Anytime that you place a loved one in the care of others, there is always room for disagreement. Some disagreements are not much more than a difference in opinion or a misunderstanding, others are relatively severe and cause for demanding immediate action and turning to authorities for resolution. No matter how sensitive and caring the staff of a nursing home, nursing home staff and the senior or the senior’s family can develop a misunderstanding or a disagreement.
When significant problems arise, it’s often best to involve a geriatric care manager (GCM). A GCM will act as independent expert who can evaluate the conditions and disagreements in light of state and Federal laws, industry norms, and the specific needs of the senior. The GCM can also often act as a mediator to talk to the administrator of the facility in terms that they understand, with less emotion because they are not personally involved. Administrators know that the opinion of a GCM is important as an independent person, should the case ever have to be resolved in court. In short, nursing home administrators often attempt to work with a GCM when they would not with an irate family member.
You find yourself single again – perhaps through a divorce or the death of your spouse. This is a difficult time emotionally. You may be weary of court proceedings and legal matters – however, you must give attention to estate planning matters.
Your single status affects:
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Your real estate. You now own your property alone. There are inheritance issues which much be addressed – you no longer have the protection of joint with the right of survivorship.
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Your will. If you have an existing Will, it needs to be changed. This is especially true if you are divorced. You will now need to specify new primary beneficiaries of your estate and name new personal representatives. If you never had a Will, it is particularly important to establish one now – there is no joint ownership now. Who will be your heirs?
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Your trust . As with your Will, you must change your trust after a divorce to reflect your single status and specify beneficiaries and successor trustee(s). If you are recently widowed, you need to sit down examine what the status of all provisions in the trust are, which need to be changed, which can be changed.
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Guardianship designations. You should designate your preference for guardian and conservator for your children if you are incapacitated or die.
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Your Powers of Attorney. You will need to designate new agents under your Durable Power of Attorney (for legal affairs) and under your Designation of Patient Advocate (Durable Power for Health Care.
It is important for you to sit down with an Estate Planning Attorney and address these important issues which affect you today and tomorrow. You owe it to yourself to find out what impact becoming “suddenly single” has had on your estate planning matters and how you can plan for the future.
A good way to reduce a parent’s countable assets when trying to qualify for Medicaid nursing home benefits is by having the child charge the parent for caregiving services provided. A child or other family member is permitted to contract with the parent to provide personal care to the parent. Such payments will help to deplete the parent’s countable assets without causing the imposition of a penalty. The payments must be considered reasonable and in line with the going rate for similar services provided by outside companies in the same area. The following guidelines should be followed for personal care contracts:
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Prepare a written contract prior to the delivery of the personal care services.
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Detail what types of services are included.
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Both parties to the contract should sign in front of witnesses and a notary
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A doctor’s note should be obtained indicating that the parent needs the services being provided in the contract.
It is best to contact an Elder Law attorney for assistance when considering a personal care contract.
Long-term care costs are not covered by private health insurance or any of the Medicare plans. Under traditional Medicare Part A, a three-night hospital stay triggers up to 100 days of skilled care in a nursing home. The majority of long-term care costs are either paid privately by the resident and the resident’s family, long-term care insurance, or paid by Medicaid.
Eligibility for Medicaid is determined based on strict income and asset rules. However, typically a single person can only have a maximum of $2,000 in countable assets plus certain excluded assets such as the individual’s personal residence, one car, personal effects and a pre-paid funeral contract. There are various planning techniques that may allow an individual to protect more assets. However, the Medicaid rules frequently change. Therefore, it is wise to seek the advice of an experienced elder law attorney when considering any type of asset preservation planning.
Roles and rivalries
Recognizing and taking responsibility is not always in a person’s psyche. Each sibling was brought up with a different relationship to the family, to their parents and to their own responsibilities. Sometimes, the way people behave has a lot to do with the relationship they have with their parents. The child who felt most loved by the parents or the one who self-identifies as the “good” son or daughter might be more likely to take on the primary caregiver role. The child who took the most browbeating, or who feels like a disappointment, or who feels ignored would be less willing to extend themselves to a needy parent. It is important to recognize that, while a child may be avoiding helping the parent for whatever reason, he or she is also abandoning their sibling.
Sharing responsibilities
When it comes to dividing care-duties for an elderly parent, there’s no cookie-cutter solution that will work for all families. Every family is different, so every family has to work out the best arrangement for them. Acknowledge that everyone has different abilities, resources, and availability. One sibling may handle legal matters while another handles personal care and medical questions, while a third does the shopping and maintains the house. In many cases, the effort can’t be equalized, especially if some siblings live close to the parents while others live far away. It is important to give everyone some kind of responsibility, even if it means writing a check or calling the parent on a regular basis.
Spending and needs assessments
Plenty of otherwise-rational adults can be torn apart by end-of-life care for their parents, and often the accelerant for the arguments is money. Siblings may disagree about how the parents’ money should be spent for care–in-home aides vs. assisted living vs. nursing home care vs. allowing the parents to move into one sibling’s home. Often the disagreements stem from a lack of understanding of the parents’ real needs. What one sibling witnesses may be different from what another hears when talking on the phone with the parent, or when they drop by for a casual visit. Sometimes it is best to have an outside counselor such as a social worker assess the needs of the parents and say, ‘Here’s what your parent needs. Here’s what’s available. Now what are you each willing to contribute?’ Having that outside observer can really help siblings take an objective view of the situation.
