Free Services for Seniors or Their Caregivers

Most seniors these days are living on limited incomes from sources that may include Social Security, a small pension or maybe some other form of government assistance. With few resources at their disposal, finding services for free or discounted prices is vital.

There are likely many of these types of services available through your local Office for the Aging (the name of this government agency may be different in your local area, i.e. Division of Senior Services) or local charities such as Lions Club or Meals-on-Wheels, or on the Internet through sites like ElderCare.gov.

However, in my opinion, the most rewarding of these freebies for seniors and their caregivers – things like free hearing aids and free dentures – will be more difficult to come by. From my experiences as a caregiver, I have compiled a list of these types of services and provided a roadmap and examples for how to find them.

Free or Discounted Services for Seniors and Their Caregivers

  1. Benefits Counseling
    How many times have you, either as a senior or as a caregiver, wrestled with trying to figure out what type of help was available to you? There is free counseling available through your local Office for the Aging that can provide this type of assistance and point you in the right direction to receiving the help you need.

    You can get answers regarding health insurance, food stamps and other services through these counselors.

  2. Adult Day Care
    Adult day care centers can be run by a government entity, or through a local charity or house of worship. The purpose of these senior centers is to provide a safe place to socialize and have a hot meal in a protected setting. These adult day care centers are ideal for seniors who cannot remain alone, but are not in need of the care that a nursing home provides.

    If you go through your local Office for the Aging, they will probably be able to direct you to such a day care center, let you know if there is a charge for the facility and what the eligibility requirements are.

    As for the fees associated with these facilities, if the facility does in fact charge a fee they are normally quite nominal and are just there to help the center cover its own costs for meals and operating costs like utilities.

    As for the eligibility requirements, that will depend upon the capabilities of the staff at each individual facility. As an example, some adult day care centers will only accept those who are continent because they will not have the supplies to change adult diapers. Other facilities may require a certain amount of mobility for those attending (i.e. they are able to get out of a wheelchair on their own or with minor assistance). It is really ‘hit or miss’ because each facility will have their own requirements.

    When initially contacting the Office for the Aging or the local charity, give them as much information upfront regarding both the fees (if you are only looking for a free facility) and the physical condition of the applicant. This way they can act as a filter to point you in the right direction.

  3. Dentists That Accept Medicaid
    Due to the problems of billing and getting paid by the government, there aren’t many dentists that accept Medicaid, but a few do. This means that a senior with no dental insurance may still be able to get the dental care needed…you just might have to travel to get it.

    To find a dentist in your state that accepts Medicaid, contact your state Department of Health, but keep in mind that you may have to travel out of your way to get these services. For example, in my home state of New York, the state Department of Health website lists about 40 dentists that accept Medicaid. That’s not a great number for a state with a population of 19,500,000. On Long Island, where I live, there are only two.

  4. Free Dentures
    As incredible as it may seem, it is possible for low-income seniors to receive a free set of dentures. In addition to calling your Office for the Aging to see if they know of a source, here are two additional places to look into:

    Your State Dental Association: here you will be able to access free or low-cost dental programs. As an example, one of my customers contacted the Ohio Dental Association and was then directed to Dental Options (in Ohio). She discovered her mother was eligible and will soon be getting the help she needs. While these services will vary based on your location, the place to start is with your state dental association.

    Dental Colleges: while not free, if there is a local dental college in your area you could get a substantial discount on dental care.

  5. Elderly Pharmaceutical Assistance Program (EPIC)
    EPIC is the name of the State Pharmaceutical Assistance Program in New York. New York is one of the 23 states that have such a program (the other 27 canceled their programs after the Federal government instituted Medicare Part D). If you live in Colorado, Connecticut, Delaware, Idaho, Illinois, Indiana, Massachusetts, Maryland, Maine, Missouri, Montana, North Carolina, New Jersey, Nevada, New York, Pennsylvania, Rhode Island, Texas, the U.S. Virgin Islands, Virginia, Vermont, Washington State or Wisconsin, you have access to another means of assistance to obtain your prescription medications.

    Income requirements vary from state to state, so you will have to check with your state administrators to determine your level of eligibility, but this can be a great way for seniors to save on their prescription drug costs.

  6. Low Cost Prescription Drugs
    Despite the advent of Medicare Part D, and certain state run assistance programs such as EPIC (outlined above), there are still many seniors that cannot afford their medications.

    This is why most manufacturers of prescription drugs provide assistance for those who cannot afford their medications. A comprehensive list of these programs is provide by the Partnership for Prescription Assistance as well as the steps to follow to apply for assistance.

    Another cost saving strategy is to make the switch to generic drugs. According to the Food and Drug Administration, “Generic drugs are important options that allow greater access to health care for all Americans. They are copies of brand-name drugs and are the same as those brand name drugs in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use.” Generic drugs cost about 50 to 80 percent less than their brand name equivalents, so it makes all the sense in the world to speak with your doctor about making the switch.

  7. Family Caregiver Support Programs
    These programs are often offered through the government, or volunteer organizations. Either way, as a caregiver, you can be provided with respite care by volunteers, as well as counseling and Support Groups to ensure your physical and emotional wellbeing. These services are designed to supplement, not replace, the efforts of the family in caring for a loved one.
  8. Free Cell Phones or Discounted Phone Service
    LifeLine is a federal government program for qualifying low-income consumers designed “to ensure that all Americans have the opportunities and security that phone service brings, including being able to connect to jobs, family and emergency services.”

    LifeLine assistance provides one free or discounted phone (either landline or wireless cell phone) per household. To qualify, seniors will likely have to be on some form of government assistance, such as Medicaid, food stamps, Supplemental Social Security, Temporary Assistance for Needy Families, or the Low Income Home Energy Assistance Program. Visit LifelineSupport.org to see if you qualify and to find participating companies in your state.

