An Understanding of Senior Care Technology and Elder Law

April 17, 2023Filed Under: Elder Law, Estate Planning, Long Term Care

As a result of technological advancements in self-monitoring medical devices, telehealth, and smart homes, many aging Americans are able to remain in their homes for longer and live more safely. Elder law and at-home medical technology uses can intersect in several ways. Whether you are a senior looking to stay in your current home or have an aging parent and want to implement systems that create better safety and communication, an elder law attorney can help you craft a plan.

Strategies

Legal Documents

Elder law attorneys can assist older adults when creating legal documents, such as durable powers of attorney and health care proxies, in an online environment. These and other legal documents are crucial to have in place as they authorize someone to make decisions about the older adult’s medical treatment and the use of at-home medical technology.

Meetings with your estate planning or elder law lawyer and family members can happen virtually, and some states now legally recognize e-signatures. Creating these documents without leaving your home benefits seniors with mobility and transportation issues and protects against exposure to infectious diseases.

Privacy and Security

Elder law attorneys can advise older adults on the privacy and security of their personal information and medical data when using at-home medical technology. Secure network communication protocols will keep hackers from stealing your information and ensure the data integrity of communications with medical professionals and entities.

Medicaid Eligibility

Medicaid, the government health insurance program for low-income individuals, may pay for certain at-home medical technology if it’s deemed medically necessary. An elder law attorney can help older adults navigate the Medicaid eligibility process to ensure they receive all the benefits to which they are entitled.

Telehealth services allow Medicaid to reach more seniors at a lower cost than ever. Whether you’re having issues with eligibility, understanding home health services, or selecting home health providers, an elder law attorney can help you understand your Medicaid options.

Long-term care planning

Elder law attorneys can help older adults plan for future needs of long-term care, including using at-home medical technology to help them age in place and maintain their independence for as long as possible. Incorporating at-home medical technology into long-term care planning may include the following:

Monitoring Health – Technology such as wearable devices, remote monitoring systems, and telehealth services can track vital signs and send alerts to caregivers if there are any concerns.
Medication Management – Personal emergency response systems (PERS) and smart home devices can ensure that older adults are safe and can call for help if needed.
Mobility Aids – Robotic exoskeletons, stairlifts, and smart home devices can help older adults with mobility issues move around their homes and control the environment (locks, lighting, temperature) more easily.
Social Engagement – Virtual reality, video conferencing, and social networks can connect older adults with loved ones and socialize with others combating isolation and feelings of loneliness.
Care Coordination – Medical technology can connect older adults with care providers and healthcare professionals, such as doctors, nurses, and social workers, to monitor the care and support they receive at home.

At-home medical technology is a more affordable option than expensive institutional care. When planning for long-term care, it’s important to consider how technology can help older adults maintain their independence and quality of life.

Guardianship and Conservatorship

In some cases, older adults may be unable to make decisions about their medical treatment or use of at-home medical technology due to cognitive decline or other health issues. Elder law attorneys can assist in appointing a guardian or conservator to make these decisions on behalf of their loved one.

Getting Started

An elder law attorney can help an aging adult, and their family understand what at-home medical technology is available and if government programs will pay for it. Getting seniors to use at-home medical technology can be challenging and generally falls under the direction of the family. There are several strategies to implement to make the process easier:

Keep it simple by starting with the basics. Then gradually introduce more advanced features as your loved one becomes more comfortable with the technology.
Make sure the senior understands the benefits of the technology. Explain how it will help them stay healthy and independent and make their life easier.
Demonstrate how to use the technology. Walk your loved one through the setup and use of each device, making sure they know how to operate it.
Provide your loved one with a user manual or guide for reference.
Schedule regular check-ins with your loved one to see how they’re doing with the technology, answer any questions and ensure their communications with medical professionals are timely and accurate.
Provide your loved one with technical assistance while visiting, and have them contact you if they experience technical issues. Everyone needs reliable IT support.
Look for local support groups and online communities so your loved one can connect with others using similar technology.
If your loved one is having difficulty understanding or not using the technology, consider hiring a professional to help with device setup, training, and guidance.
Encourage your loved one to engage in a trial period with each new technology and see how they feel about it. If they don’t use or are uncomfortable with that particular technology, there might be better solutions.

