As senior issues and caregiver concerns get more media attention, more and more families are making the question of who becomes mom or dad’s primary caregiver a family decision. Although one sibling may still take on the role of “primary caregiver,” families are making the conscious decision to try to share caregiving responsibilities more equally. This is definitely a step in the right direction, but as this article from the Family Caregiver Alliance points out, there are still likely to be challenges.

Choosing a Primary Caregiver. The primary caregiver often ends up being the sibling who lives closest to mom or dad; it may start with a ride to the doctor here and there, but before you know it one sibling is shouldering almost all the responsibilities. Discussing the role of primary caregiver as a family can make everyone feel more involved and result in more support for mom or dad. The local sibling may still choose to care for parents’ daily needs, but out of town siblings may choose to take mom or dad on annual vacations or provide financial support.

Making Financial Decisions. Hopefully your parents have made arrangements for their long-term care expenses; but if not, you and your siblings may feel honor-bound to take care of the expenses yourselves. While the most logical route may seem to be an equal division of expenses between siblings, this may not be feasible or fair for every family. Siblings should take the time (and perhaps consult with an advisor) to discuss the various medical and care expenses, payment options, and financial strategies.

Living Arrangements and Long Term Care. Facing the reality that mom can no longer care for herself is a painful revelation for any family; making the decision to move a parent to a nursing home or long term care facility can be fraught with feelings of anger, guilt, or even denial, and siblings may be tempted to lash out at each other during this emotional time. Consulting with a Geriatric Care Manager or another trusted advisor at this time can help the entire family understand the situation, manage expectations, and keep emotions in check.

Making decisions as a committee can be difficult, especially when some members of the “committee” live far away, but when everyone is involved in the decision-making process then everyone is more likely to support a final outcome. Getting together with your sibling on a regular basis—even if it’s only by phone—to discuss the care of elderly parents can not only keep everyone on the same page and minimize disagreements, it can also provide a rare opportunity to grow closer as a family.

One of the primary concerns of the aging population is long-term care. As the life expectancy of Americans goes up so does the expectation that they will someday need some form of long-term care. You may not know whether that care will happen in a hospital, a nursing home, or in your own home, but you can be sure that it will be expensive.

How expensive will long term care be? It turns out the answer to this question depends a great deal on where you live. The AARP, The Commonwealth Fund, and The SCAN Foundation recently released a report which they call “The Long Term Scorecard,” which compares states and ranks them according to categories. The website Web MD has an article explaining how to use the scorecard and what it means.

The article in Web MD states that “Long-term care is unaffordable for middle income families, according to [The Long Term Scorecard report.] Even in states where nursing home care is most affordable, such care averages 171% of an older person’s household income. The national average is 241%.”

Some states, however, have been making the issue of long-term care a priority, and have been wrestling with questions such as how to make it more affordable to residents and how to provide support to family caregivers. According to the article in Web MD, they’ve broken down the information in “The Scorecard” to help readers understand which states provide the best support (either financial, social, emotional or legal) for the elderly and their caregivers.

The article “ranks states’ performance according to four categories: 1. Affordability and access, 2. Patient choice of both provider and setting, 3. Quality of life and care, and 4. Support for family caregivers.” The states ranked highest overall were Minnesota, Washington, Oregon, Hawaii and Wisconsin; while the lowest ranking states turned out to be Mississippi, Alabama, West Virginia, Oklahoma and Indiana. (For more information on how the states were ranked and what each ranking means please read the article here.)

Perhaps the most important lesson to take from all this is that no matter where you live, or what your health is like right now, it is very likely that you will need some kind of long-term care in the future, and that that care will be expensive. Burying your head in the sand or choosing to “think about it when the time comes” will only make things worse for you and for your family. Call our office and let us help you prepare now for whatever the future may bring.

According to a recent article in the Wall Street Journal, many Baby Boomers are no longer worried about when they will be able to retire, but if they will be able to retire at all. In many cases the reason for this worry stems not so much from any kind of selfish inability to save, but from a tendency to be too generous.

In addition to a growing trend (hinted at in the WSJ article above) of Baby Boomers tapping their own retirement funds to help pay for the care of their elderly parents, this article in USA Today warns of the all-too-common danger of Boomers shorting their own retirements to pay for their children’s college educations.

“People are willing to go to extreme measures because they value a college education so highly… Among parents who are planning for their children’s college, 24% say that they tap their retirement accounts. And that doesn’t reflect people who reduce or halt retirement contributions [to make tuition payments.]”

