Senior Health and Wellness

Passing On Family Values As Part of Your Estate Plan

August 6, 2020Filed Under: Asset Protection, Estate Planning, Senior Health and Wellness

Multl generation family in autumn park having fun

Successfully addressing and legally formalizing inheritance of family values and assets can be challenging, especially if parents wait too long to begin instilling family values. Undoubtedly the best time to teach and empower your children as eventual inheritors of your family legacy is during childhood, then continuing throughout adulthood. Waiting until your later stages in life to discuss family values as a guide to handling inherited worth is often ill-received as grown adult children prefer not to feel parented anymore, particularly when they are raising children of their own.

There is value in the spiritual, intellectual, and human capital of rising generations, and it is incumbent upon older generations to embrace this notion and work with their heirs rather than dictating to them their ideas about how to facilitate better outcomes. While the directions taken by newer generations will likely differ and can sometimes be downright frightening than that of their elders, there can still be a deep sense of service and responsibility to family values and stewardship of inherited wealth. Allow your children to exert their influence over the family enterprise early on in life and make adjustments that create synergy, connection, and like-mindedness.

If this description of a somewhat ideal family system does not resemble yours, take heart. Most families do not conform to perfect standards of interaction. The more affluent a family is, the higher the failure rate to disperse assets without severe fallout. The Williams Group conducted a 20-year study and determined there is a 70 percent failure rate that includes rapid asset depletion and disintegration of family relationships during and after inheritance. Establishing inheritable trusts can provide real benefits. Benefits include avoiding probate, reducing time to handle estate matters, privacy protection, the elimination or reduction of the estate tax, and can be effective pre-nuptial planning. A parent who wants to control outcomes should focus on these benefits of the trust instead of trying to legislate their future adult children’s behavior.

It is imperative not to allow your values and legacy to become weaponized within the family system. A sure-fire way to inspire conflict is via “dead hand control,” meaning trying to control lives from the grave. Most often, if you put excessive trust restraints on adult children, they will act accordingly to your perception that they are not adult enough to handle wealth. Instead, consider enrolling them in a few classes about managing wealth. Spark an interest in them to learn how you have created wealth, the mechanisms you used, and what their future endeavors may look like long after you are gone. Formally educate your children about finances, the earlier the better, and instead of talking about who gets what the conversation can shift to the mechanics of managing wealth. This tactic resets the context of the issue and aligns purpose and intended long term outcomes.

Estate planners try to encourage trust choices that lead to flexibility. If a beneficiary is genuinely incapable of making the right decisions, a trustee can be appointed to make distributions in the beneficiary’s best interest. This trustee discretionary power of money management can help a well-funded trust survive for generations.

You can also write a letter of wishes or provide a statement of intent to your children. Though these are not legally binding, it gives you a platform to remind them of family values and your desire for these values to be maintained for future family generations. This type of letter is an opportunity for you to convey your vision for how your wealth can bring growth and chance for fulfillment to beneficiaries.

Prosperity should positively shape lives. Family trust beneficiaries hopefully already have a self-driven life that includes purpose, responsible behavior, and a basic understanding of personal finance. If you worry your children may squander inheritable assets, create the opportunity for them to succeed through classes that teach them about managing legacy family values and wealth. Address your concerns legally and directly through a detailed trust that can help but not overly constrain them to achieve what you envision they can become. Start an honest conversation early on, but remember it is never too late to make good choices and create positive family value influences for the coming generations. A well-known Ann Landers quote sums it up neatly, “In the final analysis it is not what you do for your children but what you have taught them to do for themselves that will make them successful human beings” – a worthy goal of any family value system.

If you are interested in establishing a trust to pass wealth on to your children, we can help. We can also guide families on how to pass on family values in a meaningful way. We look forward to the opportunity to work with you.

Strategies to Help Cover the Cost of Assisted Living

July 31, 2020Filed Under: Medicaid Planning, Senior Health and Wellness

With the price of assisted living rent varying from $2,000 to $5,000 monthly, it’s important to understand the strategies available to help cover these high costs. There are many paths available to offset these costs and the right path for you will determine on the unique circumstances of your past life, current situation, and future wishes.

