The Healing Power of Pets for Elderly People

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Via agingcare.com

For elderly pet owners, who often live alone or in group facilities, pets can help reduce stress, lower blood pressure, increase social interaction and physical activity and help them learn.

“A new pet can stimulate someone to read up on an animal or breed, which can be very mentally stimulating and important at that age,” says Dr. Katharine Hillestad, a veterinarian with the office of Doctors Foster and Smith in Rhinelander, Wis., which provides online advice and retails pet supplies and pharmaceuticals.

Pets provide other intangibles. “Dogs—and other pets—live very much in the here and now. They don’t worry about tomorrow. And tomorrow can be very scary for an older person. By having an animal with that sense of now, it tends to rub off on people,” says Dr. Jay P. Granat, a New Jersey psychotherapist.

And pets can reduce depression and lessen loneliness. “Older pet owners have often told us how incredibly barren and lonely their lives were without their pet’s companionship, even when there were some downsides to owning an active pet,” says Linda Anderson, who with husband Allen founded the Angel Animals Network in Minneapolis. The couple speaks about the joys of pet ownership and has authored books.

In Angel Dogs: Divine Messengers of Love (New World Library, 2005), the Andersons tell about Bonnie, a golden retriever Marjorie and Richard Douse adopted, which became an indispensable family member. “We never felt alone when Bonnie was in the house. As we aged and tended to go out less, she provided us with loving companionship,” the Douses say in the Anderson’s book.

Psychologist Penny B. Donnenfeld, who brings her golden retriever mix Sandee to her New York City office, has even witnessed her ability to rev up elder owners’ memories. “I’ve seen those with memory loss interact and access memories from long ago,” she says. “Having a pet helps the senior focus on something other than physical problems and negative preoccupations about loss or aging.”

Pets benefit, too, particularly when older folks adopt older pets. “These lucky pets go from the pound to paradise. Since most of the adopters are retired, they have lots of time to devote to a previously unwanted pet,” says Chicago veterinarian Tony Kremer, who with his wife Meg operates Help Save Pets—Humane Society, which operates adoption centers.

Here are some things caregiver’s should consider when purchasing a pet for their senior mom or dad.

  • Right pet for the right owner. But because people age so differently, the decision needs to be made carefully—and not just by grown loving children who think it sounds like a way to provide camaraderie. Because there’s no single right pet, ask the following questions to help narrow the field, says Dr. Donnenfeld.
  • Are you set in your ways? If you don’t like change, you may not be a good candidate, say the Andersons.
  • Have you had a pet before? Amy Sherman, a licensed therapist and author of Distress-Free Aging: A Boomer’s Guide to Creating a Fulfilled and Purposeful Life thinks it’s best if the elderly person is an experienced owner.
  • Do you have disabilities? Dogs can be wonderful companions who encourage a senior with no major physical limitations to walk and interact with others, Dr. Donnenfeld says. For those who are physically challenged, cats often need less care than dogs, she says. A small dog that’s paper-trained or an indoor bird is also sometimes preferable, she says.
  • Do you need a therapy pet? If the person is very infirm or impaired, they may be a candidate for an assistance or therapy dog to help them function or interact.
  • Is the pet the right age? A puppy or kitten may not be the best choice for elderly owners because of the care they require. A young pet may outlive its owner. Birds especially have long life spans. Yet, it’s also important that the pet isn’t too old since it may start to have physical limitations and get sick, Dr. Donnenfeld cautions.
  • Does the pet have a good temperament? Although some older owners may think a Great Pyrenees would be too big to handle, Daffron found one mixed two-year old so mellow that it would have been a good pet for a senior. “Many older people might think they’d do better with a Jack Russell terrier because it’s small but they are very, very, very high energy and require more effort and commitment. So much depends on personality,” she says.
  • Is the pet healthy? It’s important that any pet be examined by a professional. “You don’t want to compromise an older person’s immune system since some pets carry diseases,” says Dr. Hillestad.
  • One pet or two? While multiple pets can keep each other company, that may not be a good idea for an older person, says Dr. Hillestad. “Two puppies may bond with each other rather than with the owner,” she says.
  • Are finances an issue? Pets cost money. A small puppy can run more than $810 its first year for food, medical care, toys and grooming while a fish is less expensive–about $235, according to the American Society for the Prevention of Cruelty to Animals. If the pet takes ill, dollars snowball. Groups are available to help allay costs.