    I was able to get my mother a free cell phone within five days of her being approved for Medicaid, after providing a picture of my mother’s Medicaid award letter (yes, I know it is shocking for the government to move that quickly). The only drawback to the program is the type of phone that you are sent. My mother can use it but it has smaller buttons that can make it confusing. I would prefer for her to have a larger handset with larger buttons, but this is working for the moment.

  9. Free Phone for Hearing Impaired
    A new service that is (at least temporarily) being funded by the FCC, called CaptionCall, provides free phones to those with medically recognized hearing loss.

    The way that this phone works is simple. A screen on the phone instantly takes the words being spoken and puts them onto a screen on the phone so that hearing impaired individuals can read what is being said. You can learn more at CaptionCall.com/Caregiver (and click on Promotions) for more information.

  10. Supplemental Nutritional Assistance Program (SNAP)
    This used to be called Food Stamps, but is now known as the Supplemental Nutritional Assistance Program (SNAP). You can apply through your state Office for the Aging, or Elder Affairs Department.

    Each state has slightly different requirements based upon income, but what I have found is that most states have a website (www.mybenefits.ny.gov in my home state of New York) where you can set up an online account and, based upon your age, zip code, income and residence status, you are then directed to all of the benefits that you are eligible for.

    Once you are approved, the maximum monthly benefit depends upon the size of your family, from $200 all the way up to $1,500.

  11. Other Free Food Services
    In addition to programs such as SNAP, there are many nutrition programs, offered either by local charities or local governments that can provide seniors with a nutritious meal (typically lunch) and the opportunity to socialize.

    Check with your local Office for the Aging to see what programs are available in your area. In my county, there are 33 such nutrition sites that seniors can attend and, in some cases, transportation is provided.

    There are also websites that have listings of local food banks where qualifying individuals can receive free food. The best food bank search engine is at Feedingamerica.org. Simply plug in your state and a listing of locations and the types of services offered at each food bank will pop up.

  12. Free Hearing Aids
    Buying a new hearing aid can run into the thousands of dollars, so it’s no wonder that seniors are hard pressed to pay for these devices. But I have found that there are a few ways to obtain free hearing aids. Some will be new, and others may be used, but they will all be free.

    First, try your local Lion’s Club. Most chapters either operate or know of a local hearing aid bank that can match needy seniors with recycled hearing aids.

    Another approach is to seek out clinical trials of new hearing aids. Contact hearing aid manufacturers and see if you can volunteer for a trial. When the trial is over, you typically get to keep the hearing aid. I recently saw a commercial from one hearing aid manufacturer that was advertising for people to participate in trials, so they are open to this idea.

    You will have to medically qualify for the trial and you may have to contact several manufacturers until you find one that works for you. You may also get put on a waiting list. Regardless, this can be a powerful way for very low income seniors to receive a free hearing aid.

  13. Free Legal Help
    When my mother had her heart attack and I started the Medicaid application process, I quickly realized that there would not be any money to pay our mounting bills. So I called my local Office for the Aging and they put me in touch with a local law school that operated a Senior Law Center for low income seniors like Mom.

    They wrote a letter to the creditors on my behalf asking for the debts to be forgiven. With this letter I attached a letter from the nursing home detailing Mom’s prognosis. That was 14 months ago, and I haven’t heard from the creditors since, so I guess that ‘no news is good news.’ I did receive one confirmation letter, from Wal-Mart, that the debts were forgiven. The others have not contacted me yet, so I am hopeful that they’ve written the debts off as bad debt.

    These types of law centers won’t represent you in a large scale, but they can be invaluable in drafting a simple will, certifying a POA or health care proxy, or drafting a letter to creditors.

    If your Office for the Aging is unaware of a local resource for such help, another place to look would be the Lion’s Club. Many of the members of the Lion’s are attorneys and local business leaders who may be able to help you find a pro bono attorney to handle something like this.

  14. Free Medical Alert System
    We have all seen the television commercial with the elderly woman in the bathroom saying, “Help, I’ve fallen and I can’t get up!” That’s what a medic alert system is for. It is a waterproof pendant that is worn around the neck or wrist, that works in conjunction with a wireless phone attachment. In an emergency, the wearer presses the button to be connected with the monitoring service and speaks into the pendant.

    The actual system is totally free, even the shipping. The monitoring service does have to be paid for, but that is normally around $30 a month.

    One thing I would advise you to consider when choosing a medic alert company. Make sure that the company you choose does NOT outsource its central station monitoring service. When your loved one hits that button, you want a trained, competent professional who can calmly contact emergency services and stay on the line with your parent until help arrives.

    There are many medical alert products out there, such as, LifeStation and Rescue Alert, that offer this type of service.\

  15. Free Walkers or Rollators
    A walker will run you around $40 (rollators are a little more expensive). That can be a lot of money for a cash-strapped senior. If you are looking for a discounted or free walker, try thrift stores such as Goodwill, which operates stores throughout the country and has very reasonable prices. Hospitals and nursing homes may periodically dispose of reliable, used equipment that may be ideal for you.
  16. Home Energy Assistance Program (HEAP)
    Through your local or state Office for the Aging, you can apply for assistance either in the form of weather upgrades to your residence – such as added insulation in the attic to improve the energy efficiency of your home (this is known as the Weatherization Assistance Program) – as well as direct cash assistance based upon your income level.

    One not widely known fact about HEAP is that it is available to both homeowners and renters, making it more widely accessible for low-income seniors.

  17. Ombudsman Services
    For caregivers of nursing home patients, the state ombudsman’s office is there to address issues with the care of their loved ones. You can think of the ombudsman as similar to a union rep. They will investigate complaints on your behalf to insure that nursing home residents are being treated fairly.

