety year-old father, Ed, recently suffered a massive stroke. After spending four days in the hospital, Ed was transferred to the Odd Fellows Home in Worcester, Massachusetts for round the clock skilled care. Medicare covered the entirety of Ed’s expenses for the first 20 days of his stay, and Ed fronted a $95 copayment for days 21-100. It is now day 101. Medicare refuses to pay for Ed’s care because the program contends coverage has ended and that Ed now must meet his skilled care expenses from another source.  Ed has been primarily dependent on monthly Social Security checks after running through his savings a few years ago. Jo-Ann is a single mother of four children who fears that she won’t be able to keep her father in a nursing home due to her financial inabilities and his exhausted savings. She thought that since Ed paid taxes his whole life it would have guaranteed him government-funded nursing home care. What are Ed’s options?

It is easy to confuse Medicare with Medicaid. Medicare is a federal health insurance program. Anyone who has paid their taxes and meets specific qualifications (is over the age of 65, or who has been blind or disabled for the past two years) is entitled to Medicare coverage. Hospitalization, immunizations, medical equipment, and physician visits are covered by Medicare, while deductibles and co-pays are often covered by a form of supplemental policy. Medicare applies regardless of financial need but will not pay for nursing home care except in extremely limited circumstances, and then only for small durations.

Ed might benefit from applying for Medicaid, or MassHealth in Massachusetts. A joint federal and state program for individuals with certain medical needs who are financially needy, Medicaid/MassHealth is often the chief financier for nursing home care. An applicant may have no more than $2000 in countable assets (cash, savings, mutual funds, retirement accounts, houses) before requesting Medicaid/MassHealth. To achieve Medicaid/MassHealth payouts, many individuals will seek to transfer their assets to loved ones to demonstrate financial need. It is important to note that the transfer of assets for less than their fair market value will result in a corresponding ineligibility period for Medicaid/MassHealth coverage of nursing home care.

The average cost of a nursing home in Massachusetts is an astounding $11,000 per month. If you or a loved one has exhausted all means of paying for skilled care, it is important to contact an Elder Law attorney to discuss your options. After recommending Medicaid/MassHealth, an Elder Law attorney may suggest ways to set aside funds and assets for your family without jeopardizing the patient’s medical care and “spend down” ideas which benefit the patient.

Medicaid/MassHealth rules are complex and confusing. Further, nothing in this area is concrete or insulated from legal or policy change. Vickstrom Law can help explain the interrelationship between Medicaid/MassHealth and nursing homes and can assist with protecting and preserving assets for a spouse or other family members.

Consider Home Security Systems for the Elderly

Home security systems can be extremely useful for all home owners, but they can be particularly beneficial to the elderly and senior citizens. As elderly people often stay at home during old age, these systems can provide reassurance, as well as added security.

There are many benefits to be had from installing a home security system. Not only do such systems act as a deterrent from intrusion, but they can also be used to raise the alarm should such an intrusion take place. Surveillance cameras and motion sensor technology can provide a high level of security, which is particularly beneficial for more vulnerable member of the community. For elderly people who might be concerned that they would be unable to alert authorities in the event of an intrusion, it can be extremely reassuring to know that this would happen automatically. This can also provide reassurance for those who live some distance from their elderly relatives.

You can also tailor your home security packages to suit your own individual needs. Those looking to install an ADT Home Security System, for example, will be given a choice of the type of security which they would like to invest in. Those with easily accessible entrances to their property might decide that their priority is installing floodlights, which act as a deterrent. On the other hand, those who might struggle to operate a standard system can invest in home security that is can be armed and disarmed remotely. When it comes to home security, the choice is entirely yours.

Senior citizens often tend to spend more time at home, so it makes sense to install a reliable home security system to provide efficient round-the-clock monitoring. For those who rely upon a pension as their main source of income, there are plenty of affordable options, which could well prove to be an extremely valuable investment. If you, or members of your family, will be spending a lot of time at home during retirement, then it is worth bearing in mind the advantages of installing high quality home security equipment. In the event of an emergency, alarm systems, floodlights and surveillance cameras can provide an excellent level of protection to senior citizens.