Depending on what type of care your loved one needs, assisted living can be the most affordable solution when compared to a nursing home ($5,000 to $10,000 or more per month) or long-term in-home care. If closely monitored medical supervision is not necessary for your aging senior, assisted living might be the best financial choice.

The Various Strategies Available to Cover the Cost of Assisted Living

One payment strategy that has become popular is to use Medicaid. If your loved one does not have many financial assets and their income levels are low, this could be the right solution for them. Medicaid varies from state to state both in name and in eligibility requirements. Many states dictate that a senior is eligible if he or she has less than $2,000 in assets, or $3,000 if married.

If you are trying to help a senior with a creative financial strategy by gifting money and other assets to family members, known as “Medicaid spend-down”, the government has a five-year look-back rule regarding financial transactions. There are strict guidelines about Medicaid spend-down. If a senior is caught incorrectly spending down resources to qualify for Medicaid, the penalties are steep, including disqualification from receiving Medicaid for a lengthy period. Also, many states do not cover assisted living under Medicaid, but require the submission of an additional wavier. Be aware that Medicaid assisted living payments are only accepted by some communities and Medicaid beds are usually limited. There can be long waiting lists to enter into a Medicaid financed assisted living facility.

If your senior has a disability, he or she may qualify for Supplemental Security Income (SSI), which is a federally administered program. SSI is the government safety net for those destitute and wholly or partially disabled by illness or injury. SSI is a monthly payment which a senior can use to pay for assisted living. To qualify for SSI, contact the appropriate local Social Security office and provide financial documentation and a doctor certification to attest to your senior’s inability to work because of a medical disability.

If your loved one or their spouse is a Veteran, residential care could be paid for in a variety of situations with Veterans benefits. There is a set of benefits available to those with disabilities or service-related injuries, and there is also another set of benefits called Aid and Attendance, made available to any Veteran or surviving spouse who is both disabled and whose income is below a certain threshold. The Veterans Administration website outlines the complicated process to access benefits. It is extremely beneficial to work with an elder law attorney who knows the details of the programs and can assist with the application.

A life insurance policy can pay for your loved one’s assisted living. Often, seniors have a long-standing policy that was implemented to help family members upon their death, but a life insurance policy can provide financial support now. A process known as “accelerated” or “living” benefits is a “cash out” policy that can have your senior redeem 50 to 75 percent of the face value of the policy. Each amount is based on specific policy conditions as well as individual corporate rules. Some policies can only be cashed out if the policyholder is terminally ill while other companies are more flexible in cash outs. If your senior’s particular company does not allow the policy to be cashed, it can still be sold to a third-party company who usually affords the same 50 to 75 percent face value cash out. That company continues to pay the original premiums until their death, at which time the company redeems the full value of the policy. Finally, if your loved one’s policy is of lesser value, it may qualify for a life settlement option known as a “life assurance” benefit or conversion program, which allows the senior to convert between 15 and 50 percent of the policy value directly into long-term care payments.

Does your loved one have a long-term care insurance policy? It can pay for assisted living care. Policies vary, but once the determination and action is taken to collect on it, those monies can be paid directly to an assisted living facility or to the beneficiary who in turn pays the facility. It is wise to consult with an elder law attorney to help understand individual company requirements to optimize the process of collection.

An annuity can be used to pay for some or all of the senior’s assisted living. If your loved one invests a lump sum into an annuity, they will receive regular payments over a promised time period, usually the rest of their life. The annuity helps to stretch your senior’s budget and guarantee at least some money is coming in, even in the event they live longer than expected. Most annuities allow the beneficiary to continue to receive money regularly even if the purchase premium runs out. If your senior were to live a very long time, they would get more back than they put in and an added bonus is that annuities are oftentimes not fully counted as assets by Medicaid when applying for government assistance. The income is counted but not the value of the asset. It is imperative to seek the advice of an elder law attorney before opting into an annuity as they are complex financial products and a wrong decision could be disastrous.