It should come as no surprise that falls are the leading cause of serious injuries in older patients. According to the American Geriatrics Society, each year about one third of Americans aged 65 and older fall, leading to hospitalizations, admissions into long-term care facilities, and even death.
And while many health problems, including arthritis, poor balance, muscle weakness, poor vision, dementia, and certain medications may increase fall risk, vitamin D deficiency plays a surprising role in older adults’ falls.
Vitamin D appears to reduce the risk of falls in older adults by improving muscle function and strength. How does Vitamin D help? Vitamin D regulates calcium transport into muscle cells, which is necessary for muscle contraction. Vitamin D also plays a role in regulating protein synthesis within muscle cells, which is necessary for building and repairing muscle fibers. Studies show that individuals with low vitamin D levels are more likely to have worse physical function, such as, slower gait and worse physical performance and balance, as well as lower strength. Older adults with vitamin D deficiency also have an increased risk of muscle weakness and bone diseases.
Nearly 7 million Americans care for an elderly relative from a distance, reports the National Alliance for Caregiving (NAC). If you’re among them, you know full well the guilt and anxiety of not being able to be there 
at a moment’s notice. Whether your parent could use a hand with housework or requires full-time care because of a disabling condition, you want to do all you can to help. Here are some strategies that can help reduce the stress of long distance caregiving without sacrificing quality of care:
1. Know Parents’ Needs–Exchange numbers with Mom and Dad’s best pals; ask them to contact you if they notice anything unusual. Also, time your next visit to coincide with a primary care doctor’s appointment; that way, you can introduce yourself and get your parent to sign a HIPAA consent form, which allows the doctor to share diagnosis and treatment information with you. Once you determine that assistance is needed, broach the issue gently with your parent, framing it as a concerned observation about a challenge mom/dad is facing rather than your own fears.
2. DIY Plan–If your parent just needs help with chores, errands, and the like, you may be able to put together a piecemeal care plan that costs nothing. Talk with family and friends who live nearer to your parents to see how they might be willing to help — whether it’s taking Dad to the doctor, having him over for meals, or doing his laundry. Then figure out how you can assist from a distance. You may, for example, arrange for food deliveries from a grocery store or for a cleaning person to come weekly. You can also help your parent manage money, if that’s an issue.
3. Get Low-Cost Help–Even with a solid network, you may have gaps you can’t cover. Fortunately, your local Agency on Aging can help you access services for the elderly, including food delivery and meal programs, transportation around town, social activities, help with tax prep, and more.
4. Bring on a Professional–If your relative requires more hands-on help than all these services provide, but isn’t ready yet to leave his or her home, you may have to hire an aide. A personal-care aide can provide help with cooking, light housekeeping, and bathing; a home health aide or visiting nurse may be more appropriate in situations where medical monitoring is needed. Seem like too much to manage from afar? Call in a geriatric-care manager, a certified professional who knows the local offerings and can help you assess your options.
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.
Here are some advantages as to why one would want to buy a preneed plan for funeral and burial services and goods.
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It provides peace of mind knowing these arrangements have been made in advance.
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It avoids the burden on family members to make decisions when they are most vulnerable to manipulation.
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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.
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It helps the family to avoid taking loans, arranging finance plans, raiding savings or selling assets to pay for a funeral and burial.
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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.
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It locks in guaranteed prices (available with some contracts) forever.
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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.
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Depending on the contract, it may allow for transfer to another funeral home or for partial or full refund.
A “CCRC” is a Continuing Care Retirement Community, the most comprehensive retirement living option available to seniors in America today.
A CCRC combines the services of an independent living retirement community with an assisted-living facility and a nursing home at a single location.
In exchange for an entrance fee and ongoing monthly service fees, the resident receives the immediate benefit of all of the independent living services, together with the assurance of high quality assisted-living or nursing home services if the need should arise, for the rest of the resident’s life.
Most CCRCs are operated by charitable or religious organizations on a not-for-profit basis. Financial surpluses generated in these CCRCs are reinvested in the community for the benefit of its residents, rather than distributed to investors as dividends. This reinvestment enables most CCRCs to continue to care for their residents who outlive their assets. Virtually all for-profit long-term care facilities require such residents to move out and/or receive government assistance.
Recently, a few of my clients have asked me questions regarding a financial product that was offered to them by their investment advisor. The product is called a “FDIC Insured Callable Certificate of Deposit” (Callable CDs).
According to my research, callable CDs are certificates of deposit that may be redeemed at the discretion of the issuer on a specified call date, returning the outstanding principal amount, plus accrued interest. Callable CDs are typically available with maturities ranging from 2-15 years and in minimum denominations and increments of $1,000 to $250,000.
Callable CDs are typically FDIC insured up to the maximum of $250,000 for principal and accrued interest combined.
In the event of death or the adjudication of incompetence of an individual owning a callable CD, early withdrawal of the entire CD will generally be permitted without penalty.
In a nutshell, callable CDs are FDIC insured CDs that typically offer a higher return because of the callable feature, with the added benefit of a penalty free withdrawal in the event of the owners death or incapacity.
WAIVER: CHRISTOPHER B. KROLL AND ASSOCIATES, P.C. IS NOT IN THE BUSINESS OF OFFERING OR RECOMMENDING ANY TYPE OF FINANCIAL INVESTMENT PRODUCT OR ADVICE. FOR FURTHER DETAILS, PLEASE CONSULT YOUR FINANCIAL ADVISOR.