    I previously wrote about my own experience with nursing home neglect against my mother and how I brought in the state ombudsman to investigate the issue.

    If you feel there is an issue of neglect or abuse of a nursing home resident, getting the contact information is easy. This information must be prominently displayed in the lobby of all nursing homes, along with the website and phone number to call for help.

  18. Residential Repair Services
    Need some minor work done around the house, but can’t afford the labor? Many Offices of the Aging run a residential repair service where seniors can have minor work done to their home or rental at no labor cost.

    NOTE: You will have to pay for supplies, but the labor is free from the volunteers.

  19. Silver Alert Program
    Caregivers of seniors with dementia are often concerned about a loved one wandering or getting lost, especially if they are driving with dementia. There are many ways to combat this. One way is through a Silver Alert program, which is a public notification system in the United States to broadcast information about missing persons – especially seniors with Alzheimer’s Disease, dementia, or other mental disabilities – in order to aid in their return.

    Silver Alert and similar programs vary greatly by state. The way the Silver Alert program works in my local area is as follows:

    The caregiver will preemptively enroll their loved one by contacting the local police department and filling out a form identifying the senior and giving a physical description, as well as any medical information you wish to disclose.

    Your parent will then be issued a Silver Alert bracelet that will have a unique ID number and instructions for anyone who locates them to call a non-emergency police number. This way they can be safely returned home without compromising any personal information on the part of the senior or caregiver.

Regards,

ElderLawNews

Elder Abuse is a National Epidemic

Via Huffington Post…

When Helping Hurts

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Elder abuse is a national epidemic. Each year in the United States, an estimated 10 percent of older Americans are injured physically, debilitated emotionally, exploited financially and/or neglected — often by an adult child, spouse, other relative or caregiver. Elder abuse victims have a three-fold risk of death compared to their non-abused counterparts. Frequently, an elder is isolated, their mistreatment hidden.

In 2006, newspapers around the country headlined the story that Brooke Astor, the legendary New York City philanthropist and socialite, was financially exploited and neglected by her son and attorney. The case attracted national attention as her grandson, with the help of others, sought elder justice – first, by petitioning for guardianship to help his grandmother and those who were (also) helping her, and second, to help bring some of her perpetrators (his father included) to justice. The Elder Abuse Unit of the New York County’s District Attorney’s Office indicted and convicted Brooke Astor’s son and attorney. Elder justice was realized.

That is rare. Most of the millions of elder abuse victims, their suffering shrouded in silence, do not receive justice. Only one in 24 elder abuse cases are reported to authorities. What is not rare is that, despite an almost total lack of support or resources, family, friends and neighbors step up to help. Yet helping hurts, as confirmed by new findings of our research.

 

Staggering Number Know About Elder Mistreatment, Assist Victims, and Feel Distress

Along with colleagues at Cornell University, University of Toronto and Purdue University, we utilized Cornell University’s Survey Research Institute’s omnibus survey to learn about these concerned persons who step up for elder abuse victims — a population that had never been assessed. The survey results were recently released in The Gerontologist. They show that when findings are extended to the general population (U.S. Census Bureau, 2016), approximately 73 million adult Americans have had personal knowledge of a victim of elder mistreatment. Further, approximately 44 million adult Americans have become involved in helping an elder abuse victim. And for over 32 million adult Americans, just knowing about an elder abuse situation is generally highly stressful. Actually providing help to the victim tends to intensify this personal distress.

We need more research to understand what specific aspects cause this distress. We do know from conversations with concerned persons that the path to assisting elder abuse victims is often fraught with challenges. Concerned persons may witness the decline in the victim’s health and seek to obtain medical care, or provide what care they can themselves. They might feverishly focus efforts on trying to stop a financial exploiter from completely emptying bank accounts. They may try to lessen the victim’s despair. Often, they are often the only ones standing between the victim and the abuser, preventing the victim from slipping into total isolation.

Yet they are usually wholly unprepared for how this intervention might take a toll on they themselves. Relationships with friends they confide in and family may become strained, sometimes to the breaking point. They may suffer financial consequences. And seeing or confronting an abuser can be dangerous, so they personally risk becoming the target of abuse. Intervening can take real courage, and even more to remain involved. And it requires time, as elder abuse cases tend not to resolve quickly. It is not surprising that concerned persons can experience anguish, frustration and trauma. Yet like the victims they help, they are largely invisible: their deeds often not recognized, their needs unacknowledged.

 

Communities Can Help

What can communities do? A new program to be launched this spring in New York City is a beginning. The New York City Elder Abuse Center is launching a pilot helpline for concerned persons assisting elder mistreatment victims residing in New York City. Funded in part by the Fan Fox & Leslie R. Samuels Foundation, it will provide information, referrals and support. This is an important first step, but the need is great. Programs must be developed for concerned persons — and elder abuse victims — in every community. This will require support from foundations, private philanthropists, businesses and government. Brooke Astor fervently believed in a collectively expressed philanthropy, a

Elder abuse is a national epidemic. Each year in the United States, an estimated 10 percent of older Americans are injured physically, debilitated emotionally, exploited financially and/or neglected — often by an adult child, spouse, other relative or caregiver. Elder abuse victims have a three-fold risk of death compared to their non-abused counterparts. Frequently, an elder is isolated, their mistreatment hidden.

In 2006, newspapers around the country headlined the story that Brooke Astor, the legendary New York City philanthropist and socialite, was financially exploited and neglected by her son and attorney. The case attracted national attention as her grandson, with the help of others, sought elder justice – first, by petitioning for guardianship to help his grandmother and those who were (also) helping her, and second, to help bring some of her perpetrators (his father included) to justice. The Elder Abuse Unit of the New York County’s District Attorney’s Office indicted and convicted Brooke Astor’s son and attorney. Elder justice was realized.

