The Health Challenges Posed by Dementia Are Significant

August 22, 2022Filed Under: Long Term Care, Senior Health and Wellness

A person with dementia is diagnosed every three seconds somewhere in the world. Dementia is a catchall phrase that refers to many types of neurodegenerative diseases. Neurodegenerative diseases bring about the onset of dementia including but not limited to: Alzheimer’s disease, Lewy body dementia, Parkinson’s disease dementia, vascular dementia (currently the second most common form of dementia), amyotrophic lateral sclerosis, and the most recently identified LATE (limbic-predominant age-related TDP-43 encephalopathy) which mimics Alzheimer’s symptoms but is caused by a different brain mechanism.

There is a long-held view that cognitive decline is a normal consequence of aging; however, this has been disproven by the successful aging of many individuals who remain in full control of their mental faculties. Just because you get old does not mean you will get dementia; and yet, the likelihood that you will get dementia does increase (doubling every five years) over the age of 65, in particular, if you carry the apolipoprotein E gene variant APOE ε4.

The economic impact of dementia is profound. The Center for Disease Control and Prevention (CDC) projects that by 2040, the US cost of treating Alzheimer’s disease alone is estimated to be a staggering $379 to $500 billion annually. These costs include the direct costs of social and medical care as well as care provided by unpaid family care providers. It is very costly to create a secure scenario for those who have dementia. Although Alzheimer’s can now be detected 20 years before the onset of symptoms, there is no known cure for it or other forms of dementia. Research efforts to find a cure have been expensive without much reward, and as such many drug companies are halting their efforts to find a cure for economic reasons. Those who have dementia have a disability and dependence on loved ones and a health care system that is woefully unprepared for the scale and cost of maintaining their lives. Some biomarkers that identify Alzheimer’s disease early on may accelerate the development of new therapies as the disease timeline progression is substantial, but it remains unknown which treatments will be most effective and at what point in the disease continuum.

The number of people suffering from dementia diseases is rising, but that is most likely because the overall number of aging people is increasing. Even though dementia is not an inevitable consequence of aging, the increase in its probability plays into the laws of large numbers. There are reports of certain modifiable lifestyle choices that can increase the chance of not developing dementia disease. In particular, diet seems to influence oxidative stress and inflammation in the brain. A Mediterranean diet appears to have a positive effect on brain health in general. Exercising and maintaining positive social relationships also help maintain balanced brain health. Combining these three aspects is most effective for brain health. Diet, exercise, and positive social relationships may reduce the risk of a dementia diagnosis. These modifiable habits are proactive to keep the brain from neurodegeneration rather than reactive to a dementia diagnosis.

The World Health Organization (WHO) identifies the principal goals for dementia care as: “early diagnosis in order to promote early and optimal management, optimizing physical health, cognition, activity, and well-being, identifying and treating accompanying physical illness, detecting and treating challenging behavioral and psychological symptoms, and providing information and long-term support to careers.”

Though there is always hope for a future dementia solution, there are still the issues at hand today. A diagnosis of dementia has profound consequences for health and wellness, relationships, retirement, and economic well-being. Some states already have dementia health directive templates to address future issues of dementia while a person is still mentally capable of making sound decisions. Like all things in life, it is best to proactively manage circumstances rather than react to problems.

We can help you and your loved ones prepare for the possibility of a dementia diagnosis. We help families determine the best type of care, how to pay for that care, and how to put the proper legal documents in place to make sure appropriate persons are named to step in and make decisions for you if needed. We hope you found this article helpful.

Managing Long-Term Care Costs

July 18, 2022Filed Under: Long Term Care, Medicaid Planning

Almost seventy percent of retirees in the United States will need some kind of long-term care (LTC), according to figures released by the US Department of Health and Human Services (HHS). According to research by Genworth, the median annual cost for these services will range from $53,768 to $105,850. HHS also reports that those who receive Medicaid-financed nursing home care will spend more time in residence than those who self-finance their care or have private long-term care insurance. These long-term care services and supports (LTSS) are becoming more critical as retirees live longer lives and worry about outspending their assets.