Susan Daffron, author of Happy Hound: Develop a Great Relationship with Your Adopted Dog or Puppy (Logical Expressions, 2006), has taken pets to nursing homes through shelter outreach programs. “I go down halls and people will say, ‘Oh, this looks just like my dog,'” she says. She has also helped elderly folks adopt the right animal. One woman, 86, wanted to be able to walk a dog but didn’t want a hyper pet. “She was good at judging her limitations,” Daffron says.

Angie Jones became interested in training therapy dogs after bringing her dog Hunter to visit her late father in a retirement home. “It took us half hour to get to my dad’s room because everyone stopped us along the way and wanted to pet the dog and tell me about their dog,” she says. “Hunter brought my father great joy and opened the door of communication since he was more of a recluse,” says Jones who started Central Ohio Good Shepherds, a chapter of Therapy Dogs International Inc.

Where to find the pet. While breeders are a good source, some shelters also provide a pet for less and offer the advantage of rescuing it from euthanasia. Purina Pets for Seniors partners with 200 shelters nationwide to provide seniors pet adoptions at a reduced cost (www.petsforpeople.com). Local services also exist such as Paws/LA in Los Angeles (www.pawsla.org).

Shelter employees often know the pet’s personality well and can make a good match, says Daffron. Online pet shopping is also possible, thanks to sites like www.petfinder.com, which pairs owners with 250,000 adoptable pets from 11,000 animal and rescue groups nationwide.

How to provide care long-term for a pet. Because an older owner may take ill or die, it’s important that the pet is provided for in a will and a caregiver named, says Dr. Hillestad. Even more basic is that someone knows that an elderly person has a pet. “If the person is rushed to the hospital, it could be left alone if nobody knows,” says Allen Anderson.

RELATED ARTICLES: HOW PET THERAPY HAS CHANGED ASSISTED LIVING

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When Is A Guardian Required for an Adult?

Guardianships are set up to protect and help people in need, such as an elder or loved one unable to care for their own financial or health related well being. When is it required? What is the process?

When is a Guardianship Required For An Adult?

It may be necessary to petition a court to appoint a legal guardian for persons: Who have a physical or mental problem that prevents them from taking care of their own basic needs; Who as a result are in danger of substantial harm; and Who have no person already legally authorized to assume responsibility for them. Under some circumstances, it may be necessary for a court to appoint an emergency guardian, who can act on your behalf during a crisis (such as immediately following a car accident) until you regain your ability to make your own decisions.

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How is a Guardian Appointed?

The precise procedure will vary to some degree from jurisdiction to jurisdiction. The typical steps are as follows:The person seeking the appointment of a guardian files a petition with the probate court for the jurisdiction where the allegedly legally incapacitated person resides. This petitioner is often a relative, an administrator for a nursing home or health care facility, or other interested person. A petition is ordinarily accompanied by medical affidavits or other sworn statements which evidence the person’s incapacity, and either identifies the person or persons who desire to be named guardian or requests the appointment of a public guardian.The court arranges for any necessary evaluation of the allegedly legally incapacitated person. Often, this will involve the appointment of a “guardian ad litem”, a person who is appointed to provide an independent report to the court on behalf of the allegedly legally incapacitated person.