Many providers make smart home technology for aging adults. The best options depend on the specific needs and preferences of the older adult and compatibility with existing technology and devices. Technology needs will also change with additional health challenges that invariably occur when aging.

Summary

Elder law attorneys can recommend at-home technology so that an aging adult can safely live at home. Family members must participate in the installation of the technologies to ensure their loved one’s security and privacy. Technology alone is not a solution. A support system, including family, friends, lawyers, and healthcare providers, must coordinate efforts in the senior’s best interest.

Whether you need to plan for future at-home health care or already require care management via remote health monitoring, consumer health technology can make senior care more patient-centric, personal, and accessible. Talk with an elder law attorney and see what senior technology strategies can benefit you or your loved one.

We hope you found this article helpful. If you’d like to discuss your particular situation, please don’t hesitate to reach out. Please contact our Cincinnati office by calling us at 513-771-2444 and schedule a consultation. We look forward to the opportunity to work with you.

An Overview of Estate Planning and How Life Insurance Plays a Role

February 6, 2023Filed Under: Estate Planning, Long Term Care

When it comes to distributing your assets in your estate plan, life insurance may not seem relevant at first glance. However, life insurance can be an integral, indispensably important part of a well-thought-out estate plan. There are numerous other benefits to owning a life insurance policy aside from providing a large sum of money to beneficiaries.

Life insurance provides immediate cash upon death that can pay debts, final income taxes of the insured, and funeral expenses.
Life insurance cash can also pay estate taxes and avoid the forced sale of assets.
Mostly, the proceeds from life insurance will pass to the named beneficiary free of income tax.
Life insurance proceeds can transfer to a trust as part of a will the insured created for the benefit of minor children, special needs, or elderly relatives.
The proceeds of a life insurance policy can be payable to someone other than the insured’s estate and avoid passing through probate when owned by an irrevocable insurance trust. For example, the funds can pay marital settlement obligations for spousal or child support.
If the insured owns a closely-held business, a life insurance policy can fund a buyout of their interest.
Proper beneficiary designation forms of a life insurance policy prevent proceeds from going through probate.

Do not underestimate the importance of having cash funds immediately available in an uncomplicated way. Often the passing of a loved one or family member comes with a string of expenses that often exceed cost expectations. Much of what Americans have resides in investments like 401ks, IRAs, housing, and other illiquid assets with very little cash on hand. Life insurance proceeds protect families from having to force the sale of these assets at unfavorable tax rates. Some inheritable assets come with immediate payment requirements. Homes not fully paid off, cars, and the like can leave families with short-term liabilities requiring cash.

Understanding Estate Planning Strategies with a Life Insurance Policy

One of the more popular estate planning strategies that fit many situations is an irrevocable life insurance trust (ILIT). Though a beneficiary or third party cannot rescind the trust, modified, or amended post-creation, it still offers heirs several financial and legal advantages. These advantages include asset protection, favorable tax treatment, and assurance beneficiaries use the proceeds in a manner concurrent with the benefactor’s wishes. Typically, life insurance policies are the chief assets held in an ILIT.

Before purchasing a life insurance policy, particularly if you want to create an ILIT, speak with your estate planning attorney regarding potential income and estate tax consequences. If you have an estate large enough, it can be subject to federal and state estate taxes depending on the applicable laws in place at the time of your passing. Your ILIT should be in place before binding a life insurance policy to it. Remember that states have different laws regarding an ILIT; to avoid problems, your ILIT must follow your state’s rules.

Using a Gifting Strategy for your Life Insurance Plan

It is possible to gift an existing life insurance policy to your ILIT. Unfortunately, if you were to die within three years of making the gift, the policy amount can be included in your estate for tax purposes due to a rule known as a “lookback period.” In effect, this isn’t making the policy proceeds taxable, but it adds the policy proceeds amount to the total value of the estate, in turn making it part of your estate subject to taxes. As federal estate tax exemption amounts frequently change, it is prudent to fund your ILIT by purchasing a new policy. Doing so will avoid the possibility of a lookback period.