That is rare. Most of the millions of elder abuse victims, their suffering shrouded in silence, do not receive justice. Only one in 24 elder abuse cases are reported to authorities. What is not rare is that, despite an almost total lack of support or resources, family, friends and neighbors step up to help. Yet helping hurts, as confirmed by new findings of our research.

 

Four Social Security Myths Debunked

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There are a lot of misconceptions surrounding the Social Security system. Here are four common myths and the truth about how Social Security works and its future prospects.

Myth 1: You Should Collect Benefits EarlyThis is one of the biggest Social Security myths. In 2015, more than half of Social Security recipients began collecting benefits before their full retirement age (66 for those born between 1943 and 1954), potentially costing themselves thousands of dollars in additional benefits. If you take Social Security between age 62 and your full retirement age, your benefits will be permanently reduced to account for the longer period you will be paid.

On the other hand, if you delay taking retirement, depending on when you were born your benefit will increase by 6 to 8 percent for every year that you delay, in addition to any cost of living increases. There are a lot of factors that go into the decision as to when to take Social Security benefits, but if possible it is usually better to wait until your full retirement age or older.

Myth 2: Your Money Goes into an Account with Your Name on It

When you pay into Social Security, the money is not set aside in a separate account, as with a 401(k) or IRA. Instead, your contributions are used to pay current recipients. When you start receiving benefits, people paying into the system will be paying your benefits.

Myth 3: Social Security Will Be Out of Money Soon

Many young people believe the Social Security system will run out of money before they have a chance to collect anything. Currently, the Social Security trustees predict that the trust fund will run out of money in 2034. Politically, it seems unlikely that Congress and the President would let this happen. Changes will likely be made to the system by either raising taxes (such as by lifting the cap on income subject to Social Security tax), reducing benefits for high-income individuals, increasing the retirement age, or doing something else that will allow Social Security to be fully funded. However, even if the trust dries up and there isn’t enough money to pay all the promised benefits, people will still be paying into the system and Social Security will be able to pay at least 75 percent of benefits.

Myth 4: If You Haven’t Worked, You Cannot Collect Benefits

If you haven’t worked outside of the home, you will not be able to collect Social Security benefits on your own record, but you may be able to collect them based on your spouse or ex-spouse’s record. Spouses are entitled to collect as much one half of a worker’s retirement benefit. This rule applies to ex-spouses as well, as long as the marriage lasted at least 10 years and the spouse applying for benefits isn’t remarried.

To learn more about Social Security, click here.

For Free Elder Law Guides, click here.

4 things to put on your to-do list for retirement prep

You may think you need a long and complicated list of tasks to accomplish your retirement goal. But a good place to start is with these four simple steps.

JUNE 20, 2016; Via Vanguard

Determine how much you need to save

Here’s where a bit of list-making—or the help of a financial professional—can make the process easier. Grab a piece of paper (or pull up a blank screen if that’s easier) and jot down some expenses associated with your retirement vision.

No matter what you see yourself doing once you retire, figure out some rough estimates for expenses you’re likely to have.

Mary Ryan“Common expenses—regardless of your plans— include housing, food, utility, and health care costs,” said Mary Ryan, a financial planner with Vanguard Personal Advisor Services.

No time for a checklist?

Consider working with a financial advisor, such as the professionals in Vanguard Personal Advisor Services®.

An advisor works closely with you to develop a customized goals-based financial plan according to your unique situation—and can manage your portfolio throughout your retirement years.

Learn more about how Vanguard Personal Advisor Services can help »

“The goal is to determine a general target of how much you’ll need to meet those expenditures, using the income you expect from things like Social Security, a pension, or annuity, along with the sum you’ll need tucked away in retirement or investment accounts,” she said.

Invest for retirement with an appropriate asset mix

Put your savings to work for your future through investing. A best practice is to invest in the right mix of stocks, bonds, and short-term cash reserves (your asset allocation), based on your goals, the length of time before you’ll need to use your savings, and your comfort with risk. Vanguard research shows that, even more than specific investment selections, asset allocation is a key component of investment success.

Anish Patel“A crucial part of determining your asset mix means being honest with yourself about how comfortable you are with risk, including when you might have to challenge your comfort level a bit for your long-term benefit,” said Anish Patel, also a planner with Vanguard Personal Advisor Services.

“Returns are the incentive to attract investors; that’s why investments with low risks also have low returns—because there’s less need to entice someone to make that investment. But risk comfort can be highly dependent on the market environment. When markets are good, many people think they have a high tolerance for risk, only to find when downturns occur, as they always do, that they have very little tolerance,” he said.

Review and adjust investments regularly, even when markets are turbulent

Markets don’t tend to move in slow-and-steady progressions. And when they shift, the changes can pull your asset allocation out of alignment with your set strategy.

“Regular reviews that focus on whether or not your asset mix is on target can help you know when to make adjustments so you can stick to your long-term plan,” said Ms. Ryan.

“Rebalancing aims to minimize risk rather than maximize returns,” Mr. Patel added.

Without rebalancing, “it’s possible for a portfolio to become overweighted with one type of investment. More often, this situation occurs with stock holdings when equity markets are strong. When stocks appreciate quickly and shift a portfolio’s balance, it’s more vulnerable to market corrections, putting it at risk of greater potential losses when compared with the original asset allocation,” Ms. Ryan said.

Minimize taxes

The saying, “Location, location, location” applies to more than just real estate. As Vanguard’s IRA investment research notes, the type of account in which you hold your assets can make a difference in the amount of taxes you owe.