Reverse mortgages are another strategy to pay for assisted living. If your loved one owns their home outright or has only a small mortgage on it, they can get cash value from their home equity in a lump sum or series of monthly payments. The bank will decide the valuation of the home based on multiple factors like the homes worth, interest rates and the applicant’s age. The borrower can stay in the house until death even if the loan balance exceeds the worth of the home. After death, the loan balance has to be repaid which usually means selling the home. Reverse mortgages were developed to help widows remain in their homes after the primary income earner passed away or if that spouse needed to move into assisted living, leaving the other spouse to reside in the long-time family home. Like annuities, a reverse mortgage is a complex financial product, and it is crucial to receive sound advice from a trusted professional and work with a reputable reverse mortgage company. If only one senior parent is living and they do not want a reverse mortgage, they might consider renting out their home and using a landlord to manage the property. The income from renting the house can be used to pay for assisted living expenses.

Lastly, it is possible to pay for assisted living with a bridge loan, which is a short-term loan of up to $50,000 explicitly designed to provide funds to move a loved one into an assisted living facility or continuing care retirement community. It is an unsecured (no collateral required) line of credit with the intent to finance the first few months of living expenses during the sale of the senior’s home, while the application for Veterans benefits is pending, or other actions that are taken that free up funds. Since the interest rates can range from 8.25 to 12.5 percent, this option is best as a short-term strategy. The other type of bridge loan is called the Capital Access Program. It is a lower interest lump sum loan secured by real estate or other assets that the company deems acceptable collateral. It is designed to help seniors come up with the large upfront entrance fee some senior assisted living facilities require. Both types of loans are based on the usual credit criteria: credit score, credit history, debt to income ratio, and more. The senior or an adult child can secure the loan, and up to six family members can cosign loan applications, allowing the risk to be shared among multiple family members.

If your loved one is healthy enough to successfully live in an assisted living facility, the monthly cost is likely a top factor when considering their options. These are some, but not all of the viable and creative ways to pay these costs. To fully explore the options available and what is best for your senior seek the advice of an experienced elder law attorney and make the best decision for your loved one. Contact our office today and schedule an appointment to discuss how we can help you with your planning and which strategy is best to help your senior pay for assisted living.

If you have questions or need guidance in your planning or planning for a loved one, please do not hesitate to contact our office at (513) 771-2444.

Medicare Kicks in for Telehealth Services

April 23, 2020Filed Under: Current Events, Elder Law, Senior Health and Wellness

In response to the COVID-19 outbreak, the Centers for Medicare & Medicaid Services (CMS) recently announced that it has increased access to Medicare telehealth services. This means that Medicare beneficiaries can receive more benefits from their doctors without having to travel to a healthcare facility.

The terms “telehealth” and “telemedicine” refer to the ability to exchange medical information from one site to another through electronic communication to improve a patient’s health. With the rapid rise of COVID-19 cases, there is the urgency to expand the use of technology to help people who need routine care. Telehealth will keep vulnerable beneficiaries and those with mild symptoms in their home, but with access to the care they need by phone and video rather than requiring an office visit.

Prior to this change, Medicare would only pay for telehealth on a limited basis, and only for persons in a designated rural area. Now Medicare beneficiaries will be able to receive the following services through telehealth: common office visits, mental health counseling, and preventive health screenings. This will help keep more of the at-risk population (Medicare beneficiaries) able to visit with a doctor from home, rather than traveling to a doctor’s office or hospital which puts the beneficiary and others at risk. Telehealth visits will be treated the same as regular, in-person visits and will be paid by Medicare at the same rates.

These changes went into effect for services starting March 6, 2020 and will continue for the duration of the COVID-19 Public Health Emergency. For more information, view the fact sheet prepared by CMS.

Better access to telehealth is a big step in getting Medicare beneficiaries appropriate care in the least restrictive way.

If you have questions or need guidance in your planning or planning for a loved one, please do not hesitate to contact our Cincinnati office by calling us at (513) 771-2444.

