Florida Elder Law Attorney - Blog

Florida Elder Care: Recognizing Symptoms of Dementia

2010-06-15T18:54:00.000-07:00

The Brown family reunion has always been an event everyone looks forward to. Family visits, games, stories and everyone’s favorite foods are always on the agenda. On the top of the menu is Grandmas Lemon Coconut Cake. Grandma always makes the traditional cake from her old family recipe. This year, however, the cake tasted a little on the salty side, perhaps a half cup full of salty.

Though the family was disappointed over the cake, of more concern was Grandma’s confusion with the recipe and her similar confusion about the loved ones around her. Could something be wrong with grandma's mental state?

One might say that for an elder person a little forgetfulness or confusion is normal, but when do you know if there is a serious problem, such as dementia?

An online article from FamilyDoctor.org outlines some common symptoms in recognizing dementia.

"Dementia causes many problems for the person who has it and for the person's family. Many of the problems are caused by memory loss. Some common symptoms of dementia are listed below. Not everyone who has dementia will experience all of these symptoms.

Recent memory loss. All of us forget things for a while and then remember them later. People who have dementia often forget things, but they never remember them. They might ask you the same question over and over, each time forgetting that you've already given them the answer. They won't even remember that they already asked the question.
Difficulty performing familiar tasks. People who have dementia might cook a meal but forget to serve it. They might even forget that they cooked it.
Problems with language. People who have dementia may forget simple words or use the wrong words. This makes it hard to understand what they want.
Time and place disorientation. People who have dementia may get lost on their own street. They may forget how they got to a certain place and how to get back home.
Poor judgment. Even a person who doesn't have dementia might get distracted. But people who have dementia can forget simple things, like forgetting to put on a coat before going out in cold weather.
Problems with abstract thinking. Anybody might have trouble balancing a checkbook, but people who have dementia may forget what the numbers are and what has to be done with them.
Misplacing things. People who have dementia may put things in the wrong places. They might put an iron in the freezer or a wristwatch in the sugar bowl. Then they can't find these things later.
Changes in mood. Everyone is moody at times, but people who have dementia may have fast mood swings, going from calm to tears to anger in a few minutes.
Personality changes. People who have dementia may have drastic changes in personality. They might become irritable, suspicious or fearful.
Loss of initiative. People who have dementia may become passive. They might not want to go places or see other people."

Dementia is caused by change or destruction of brain cells. Often this change is a result of small strokes or blockage of blood cells, severe hypothyroidism or Alzheimer’s disease. There is a continuous decline in ability to perform normal daily activities. Personal care including dressing, bathing, preparing meals and even eating a meal eventually becomes impossible.

What can family members do if they suspect dementia? An appointment with the doctor or geriatric clinic is the first step to take. Depending on the cause and severity of the problem there are some medications that may help slow the process. Your doctor may recommend a care facility that specializes in dementia and Alzheimer’s. These facilities offer a variety of care options from day care with stimulating activities to part or full-time live-in options. Sometimes if patients tend to wander off, a locked facility is needed.

In the beginning family members find part time caregivers for their loved one. At first, loved ones need only a little help with remembering to do daily activities or prepare meals. As dementia progresses, caregiving demands often progress to 24 hour care. Night and day become confused and normal routines of sleeping, eating and functioning become more difficult for the patient. The demented person feels frustrated and may lash out in anger or fear. It is not uncommon for a child or spouse giving the care to quickly become overwhelmed and discouraged.

Family gatherings provide an excellent opportunity to discuss caregiving plans and whole family support. It is most helpful if everyone in the family is united in supporting a family caregiver in some meaningful way.

"The first step to holding a family meeting, and perhaps the most difficult one, is to get all interested persons together in one place at one time. If it's a family gathering, perhaps a birthday, an anniversary or another special event could be used as a way to get all to meet. Or maybe even a special dinner might be an incentive.

The end of the meeting should consist of asking everyone present to make his or her commitment to support the plan. This might just simply be moral support and agreement to abide by the provisions or it is hoped that those attending will volunteer to do something constructive. This might mean commitments to providing care, transportation, financial support, making legal arrangements or some other tangible support."

Professional home care services are an option to help families in the home. These providers are trained and skilled to help with dementia patients. Don’t forget care facilities as well. It may be the best loving care a family member can give is to place their loved one in a facility where that person is safely monitored and cared for.

As always, before making any legal decisions, it is recommended that you consult a qualified Florida Elder Law Attorney.

Florida Elder Law: How To Avoid Exploitation of the Elderly

2010-06-08T19:18:00.000-07:00

The Trials and Heirs blog recently had an article about how to avoid exploitation of the elderly by a family member. They recommend:

1. Getting expert advise who knows the ins and outs of Florida estate planning. I would also recommend using a Florida Estate Planning Attorney who is familiar with Florida Elder Law.
2. Be careful of joint accounts as they can take the money or create ineligibility for nursing home coverage.
3. Consider "Springing" Powers of Attorney, or as we call them contingent Durable Powers of Attorney, as they only give powers once you are incapacitated.
4. Choose wisely, which may mean not choosing a family member or the oldest child because of emotional reasons.
5. Having checks and balances by using more than one person to make decisions and to avoid fights.
6. Selecting someone to monitor your accounts. This person can be a trusted advisor and should have the ability to question and stop inappropriate actions.

These are issues that should be dealt with in Florida Estate Planning as well as to avoid abuse of the elderly. To discuss your concerns or issues contact a qualified Florida Elder Law Attorney.

Florida Elder Care: The Financial Health of Aging Seniors

2010-05-13T14:17:00.000-07:00

With our current economic challenges, those of us looking forward to retirement need to be well-informed about our financial needs in coming years. And not only pre-retirees, but individuals already in retirement need to be wise to the changing economic environment. The good news is there are trained professionals who keep abreast of changes in the current economy, changes in laws and changes in government programs for the elderly. Professionals in this field are equipped to handle everything from help with retirement savings accounts, investment advice, guidance on government programs, estate planning or even new funding options such as reverse mortgages. A little planning prior to retirement will allow you to maintain your current lifestyle; whereas, a lack of planning may require you to live on an extremely tight budget. For those already retired, taking time right now to deal with financial problems instead of waiting for a crisis to happen is well advised.

A large number of retired individuals feel that they have planned well for the future only to find that rising medical costs, damage done to investment portfolios (by the current economy) and many other factors have caused them to go into debt. According to an article in "USA Today" seniors are racking up debt like never before. Elderly individuals who are in debt live with a constant burden over their heads. Most of these people are on fixed incomes and have no way of paying off credit cards and home equity loans that continue to mount to cover household budget deficits. In order to meet ongoing payments, seniors often forego purchasing medications and skimp on food budgets. They live like hermits -- never going out and pinching every penny -- in order to pay their obligations.

Most of these people worked hard their entire lives and managed their debt. They never anticipated the rising costs of prescriptions, expensive medical care or depletion of savings by living too long. The good news is there is help for these individuals. Here are just a few examples of some relief options that could be available. There are many more besides these.

Reverse mortgages - A Home Equity Conversion Mortgages (HECMs), also known as a reverse mortgage, is a risk-free way of tapping into home equity without creating monthly payments and without requiring the money to be paid back during a person's lifetime. Instead of making payments the cash flow is reversed and the senior receives payments from the bank. Thus the title "reverse mortgage". For those seniors who are less fortunate financially but own a home, a reverse mortgage can allow them to remain in the home by creating extra income.

Life settlements -- A life settlement enables older individuals, businesses and other organizations to sell life insurance policies they currently own – but no longer want or need – for an amount greater than the cash surrender value. In some cases the value can be 2-3 times the cash surrender value. Even some term life insurance policies with a conversion option to permanent coverage can qualify for a life settlement.

Government Programs -- Some government programs such as food stamps provide temporary financial help for food. Other programs provide subsidized housing, help with medical expenses and provide tax credits. For veterans there is free health care, inexpensive prescriptions and disability income. Area agencies on aging offer individual counseling, legal help and advice with Medicare costs.

As always, before making any legal plans, consult with a qualified Florida Elder Law Attorney.

Florida Elder Law: The Florida-New York Connection

2010-05-03T18:28:00.000-07:00

Many of you may be aware that Elder Law Associates PA handles New York in addition to Florida elder law and special needs planning matters. The value of that knowledge and expertise was put to the test recently in a case involving a father whose two children, located in Texas and New York, had to make a decision about where their Florida-based father should receive long term care services. First, we outlined the planning opportunities and asset preservation strategies available in both New York and Florida. We also educated our clients about the differences between New York and Florida in terms of the services available through the various government programs in each state. This was of tremendous value to the client, who was then able to determine which state offered the appropriate level of care that could be secured with the greatest amount of ease based upon the different services offered in each state.

The children decided with our guidance that New York would best serve their father’s needs. With our assistance, we secured an appropriate placement for their father in a nursing facility located in the Bronx, nearby to where the son lives. We are now in the process of implementing an asset protection strategy known as the gift and loan strategy that will allow this family to preserve a portion of their father’s assets and secure Medicaid benefits at the earliest possible date to cover the cost of the nursing facility.

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2010-04-30T12:27:00.001-07:00

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Florida Elder Care: Vitamins and Mineral Supplements Are Important for Older People

2010-04-10T19:21:00.000-07:00

Research has discovered that as we age, our diets and our need for dietary supplements become more. Doctors are increasingly concerned about boosting the levels of vitamins and minerals that we need as we grow older.

As most people get older, they tend to eat less due to a loss of appetite. As a result, many elderly individuals do not take in adequate amounts of vitamins and other nutrients as they did when they were younger. Other factors that can affect appetite and the inadequate uptake of vital nutrients are medications, medical complications, certain disabilities, diabetes, changes in the digestive system and even the changes in our skin as we age. One study estimates that one-third of the elderly are alarmingly low on important vitamins and minerals. Another study indicates that two thirds of the elderly patients admitted to a hospital are mal-nourished, resulting in low levels of vital nutrients. When a person is vitamin and mineral deficient, he or she is more susceptible to illness and infections. It is estimated that deaths due to infections are ten times more likely in the elderly.

Vitamins
So what is a vitamin and why is it so essential to our bodies? A vitamin is a molecule that our bodies need to carry out certain biological functions. With only a few exceptions, we have no way to create vitamin molecules ourselves, so these vital building blocks must come in through food that we eat. The human body is known to need at least 13 different vitamins. We are able to store some of these for long periods of time in fat cells or in the liver -- such as vitamin A -- but most vitamins need to be replenished frequently.

Vitamins don't supply us with energy. We need protein, carbohydrates, and fats for that. What vitamins do is to help the carbohydrates, fats, and proteins release energy. These vital compounds are very important and they are required for all sorts of complex chemical reactions in our bodies. Vitamins are also needed to assist the enzymes that repair tissue and help with the production of cells. Many studies show that vitamins and minerals can help or prevent some of the disorders or diseases related to aging.

There are two types of vitamins -- water soluble and fat soluble. Water soluble vitamins are not stored in our systems. They pass through us quickly. In order to keep these nutrients in our bodies we have to consume them frequently. Water soluble vitamins contribute to our health, energy and stamina. This type of vitamin also helps in the function of over one hundred enzymes and chemical reactions that give our bodies energy. Listed below are some of the well known water soluble vitamins and their benefits.

Vitamin B5 – good for reducing swelling
Vitamin B3 – reduces tissue swelling and helps increase blood flow.
Vitamin B6 – also reduces swelling. When combined with vitamin B12 in proper concentration has shown to reduce heart disease.
Vitamin B12 – This is the most vital of the B's. It aids in the formation of cells, myelin production, healthy nerves, and maintaining immune system and mental function.
Vitamin C – Vitamin C helps in the formation of cartilage and bone. Some studies have shown it may reduce the progression of osteoarthritis.

Fat soluble vitamins are vitamins that stay in the body and are typically stored in the liver. You can usually receive enough of these compounds by eating a well balanced diet. Any condition that can interfere with the absorption of fat in the body like tuberculosis, cystic fibrosis, hypothyroidism, lactose intolerance, and many other diseases or disorders can cause deficiencies in these vitamins. Before taking the daily recommended dose of fat soluble vitamins you must consult your doctor. Overdosage of these substances can cause a toxic build-up. Listed below are the major fat soluble vitamins.

Vitamin A – Lungs, throat and mouth depend on vitamin A to retain moisture. This compound is also important for your skin, bones, teeth, digestive system, urinary tract, eyes and aids in preventing skin disorders like acne, boils, and bumpy skin. Some studies show that it may aid in slowing the aging process.
Vitamin K – plays an important role in the clotting of blood. Research has linked vitamin K to bone health.
Vitamin D – is produced in the skin by exposure to the sun. Deficiencies mostly occur in people living in northern latitudes where daylight is brief during winter months. Changes in skin as we age can also cause poor production of vitamin D. Studies show that osteoporosis might progress faster in women with low levels of vitamin D. This compound is essential in helping the body absorb calcium and in maintaining strong bones.

Minerals
Unlike vitamins, minerals are not manufactured by plants or animals. Minerals form in the earth, and are absorbed by plants and found in animals that eat the plants. Listed below are some of the essential minerals needed to maintain a healthy body.

Iron – helps carry oxygen throughout the body. Iron also helps the immune system ward off foreign entities.
Calcium – Most women as they get older need calcium supplements to prevent bone loss that causes osteoporosis. Calcium supplements will not do you any good if you do not have the right levels of vitamin D. your body cannot absorb calcium without vitamin D.
Zinc – Zinc deficiencies can affect skin, nerves, and the body’s immune system.

It is important that you take vitamin and mineral supplements with food. Fat soluble vitamins require fat ingestion to result in the best absorption. It is best to take your supplements at the biggest meal of the day.

We use vitamins every day to support the processes our bodies use to maintain life. Ongoing reduced levels of vitamins can make you weak and more vulnerable to disease. Proper nutrition with vitamins and minerals is vital for seniors to maintain a healthy lifestyle.

Florida Elder Care: Employer Support for Care Giving Employees

2010-03-10T14:26:00.001-08:00

“There are only four kinds of people in this world. Those who have been caregivers, those who are caregivers, those who will be caregivers, and those who will need caregivers.” Rosalynn Carter, Former First Lady

The U.S. Department of Labor estimates that in the year 2010, 54% of workforce employees will provide eldercare for a parent or parents and that nearly two-thirds of caregivers will experience conflict between demands at home and demands from employers.

Today’s employed Baby Boomers are the caregiver generation for their parents. They are finding themselves juggling care responsibilities around their employment obligations. Sometimes employees find they have no option but to take leave from work or use sick time to meet their caregiving demands.

Employers also feel the toll it is taking on their employees. A report by the AARP describes the cost to employers:

“Companies are also seeing the emotional and physical toll that caregiving takes on their workers. In one study, 75% of employees caring for adults reported negative health consequences, including depression, stress, panic attacks, headaches, loss of energy and sleep, weight loss, and physical pain. Businesses suffer, too, by having to pay high health insurance costs and in lost productivity. That doesn’t count the promotions or assignments workers turn down that require travel or relocation away from aging relatives."

Businesses that don’t offer benefits or address eldercare wind up paying for them. A recent study by the MetLife Market Mature Institute and the National Alliance for Caregiving states that U.S. companies pay between $17.1 billion and $33.6 billion annually, depending on the level of caregiving involved, on lost productivity. That equals $2,110 for every full-time worker who cares for an adult.

Eldercare cost businesses:

* $6.6 billion to replace employees (9% left work either to take early retirement or quit)
* Nearly $7 billion in workday interruptions (coming in late, leaving early, taking time off during the day, or spending work time on eldercare matters)
* $4.3 billion in absenteeism" AARP

Typically, human resource departments work with employees on many issues that may affect their work productivity. There are programs for drug and alcohol abuse, domestic violence, illness, absenteeism and child care; but, help with eldercare issues is not normally provided.

The AARP report follows several companies who are providing help with eldercare issues and what they are doing for their employees.

* “Freddie Mac has a free eldercare consultant and access to subsidized aides for a relative up to 20 days.
* Verizon Wireless offers seminars on eldercare issues and allows full-time workers 80 hours a year in back-up care, 40 hours for part-time, and $4/hour for in-home help.
* At the Atlanta law firm Alston & Bird LLP, workers can donate vacation time to colleagues who have used up theirs to care for family members. “ AARP

A growing number of companies nationwide are directing their HR departments to provide resources, education and group help for caregiving issues by:

* Providing materials from community resources such as phone numbers to their local Senior Centers or Area Agencies on Aging.
* Making available brochures and booklets on specific programs and services by eldercare experts
* Providing speakers to educate employees on caregiving options
* Allowing options to use paid sick leave, employee job sharingand flexible hours
* Allowing employee caregivers to use business computers for caregiving research
* Contracting with companies who provide eldercare services to help employees

Eldercare service providers are also reaching out to help employee caregivers by providing informational presentations at the work place during lunch time or other times set up by employers. One such presentation provided information on reverse mortgages. Jason, who had been trying to help his parents pay for home care, learned at a work site presentation that a reverse mortgage was one way to cover caregiver expenses.

The HR Department of a local business in Utah, invited the Salt Lake Eldercare Planning Council to present a “Brown bag, Lunch and Learn” during their employees' lunch hour. In 30 minutes time, those who attended learned how the services of a Care Manger, Home Care Provider, Elder Attorney, Medicaid Planner and Financial Consultant can help with caregiving decisions. Problems were discussed, questions answered and employees left armed with information and the names of professional people they knew could help them.

“This was the most productive lunch I have ever attended”, related Mary, one of the attendees.

“I had been very hesitant to contact an attorney to discuss my parents' estate, because of the cost involved. The attorney at our 'lunch and learn' answered my few basic questions which will allow me to prepare what I need before I meet with him to finalize my parents' estate planning.”

Besides workplace help for employers and employees dealing with caregiving, the internet is also a great research tool. The National Care Planning Council website at www.longtermcarelink.net is a comprehensive resource for eldercare, senior care and long term care planning. It contains hundreds of articles on all aspects of eldercare. Professional providers list their services on the NCPC website. Each of their listings provides unique information on specific eldercare services and how to obtain help.

Employers, employees and eldercare service providers working together can make parent or senior caregiving a workable solution for all.

Florida Elder Care: Caregiver Tip - Ask Questions of the Doctor

2010-02-23T14:28:00.000-08:00

The Department of Health and Human Services Agency for Healthcare Research and Quality has provided a top notch WEB page to guide us all in improving the healthcare we receive by being involved, interactive and asking questions.

They list the ten primary questions as:

1. What is the test for?
2. How many times have you done this?
3. When will I get the results?
4. Why do I need this surgery?
5. Are there any alternatives to surgery?
6. What are the possible complications?
7. Which hospital is best for my needs? (and why)
8. How do you spell the name of that drug? (or medical term)
9. Are there any side effects?
10. Will this medicine interact with medicines that I'm already taking?

They continue why nine more lists of questions pertinent to specific situations such as when considering surgery, picking a hospital, etc. To learn more about these excellent tools you can go to their site by clicking on the link below.

HRQ.gov/QuestionsAretheAnswer

Of course, when doing Elder Care Planning, please make sure you consult a Florida Elder Law Attorney to get the best advice possible.

Florida Elder Care: Caring for Senior Veterans – VA Long Term Care Benefits

2010-02-08T13:41:00.001-08:00

In the month of February we celebrate Presidents Day in honor of two great United States Presidents; George Washington and Abraham Lincoln. Both were heroes of wars fought on U.S soil for freedom and unity of our great country.

The United States has fought many wars throughout the world since that time to keep freedom here at home and continues to do so. From the beginning our country has established a program to care for the men and women of our military who fought in those wars.

The veterans assistance program goes back to 1636 when Pilgrims of Plymouth Colony fought with the Pequot Indians. The Pilgrims enacted a law from English law that reads, “If any man shall be sent forth as a soldier and shall return maimed, he shall be maintained competently by the colony during his life.” In 1789 U. S. congress passed as law that pensions were to be provided to disabled veterans and their dependents and in 1811 the first domiciliary and medical facility for veterans was completed.

Since that time the Department of Veterans Affairs has opened a multitude of care facilities nationwide. An article from the US Department of Veterans Affairs website states:

“VA's health care system has grown from 54 hospitals in 1930 to 157 medical centers in 2005, with at least one in each state, Puerto Rico and the District of Columbia . More than 5.3 million people received care in VA health care facilities in 2005, a 29 percent increase over the 4.1 million treated just four years earlier.

VA operates more than 1,300 sites of care including nearly 900 ambulatory care and community-based outpatient clinics, 136 nursing homes, 43 residential rehabilitation treatment programs, nearly 90 comprehensive home-care programs, and more than 200 Veterans Centers.”

State veterans homes have been built or are approved for future construction in many states.

Here are some of the benefits provided for Veterans by the Department of Veterans Affairs:

* Health Care Clinics
* Mental Health
* Counseling
* Job training
* Burial and Memorial benefits
* Education
* VA Home Loan
* DIC
* Compensation
* Pension
* Care Management
* Home Renovation for Disability
* Assisted Living
* Prosthetics
* Rehabilitation
* Weight management
* Nursing Homes
* Prescriptions
* Hospitals
and much more

Thomas Day, founder and Director of the National Care Planning Council, has a deep gratitude for the services provided by the VA. He served as an Air Force pilot during Vietnam. Later he developed a crippling auto-immune disease. It was the doctors at the George A Wahlen VA Regional Medical Center who prescribed a new treatment that saved his life. Many of the VA programs continue to improve his life.

Tom is passionate about the Aid & Attendance Pension Benefit and the relief it brings to veterans and their families who need care services and ways to pay for it in their elder years.

“Aid and attendance" is a commonly used term for a little-known veterans’ disability income. The official title of this benefit is "Pension." The reason for using "aid and attendance" to refer to Pension is that many veterans or their single surviving spouses can become eligible if they have a regular need for the aid and attendance of a caregiver or if they are housebound. Evidence of this need for care must be certified by VA as a "rating." With a rating, certain veterans or their surviving spouses can now qualify for Pension. Pension is also available to low income veteran households without a rating, but it is a lesser dollar amount.

Pension is an underused benefit.

There are different income categories for Pension, but the highest could pay as much as $1,949 a month in disability income to a qualifying veteran household. A study commissioned by VA in 2001 estimated, over the next 14 years, only about 30% of eligible veterans would apply for Pension. This is likely due to the fact that most veterans simply don't know about it. In fact, about a third of all seniors in this country, age 65 and older, could become eligible for pension under the right circumstances. That's how many elderly war veterans or their surviving spouses there are.

To receive Pension, a veteran must have served on active duty, at least 90 days, with at least one of those days during a period of war. There must be a discharge under conditions other than dishonorable. Single surviving spouses of such veterans are also eligible. If younger than 65, the veteran must be totally disabled. If age 65 and older, there is no requirement for disability. There is no age or disability requirement for a single surviving spouse.

There are income requirements, but a special provision does allow household income to be reduced by 12 months worth of future, recurring medical expenses. Normally, income is only reduced by medical expenses incurred in the month of application. These allowable, annualized medical expenses are such things as insurance premiums, ongoing prescription drug costs, out-of-pocket cost of monthly medical equipment rental, the cost of home care, the cost of paying adult children to provide care, the cost of adult day services, the cost of assisted living and the cost of a nursing home facility. These are all considered medical costs and they can be deducted from income to receive this benefit.

According to Mr. Day,

"I talk to a number of people every day who are inquiring about this benefit. In many cases they don't know that the benefit can pay members of the family to take care of the veteran, the veteran couple or the surviving spouse at home. I have literally had people who are sacrificing dearly to take care of their loved ones at home, break down and cry when they find they can receive some money from the government for that sacrifice."

Thomas Day has written two books for the National Care Planning Council to educate and help veterans obtain this long term care benefit. The first, “How to apply for the Aid & Attendance Pension Benefit” is to educate the public what the benefit is and how to get it. The claims process for pension is described and information is provided to help understand what documentation is necessary to provide evidence of recurring medical expenses. All forms necessary for filing a claim are included in the form support section of the book. Here is a link to the book. http://www.longtermcarelink.net/a16Veterans_standard_book.htm

Although this is a do-it-yourself book, Tom recommends if you have excessive assets and income or are not sure how to apply medical deductions, use the services of a qualified consultant.

The second book, “Aid & Attendance Handbook for Professionals & Consultants,” is for the professional consultant. It is 782 pages of rules, forms, instruction on the submission process and Medicaid planning strategies as well as software for calculating income, benefit and medical expenses. Here is a link to that book. http://www.veteranbook.com

The secret for receiving a successful award for aid and attendance or housebound ratings is not in filling out the form but in knowing what documents and evidence must be submitted with the application. Knowing the secrets for a successful award -- with the special case of long term care recipients -- is 95% of the battle. Even though the form is challenging, filling out and filing a claim is a formality.

A knowledgeable consultant can provide information to shorten VA’s decision window of 6 to 12 months to possibly 3 or 4 months. The consultant also understands how to maximize the benefit or avoid a denial. The consultant can also provide guidance for meeting the asset test. Finally, the consultant can provide the actual strategies for reallocating assets and he or she can arrange for trusts or income conversions to allow for the best possible accommodation of assets for beneficiaries thus avoiding or reducing taxes, family disputes and Medicaid penalties.

Florida Elder Care: Healthcare-Associated Infections

2010-01-28T13:25:00.001-08:00

For those people who are caring for an elder parent or relative (and that's most of our clients) healthcare-associated infections are not a new issue. But what you need to know is that this is a largely preventable problem.

Recognizing the rapid growth in cases of hospital-related infections like MRSA and ventilator-associated pneumonia (VAP), a new Web site has been created. Called "Not on My Watch" at http://www.haiwatch.com, it's purpose is to educate patients and healthcare professionals. Their goal is to eliminate these preventable illnesses and their often tragic consequences.

Reaching more people with this important information means fewer people having to endure avoidable infection and suffering. There's even a micro-site that covers just the latest news on the subject: http://haiwatchnews.com

If you have any questions about the legalities of caring for an elderly parent or relative, please contact the qualified Florida elder law attorneys at Elder Law Associates at info@elderlawassociates.com. Your inquiry will be handled quickly and privately.

