Long Term Care

2022: Long-Term Care Options

April 11, 2022Filed Under: Elder Law, Long Term Care, Medicaid Planning

At the beginning of a new year, we all take stock in our lives and make health care plans. Americans continue responding to the ever-present threat of COVID-19 in its many iterations, and we are identifying that which is most important in our lives to preserve our health and financial future best.

For many, the mere mention of long-term care health insurance congers up images of twilight years seemingly far removed from our daily lives. However, the reality is that you may find yourself in need of long-term care due to a sudden disease or illness or as the result of an accident. The US Department of Health and Human Services statistics currently show that about seventy percent of individuals over the age of 65 will require some long-term care during their lives. Genworth’s latest statistics show that a full thirty-seven percent of these long-term care recipients are, in fact, under sixty-five years of age.

Regardless of your age or cause, when long-term care becomes a requirement, it is important to know and plan for your options regarding funding the care you need, where and how you prefer to receive it. Your planning today can make a huge difference in your financial solvency and those caregivers (mostly family) who participate in the financial burden of your care.

Naturally, the best scenario is having prepared for the future by having healthy balances saved in your retirement programs and health savings accounts. If the funding is available to cover long-term care costs for yourself or a loved one, it is prudent to do so. Perhaps you can only make part of the funding happen, in which case you may have to ask loved ones for help. They may have the financial where with all to finish covering premium costs. Paying some out-of-pocket for an aging parent early on means less of a toll emotionally, physically, and financially, should a family member have to assume becoming a full-time caregiver.

The IRS considers long-term care insurance as a medical expense. As long as the policy is qualified, it is deductible. IRS rules state the policy must have been issued on or before January 1, 1997, and adhere to certain requirements. Policies purchased before this date may qualify to become grandfathered if the state’s insurance commissioner approves the selling of the policy. The IRS rules from 2021 to 2022 are little changed, most notably in age categories from sixty to seventy years old the IRS reduced the deduction by ten dollars.

Note these tax deductions are, for the most part, not available in hybrid policies. These policies combine life insurance and annuity policies with a long-term care benefit. Hybrid policies are becoming particularly popular because if long-term care is not a requirement, the individual’s heirs may receive a death benefit. Your medical expenses need not exceed a certain percentage of your income to be tax-deductible. As long as you earn a profit, you may take the amount of your long-term care insurance as a deductible.

Public programs are becoming more heavily leveraged for lower-income individuals to plan for long-term care services. There is nothing wrong with taking advantage of these programs; however, most Americans do not understand the differences between Medicare and Medicaid, what and who they fund, and for how long. The answers are complex as there are physical and financial thresholds to qualify for benefits, and these may vary from state to state. Here is a general overview of qualifications and limitations in coverage and choices of care facilities.

Sometimes referred to as Medicaid crisis planning, an elder law attorney can guide you through the process of sheltering some of your assets. Medicaid is a federal/state program helping low-income seniors with limited income and assets afford healthcare and long-term care. Many seniors believe their only option to qualify for the program is to “spend down” their assets. While this is true in some cases, proactive Medicaid planning can protect a substantial portion of your assets if done correctly.

The program’s eligibility rules are complicated, as is the application process, so it is best to navigate the process with a specialized Medicaid planning elder law attorney well before you need to tap the benefits. Always seek professional legal advice when creating your long-term care strategy using Medicaid. Applications are rarely successful as a do-it-yourself project, and mistakes can have devastating long-term consequences on a family and their finances.

Options for long-term care exist; however, finding the best solution for your financial circumstances is complex. As 2022 is upon us, it behooves us all to look to the future of our healthcare and prioritize proactive planning, ensuring there will be a plan in place when we encounter the likelihood of a long-term care requirement. 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.

Brain Injury Awareness Month is in March

March 28, 2022Filed Under: Estate Planning, Long Term Care

Brain Injury Awareness Month kicks off in March as it has for thirty years. Brain injury often referred to as traumatic brain injury (TBI), can range from mild (commonly called a concussion) to severe and is caused by an impact to the head or the body or by a penetrating head injury. But there are also non-traumatic brain injuries that begin internally due to disease, poisoning, a hereditary condition, stroke, lack of oxygen, or other internal medical conditions. Millions of Americans are affected by a brain injury every year, including the family members who make adjustments to accommodate the “new normal” brought about by a loved one’s brain injury.

The month-long campaign aims to support and promote the country’s major brain health organizations using campaigns and social media activity that encourages interest in and education about brain injury. The campaign also seeks to de-stigmatize brain injury, empower those who have survived, promote support organizations, and raise funds to assist and support those affected. More than 5.3 million Americans are living with brain injury-related disabilities. According to the Centers for Disease Control and Prevention (CDC), direct medical costs of TBI and indirect, like lost productivity, amount to 76.5 billion dollars annually. Costs of fatal TBI’s and those requiring hospitalization account for 90 percent of TBI medical costs.