If appointed, the guardian ad litem will meet with the allegedly incapacitated person, inform that person of his or her legal rights, and report back to the court on the person’s wishes. The guardian ad litem may also speak to the petitioner, to health care providers, and to other interested individuals in order to provide the court with full information about the allegedly incapacitated person’s condition and prognosis. Depending upon state law, the court may appoint a doctor or professional to examine the allegedly incapacitated person. If the person contests the appointment of a guardian, a trial is scheduled during which sworn testimony will be given, and at the conclusion of which the judge will decide if the petitioner met the requisite burden of proof for the appointment of a guardian. The allegedly incapacitated person is ordinarily entitled to appointed counsel, if unable to afford a private attorney.If the allegedly incapacitated person consents to the petition, or is unable to respond to inquiries due to disability, the court will hold a hearing at which witnesses will provide sworn testimony to support the allegations in the petition. If the evidentiary basis is deemed sufficient, the guardian will be appointed.If a guardian is appointed, the judge will issue the guardian legal documents (often called “letters of authority”) permitting the guardian to act on behalf of the legally incapacitated person.What Are a Guardian’s Duties?The guardian makes decisions about how the person lives, including their residence, health care, food, and social activity. The guardian is supposed to consider the wishes of the incapacitated person, as well as their previously established valued, when making these living decisions. The guardian is intended to monitor the legally incapacitated person, to make sure that the person lives in the most appropriate, least restrictive environment possible, with appropriate food, clothing, social opportunities, and medical care.A guardian may be required to post a bond, unless the requirement is waived by the court. In most jurisdictions where bond is required, waivers are routine.

What’s the purpose of court supervision?

The court supervises the guardian’s choices on behalf of the ward. After the initial appointment of a guardian, an initial review is usually scheduled, followed by annual reports by the guardian to the court. The purpose of this supervision is to ensure that the legally incapacitated person is in fact benefiting from the most appropriate, least restrictive living environment possible, with appropriate food, clothing, social opportunities, and medical care.

Avoiding Guardianship:

It is possible to avoid the necessity of a guardianship through estate planning. A good estate plan will include a medical power of attorney which will enable a trusted individual to make health care decisions for you in the event of incapacity, and a general durable power of attorney to permit a trusted individual to manage your personal affairs. To a considerable extent, those documents can specify how you wish to live, and how you wish to be treated, in the event of disability – whereas a court or guardian may make decisions with which you would disagree. In most cases, when these documents have been executed in accord with the laws of your state, it will not be necessary for your loved ones to seek the appointment of a guardian or conservator should something happen to you – something that can be cumbersome and emotionally taxing at an already difficult time.

8 Things Seniors Should Remember at Tax Time

April 15th is approaching and it is time to begin crossing T’s and dotting I’s in preparation for paying taxes. As tax time draws near, you want to make sure you file all the proper forms and take all deductions you’re entitled to. Following are some things to keep in mind as you prepare your tax form.

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  • Gifts. Did you give away any money this year? The gift tax can be very confusing. If you gave away more than $14,000 in 2015, you will have to file a Form 709, the gift tax return. This does not necessarily mean you will owe taxes on the money, however. Click here for more information.
  • Medical Expenses. Many types of medical expenses are tax deductible, from hospital stays to hearing aids. To claim the deduction, your medical expenses have to be more than 10 percent of your adjusted gross income.  (For taxpayers 65 and older, this threshold will be 7.5 percent through 2016.) This includes all out-of-pocket costs for prescriptions (including deductibles and co-pays) and Medicare Part B and Part C and Part D premiums. (Medicare Part B premiums are usually deducted out of your Social Security benefits, so be sure to check your 1099 for the amount.) You can only deduct medical expenses you paid during the year, regardless of when the services were provided, and medical expenses are not deductible if they are reimbursable by insurance. Click here for more information.
  • Parental Deduction. If you are caring for your mother or father, you may be able to claim your parent as a dependent on your income taxes. This would allow you to get an exemption $4,000 (in 2015) for him or her. Click here for more information.
  • Long-Term Care Insurance Premiums. Premiums for “qualified” long-term care policies are treated as an unreimbursed medical expense. Long-term care insurance premiums are deductible for the taxpayer, his or her spouse and other dependents. Click herefor more information.
  • Social Security Benefits. Although Social Security benefits are generally not taxable, people with substantial income in addition to their Social Security may pay taxes on their benefits. If you file a federal tax return as an individual and your “combined income,” including one half of your Social Security benefits and nontaxable interest income is between $25,000 and $34,000, 50 percent of your Social Security benefits will be considered taxable. If your combined income is above $34,000, 85 percent of your Social Security benefits is subject to income tax. Click here for more information.
  • Home Sale Exclusion. Married couples can exclude from income up to $500,000 in profit on the sale of a home ($250,000 for single individuals). If a surviving spouse sells the home, he or she can still claim the exclusion as long as the house was sold no more than two years after the spouse’s death. Click here for more information.
  • Elderly or Disabled Tax Credit. Some low-income elderly or disabled individuals are entitled to a special tax credit. To be eligible, you must meet income limits. For more information, click here.
  • Tax Refunds. Getting a federal tax refund should not affect your Medicaid or Social Security benefits. For a year after recieving a tax refund from the federal government, the refund will not be considered income or resources for SSI or Medicaid purposes. You can also transfer the refund within a year without incurring a penalty. For more information, click here.
The IRS’s Tax Counseling for the Elderly (TCE) Program offers free tax help to taxpayers who are 60 and older. For more information, click here. The IRS also publishes a Tax Guide For Seniors.