Florida Elder Law Attorneys Specialize in Helping the Elderly

2010-01-12T16:21:00.001-08:00

Many elderly persons rely entirely on their children, family members or other trusted individuals to help them. This dependence upon caregivers or family members makes an older person more vulnerable to abuse and financial exploitation. Legal arrangements and protective actions by family may be necessary to shield loved ones from making bad decisions or from being taken advantage of. It is very important to find a qualified Florida Elder Law Attorney to help you make any legal decisions.

Though you wouldn’t think a child could take advantage of his or her mother or father, there is no way to know what someone will do who is desperate for money or who feels entitled to an inheritance. For example:

David’s parents' health was failing and living alone in their home was becoming a concern. His sister Jill wanted to look into assisted living for them. David immediately became upset at Jill for wanting to spend their money. He packed up his parents and brought them to his home. Being single and working, he was not available to them during the day, but left food and water on the table to sustain them until he returned home in the evening. Jill lived over 300 miles from David and when she could get to his house to visit; she found her parents' care was not acceptable. They could not remember if they took their medications or if they had even eaten a meal that day. David was also draining their savings account and when confronted about it, became angry and complained that he needed their money to pay expenses for their care. Clearly Jill felt her brother's care of their parents was abusive, but David’s defense was he provided a home for his parents in which he could care for them. This family needs a professional advisor to help them understand and clarify the issues concerning their parents' care.

Making legal decisions about property, finances, power of attorney, and final wishes are important tasks to complete for the final years of life. Having legal documentation for a will, for medical treatment and for the person designated to be responsible for parents' welfare can avoid family disputes and financial abuse, and help to conserve assets that are needed for care.

Elder law attorneys specialize in legal issues affecting the elderly. They are knowledgeable about Medicare and Medicaid programs. They work with the elderly in assisting them and their families with all aspects of estate planning and implementing necessary legal documents for the final years of life. In addition, they help individuals to apply for and possibly accelerate coverage from Medicaid. An elder law attorney can also help with disputes with Medicaid. Below is a partial list of what an elder law attorney might do:

Preservation or transfer of assets seeking to avoid spousal impoverishment when a spouse enters a nursing home
Medicaid qualification and application and Medicaid planning strategies
Medicare claims and appeals
Veterans Benefits claims
Social security and disability claims and appeals
Disability planning, including use of durable powers of attorney, living trusts and living wills
Help with financial management and health care decisions; and other means of delegating management and decision-making to another in case of incompetence or incapacity
Probate
Administration and management of trusts and estates
Long term care placements in nursing homes and assisted living
Nursing home issues with patients’ rights and nursing home quality
Elder abuse and fraud recovery cases

A Certified Elder Law Attorney (CELA) is an elder law attorney who is highly proficient in meeting the legal needs of elders and in understanding and applying the rules of Medicaid. A CELA has successfully handled a requisite number of pertinent cases in order to receive that designation. This experience will make an attorney with this designation more competent with elder planning issues than other attorneys lacking this designation.

Most elder law attorneys do not specialize in all of the areas iterated above. When considering an attorney you will want to find one who has experience in the area you need help.

According to The National Academy of Elder Law Attorneys -- http://www.naela.org/:

“Ask lots of questions before selecting an elder law attorney. You don't want to end up in the office of an attorney who can't help you. Start with the initial phone call. It is not unusual to speak only to a secretary, receptionist or office manager during an initial call or before actually meeting with the attorney. If so, ask this person your questions.

How long has the attorney been in practice?
Does his/her practice emphasize a particular area of law?
How long has he/she been in this field?
What percentage of his/her practice is devoted to elder law?
Is there a fee for the first consultation and if so, how much is it?
Given the nature of your problem, what information should you bring with you to the initial consultation?"

A good way to choose an attorney is by referral from friends, family, clergy or other associations. Before you meet for your initial consultation, prepare the items you want discussed and taken care of. Bring pertinent documents and questions. Be sure you get clear answers and that you understand what your attorney is proposing.

Two-way communication is the best way your attorney can understand your needs and concerns. Does the attorney listen to what you say, appear to really care about your concerns or return your phone calls? If not find another attorney. Most Elder law Attorneys sincerely want to help make you or your parent's elder years a well planned for, peaceful experience for all involved.

There are a number of ways attorneys charge for their services. They may charge a flat hourly rate. Or they may charge hourly for some services and add on additional expense for out-of-pocket costs such as paperwork, stamps, phone calls, etc. Or they may charge a single fee for a mutually agreed-upon course of action or plan. Some attorneys who specialize in appeals for veterans benefits or Social Security may work on a contingency basis. It is important to understand how you will be billed so there will be no surprises in the end.

Florida Elder Law: Bank Pays for Refusing to Honor Request Made Under a Power of Attorney

2010-01-10T13:28:00.001-08:00

In a recent Florida case, Bank of America rebuffed the request of an agent under a durable power of attorney (POA) to withdraw funds from a jointly held account. The agent fought back in court and just won a $64,000 judgment against the bank. (It's always important to find a qualified Florida Elder Law Attorney who can litigate the cases.)

Clarence Smith, Sr., named his son, Clarence Smith, Jr., as his agent under a POA. When his father no longer wanted to manage his own finances, he asked Clarence Jr. to step in as his agent. Clarence Jr. reviewed his father's account activity and became suspicious about some withdrawals from a bank account that Clarence Sr. owned jointly with a friend from his retirement community.

Acting as his father's agent under the POA, Clarence Jr., asked Bank of America to transfer $65,000 from the account into a new account that listed only his father as the owner. Before doing so, Bank of America contacted the other person named on the account. When she told the bank that she did not want the funds withdrawn and also accused Clarence Jr. of stealing his father's money, Bank of America refused to honor Clarence Jr.'s request. The other account owner then withdrew all of the funds from the account and placed them into her own account. Clarence Sr. died several weeks later.

Clarence Jr. sued Bank of America under a Florida law that imposes penalties on financial institutions that refuse to honor reasonable requests from agents named in properly executed POAs. In November 2009, after a week-long trial, a Florida jury returned a verdict against the bank and awarded $64,142 to Clarence Sr.'s estate. The jury found that Bank of America had not acted reasonably when it rejected Clarence Jr.'s request, even though the joint owner of the bank account had not agreed to the release of the funds.

Bank of America plans to appeal. "We believe that neither the facts nor the law support the verdict," said spokeswoman Shirley Norton.

Florida Elder Law: Who Was Supposed To Be Watching Grandma?

2009-12-20T17:39:00.001-08:00

There is a popular tune played this time of year called “Grandma Got Run Over by A Reindeer” which relates that Grandma -- after drinking too much eggnog -- went out into the winter cold to get her medication and was run over by a reindeer. The question is, “Who was supposed to be watching Grandma?”

Though this little tune is just for fun, it may very well raise alarms to many caregivers of the elderly. Caregivers know that even at a holiday party they cannot let down their diligent watch over their elderly loved one. As far-fetched as it may sound, with all the people and noise, an elderly family member with dementia or Alzheimer’s may be enjoying the family gathering and then suddenly become confused and walk to the door and leave. (One should alway make plans well before-hand with the wise counsel of a qualified Florida Elder Law Attorney.)

For family caregivers the added stress of the holidays with decorating, shopping, parties and keeping up with all the family traditions is an overwhelming quest. Feelings of isolation, depression and sadness come with this added stress. There are millions of Americans who are caring for elderly frail loved ones and most of these caregivers will go through some of these emotions, especially this time of year.

There are some things you can do as a caregiver to help you and those you care for enjoy the holiday season.

First take care of yourself. Try to eat right, get plenty of sleep and exercise. This will help reduce stress and strengthen your ability to cope with caregiving responsibilities.

Prioritize your holiday traditions. Perhaps instead of cooking a large family dinner, have everyone bring his or her favorite dish. Use paper plates. Forfeit the traditional outside light decorating for a lighted wreath on the front door. Choose one or two parties or concerts to attend instead of trying to do it all.

Arrange for help. Call on other family members to help with the caregiving while you do your shopping or go out for the evening. If family is not available, ask your church group or a neighbor if they would donate a few hours.

Use community services. Many senior centers provide meals for the elderly and supervised activities, onsite, at no charge or a minimal charge. For locating senior services in your state, call your state Area Agency on Aging or check the national locator website at http://www.n4a.org/

Use adult day care services. Some assisted living facilities provide day activities and meals for seniors on a day by day basis. Other organizations called "adult day service providers" specialize exclusively in this sort of care support at a reasonable cost. These support services provide respite for caregivers from their caregiving responsibilities as well as social interaction for their elderly family members. There is a cost for adult day services, but the benefit for all is worth it.

For example:

Jean had brought her mother into her home to care for her when mom's Alzheimer’s made it impossible for her to be alone. When the Christmas season approached, Jean realized she had to make some choices. She did not want to give up the traditions she had set with her daughters in shopping and lunches, but it wouldn’t be possible with her caregiving responsibilities. In searching for a solution, Jean visited an adult day services facility near her home. She found she could schedule the days she needed off for her mother to come in. The adult day services company also provided transportation and would pick up mom and bring her home in the evening.

Although Jean's mother was not sure she would like to go at first, she found she enjoyed the programs, meals and conversation with new friends and the activities provided.

The time it gave Jean to have for herself was worth the extra cost for the day care.

Technology to the rescue. Here is a solution that would have kept “Grandma” from going out in the winter cold and getting run over by a reindeer. Companies that have created monitoring systems, security alarms and other safety equipment are “tweaking” them to adapt to the needs of seniors and their care givers.

Here are a few examples:

Ankle or wrist bands that monitor location and alert the provider when a person has gone beyond the designated perimeter, such as out the front door of the house.
Motion detectors. Set throughout the home, motion detectors allow someone outside the home to follow a senior as he or she moves through the house.
Smart medication dispensers. Live monitoring and dispensing of pills.
Emergency response alert. At a touch of a button on a desktop monitor, bracelet or necklace, emergency help is summoned.

Whether providing care in your home or helping senior family members in their own homes, your use of monitoring and “tech” help aids can provide extra safety for your loved ones, and peace of mind for you.

You are not alone. Join a caregiving help group. Your local senior center may have one or go on the internet to find one. Hearing about other caregivers' problems and solutions and being able to share your own and ask questions is a great way to relieve stress and gain a new perspective. Check out websites like the National Family Caregivers Association at http://www.nfcacares.org/

Work with a Senior Care Professional. Recognize that you are doing the very best you know how. You are not a geriatric health care practitioner, geriatric care manager, home care nurse or aide, hospice provider or family mediation counselor, nor do you have the years of training and experience these professionals have, but you can definitely use their experience. In fact, using a senior care specialist will make caregiving easier for you and more beneficial for your elderly family member.

As an example:

Mark stopped by his father Dan’s home every night after work to help with any errands or things he needed around the house. He began to notice that Dan was not showering, dressing or even fixing meals some days. Another concern was his father's growing confusion and disorientation. A trip to the family doctor only brought more concern to Mark, since the doctor claimed it was just the aging process that caused the confusion.

Wanting a second professional opinion on what was best for his father, Mark hired Shelly -- a Professional Geriatric Care Manger -- to do an assessment. Shelly arranged for Mark and Dan to see a geriatrician, who advised that proper meals and an increase in some vitamins, would help clear up the confusion and disorientation. Shelly arranged for a home care company to come in daily to help with personal needs and prepare meals.

Soon Dan was back to his old self and able to function on his own.

One more thing to remember. As a family caregiver, the greatest gift you are giving this holiday season is “Love.”

Have You Planned for the Future of Your Loved One with Special Needs?

2009-12-16T18:51:00.001-08:00

Caring for a child or loved one with special needs carries
certain challenges that many cannot understand, and yet
too many of us are confronted by these challenges on a
daily basis. A Special Needs Planning Attorney can assist
you with Medicaid Planning, planning for your loved
one with special needs trusts and comprehensive estate
planning. A Special Needs Planning Attorney recognizes
that caregivers typically do not add up the cost of support
and caring for an individual with a disability. Caregivers
provide many services “naturally” and willingly to loved
ones to help enhance their quality of life. These services
might include any one or more of the following:

Advocate
Social service coordinator
Companion
Guardianship
Job coach
Chauffeur
Personal care attendant
Money manager
Recreation director

If you become unable to provide these services or die
without planning for the continuation of these services,
your loved one’s quality of life may suffer.

An experienced Special Needs Planning Attorney will:

Establish comprehensive care plans organized so that monies for your loved one with special needs will not be at risk from estate taxes or the long-term care costs of caregivers
Assist with applying for SSI benefits for a person with disabilities
Apply and qualify for Medicaid for a person with disabilities
Provide for a person with special needs in your Will
Apply for Guardianship
Set up a Special Needs Trust
Set up a Supplemental Needs Trust
Assist in the creation of a Letter of Intent
Inform you of the estate planning options available to you
Assist families with long term care planning for loved ones with special needs

What is a Special Needs Trust?

A special needs trust (usually funded with the assets
of the disabled individual) or a supplemental needs
trust (usually funded with the assets of a third party,
such as the parents of a disabled individual) makes it
possible to appoint a trustee to hold property for the
benefi t of your disabled child after you’re gone. A special
needs trust provides for the needs of a disabled person
without disqualifying him/her from government benefi ts
programs such as Social Security and Medicaid.
Why Can’t I Leave My Assets to Other Family Members?
While it might seem like a good idea simply to leave a
certain amount of money to your disabled child’s sibling
or other close relative, with the understanding that the
money will be spent on the disabled child, this approach
is not the best strategy and often produces negative
consequences. For example, any one or more of the
following can occur by leaving your assets to another
family member:

The money can become subject to judgments, divorce settlements or bankruptcy decrees against the relative
The disabled person has no legal right to force the relative to use the money to benefit the disabled person
The relative to whom the money is left may be taxed at a higher income tax rate than the disabled child or a trust
Should the relative die before the disabled child, the money would go to the relative’s heirs and not the disabled child

A special needs trust avoids these potential problems
without putting an emotional strain on family relations.

Monthly SSI benefi ts can be spent on food and shelter.
The special needs trust money can be used to pay for
additional items that will enhance the quality of life of
your disabled child. Such things might include:

Summer camp
Lessons
Educational expenses
Airline tickets for travel
Electronic video games
Vitamins and grooming supplies
Funeral and burial expenses

Preparing a Letter of Intent

One way to set forth what your intentions are for your
disabled child’s future is to sign a “Letter of Intent.” This
letter can be given to the trustee of the special needs trust
at the time of your death. This document gives family
members and others the benefi t of your knowledge
about your child’s capabilities, needs and interests. Once
completed, you can update the letter as necessary should
the child’s needs change or should your goals for your
child change.

A typical letter of intent will include:

Biographical information
Financial details
Medical history and needs
Social contacts
Any negative infl uences you would like to guard against
Personality traits
Skills, hobbies and physical abilities
Goals your child is working toward

While the challenges facing your disabled loved one are
daunting, they can be even more so if you are not around
to attend to his or her needs. However, with a little
forethought and planning, you can make your disabled
child’s future potentially much brighter.

Howard S. Krooks, JD, CELA, CAP is a partner of Elder Law
Associates PA, which has offi ces in Boca Raton, Aventura,
Weston and West Palm Beach. He is admitted to practice
law in Florida and New York, where he serves as Of Counsel
to Amoruso & Amoruso LLP in Westchester County. His
professional practice is devoted to elder law and trust and
estate matters, including representing seniors and persons
with special needs and their families in connection with asset
preservation planning, supplemental needs trusts, Medicaid,
planning for disability, guardianship, wills and trusts.

Mr. Krooks is certified as an Elder Law Attorney by the
National Elder Law Foundation and is a member of the
Council for Advanced Practitioners of the National Academy
of Elder Law Attorneys (NAELA).

He is an active member of the Special Needs Planning and
Elder Law community on the local, state and national level.
Mr. Krooks currently serves on the NAELA Board of Directors
and is an offi cer of NAELA (Secretary). As a member of the
Joint Public Policy Task Force of The Florida Bar Elder Law
Section and the Academy of Florida Elder Law Attorneys,
Mr. Krooks works to protect the rights of the state’s most
vulnerable citizens. He recently was invited to join a special
sub-task force to review policies of The Florida Department of
Children and Families (DCF) that may not be in compliance
with federal law. The special task force will also determine
whether DCF policies have followed proper rule-making
procedures.

Florida Elder Care: Long Term Care for Senior Veterans

2009-11-15T15:01:00.001-08:00

In the year 1919 President Woodrow Wilson proclaimed November 11 as Armistice Day to honor those Veterans who served during World War I. On November 11, 1954, Armistice Day was proclaimed a legal national holiday and the name was changed to "Veterans Day" to honor all veterans of all wars.

Every November 11, ceremonies are held throughout the United States honoring Veterans of wars. A National Ceremony is held at Arlington Cemetery at the Tomb of the Unknown Soldier, where the laying of the presidential wreath and military playing of “Taps” is presented.

Since its establishment in 1930, the Department of Veterans Affairs has evolved to supporting and aiding the nation’s veterans in numerous ways. One of these services for example, the Veterans Health Administration, is the largest single provider of medical care in the United States. Its 22 regions with 154 hospitals and their associated 875 outpatient clinics offer the following services.

* Hospital, outpatient medical, dental, pharmacy and prosthetic services
* Domiciliary, nursing home, and community-based residential care
* Sexual trauma counseling
* Specialized health care for women veterans
* Health and rehabilitation programs for homeless veterans
* Readjustment counseling
* Alcohol and drug dependency treatment
* Medical evaluation for disorders associated with military service in the Gulf War, or Treatment for exposure to Agent Orange, radiation, and other environmental hazards
* HISA grants
* Other special benefits

The Department of Veterans Affairs provides three types of long term care services for veterans.

The first are health care benefits provided to veterans who have service-connected disabilities, who are receiving VA Pension or who are considered low income. These services include free medical care, possible free prescription drugs, orthotics and prosthetics, home renovation grants for disabilities, home care, assisted living, domiciliary care, nursing home care, and a possible host of other services or benefits.

The second benefit is state veterans homes. The majority of these homes offer nursing care but some may offer assisted living or domiciliary care. The Department of Veterans Affairs in conjunction with the states helps build and support state veterans homes. Money is provided to help with construction and a federal subsidy of $72.71 a day is provided for each veteran using state veterans nursing home services. These homes are generally available for most veterans and sometimes their spouses and in some cases for so-called "Goldstar parents." Veterans homes are run by the states, sometimes with the help of contract management. There may be waiting lists in some states.

The third benefit for veterans is disability income programs. The most familiar of these benefits is an income for service-connected disabled veterans called "Compensation." The least known of these is a program officially called "Pension" but popularly known as the "aid and attendance benefit."

All active-duty veterans who served at least 90 days during a period of war are eligible for Pension and the additional income from aid and attendance or housebound allowances. A single surviving spouse of such a veteran is also eligible.
All qualifying veteran applicants over the age of 65 are eligible for pension but must meet income and asset tests. Applicants under the age of 65 must in addition be totally disabled to qualify. Disability does not have to be service-connected.
A surviving spouse can be any age and there is no need for disability.
The aid and attendance benefit can pay additional income to provide for the costs associated with home care, assisted living, nursing homes, adult day care and other unreimbursed medical expenses. It can also pay for a family member other than a spouse to be the care giver. The amount of payment varies with the type of care, recipient income and the marital status of the recipient. Here are some examples of how this benefit can help veterans.

Example #1
The National Care Planning Council receives many calls from family members of veterans, asking if there is any help available to them. One such call came from a woman who had been juggling her job and caring for her father in her home for over five years. She had just lost her job and with no income, did not know how she would keep her home or give her father the care he needed. She read an article that had been written by the National Care Planning Council and published in her local newspaper and called their phone number. The article mentioned that a member of the family -- not including a spouse -- can be paid through VA to provide care for a loved one at home who is either a war veteran or the surviving spouse of a war veteran. Her father is a war veteran. When told that she could get an additional $1,644 a month through her father by providing her father's care she was shocked. She was also extremely grateful and ended up sobbing into tears over the phone when she found out about the benefit and realized it would help her keep her home and her father may probably get a check for her retroactive previous care from VA worth tens of thousands of dollars.

Example #2
Another recent caller’s mother is 89 years old and has been in assisted living for four years. As a widow of a veteran she did not qualify for the Aid & Attendance Pension 4 years ago because her assets were too high. In the meantime she has been using up her assets along with her income to pay for the assisted living. The local veterans service office has not been helpful in getting this claim approved even though she had reached the allowable asset limit over two years ago. The family was considering putting her in a less desirable facility under Medicaid. The family knew this would be devastating for their mother. Her health was still good and she had many friends and comforts at the assisted living.

The National Care Planning Council directed the caller and his family to a more cooperative veterans service office that will submit the claim and likely get it approved retroactively so that this woman can get a check for roughly $40,000 worth of previous care costs for which she was not reimbursed. In addition, she will likely get the full benefit of $1,056 a month to help pay the cost of the assisted living where she is happy.

These types of claims require medical evidence in order to receive a rating for aid and attendance or housebound allowances. These ratings must be received or certain non-medical expenses associated with long term care are not deductible from income. Special rules also allow for deducting the annual anticipated cost of month-to-month long term care from household income in order to meet the income test. This special treatment requires special documentation and evidence. In addition, those households with substantial assets will be denied for a Pension income unless those assets are below a certain level determined for each case by VA. The personal residence, personal vehicles and personal property are exempted from this asset test. Finally, evidence must be supplied every year in January that the anticipated costs for the previous year were actually incurred or VA will likely demand for its money back.
The National Care Planning Council has compiled the necessary forms, rules and information about claims together in one book titled “How to Apply for the Veterans Aid & Attendance Pension Benefit.”

This book contains information about how a typical applicant receives a successful pension award. VA often tells callers to go ahead and fill out the application but generally provides no information on the special treatment of annualization of anticipated recurring medical costs. The claims form also contains no information on this important issue. One simply has to know how to do it. This crucial information can make the difference between a successful award and being declined. All necessary forms for filing a claim are in the book.

Veterans who have substantial assets may need to do some estate planning and realigning of assets to qualify. An expert in this area should be sought to help with the application in order to avoid lengthy delays in awarding a benefit or a possible denial of benefits.

To learn more about this benefit go to http://www.veteransaidbenefit.org/

Florida Elder Law: Protect Yourself from Financial Exploitation

2009-10-20T18:20:00.000-07:00

Financial exploitation is the illegal or improper use of another individual’s resources for personal profit or gain. This type of exploitation encompasses a broad range of conduct, from deception to intimidation. If you think you've been exploited, please contact a qualified Florida Elder Law Attorney.

Ways to Prevent Exploitation: Stay Socially Active

Social isolation increases your risk of becoming a victim of abuse. Become familiar with the many programs in your community designed to bring people together and to help elderly people and their families.

Get to Know Your Banker, Attorney, and Financial Consultant

Establish relationships with the professionals who handle your money. They can help detect changes in your financial activity that may signal a problem.

Don’t Give Away Property

Before you enter into an agreement for lifelong care, discuss the arrangement with a trusted friend or advisor. Document the agreement and specify the compensation, if there is any, paid to the caregiver. If there is someone helping you with your personal finances, get a trusted third party to review your bank statement.

Understand What You Are Signing

Before you assign a power of attorney, be sure you understand the scope of the agreement and the authority you are giving to your agent. Know the person to whom you are giving this authority. Also, specify the compensation, if any, to be paid to your agent.

Be Cautious of Joint Accounts

Both parties are equal owners of the account and both have equal access to the funds in the account.

Document Financial Arrangements

By putting financial arrangements in writing, you not only protect yourself but you also reduce the likelihood of legal proceedings. Put all financial instructions in writing and be specific. Keep complete financial records of all transactions. Put all financial documents in a safe place.

Ask For Help

Financial matters can be confusing. If you have questions or need assistance, ask for help from your bank, a trusted family member, clergy member, social worker or other professional.

Other helpful tips include:

· Use Direct Deposit for your checks.

· Don’t sign blank checks allowing another person to fill in the amount.

· Don’t leave money or valuables in plain view.

· Don’t sign anything you don’t understand.

· Protect your money. The bank may be able to protect your money by arranging your accounts to control access to your funds.

· Be aware of scams. If it sounds too good to be true, it probably is.

· Don’t give anyone your ATM PIN number, and cancel your ATM card immediately if it is stolen.

· Check your bank statements carefully for unauthorized withdrawals.

· Be cautious of joint accounts.

· Build good relationships with your professionals who handle your money.

To report Elder Financial Abuse, Neglect, or Exploitation, please call the Adult Protective Services Abuse Hotline at (800) 962-2873.

Florida Elder Law: Planning for Your Elder Years

2009-10-15T18:22:00.001-07:00

If we were to ask an older person what his or her most important concerns for aging are, we would probably get a variety of different answers. According to surveys frequently conducted among the elderly, the most likely answers we would receive would include the following three principal concerns or life wishes:

1. Remaining independent in the home without intervention
from others

2. Maintaining good health and receiving adequate health care

3. Having enough money for everyday needs and not outliving
assets and income

To address these concerns or wishes and maintain the quality of life wanted in the elder years, it simply takes a little preplanning.

Few people do this kind of planning.

It is human nature not to worry about an event until it happens. We may prepare financially for unexpected financial disasters by covering our homes, automobiles and health with insurance policies.

However, no other life event can be as devastating to an elderly person’s lifestyle, finances and security as needing long term care. It drastically alters or completely eliminates the three principal lifestyle wishes listed above.

The majority of the American public does not plan for this crisis of needing eldercare. The lack of planning also has an adverse effect on the older person's family, with sacrifices made in time, money, and family lifestyles.

Because of changing demographics and potential changes in government funding, the current generation needs to plan for long term care before the elder years are upon them.

Let us look at some facts.

The population of the "very old,"--older than age 85--is the
fastest growing group in America. This population is at
highest risk for needing care. (Statistical abstract of the United States,
2008, population)
Medical science is preventing early sudden deaths, which
means living longer with impaired health and greater risk of
needing long term care.
The Alzheimer's Association estimates the risk of
Alzheimer's or dementia beyond age 85 to be about 46% of
that population.
It is estimated that 6 out of 10 people will need long term
care sometime during their lifetime.
Children are moving far away from parents or parents move
away during retirement making long distance care giving
difficult or impossible.
Government programs--already stretched thin for long term
care services--will experience even greater stress on
available funds in the future.

One of the important things for planning is how to maintain your lifestyle as you age. You may be healthy enough to stay in your own home with help provided for the following activities of daily living:

maintaining a home,
providing meals,
supervision,
companionship,
transportation and
shopping services.