The Dilemma of Affording Long-term Care

Paying for long-term care planning remains a significant challenge for most older Americans and preparing for service payments can be tricky. LTC insurance may cover a portion of services or all of them, and premiums depend on a person’s age, gender, health, location, and other criteria. The American Association of Long-Term Care Insurance lists 2021 average premiums for initial benefits of $165,000 (with a 1 to 5 percent annual growth rate) for a healthy fifty-five-year-old male to be between $1,375 to $3,685 per year. For the same coverage type, a healthy fifty-five-year-old woman can expect to pay between $2,150 to $6,400. Premium hikes tend to be costly because metrics used years ago in the insurance industry were faulty and did not accurately project the real LTSS costs.

What is Hybrid Long-term Care Coverage?

A different payment option is hybrid long-term care coverage. These policies are part annuity or life insurance and part long-term care coverage. You may purchase a policy upfront eliminating any future risk of premium increases, and your heirs may receive a death benefit if you do not need long-term care. This option is an arbitrage approach hoping that you will not require LTSS and that your heirs may benefit. Hybrid policy price comparisons are more difficult to ascertain than a standalone long-term care coverage policy.

How to Utilize Health Savings Account to Pay for Long-term Care

A third option is for those retirees with sizable health savings accounts to use pre-tax funds to cover long-term care expenses or premiums. Currently, those itemizing deductions can write off long-term care expenses above 7.5 percent of their adjusted gross income on their taxes. Finally, those low-income retirees with assets below a certain threshold may qualify for Medicaid LTSS. Applicants must pass a five-year “look back” period to assure they did not gift or spend down assets to qualify.

Typically, family members play an important caregiver role for their loved ones who need help regarding activities of daily living. This statement is particularly true in the earlier stages of requiring care, where someone may need help with just one activity of daily living. In-home assistance, community programs, and residential facilities can help your loved one stay as active as possible, accomplishing everyday tasks. The family-style approach constitutes most living arrangements for those who receive long-term care.

HHS

Many available resources help older adults continue to reside in-home and participate in their communities. The stay-at-home option in the earlier stages of a significant long-term need, or if projected care requirements may be a matter of two to three months, may be the most viable and cost-effective solution. Pivoting to in-home service provision is the most likely scenario for most American retirees. Nursing home residential space is expensive, and Medicaid can only supply so much aid. While most LTSS stays remain paid care and have relatively short durations, the lifetime risk for expensive out-of-pocket costs runs high.

Unfortunately, receiving paid LTSS care is not equally distributed among the US population. Generally, people with limited education and less financial resources are the most likely to experience severe LTSS needs. Over a lifetime, however, the more well-educated population with different socioeconomic advantages tend to live longer and can outlive their assets. Family is an integral part of the solution for long-term care while the federal government responds to the growing need to make this care more available and affordable. For your best outcome, be proactive in your planning. Most Americans will need LTSS, but few will have taken steps to plan for it. 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 with any questions.

An Overview of Co-Agents

July 11, 2022Filed Under: Elder Law, Estate Planning, Long Term Care

Choosing which of my two children will be my legal representative when I need help paying my bills and talking to doctors is a difficult decision for me. Can’t I just name them both? You can, but please don’t. You risk creating conflict or chaos if you name more than one child to serve simultaneously. Instead, pick one child at a time.

What to Consider When Deciding Your Health-Care Agent

Think about which child is better suited to the responsibilities. For health-care decision-making, your agent should ideally be calm in stressful situations and be able to advocate courteously but firmly with doctors and nurses for the treatment you want. For financial management, your agent should be organized, careful, and good with numbers.

Your health-care agent should live nearby, but if the child who lives locally is terrified of things like needles and blood, the other, sturdier child might be a better choice. On the other hand, who can manage finances from afar, but if that child didn’t cope with a checkbook, the other would be better. So if one child is good in one area and the other child is good in the other, the dilemma is solved. You can name the number-proficient daughter for the financial side and your son for the health care. Or, if just one child is altogether more capable than the other, name that one child for both health-care and financial powers.