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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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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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Choosing a trustee and an executor

The requirements for a trustee and how to choose one

How do you choose a trustee? What qualities should a trustee have? Alisa Shin and Sarah Price of Vanguard Advice Services discuss the requirements for a trustee and how to go about choosing one.

Video: https://personal.vanguard.com/us/insights/video/3437-Retail-Exc3

Transcript:

Liz Tammaro: And, Alisa, what are the pros and cons of creating a trust?

Alisa Shin: That’s a great question. People hear the word “trust,” and they automatically think of controlling people, and that’s not necessarily true. There are a lot of different types of trusts. I think most trusts that people are familiar with are trusts that are irrevocable, trusts that can’t be changed. And for a lot of people, that’s scary because they end up—They think they’re going to create this document that will date back to the dinosaur age, and, you know, they can’t ever change it again, and so they have to live with it. And that’s not necessarily true.

Trusts, irrevocable trusts, are really used for many reasons. One, obviously, if you have children or beneficiaries who are young and who can’t manage the money, a trust is a way to protect that money, to put a structure in place for the investment management and the management of how the assets are distributed to the beneficiary. And you can time it out so that a 15-year-old isn’t getting a large sum of money, and they can get it at a more appropriate time.

The more common reasons why people also use trusts is, one, to provide asset protection. A properly drawn irrevocable trust can protect those assets from future creditors in case the beneficiary gets sued, and a future creditor can also mean a divorcing spouse. So even if a beneficiary doesn’t have a prenuptial agreement, an irrevocable trust, if it’s drawn up correctly, could protect those assets so the divorcing spouse could not get those assets.

Liz Tammaro: And I’m hearing you say irrevocable doesn’t necessarily mean not changeable, right?

Alisa Shin: Correct. So there’ll be restrictions as to who could make the change, but a lot of times, when we talk with clients here at Vanguard, we really encourage clients because we just don’t know what the future is going to entail, to empower a beneficiary to have the ability to change the terms of the trust and determine who should get it at the beneficiary’s later passing, at their death.

And that’s typically called a testamentary limited power of appointment. It’s limited because you can decide who could receive the money. You could say that your child could give it to anybody they would like, or you could say that they can only give it to their descendants or charitable organizations. You can make it as broad or as restrictive as you would like.

Liz Tammaro: Okay, so you talked about some of the benefits of a trust. How about, are there any drawbacks to creating trusts?

Alisa Shin: You know, the drawbacks of creating a trust, it creates a little bit of a complexity in your life. When someone has a trust, that trust is a separate taxpayer, technically. It will have a second taxpayer identification number. So that means that that trust will have to file its own income tax returns, meaning the trustee will do that for them. It will have a separate account that won’t be combined into your own personal account because you want that to make sure that it stays protected from future creditors and so forth for the reasons we discussed.

Sometimes, depending on who your trustees are, there are additional costs associated with the trust. You need to, if you have a professional trustee serving, they might charge a commission. Clearly, if you have an accountant who’s preparing the tax return, there’s going to be one additional tax return that needs to be prepared for that trust.