“Investments that generate capital gains distributions or taxable income are better held in tax-advantaged accounts. For example, taxable bond returns are almost all income and thus subject to income taxes, so holding them in an IRA is a smart strategy,” said Mr. Patel.

Ms. Ryan added, “Conversely, tax-efficient investments make more sense held in taxable accounts. So it often makes more sense to hold equity index funds, which generally have less turnover and fewer capital gains distributions, in taxable accounts.”

Get help

If you need a sounding board as you complete the tasks on your to-do list, a financially savvy family member may fit the bill. An advisor can also serve as that sounding board. And, if you don’t have the inclination—or the time—to perform these steps, it makes sense to enlist professional help. (Vanguard has a team of financial planners, including Certified Financial Planner™ (CFP®) professionals, who don’t receive extra compensation for their recommendations; they work solely to help you reach your goals.)

Whether you work in partnership with a financial planner or act independently, checking these items off your to-do list can help you be more prepared for retirement.

* A Vanguard advisor may add about 3% on average to your net portfolio returns over time by following the Advisor’s Alpha principles discussed in Putting a value on your value: Quantifying Vanguard Advisor’s AlphaThis research isn’t an exact science. Potential value added relative to “average” client experience (in percentage of net return) is as follows: Investment coaching may add 1.50%; rebalancing your portfolio may add 0.35%; asset location between taxable and tax-advantaged accounts may add up to 0.75%; low-cost funds may add 0.45%; and tax-smart retirement spending may add up to 0.70%. It’s not added over a specific time frame but can vary each year, and according to your situation. It can be added quickly and dramatically—especially during times of a rapidly rising or falling market, when you may be tempted to abandon your well-thought-out investment plan—but it may be added slowly.

Notes:

  • Please remember that all investments involve some risk. Be aware that fluctuations in the financial markets and other factors may cause declines in the value of your account. There is no guarantee that any particular asset allocation or mix of funds will meet your investment objectives or provide you with a given level of income.
  • Advisory services are provided by Vanguard Advisers, Inc. (VAI), a registered investment advisor.

 

Protecting Your House from Medicaid Estate Recovery

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After a Medicaid recipient dies, the state must attempt to recoup from his or her estate whatever benefits it paid for the recipient’s care. This is called “estate recovery.” For most Medicaid recipients, their house is the only asset available.

Life estates

For many people, setting up a “life estate” is the simplest and most appropriate alternative for protecting the home from estate recovery. A life estate is a form of joint ownership of property between two or more people. They each have an ownership interest in the property, but for different periods of time. The person holding the life estate possesses the property currently and for the rest of his or her life. The other owner has a current ownership interest but cannot take possession until the end of the life estate, which occurs at the death of the life estate holder.

Example: Jane gives a remainder interest in her house to her children, Robert and Mary, while retaining a life interest for herself. She carries this out through a simple deed. Thereafter, Jane, the life estate holder, has the right to live in the property or rent it out, collecting the rents for herself. On the other hand, she is responsible for the costs of maintenance and taxes on the property. In addition, the property cannot be sold to a third party without the cooperation of Robert and Mary, the remainder interest holders.

When Jane dies, the house will not go through probate, since at her death the ownership will pass automatically to the holders of the remainder interest, Robert and Mary. Although the property will not be included in Jane’s probate estate, it will be included in her taxable estate. The downside of this is that depending on the size of the estate and the state’s estate tax threshold, the property may be subject to estate taxation. The upside is that this can mean a significant reduction in the tax on capital gains when Robert and Mary sell the property because they will receive a “step up” in the property’s basis.

As with a transfer to a trust, the deed into a life estate can trigger a Medicaid ineligibility period of up to five years. To avoid a transfer penalty the individual purchasing the life estate must actually reside in the home for at least one year after the purchase.

Life estates are created simply by executing a deed conveying the remainder interest to another while retaining a life interest, as Jane did in this example. In many states, once the house passes to Robert and Mary, the state cannot recover against it for any Medicaid expenses Jane may have incurred.

Trusts

Another method of protecting the home from estate recovery is to transfer it to an irrevocable trust. Trusts provide more flexibility than life estates but are somewhat more complicated. Once the house is in the irrevocable trust, it cannot be taken out again. Although it can be sold, the proceeds must remain in the trust. This can protect more of the value of the house if it is sold. Further, if properly drafted, the later sale of the home while in this trust might allow the settlor, if he or she had met the residency requirements, to exclude up to $250,000 in taxable gain, an exclusion that would not be available if the owner had transferred the home outside of trust to a non-resident child or other third party before sale.

Contact me to find out what method will work best for you.

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Medicaid Applicant’s Irrevocable Trust Is an Available Resource Because Trustee Can Make Distributions

medicare denial

An Alabama appeals court rules that a Medicaid applicant’s special needs trust is an available resource because the trustee had discretion to make payments under the trust. Alabama Medicaid Agency v. Hardy (Ala. Civ. App., No. 2140565, Jan. 29, 2016).

Denise Hardy inherited a one-half interest in a house and placed it in an irrevocable trust. The trust instrument stated that the trustee could distribute income to Ms. Hardy at the trustee’s discretion and that the trust was intended to be a special needs trust. Ms. Hardy entered a nursing home and applied for Medicaid. The state determined that the trust was an available resource.

Ms. Hardy appealed, and an administrative law judge agreed that the trust was an available resource. Ms. Hardy appealed to court, arguing that the trust was not available because it was irrevocable and could not be altered. The trial court reversed the state’s decision and ordered the state to pay Ms. Hardy benefits. The state appealed.

The Alabama Court of Civil Appeals reverses, holding the trust is an available resource. According to the court, a trust is an available resource if there is any circumstance under which payments can be made to the beneficiary, and that in this case, “if the house was sold and half of the proceeds of the sale were placed in the trust, the trustee could then make distributions as required by the terms of  [Ms.] Hardy’s trust.”