The Brain Injury Awareness campaign also seeks to mitigate risks in a measured way, especially for those most vulnerable, the elderly. Falls are the leading cause of TBI, and the older a person is, the higher the risk of and associated adverse outcome effects of TBI. The CDC’s Morbidity and Mortality Weekly Report (MMWR) documents a 17 percent increase nationwide in the rate of fall-related deaths due to TBI from 2008-2017, including increases in most states.

Unsurprisingly the largest increase in fall-related TBI deaths was among older adults 75 or more years old. To combat this trend, the CDC began the initiative, Stopping Elderly Accidents, Deaths & Injuries (STEADI), including tools and resources for health care providers to improve identification of older adults at risk for a fall. The initiative also includes effective strategies that reduce the risk of fall-related injuries, including TBI. Increasing uses of lightweight wearable sensors that continuously monitor and identify changes in gait and other markers in activities of daily living is a promising low-cost technology in the effort to prevent older adult falls, particularly those opting to age in place.

What can you do to help during Brain Injury Awareness Month? You have already accomplished one activity, and that is learning about traumatic brain injury by reading this. You can post your support for brain injury awareness on your social media channels. You can fundraise via a local bake sale, garage sale, or create a webpage that raises funds employing a site like First Giving, or you can donate directly to a credible brain injury support organization. You can invite a speaker to your workplace, place of worship, or service organization for an educational workshop or attend an awareness event. You can volunteer, distribute literature, or help an individual or family in need. Finally, if you are a survivor of a brain injury, tell your story. The Brain Injury Association has a special page to share your story here. Sharing experiences help others know they are not alone and may provide insight, sage advice, and support. A caring community can help problem solve and prevent the growing incidents of brain injury.

If you or a loved one have suffered a brain injury or other type of debilitating injury, we would be happy to talk with you about an estate plan to make sure your needs (or those of a loved one) are met both now and in the future. At a minimum, there are important legal documents that should be created to cover your choices about care, who will provide it, as well as who will make financial decisions for you if you are unable to. 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 with any questions.

What Should I Do If My Loved One Needs Care Resides With Me?

March 21, 2022Filed Under: Long Term Care, Senior Health and Wellness

Aging in place continues to gain popularity, but what to do when a loved one is having difficulty living safely at home is a common problem. Troublesome signs like a dirty home in poor repair, unpaid bills, piles of mail, food out of date or spoiled in the kitchen, poor personal hygiene, and trouble managing medications are all warning signs that your senior is struggling. When visiting, you may notice a loss of weight, disoriented behavior, or lonely and depressive behaviors. When these signs reveal themselves to you, it is time for your older relative to move in with you or into some senior living community where the situation is safer.

Even before the pandemic, polls began showing a shift to the living trend of a century ago, when most seniors lived with their adult children in a multi-generational house. The American Association of Retired Persons (AARP) reports that older parents are moving in with their adult children and comprising a larger component of shared living than a generation ago. AARP states, “Today, 14 percent of adults living in someone else’s household are a parent of the household head, up from 7 percent in 1995.” And with many Americans now working from home, keeping a watchful eye over a parent is easier than ever.

If you consider moving your loved one into your home, there are several things to consider before making a move. For example, you might think the idea is fantastic, but how will it affect other current household members, spouses, or children? Does everyone get along, or will you be importing conflict? Are your lifestyles compatible regarding quiet hours, entertaining guests? Is smoking a habit of someone that needs consideration? Is your home big enough, or will someone have to give up their room?

Is your home suitable for the needs of your loved one? Can they be housed on a single floor without having to use stairs? Can your parent bring their familiar belongings and furniture with them? Perhaps it is feasible to create a “mother-in-law” apartment with a separate entrance or invest in a backyard cottage, the so-called granny pod. If they reside in your active home, what modifications can you make to create a safer environment? Things like night lights, the removal of area rugs, or adding grab bars in the shower or an additional handrail on the stairs can make big safety differences.

Who will be tasked to help your parent? The fact that your parent now lives with you should not mean you are at their service all of the time. Many well-meaning adult children make this mistake. At the outset of living together, a parent is usually fairly self-sufficient. Still, in time they will require more, and if you do not begin your living experiment employing outside help, you will fall into a trap where your time is no longer your own. Share tasks with other family members and make them do their part. Find local senior support services and check out professional in-home care to ensure your loved one becomes accustomed to others providing support to them.

If not in your home, where will your loved one go? Living in a family multi-generational home isn’t for everyone. Your parent might prefer “shared-living” adults living under the same roof but not romantically involved, a sort of roommate experience. Or perhaps a retirement community with defined living stages, from independent to assisted, and full-time care. Many families find living together can save money but not necessarily sanity and look to house their parents out of direct living contact. Talk it out as a family. Even if the conversation is difficult to have, it is better than responding to a catastrophic fall or illness, forcing a change of housing for your parent.