Liz Tammaro: And one other thing, I’ll just open this up to both of you. I heard you say that it’s really important that it’s drawn up properly. Talk to me a little bit more about what you mean there?

Alisa Shin: In terms of, I assume, asset protection and so forth?

Liz Tammaro: Yes, the trust. You said it’s really important that it must be drawn up properly; the document must be— What do you mean by that?

Alisa Shin: There are certain provisions, something called a spendthrift provision that would need to be included in the document. I would say, in today’s day and age, a spendthrift provision is almost always in every trust document. But the other part of drawing it up properly is understanding what impact guaranteeing money from the trust would have for your beneficiary.

So if you create a trust that says, “Pay the income to my beneficiary every month,” because that’s a guaranteed income stream, that income stream loses its protection from a future creditor. Whereas, if the trust said, “The trustee has the discretion to use the income for my beneficiaries’ benefit,” that gives it a more solid layer of protection from a future creditor or a divorcing spouse.

So when you think about asset protection, divorce protection, it’s really a balancing game between giving your beneficiary access to the money and some comfort knowing that he or she might be able to get the money that they needed versus leaving it to a trusted advisor, a trusted family friend to make sure those assets are protected.

Important information

All investing is subject to risk, including the possible loss of money you invest. Diversification does not ensure a profit or protect against a loss.

This hangout is for educational purposes only. We recommend that you consult a tax or financial advisor about your individual situation.

Read more on the subject: Download Free Probate Guide.

Careful…Gifting To Family Can Affect Medicaid Eligibility

By Matthew S. Raphan, Esq.  Attorney at The Law Offices of Brian A. Raphan, PC

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View image | gettyimages.com

Every so often a client says to me, “I’ve been gifting money to my children and grandchildren so I can apply for Medicaid.” While gifting may offer benefits to you and your family, if you think you may someday apply for Medicaid benefits, you should be aware that giving away money or property can interfere with your eligibility.

Under federal law, if you transfer certain assets within five years prior to applying, you may be ineligible for Medicaid benefits for a period of time. This is called a transfer penalty, and the length of the penalty depends on the amount of money transferred. (This waiting period can also be costly as you may pay for your care out of your own pocket.) Even small transfers can affect eligibility. Although federal law currently allows individuals to gift up to $14,000 a year without having to pay a gift tax, Medicaid still treats that gift as a transfer.

Any transfer that you make, however nominal, may be scrutinized. For example, Medicaid does not have an exception for gifts to charities. If you make a charitable donation, it could affect your Medicaid eligibility down the road. Similarly, gifts for holidays, weddings, birthdays, and graduations can all trigger a transfer penalty. If you buy something for a friend or relative, this could also result in a transfer penalty.

Some people have the notion that they can also go on a spending spree for themselves or family. Not so fast. Spending a large sum of cash at once or over time may prompt the state to request documentation showing how the money was spent. If you don’t have receipts showing that you received fair market value in return for a transferred asset, you could be subject to a transfer penalty.

While most transfers are penalized, certain transfers are exempt from this penalty. For example, even after entering a nursing home, you may transfer any asset to the following individuals without having to wait out a period of Medicaid ineligibility:

  • your spouse;
  • your child who is blind or permanently disabled;
  • a trust for the sole benefit of anyone under age 65 who is permanently disabled.

In addition, you may transfer your home to the following individuals (as well as to those listed above):

  • your child who is under age 21;
  • your child who has lived in your home for at least two years prior to your moving to a nursing home and who provided you with care that allowed you to stay at home during that time;
  • your sibling who already has an equity interest in the home and who lived there for at least one year before you moved to a nursing home.

Before transferring assets or property, check with us or your elder law attorney to ensure that it won’t affect your Medicaid eligibility.

For more information on Medicaid’s transfer rules, click here.

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If you have a question you can send us a message here.

State Not Required to Treat Medicaid Applicant’s Multiple Transfers as One Transaction

A Kentucky appeals court rules that a Medicaid applicant’s penalty period is appropriate because the state is not required to treat multiple transfers as a single transaction when the transfers are not related. Marcum v. Commonwealth (Ky. Ct. App., No. 2014-CA-000487-MR, April 10, 2015).