For the full text of this decision, go to: https://acis.alabama.gov/displaydocs.cfm?no=713449&event=4JX0KDU8D

8 Medicaid Planning Mistakes to Avoid: Click here

Additional Medicaid Planning questions? Click here

Regards,

Brian A. Raphan

 

Online Retirement Planning Calculators Measure Risk Poorly, Study Finds

If you are retired or are nearing retirement, the main questions on your mind are probably “Will I run out of money in retirement?” and “Will I be able to maintain my standard of living?” For answers, people often turn to free online retirement calculators that gauge how much users will need to save to achieve their retirement objectives, based on details about their finances.

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But how well do these calculators account for the inherent risks in retirement, such as how long you will live, how your investments will perform, what the inflation rate will be, and health care and long-term care costs? Not very well, according to a 2009 study by the Pension Research Council.

“We conclude,” the study’s authors write, “that on the whole, the tools do not highlight nor address retirement risk particularly well; rather, they mainly mask risk.”

The authors, retirement experts Anna M. Rappaport and John A. Turner, reviewed the available research on five leading Web-based calculators to see how they handle post-retirement risks. The calculators they looked at were Fidelity’s Retirement Income PlannerAARP’s retirement planning calculatorMetLife’s calculatorthe U.S. Department of Labor’s calculator and T. Rowe Price’s Retirement Income Calculator.

In their working paper “How Does Retirement Planning Software Handle Post-Retirement Realities?” Rappaport and Turner conclude that while the calculators “can provide a rough idea of whether the user is on target for retirement,” all inadequately assess the risk of running out of money.

For example, one calculator determines income sufficiency based on average life expectancy and overlooks the very real chances of living longer than the average. Another assumes that everyone, even if not married, receives the same Social Security benefits. Several do not permit calculations to take spouses into account. Among the authors’ other findings:

  • None of the consumer calculators they evaluated treat inflation as a risk, instead assuming that inflation is constant over the retirement period analyzed.
  • None treated expected medical and long-term care expenses as a risk factor or alerted users to the potentially huge impact such expenses could have on retirement plans.
  • Few have checks on inconsistent or outlandish assumptions. For example, many programs permit the user to specify long-term risk-free rates of return of 10 or even 20 percent.
  • Some calculators do not ask users to indicate expected inheritances or other one-time receipts of assets, and some do not include the value of housing as a source of retirement income.
  • Several of the programs ignore taxes, leading users to conclude that they have more retirement resources than they actually do.
  • The calculators cannot take account of extreme events such as the recent financial crisis, in which housing values have fallen and mortgage rates have risen — at the same time that people are losing jobs.

The authors note that “consumers or financial professionals working with them could benefit from trying alternative programs and scenarios within each program.”

The study also looked at retirement planning software for financial planning professionals. The authors concluded that while these tools are more complex than their consumer counterparts, they still contain flaws.

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How To Look Out for a Relative in a Nursing Home

The best ways to make sure your loved one gets the care that was promised.

Screen Shot 2015-12-16 at 9.31.06 PMvia U.S.News  Kurtis Hiatt

Finally, after ticking off the last item on a lengthy list of must-haves, you think you’ve found the best nursing home for your mom. The staff seems caring and professional. It’s comfortable, homey, and Mom is OK with it. She might even come to like her new life.

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But your work isn’t over. You want to make sure Mom gets the care you were told she’d receive—and the care she deserves. “The resident’s needs should be met by the facility, rather than having the patient meet the facility’s needs,” says Barbara Messinger-Rapport, director of the Cleveland Clinic‘s Center for Geriatric Medicine.

How do you make that happen?

What to ask
Start with your loved one. Isn’t Dad going to be your best source of information on his own care? “Ask the questions you would want to be asked if the roles were reversed,” says Cornelia Poer, a social worker in the Geriatric Evaluation and Treatment Clinic at Duke University Medical Center in Durham, N.C. Questions such as:

  • Are you comfortable?
  • Is anything worrying you?
  • Do you feel safe?
  • Do you feel respected?
  • If you need help and you push the call button, how long before somebody comes?
  • Have you gotten to know any of the other residents?
  •  Do you like the staff—and any staff member in particular?

That last point may seem small, but whether your loved one clicks with a specific caregiver is important, says David A. Nace, chief of medical affairs for UPMC Senior Communities, a long-term care network in western Pennsylvania that is part of UPMC-University of Pittsburgh Medical Center. It shows he’s making connections, growing in new social relationships. The trust that develops may also mean Dad takes his medication more reliably, or if behavioral issues stemming from dementia are a concern, it may be easier for one nurse than for another to manage them, says Nace.

Show interest and concern and identify major problems, but don’t go overboard. “Inquiries are important, but try to avoid turning every visit into an interrogation,” Poer says. “You will be able to determine if there are areas of concern in normal, everyday conversation.”

[Read: 9 Warning Signs of Bad Care.]

Some questions will be better directed at staff members, particularly if your loved one has a cognition problem such as dementia or Alzheimer’s disease. In the first days and weeks, the focus should be on the initial adjustment. Do Mom’s nurses see any signs of depression? Does she appear to be making the transition smoothly? If not, what, specifically, is being done to help her?

Then drill down to her day-to-day routine:

  • When is she up?
  • Are her meals appropriately prepared—soft or pureed food if she has trouble chewing, low in fat and salt if she has a heart condition?
  • Is she taking her medications when and as often as she should? (The timing of each medication should be documented.) If there’s been a consistent problem, how is that being addressed?
  • Is there a reason to change any of her medications?
  • Is she exercising or participating in other physical activities?
  • Is she social?