This type of care at home is non-medical and must be provided free of charge by family, friends, or volunteers or the care must be paid for out-of-pocket by the family.

Government programs, in most cases, will not pay for this kind of care. It is estimated that 80% of all long term care is non-medical, with 90% of that care provided in the home. It is most likely that your long term care will begin with home care.

It is wise to plan now how you will pay for care when it is needed. In evaluating your future income you may find it necessary to add some resources such as long term care Insurance to pay for assisted living or nursing home costs. Long term care insurance must be purchased while you are younger and healthy. Failing health, stroke or other aging issues will not allow you to qualify for this insurance.

A reverse mortgage will also help pay for home care if staying in your home is an option.

Consider where you may want to live in your elder years. Many assisted living facilities offer complete care alternatives with a nursing home wing if needed. Senior retirement communities also offer many amenities with some including home care options.

Now is the time to do estate planning. A professional estate planner will give you direction on how best to protect your assets for future needs and for Medicaid planning.

Do your paper work. Now is the time to create your trusts, will, medical directives in a living will and any other documents you want noted for future use. Gather Insurance policies and bank records where they can be found by family members in case you are not able to get them yourself.

We don’t like to think of our elder years in terms of health problems, but a sudden stroke, heart failure or onset of dementia could make it impossible to carry out our own wishes if preparation was not made ahead of time.

The process of long term care planning involves the following four
principles:

1. Knowledge and preparation are the keys to success.
2. Having funds to pay for care expands the choices for care settings and providers.
3. Using professional help relieves stress, reduces conflict, and saves time and money.
4. Success is assured through a written plan accepted by all parties involved.

As always, before making any plans, please consult a qualified Florida Elder Law Attorney.

Florida Elder Law: Long-Term Care Hybrid Products Give Buyers More Options

2009-10-13T06:04:00.001-07:00

With many people unwilling to purchase long-term care insurance policies due to the cost, insurers are rolling out new products that combine long-term care insurance with either a life insurance policy or an annuity. These new products have been on the market for awhile, but they are gaining in popularity due to a law that goes into effect Jan. 1, 2010, making distributions from life insurance and annuities tax free when used to pay nursing home costs.

Even though long-term care costs continue to rise, long-term care insurance has not become widespread. Long-term care insurance is expensive and many people do not want to pay premiums for something they might not need. A hybrid product has the benefit of combining two products into one. If you don't use the long-term care insurance, you can still benefit from the life insurance or the annuity.

The products vary in the details, but the general idea of a hybrid life insurance policy is to allow a buyer to purchase a cash-value life insurance policy and to use a portion of that policy for long-term care benefits, if necessary, and keep the rest as a death benefit that will be paid to the purchaser's beneficiary. If long-term care benefits are used, the death benefit may be reduced.

Hybrid annuity products also vary significantly, but in general they allow a buyer to purchase a fixed deferred annuity with a long-term-care rider attached. The annuity may pay out for a specific number of years or for life. For example, a purchaser could deposit $150,000 into an annuity. The annuity would provide approximately $4,700 a month of long-term care benefits for 36 months. For an additional cost, the purchaser could get the $4,700 monthly benefit for life.

While a two-for-one product may seem attractive, these products are not for everyone. For one thing, you may have less flexibility with a combined product than you would with a stand-alone product. Hybrid products may not cover home care or include inflation protection, for example. In addition, hybrid products may not offer enough long-term care coverage for what you need. It is impossible to predict exact coverage needs, but click here for more information on how to figure out how much insurance to purchase. A hybrid product is likely less expensive than purchasing two separate products, but it is often more expensive than purchasing a stand-alone long-term care insurance policy.

As with any major purchase, you need to evaluate it carefully before purchasing. Before deciding what to buy, get advice from an impartial investment advisor, not a sales agent who makes a commission off the sale of policies.

For more information on long-term care insurance, click here.

For an article on hybrid long-term care insurance policies from MarketWatch, click here.

Florida Elder Care: PreNeed (Pre-Paid) Funeral and Burial Plans

2009-10-01T18:56:00.001-07:00

Advantages and Disadvantages of Prepaid Plans
One way to plan in advance for the end of one's life is to sign a formal contract called a "preneed funeral plan." With this plan, money to pay for a funeral and/or burial is held in a trust, in an escrow account or paid through an insurance policy on the life of the person desiring the plan. Parts of or all of the funeral service and burial are designed in advance and pre-funded in advance and the family has little to do but show up.

This type of planning has become very popular in recent years. A survey conducted by the AARP in 1999, found that two out of five people over age 50 had been approached to pre-purchase funerals and burial goods and services. An AARP survey in 1998 indicates that 32% of all Americans over age 50, roughly 21 million people, have prepaid some or all of their funeral and or burial expenses (but not necessarily through a formal preneed plan). Breaking that down; about 25% of the over age 50 population have prepaid for their burials (cemetery plot, mausoleum or niche), 18% have prepaid for headstones, urns, caskets , grave liners or vaults, opening and closing of graves and so on and 13% have prepaid for goods or services from a funeral home or funeral director. The same survey indicates that over $25 billion is being held in preneed trust funds. Roughly another $25 billion is waiting to be paid out in life insurance benefits. Prepaid or preneed funerals and burials are big business.

Funerals and burials funded privately by the family, or paid from an individual life insurance policy and arranged informally through a funeral home or funeral director are generally not subject to state regulation. Any formal arrangement through a second party or involving a contract is subject to regulation in all states. Each state has adopted different rules as to who can sell these plans, what the plans can provide, what contract provisions must be, how the plan is to be funded and what recourse purchasers might have in the event of fraud or default. All states call these regulated plans "preneed" funeral and burial arrangements.

Here are some advantages as to why one would want to buy a preneed plan for funeral and burial services and goods.

It provides peace of mind knowing these arrangements have been made in advance.
It avoids the burden on family members to make decisions when they are most vulnerable to manipulation.
It allows one to virtually control from the grave by determining in advance the funeral products, funeral services, burial products and burial services that one would prefer having for final arrangements.
It helps the family to avoid taking loans, arranging finance plans, raiding savings or selling assets to pay for a funeral and burial.
It guarantees (for many contracts) that if products and services currently purchased are not available in the future, equivalent substitutes will be provided at no additional cost.
It locks in guaranteed prices (available with some contracts) forever.
It allows for inflation in future costs (for those contracts that do not guarantee prices) by investing money in an interest-bearing account or buying life insurance that increases in value over time.
Depending on the contract, it may allow for transfer to another funeral home or for partial or full refund.

Unfortunately, there are also problems with prepaid, preplanned final arrangements.

With some trust fund and insurance funding options there may be no refund if someone wants to cancel the plan in the future.
If a purchaser moves to another state there may be no transfer options or there may be different rules governing the funding option.
In some contracts, interest earnings on investments resulting in excess money not needed for the plan may be retained by the funeral home or funeral director.
On installment plans interest may be charged but not credited to the account.
In certain insurance funded contracts, the ownership or death benefit may be irrevocably assigned to the contract holder (funeral home), preventing the purchaser from enjoying ownership rights in the policy.
In certain insurance funded contracts, a growth in the death benefit over time that exceeds the cost of the preneed plan services and goods may be pocketed by the contract holder (funeral home) instead of being refunded.
If the contract provider goes out of business or fails to secure 100% of the funds for future payment, there may be no recourse to get all of the money back that was put in.
If certain services or goods that were purchased initially are not available in the future, but more expensive versions might be, the family may be forced to pay extra for those items.
In certain insurance funded plans, if the insured dies too soon, there may have been a waiting period in which few or no benefits are paid at death, thus forcing the family to pay out of pocket for the funeral.
Certain unscrupulous providers may have failed to provide an itemized list of services and goods or failed to identify properly, specific services and goods, thus allowing the provider in the future to substitute less expensive items or to leave out services and goods that were originally anticipated in the agreement.

What Services and Goods Can Be Prepaid?
All states allow for prepaid plans for funeral services and merchandise. This would include such things as picking up the body, embalming and restoration, rooms or chapel for viewing and funeral services, casket, vault or grave liner, transportation, permits, death certificates, obituaries and so forth. Almost all states allow for prepaid burial services and merchandise as well. Only about six states do not allow it. Burial services and merchandise might include opening and closing the grave, grave markers, vaults or grave liners, mausoleums or niches. Cemetery plots are excluded from prepaid plans in all states.

The AARP has excellent information for consumers on planning for funerals. Quoting from the AARP:

"Most states have a licensing board that regulates the funeral industry. You may contact the board in your state for information or help. If you want additional information about making funeral arrangements and the options available, you may want to contact interested business, professional and consumer groups."

Florida Elder Law: Recent Articles in Media Highlight Need for Estate Planning

2009-09-29T20:34:00.001-07:00

Good evening, everyone.

Yesterday was a busy day for online articles about estate planning. CBS MarketWatch.com posted a "Feature Package" of articles titled Keep the Money in the Family - short, simple articles that are an excellent reminder for clients and referral sources of the need to do planning. Available online at http://moneywatch.bnet.com/retirement-planning/feature/keep-the-money-in-the-family/338108/?tag=content;col1, the "package" includes the following articles:

8 Steps to Protect Your Family
12 Tough Questions to Ask Your Parents
Death in the Family: 12 Things to Do Now
Will Essentials: What You Need

And Forbes.com posted an article titled You Go-To Guide to Estate Planning, available online at http://www.forbes.com/2009/09/02/estate-financial-planning-forbes-woman-net-worth-guide.html. Directed at women, this is another simple explanation as to why people should plan, with links to related articles.

We hopes this provides some insight as to why Elder Law is so important, and why it's imperative to consult with a qualified Florida Elder Law Attorney before making any commitments. Please contact us for a consultation.

-- Ellen Morris and Howard Krooks

Elder Law: 2009 Long-Term Care Insurance Prices Rise Slightly, Range Widely

2009-09-18T10:33:00.001-07:00

A 55-year-old individual considering a basic level of long-term care insurance protection -- a $100 daily benefit and three years of coverage -- can expect to pay $723 a year if married or $1,060 if single, according to the 2009 Long-Term Care Insurance Price Index, an annual report from the American Association for Long-Term Care Insurance, an industry group.

A 65-year-old purchasing comparable coverage will pay $1,364 (married) or $2,028 (single) according to the report. Costs for coverage increased about 2 percent over those reported in 2008.

"For some age bands the cost of long-term care insurance actually declined," notes Jesse Slome, the association's executive director. "What we did see is a far wider range of prices between insurers offering basically the same coverage." According to the Association study, costs can vary by as much as 100 percent. "This could reflect different benefits or simply the individual insurer's pricing assumptions," Slome explains. "Consumers should compare policies or work with a knowledgeable insurance professional who can analyze for them."

The cost for long-term care insurance is closely tied to interest rates, which dictate how much insurers can earn on the premiums they invest. Slome told ElderLawAnswers that "for every one percent drop in interest rates, an insurance company needs a 10 to 15 percent premium increase." Interest rates have declined in recent years.

The annual index measures current costs for top-selling long-term care insurance policies that offer consumers approximately $115,000 in current benefits (base-level coverage), with protection increasing yearly as the individual ages. The study compares costs for plans that provide benefits for three years or longer and also offer an inflation option that increases the available insurance benefits by five percent compounded each year. "A solid base plan of protection will grow in value to over $305,000 of protection 20 years from now," Slome explains.

Below is the 2009 price index:
2009 National LTCi Price Index
Average price for a comprehensive long-term care insurance policy (100 percent home care benefit + skilled care coverage) 90-Day Elimination Period with 5 percent Compound Inflation Protection Option

Age 55
$100 Maximum Daily Benefit x 3 Year Benefit Period Cost: $723 per year. Individual Qualifies for Preferred Health and Spousal Discounts
2008 Cost: $709 per year (2% increase)

Age 55
$100 Maximum Daily Benefit x 3 Year Benefit Period Cost: $1,060 per year. Individual is single (preferred health discount)
2008 Cost: $1,095 per year (3% decrease)

Age 55
$150 Maximum Daily Benefit x 3 Year Benefit Period Cost: $1,084 per year. Individual Qualifies for Preferred Health and Spousal Discounts
2008 Cost: $1,064 per year (2% decrease)

Age 55
$150 Maximum Daily Benefit x 3 Year Benefit Period Cost: $1,590 per year. Individual is single (preferred health discount)
2008 Cost: $1,578 per year (less than 1% increase)

Age 65
$100 Maximum Daily Benefit x 3 Year Benefit Period Cost: $1,364 per year. Individual Qualifies for Spousal Discounts (standard health)
2008 Cost: $1,342 per year (1% increase)
Age 65
$100 Maximum Daily Benefit x 3 Year Benefit Period Cost: $2,028 per year. Individual is single (standard health)
2008 Cost: $1,999 per year (1% increase)

Age 65
$150 Maximum Daily Benefit x 3 Year Benefit Period Cost: $2,047 per year. Individual Qualifies for Spousal Discounts (standard health)
2008 Cost: $2,013 per year (2% increase)

Age 65
$150 Maximum Daily Benefit x 3 Year Benefit Period Cost: $3,042 per year. Individual is single (standard health)
2008 Cost: $2,998 per year (1% increase)

Age 65
$240 Maximum Daily Benefit x 3 Year Benefit Period Cost: $3,274 per year. Individual Qualifies for Spousal Discounts (standard health)
2008 Cost: $3,221 per year (2% increase)

Age 65
$240 Maximum Daily Benefit x 3 Year Benefit Period Cost: $4,867 per year. Individual is single (standard health)
2008 Cost: $4,729 per year (3% increase)

Florida Elder Care: Medication Problems and the Elderly

2009-09-09T17:36:00.000-07:00

At 83 years old, Martha still lived in her own home, and enjoyed working in her garden and canning peaches. It was becoming harder to motivate herself, to get up in the mornings and accomplish the day's tasks. She confided to her daughter that she felt anxious and tired. Her daughter, who was taking medication for her anxiety, took Martha to her own doctor, not Martha's and got her a prescription for Valium. In doing so, the daughter's doctor, who had never seen Martha and who did not have her medical history, was only aware of a few medications they told him she was taking.

Martha, in fact, was taking 9 different medications as well as herbal supplements.

The addition of Valium to her existing list of prescribed drugs sent her to the emergency room with respiratory distress. If she had gone to her own doctor, he would have found that a dosage adjustment of her current medications would have solved her anxiety.

Medication errors are common in the elderly. Many seniors take on average 6- 8 different prescriptions as well as over the counter drugs. Many times the elderly will not go back to their doctor to have their dosage evaluated and changed if necessary. Family members should be aware, that elderly parents may tend to take the family's advice over going to their own doctor. Even though children want to help increase the health and stamina of their parents, they may in fact be causing damage by misdirecting their loved ones.

Where a younger person can benefit from herbal supplements like Ginkgo Biloba, Saw Palmetto and others, in older people, these herbals may cause adverse reactions with their prescription medications.

In 2003, a panel of experts put together a list of potential medications that would not be appropriate to give to seniors. This is called the “ Beers List ” after one of the research professionals.

Dr. Donna M Fick, R.N. one of the panel members for updating the “Beers List,” states in her article on Seniorjournal.com:

"Just as our bodies physically slow down as we age, changes occur in the way that older bodies handle pharmaceuticals, and this has motivated experts to develop a list of drugs that may be harmful to elderly patients.

"With age, drugs tend to build up in the body, and the distribution and elimination of drugs from the body changes as well," says Dr. Donna M. Fick, R.N., associate professor of nursing at Penn State. "Many drugs, like diazepam (Valium) and other anti-anxiety drugs build up fast."

An on-line article on HealthSquare.com , Titled "Drugs and the Elderly," talks about physical symptoms and medications.

“ Among the first signs that a drug may not be working properly in an older person is a change in mood, energy, attitude, or memory. Too often, these alterations are overlooked, ignored, or chalked off to "old age" or senility. Older people may themselves feel that their blue mood is caused by something external such as the death of a friend or simply by boredom. Nothing could be farther from the truth. Virtually every heart medication, blood pressure drug, sleeping pill, and tranquilizer has been known to trigger depressive symptoms.

When a psychological symptom appears in an older person, examine his or her medication or drug use first. Consider, too, factors like alcohol intake, poor nutrition, and hormone imbalance. And never dismiss the possibility that a real psychological problem has developed and may itself require medication.”

There are many things family members can do to help monitor medications for their elderly parents.

* Make a list of medicines prescribed and all supplements being taken.
* Give this list to the doctor and pharmacist and have one on hand for emergencies.
* Use the same Pharmacy to fill all prescriptions. Pharmacies keep a record of your prescribed drugs and will verify your doctor's instructions. They will also tell you if foods or over the counter supplements will interact with a prescription.
* Dispense pills in a daily pill organizer box.
* Have a family member be responsible to call or physically monitor the taking of medication

Family members who live long distances from their elders have available to them new technology in medication monitoring.
* Alarms for pill boxes, watch alarms, medical alarm bands and necklaces that ring a reminder.
* Computerized pill box dispensers that ring a designated number if the pills have not been taken.
* Home Telehealth - “Technology has developed computer and computer cameras to help the elderly in their homes stay safe and healthy. Home telehealth-set up by medical professionals in the home--enables providers to monitor such things as medications and blood pressure and actually see the patient. Patient questions are answered and advice is given, while the monitoring nurse views through the video phone how his or her patient looks physically.” The 4 Steps of Long Term Care Planning, Pg 92
* Home Care Agencies – Home care companies offer a variety of service options in helping families care for and properly dispense medication to their elder parents.

Overmedication or taking medication incorrectly may lead to early mental confusion and decline in health in seniors. “If medication problems were ranked as a disease in cause of death it would be the 5 th leading cause in the United States”.

Florida Elder Care: Community Aging Services and Senior Centers

2009-09-03T15:57:00.000-07:00

Community Aging Services and Long Term Care
There are many private, religious and government organizations across the country that provide supportive services for older people. Many of these services center around helping people stay in their homes and avoid having to go to live in an institution or perhaps move in with family. Because of the emphasis on helping people remain independent, many community aging programs could be viewed as long-term care programs. In fact it's probably just a matter of semantics; long-term care and community aging services are just two sides of the same coin. Other community services may provide socialization or training opportunities. Community aging programs might include:

Meals served in community centers or delivered to the home
Community Senior Center activities and training
Transportation and shopping services for people who can't drive or leave their homes
Home repairs, snow shoveling, telephone support, caregiver support, care management, legal services, energy and weatherization services, housing subsidies, home health care, counseling and much more
Adult day care
Protection from abuse
Help with health insurance and government entitlement programs

Private support groups might be the Red Cross, women's auxiliaries or foundations. Many religious communities support activities for their elderly members as well as nonmembers. Both private and religious groups often provide services for free to people with little income and few assets. They may, however, charge people for services who have adequate income or assets. Many of these groups may also operate nursing homes and assisted-living facilities.

Senior centers are often the focal point for all aging services in a community. Experts or contact people are housed in senior centers and can provide many services in the center itself or refer out to other organizations that can help. The community served meals or congregate meals in senior centers are a means for attracting older people into the centers. Seniors can then be exposed to the many services that are available.

Government support for aging services comes from the Older Americans Act, passed in 1965. This act, over the years, has produced a large network of care providers and local government managers called Area Agencies on Aging. This network also includes federal agencies, state agencies as well as local area agencies and is called the "national aging network".

The National Aging Network
The Older Americans Act establishes an effective interrelationship between the federal government, State aging units and local service coordinators called Area Agencies on Aging. All three centers of service, the Federal, the state and the local engage in detailed future planning in order to accomplish their jobs. Input at the local level is received from diversified advisory boards representing stakeholders in the elder community. Community meetings and feedback from patrons of senior centers are also used in the planning process. Over the past 44 years, a great deal of thought and energy and research has gone into devising a delivery system that is both efficient and cost effective. In fact, the 29,000 service providers nationwide providing care under the act are the largest single network of long-term care providers in the country.

Local agencies on aging represent geographic areas in a state that can be serviced effectively by that local unit. Area agencies on aging normally contract with local for profit or nonprofit or public providers to deliver benefits. An agency may be allowed to provide directly, supportive services, nutrition services, or in-home services if it can prove a case for providing these services more effectively. An agency may also provide directly, case management services and information and assistance services depending on the methods used for such services in that state. Agencies may also use employees from cooperating or sponsoring counties or cities to staff and administer programs such as senior centers. Much of the work performed comes from dedicated volunteers who are both individuals and employer sponsored teams. This entire aging network system seems to work very well in accomplishing the goals of the Older Americans Act.

Why Is the Older Americans Act Important?
The decade from 1960 to 1970 was a period of social unrest and change. We lived through an unpopular war which resulted in student protests and mass demonstrations. Hippies, it seems, were everywhere and we were experiencing the so-called sexual revolution. It was a exciting time when civil rights were being extended to all Americans.

During this same period a number of organizations were lobbying Congress for the rights of older Americans. An outcome of this effort was not only the 1965 creation of Medicare and Medicaid but also the passage of the Older Americans Act. The act was designed to protect elderly Americans, including Indians, from unfair discrimination in the workforce as well as providing protection and services to help older people stay independent and remain in their homes.

Although the initial emphasis was directed more towards civil rights and recognition of the dignity of the elderly, over the years, new provisions of the Older Americans Act have become more focused on providing long-term care services for older Americans. These benefits are designed to help frail, memory-impaired, disabled, poor and socially needy elderly remain in their homes and avoid the cost of elder care institutions. And more recently, funds were provided under the act to support caregivers of the elderly and elderly grandparents babysitting or raising minor children at home.

The OAA provides benefits to all Americans over the age of 60. And employment benefits are available for all Americans over the age of 55. The act itself stipulates reauthorization or amendment on an ongoing basis and since 1965 the OAA has been changed and updated 14 times. The year 2005 is designated as a reauthorization year and Congress is busily working on additions to the act. Because of the constant additions, the Older Americans Act has become a giant mishmash of thousands of words, redundant sentences and hundreds of rules and procedures. It's our guess that the complexity of the act probably requires states to hire attorneys to run their aging departments. Notwithstanding, members of the care community who provide administration and services with the Older Americans Act work around the complexity of its rules in serving the aging community.

Funding for the services required under the OAA is provided by Congress yearly. These funds are then distributed to states, territories, the District of Columbia , Indian tribes and native Hawaiians on a formula basis which provides minimum funding levels to small population groups and sparsely populated states and proportional funding levels based on state elderly populations of the majority of the other states. Because of its large elderly population, as an example, California receives almost 10% of the money. And because of its high proportion of older people, Florida is next. Ten states receive 52% of the money.

Funds are provided in the form of grants for various programs authorized under the act and states have some limited latitude in administering these monies in local areas. Certain of the mandated programs require matching funds from state and local governments. Other program funds do not require matching dollars. Many states chip in additional funds to maintain their programs and these funds often exceed matching requirements. States, counties and cities recognize the value of these services and are often generous in providing additional funds, buildings, office space and other in-kind economic benefits. For every dollar provided by Congress local governments provide about two dollars in direct money, in-kind services from volunteers, community voluntary contributions and cost sharing funds.

The federal appropriation for 2005 was $1,369,028,000 and the breakdown for specific spending categories is listed below. Notice that over half of the dollars goes towards nutrition services which are typically weekday meals provided in community settings or delivered at home as well as incentive programs to help the elderly maintain proper nutrition.

Congregate Nutrition Services, Home-Delivered Nutrition Services, and Nutrition Services Incentive Program (money from the Department of Agriculture), 52.1%
Home & Community-Based Services, 25.9%
National Family Caregiver Support Program, 11.7%
Grants for Native Americans, 1.9%
Program Innovations Grants, 1.7%
Preventive Health Services, 1.6%
Protection of Vulnerable Older Americans, 1.3%
Program Administration, 1.3%
iAging Network Support Activities Grants, 1%
Alzheimer's Disease Demonstration Grants, 0.8%
White House Conference on Aging, 0.3%
Senior Medicare Patrols (HCFAC), 0.2%

Find your state Area Agencies on Aging or State Aging Services

Senior Citizen Centers
The first Senior Center in the country opened in 1943 in the Bronx, New York and was called the William Hodson Community Center . By 1961 about 218 senior centers had opened all across the country. The first Senior centers were operated by cities or nonprofit or religious organizations. Funding came from government, community donations and fees from people using the facilities. In the early days some federal funding came from Title XX of the Social Security act but funding for Title XX has been decreasing and much of that money today is being used for other programs. In 1972, the Older Americans Act was amended to provide funding for senior centers as this was considered to be an important piece of the aging network. Today, there are estimated to be about 15,000 senior centers across the country serving about 10 million older Americans annually. About 6,000 of these centers receive part or all of their funding through the Older Americans Act.

Senior centers act as a focal point for older Americans to receive many aging services. They are a vital part of the aging network. For Area Agencies on Aging, the senior center has become a place where many AAA services can be provided, where outreach and targeting can occur and where feedback can be received from the elderly. The most common services offered at a senior center are:

Health and wellness programs
Arts and humanities activities
Intergenerational programs
Employment assistance
Community action opportunities and social networking opportunities
Transportation services
Volunteer opportunities
Educational opportunities Information and referral
Financial assistance
Senior rights counseling and legal services
Meal and nutrition programs
Leisure travel programs

Larger senior centers in major cities may offer additional specific services because they serve a large and diverse group of patrons. Here are some examples:

Education classes, perhaps through a local college
Foot care
Health clinics
Haircuts
Daily exercise
Telephone friends
Support groups for Alzheimer's caregivers
Support for Parkinson's disease
Low vision and diabetes services
Weekly health speakers
Grocery shopping
Many and varied classes for personal growth and learning
Special events and fundraisers such as auctions, raffles, sales, bazaars, rummage sales, bingo, special meals and parties, fashion shows and facility rentals

Most elderly people are aware of senior centers in their neighborhoods but for those who are not familiar with the program, senior centers are listed under that title in the Yellow Pages.

Florida Elder Care: One Stop Shopping for Elder Care Services

2009-08-30T13:21:00.001-07:00

A fast-growing generation of elderly people, needing care, is starting to put a great deal of pressure on caregiving family members. More and more we are seeing articles and books about the burden of long term care on families. (Of course, before making any firm plans, please consult a qualified Florida Elder Law Attorney.)