In July 2011, Betty Marcum applied for Medicaid and the state imposed a penalty period based on a transfer of assets. During the penalty period, Ms. Marcum sold her home and transferred the proceeds into an irrevocable trust, with her family gifting a portion of the money back to her. She also made other transfers from her bank account. In June 2012, Ms. Marcum applied for Medicaid benefits again. The state imposed a second penalty period, running from the date of the second application.

Ms. Marcum appealed, contending that the state incorrectly calculated the penalty period. The state’s Medicaid operations manual requires that multiple related transfers be counted as a single transaction that occurred on the date of the first transfer and that once a penalty period has been established, it runs until expiration. Ms. Marcum argued that these provisions required the state to treat all of the disqualifying transfers together in a single penalty period. A state appeal board upheld the imposition of the second penalty period, and a trial court affirmed.

The Kentucky Court of Appeals affirms, holding that because Ms. Marcum’s second application involved transfers that were not related to the first penalty period, the state was not required to treat the transfers as a single transaction. The court rules that the state cannot “simply recalculate the first disqualification period to include transactions occurring after that period was imposed.” Similarly, the state cannot allow “the first disqualification period to be modified after it had expired.”

Remember, although federal funded, Medicaid rules do vary by state. For a free initial consultation or more information on how to protect and preserve your assets with Medicaid Planning, click here.

Tips for Seniors in Preparing their Taxes

As April 15th is around the corner, the IRS has these tips for seniors preparing their taxes:

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Current research indicates that individuals are likely to make errors when preparing their tax returns. The following tax tips were developed to help you avoid some of the common errors dealing with the standard deduction for seniors, the taxable amount of Social Security benefits, and the Credit for the Elderly and Disabled. In addition, you’ll find links below to helpful publications as well as information on how to obtain free tax assistance.

Standard Deduction for Seniors – If you do not itemize your deductions, you can get a higher standard deduction amount if you and/or your spouse are 65 years old or older. You can get an even higher standard deduction amount if either you or your spouse is blind. (See Form 1040 and Form 1040A instructions.)

Taxable Amount of Social Security Benefits -When preparing your return, be especially careful when you calculate the taxable amount of your Social Security. Use the Social Security benefits worksheet found in the instructions for IRS Form 1040 and Form 1040A, and then double-check it before you fill out your tax return. See Publication 915Social Security and Equivalent Railroad Retirement Benefits.


Credit for the Elderly or Disabled – You must file using Form 1040 or Form 1040A to receive the Credit for the Elderly or Disabled. You cannot get the Credit for the Elderly or Disabled if you file using Form 1040EZ. Be sure to apply for the Credit if you qualify; please read below for details.

Who Can Take the Credit: The Credit is based on your age, filing status and income. You may be able to take the Credit if:

Age: You and/or your spouse are either 65 years or older; or under age 65 years old and are permanently and totally disabled.

AND 

Filing Status: Your income on Form 1040 line 38 is less than $17,500, $20,000 (married filing jointly and only one spouse qualifies), $25,000 (married filing jointly and both qualify), or $12,500 (married filing separately and lived apart from your spouse for the entire year).

And, the non-taxable part of your Social Security or other nontaxable pensions, annuities or disability income is less than $5,000 (single, head of household, or qualifying widow/er with diependent child); $5,000 (married filing jointly and only one spouse qualifies); $7,500 (married filing jointly and both qualify); or $3,750 (married filing separately and lived apart from your spouse the entire year).

Calculating the Credit: Use Schedule R (Form 1040 or 1040A), Credit for the Elderly or Disabled, to figure the amount of the credit.  See the instructions for Schedule R (Forms 1040 or 1040A) if you want the IRS to figure this credit for you.

Also see Publications 524 (Credit for the Elderly or Disabled); and 554 (Tax Guide for Seniors). 

Free IRS Tax Return Preparation –  IRS-sponsored volunteer tax assistance programs offer free tax help to seniors and to low- to moderate-income people who cannot prepare their own tax returns.