Relationship Dynamics When a Spouse Becomes a Caregiver

March 18, 2020Filed Under: Long Term Care, Senior Health and Wellness

Caring for a seriously ill spouse can trigger relationship challenges. In the process of change, you can lose your best friend, your love, and your future as you both had imagined it. Promises will change from words spoken in oath on your wedding day to deeds of care in your mostly, but not exclusively, older years. The new caregiver morphs from a loving spouse into their new role, which is an entirely different sort of relationship of primary service. In more tragic cases, the caregiver can become distant to the marital bond, struggling with feelings of loss, fear, anger, resentment, or misunderstanding.

It’s a situation no spouse looks forward to on either side of the equation. A loving couple does not look forward to the day when they either must watch and tend to the mortal decline of their spouse or, conversely, be the spouse who feels wracked with guilt feelings knowing their health problems are placing a tremendous caregiving burden on their spouse. No matter the desire to avoid the experience, very few married couples will elude the complication that serious illness brings to their shared lives. Sadly, the needs of the caregiving spouse are often overlooked at a time when they need renewed strength to support their partner in new ways.

The caregiving pressures exerted on a spouse are significant. According to an analysis of 168 studies, while the caregiving spouse will protect their mate, they report more symptoms of depression, lower levels of psychological well-being, and more significant physical and financial burdens. To cope with the changes presents challenges, and sadly, the longer you have been married, the more difficult the process of rewriting the relationship’s rules and expectations become. Early on in the illness diagnosis, spouses are unclear as to how to handle the short-circuit in communication and productively process their feelings.

Many new spousal caregivers will feel the complications of isolation. Family members and close friends may not visit, not help, or even ignore the couple struggling to create new behavioral norms. Health Affairs reports that 55 percent of older spouses experience their end of life caregiving years without help from children, other family members, or even paid home health aides. The entirely new sort of relationship that becomes forged between husband and wife becomes defined by illness and lost emotional connections.

The need then becomes the focus on what to do to improve the situation. The first is the caregiving spouse needs an accurate understanding of the condition, treatment, prognosis, and needs of their ill spouse, whether they are diagnosed with dementia, cancer, heart failure, kidney dysfunction, or another serious illness. The information needs to come directly from attending physicians and health care providers. Caregivers need to participate in medical appointments and become an active participant in identifying health and wellness issues and potential fixes. Medical recommendations need to be prioritized so that the caregiver can be a positive, encouraging reinforcement rather than a nagging, stress-inducing reminder that can trigger frustrations on both sides.

If family and friends are willing to help lighten the load, it is imperative to accept help. Housekeeping, erranding, providing casseroles, transportation, visiting, anything that can reduce your workload as a caregiver is essential to accept graciously. Review your insurance plans as many give some level of coverage of home nursing services, occupational, and physical therapy. These services can improve your partner’s abilities and safety in your home.

Share as much time as reasonable with your spouse, listen to their thoughts, and spend time in quiet reflection. Follow routines that are established patterns in your life together. A Friday movie night at home with popcorn, walking the dog, or sharing morning coffee as a continued routine helps to keep a sense of continuity in the face of the unknown.

Recognize that you are not alone in your struggle. Authors Barbara Kivowitz and Roanne Weisman have written about their journeys as the caregiving spouse of a seriously ill mate in a book entitled Love in the Time of Chronic Illness: How to Fight the Sickness – Not Each Other. The most poignant recommendation describes shifting the notion of caregiving from a set of daily responsibilities to an act of expressing compassion. Kivowitz encourages couples to “Measure success by how well you connect, love and feel loved.” Don’t let a serious illness shake the foundation of your marriage. Identify your roles and set structure to address the issues at hand, and in the face of the unknown, you both will be better for it.

If you have questions or need guidance in your planning or planning for a loved one, please do not hesitate to contact our Cincinnati office by calling us at (513) 771-2444.

Passing On Family Values As Part of Your Estate Plan

Strategies to Help Cover the Cost of Assisted Living

The Various Strategies Available to Cover the Cost of Assisted Living

Medicare Kicks in for Telehealth Services

Relationship Dynamics When a Spouse Becomes a Caregiver

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