According to research By the National Care Planning Council, only about 16% of long-term care services are covered by the government. The other 84% are provided free of charge by family caregivers or provided by services paid out-of-pocket by families or from those receiving care. And the bulk of government care services are provided only after a care recipient has depleted all of his or her savings. The Council also estimates that at any given time approximately 22% of the population over age 65 is receiving some form of long term care support. About 44.4 million adult caregivers provide 21 hours a week of care with 4.3 years average time spent providing care.

Dilemma of Finding Eldercare Services
The need for care usually occurs without warning, when a stroke, heart failure or other medical condition or illness incident to age suddenly happens to an aging senior. Family members end up in panic mode trying to understand and educate themselves on what needs to be done and what resources are available. If they need to take time from work to handle the crisis then it becomes urgent to find answers and solve caregiving needs. The need to balance work with urgent caregiving responsibilities creates untold stress on employed family caregivers.

Most family caregivers simply don't know where to turn for help and advice.
Long term care services are complicated and provider contacts are fragmented throughout the community. For the majority of Americans, eldercare becomes a frustrating do-it-yourself process. How do you find out what government services are available and what they will pay for? What legal documents are necessary and how do you protect assets? What type of home care or facility care is needed? Should you quit your job to become the caregiver? Will the government or insurance pay you for caregiving to help replace your lost income?

The question often arises as to whether to use long term care professionals or go it alone in arranging care and services.

“Using care professionals is the most cost effective and efficient way to provide help for a loved one. Hiring professional advisers or providers to help with long term care is no different than using professionals to help with other complex issues such as car repairs, dealing with taxes, dealing with legal problems, or needing trained employees to help run a business. With their education and training, long term care professionals also bring experience that only comes from dealing with countless hands- on caregiving challenges”.

One Central Source for Locating Help and Advice
The National Care Planning Council recognizes the need for family caregivers to educate themselves and find the needed resources and professional help quickly.

To fill the need for caregivers nationwide, the National Care Planning Council web site "Long Term Care Link", was developed as a comprehensive resource for long term care planning. There are hundreds of pages containing articles on long term care covering all aspects of caregiving and care services. Books are also available on how to plan for long term care and how to apply for your veterans benefits for long term care.

If you are looking for government and community resources, there are lists with applicable website links. Some of those lists include National and State Area Agency on Aging Services, Senior Centers and Veterans Service Offices.

There are over 100 links to websites filled with reference materials. For example; the Gerontological Society of America, National Nursing Home Survey, Elder Law Answers, Senior Corps.

Find Eldercare Professional Service Providers in Your Area
The National Care Planning Council lists eldercare specialists and advisers who help families deal with the crisis and burden of long term care. These specialists can be found under the services category lists like the ones below, on the website. Each professional is listed under the State and area in the State that he or she services. A caregiver can go to the National Care Planning Council website and find someone in the area of need and read about the services of the listed company, individual or facility. Website visitors needing help can then call, email or fill in a request form to receive contact from a listed provider.

Listing categories on the website include the following specific services.

Care Management, Guardianship, Conservatorship and Dispute Resolution
Non-Medical Home Care
Home Health Agency – Medicare-Covered Home Care and Hospice
Home Maintenance, Deep Cleaning, Remodeling and Yard Work
Veterans Benefits -- Consultant for the Aid and Attendance Pension Benefit
Geriatric Health Care Practitioner or House Call Doctor
Reverse Mortgage Specialist
Elder Law Advice and Medicaid Advice
Estate Planning, Tax Planning, Trust Management Services and End-Of-Life Planning
Care Facility or New Home Search, Relocation, Downsizing and Real Estate Services
Adult Day Care Services
Insurance Products, Retirement Planning and Financial Advice
Funeral & Burial Preplanning

THE NATIONAL CARE PLANNING COUNCIL INTRODUCES
ITS STATE CARE PLANNING COUNCIL WEBSITES

A state care planning council is an informal statewide alliance of eldercare specialists and advisers that helps families deal with the crisis and burden of long term care. When you go to your state care planning website, your search for help is right in your neighborhood.

Purpose of the State Care Planning Council

Educate the public on the need for care planning before a crisis occurs.
Provide, under one source, a list of providers representing most of the available
government and private services for eldercare.
Offer a trusted team of providers and advisers that the public will recognize in their area and can turn to for expert help in dealing with the challenges of long term care.

One Stop Shopping for Eldercare Services
State Care Planning Council websites offer a closer-to-home option for finding help and services to solve caregiving problems. Many of the local service providers work together as a team to help meet specific eldercare needs of the individual.

For example:
Tim and Debra, both in their late 80’s, were adamant about staying in their home. Both were taking medications and were mobile with walkers. Their daughter, Julie was concerned about their safety in the home, especially with avoiding hazardous falls, bathing and preparing meals. Tim insisted he could drive his car, even though he was a hazard on the road. Julie had taken the car keys and therefore faced an argument every time she went to their home.

Lately, Julie noticed that the required medications were not being taken. Tim was a diabetic and required monitoring with his insulin and diet. Julie ordered “Meals on Wheels” which her mother quickly canceled. Frustrated at having no cooperation from her parents, Julie realized she needed outside help.

Checking the internet for resources in her area, she found the name of a Professional Care Manager in her area listed on her State Care Planning Council website. Jackie -- the professional care manager and family dispute professional -- had worked many times with families like Julie and her parents.

A meeting was arranged where all parties to the caregiving were involved. Tim expressed that he did not want to give up his freedom driving to the store or other places he liked to go. Jackie suggested selling the car and using the money to pay a taxi or community transit. She arranged for Tim to see a geriatric physician to get his diet under control for his diabetes. Some in-home help with bathing, meal preparation and medication reminders was arranged by having a local non-medical home care company come in daily. Jackie gave Julie explicit instructions on how to organize the house to help prevent falls. To pay for the extra expense, Jackie introduced a reverse mortgage broker who explained how their home equity-- on a risk-free basis --could provide the money they needed for their care.

Every service provider or adviser Jackie brought in worked side-by-side with her on the state care planning council. Jackie knew they could provide the needed help with expertise and integrity.

Julie found that using professionals gave her peace of mind and confidence that her parents' care was in good hands.

The State Care Planning councils are just starting to grow and be populated with professional service providers throughout the Untied States. Like the National, the State websites are filled with resource material and articles for the public use.

Florida Elder Care: Elder Help One Line at a Time

2009-08-27T20:05:00.001-07:00

Some times helpful tips do not need explanation, facts and figures or supportive arguments. They just make sense on their own.

* Be a helper not a boss..
* Walk ahead going down stairs and behind going up stairs.
* When they can't hear you, change your pitch not just the volume.
* Take care of yourself.
* Empathize what an elder can do and avoid talking about what they can't do.
* Laugh.
* Ask for help.
* Medications are both savior and killer, be very, very careful.
* Alzheimer's patients should be agreed with, not corrected.
* Write down what the doctor tells you.
* Never transfer ownership of their money without consulting an attorney
* No skipping meals.
* Make conversation by asked about events from their younger life.
* Drink plenty of liquids.
* Install smoke and carbon monoxide detectors and change the batteries.

Let us hear your one line tips. Send us an email at info@elderlawassociates.com.

Florida Medicaid: Florida leaders warn health care reform could bankrupt Medicaid

2009-08-25T19:38:00.001-07:00

Here's an important story that we found in the Orlando Sentinel that could impact many of our Florida Medicaid clients. (Elder Law Associates are qualified Florida Medicaid Planning Attorneys, with years of experience.)
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Florida Medicaid can't afford 1.4 million more uninsured and $1.6 billion more in costs, legislators say
Josh Hafenbrack, Tallahassee Bureau

TALLAHASSEE -- Florida officials have calculated that the health-care proposals being debated in Congress could add 1.4 million uninsured residents to the state's Medicaid rolls — and cost state taxpayers $1.6 billion a year.

Click here to read the complete article.

Florida Elder Care: Old Age - Blessings, Curses

2009-08-13T19:18:00.001-07:00

We came across an interesting op-ed in the USA Today that has started a strong dialogue about old age. It's worth a quick read, and it may provide some insight.

Click here to read "Old age: blessings, curses."

Ellen Morris and Howard Krooks
Florida Elder Law Attorneys

Florida Elder Care: Treating Delirium: An Often Missed Diagnosis

2009-08-10T17:52:00.001-07:00

We heard this story on NPR and thought it was interesting and thought provoking, especially to our Florida Elder Care clientele. It's about delirium, a sudden and frightening onset of confusion. A common but often unrecognized problem in hospitalized elderly people, delirium is estimated to affect more than 2 million seniors a year.

Click here to read or listen to the story from NPR's Web site: Treating Delirium: An Often Missed Diagnosis

Ellen Morris & Howard Krooks
Florida Elder Law Attorneys

Florida Special Needs Trust: U.S. Supreme Court Holds Local School District Must Pay for Private Special Ed

2009-08-04T19:35:00.001-07:00

Individuals with Disabilities Education Act, the nation's special education students are entitled to a "free and appropriate public education."

Schools have argued that the law says parents of special education students must give public special education programs a chance before seeking reimbursement for private school tuition.

But advocacy groups and parents of some special education students contend that forcing them to try public schools first could force children, especially poor ones, to spend time in an undesirable situation before getting the help they need.

Justice John Paul Stevens said in his majority opinion that the federal Individuals with Disabilities Education Act requires a school district to pay for private special ed services if the public school does not have appropriate services.

"We conclude that IDEA authorizes reimbursement for the cost of special education services when a school district fails to provide a FAPE [Free Appropriate Public Education] and the private-school placement is appropriate, regardless of whether the child previously received special education or related services through the public school," Stevens said.

In the case before the Supreme Court, the family of a teenage Oregon boy diagnosed with attention deficit hyperactivity disorder - who was identified only as T.A. - sued the school district, saying the school did not properly address the student's learning problems. The family is seeking reimbursement for the student's tuition, which cost $5,200 a month. The family paid a total of $65,000 in private tuition.

In its appeal, the Forest Grove School District said students should be forced to at least give public special education programs a try before seeking reimbursement for private tuition. If not, parents would bypass public schools and go directly to private school - and then ask for reimbursement from school systems already burdened by ever-increasing costs.

The court's decision does not require reimbursement, but Stevens said school officials "must consider all relevant factors, including the notice provided by parents and the school district's opportunities for evaluating the child, in determining whether reimbursement for some or all of the cost of the child's private school education is warranted."

Justice David Souter, Antonin Scalia and Clarence Thomas dissented.

"Given the burden of private school placement, it makes good sense to require parents to try to devise a satisfactory alternative within the public schools," Souter said in the dissent.

This is the court's second attempt at resolving this issue. The high court split 4-4 on a similar case from New York City two years ago. Justice Anthony Kennedy recused himself in the New York case but was among those who ruled on the Oregon case.

Nationwide, the number of special education students placed in private schools at public expense has not changed significantly over the last two decades, Justice Department lawyers said, citing statistics from the U.S. Department of Education. Just under 67,000 pupils were in private placements in 2007 - just 1.1 percent of the country's nearly 6 million special education students.

The case is Forest Grove School District v. T.A., 08-305.
To consult with a qualified Florida Special Needs Trust Attorney, click here.

Ellen Morris in Sun-Sentinel

2009-07-10T12:16:00.001-07:00

Ellen Morris, partner in Elder Law Associates, was recently quoted in an article by the Sun-Sentinel on the custody issues surrounding Michael Jackson's children.

Click here to read the article.

Of course, Elder Law Associates provides a number of legal services to their clients, including Elder Law, Guardianship, Litigation and Estate Planning. Feel free to contact us at 561.750.3850 for more information.

Florida Estate Planning: Family Reunions Are a Good Time for Family Planning

2009-07-10T06:39:00.000-07:00

Summertime brings a lot of family time. With family reunions, picnics, weddings and other events, long distant family members travel to gather together. It is also the perfect time to do some planning for the future. With parents aging and their health and lifestyles changing, children need to discuss some changes and decisions that will be needed in the near future. Parents should take the time to tell their children where important documents are kept and what their wishes are in the event of needing health care directives or experiencing long term care needs.

For those children who live away, the change they see in their parent's health and mental capacity may be alarming -- whereas siblings that have daily contact are working with these issues constantly. Here is the chance to compare notes and work together as a complete family in the long term care planning process.

For you parents who are well and active, this is a good time to hold a family meeting and share with your children your plan for long term care. Tell them where financial and legal documents are located. Review health care directives, living wills and long term care alternatives.

Experience has shown that even families that are close can quickly grow angry, jealous and hostile towards each other when an aging parent begins to need long term care. If a sibling moves into the parent's home, others can easily be suspicious of ulterior motives and fear losing their inheritance. On the other hand, the child providing the elder care becomes bitter and feels there is no support or help from siblings. Pre-need meetings for the purpose of making a plan, before eldercare becomes imminent, avoids these types of conflicts.

In its book, “The 4 Steps of Long Term Care Planning,” the National Care Planning Council provides guidelines and checklists for family planning meetings. Here's an excerpt from the book:

“The first step to holding a meeting, and perhaps the most difficult
one, is to get all interested persons together in one place at one time.
If it's a family gathering, perhaps a birthday, an anniversary or
another special event could be used as a way to get all to meet. Or
maybe even a special dinner might be an incentive.

The person conducting the meeting can be a parent or one person of
a couple who are doing their planning, years before the need for care
arises. A meeting on behalf of someone already receiving care or
needing care in the immediate future could be conducted by that
person or by a member of the family, by an adviser or a friend.
The agenda could be formal or informal. If you want a formal
agenda, we suggest using our care planning checklist as the agenda.

Copies of the care plan should be prepared prior to the meeting and
presented to those attending. Discussion is encouraged and we
recommend that the person in charge not dictate but encourage input from everyone.

After a thorough discussion of the issues and the presentation of the
solutions to the problems that will be encountered, there should be a
consensus of all attending to support the plan. If the plan needs to
be altered to meet everyone's expectations then by all means do so if
that can be done. But it is not always possible to please everyone so
there must sometimes be compromise.

The end of the meeting should consist of asking everyone present to
make his or her commitment to support the plan.

GET IT IN WRITING! All good intentions seem to be forgotten
with time. It may be years after this meeting before the long term
care plan begins. If there are vocal commitments to help with
transportation to doctors, give respite to the caregiver or other
commitments, write them down on the care agreement. You can
even have each person put a signature to his or her commitment if
you think that is important.”

“The 4 Steps of Long Term Care Planning ,” by The National Care Planning Council

The U.S Department of Health and Human Services states:
“No one wants to think about a time when they might need long-term care. So planning ahead for this possibility often gets put off. Most people first learn about long-term care when they or a loved one need care. Then their options are often limited by lack of information, the immediate need for services, and insufficient resources to pay for preferred services. Planning ahead allows you to have more control over your future”.
http://www.longtermcare.gov

"Whether you plan a formal meeting with an agenda or informally gather for a discussion, when the family is together make it a point to start the long term care planning process. There is a lot to learn and many decisions to make concerning finances, health issues and legal work. It may take research and a lot of time to put a plan together, but if everyone is involved it will work, and be worth it."
National Care Planning Council

Aging Research: New Florida Charity Supports the Science of Healthier Aging

2009-07-08T11:21:00.001-07:00

In an era when cutbacks in federal research dollars jeopardize the careers of many promising investigators working to understand how aging influences disease, the American Federation for Aging Research (AFAR) has opened a new Florida Affiliate and has already attracted significant support from AvMed Health Plans.

"As a Florida-based and Florida-focused company, we are proud to support the work of AFAR Florida," said Ed Hannum, AvMed's president. "Our mission is very much aligned with the goals of AFAR Florida - that is, to improve the health and quality of life of Floridians. We believe aging research is essential to understanding the underlying causes of many diseases prevalent among seniors and we support AFAR's efforts to reduce the suffering and ultimately, the healthcare costs associated with these diseases."

Since its founding, AFAR has supported the science of healthier aging by providing critical start-up grants to promising young researchers, many of whose findings are dramatically changing both our understanding and the practice of medicine.

According to one AFAR Florida researcher, Dave Morgan, Ph.D., who directs the Alzheimer Research Laboratory and Basic Neuroscience Research at the University of South Florida in Tampa, "Almost without exception, AFAR picks the winners. AFAR identifies those scientists who are truly committed - the top 20% that will go on to have highly productive research careers. AFAR has found a special niche by maximizing the use of its funds, moving young scientists into academic research careers."

Another AFAR investigator, Chad A. Dickey, Ph.D., now an assistant professor at USF's Johnnie B. Byrd Sr. Alzheimer's Center and Research Institute, stated, "AFAR is one of the few organizations that realizes that an emphasis on basic science is not only essential, but the key to building the foundation for the future. Many of today's advances in heart disease and cancer treatments were made possible because of an emphasis on basic science."

AFAR-supported investigators study a broad range of biomedical and clinical topics including the role of estrogen in the development of osteoporosis, the genetic factors associated with Alzheimer's disease, the effects of nutrition and exercise on the aging process, and much more.

To support this worthy charity, visit www.afarfl.org, or contact Susan Lichtman, regional director, susan@afar.org, 305-598-1115.

Florida Elder Law: Putting Home Care in Perspective

2009-06-29T11:35:00.001-07:00

The Evolution of Home Care
In the first century of our country's history there was no such thing as nursing homes or assisted living. Society was mostly rural and people lived in their own homes. Families cared for their loved ones at home till death took them. In the latter part of the 1800's because of an increasingly urban society, many urban families were often unable to care for loved ones because of lack of space or because all family members including children were employed six days a week for 12 hours a day. During this period many unfortunate people needing care were housed in County poor houses or in facilities for the mentally ill. Conditions were deplorable. In the early 1900's home visiting nurses started reversing this trend of institutionalizing and allowed many care recipients to remain in their homes. Nursing homes or so-called rest homes were also being built with public donations or government funds. With the advent of Social Security in 1936, a nursing home per diem stipend was included in the Social Security retirement income and this government subsidy spurred the construction of nursing homes all across the country.

By the end of the 1950s it was apparent that Social Security beneficiaries were living longer and that the nursing home subsidy could eventually bankrupt Social Security. But in order to protect the thousands and thousands of existing nursing homes Congress had to find a way to provide a subsidy but remove it as an entitlement under Social Security. In 1965 Medicare and Medicaid were created through an amendment to the Social Security Act. Under Medicare, nursing homes were only reimbursed on behalf of Social Security beneficiaries for short-term rehabilitation. Under Medicaid, nursing homes were reimbursed for impoverished disabled Americans and impoverished aged Americans over the age of 65. It has never been the intent of Congress to pay for nursing home care for all Americans. The nursing home entitlement for all aged Americans was now gone.

Over the last 40 years, there has been a gradual change away from the use of nursing homes for long-term care towards the use of home care and community living arrangements that also provide in-house care.

With Proper Planning People Could Remain in Their Homes for the Rest of Their Lives
We are seeing a trend towards working conditions like those in urban America in the early 1900's where both husband and wife are working and putting in longer hours. We are also seeing a return of the trend in the early part of the 20th century where outside visitor caregivers are becoming available to replace working caregiver's and allow the elderly to receive long-term care in their homes. In addition there is a significant trend in the past few years for Medicaid and Medicare to pay for long-term care in the home instead of in nursing homes.

Given enough money for paid providers or government funding for the same, a person would never have to leave his home to receive long-term care. All services could be received in the home. Adequate long-term care planning or having substantial income can allow this to happen.

We only need to look at wealthy celebrities to recognize this fact. Christopher Reeve, the movie star, was totally disabled but he had enough money to buy care services and remain in his home. President Ronald Reagan suffered from Alzheimer's for many years but received care at his California ranch. He was also wealthy enough to pay for care when needed. Or what about Annette Funicello or Richard Pryor? Income from their movie careers allowed them to receive care with their multiple sclerosis at home. We will be willing to bet that Mohammed Ali, who is severely disabled with Parkinson's disease, will probably never see the inside of a care facility, unless he chooses to go there to die. With the proper planning and the money it provides, most of us could remain in our homes to receive long-term care and we would never have to go to an institution or a hospital.

The Popularity of Home Care
Most of those receiving long-term care and most caregivers prefer a home environment. Out of an estimated 8 million older Americans receiving care, about 5.4 million or 67% are in their own home or the home of a family member or friend. Most older people prefer their home over the unfamiliar proposition of living in a care facility. Family or friends attempt to accommodate the wishes of loved ones even though caregiving needs might warrant a different environment. Those needing care feel comfortable and secure in familiar surroundings and a home is usually the best setting for that support.

Often the decision to stay in the home is dictated by funds available. It is much cheaper for a wife to care for her husband at home than to pay out $2,000 to $4,000 a month for care in a facility. Likewise, it's much less costly and more loving for a daughter to have her widowed mother move in to the daughter's home than to liquidate mom's assets and put her in a nursing home. Besides, taking care of our parents or spouses is an obligation most of us feel very strongly about.

For many long-term care recipients the home is an ideal environment. These people may be confined to the home but continue to lead active lives engaging in church service, entertaining grandchildren, writing histories, corresponding, pursuing hobbies or doing handwork activities. Their care needs might not be that demanding and might include occasional help with house cleaning and shopping as well as help with getting out of bed, dressing and bathing. Most of the time these people don't need the supervision of a 24/7 caregiver. There are, however, some care situations that make it difficult to provide long-term care in the home.

Please note from the first graph below that a great amount of home care revolves around providing help with activities of daily living. Note from the second graph below that the average care recipient has need for help with multiple activities of daily living. Finally, it should be noted from the second graph that well over half of home care recipients are cognitively impaired. This typically means they need supervision to make sure they are not a danger to themselves or to others. In many cases, this supervision may be required on a 24-hour basis. (Graphs were derived from the 1999 national caregivers survey, courtesy www.longtermcarelink.net.)

It is precisely the ongoing and escalating need for help with activities of daily living or the need for extended supervision that often makes it impossible for a caregiver to provide help in the home. Either the physical demands for help with activities of daily living or the time demand for supervision can overwhelm an informal caregiver. This untenable situation usually leads to finding another care setting for the loved one. On the other hand if there are funds to hire paid providers to come into the home, there would be no need for finding another care setting.

Problems That May Prevent Home Care from Being an Option
Caregivers face many challenges providing care at home. A wife caring for her husband may risk injury trying to move him or help him bathe or use the toilet. Another situation may be the challenge of keeping constant surveillance on a spouse with advanced dementia. Or a son may live 500 miles from his disabled parents and find himself constantly traveling to and from his home, trying to manage a job and his own family as well taking care of the parents. Some caregivers simply don't have the time to watch over loved ones and those needing care are sometimes neglected.

The problems with maintaining home care are mainly due to the inadequacies or lack of resources with informal caregivers, but they may also be caused by incompetent formal caregivers. These problems center on five issues:

Inadequate care provided to a loved one
Lack of training for caregivers
Lack of social stimulation for care recipients
Informal caregivers unable to handle the challenge
Depression and physical ailments from caregiver burnout

In order to make sure home care is a feasible option and can be sustained for a period of time, caregivers must recognize these problems, deal with them and correct them. The responsibility for recognizing these problems and solving them is another function of the long-term care planning process and the team of specialists and advisers involved.

Adequate Funding Solves Most Problems Associated with Providing Home Care
None of the problems discussed in this article would be an obstacle if there were enough money to pay for professional services in the home. These services would be used to overcome the problems discussed in the previous section. If someone desires to remain in the home the rest of his or her life, adequate preplanning could provide the solution.

This planning must occur prior to retirement. The most obvious way to provide sufficient funds for home care is to buy a long-term care insurance policy when someone is younger, healthy and able to afford the lower premiums. If insurance is not an option, then money must be put aside early in life to pay for care in the future. The only other option is to be rich.

Unfortunately, very few people address the issue of needing long-term care when they are older. This leads to a lack of planning and in turn leads to few options for elder care when the time comes. Lack of planning means most people do not have the luxury of remaining in their homes and must rely on Medicaid support in a nursing home to finish out the rest of their lives.

For your full Medicaid planning and home care options, consult a qualified Florida elder law attorney.

Florida Guardianship: Florida Nonprofit Receives Congressional Support for Affordable Guardianship for Persons with Disabilities and Seniors

2009-06-22T14:14:00.000-07:00

Karen Greenberg and Jaret Vogel, directors of Prosperity Life Planning, a special needs educational nonprofit organization, have created a new corporation called the Special Needs Tax Credit Alliance (SNTCA). The mission of SNTCA is to build national support for Congress to enable a $5,000 refundable tax credit, to reimburse parents of adults with disabilities and seniors with dementia for the legal expenses of guardianship for their loved ones, and/ or creation of a Third Party Irrevocable Special Needs Trust. The legal work for this mission was completed pro bono by the international law firm of Proskauer, Rose LLP. An IRS filing for 501(c)(4) status (Social Welfare Organization) is currently in progress. Donations will not be tax deductible for the donor but will be tax exempt for the companies' purpose.

The Special Needs Tax Credit Alliance will enlist the support of national parent, disability, senior and guardianship advocates, as well as attorneys and bar associations to support this tax credit proposal. SNTCA is completing final State of Florida registration to allow donations be made to support their cause.

"Having met numerous parents in our counseling of special needs families, we've seen their great surprise to learn that when their child turns 18, the parents are no longer considered the legal guardian. They are further shocked to learn it may cost $5,000 to retain guardianship. Many families cannot afford this legal expense. The child is then left in a 'Catch-22' situation: they do not have the competence to speak for themselves in legal, health care and financial matters, yet the parents cannot afford the legal expense to retain guardianship. The Special Needs Tax Credit Amendment addresses these issues, and provides a sensible and affordable method for these parents to protect their loved ones' interests."

Professional fees, court costs and filing fees bring the approximate cost for full guardianship to $5,000. A number of families may have two or more children with disabilities, thus further straining the family budget. Many of these families have had extraordinary expenses over the course of their child's life for therapies, equipment, specialized recreation, specialized diets, and other expenses, that "typical" children do not require.

A "refundable tax credit" is a dollar-for-dollar reduction in the amount of taxes due. To the extent taxes are paid by a parent, a receipt for legal services would allow a tax refund of their expenses. To the extent that the cost exceeds the amount of federal income tax paid, the government would provide the additional tax refund, much like the child tax credit currently employs.