“I like to see if the patients are usually in their rooms,” says Susan Leonard, a geriatrician at Ronald Reagan UCLA Medical Center. “Not being in their rooms means they are participating in activities, dining, or in the hallway socializing with others, which may suggest a better social environment for residents.” But you’ll want to see for yourself whether empty rooms might only mean residents are parked on sofas and in wheelchairs elsewhere in front of TVs.

Don’t be afraid to broach more sensitive topics. If you were recently alerted of a behavioral issue or medical emergency, talk to both Mom and the staff to figure out whether it was handled properly. You want to know what the staff did and what changes in care they’ve made.

It’s helpful to have a main point of contact during the day’s various shifts. You should feel like you can call at any time, but Nace observes that it’s good to know up front what the best times are for getting general updates. And don’t settle for less than you need to know. If you don’t get an answer, head up the chain of command to a unit supervisor, assistant director, or director.

What to inspect
Getting a feel on your own for the overall environment goes a long way, says Audrey Chun, associate professor of geriatrics and palliative medicine at Mount Sinai Medical Center in New York. Are common areas, rooms, and residents’ clothes clean? What about lighting and temperature? These are especially important to older adults, says Poer. Does the room feel homelike? If you send cards, are they hanging on a bulletin board in the room?  If cards and drawings are up and Mom couldn’t put them up herself, that’s a great sign. “It means the staff took the time to do it for the resident,” Nace says. “The staff cared enough to do this.”

Look around. Do you see any safety hazards—a hanging TV that isn’t strapped down or blocked exits? What about bruises, such as on the upper arms where staff may have handled Dad too roughly? Watch the staff—are they affectionate, genuine, and helpful?

Use your nose. Are there odors in the hallways and rooms? “Yes, bowel movements happen—this is a long-established fact of life—but it should not be the thing that greets you every time you are in the hall,” says Nace.

Listen. Do you hear birds, music, laughter? Or do you hear creaky floors and clanging pipes? Constant small annoyances can affect a person’s mood and eventually her day-to-day demeanor.

How often to check in—and what to do if you can’t
Some homes have a “care conference” shortly after admission and then quarterly to give you and your loved one a regular time to talk with staff, says Nace. But stopping by on various days and at various times is smart. You can ensure Mom or Dad isn’t “overmedicated or spending time sitting in front of the TV,” says Messinger-Rapport. When you do check in, swing by the nurses’ station to signal to the staff that you’re actively involved in Dad’s care.  If distance keeps you apart, staff might be able to send you photos or videos of Dad or set up a videoconference with Dad and his caregivers. If you’re abroad, staff might be able to print out an email for Mom if she doesn’t have a computer, Nace says.

Better still, says Poer, “having someone on the ground to be your eyes and ears can be very useful.” Enlist a local family member or close friend. Or consider a case manager or ombudsperson to advocate for you and Mom.

What the staff needs from you
Make sure the home’s staff has a number where they can receive a prompt response if necessary. And while staff has a professional responsibility, your appreciation—particularly if someone worked with you to resolve a concern, and even if it meant you had to compromise—will go far. “Be respectful of the staff and their time; their job is very demanding,” Poer says.  Let the nurses and other caregivers into your and your loved one’s lives by sharing personality quirks, interests, preferences. But above all, stay optimistic about Dad’s future and his ability to accept and adjust to his new life. Flycasting for bass on the Susquehanna River, Nace’s dad’s longtime passion, faded into a treasured memory after he moved into a nursing home, traded in for newfound pastimes: baking and painting.

[See our other posts on legal issues and nursing homes]

Regards,

Brian

http://www.RaphanLaw.com

Financial Abuse of the Elderly: Sometimes Unnoticed, Always Predatory

Caution to elders and family members of elders. This happens too often:

Via The New York Times 11/27/15 Elizabeth Olson

It was only after Mariana Cooper, a widow in Seattle, found herself with strained finances that she confessed to her granddaughter that she was afraid she had been bilked out of much of her savings.

Over three years, Ms. Cooper, 86, had written at least a dozen checks totaling more than $217,000 to someone she considered a friend and confidante. But the money was never paid back or used on her behalf, according to court documents, and in early November the woman who took advantage of Ms. Cooper, Janet Bauml, was convicted on nine counts of felony theft. (She faces sentencing on Dec. 11.)

Ms. Cooper, who lost her home and now lives in a retirement community, is one of an estimated five million older American residents annually who are victimized to some extent by a caregiver, friend, family member, lawyer or financial adviser.

With 10,000 people turning 65 every day for the next decade, a growing pool of retirees are susceptible to such exploitation. As many as one in 20 older adults

said they were financially mistreated in the recent past, according to a study financed by the Justice Department.

Traditionally, such exploitation, whether by family, friends or acquaintances, often has been minimized as a private matter, and either dismissed with little or no penalty or handled in civil court.

Even when the sums are large, cases like Ms. Cooper’s are often difficult to prosecute because of their legal complexity and because the exploitation goes unnoticed or continues for long periods. Money seeps out of savings and retirement funds so slowly it draws attention only after it is too late.

Ms. Cooper, for example, wrote her first check, for $3,000, in early 2008, and later gave Ms. Bauml her power of attorney. In early 2012, after Ms. Cooper realized that Ms. Bauml was not going to repay her in time for her to afford a new roof for her house, she told her granddaughter, Amy A. Lecoq, about the checks. She later called the police.

Ms. Bauml maintained that Ms. Cooper gave her money for services she provided as a home organizer or as loans.

Later, testing by a geriatric mental health specialist found that Ms. Cooper had moderate dementia, which showed her judgment had been impaired.

The diagnosis “helped the jury to understand why she would keep signing all these checks to this woman as loans when she was never being paid back,” said Page B. Ulrey, senior deputy prosecutor for King County, Wash., who pressed the case against Ms. Bauml.