If you have recently done some Estate Planning, check with us and your accountant to make sure you are filing your returns properly.

FREE ESTATE PLANNING GUIDE

Regards, Brian

The Law Offices of Brian A. Raphan, PC

Bed and/or Chair Rest + Neglect = Bedsores

Article by Brian A. Raphan. Published 3/17/15 in ‘THE DOCTOR WEIGHS IN’

When a patient develops pressure ulcers, it is often a sign of neglect and can even be the result of hospital malpractice, nurse malpractice or nursing home negligence.

Any time a patient is confined to a bed or chair for a period of time and not provided proper and adequate care, the risk of pressure ulcers increases.

The National Pressure Ulcer Advisory Panel (NPUAP) defines a pressure ulcer as a “localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear.” Illustrations of the stages of pressure ulcers are shown below:

stages of bedsores

Sadly, pressure ulcers are the underlying cause of mortality and morbidity for several thousand patients across the country each year. Researchers analyzing the national Medicare Patient Safety Monitoring System (MPSMS) database found that the nationwide incidence rate for hospital-acquired pressure ulcers was 4.5 percent. The five states with the highest incidence rates are New York (5.2%), Missouri (5.3%), New Jersey (5.3%), Massachusetts (5.5%) and Pennsylvania (5.9%).

The federal government, in its first year of a federal initiative to improve patient safety, recently imposed penalties aimed at reducing preventable harm. Five states saw a significant percentage of hospitals being penalized: New York, where 26% of hospitals were penalized by having their Medicare reimbursements cut by 1%; Missouri, 25%; New Jersey, 37%; Massachusetts, 22%; and Pennsylvania, 25%.

In New York State, penalized hospitals included some well-known healthcare facilities, such as Beth Israel Medical Center and New York University Langone Medical Center.

All sedentary patients are vulnerable, but the elderly and patients whose skin condition has been compromised are especially at risk. Pressure ulcers are most common on bony prominences with little protective fat or muscle (such as heels, hips, shoulders, and tail bones), and they develop when patients stay in one position for too long without shifting their weight. The constant pressure against the skin reduces blood flow to contact areas. The skin begins to break down and the tissue dies, possibly in a matter of hours. Friction and shear caused by sliding down in the bed, or being moved improperly from a stretcher to a bed can exacerbate the problem. Pressure ulcers slow a patient’s recovery, can lead to other issues and infection and prolong hospital stays. The total annual cost for treating pressure ulcers in the U.S. is estimated at $11 billion. However, pressure ulcers (also known as bedsores and decubitis ulcers) are preventable.

To prevent pressure ulcers and damage to the skin, recent NPUAP recommendations can be summarized in seven steps:

prevent bedsores

Because these seven steps are so easy to follow, when a patient develops pressure ulcers, it is often a sign of neglect and can even be the result of hospital malpractice, nurse malpractice or nursing home negligence.

Upon admission to a hospital for another health concern the issues can go unnoticed, allowing further damage to take place in a relatively short time. This also creates liability on the part of the hospital.

In many lawsuits that we handle, the hospital is dealt a bad hand by receiving a patient from a nursing home where a skin breakdown or pressure ulcer has already begun. At times, due to dementia for example, a patient may not be able to express or know how to communicate pain upon entering the hospital. However, this is no excuse for not identifying a high-risk patient and making regular daily assessments.

To be clear, pressure ulcers are not the fault of the patient. The patient is a victim. Medical negligence by a hospital, doctor, nurse, aide or medical technician is unacceptable and may be the cause of pain and suffering, or even result in death. It is simply not acceptable for patients to develop bedsores or pressure ulcers while they are in the care of medical professionals and receiving medical care and treatment at a facility.

There is no doubt that hospitals and staff, from talented skilled doctors, nurses and medical professionals to support staff and administration, do their best to help and treat patients. However, protocols exist in every facility, and perhaps, it is just a matter of every individual being a bit more aware, and caring just a little more, when dealing with the elderly and at-risk patients.

By Brian A. Raphan (Principal Attorney, Law Offices of Brian A. Raphan, P.C.

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