Jaret Vogel, Director of SNTCA states "Since the time of our earliest colonists, Americans have sought to have a voice in their affairs. The Special Needs Tax Credit Amendment will enable family members to speak for their loved ones who cannot speak for themselves, currently a disenfranchised population. We see this situation as a violation of the First and Fourteenth Amendments, which guarantee Freedom of Speech and equal treatment under the law. How can these people participate if the family cannot afford the extraordinary expenses of guardianship, expenses "typical" families are not burdened with?"

For more information, call Jaret Vogel at 561-865-2921, or email to info@specialneedstaxcredit.com.

Florida Elder Law: The Hidden Secret of Elder Abuse

2009-06-04T18:23:00.000-07:00

Many elderly people rely entirely on family or other trusted individuals to help them. Whether it is for physical needs or emotional needs, as people grow older they tend to need more and more help from others. This dependence on caregivers or family members makes an older person more vulnerable for abuse. Of course, if you suspect abuse, contact a Florida elder law attorney.

For example, an older person relying on her children to provide meals and transportation and help her with financial decisions finds it difficult to complain when one of her children takes advantage of her. If, for instance, the child takes her money, hits her or neglects her care, the parent may be threatened with loss of support from the child if the parent complains. The child may also use threats of violence to keep the parent in line.

It is estimated that 5% to 10% of elderly Americans are suffering abuse. According to the National Committee for the Prevention of Elder Abuse,

“Spiraling rates of elder mistreatment are reported by both practitioners and researchers. In a recent national study of Adult Protective Services (APS), typically the agency of first report concerning elder abuse, there were 253,421 reports of abuse of adults age 60+ or 832.6 reports for every 100,000 people over the age of 60 (Teaster, Dugar, Otto, Mendiondo, Abner, & Cecil, 2006). The National Elder Abuse Incidence Study (National Center on Elder Abuse, 1998) found that more than 500,000 persons aged 60+ were victims of domestic abuse and that an estimated 84% of incidents are not reported to authorities, denying victims the protection and support they need.”

Much attention has been focused on abuse in nursing homes but most of the elder abuse in this country is at the hands of family members or other caregivers in the home.

In 2004, Utah Adult Protective Services workers investigated approximately 2,400 allegations of abuse, neglect or exploitation of vulnerable adults. In Utah, a vulnerable adult is defined as an elder adult (65 years of age or older) or an adult (18 years of age or older) who has a mental or physical impairment, which substantially affects that person's ability to protect or provide for themselves. The majority of the victims were females between the ages of 60-89 and 60% of the perpetrators were family members/relatives, while 24% were non-related paid caregivers.

The protective needs identified were as follows:

self-neglect 31%
physical abuse 16%
exploitation 19%
caretaker neglect 12%
emotional abuse 19%
sexual abuse 3%

In conducting the investigations, it was not uncommon to find that adults who were self-neglecting were also being exploited or abused. As stated previously, these statistics are based on approximately 2,400 cases, thus, if only one in ten cases are ever reported, it is possible that there were actually 24,000 or more cases in Utah that year. We suspect 9 out of 10 is close to the actual ratio of unreported versus reported cases in Utah.

We also believe that Utah's lack of reporting elder abuse is not unlike other states in the country. We suspect all the states are experiencing close to the same ratios of underreporting as in Utah.

There are a number of reasons why incidents of abuse, neglect, or exploitation are not reported to Adult Protective Services or other authorities. One of the most common reasons is the victim's fear of losing support. Many of the perpetrators are family members and the victim fears that reporting the crime will result in removal of the caregiver, as the perpetrator may face incarceration or may discontinue relations with the victim once accused, charged, or convicted. Many of these victims fear that by reporting abuse they will be left alone and expected to care for themselves or they will be forced to live in a nursing home.

Many states have implemented mandatory reporting laws to assist in the prevention of abuse, neglect or exploitation of vulnerable adults. Utah is one of the many states to have a mandatory reporting law (U.C.A. § 76-5-111). Utah law states that any person who has reason to believe that a vulnerable adult has been the subject of abuse, neglect, or exploitation shall immediately notify Adult Protective Services or the nearest law enforcement agency. Anyone who makes the report in good faith is immune from civil liability in connection with the report; however, any person who willfully fails to report is guilty of a class B misdemeanor.

It is important to note that the anonymity of the person or persons making the initial report and any other persons involved in the subsequent investigation shall be preserved and may only be released in accordance with the rules of the division (U.C.A. § 62A-3-311). In addition, all investigation information is confidential.

The following is a list of indicators of abuse, neglect or exploitation. It is important to note that the following lists are merely indicators and may not always be violations.

Signs of Abuse:

Unexplained bruises, welts, fractures, abrasions or lacerations
Multiple bruises in various stages of healing
Multiple/repeat injuries
Low self-esteem or loss of self determination
Withdrawn, passive
Fearful
Depressed, hopeless
Soiled linen or clothing
Social Isolation

Signs of Neglect/Self-Neglect:

Dehydration
Malnourishment
Inappropriate or soiled clothing
Odorous
Over/under medicated
Deserted, abandoned or unattended
Lack of medical necessities or assistive devices
Unclean environment
Social Isolation

Signs of Exploitation:

Missing/"disappearing" property
Inadequate living environment
Frequent/recent property title changes or will changes
Excessive home repair bills
Forced to sign over control of finances
No/limited money for food, clothes and other amenities

Prevention can only occur if there is awareness, the statutes are adhered to, and any suspicions of abuse, neglect or exploitation of vulnerable adults are immediately reported to Adult Protective Services and/or law enforcement.

All states have agencies that receive complaints of abuse. In some states failure to report abuse of the elderly is a crime. To contact an abuse complaint department, call your local area agency on aging.

Florida Elder Law: Howard Krooks Named to NAELA Board and Honored by NAELA

2009-06-02T13:12:00.001-07:00

We are proud to announce that Howard S. Krooks, JD, CELA was appointed to a one-year term as Secretary for the National Academy of Elder Law Attorneys (NAELA) Board of Directors. Mr. Krooks was also recently honored at the NAELA Annual Conference, which took place April 1-5, 2009, in Washington D.C. Mr. Krooks was one of four attorneys bestowed the organization’s highest honor of becoming a NAELA Fellow.

Howard S. Krooks is a partner of Elder Law Associates PA with main offices in Boca Raton, Florida and Of Counsel to Amoruso & Amoruso, LLP in Westchester County, New York. He is admitted to practice law in Florida and New York. Mr. Krooks’ professional practice is devoted to elder law and trusts and estates matters, including representing seniors and persons with special needs and their families in connection with asset preservation planning, supplemental needs trusts, Medicaid, planning for disability, guardianship, wills, trusts and advance directives.

As a member of the Joint Public Policy Task Force of the Florida Bar Association Elder Law Section and the Academy of Florida Elder Law Attorneys, Mr. Krooks works to protect the rights of the state’s most vulnerable citizens. Mr. Krooks is certified as an Elder Law Attorney by the National Elder Law Foundation. He was honored with the designation of NAELA Fellow in 2009. He serves on the Executive Council of the Elder Law Section of The Florida Bar as the NAELA Liaison. He is a Past Chair of the Elder Law Section of the New York State Bar Association (NYSBA), where he continues to serve on the Executive Committee.

Florida Elder Care: Government Program Pays Family Members for Taking Care of Mom and Dad

2009-05-22T12:53:00.000-07:00

Looking for a way to help Mom and Dad pay for Home care or assisted living? Perhaps you are their caregiver. Wouldn't it be nice to receive some extra income to help you provide their care? There is financial help available for senior veterans and their spouses.(Of course, it always helps to consult with an elder law attorney before making any long-term care plans.)

For veterans who served during a time of war or for their surviving spouses, the Veterans Aid & Attendance Pension will pay additional income to cover long term care costs. The great news about this program is that VA will allow veterans' households to include the annual cost of paying any person such as family members, friends or hired help for care when calculating the Pension benefit.

Pension can provide an additional monthly income of up to $1,949 a month for a couple, $1,644 a month for a single veteran or $1,056 a month for a single surviving spouse of a veteran. This money can be used to help pay the cost of home care, adult day services, assisted living or nursing home services.

In order to reduce income to meet the income test for pension, a rating for "aid and attendance" or "housebound" is crucial. Not only does the rating significantly increase the benefit amount but without a rating, room and board costs for assisted living are not deductible for purposes of reducing income. Only the much smaller assisted living medical costs are deductible.

For home care, non-medical costs are only deductible if the in-home attendant is licensed for healthcare in that state or if there is a rating. Since the non-medical costs for home care represent the bulk of all costs for long-term care at home, without a rating, those households with a non-licensed attendant would not qualify for the benefit. Examples of medical or nursing services at home would be help with activities of daily living such as dressing, bathing, toileting, ambulating, feeding, diapering and so on. Other services might include medication reminders or supervision necessary to provide a protective environment for the care recipient -- in the case of dementia or Alzheimer's.

A rating for aid and attendance is automatic if someone is a patient in a nursing home or that person is blind or so nearly blind as to need assistance.

It is our understanding that a non-licensed in-home attendant could be just about anyone receiving pay for providing services. This might be members of the family, friends, or someone hired to live in the home. Unfortunately, a spouse cannot be included in this list for reimbursable caregivers.

For a disabled person who has been rated, a family member will be considered an in-home attendant, but that family member has to be paid for services duly rendered. There is potential for fraud here where a family member may move into the home and ostensibly receive payment as a caregiver but not actually provide the level of care paid for. Documentation for this care must be provided to VA, and it is reasonable for VA to question whether the services being purchased from a family member living in the household are legitimate. Such arrangements should be extensively documented and completely arm's-length.

The care arrangements and payment for home care must be made prior to application and there must be evidence that this care is needed on an ongoing and regular basis. We recommend a formal care contract and monthly invoice billing for services. Money must exchange hands and there must be evidence of this. All of this documentation must be provided as proof to VA when making application for the pension benefit. Costs for these services must be unreimbursed; meaning these costs are not paid by insurance, by contributions from the family or from other sources. Even though the family member being paid for services cannot reimburse the veteran household directly,the family may pay the bills for the veteran household. This indirect form of support is allowed.

There is an application form to be submitted, along with a doctor's report form, documentation of medical expenses and payment of home care services or facility fees. Other documentation includes original discharge papers, marriage records if applicable and a death certificate where applicable. An inventory of all sources of household income and all household cash equivalent assets is also required. Providing complete documentation with the initial application will expedite a rating and approval for pension payment.

For those who want to do it themselves, the National Care Planning Council provides help in their book “How to Apply for the Veterans Aid & Attendance Pension Benefit.”

This book provides, in detail, a description of application for the Pension Benefit and what information and documentation other than the application form should be submitted. All necessary forms are included in the book such as the application form and forms for medical expenses and other costs.

ElderLawAnswers.com review of this book states; “This is the book to get if you want an in-depth understanding of how veterans' benefits work, what options are available and how to apply. http://www.elderlawanswers.com/resources/article.asp?id=6209&section=5&state =

One purchaser of the “How to Apply” book emailed his successful experience.

“I purchased " How to Apply for the Veterans Aid & Attendance Benefit" earlier this year, and I wanted to let you know how much of a blessing this book was.

I followed the instructions exactly as stated in the book. I used the forms provided (Forms 1-4). I made copies of everything. I submitted my dad's application on March 31, 2009. I received a response TODAY, May 2, 2009, that approves my father's application, and he will be receiving a substantial amount in benefits monthly, beginning April 1st.

In addition, the VA sent additional forms for me to submit stating that my dad may be eligible to receive additional benefits for medical expenses incurred from March 31, 2008 to March 31, 2009.

In essence, I had to submit no additional documentation, just the documentation you suggested in your book. I was approved in one month's time. NO DELAYS!!!

Thank you for your wonderful book! I needed no consultants, no attorneys, no one and nothing but the advice contained within your book. I highly recommend this book to EVERYONE who is seeking to apply for this valuable benefit.”

Veterans Benefits Consultant

A veterans benefits consultant is an individual who helps veterans understand long term care benefits available through VA. This can include information on veterans health care, state veterans homes and veterans disability income benefits. Consultants place particular emphasis on Pension and Death Pension because these benefits are typically more useful for the elderly needing long term care. Pension is also known as "the aid and attendance benefit." Being a consultant is not a formal title but is merely a description of this person's function.

Consultants provide information about the aid and attendance benefit including what it is, who can qualify and what information and documentation are necessary in order to file a claim. A consultant does not participate in any way in the application process unless that consultant is an accredited attorney representing his or her client in proceedings before VA. Consultants who are accredited veterans service organization representatives can also assist claimants with the filing of a claim. For all other consultations, veteran households seeking help with filing a claim are directed to an appropriate veterans service organization or to a state or county veterans service officer or, where appropriate, they are encouraged to file a claim on their own.

Some consultants also help potential claimants realign their assets and complete important estate planning documents prior to making application.

Veterans Benefits Consultants are private practitioners or in some cases representatives of veterans service organizations and are not connected with the Department of Veterans Affairs.

Florida Elder Care: Keeping Mom and Dad Safe at Home

2009-05-14T17:37:00.000-07:00

Generally, elderly parents want to remain living in their own home. However, remaining in the home becomes a concern when children see their parents slowing down, perhaps even having trouble with handling stairs and doing general daily activities. Yet, with parents' mental and physical health currently not creating problems, there seems to be no imminent need to search out support services or other accommodations for aging parents.

This is now the time to evaluate the home to make it safe and secure for your loved ones -- now and in the near future -- in anticipation of aging disabilities that may occur. Help and support are available. The nation as a whole is more aware of elderly needs and services and products are becoming available at an outstanding pace. This, then, is the perfect time to consult with a qualified Florida elder law attorney to make elder care decisions and plans.

The Bureau of Labor Statistics states,

“Employment of personal and home care aides is projected to grow by 51 percent between 2006 and 2016, which is much faster than the average for all occupations. The expected growth is due, in large part, to the projected rise in the number of elderly people, an age group that often has mounting health problems and that needs some assistance with daily activities.” Bureau of labor Statistics-Occupational Outlook Handbook, 2008-09 Edition

This growing need for aides and services also encompasses

home remodeling services -- making a home more serviceable to the elderly;
safety alert systems and technology;
motion sensors to monitor movement;
telehealth services -- using home-based computer systems for the doctors office or a nurse to monitor vital signs and
even a pill dispenser that notifies when it is time to take medication.

Where do you begin to make sure your elderly family member is safe and managing well in his or her home?

Visit often and at different times of the day and night. Make note of daily activities that appear challenging and where changes might be made to add safety and convenience. Remove rugs that slide -- causing a fall -- and move furniture with sharp edges. Set the water heater at a lower temperature. This will protect their older sensitive skin from scalds and burns. Be sure smoke detectors and carbon monoxide detectors are in place.

Bathrooms are a hazard area for the elderly. Grab bars by the toilet and shower are a must to help prevent falls. There are easy to install bars at your local hardware store if you want to do the work yourself. Another item that is good to have is a shower stool or chair.

If you are not sure of what needs to be done, consider hiring a professional. There are companies that specialize in home remodeling and accommodation for seniors. Michelle Graham of Accessible Design by Studio G4 says about senior home remodel projects,

“The main thing we incorporate in all of our projects is a careful study of needs and potential needs that may develop throughout a client's lifespan.”

Keep in mind what future home adjustments might be needed for your parents to “age in place” in their home.

Home safety or medical alert companies provide GPS-based bracelets or pendants to track the elderly at home who tend to wander. Or the companies may provide alarm devices such as pendants or bracelets which allow the elderly to alert someone if there has been a fall or a sudden health-related attack. In the event an alarm has been triggered, a 24 hour monitoring service will alert the family or medical emergency services or call a neighbor depending on previous instructions. In addition there are companies that will install motion sensors in the home to monitor the elderly on a 24 hour basis.

Don't forget your parents' community as a valuable resource for helping them stay in their home. Take Margaret Muller as an example. At 82 years of age, Margaret lives alone in her small home. She manages very well with the help of her local Senior Center. The Center's “Senior Companion” program sees that Margaret is taken to the store for groceries and other needs and checks in with her often to see how she is doing. Once a day, the Senior Center delivers a hot healthy meal to her door. Having these services and visits gives Margaret the help she needs and peace of mind that she is not alone.

Neighbors, local church groups, senior centers and city centers are some places to look for assistance. Most of the time there is little or no cost for these services.

Your state aging services unit is a valuable community resource. The National Area on Aging website www.aoa.gov states:

“AoA, through the Older Americans Act and other legislation, supports programs that help older adults maintain their independence and dignity in their homes and communities. In addition AoA provides funding for a range of supports to family caregivers.”

Some of the programs the site lists are:

“Supportive Services and Senior Centers

Nutrition Services

National Family Caregiver Support Program

Grants for Native Americans

Nursing Home Diversion Grants

Aging & Disability Resource Centers

Evidence-Based Disease Prevention

Long-Term Care Planning

Alzheimer's Disease Grants

Naturally Occurring Retirement Communities”

A few thoughts on hiring home care aides or live-in care givers.

The classifieds are filled with people looking for work as aides to the elderly. Many of these aides are well-qualified, honest people who will do a good job; but, of course, there will be some not so reputable. If you are looking to hire someone, be sure you interview and check references and qualifications. You will be responsible for scheduling that person and doing payroll and taxes as well. Be very sure you hire someone trustworthy, as the elderly seem to trust these helpers more than they should and therefore can easily be taken advantage of.

A professional home care service will eliminate your employment concerns. Professionally-provided aides are usually bonded and service is guaranteed. Home care companies take care of the scheduling and payment of their employees. Home care companies cater to the elderly in their homes by offering a variety of services.

These providers represent a rapidly growing trend to allow people needing help with long term care to remain in their home or in the community instead of going to a care facility. The services offered may include:

companionship
grooming and dressing
recreational activities
incontinent care
handyman services
teeth brushing
medication reminders
bathing or showering
light housekeeping
meal preparation
respite for family caregivers
errands and shopping
reading email or letters
overseeing home deliveries
dealing with vendors
transportation services
changing linens
laundry and ironing
organizing closets
care of house plants
24-hour emergency response
family counseling
phone call checks
and much more.

Thomas Day, Director of the National Care Planning Council states,

“Care in the home provided by a spouse or a child is the most common form of long-term care in this country. About 73% of all long term care is provided in the home environment typically by family caregivers.”

As their caregiver, you can make the difference in the quality of life for your aging parents and if staying in their home is a possibility, you have the resources to make it happen.

Financial Downturn Coupled With Changing Estate Tax Rules Mean It's Time to Review Your Estate Plans

2009-05-11T17:42:00.001-07:00

The financial crisis, coupled with possible changes in the estate tax law, make now a good time to review your estate plan. The future of the estate tax will likely be up for debate in Congress soon because one of the priorities of the Obama administration is making the estate tax permanent. Given the uncertain climate, it is important to make sure your estate plan does what you want it to do.

Under current law, the estate tax rate is 45 percent for 2009, but the estate tax will be eliminated in 2010. The tax is scheduled to return in 2011 at a rate of 55 percent. The amount of an estate that is exempt from taxes also changes under current law. It is now $3.5 million, but will drop to $1 million when the law is reinstated in 2011. The Obama administration would like to eliminate the one-year repeal of the estate tax. It isn't clear what the permanent rate would be, but according to an article in the New York Times, most tax experts believe the exemption will be kept at $3.5 million and the rate will stay at 45 percent.

The Times article identifies several things to consider when reviewing your estate plan:

Formula clauses in wills. Wills that give specific amounts to trusts can be problematic given the change in the estate tax. Instead of naming a specific sum to go into a trust, your will could name a percentage of whatever limit is currently in place.

Bypass or credit shelter trusts. Bypass trusts allow you to put any money up to the exemption amount into a trust. Your spouse would receive income from the trust and the remainder would go to other family members after your spouse dies. The problem with this is that with the exemption being so large, most of your estate could go into a trust, thereby limiting your spouse's inheritance. You may need to make sure the trust is structured in a way that allows your spouse access to the funds.

State estate tax. States have different exemption amounts that may be less than the federal amount. You may put more money in the bypass trust to avoid paying federal estate taxes, but end up still having to pay state estate taxes. Consult with a lawyer to determine a way to provide your executor with flexibility to deal with this issue.

Grantor retained annuity trust (GRAT) . A GRAT is a way to avoid gift tax for lifetime gifts of more than $1 million. You put appreciating assets in a short-term (two-year) trust and keep the right to an income stream for the life of the trust. If assets appreciate above a rate set by the IRS, your family members will receive the appreciation. Current law allows you to set up a GRAT that will result in little or no gift tax, but Congress is considering changing the law, so setting up a GRAT now may be especially appealing.

Family limited partnerships. Family limited partnerships are another giving technique. You can put assets like securities, real estate, or businesses into a such a partnership. Then you can give away shares of the partnership to family members. Because these shares can't be sold to non-family members, the price is discounted. Congress is considering ending the discount, so if you want to establish one of these partnerships, you should act soon.

Beneficiary designation forms. Money from a retirement account usually passes outside an estate to the person you designate on your beneficiary designation form. With all the consolidation in the financial industry, you should make sure your 401(k) or other retirement account has the correct beneficiary designation form.

To read the entire New York Times article, click here. For a related Times article, click here.

Florida Guardianships & Second Marriages

2009-05-07T17:30:00.001-07:00

Second marriages, significant others and blended families potentially give rise to contested guardianship situations.

One such case I recently handled involved a man who suffered from dementia in the middle, his three children from his first marriage of over 40 years on one side and his second wife on the other. In this case, the wife exhibited frustration and even violence toward her helpless spouse during his illness. She also refused to provide expensive, high quality care for him because it would reduce her spending money. His kids sued for guardianship to protect him, his assets and ensure he received the best care his money could buy.

After all, we work hard and save our money. Then, when we are ill and can afford personal, private care, we should be able to use our money for that purpose. The court granted our petition for the children to be their father's guardians. The wife no longer had control of his care or finances. The man had private care in his home for many years.

Signing Declarations of Pre-need Guardianship, Durable Powers of Attorney and Designations of Health Care Surrogate may negate the need for a guardianship. However, be sure the person you appoint has solely your best interest in mind and heart. Even with these documents, but especially without them, the guardianship process may provide the only forum for ensuring the best interests of the incapacitated person.

It's always best to consult a qualified, reputable Florida Guardianship Attorney when dealing with such matters. We invite you to call us anytime for an initial consultation.

-- Ellen S. Morris, Esq.

Howard S. Krooks, Esq., CELA Honored at NAELA's Annual Conference

2009-04-30T07:33:00.000-07:00

Partner Howard S. Krooks, Esq., CELA was recently honored at the National Academy of Elder Law Attorneys (NAELA) Annual Conference, in Washington D.C. Mr. Krooks was bestowed the organization's highest honor of becoming a NAELA Fellow. NAELA Fellows are attorneys who have distinguished themselves both by making exceptional contributions to meeting the needs of older Americans and by demonstrating a commitment to NAELA. Election as a Fellow signifies that peers recognize the lawyer as a model for others, and an exceptional lawyer and leader. Mr. Krooks is proud to be honored in the limited elite group of 76 attorneys who hold this title throughout the United States.

The NAELA conference focused on legislative advocacy and laws affecting the elderly. The key issues discussed were the Elder Justice Act, pooled trust changes and long-term care issues. While in Washington, Mr. Krooks met with staff from the White House, Senator Bill Nelson's office and Senator Mel Martinez's office to discuss long term care issues and how federal lawmaking affects seniors and people with disabilities in the State of Florida.

Florida Elder Care: Helping Your Older Parents Stay Happy and Healthy

2009-04-23T19:12:00.000-07:00

If you're fortunate enough to have one or both parents still living, you may have noticed a role reversal taking place in your relationship. Remember the days when Mom shuttled you to the doctor whenever you were sick? Now, it may be you who's driving her to her medical appointments. Perhaps you've become even more involved in managing her healthcare needs – serving as her healthcare proxy, moving her into your home to care for her, or even having to select a nursing home for her to live in.

Whatever the case, it's natural to feel challenged – and, yes, intimidated – in the role you've undertaken. But if you stay positive and proactive (and consult a qualified Florida Elder Law Attorney before making your long term care plans), you'll be in a great position to advocate for your parents' optimal care. And, really, what better way is there to say "Thank You" for all they've done for you over the years?

The following six recommendations will help you understand what may be happening to your parents as they age – and what you can do to help.

1. Stay vigilant to sudden changes.
Typically, sudden changes arise from sudden problems. Your elderly father who becomes confused one week but was alert and oriented the week before, or becomes unsteady walking and starts falling, is likely experiencing an acute problem – an infection, medication side effect, or perhaps, a heart attack or stroke.

If you pay attention to your parent's baseline health and behavior, you'll be alert to sudden, and subtle, fluctuations. Being attuned to what's “normal” for your parent is critical in advocating for his care. By informing his physician of these changes, you help ensure that he receives a proper diagnosis and timely treatment – especially important in acute conditions.

2. Investigate the source of gradual decline.
Several years ago, I met an elderly woman living in a nursing home. Her family, assuming she had dementia, had moved her there after she had gradually stopped speaking.

After performing a brief procedure on her, I asked how she was doing. “I'm OK,” she replied.

A miracle? Not exactly. I'd removed bullet-sized pieces of wax from her ears. She'd stopped speaking because her ears were too plugged to hear.

A host of conditions can cause gradual decline. Before jumping to the conclusion – as many people do – that Alzheimer's disease is the culprit, recognize that your parent may be experiencing an altogether different problem: a vitamin B12 deficiency, an underactive thyroid, Parkinson's disease or depression, to name a few.

When discussing your parent's decline with her physician, make sure the two of you consider all the possibilities. To prepare for the appointment, make notes detailing how her decline has manifested itself – loss of appetite, a failing short-term memory and so forth – and how long you've noticed these changes. That way, you won't leave anything out. There's a free checklist that either you or your parent can complete at seniorselfassessment.com – make sure you print or email the “Test Result Details” at the bottom of the page to analyze your responses and give you advice based on your answers.

3. Know thy parent's medicine cabinet.
Familiarize yourself with the medications your parent takes: what each one is for and how often he takes them. Make sure you notify each doctor your parent visits of all the medicine he takes, including over-the-counter products. Ask what side effects you might observe from each medication and whether it's potentially dangerous if your parent takes them together. You also want to tell the doctor whether your parent drinks alcohol or caffeinated drinks and whether he smokes, as these substances can affect some medications' efficacy and safety. To recognize which medications might cause the symptoms your parent experiences, check out drugscanmakeyousick.com .