The case was challenging in part because Washington State does not have an elder abuse statute, said Ms. Ulrey, who is one of a small but growing number of prosecutors around the country with the specific duty of prosecuting those who take financial advantage of elders, whether it is connected to investments, contracts or other fraud.

As the number of complaints grows, more municipalities are trying to combat such abuse, which is often intertwined with physical or sexual abuse, and emotional neglect.

Some organizations also have set up shelters, modeled on those for victims of domestic abuse. In the Bronx, for example, the Weinberg Center for Elder Abuse Prevention at the Hebrew Home in Riverdale started such a shelter in 2005. Since then, 14 other such shelters have been opened in various long-term care operations around the country to deal with urgent cases of financial abuse.

One such woman, who agreed to talk only if she was not identified by her last name, stayed at Riverdale after she was threatened with eviction. A neighbor discovered that the woman, a 73-year-old widow named Irene, had not paid her rent in six months because relatives living with her had been withdrawing money from her account and leaving her short of funds.

“I had to leave with one small suitcase,” Irene said. “They were abusing me.”

She was later able to move to federally subsidized housing away from the abusive situation.

To help elders in financial and other distress, more municipalities, using federal funds, are training law enforcement officers, prosecutors, and social workers how to spot the sometimes subtle signals that may indicate someone has been swindled.

“We see many cases where someone convinces an older person to give them the power of attorney, and then uses that authority to strip their bank accounts, or take the title of their home,” said Amy Mix, a lawyer at the AARP Legal Counsel for the Elderly, which works with the Adult Protective Services division in the District of Columbia government as well as the city’s police department.

In the most recent fiscal year, 934 cases of abuse were reported in Washington. About one-quarter of those were financial exploitation, according to Sheila Y. Jones, chief of Adult Protective Services. “And they involve millions of dollars,” she said.

But many cases are not counted officially because older people are reluctant to pursue legal remedies against relatives and friends. Louise Pearson, 80, a retired government computer analyst, declined to press charges against a security guard in her building who had befriended her and later obtained $30,000 from her savings.

“There was something about him you just had to take to,” Ms. Pearson said.

When she finally asked Malika Moore, a social worker at Iona Senior Services in Washington, for some assistance with her shaky finances, the social worker realized that the situation was serious.

One clue, she said, was that, “When I opened her refrigerator, it was empty.”

Ms. Moore was able to get Ms. Pearson home-delivered meals, and after the bank confirmed that she was missing savings, help to find a conservator to handle her money. Ms. Pearson, who now lives in a housing complex for the elderly, said, “I get money whenever I need it, and more than I did before.”

In Seattle, Ms. Cooper’s granddaughter expressed determination to educate others on the warning signs of financial abuse. “I wish we had known some of the red flags,” she said.

But even though she’s a trained social worker, it’s not surprising she missed the signs. She was deeply involved in caring for her mother, Ms. Cooper’s daughter, who was fighting cancer and died shortly before the period when her grandmother was writing the checks.

“Our family saw her regularly,” Ms. Lecoq said, “but we just didn’t see indications of what was going on.”

In retrospect, she might have been more suspicious with “my grandmother suddenly having a new friend and a friend who got so close so fast.”

Once Ms. Lecoq and her husband, John, recognized what had happened, they pushed for prosecution. Ms. Ulrey, the prosecutor, said the case required medical tests and search warrants for both the victim’s and the suspect’s financial accounts.

Ms. Cooper was unable to recover her lost money and worries about how long she will be able to pay for her retirement home. “She’s ashamed and embarrassed and feels guilty,” Ms. Lecoq said of her grandmother. “But I tell her: ‘You were a victim of a crime.’”

To help older people, families and friends should be on the lookout for some of the warning signs of financial abuse. These include not being able to cover normal expenses; paying for excessive, unexpected gifts to others; and signing over power of attorney or transferring property to unrelated individuals. 

To learn more about protecting the savings of the elderly and helping them avoid being exploited financially, these publications are worth reading: 

Seeking long-term care? How your local Ombudsman can help…

    • OMBUDSMAN: What is the Program/Service   Via www.aging.ny.gov

      Educating, empowering and advocating for long-term care residents. The Ombudsman Program is an effective advocate and resource for older adults and persons with disabilities, who live in nursing homes, assisted living and other licensed adult care homes. Ombudsmen help residents understand and exercise their rights to good care in an environment that promotes and protects their dignity and quality of life.
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      The Ombudsman Program advocates for residents by investigating and resolving complaints made by or on behalf of residents; promoting the development of resident and family councils; and informing government agencies, providers and the general public about issues and concerns impacting residents of long-term care facilities.

      Mandated by the federal Older Americans Act, in New York the Ombudsman Program is administratively housed at the State Office for the Aging (NYSOFA), and provides advocacy services through a network of 36 local programs. Each local Ombudsman Program is lead by a designated ombudsman coordinator who recruits, trains and supervises a corps of volunteers, currently more than 1000 statewide. These certified volunteers provide a regular presence in nursing homes and adult care facilities are available to help residents with questions and concerns about their care and living conditions.

      Conversations with the ombudsman are confidential and residents or other persons can register a complaint anonymously. Ombudsmen handle a wide variety of complaints involving quality of care, residents’ rights, discharge, medications, lost or stolen items, dietary issues, and quality of life concerns. Ombudsmen can also provide information and consultation about how to choose a facility and how to pay for long-term care.

    • Who is Eligible?

      While the program serves all residents of licensed long-term care facilities regardless of age.

    • Is There a Cost?

      Ombudsman services are provided free of charge.

READ ABOUT PROTECTING YOUR ASSETS FOR YOUR FAMILY WHILE GETTING THE CARE YOU NEED