Find out how your aging loved one feels about the next step when they will no longer be able to live alone. Your parent’s thoughts may surprise you. It can help to speak with an elder attorney to address issues that invariably present themselves. If your parent sells their home, how will they handle the profit? Should you want a monthly living expense contribution? Can you claim your parent as a dependent on your tax return? Your parent may no longer have to pay bills but may have other assets and policies to manage; who will handle asset management and premium payments? Goodwill goes a long way to a successful living arrangement but so does preparedness. Having pre-set a structure to address issues will allow you to focus on enjoying your time with your loved one.

If you have questions or would like to discuss your personal situation, please don’t hesitate to reach out. Please contact our Cincinnati office by calling us at 513-771-2444 with any questions.

The FDA Approves Aducanumab as a Treatment for Alzheimer’s

March 14, 2022Filed Under: Estate Planning, Long Term Care

AduhelmTM is the first Alzheimer’s drug approved by the Food and Drug Administration (FDA) since 2003. The drug, Aducanumab, is a therapeutic drug that clinically demonstrates a potential to delay further decline from Alzheimer’s disease and is also the first FDA approval for a drug that does more than address the symptoms. This drug therapy can target the fundamental pathophysiology of Alzheimer’s disease. In clinical studies, Aducanumab demonstrates an ability to remove amyloid plaque from the brain, delaying the disease’s progression.

Understanding Aducanumab for Treat Alzheimer’s Disease Patients

Multi-national pharmaceutical company Biogen (Corporate Headquarters Cambridge, MA International Headquarters in Baar, Switzerland) has been researching and developing approaches to treat Alzheimer’s patients for over a decade, according to CEO Michel Vounatsos. The hope is this drug can help those diagnosed with the disease in its earlier stages and can quell the ever-increasing number of Americans suffering from the disease, a number that now stands at 6.2 million. While not a cure, Aduhelm™ is a significant advancement in the treatment of the disease. Further clinical testing must be done on people with more advanced cases of dementia to qualify its effectiveness.

To date, Alzheimer’s disease is an irreversible, progressive brain disorder. The disease slowly attacks thinking and memory capabilities and is characterized by a build-up of amyloid plaque and neurofibrillary (tau) tangles resulting in the loss of neurons and connections. Aducanumab is the first drug to receive FDA approval that may slow the damage occurring in the brain.

The Effects of Aducanumab for Treat Alzheimer’s Disease

Like all drugs, Aduhelm™ comes with FDA warnings that include a host of side effects, many of which fall under the umbrella of amyloid-related imaging abnormalities (ARIA). ARIA can include vasogenic edema. Vasogenic is an extracellular fluid accumulation due to disruption of the blood-brain barrier and edema being swelling due to this fluid accumulation. Other more readily understood side-effects may include headache, diarrhea, fall, and altered mental status such as delirium/confusion/disorientation.

Because the FDA’s approval of Aduhelm™ used the accelerated approval provisions, Biogen must conduct newly randomized, clinically controlled trials to verify the drug’s benefit further. Should the drug fail in these trials, the FDA reserves the right to withdraw approval of the drug.

Understanding the Cost of Aducanumab

Biogen and its investors expect Aduhelm™ to generate billions of dollars in revenue for the company. Aducanumab’s list price is 56,000 dollars per year. While some analysts expected the price range to be 10,000 to 25,000 dollars, Biogen defends its pricing model, citing billions spent in research to bring the drug to market. Pushback from patients regarding the cost of the drug gets lost in the typical “out-of-pocket cost to patients is health care coverage dependent.” CEO Vounatsos also cites that Alzheimer’s disease and other dementias cost the US more than 600 billion dollars annually and cost patients 500,000 per year. Insisting the time to “invest” in Alzheimer’s drug therapy is now.

In a CNBC interview, Biogen’s Vounatsos defends the drug pricing calling it “fair” as Biogen has experienced “two decades of no innovation” in research for Alzheimer’s drug therapies until now. The CEO further elaborated, promising that the drug price of Aduhelm™ would not increase for the next four years. Biogen works closely with federal CMS programs, Medicare and Medicaid, and private medical insurance companies to keep patient out-of-pocket costs as reasonable as possible.

The FDA’s accelerated approval process and the exorbitant cost of Aduhelm™ seem to be overlooked as Alzheimer’s patient groups are desperate for treatments. Even before the drug’s release, the NYT reports the FDA’s independent advisory committee and several prominent Alzheimer’s experts were not for greenlighting the drug last November. The independent FDA committee overwhelmingly voted against recommending the fast track approval saying, “data failed to demonstrate that aducanumab slowed cognitive decline.”

Aducanumab may provide significant therapeutic advantages over existing treatments, but much is still to be understood. Alzheimer’s is a devastating illness that destroys the lives of the people diagnosed with the disease and the families who love and care for them. The impact is physically, emotionally, and financially draining on many levels. Treating the underlying disease process of Alzheimer’s with Aduhelm™ rather than just the symptoms is a promising step in eradicating the disease.

If you or a family member has dementia and would like to discuss how this may affect your estate plan (or if you need to create an estate plan), please give us a call. Please contact our Cincinnati office by calling us at 513-771-2444. We’d be honored to help.