4. Discourage ageist attitudes.
Simply put, ageism is prejudice against the elderly. It exists in many forms but can be particularly damaging to an older person's self-esteem when it assumes that all of her woes are age-related. Here are a couple of ways of expressing ageism to an elderly parent:

“What do you expect at your age?”
“You're not getting any younger.”

If you're ever tempted to utter something similar, remind yourself that by chalking up everything that ails her to her age, you sell your parent short. If she's depressed, it may have nothing to do with the fact that she's 80 and everything to do with a biological predisposition to depression. And remember that right-knee pain in a 90 year-old can't be just from age if there's no problem with her left knee.

5. Address not just symptoms—but emotions, too.
There is disease and then there is “dis-ease” – that is, a lack of ease, security or well-being. “Dis-ease” can manifest itself as myriad emotions in an elderly person: fear, grief, boredom, embarrassment and sadness among them. The fact is, these emotions can be every bit as debilitating as disease.

Take the case of a parent who's incontinent. Too embarrassed to socialize, she cuts herself off from friends. Without companionship, she becomes lonely. Instead of allowing her to become a hermit, discuss with her doctor how to address the incontinence. Together, you can consider different solutions that will ease her embarrassment and reinvigorate her social life.

6. Strive to maximize your parent's quality of life.
No matter our age, we all want to enjoy life to the fullest and have the capability to do the things we want to. Improving the enjoyment of life and a patient's functional ability are the cardinal goals of geriatric care. But you don't need a medical diploma on your wall to help your parent achieve either of those goals.

Being there to solve a problem or provide company are tremendously worthwhile services you can provide – no expertise required. Remember, as your parent gets older, his quality of life becomes more important to him than how much longer he lives. And he doesn't necessarily need medications or surgery to ensure that he's living the latter part of his life to the fullest.

If he enjoys books but has difficulty reading regular-sized type, check out sight-saving titles at the library. If he's grieving the loss of his best buddy, introduce him to new acquaintances at the senior center. If he's living in a nursing home, bring your kids there to share a meal with him.

Sometimes, it's the small gestures that have the most profound impact. As the child of an elderly parent, you are uniquely positioned to deliver these life-changing gifts.

Florida Elder Care: Long Distance Care Givers Receive Help

2009-04-20T18:25:00.000-07:00

Living in a different city or state -- miles from aging parents -- can be very difficult. Keeping in touch by telephone and making long trips to help parents or aging relatives with their needs can be time consuming and not nearly as effective as being available full time in person. (That's just one of the reasons why when planning for elder care that you contact a qualified Florida Elder Law Attorney - one familiar with Florida Estate Planning - before making long term care plans.)

Mark Sessions spent two years juggling his restaurant business with multiple daily phone calls to his elderly parents, checking on their needs and answering their questions. Family vacations were spent traveling the 500 miles to his parent's home to personally take care of home maintenance and provide health care visits to their doctor. During his last visit, Mark noticed his father had difficulty walking and his mother was confused as to which medications she was to take and at what time. This alarming change in his parent's condition concerned Mark that his parents' care needs required more than frequent phone calls and vacation visits. Running his business and handling his parent's long distance care was now becoming very challenging.

According to a report by the Alzheimer's Association of Los Angeles & Riverside, California, there are approximately 3.3 million long distance caregivers in this country with an average distance of 480 miles from the people they care for. The report also states that 15 million days are missed from work each year because of long distance care giving. Seven million Americans provide 80% of the care to ailing family members and the number of long distance caregivers will DOUBLE over the next 15 years.
Long Distance Caregiver Project – Alzheimer's Association LA & Riverside, Los Angeles, CA (May 15, 2002, National Web Seminar by Judith Delaney, MFT, Clinical Coordinator)

The long distance caregiver is a new role that is thrust upon children and younger family members. Families used to live closer together, with children residing and working near their parents. But nowadays family members are more distant from each other. Society, today, is recognizing this. Some caregiver services have tweaked their programs to work as liaisons between long distance caregivers, senior loved ones and local medical professionals.

Professional care managers -- a lso known as Geriatric Care Managers, Elder Care Managers or Aging Care Managers -- represent a growing trend to help full time, employed family caregivers provide care for loved ones. Care managers are expert in assisting caregivers, friends or family members find government-paid and private resources to help with long term care decisions.

They are professionals -- trained to evaluate and recommend care for the aged. A care manager might be a nurse, social worker, psychologist, or gerontologist who specializes in assessing the abilities and needs of the elderly. Care manger professionals are also becoming extremely popular as the caretaker liaison between long distant family members and their aging elder loved ones.

Jacqueline Marcell -- author of "Elder Rage, or Take My Father...Please! How to Survive Caring for Aging Parents" (Impressive, 2000) -- says,

"The most important thing to do is to find a geriatric care manager in the area where your loved one lives. She will have knowledge of all the services in the area and can be your eyes."

Below is a partial list of what a care manager or Professional Geriatric Care Manager might do:

Assess the level and type of care needed and develop a care plan.
Take steps to start the care plan and keep it functioning.
Make sure care is in a safe and disability friendly environment.
Resolve family conflicts and other issues with long term care.
Become an advocate for the care recipient and the caregiver.
Manage care for a loved one for out-of-town families .
Conduct ongoing assessments to implement changes in care.
Oversee and direct care provided at home.
Coordinate the efforts of key support systems.
Provide personal counseling.
Help with Medicaid qualification and application.
Arrange for services of legal and financial advisors.
Provide placement in assisted living facilities or nursing homes.
Monitor the care received in a nursing home or in assisted living.
Assist with the monitoring of medications.
Find appropriate solutions to avoid a crisis.
Coordinate medical appointments and medical information.
Provide transportation to medical appointments
Assist families in positive decision making
Develop care plans for older loved ones not now needing care

Services offered will depend on the educational and professional background of the care manager, but most are qualified to cover items in the list above or can recommend a professional who can. Fees may vary. There is often an initial consultation fee that is followed by hourly fees for services. Health insurance does not generally cover these fees but long-term care insurance might.

In 2002, the AARP published a survey from geriatric care mangers about their fees:

“Respondents were asked how much they charged for their services, which might include: an initial consultation; fees on an hourly or per visit basis; fees for development of a care plan; and fees on a fixed-price contract basis. Hourly fees averaged $74 an hour. GCMs charged an average $168 to develop a care plan. Initial consultations averaged $175. Seven of ten current GCMs responded in the affirmative when asked if they had a statement that listed their fees. ” Written by Robyn Stone, DrPH, Principal Investigator; Susan Reinhard, RN, PhD, Co-Principal Investigator; Jean Machemer, MSG, Research Associate; and Danylle Rudin, MSW, Research Associate of The Institute for the Future of Aging Services, Washington, D.C.Barbara Coleman, Project Manager, AARP Public Policy Institute November 2002

When you take into account the time absent from work and time to find the right care resources for your loved ones, along with the cost of travel expenses to monitor their care, you will probably concur that using a caregiver is money well spent. Add on to this the stress of handling your own life circumstances combined with being a caregiver and you will probably wonder how you could have ever done without the care manager.

A professional or geriatric care manager can be an important asset to all families in elder care situations. Here is an example of how a care manager can help.

Mary is taking care of her aging husband at home. He has diabetes and is overweight. Because of the diabetes, her husband has severe neuropathy in his legs and feet and it is difficult for him to walk. He also has diabetic retinopathy and, therefore, cannot see very well. She has to be careful that he does not injure his feet, since the last time that happened he was in the hospital for four weeks with a severe infection. She is having difficulty helping him out of bed and with dressing and using the bathroom. She relies heavily on her son, who lives nearby, to help her manage her husband's care.

On the advice of a friend, Mary is told about a professional care manager, Sharon Brown. The cost of an initial assessment and care plan from the care manager is $175.00. Mary thinks she has the situation under control and $175.00 for someone from the outside to come in and tell her how to deal with her situation seems ridiculous.

One day Mary is trying to lift her husband and injures her back severely. She is bedridden and cannot care for her husband. Her son, who works fulltime, now has two parents to care for. On the advice of the same friend, he decides to bring in Sharon Brown and pay her fee himself.

Sharon does a thorough assessment of the family's needs. She arranges for Mary's doctor to order Medicare home care during Mary's recovery. Therapists come in and help Mary with exercises and advice on lifting. Sharon advertises for and finds a private individual who is willing to live in the home for a period of time to help Mary with her recovery and watch over her husband. Sharon makes sure the new caregiver is reliable and honest and that taxes are paid for the employment. Sharon enlists the support of the local area agency on aging and makes sure all services available are provided for the family.

Sharon also calls a meeting with Mary's family and explains to them the care needs and how they need to commit to help with those needs. Sharon makes arrangements to rent or purchase medical equipment for lifting, moving and easier use of the bathroom facilities. Medicare will pay much of this cost. Sharon also works closely with an elder law attorney and a financial planner who specializes in the elderly. The attorney prepares documents for the family including powers of attorney, a living will and advice on preserving Mary's remaining assets. The financial planner recommends a reverse mortgage specialist to help Mary and her husband tap unused assets in their home's equity. Some reverse mortgage proceeds are used to pay off debt. The remaining proceeds are converted into income with a single premium immediate income annuity in order to provide Mary adequate income when her husband is gone and she looses one of the Social Security payments.

With the help of the care manager, Mary's life and future have been significantly improved. Her husband as well, if he adheres to the care plan, may end up having a better quality of life for his remaining years.

Florida Guardianship: Lengths People Go To For Financial Gain

2009-04-06T12:09:00.000-07:00

In a recent guardianship case (and the Florida guardianship attorneys here at Elder Law Associates do MANY guardianship cases), I was amazed at the lengths to which family members will go for financial gain at their loved one's expense.

In this case, a perfectly competent individual who was experiencing above average stress and aggravation, and was thus displaying his anger, was forced to endure a declaration of incapacity against him at enormous expense until I was successful in having the guardianship terminated.

The guardianship proceedings were brought by his only daughter, who failed to disclose the existence of large sums of her father's money and took wrongful control of that money. Had my client engaged me as his Florida guardianship attorney at an earlier stage, he may have been spared more than a year of humiliation and continuing exorbitant expense.

Moral of the story: Hire a Florida guardianship attorney who is very experienced in contested guardianships if anyone questions your capacity.

-- Ellen S. Morris, Esq.

Alzheimer's Association Memory Walk

2009-03-25T19:21:00.001-07:00

Millions of American families are caring for a loved one with Alzheimer's. The Alzheimer's Association, the world leader in Alzheimer's research, care and support, is dedicated to finding prevention methods, treatments and an eventual cure for the disease.

FALC member Elder Law Associates PA is gearing up for the Alzheimer's Association Southeast Florida Chapter Memory Walk on April 4th in West Palm Beach. Please show your support! Click here to visit Team Elder Law Associates' web page and help their efforts to support this worthy cause by making a donation.

Florida Estate Planning: Pre-paid Funeral Arrangements

2009-03-23T17:43:00.001-07:00

We found this article about pre-paid funeral arrangements in the Chicago Tribune enlightening, and think that you may, too:

The funeral industry is reconsidering one of the biggest selling points of prepaid funeral contracts—locking in the price prior to death.

Of course, it just highlights some of the many reasons it pays to consult with an up-to-date Florida Elder Law Attorney when planning your estate.

Florida Elder Care: Little-Known Government Program Pays the Cost of Elder Care

2009-03-18T17:22:00.000-07:00

WHAT IF 33% OF ALL SENIORS IN THIS COUNTRY could receive up to $1,949 a month in additional income from the government to help cover their elder care costs? THEY CAN! Talk to a Florida elder law attorney today!

Under the right circumstances, a little-known federal program will pay additional income to cover long term care costs for at least 1/3 of all US senior households -- that's how many war veterans or their surviving spouses there are in this country. But the provisions of this program are such a well-kept secret that only 4.7% of US seniors are actually receiving the benefit. The great news about this program is the Department of Veterans Affairs will pay you to hire your family, friends or just about anyone to take care of you (Caregiving spouses can't be paid under this program). The program is called "Veterans Pension."

Most people who have heard about Pension know that it will cover the costs of assisted living and, in some cases, cover nursing home costs as well. But the majority of those receiving long term care in this country are in their homes. Estimates are that approximately 70% to 80% of all long term care is being provided in the home. All of the information available about Pension overlooks the fact that this benefit can also be used to pay for home care.

It also comes as a surprise to most people that the Department of Veterans Affairs will allow veterans' households to include the annual cost of paying any person such as family members, friends or hired help for care when calculating the Pension benefit. This annual cost is deducted from household income and used to calculate a lower "countable income" which in turn enables families to receive this disability income from VA. Even though VA claims the benefit is for low income families, because of the special provision in the regulations -- allowing for deduction for care costs -- households earning between $3,000 to $6,000 a month or more can still qualify for Pension under the right conditions.

This extra income can be a welcome benefit for families struggling to provide eldercare for loved ones at home. Under the right circumstances, this annualized medical expense for the cost of family members, friends or any other person providing care, could create an additional household income of up to $1,056 a month for a single surviving spouse of a veteran, up to $1,644 a month for a single veteran or up to $1,949 a month for a couple.

If the disabled care recipient has been rated "housebound" or in need of "aid and attendance" by VA, all fees paid to an in-home attendant will be allowed as long as the attendant provides some medical or nursing services for the disabled person. The attendant does not have to be a licensed health professional. There is also no need to distinguish between medical and nonmedical services -- all are deductible.

For a disabled person who has been rated "in need of aid and attendance" or "housebound", a family member will be considered an in-home attendant, but that family member has to be paid for services duly rendered. There is potential for fraud here where a family member may move into the home and ostensibly receive payment as a caregiver but not actually provide the level of care paid for. Documentation for this care must be provided to VA, and it is reasonable for VA to question whether the services being purchased from a family member living in the household are legitimate. Such arrangements should be extensively documented and completely arm's-length.

The care arrangements and payment for home care must be made prior to application and there must be evidence that this care is needed on an ongoing and regular basis. We recommend a formal care contract and weekly invoice billing for services. Money must exchange hands and federal law requires employment taxes must be withheld and there must be evidence of this. All of this documentation must be provided as proof to VA when making application for the pension benefit. Costs for these services must be unreimbursed; meaning these costs are not paid by insurance, by contributions from the family or from other sources. VA will allow, however, family caregivers being paid by their loved ones, to turn around and pay the household bills for their loved ones to help defray the cost of the care.

Due to the need for a rating, documentation for annualizing care costs and the extensive proof needed to show the caregiver is indeed an employee of the care recipient, most people should not try this on their own. An expert in this area should be sought to help with the application in order to avoid lengthy delays in awarding a benefit or a possible denial of benefits.

Florida Medicaid Asset Protection Trust

2009-03-14T18:33:00.000-07:00

One very useful Medicaid planning technique in the arsenal of a Florida Elder Law Attorney involves the creation of an irrevocable Medicaid Asset Protection Trust. With a Medicaid Asset Protection Trust a person or couple can transfer some of their property to the trust to hold and manage for their benefit during their live with the remainder paid to their family after their death.

Example: Joe and Joan have assets in their savings and stock accounts of $250,000. They currently live off income from their investments, social security, and other retirement benefits. They are concerned that if they need nursing home care they will not have enough money to support their lifestyle and pay for the medical expenses for the remainder of their life.

Solution: Joe and Joan decide to transfer $150,000 to a Medicaid Asset Protection Trust. The trust provides that all income is paid to them while alive and in the even one need nursing home coverage under Medicaid the income is paid to the other. Upon the death of the surviving spouse, the trust will terminate and distribute the remainder to their children. By using this type of irrevocable trust their assets are protected and they receive an income stream for their lives.

Potential Problems: The gift to the Medicaid Asset Protection Trust can cause the a period of ineligibility for Medicaid benefits. The length of the ineligibility period depends upon the value of the assets given away as well as how long before the care is needed they are disbursed. After the ineligibility period, the assets in the Medicaid Asset Protection Trust should be protected and not counted as a disqualifying asset for Medicaid planning purposes. In addition, this removes the assets from the reach of the spouses.

A Medicaid Asset Protection Trust is not for everyone, but it can be a means of protecting a family's financial security. These trusts can be complicated and must be tailored to the families resources and needs. It is important that you use a Florida Elder law attorney who is familiar with the Florida Medicaid laws and who has experience in creating this type of trust.

Please note: The Irrevocable Medicaid Asset Protection Trust is not the same as a "revocable trust", "revocable living trust" or "living trust" that is currently being sold through Trust Seminars. As always, when considering these types of instruments, please consult a Florida Elder Law Attorney.

Florida Elder Care: Quiet Care

2009-03-03T18:26:00.001-08:00

Elder Law Associates just learned about this great product called QuietCare, which helps seniors maintain their independence safely, without intruding on their privacy. By observing a senior's normal patterns of daily living key to their well being, the system will alert an emergency response operator in case of emergency to call the senior and, if needed, their designated family members, caregivers or local emergency services. No cameras or microphones are used and no action by the senior is required.

Click here to find out more.

Florida Elder Care: Nursing Homes for Veterans

2009-03-02T19:15:00.001-08:00

Nursing home coverage for veterans is available from two sources within the Department of Veterans Affairs -- the veterans health care system and the state veterans homes system. As always, if you are making elder care plans for a veteran, consult with a Florida elder law attorney.

Nursing Home Coverage through the VA Health Care System
Nursing home coverage along with other long term care services such as home care and assisted living as well as geriatric care management are available through the Veterans Health Administration for qualifying veterans.

In order to get into the veterans health care program, the veteran must have service-connected disabilities, or be below a qualifying income level or be receiving Veterans Pension income. Once in the system, veterans are not guaranteed long term care services, including nursing home care, unless they meet specific requirements. Here is a list of these requirements for nursing home coverage.

Who is Eligible for Nursing Home Care

Any veteran who has a service-connected disability rating of 70 percent or more;
A veteran who is rated 60 percent service-connected and is unemployable or has an official rating of "permanent and total disabled;"
A veteran with combined disability ratings of 70 percent or more;
A veteran whose service-connected disability is clinically determined to require nursing home care;
Nonservice-connected veterans and those officially referred to as "zero percent, noncompensable, service-connected" veterans who require nursing home care for any nonservice-connected disability and who meet income and asset criteria; or
If space and resources are available, other veterans on a case-by-case basis with priority given to service-connected veterans and those who need care for post-acute rehabilitation, respite, hospice, geriatric evaluation and management, or spinal cord injury.

VA's nursing home health system programs include VA-operated nursing home care units and contract community nursing homes. Many VA hospitals operate nursing home care units located in or near the hospital. Other hospitals, without adequate nursing home beds, contract with approximately 2,500 community private nursing homes nationwide to provide services.

State Veterans Homes
State veterans homes fill an important need for veterans with low income and veterans who desire to spend their last years with "comrades" from former active-duty. The predominant service offered is nursing home care. VA nursing homes must be licensed for their particular state and conform with skilled or intermediate nursing services offered in private sector nursing homes in that state. State homes may also offer assisted living or domiciliary care which is a form of supported independent living.

Every state has at least one veterans home and some states like Oklahoma have a number of them. There is great demand for the services of these homes, but lack of federal and state funding has created a backlog of well over 130 homes that are waiting to be built.

Unlike private sector nursing homes where the family can walk in the front door and possibly that same day make arrangements for a bed for their loved one, state veterans homes have an application process that could take a number of weeks or months. Many state homes have waiting lists especially for their Alzheimer's long term care units.

No facilities are entirely free to any veteran with an income. The veteran must pay his or her share of the cost. In some states the veterans contribution rates are set at a certain level and if there's not enough income the family may have to make up the difference. Federal legislation, effective 2007, also allows the federal government to substantially subsidize the cost of veterans with service-connected disabilities in state veterans homes.

State Veterans Homes Per Diem Program
The Veterans Administration pays the state veterans homes an annually adjusted rate per day for each veteran in the home. This is called the per diem. The 2008 nursing per diem amount is $74.42 and for domiciliary care it is $34.40. Adult Day Health Care – up to one-half of the cost of care -- cannot exceed $66.82 per day. The goal of state veterans homes is to get Congress to increase the per diem rate for nursing care to 75% of the state private nursing rates. In most states the per diem falls well short of this goal.

The per diem program and construction subsidies mean that State veterans homes can charge less money for their services than private facilities. Some states have a set rate, as an example $1,400 a month, and they may also be relying on qualified veterans receiving the Pension benefit with aid and attendance plus the per diem to cover their actual costs. Other states may charge a percentage of the veteran's income but be relying on other subsidies to cover the rest of the cost. Some state homes can receive Medicaid support as well.

Most of the states with income-determined rates are selective about the veterans they accept. These states may rely on a variety of private and public sources to help fund the cost of care.

Eligibility and Application Requirements for State Veterans Homes
From state to state, facilities vary in their rules for eligible veterans. And even in the same state it is common, where there is more than one state home, for some homes to have very stringent eligibility rules and others to be more lenient. These differing rules are probably based on the demand for care and the available beds in that particular geographic area.

Some homes require the veteran to be totally disabled and unable to earn an income. Some evaluate on the basis of medical need or age. Some evaluate entirely on income -- meaning applicants above a certain level will not be accepted. Some accept only former active-duty veterans, while others accept all who were in the military whether active duty or reserve. Still others accept only veterans who served during a period of war. Some homes accept the spouses or surviving spouses of veterans and some will accept the parents of veterans but restrict that to the parents of veterans who died while in service (Goldstar parents).

Federal regulations allow that 25% of the bed occupants at any one time may be veteran-related family members, i.e., spouses, surviving spouses, and/or gold star parents who are not entitled to payment of VA aid. When a State Home accepts grant assistance for a construction project, 75% of the bed occupants at the facility must be veterans.

Domicile residency requirements vary from state to state. The most stringent seems to be a three-year prior residency in the state whereas other homes may only require 90 days of residency.

All states require an application process to get into a home. Typically a committee or board will approve or disapprove each application. Many states have waiting lists for available beds.

Insuring Your Retirement Funds

2009-02-22T18:42:00.001-08:00

It might sound strange to be told to insure your retirement funds, but after working hard and diligently saving all that money, wouldn't you want to make sure that the funds will be there for you when you need them?

As you move into retirement, you are also moving towards age-related health problems. Events beyond your control, such as stroke, heart disease and cognitive impairment can change one's way of life.

Many people are under the impression that government programs such as Medicare or Medicaid will cover the costs of long term care. Medicare will cover some skilled nursing for a limited period. Medicaid will only cover long term care costs for impoverished individuals. Health insurance does not cover nursing home or other long term care costs except for short-term rehabilitation.

Out of pocket costs for needed long term care resulting from age-related health problems such as home care, nursing home or assisted living will quickly deplete retirement funds and leave the remaining healthy spouse impoverished.

Long term care insurance is the answer to insure your retirement funds and provide protection so that the money stays intact and at the same time insurance provides a way to pay for elder care services.

In his book "The Total Money Makeover," Dave Ramsey says of long term care insurance, "If you are over sixty, buy long term care insurance to cover in-home care or nursing home care. The average nursing home stay costs $40,000 per year, which will crack and scramble a nest egg in a heartbeat. Dad in the nursing home can use up Mom's $250,000 savings in just a few short years."

Long term care Insurance to insure your retirement makes sense. You insure your car against damage, your home against fire, and you purchase life insurance, so why not insure what can be the largest and most devastating risk to you and your family? And unlike the other risks you insure against, long term care is the most likely to happen. Long term care insurance will also help you keep your independence and dignity and allow you to make choices about where you want to spend your final years.

Here are some specific reasons for buying long term care insurance:

• If you are married and you have a need for long term care, your spouse will be able to pay for an outside caregiver and receive needed rest and recuperation.
• If your children promise to take care of you, then when the time comes that you need care, insurance will help them do that by paying for aides to help with tasks such as bathing and incontinence.
• If you are single and a need for long term care arises and you have no family who can help you, insurance can pay for and coordinate that care.
• If you have the desire to leave assets behind when you die, insurance will help preserve those assets from the cost of long term care.

You should also consider buying long term care insurance at a younger age. There is an advantage for doing this. The premium is lower.

For example, a person, currently age 45, buying a typical policy with a spouse, could spend $21,146 in total premiums to age 78.

Suppose this same person chooses to wait to buy the equivalent coverage at age 65.

If that same policy were available in the future, the couple that waits could pay $52,566 in total premiums over their 13 remaining years to age 78. Because they waited, they would pay 2 ½ times more for the same policy.

In addition to the rates going up with age, the health qualifications will be stricter and development of health problems related to aging may even disqualify a person from obtaining a policy.

There are dozens of long term care insurance companies selling a multitude of different policy options. It can become very confusing. For each policy, there are literally thousands of benefit combinations for home care, assisted living, nursing home care, waiting periods, payment amounts, inflation riders, and the list goes on.

You can take the time to do your own research or find a competent long term care insurance agent. Here is a checklist of some of the things you need to know before you purchase a policy.

LONG TERM CARE INSURANCE BUYING CHECKLIST
The more "yes" answers you get the better off you are.

1) Is the insurance company rated by A. M. Best (the rating company) with a rating of at least A, A+ or A++?

2) Is it a large diversified company with deep pockets and selling more than just long term care insurance?

3) Is the insurance representative an expert in long term care insurance? (Because of its complexity, almost all LTCi experts only sell LTCi; they seldom sell anything else.)

4) Does the representative have a degree and/or industry financial designations?

5) Does the representative own a personal long term care insurance policy for himself or herself?

6) Is the policy you like tax qualified, and if not, do you understand the ramifications?

7) Are there at least 6 ADL's (Activities of Daily Living) allowed for in the benefit certification?

8) Does it allow "standby assistance"?

9) Is it a "pool of money" as opposed to a "stated period"?

10) Is it "integrated" as opposed to "2-pool"? (2-pool is not allowed in many states.)

11) Do you understand how the elimination period works? (This is extremely important.)

12) Does it have prohibitive cost containment provisions?

13) Is there any "capping" or other future reduction of automatic benefit increase riders?

14) Do you understand how the waiver of premium works?

15) Does the assisted living facility benefit pay the same as for nursing home?

16) Are you buying adequate home care coverage?

17) Does the company have a history of premium rate stability without periodic increases?