When using an ILIT, whether or not you are married, use the second-to-die, survivorship policy, or are single and have an individual policy must be considered. Choosing between variations of permanent life insurance for your ILIT, such as whole standard life, universal life, and variable life insurance, can be confusing, and your estate planning attorney can guide you to your best option.

If you own a business and one adult child will take over the business. Still, other adult children are not interested or involved in the enterprise. The life insurance proceeds can provide the cash to buy out those inheritors’ business interests while leaving the business intact. Blended family systems can also benefit from life insurance payouts to ensure that all children receive an inheritance, not just the children of the last surviving spouse.

Life insurance should be a part of your family estate plan. It can increase the wealth your heirs inherit and provide a ready source of cash for immediate financial obligations after your death. Which form of life insurance best suits your needs will depend on your age and situation. Speak with your estate planning attorney about how a life insurance policy can be an effective way to transfer wealth to your beneficiaries.

Appeal Rights for Medicare Recipients

January 30, 2023Filed Under: Elder Law, Long Term Care

An appeals court recently ruled that some Medicare beneficiaries may now appeal decisions regarding their patient status.

The Underlying Issue

When Medicare patients go to a hospital, they often enter through the emergency department. The physician who attends to them must decide whether to admit them into the hospital as an inpatient, discharge them, or keep them in the hospital under observation status. A patient under observation services receives care virtually identical to inpatient care but is classified as an outpatient to qualify for traditional Medicare coverage.

If the patient receiving observation services must go to a nursing home to continue their recovery, traditional Medicare won’t cover the nursing home care because they were not classified as an inpatient for at least three consecutive days when they were in the hospital. This can have a serious financial effect on the patient since they must pay for the services on their own. What made the situation worse is that the Centers for Medicare & Medicaid Services would not allow patients to appeal the decision.

Observation Status

A patient in observation status is in limbo since a physician has determined that they are too sick to go home but not sick enough to be admitted into the hospital as an inpatient. They receive basically the same level of care as a patient who is classified as an inpatient, including mental and physical assessments, diagnostic tests, short-term treatments, medications, and feedings.

In 2015, then-President Barack Obama signed the Notice of Observation Treatment and Implication for Care Eligibility Act, a.k.a. Notice Act. The Notice Act requires hospitals to notify patients if they have been receiving hospital services under observation status for more than 24 hours. Patients must be given both written and oral notifications if their observation status exceeds 36 hours.

The written notice must explain why the patient is not classified as an inpatient. It must explain how their observation status may affect the cost of their hospital care and their eligibility for skilled nursing facility care coverage. The written notice must be signed by the patient or someone acting on the patient’s behalf. If they refuse to sign the notice, then a staff member of the hospital must sign it.

Alexander v. Azar

A recent federal court decision in the Alexander v. Azar case sided with Medicare beneficiaries who had been admitted to hospitals as inpatients but then changed to observation status. If you were a patient in a hospital and switched from inpatient status to observation status, you may have the right to appeal Medicare’s decision. To appeal your observation status decision, you must have been:

Hospitalized since January 1, 2009
A Medicare beneficiary with traditional Medicare (not Medicare Advantage) during your hospitalization
Admitted to the hospital as an inpatient before your status was changed to observation status
Notified of Medicare Outpatient Observation status from the hospital or have a Medicare Summary Notice stating that you will, or did, receive observation services that are not covered by Medicare part A
Qualified for either both Medicare Part A and Part B or only Medicare Part A
Hospitalized for at least three consecutive days but fewer than three days as an inpatient
Admitted to a skilled nursing facility within 30 days of discharge from the hospital.

Stay up to date as this situation develops by checking in with the Center for Medicare Advocacy.

Help with Medicare and Medicaid

Navigating the complicated Medicare and Medicaid systems can be difficult and time-consuming. It is all too easy to make mistakes that will cause coverage to be denied. An experienced elder law attorney can guide you through the process to get the benefits you need.