But you do not want to create a situation where children who share the job start arguing about what health care you would want. Busy physicians have little time or patience to mediate fights like that. Likewise, you do not want your children quarreling about how you would want your money to be spent.

That’s why it’s best to give one child decision-making authority at a time. You can name the other as a backup in case the first child becomes unavailable, but naming both to serve simultaneously is generally not a good idea. 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 with any questions.

Medicaid: Five Years of Looking Back Without Penalties

June 6, 2022Filed Under: Elder Law, Long Term Care, Medicaid Planning

Planning for long-term care is important because nearly everyone will require it at some point in their lives. While we cannot predict the timing or level of care, we can take steps to prepare for an unexpected medical and financial crisis to help reduce the stress on ourselves and our family members. The cost of care continues to rise, but Medicaid planning can protect your assets, such as your home, hard-earned savings, retirement fund, or anything you wish to pass on to your loved ones.

Medicare is a federal and state program that helps seniors with limited assets and income afford long-term healthcare. Many seniors believe their only option to qualify for the program is to “spend down” their assets. However, proactive Medicaid planning can protect a substantial portion of your estate if done correctly. That means preparing at least five years before the potential need for benefits. The program’s eligibility rules are complicated, as is the application process. That’s why many people choose to hire an elder law attorney who specializes in Medicaid planning to evaluate their estate and reorganize assets over time.

Medicaid qualification requires a five-year look-back period at financial transactions in most states. The program verifies income and makes sure you haven’t gifted property to others under fair market value to reduce countable assets. Gifting assets is subject to a penalty that results in a period of ineligibility for benefits. The rules for gifting change state by state, and it’s important to know the rules where you live. If you begin early, you can ensure qualification for benefits when you really need them.

Qualifying for Medicaid Without a Penalty

A combination of options gives you the best outcome when applying for Medicaid benefits. An elder law attorney can customize a Medicaid planning strategy that works for your specific needs and goals. When you find yourself in need of long-term care services, you can receive Medicaid benefits to offset costs ranging anywhere from $60,000 to $100,000 a year.

The rising costs of long-term care can be overwhelming and unaffordable, depending on an individual’s needs. Your Medicare policy doesn’t cover long-term in-home or nursing facility services, and long-term care insurance premiums are very high. To discover more options, you’ll need a list of countable assets to determine ways to spend down that comply with Medicaid rules. It makes sense to spend down if it offers advantages:

Make home modifications like stairlifts, wheelchair ramps, walk-in showers, and other convenient amenities
Purchase a funeral benefits plan to cover final expenses
Pay off debt
Gift assets at fair market value with legal documentation
Create caregiver agreements to compensate for care

Caregiver Agreements are formal agreements to compensate caregivers who can be relatives or friends, but they need to be carefully drafted by a professional.

Qualified Income Trust

You may still have too many assets to qualify for Medicaid benefits, but those assets can be protected from Medicaid’s Estate Recovery Program. Your elder law attorney may recommend transferring them to a trust called a Qualified Income Trust (QIT) or Miller Trust. It is an irrevocable trust managed by a trustee who has legal control of the funds. Once they are transferred, they are no longer countable assets.

Medicaid Exempt Annuities

This life insurance annuity type is common to avoid Medicaid penalties during the look-back period. An annuity is a lump sum investment by an individual in return for a monthly payment for the duration of that person’s life or a set number of years. These annuities turn assets into income, lowering the countable assets of the Medicaid candidate below the eligibility limit. However, not all annuities qualify, and your attorney will help you choose the right product.

The surest way to avoid violating a look-back period when qualifying for Medicaid is to consult a qualified Medicaid planning and elder law attorney before you gift or transfer any assets. If a violation has already occurred, they can also offer assistance to correct a problem.

Always seek professional legal advice when creating your long-term care strategy using Medicaid. Applications are rarely successful due to mistakes when filling out forms, and it can have devastating long-term consequences on a family and their finances. Begin well before you anticipate needing long-term care. Become well-informed about all your options as you go through the application process. Proactive planning and expert legal strategies can help protect your assets and offer considerable help for your long-term care costs. 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 with any questions.