One thing that both of these articles agree on is that when it comes to saving money, Boomers need to put their own needs first. While the immediate financial needs of an elderly parent or college-bound child may feel more pressing, it’s a very bad idea to short your own retirement account (and your future) to cover their costs. If you have an elderly parent in need, before you dip into your own savings contact a good elder law attorney who can help you review your (and your parent’s) options, and help navigate the VA Benefits or Medicaid system if applicable.

As far as college tuition goes, by neglecting your own retirement to pay for your children’s college education you may simply be perpetuating a dangerous cycle, putting your children in the position of having to pay for your expenses when your savings runs out in the future. Financial advisors, college admissions counselors, and the school’s financial services center may be able to help you explore your options for paying for tuition.

Last month saw some good news for seniors and their families in the state of New York. State Governor Andrew Cuomo announced on his website that he “signed a law to create a statewide alert system for missing vulnerable adults, similar to the nationwide Amber Alert program, which will help authorities locate cognitively impaired persons who go missing.” By signing this law Governor Cuomo added New York to the growing list of states with similar programs in place to help find and protect seniors with Alzheimer’s who may wander away from their homes in confusion.

The first state-wide public notification system for vulnerable adults, sometimes called “Silver Alert” programs, was passed in Oklahoma in 2006. Since then 28 states have joined Oklahoma in passing Silver Alert legislation (or something similar) and five states have some kind of vulnerable adult alert legislation pending.

According to Governor Cuomo’s announcement, New York’s new Amber Alert for Seniors program “provides for the rapid public dissemination of information regarding adults with dementia, Alzheimer’s, or other cognitive impairments who go missing. Under the new law, the same Amber Alert mechanisms used to find missing children will be activated for missing vulnerable adults, including the printing and distribution of photographs and posters, a toll-free twenty-four hour hotline, a curriculum for training law enforcement personnel, and assistance for returning missing vulnerable adults who are located out of state.”

New York’s program—and the similar programs in all participating states—are a comfort to the families of seniors afflicted with Alzheimer’s or dementia. Too often we read news stories about seniors who have wandered away from their homes and are not found until it’s too late. If you worry that your elderly relative may be at risk for wandering, check the laws of your state to find out which programs are available to you and how to enroll (if necessary).

If your state does NOT have a program in place you may want to consider enrolling your elderly loved one in the MedicAlert® + Alzheimer’s Association Safe Return® program. To learn more about this nation-wide emergency response service click here.

The “golden years” are supposed to be a time to retire and relax after a life of working hard for yourself and your family, but according to a recent story on NPR, Baby Boomers have some big financial concerns about the future, many of which involve how they will pay for health care in their golden years.

“The struggling economy, a longer life expectancy, ever-increasing health care costs and challenges facing Social Security are putting added pressure on the boomers, those born between 1946 and 1964.”

An Associated Press LifeGoesStrong.org poll questioned almost 1,500 adults, over 1,000 of whom were Baby Boomers, and found that while ALL Boomers had some concerns about financial comfort and survival as they aged, the younger Boomers in particular (those born in the ‘60s) had the strongest—and the most all-encompassing—concerns.

This discrepancy in fear makes sense when you consider that “Many older boomers still have a defined benefit pension plan, probably some decent retiree medical insurance and Social Security,” whereas “the youngest boomers… face more uncertainty about their pensions, their Social Security, their housing and their medical care.”

The NPR article does not offer any easy fixes or instant comforts to these financial concerns—indeed there are no easy fixes—but it does offer a few suggestions to help Boomers ease their minds about those things that worry them the most:

* Push retirement back as long as you can to put off drawing on your savings until absolutely necessary.

* Start investing in long term care insurance, and do so as early as possible. “Costs for long-term care insurance can range from $1,000 to $8,000 a year, depending on age, health conditions, policy term and other factors.” As you get older the cost goes up—sometimes very steeply.

* Don’t neglect your estate planning. According to the poll, “Forty-percent of the boomers polled said they had a legal will to spell out how their possessions should be distributed after death,” and even fewer had health care directives, proxies, or living wills. A health care directive “allows people to document their wishes concerning medical treatment, and the proxy is a medical power of attorney that allows for the appointment of a trusted person to make medical decisions in case an individual is unable to do so.”

Our office can help you address any concerns you might have about your own (or a loved one’s) golden years. Don’t hesitate to contact us.

One of the services Elder Law and Estate Planning attorneys often provide is helping clients navigate the application procedures and bureaucratic systems for the various state and federal medical insurance programs; and one thing that remains a surprise throughout the years is how many people forget about the VA Aid and Attendance Program for war veterans.