This article offers a summary of aspects of estate planning, elder law, and Medicaid and Medicare coverage. It is not legal advice and does not create an attorney-client relationship. For legal advice, you should contact our Cincinnati office by calling us at 513-771-2444 and schedule a consultation.

How to Take Care of Your Elderly Parents

January 16, 2023Filed Under: Elder Law, Long Term Care

There is nothing you can do about aging, and it affects everyone in your family. It can be challenging for adult children to imagine their parents as seniors and to understand and respond to the reality that each parent will age differently. Even if you are in the fortunate circumstance where your aging parents can go it alone for a long time there will come a day when assistance or long-term care will be needed. There are things to consider as you help your parents live their best possible aging scenario. Managing their welfare takes time, research, and planning.

Your parents and their abilities to remain independent are most easily defined by activities of daily living and instrumental activities of daily living (ADLs and IADLs). Activities of daily living address daily functional mobility like getting in and out of bed or a chair, self-feeding, bathing and personal hygiene, the ability to use the toilet, and the ability to get dressed. These are essential daily living requirements that promote dignity and physical as well as emotional well-being for your elderly parents. If your parents are having difficulty managing these ADLs, it is an appropriate time to find help for them whether it is you or another qualified caregiver.

IADLs include all ADL activities and more. The additions are grocery shopping and cooking, medication management, laundry, and other housework, bill paying and finance management, using a telephone, and driving or using public transportation. Recognizing your parent’s limitations in any of these categories is a sign that you need to develop a care plan that provides appropriate assistance. The degree of change or sometimes multiple changes is an indication that staying at home may no longer be appropriate and safe for your parent. If you require assistance in determining suitable care needs, you can set up a comprehensive geriatric assessment by a medical professional. Take an honest look at the stage of life your parent is experiencing and then find the support and help they require.

Your aging parents’ geographical location is critical to consider as a family. Families are fortunate when one adult child lives nearby and can ensure their parent’s well-being. Video chat either online or through a phone application is one way to daily check on a parent. A friend may live close by and can do wellness checks and provide information about behavioral or health changes. If none of these options are viable, it may be time to discuss the idea of your parent(s) downsizing into another more supportive location and living arrangement.

Having this discussion is best before a parent’s adverse health event. Making residential changes without a previous plan in place can negatively impact the parent, especially when experiencing a health care crisis. When aging at home cannot be appropriately managed, it is time to consider the alternatives. These alternatives may include independent living communities, assisted living communities, nursing homes, or living with a trustworthy and capable relative or family member.

All of these assessments and changes in your parents’ lives impact their financial outlook. Making necessary residential changes can often be very costly, and your parent may need additional financial support from government or community programs to offset the difference in expenses. It is critical to take advantage of all possible financial help. As an adult child, you may have to begin managing your finances and retirement funds more actively. There are various federal, state, and non-profit groups that provide free tax assistance for seniors.

Some of the better organizations to help you navigate what is available are online and include Benefits.gov, Area Agency on Aging, and Benefitscheckup.org. These groups can help you assess the best strategies for housing, healthcare, financial assistance, legal aid, transportation, in-home services, prescription drugs, energy and utility support, and nutrition. BenefitsCheckUp is part of the National Council on Aging and is considered the nation’s most comprehensive online service for seniors with limited income and resources. The information available canvases all 50 states and the District of Columbia.

Caring for your aging parents should not be the job of one family member. The commitment should not be a burden, and responsibilities should be shared. Look for caregiver support organizations and forums as well as involving all family members. Everyone should do their part. The goal is to find the best blend of options and resources to allow your parents to age happily and well. Your parents’ health changes require that programs and opportunities change too. Caring for your aging parent is a dynamic process that must be retooled as their needs change.

We help families who are trying to navigate the maze of long-term care either for themselves or for an aging parent. We hope you found this article helpful. If you have questions or would like to discuss your personal situation, please don’t hesitate to contact us at 513-771-2444.