18) Does the policy pay for homemaker services?

19) Does the policy offer an alternative plan of care for services that don't exist today?

Avoiding Probate and Taxes & Remaining Eligible for Medicaid

2009-02-09T19:05:00.000-08:00

As our population continues to age, more and more individuals are concerned about how they will pay for care as they get older. Often individuals and families find that they are unable to take care of themselves and need assistance.

As medical costs have continued to rise, so have the costs of home health care. As a result we are seeing more individuals need the assistance of Medicaid. Too often we find individuals who have received advise from family members, friends, and professionals who do not understand Medicaid and only deal with elder law or estate planning issues. While it may be great to avoid the costs and fees associated with probate, what if you end up being disqualified from nursing home coverage. This could cost far more than the savings on probate.

Florida is a great state to live at the time you need Medicaid coverage because of the large exemption allowed on one's home. Generally you can protect up to $500,000 of equity in a Florida homestead. Unfortunately in an effort to save a few thousand dollars many individuals transfer a partial ownership in the property to their children with rights of survivorship. Often this is done with a life estate deed.

This can cause many problems for the owner in the event they ever need nursing home coverage. There is way to accomplish similar results without risking the tax detriments, gifting issues, loss of control, and Medicaid eligibility - use a Florida Enhanced Life Estate Deed.

If you would like a review of your estate planning that takes into account Florida Elder Law, Medicaid planning, and probate and tax issues Contact a Florida Elder Law Attorney who is familiar with estate planning and medicaid planning.

-- Ellen Morris, JD

Plan for Long Term Care

2009-01-26T18:30:00.000-08:00

According to some sources, 60% of us will need long term care sometime during our lives. It is important for all of us to prepare for that day when we will need to help loved ones with elder care or we will need elder care for ourselves. Of course, one should always consult with a reputable Florida elder law attorney before making any concrete plans.

It is simply a fact of life to prepare financially for unexpected disasters by covering our homes, automobiles and health with insurance policies and to provide funding for our retirement. But no other life event can be as devastating to our lifestyle, finances and security as needing long term care. It drastically alters or completely eliminates the three principal retirement dreams of elderly Americans, which are:

1. Remaining independent in the home without intervention from others
2. Maintaining good health and receiving adequate health care
3. Having enough money for everyday needs and not outliving assets and income

Yet, it is our experience that the majority of the American public does not plan for the devastating crisis of needing eldercare. This lack of planning also has an adverse effect on the older person's family, with sacrifices made in time, money, family lifestyles and even affecting the family's or caregiver's medical and emotional health." National Care Planning Council "The 4 Steps of Long Term Care Planning".... read the entire article by going to http://www.planforcare.org.

-- Ellen S. Morris, JD

Long-Term Care Premium Deductibility Limits for 2009

2009-01-15T19:53:00.001-08:00

The Internal Revenue Service has announced the 2009 limitations on the deductibility of long-term care insurance premiums from taxes. Any premium amounts above these limits are not considered to be a medical expense. (For details, click here.)

Attained age before the close of the taxable year

Maximum deduction

40 or less

$320

More than 40 but not more than 50

$600

More than 50 but not more than 60

$1,190

More than 60 but not more than 70

$3,180

More than 70

$3,980

Benefits from per diem or indemnity policies, which pay a predetermined amount each day, are not included in income except amounts that exceed the beneficiary's total qualified long-term care expenses or $280 per day (for 2009), whichever is greater.

For details from the American Association for Long-Term Care Insurance, click here. Of course, if you are planning for long-term care, you should always consult a Florida elder law attorney.

Elder Care: Appliances to Soothe Aging Boomers

2009-01-10T17:14:00.001-08:00

The appliance market is responding to the demands of boomers who want appliances that help them cope with the aches, pains and other infirmities they confront as they grow older, reports an article in the Wall Street Journal.

Some examples of the "senior-friendly" features for washing machines include pedestals that raise the height of the machine for easier access, large knobs that make a louder-than-usual noise when they're set, and musical chimes to indicate washing temperature.

Click here to read the entire article.

Medicaid Spousal Impoverishment Figures for 2009

2009-01-05T17:36:00.000-08:00

In 2009, the spouse of a Medicaid recipient living in a nursing home (called the "community spouse") may keep as much as $109,560 without jeopardizing the Medicaid eligibility of the spouse who is receiving long-term care. Called the "community spouse resource allowance," this is the most that a state may allow a community spouse to retain without a hearing or a court order. While some states set a lower maximum, the least that a state may allow a community spouse to retain in 2009 will be $21,912.

Meanwhile, the maximum monthly maintenance needs allowance for 2009 will be $2,739. This is the most in monthly income that a community spouse is allowed to have if her own income is not enough to live on and she must take some or all of the institutionalized spouse's income. The minimum monthly maintenance needs allowance of $1,750 took effect July 1, 2008 and will not rise until July 1, 2009.

The new figures are effective January 1, 2009.

Of course, all Medicaid planning is best done with advice from a Florida Elder Law Attorney.

--Ellen S. Morris, JD

Caregiver Burnout - Adult Day Care Services to the Rescue

2008-12-21T17:47:00.000-08:00

If you are a primary caregiver for a loved one, you are well aware of the daily stress and emotional and physical impact it can have on your health. As Florida elder law attorneys, we see this every day, as our clients come into our office.

Susan learned this first hand when she and her husband, Tom, brought his Mom home to live with them. Mom suffered from dementia and had to be watched constantly. Susan found that when you become a caregiver, you start by giving up a few things you usually do for yourself to make up for the time needed for caregiving. Even though your service is one of love and you are willing to do the sacrifice on behalf of your loved one, you find yourself giving up a lot more as time goes on.

“As a caregiver,” Susan laments, “You are often frustrated that you can’t do enough for your loved one and so guilt and feelings of inadequacy set in. Couple that with feelings of being unduly burdened, of resentment, of stress and then of more guilt at having those feelings."

She continues, "Now don’t get me wrong, I am very glad that I spent those years in caregiving. There were many cherished moments with Mom that only I experienced.”

In order to enjoy those moments and sustain your caregiving momentum, a little respite is essential.

An article posted on About.com by Carrie Hill, PhD states:

“Caregivers who use respite care often tell me that although caregiving is one of the hardest jobs they've ever had, they wouldn't trade the experience for anything. Helping a family member or close friend who has Alzheimer's disease can provide a sense of purpose and great satisfaction. Still, the emotional and physical demands of caregiving make it hard to be a caregiver 24 hours a day, 7 days a week. Without respite care -- a temporary break from the demands of caregiving -- you may be more susceptible to the effects of caregiver stress, such as depression, exhaustion and other health problems.

Carrie Hill, PhD, About.com “Why Caregivers Need Respite CareGiving Yourself a Break Helps You and Your Loved One” Updated: August 3, 2008

Be on the lookout for caregiver burnout. It can creep up on you without your noticing it. Caregiver burnout symptoms can include:

depression
anxiety, irritability, or anger
feelings of exhaustion
self-criticism
Withdrawal from usual activities
trouble with handling caregiving responsibilities
substance abuse

The need for support for caregivers at home has received national recognition. State Human Resource Departments and Area Agency on Aging Services are offering more counseling and respite services for caregivers. The ARCH National Respite Services is also an organization that is reaching out to educate and support caregivers in many states. There is, however, one service that is highly valuable but very underused:

Adult Day Care to the Rescue!

Adult Day Care respite is two-fold. It gives the caregivers much needed time to themselves and gives their loved ones social and interactive therapy with their peers.

Many adult day services offer such things as:

Social activities; music, movies, crafts, excursions
Meals
Fellowship support
Assistance with daily living
Nursing care
Help with activities of daily living
Medications
Physical therapy
Transportation

Finding an Adult Day Services provider takes a little investigating on your part. It is important to know what you are getting and that your loved one is comfortable with his or her new surroundings.

First: Ask for recommendations.

Check with your local Senior Center, Area Agency on Aging Services, Mental Health Centers, Doctor, Clinic, Family, Friends and neighbors. The best recommendation is by someone who has used the adult day services or is familiar with those who run it.

Second: Call and ask the facility to send you information.

Ask specifically to be sent the application, eligibility requirements and payment information.

Ask to see the calendar of activities, menus, hours and days of operation are needed to be sure to fit your schedule.

Ask about availability of transportation to and from the location and what is the cost.

Ask who runs the facility. Is it private, non-profit or a franchise or part of an assisted living facility or a nursing home?

Third: Visit the Adult Day Care facility.

Go visit the provider location along with the person you are caring for.

See if the staff is friendly.

Check that it is clean and odor free.

Ask about the experience of the staff.

Request a list of references.

Fourth: Find out the cost and payment requirements.

A survey from NCOA/NADSA provides the following information on fees:

“Fees for Adult Day Care providers range from $25 per day to $70 per day, with the average around $50 per day. Many facilities provide services with a sliding fee scale.”

One last word of advice. Don’t feel guilty about taking your loved one to adult day care.

Susan’s mother-in-law complained bitterly about leaving home and going to the adult day care facility, expounding on how Susan just didn’t want her around anymore. This only increased the guilt Susan was already feeling, but Susan was also determined that she needed the respite time the day care would provide and they pressed forward. That evening as Susan picked up Mom and helped her into the car, Mom -- who suffered from dementia -- exclaimed, “That was the nicest resort I have ever been to!”

To learn more about the AOA National Caregiver Support Program go to:

http://www.aoa.gov/prof/aoaprog/caregiver/caregiver.aspx

Hiring a Home Health Aide

2008-12-18T19:31:00.001-08:00

Plan and consider before you jump.

Bringing a stranger into an elder's home is a big step and thought and consideration will go a long way in helping this big change be a success. First and foremost the elder needs to be involved as much as possible. How would you like having someone else arrange to bring a stranger into your home?

Start by making a list of which areas the elder needs help, such as cleaning and meal preparation, personal care like bathing and toileting or medical attention for medications, therapy, skin care, etc. A different type of aide is needed for the different levels of care. Will they need to drive and if so will the aide need to have her own car?

Next, how much help is needed, 4 hours twice a week, every day all day, or day and night? If someone needs to be on hand for 24 hours, will they be able to sleep through the night or must someone be alert at all times. This will determine whether you can have a live-in or if you will need shifts. A live-in is much less costly than shifts and helps to maintain a more stable situation.

Also critically important is the need to define a compatible personality that will interact well with your elder. Will the aide need to be able to keep control and be assertive, need to be tolerant of mood swings, need to play cards, or discuss current events, etc? With the needs defined you are now ready to start your search.

There are some community resources available for home care which may meet your needs. You can call the Eldercare Locator at (800) 677-1116 to learn what public agencies are in your area and how to contact them. However, most of these agencies are stretched to the breaking point and often will be unable to provide you with the level of care required, if they can provide any care at all.

Most areas have multiple private home health agencies available which you can find online, in the phone book and by asking for referrals. It is possible to save money by hiring someone directly, but if you have not had experience doing that, the choice can be fraught with obstacles such as medical screening, criminal background checks, payroll tax issues and more which you will have to handle yourself. You definitely do not want to have someone come into the house without the medical and background checks being made. If you do not have that experience, I strongly recommend you use an agency. Contact two or more different companies so that you will get more than one input about pricing, the amount of care needed, what type of aide, Home Health Aide (HHA), Certified Nursing Assistant (CNA), License Practical Nurse (LPN), etc. is required. Have them provide you a copy of their agency license, and referrals which you should call.

Determine whether the same person or persons will be providing the care. A revolving door of different aides is a prescription for problems. If it is a live-in will they really be there every day, or do they have obligations to a family and home. You may need two live-ins so they will they both be able to maintain a consistent schedule. If they will be driving get a copy of their driver's license and if they will be using the elder's car, make sure the insurance will cover them. Interviewing aides from more than one agency will give a wider choice of candidates. The first person you hire, or even the second or third person may not be the right one. Don't get discouraged, the right match is out there. Do not settle for someone that does not meet all your expectations.

It is also critical that you provide adequate supervision during the start of the process. If you do not live near by, you should get the help of a friend or relative. If there is no one, give serious consideration to getting a Geriatric Care Manager to help, at least in the beginning. Be sure to also ask your elder's opinion about the aide, but only when the aide is not present.

If you are not using a Platinum LifeLedger you will need to collect and make a copy available for the aide and the agency of all the many things they will need to know

Bringing help into the home is big project and you will need to be prepared for these new, added responsibilities. Do the best you can - perfect is not going to happen.

Elder Mediation Resolves Family Conflicts

2008-12-11T19:40:00.001-08:00

Elder care includes resolving family conflicts, a situation as Florida elder law attorneys, we're unfortunately very familiar with.

"My daughter is insisting I move in with her," complains Martha. "She just wants to control my life and take away my freedom," she continues.

Jenny, Martha’s daughter worries that her mother keeps falling, and fears one day she will break her hip or hit her head.

"I’ll take my sister to court before I will let her get control of mom and my inheritance," exclaims Jim about Jenny’s desire to move her mother in with her.

It is amazing how quickly formerly cordial relationships between family members will sour when the family has to deal with care of elderly parents or inheritance at their death. Sometimes the consequence of dealing with the final years of elderly parents can break families apart and create long-lasting animosity.

The National Care Planning Council has seen an increase in requests from caregiving children for help in solving disputes with siblings. In one case, the caregiver was being sued by her sister for abusing their parent and stealing the Social Security checks. In another, the caregiving child would not allow siblings to see their mother, claiming they would take advantage of her.

A lot of times it is a “she said,” “he said” situation with neither party really understanding what the elder person needs or wants.

Some families find it hard to communicate with each other when their parent is in need of care. Perhaps when they grew up together they were not accustomed to come together as parents and children to work out problems. And now those children are older and taking care of parents and they don't have this family council strategy to rely on. It may seem unnatural to them. But that is often exactly what is needed, especially in situations where perhaps one child is caring for the parents and the others are left out of the loop.

Children all have a common bond to their parents and as a result a common obligation or responsibility to each other. When disagreements arise, suspicions begin to grow. Suspicions or distrust often lead to anger and the anger often leads to severing the channels of communication between family members. This can occur between parent and child or between siblings or between all of them.

It is often at this point that a neutral third party can come in and repair the damage that has been done and help correct the problems that have come about because of the disagreement.

A practitioner experienced in elder mediation is a perfect choice for solving disagreements due to issues with the elderly.

WHAT IS ELDER MEDIATION?

Mediation is a non-adversarial approach to solving disputes. Mediation is a process of bringing two or more disputing parties together and having them mutually negotiate a solution to their disagreement. The mediator is not a judge and does not render a decision but is there to make sure that communication flows freely between the disputing parties. Elder Mediators are trained in the art of negotiating resolutions between elderly parents and family members.

Mediation can achieve results that the family by itself may not be capable of realizing or have the expertise of achieving. Here are some reasons that make Elder Mediation so valuable.

• A trained expert on communication gives the family a perspective it could not gain by meeting together on its own;
• All family members involved meet and prevent problems from arising by anticipating situations that may cause disputes;
• Allows for the mediator to invite experts such as care managers or other care providers into the meeting to educate the family and give them a new perspective;
• Allows parents to focus on their abilities rather than their limitations;
• Allows children to come up with and consider options not thought of previously;
• Encourages uninvolved family members to become involved;
• Allows parents to express wishes and desires that had previously gone unuttered;
• Allows for a neutral third party to challenge family members and make them take responsibility for their actions;
• Promotes consensus of all involved which in turn creates a much higher rate of compliance with the plan than with any other process; (the success rate for compliance with elder mediation is estimated to be about 80% to 85%)
• Requires a written plan with specific responsibilities which makes compliance feasible.

There are many organizations and companies throughout the country providing expertise in "Elder Mediation" to help seniors and their families. You will also find that mediators often have many coincident professional accreditations such as, Professional or Geriatric Care Manager, Elder Attorney, Clinical Social Worker or Certified Mediator.

In choosing a mediator, consider your needs. Is there a need for a medical assessment to determine the type of care? Are legal concerns with inheritance or family business or power of attorney, the main need? Perhaps, just bringing the family together to communicate on what needs to be done and who will do it is the agenda for now.

In one case, after months of dispute with her parents over their health and safety issues, Connie enlisted the service of a professional care manager mediator.

“Bringing a neutral person with a professional and compassionate attitude into our disputes was the best thing for all involved,” Connie recalled. “My parents shared their concerns and listened with acceptance to mine. All of a sudden we could communicate and work out a plan that they could live with and I could relax knowing they were safe.”

Seniors Use Mediators to help the family plan for long term care.

In the National Care Planning Council's book, “The 4 Steps of Long Term Care Planning,” the process of creating your own “Care Plan” before you need it is introduced. Quoting from the book:

“If the current or future caregiver wants the other persons attending the meeting to give support with respite care, transportation to doctors, etc., everyone needs to be aware of this and in total agreement to do it. All must also be willing to work with the member of the family, friend or professional who is designated as the Personal Care Coordinator.

If you feel the communication will be strained, consider having a professional mediator present. The mediator will be able to keep things calm and running smoothly
and help work out each person's concerns.”

“The 4 Steps of Long Term Care Planning” book can be found at http://www.longtermcarelink.net/a16four_steps_book.htm

Where to Find an Elder Mediator

• In your local phone book, on the internet or with your community senior services.
• References from friends and neighbors
• Contact the local area agency on aging
• Contact your state bar association
• Contact a local university or college and asked to speak to the department that provides mediation training and ask for a referral.
• On the internet look up mediation in your area
• Yellow pages in local phone books

Eight Unselfish Ways to Put Yourself First

2008-12-08T17:33:00.001-08:00

Eight Unselfish Ways to Put Yourself First

1. Eat a well-balanced diet
When you’re stressed out, you may tend to overeat. When you’re exhausted, it’s easy to resort to whatever is handy; quick snack foods, tea and toast, cheese doodles and soda. You need high quality food to perform well.

2. Get regular exercise
Exercise is the original “feel good” tonic. It helps you sleep better and wake up refreshed and ready to face another arduous day. Regular exercise improves both your mental and physical well-being, keeping your mind alert and body fine-tuned and energetic.

3. Get enough rest
This may be easier said than done, especially if you’re caring for someone who tends to wander at night. Still, most people need six to eight hours of sleep a night to maintain good health. Catch up with cat naps if necessary, early in the day.

4. Look after your own health
When you’re preoccupied with someone else’s health, it’s all too easy to neglect your own. Caregiving can be physically and emotionally exhausting, leaving you at risk for serious illness.

5. Get organized
It is very important to get an early diagnosis of your loved one’s illness, and then learn everything you can about it. That way you’ll know what to expect, and you can plan for it. (It also pays to have your legal plans well mapped out. Consult a Florida elder law attorney to do just that.)

6. Plan for emergencies
Who will take over if you do get sick? How will you cope if your loved one has a medical emergency? Be prepared. Keep a file or notebook with names and phone numbers of people you might need. In a crisis, you’ll be less likely to panic if you’re organized down to the last detail.

7. Take time out for yourself
Whether you’re caring for a parent, spouse, or other relative or friend, you need time for yourself. You need outside interests, other people, and a way to escape from the constant pressure of caregiving. You need to get away from time to time. Keep up your friendships. It’s easy to let friendships lag when you have “more important” things to do. But friends can get you through some tough times, just by being there.

8. Consider joining a support group
If you feel alone and isolated in your role as caregiver, talk to other caregivers. They’ll know what you’re up against; they’ll understand where you’re coming from. Think of it as therapeutic socializing — while you’re not actually escaping from your role as caregiver.

From the Saskatchewan Health Wellness and Health Promotion Promotions Branch
3475 Albert Street
Regina, Saskatchewan, S48 6X6

Being Social - One Key to a Longer Life

2008-12-02T19:33:00.000-08:00

A 2008 study by the Harvard School of Public Health found evidence that seniors in the United States with active social lives may have slower rates of memory decline and lower mortality rates. In fact, memory decline among the most integrated of the study subjects was less than half the rate among the least integrated (findings were independent of age, gender, race and health status).

Click here to read the entire article.

Of course, it's always prudent to make sure that elder care documents are in order. Please consult a Florida elder law attorney to make sure your loved ones are taken care of.

-- Ellen Morris, JD

Holiday Blues - Depression in the Elderly

2008-11-10T19:36:00.000-08:00

The holiday season is quickly coming upon us. If you are a caregiver for an elderly loved one, you may notice a change in your loved one's mood as the holidays approach. Perhaps you are one of many, who visit elderly parents and family during the holidays who live a distance away. When you visit you may notice that loved ones are not as physically active, or they show symptoms of fatigue or sadness and have no interest in the holiday or in their surroundings.

According to the National Institutes of Health; of the 35 million Americans age 65 or older, about 2 million suffer from full-blown depression. Another 5 million suffer from less severe forms of the illness. This represents about 20% of the senior population -- a significant proportion.

Depression in the elderly is difficult to diagnose and is frequently untreated. The symptoms may be confused with a medical illness, dementia, or malnutrition due to a poor diet. Many older people will not accept the idea that they have depression and refuse to seek treatment.

What causes depression in the elderly?
It is not the actual holiday that causes depression, but the fact that holidays tend to bring memories of earlier, perhaps happier times. Additional contributing factors that bring on depression may be the loss of a spouse or close friend, or a move from a home to assisted living, or a change with an older person's routine.

Depression may also be a sign of a medical problem. Chronic pain or complications of an illness or memory loss can also cause depression. In addition, diet can also be a factor when proper nutrition and vitamins are lacking.

As an example, Selma’s husband passed away, a few months before Christmas. Her family lived close by and would call or drop in often to check on her. Selma seemed a little preoccupied and tired, but this was to be expected as she had been the caregiver for her husband for many years. It wasn’t until the family noticed that her holiday decorations were not out and her yearly routine of Christmas card writing was not happening that they began questioning her mental and physical well being.

A trip to her physician confirmed depression, caused by not only the loss of her spouse, but a vitamin B12 deficiency. There were both mental and physical reasons for her depression.

Symptoms to look for in depression might include:

* Depressed or irritable mood
* Feelings of worthlessness or sadness
* Expressions of helplessness
* Anxiety
* Loss of interest in daily activities
* Loss of appetite
* Weight loss
* Lack of attending to personal care and hygiene
* Fatigue
* Difficulty concentrating
* Irresponsible behavior
* Obsessive thoughts about death
* Talk about suicide

How do you know if it is depression or dementia?
Depression and dementia share similar symptoms. A recent article on Helpguide.org gives some specific differences:

In depression there is a rapid mental decline, but memory of time, date and awareness of the environment remains. Motor skills are slow, but normal in depression. Concern with concentrating and worry about impaired memory may occur.

On the other hand, dementia symptoms reveal a slow mental decline with confusion and loss of recognizing familiar locations. Writing, speaking and motor skills are impaired and memory loss is not acknowledged as a being problem by the person suffering dementia.

Whether it is depression or dementia, prompt treatment is recommended. A physical exam will help determine if there is a medical cause for depression. A geriatric medical practitioner is skilled in diagnosing depression and illnesses in the elderly. If you are a care taker of an elderly person it may be beneficial for you to seek out a geriatric health care specialist. For more information on senior health services go to http://www.longtermcarelink.net/about_senior_health_services.htm

Treating depression in older people.
Once the cause of depression is identified, a treatment program can be implemented. Treatment may be as simple as relieving loneliness through visitations, outings and involvement in family activities. In more severe cases antidepressant drugs have been known to improve the quality of life in depressed elderly people. Cognitive therapy sessions with a counselor may also be effective.

As a care giver or family member of a depressed older person, make it your responsibility to get involved. The elder person generally denies any problems or may fear being mentally ill. You can make the difference in and remove the Holiday Blues from seniors suffering from depression.

The Geriatric Mental Health Foundation offers a “Depression Tool Kit.” To read more about the tool kit and depression in the elderly go to http://www.gmhfonline.org/gmhf/consumer/depression_toolkit.html

-- Ellen Morris, JD

Medicare Enrollment Starts November 15, 2008

2008-10-25T19:00:00.000-07:00

If you work with individuals over the age of 65 (as all Florida elder law attorneys do), you may be getting phone calls requesting help with Medicare questions. It’s that time, once again, to make changes to Medicare options. According to CMS, which is the government entity that oversees Medicare, the six weeks from November 15, 2008 through December 31, 2008 is a hectic time of the year otherwise known as the Annual Election Period (AEP.) Once a year, Medicare allows enrollees to opt in or out of Medicare Part D and Medicare Part C -- otherwise know as Medicare Advantage Plans. Before we get into what that means, some background is in order.

Medicare consists of four parts -- Part A, Part B, Part C and part D. The majority of Medicare enrollees have Part A and Part B. In addition they may have an employer-sponsored supplement or a Medigap policy to go along with Part A and Part B. The fourth part of Medicare is Part D or prescription drug coverage. Most people think that the "D" in Part D is because of the word "drugs." Actually it’s because there is a Part C. Part C is the Medicare Advantage program. It was started in 2003 as part of the Medicare Modernization Act -- the same Act that created the Medicare Part D prescription drug coverage. Medicare Advantage Plans have been around for some time. Before 2003 they were known as Medicare + Choice Plans. With Medicare Advantage, Medicare pays a private insurance company to take over and administer someone’s Medicare benefits. That person is still a part of the Medicare system. He or she doesn't leave the system. A person is simply now receiving his or her benefits from a Private company not the Government.

Back to the massive stack of mail from Medicare that is coming and will be coming over the next few months. Hopefully your people are sitting down. This gets confusing. From November 15, 2008 through December 31, 2008, those eligible for Medicare have the option to change existing Medicare Advantage Plans and/or Medicare Part D. This period is called the Annual Election Period or AEP.

There is also another period of time from January 1, 2009 through March 31, 2009 that is called the Open Enrollment Period or OEP. During OEP, a person can enroll in Advantage but cannot change Part D status, meaning if there is just a Part D, a change or cancellation to the drug Plan cannot occur at this time. If there is a Medicare Advantage Plan which includes Prescription Drug Coverage (MAPD), a change can be made by purchasing another MAPD. Or, if there is just prescription coverage, an MAPD can be purchased. Going the other direction from an MAPD to prescription coverage only, is not allowed.