According to the Department of Veterans Affairs website, VA Aid and Attendance is “a benefit paid to wartime veterans [or their spouses] who have limited or no income, and who are age 65 or older, or, if under 65, who are permanently and totally disabled.” Unfortunately, too many veterans and their spouses are unaware that they qualify for this benefit, or even worse, have never been informed that the program exists.

An informative article in the Washington Post quotes the VA’s deputy undersecretary for disability assistance as saying that he believes they are only reaching “about one in four eligible veterans.” Part of the reason for this is that “there are a lot of veterans where it’s been 40 years or more since they’ve been on active duty. It just doesn’t occur to them there may be a benefit from the VA.”

If you are a war veteran over the age of 65 it is very likely that you and/or your spouse qualify for Aid and Attendance Benefits. Eligibility requirements include:

* You served at least 90 days of active military service 1 day of which was during a war time period. (If you entered active duty after September 7, 1980, generally you must have served at least 24 months, or the full period for which called or ordered to active duty.)

* You were discharged from service under conditions other than dishonorable.

* Your countable family income is below a yearly limit set by law (The yearly limit on income is set by Congress.)

* You must need help with at least one activity of daily living: dressing, eating, walking, bathing, adjusting prosthetic devices or using the toilet. Those who are blind, living in nursing homes or require in-home care may also be eligible.

For many veterans and their families the financial assistance they receive from their VA Aid and Attendance benefits can be an incredible help. Unfortunately, the application process required to receive the benefits can be daunting. “It’s not a simple process. A&A applicants must mail the forms, copies of service records, marriage certificates, proof of insurance and medical records to the regional VA office. If a third party is making the application, an additional form, 21-22-a or 21-0845, must be completed.”

This is why many veterans ask a knowledgeable Elder Law or Estate Planning attorney to help with the application process. The right attorney can help you find and fill out the correct forms, gather the necessary records and materials, and keep track of progress throughout the entire process. If you think you may be eligible for VA Aid & Attendance Benefits please don’t hesitate to contact our office.

It is common knowledge in our society of aging Baby Boomers that many adult children end up taking months or even years off from their lives and careers to provide care for their elderly parents. Most children do this out of love and a sense of duty, but even in the closest of parent-child relationships there may be an unspoken expectation that appreciation for the caregiving child’s time and effort may be reflected in the parent’s will or trust. After all, professional caregivers demand a salary, is it too much to expect that a relative serving as caregiver should be compensated as well?

Take as an example the case of Anthony Olivo, who this article in Forbes describes as “a tax lawyer who ended up providing nearly full-time care for his mother and father.” Anthony “worked in law firms from 1976 to 1988 and then opened his own practice. Yet by 1994, given all the time he was devoting to his parents and their health problems, he found it hard to maintain his practice. He lived with his parents and gave them round-the-clock care from 1994 through 2003, during which he earned no significant income from his law practice.”

Now Mr. Olivo is asking that the U.S. Tax Court deduct $1.24 million from the estate of his parents for fees it paid to Anthony while he was serving as caregiver. Mr. Olivo is not challenging his parents’ wishes, he is not asking for more of the estate than his parents bequeathed to him; rather, he is asking that a “salary” for caregiving be deducted from the taxable portion of his inheritance.

Unfortunately, in the absence of a legal agreement, the tax court is unable to rule in Mr. Olivo’s favor: “The court was careful to note that Anthony rendered extraordinary care and that his efforts were commendable. However, the court ruled that his mother’s estate did not establish that Anthony was entitled to that pay. There were no written agreements and scant evidence the family agreed to pay him.” Furthermore, “There was no contract and no firm evidence of how much Anthony’s services were worth.”

We sympathize with Mr. Olivo, and hope that our firm can help save our clients from ending up in a similar situation. Simply leaving the caregiving relative “a little extra” in a will or trust is not enough, we cannot stress enough the importance of a legal caregiver agreement if a family member is providing caregiver services—especially if that family member is giving up time from his or her own career to do so.

“Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.”

-Dylan Thomas, Do Not Go Gentle Into That Good Night

The Dylan Thomas poem from which the above lines are taken fairly accurately expresses the American view of death. Even after a long and satisfying life we tend to think of death as something to be fought against with all of the tools at our disposal. We struggle to keep parents, grandparents, or patients alive for just one more week, one more day.