On April 1, 2009 and thereafter, Medicare institutes a lock-in period. During this time, no changes to drug coverage or an MAPD are allowed. As with most government programs there are a few exceptions to the rule. If a person has moved out of the area the plan operates in, or if a person becomes a resident in any long term care facility, or if a person involuntarily loses coverage, that person can enroll for new coverage under a Special Election Period or SEP. Finally, most people who are eligible for or who are on Medicaid can change coverage whenever they choose.

So why the big deal? Why does someone need to be aware each year of what is going on? The reason is the insurance companies that sponsor the Medicare Advantage and the Part D Plans have the option to change what they offer each year. Changes may come as a result of directives from Medicare, from previous years' claims experience, or from a multitude of other issues. Asking 10 people if there are pending changes to the plans they are in will result in 9 of them replying they have received notice of adjustments or premium changes. However, not all changes are for the worse. There are some instances where the plans have gotten better. Nevertheless, from year to year most plans will have changes. Sometimes a plan may pull out of an area thus forcing an individual to make an unwanted change.

Medicare allows the Advantage companies to start marketing their plans to the public on October 1 and the companies can release information on intended changes to existing plans. For any pending changes, a beneficiary should receive an Annual Notice of Change (ANOC.) Most people will receive this document in November. People need to take the time to review changes. They need to be aware of the plan they are in and the benefits it provides when they might need to use the coverage.

Medicare Advantage Plans can be a great fit for many Medicare enrollees. As with anything, one size does not fit all. During the six-week period when changes can be made, people owe it to themselves to evaluate their options. In the past, many Advantage Plan companies made a big push during this change period to move people out of existing plans and into new ones. Medicare has changed the rules on how companies can induce people to change. In the past, seniors were invited to attend presentations where they received free meals as an inducement to attend. Starting in 2009, only snacks can be provided. Preliminary indications are that pie and coffee are on the menu. Personally we like Pecan pie and free pie is good pie.

On the National Care Planning Council website, at www.longtermcarelink.net, is a link to all medicare approved advantage plans in every state. All the plans listed in an area can be found there. Finally, those people who need help or who are facing changes should contact a trusted insurance agent. Medicare Advantage plans are only available from someone who is licensed to sell health insurance.

The State of Florida and Poor Senior Care

2008-10-16T20:11:00.001-07:00

We've all known for a long time that the State of Florida has failed its obligations to provide seniors and people with disabilities access to long term care in the least restrictive setting and, if possible, in the community rather than in a nursing home. We're pleased to see that there are some who are doing something about it.

Take a look at this Associated Press article from September 20, 2008, Florida Medicaid Recipients Want Out of Nursing Homes by Matt Sedensky for details.

Dealing with the Sudden Crisis of Eldercare

2008-10-10T12:43:00.001-07:00

Eldercare providers and advisers who deal with the public know from experience that the need for long term care can often arise without warning. In many cases, desperate caregivers are frantically trying to find services, advice or care funding sources to help their loved ones with unexpected long term care needs. This sudden need for help often occurs when the loved one needing care has recently demonstrated unsafe behavior, or there has been an injury or sudden illness or there is a pending release from nursing home rehab or the current caregiver can no longer cope. Help must be found right now.

Unfortunately, many of these caregivers -- who are typically operating in crisis mode -- don't know where to turn for help. It's not that there aren't advisory services out there to help them, it's just that the caregivers often don't know where to find these services.

Government caregiver resource services such as area agencies on aging and related ADRC pilot programs typically reach out to caregivers through referrals from hospitals, discharge workers, doctors, home health agencies and nursing homes. Caregivers seeking help outside of this referral network generally aren't aware of government advisory services. In the private sector, help with caregiving issues is generally provided when a caregiver calls a specific agency, nonprofit organization or an advisor. There is no nationwide, private sector one-stop shopping source of help for all the types of care provider services that are available in the community.

The national care planning Council has discovered an answer to help desperate caregivers find the one-stop shop support they need. A 2004 study by the National Alliance for Caregiving and AARP estimates nearly six in ten (59%) caregivers are currently employed. Many of these working caregivers will use their Internet access at work to find the caregiving support they need.

The National Care Planning Council is in the process of developing websites in every state that contain the Internet resources employed caregivers are looking for. Currently, results from websites operating in 10 states indicate that harried caregivers will indeed search out these state care planning council websites for help. For example, one state website sponsored by the National Care Planning Council -- the Utah Eldercare Planning Council website, www.careUtah.com-- last year produced over 1,000 inquiries for help primarily from younger family caregivers. Additional requests for help were also received by Utah Eldercare Planning Council members through traditional outreach networking channels such as eldercare advisers, eldercare service providers, government agency referrals, associations, brochures and community presentations.

The National Care Planning Council is currently seeking qualified individuals to be Directors and oversee geographic service areas of state care planning councils. The Director's job is to coordinate local requests for help from the community and provide needed eldercare services. If you are a professional care provider or eldercare advisor please contact us about this opportunity to help the community and at the same time expand your services by becoming a Director of a Service Area. Or you may simply want to become a member of your local state care planning council.

-- Ellen S. Morris, JD

Speakers for First Annual Elder Law Forum

2008-10-05T19:03:00.000-07:00

Elder Law Associates is proud to announce our panel of speakers for our 1st Annual Florida Elder Law Forum, "A Forum for Diverse Professionals with a Common Interest: Facing the Challenges of Home, Hospital and Facility-Based Care":

Darrick D. McGhee, Director of Legislative Affairs for the Department of Elder Affairs
Jaclynn I. Faffer, PhD, Executive Director of Ruth Rales Jewish Family Service (RRJFS) of South Palm Beach County
Elayne Forgie, PhD, CMC, president and founder of the ElderCare Resource Center, ElderCare at Home, and The ElderCare Foundation, a not-for-profit corporation that provides 24 hours of emergency respite care in the patient’s home.
Veronica Logan, Administrator of Springtree Rehabilitation and Health Care Center in Sunrise, Florida
Marc Dubin, Esq., Director of Advocacy for the Center for Independent Living of South Florida (Miami-Dade) and consultant on the federal civil rights of people with disabilities
Laura Goodhue, Executive Director of Florida CHAIN, a statewide health care advocacy organization that leads the state in championing for access to affordable and quality health care for all Floridians
Yolanda Rodriguez, Project Director of the Northwest Focal Point Senior Center and Adult Day Care in Margate, Florida
Julie Gelbwaks Gewirtz, VP of Marketing for Gelbwaks Insurance Services, Inc.

We hope to see professionals of all kinds on November 12, 2008 from 1:00 pm to 4:30 pm at the Classic Residence by Hyatt in Boca Raton.

Play Golf and Fight Alzheimer's

2008-10-03T04:12:00.000-07:00

As a member of the Alzheimer's Association Golf Classic Planning Committee, I hereby invite you all to the Golf Classic tournament, which takes place October 24. (Click here to download the entry form.)

I can promise it will be a great time, and that you will be properly hydrated: Elder Law Associates is sponsoring the three beverage carts at the event. Come, you'll have a great time and support a very worthy cause.

-- Howard Krooks, JD, CELA

Ten Tips for Helping Families with Special Needs

2008-09-25T17:58:00.001-07:00

A long blog post today, but I hope you'll indulge me, as this is an important topic that is dealt with in a straightforward manner. It's not an article I wrote, but definitely one worth reading: Ten Tips for Helping Families with Special Needs by Louis W.Pierro, Esq., who is an attorney in New York. Nonetheless, this should be mandatory reading by all Florida elder law attorneys.

COSTLY MISTAKE #1: Disinheriting the child.

Many disabled people rely on SSI, Medicaid or other government benefits to provide food and shelter.Your clients may have been advised to disinherit their disabled child -the child who needs their help most - to protect that child's public benefits. But these benefits rarely provide more than basic needs. And this "solution" does not allow your clients to help their child(ren) after the client becomes incapacitated or is gone. When a child requires, or is likely to require, governmental assistance to meet his or her basic needs,parents, grandparents and others who love the child should consider establishing a Special Needs Trust.

Planning Tip:It is unnecessary and infact poor planning to disinherit a special needs child. Clients with special needs beneficiaries should consider a Special Needs Trust to protect public benefits and care for the child during the client's incapacity or after the client's death.

COSTLY MISTAKE #2: Procrastination.

Because none of us knows when we may die or become incapacitated, it is important that your clients plan for a beneficiary with special needs early, just as they should for other dependents such as minor children. However, unlike most other beneficiaries, a child with special needs may never be able to compensate for a failure to plan. A minor beneficiary without special needs can obtain more resources as he or she reaches adulthood and can work to meet essential needs, but a child with special needs may never have that ability.

Planning Tip: Parents, grandparents, or any other loved ones of a special needs child face unique planning challenges when it comes to that child. This is one area where the client simply cannot afford to wait to plan.

COSTLY MISTAKE #3: Failure to coordinate aplanning team effort.

It is critical that the advisor assisting with special needs planning include in the planning team: an attorney who is experienced in this planning area; a life insurance agent who can ensure that there will be enough money to maintain the benefits for the special needs child; a CPA who can advise on the Special Needs Trust's tax return; an investment advisor who can ensure that the trust fund's resources will last for the child's lifetime; and any other key advisors that may support the goals of the trust going forward.

Planning Tip:Special needs planning dictates that the client's advisors work together to ensure that there are sufficient trust assets to care for the child throughout his or her lifetime.

COSTLY MISTAKE #4: Ignoring the special needswhen planning for the child's benefit.

Planning that is not designed with the child's special needs in mind will probably render the child ineligible for essential government benefits. A properly designed Special Needs Trust promotes the special needs person's comfort and happiness without sacrificing eligibility.

Special needs can include medical and dental expenses, annual independent check-ups,necessary or desirable equipment (for example, a specially equipped van),training and education, insurance, transportation, and essential dietary needs. If the trust is sufficiently funded, the disabled person can also receive spending money, electronic equipment & appliances, computers, vacations, movies, payments for a companion, and other self-esteem and quality-of-life enhancing expenses: the sorts of things your clients now provide to their child or other special needs beneficiary.

Planning Tip: When planning for a child with special needs, it is critical that the client utilize a Special Needs Trust as the vehicle to pass assets to that child. Otherwise, those assets may disqualify the child from public benefits and may be available to repay the state for the assistance provided.

COSTLY MISTAKE #5: Creating a "generic" special needs trust that doesn't fit.

Even some "special needs trusts" are unnecessarily inflexible and generic. Although an attorney with some knowledge of the area can protect almost any trust from invalidating the child's public benefits, many trusts are not customized to the particular child's needs. Thus the child fails to receive the benefits that the parent provided when they were alive.

Another frequent mistake occurs when the Special Needs Trust includes a "pay-back"provision rather than allowing the remainder of the trust to go to others upon the death of the special needs child. While these "pay-back" provisions are necessary in certain types of special needs trusts, an attorney who knows the difference can save your clients hundreds of thousands of dollars, or more.

Planning Tip: A Special Needs Trust should be customized to meet the unique circumstances of the child and should be drafted by a lawyer familiar with this area of the law.

COSTLY MISTAKE #6: Failure to properly "fund" and maintain the plan.

When planning for children with special needs, it is absolutely critical that there are sufficient assets available for the special needs beneficiary throughout his or her lifetime. In many instances, this requires utilization of a funding vehicle that can ensure liquidity when necessary. Oftentimes permanent life insurance is the perfect vehicle for this purpose,particularly if the clients are young and healthy such that insurance rates are low.

Also, because this is an ever-changing area, it is also imperative that the clients revisit their plan frequently to ensure that it continues to meet the needs of the special needs beneficiary.

Planning Tip:Clients should consider permanent life insurance as the funding vehicle for special needs beneficiaries, particularly when the beneficiary is young given the often staggering costs anticipated over that beneficiary's lifetime.

If the client may be subject to estate tax, consider having an Irrevocable Life Insurance Trust own and be the beneficiary of the policy, naming the Special Needs Trust as a beneficiary. Alternatively, in a non-taxable situation, consider naming the client's revocable trust as the beneficiary to help equalize inheritances if that is the client's objective.

COSTLY MISTAKE #7: Choosing the wrong trustee.

During your client's life, he or she can manage the trust. When the client is no longer able to serve as trustee, they can choose who will serve according to the instructions that they have provided. They may choose a team of advisors and/or a professional trustee. Whomever they choose, it is crucial that the trustee is financially savvy, well-organized, and, of course, ethical.

Planning Tip:The trustee of a Special Needs Trust should understand the client's objectives and be qualified to invest the assets in a manner most likely to meet those objectives.

COSTLY MISTAKE #8: Failing to invite contributions from others to the trust.

A key benefit of creating a Special Needs Trust now is that the beneficiary's extended family and friends can make gifts to the trust or remember the trust as they plan their own estates. For example, these family members and friends can name the Special Needs Trust as the beneficiary of their own assets in their revocable trust or will, and they can also name the Special Needs Trust as a beneficiary of life insurance or retirement benefits.

Planning Tip:Creating a Special Needs Trust now allows others, such as grandparents and other family members, to name the trust as the beneficiary of their own estate planning.

COSTLY MISTAKE #9: Relying on siblings to usetheir money for the child with special needs' benefit.

Your client may be relying on their other children to provide for their child with special needs from their own inheritances. This can be a temporary solution for a brief time, such as during a brief incapacity if their other children are financially secure and have money to spare. However, it is not a solution that will protect the child with special needs after your client has died or when siblings have their own expenses and financial priorities.

What if the inheriting sibling divorces or loses a lawsuit? His or her spouse (or a judgment creditor) may be entitled to half of it and will likely not care for the child with special needs. What if the sibling dies or becomes incapacitated while the child with special needs is still living? Will his or her heirs care for the child with special needs as thoughtfully and completely as the sibling did?

Siblings of a child with special needs often feel a great responsibility for that child and have felt so all of their lives. When your clients provide clear instructions and a helpful structure, they lessen the burden on all their children and support a loving and involved relationship among them.

Planning Tip: Relying on siblings to care for a special needs beneficiary is a short-term solution at best. A Special Needs Trust ensures that the assets are available for the special needs beneficiary (and not the former spouse or judgment creditor of the sibling) in a manner intended by the client.

COSTLY MISTAKE #10: Failing to protect the child with special needs from predators.

An inheritance from parents who fund their child's special needs trust by will rather than by revocable living trust is in the public record. Predators are particularly attracted to vulnerable beneficiaries, such as the young and those with limited self-protective capacities. When you plan with trusts rather than a will, your client decides who has access to the information about their children's inheritance. This protects their special needs child and other family members, who may be serving as trustees, from predators.

Planning Tip: A Special Needs Trust created outside of a will ensures that information about the inheritance is not in the public record, protecting the special needs beneficiary from predators.

Conclusion
Planning for special needs beneficiaries requires particular care and the participation of all of the client's wealth planning advisors. A properly drafted and funded Special Needs Trust can ensure that the beneficiary has sufficient assets to care for him or her, in a manner intended by the client,throughout the beneficiary's lifetime.

Elder Law Article in New York Times

2008-09-22T14:18:00.001-07:00

I came across a great article in the New York Times Wealth and Personal Finance section recently entitled, "Learning to Share - Surprises in the will can leave your heirs squabbling over inheritance. The solution is to be open about who is getting what."

While its advice may be hard to follow, the article's message is both poignant and important. I invite you to read the article below and share your thoughts.

Howard Krooks, JD, CELA

Elder Law Associates in the News

2008-09-17T18:11:00.000-07:00

It never gets old, having your company mentioned in the news. Elder Law Associates is featured in a recent article by Elder Law Answers on satellite offices in the Elder Law field. With Florida Elder Attorneys in such high demand (especially quality ones), a satellite office is a natural extension for a qualified Florida elder law attorney.

Click here to read the entire article.

-- Howard Krooks, JD, CELA

First Annual Florida Elder Law Forum

2008-09-15T17:07:00.000-07:00

Elder Law Associates is very excited about how our first ever Florida Elder Law Forum is shaping up. "A Forum for Diverse Professionals with a Common Interest: Facing the Challenges of Home, Hospital and Facility-Based Care" will be held Wednesday, November 12, 2008 from 1:00 pm to 4:30 pm at the Classic Residence by Hyatt in Boca Raton.

The Forum will feature a unique array of presenters from health care, insurance, government, law (including Florida elder law attorneys)and consumer advocates, who will address critical questions facing seniors and people with disabilities living in Florida. We will focus on home and community-based care initiatives to provide a vision of the future that includes rapid changes in health care and responses to budget cuts. Stay tuned for details.

For more information, please call me, Leslie Lautin Davis, at 561.750.3850.

WHAT IS AN ELDER LAW ATTORNEY AND WHY DO YOU NEED ONE?

2008-09-11T19:35:00.001-07:00

Specialization in all professional fields has raised the standard of practice and allows the client the confidence to know that the professional handles only cases in the specialization and thus is very well versed. An elder law attorney has specialized knowledge in areas of the law that directly relates to the aging or elderly client and persons with disabilities. So what do they do and do you need an elder law attorney?

An elder law attorney (especially a Florida elder law attorney) properly plans for the possibility of disability, incapacity, home health care and/or nursing home placement and advises clients on how to receive public benefits, including Medicaid. In so doing, an elder law attorney prepares sophisticated Durable Powers of Attorney to provide authority for the client’s named designee to act for him or her regarding financial and legal matters and prepares complex Designation of Healthcare Surrogate forms in which the client chooses a loved one to make vital healthcare decisions for them when they are unable to act for themselves, as well as detailed Living Wills which specify the client’s wishes with regard to all life sustaining devices.

An elder law attorney practices in the Guardianship Court and is able to secure someone to properly handle an incapacitated person’s personal and financial affairs and some elder law attorneys are able to litigate guardianship issues including who should be chosen as a guardian, removing a guardian who mishandles the person’s affairs, and objecting to guardianship entirely.

An elder law attorney may be proficient in litigation for or against a beneficiary or a fiduciary under a will or trust or other asset which has a named beneficiary like an IRA.

An elder law attorney advises clients on long term care insurance, long term living arrangements and facility placement and can provide Geriatric Care Managers for daily, hands-on care.

Elder law attorneys are up to date with the new and evolving laws geared more and more to our aging and disabled population.

You need an elder law attorney…

…if you or your loved one is over 55 for estate planning documents,
…if you or your loved one is disabled, incapacitated or diagnosed with a disability for Medicaid planning and special needs trust planning,
…if you or your loved one is a beneficiary or a fiduciary and something doesn’t seem right,
…or, if you want to know your options for public benefits.

Please call our office at 561.750.3850 for an appointment that will ensure your legal protection.

-- Ellen S. Morris, JD

Misconceptions about Who Pays for Long Term Care

2008-09-08T17:37:00.000-07:00

A large majority of the American public still believes that the government will provide long term care when needed. It is this misconception that most likely prevents people from doing any planning at a younger age for the future need for care. According to the National Care Planning Council, many people believe they can give away assets prior to the need for long term care and qualify for Medicaid. The Council suggests that this belief prevents people from considering other ways to fund the cost of future care.

As a matter of fact, it may be possible to use the system and allow Medicaid to cover care but at what cost? Why would anyone want to plan to spend his remaining years in a nursing home--which is the preferred living arrangement for Medicaid. Why go through the expense and effort of trying to manipulate the system to get welfare care, when a little preplanning at an earlier age would be a better option?

In our Florida elder law attorney practice we hear frequent objection to long term care planning from people who think Medicare or the Veterans Benefits Administration will take care of them. While this is true to a certain extent, these people simply don't understand the limitations of these government programs.

Below are quotes taken from individuals who, over the years, have voiced misconceptions about long term care planning.

"Uncle Jim got along just fine with the government paying his care"

"I can give away my assets and have the government pay for it"

"We have a trust and all of our assets will go to our family so the government will pay for our care"

"I'm not interested in home care or assisted living, just stick me in a nursing home and Medicaid will pay the bill"

"Long term care insurance is too expensive"

Government could be more involved in providing care but our constipated system of delivery prevents this from happening. The National Aging Network, a government-sponsored program, is in the best position to help people receive long term care in their homes. And studies have shown that the cost of providing this kind of care is significantly less than the cost of providing nursing home care through government programs.

Unfortunately, for every dollar that supports a person through the Aging Network the government spends about $270 supporting a person in a nursing home. Because it has inadequate funding, the National Aging Network must confine its valuable services to people who have little income or for social reasons are disadvantaged. Moderate and middle income Americans can receive some services from the network but are mostly excluded from the more valuable caregiving services.

We believe the public's misunderstanding of Government long term care programs is an impediment to proper long term care planning. When people understand the limitations of relying on government programs they are most likely to be more motivated to plan for the future by making provisions in advance and providing advance funding to pay for care. Prior planning also allows people to have a choice in their care setting and in the type of services they receive.

--Ellen Morris, JD & Howard Krooks, JD CELA

The Bias of Medical Care Providers Toward Aging

2008-08-21T17:11:00.001-07:00

I just read this great article on the bias of medical care providers toward the elderly and aging:

"In many cultures in the world, elderly people are revered and their advice is sought and respected. In our culture, the wisdom, the knowledge and the social skills of the elderly are often overlooked and instead we focus on the mental and physical deficits of our older generation....

"Because of this prevailing attitude, older people in our society are generally regarded as less valuable than younger people....It is inevitable that many medical care providers will unconsciously have this same attitude towards their older patients.

"As a result, if an older person has a medical complaint and the cause is not readily apparent, a medical practitioner is more likely to accept the condition as a consequence of old age. This attitude causes practitioners to focus treatment on making the elderly more comfortable in their old age as opposed to finding a cure. In younger people, if the medical complaint is interfering with normal daily function, typically a more concerted effort will be made to identify and correct the problem."

Click here to read the entire article.

-- Ellen S. Morris, JD

Morris Authors Article on Elder Law and the Legislature

2008-08-18T19:17:00.001-07:00

I recently published an article on the latest goings on in the area of elder law in the Florida legislature for The Elder Law Advocate, entitled "What happened in the Florida Legislature of interest to us?"

It specifically provides you with a summary of bills of interest to elder law attorneys that are expected to be or have been signed by the governor, including:

SB 366/HB 233 - Elderly Persons & Disabled Adults/Abuse & Neglect
SM 2662/HM 1045 – Alzheimer’s Disease Research/Federal Funding
SB 1092/HB 7047 – Alzheimer’s Disease/Medicaid Waiver Program
CS/HB 739/SB 688 – Guardian Advocates for Persons With Developmental Disabilities
CS/CS/SB 2012/HB 1431 – Insurance Policies

Click here to read "What happened in the Florida Legislature of interest to us?"

-- Ellen S. Morris, JD

Feedback on an Elder Law Seminar

2008-08-04T14:33:00.001-07:00

Recently, we received this feedback in an email:

"I had enjoyed and learned much from a seminar of yours that I attended. But I never thought it would lead to your sending me unbelievable amounts of critical, interesting, necessary, enlightening, helpful, meaningful (and I could go on and on) information, articles and notices. The subjects vary from planning your own funeral to getting a Social Security debit card to the best way to choose a nursing home to every conceivable subject one needs in their "senior" living and dying. Thank you and, hopefully, keep them coming."
-Paul Molle, South Florida Financial Services

If you're interested in finding out Elder Law Associates will be speaking next, just give us a ring at 561.750.3850 or email us at info@elderlawassociates.com.

-- Leslie Lautin Davis, Director of Marketing

Krooks Authors Article on DRA in Wealth Counsel

2008-08-01T06:42:00.000-07:00

Wealth Counsel, a quarterly magazine for the estate planning community, recently published an article I wrote on the Deficit Reduction Act, entitled "How the DRA Has Affected the Use of Personal Care Contracts."

It specifically details how Medicaid agencies have responded to the upswing in the use of personal care contracts, and what you need to know when preparing a personal care contract for a loved one. (Always consult a Florida elder law attorney when preparing a personal care contract.)

Click here to read "How the DRA Has Affected the Use of Personal Care Contracts."

-- Howard S. Krooks, JD, CELA

Morris Honored, Krooks Presents at Florida Bar Elder Law Section 2008 Annual Retreat

2008-07-28T18:30:00.000-07:00

At the recent Florida Bar Elder Law Section 2008 Annual Retreat at The Sandpearl in Clearwater Beach, Florid (July 17 - 20, 2008) Elder Law Associates' partners Ellen Morris and Howard Krooks were both prominently highlighted.

Morris was awarded the Most Outstanding Member Award 2008 of Elder Law Section of The Florida Bar. Howard Krooks accepted the award on her behalf.

Krooks was a group leader for the Deficit Reduction Act (DRA) Discussion, on the DRA and the continual evolving process. Krooks reviewed client issues and problems with the DRA.

Howard Krooks Named "Super Lawyer"

2008-07-24T14:49:00.001-07:00

Partner Howard S. Krooks, Esq. has been included in Super Lawyers South Florida 2008 edition.

"I am proud to have been recognized by my peers for my dedication to my clients and my work in the State of Florida," Mr. Krooks said.

The selections for Super Lawyers are made by Law & Politics, a division of Key Professional Media, Inc. of Minneapolis, Minn. Each year, Law & Politics undertakes a rigorous multi-phase selection process that includes a statewide survey of lawyers, independent evaluation of candidates by Law & Politics’ attorney-led research staff, a peer review of candidates by practice area, and a good-standing and disciplinary check. Only 5 percent of the total lawyers in the state are selected for inclusion in Super Lawyers.

Acute Hospitalization and the Alzheimer's Patient

2008-07-21T17:38:00.000-07:00

A change in the daily routine including an unfamiliar environment filled with new sights, odors and sounds, medications and tests, and the disease process itself can all be factors that increase confusion, anxiety and agitation in a hospitalized individual with Alzheimer's disease.

Alzheimer's Disease Education and Referral Center has published a booklet that will help you meet the needs of these individuals. Containing facts about Alzheimer's disease, communication tips, personal care techniques, suggestions for working with behaviors and environmental factors to consider in the ER and in the hospital room, this guide is a must have for any caregiver of a person with a memory disorder.

When hospitalization occurs, the best option for the individual with Alzheimer's disease is the constant presence of a family member or a trusted friend. Because this may not always be possible, this booklet hopes to prepare you for the unexpected and the expected.

To learn more about Acute Hospitalization and the Alzheimer's Patient, click here!

--Ellen S. Morris, Esq.

Attained age before the close of the taxable year	Maximum deduction
40 or less	$320
More than 40 but not more than 50	$600
More than 50 but not more than 60	$1,190
More than 60 but not more than 70	$3,180
More than 70	$3,980