But the new film Consider the Conversation suggests that a natural death after a long life may not be a single event to struggle against, but rather a process to be faced with as much grace and comfort as possible. Created by Mike Bernhagen, a business development specialist turned hospice advocate after watching the slow physical and cognitive decline of his elderly mother; and Terry Kaldhusdal, a teacher and filmmaker; the documentary is a labor of love.

“Consider the Conversation does not seek to hand down answers. Rather, it provides something far more important – the questions all of us need to contemplate. That being said, the producers have three goals for this film: 1) to change the current American attitude from one that predominantly views end-of-life as a failed medical event to one that sees it as a normal process rich in opportunity for human development, 2) to inspire dialogue between patient and doctor, husband and wife, parent and child, minister and parishioner, and 3) to encourage medical professionals, healthcare organizations and clergy to take the lead in counseling others.”

The film brings up issues that every adult child should be talking about with their elderly parent, and that every elderly patient should be having with their doctor. These are also issues that you should be discussing with your estate planner as you create your Living Will or Advance Healthcare Directive.

The film Consider the Conversation is being shown on public television stations around the country. Check the website for an updated screening schedule, or to purchase the DVD.

Trudy Lieberman has had plenty of experience with Medicare—of course up until now most of it was from the outside looking in. As a journalist for more than 40 years specializing in insurance, health care, health care financing and long-term care, one would think that when the time came this year for her to enter the Medicare system herself she’d be an old pro. Unfortunately, as Ms. Lieberman discovered—and shared with the readers of her exceptional five part article series in Time Magazine’s Moneyland—entering the Medicare system as a patient can be confusing for even the most knowledgeable of inside reporters.

While her experience as a reporter may not have made signing up for Medicare any easier for Ms. Lieberman, her willingness to share her entrance into Medicare with readers may make the process easier for the rest of us. Here are just a few of the issues Lieberman has written about thus far:

Sorting through Medicare information and choosing a plan: “Brochures and ‘lead cards’ for Medicare Advantage plans and Medigap policies began flooding my mailbox in January. This stuff can be a real burden, but some of it’s worthwhile – some even important – so you can’t just throw it all away…Hopefully, my sorting system (partly informed by decades of reporting on Medicare, partly by common sense) will make the task easier for you.

Choosing a Medigap Plan to fill in the gaps of Medicare coverage: “It quickly became clear that the push to give consumers more choices and more information has actually made the job of picking a Medigap plan much harder. I ended up having to check out multiple websites, brochures, handouts and make several toll-free calls for assistance.”

Finding a plan to cover the cost of prescription drugs: “I decided to ask my pharmacy about the retail cost of the drugs I currently take. I’ve always had great drug coverage, so it was shocking to learn that my prescriptions would cost $3,131 a year if I had to pay out-of-pocket. (Of course, from interviewing seniors over the years, I know some folks actually pay four or five times that amount.)”

Part five comes out next week, and we look forward to reading the conclusion of this helpful series. We know how confusing and time consuming dealing with Medicare can be, so it’s helpful to know that many elder law attorneys specialize in helping seniors with this very process—we can help you too.

One of the most difficult aspects of caring for an elderly parent (or helping an aging parent who lives far away) is keeping one step ahead when that parent begins to lose the ability to manage his or her own finances. Many seniors can be very resistant to discussing what they feel is an extremely private and sensitive topic. Furthermore, according to this article in AgingCare.com, “for many elders, being able to take care of their own finances is an important symbol of independence and self-worth,” and one that they are not likely to relinquish easily.

Unfortunately, an elderly parent’s ability to manage their own money may cease before they are willing to ask for help. In these cases, it may be up to their children and loved ones to step in and help as best they can. What follows is a list of some non-invasive, non-offensive steps adult children and caregivers can take to help aging parents manage their finances.

* Ask for a list of important people and information you might need in case of emergency. This list would include contact information for an attorney, financial advisor, primary care physician, and insurance agent.

* Ask where your parent keeps important documents and how an executor or advisor could access those documents upon your parent’s death or incapacity.

* If your parent is willing, discuss their estate plan with them, including who they have chosen as their agent or executor, and what you can do if something happens.

* Ask your parent to make a list of monthly bills, expenses and account numbers. Although your parent may not want to hand over this information right away, the list should be stored with other important estate planning documents so that it can be accessed in case of emergency.

* As you keep track of your own financial deadlines (tax filing deadlines and the like) set up reminders for your parent as well.

* Ask that your parent list you as an “emergency contact” with their utility services, this means that you would be informed if your parent’s service is in danger of being terminated.

* And finally, talk to your parent as often as you can. Keeping open lines of communication is the very best way to stay informed about the abilities and well-being of your aging parent.