Tag Archives: Long Term Care

Financial Planning when Dealing with Dementia

Learn more about Massachusetts estate planning when dealing with dementia.Dementia is a heart-breaking mental condition that only worsens over time. When doctors diagnose dementia, it is important to start planning for the financial complications that may arise. Creating a will and setting up a power of attorney is essential for the future. Financial planning must consider all of the possible challenges that may arise, including the possibility that loved ones will need to make hard medical decisions.

Setting up a Will

In many cases, the first consideration after a diagnosis of dementia is the will and power of attorney. Working with a Massachusetts estate planning attorney can help simplify the process of setting up a will and getting legal affairs in order before the medical condition makes it impossible to personally develop a plan.

A Massachusetts estate planning lawyer can offer valuable legal advice about the best ways to prevent belongings from going into probate. It is also helpful to set up power of attorney in case it is not possible to make medical or financial decisions in the future. The attorney will help develop a plan based on personal concerns and goals.

Preparing for Medical Costs

Medical costs will increase as dementia develops. Depending on the situation and the progress of the disease, it may be necessary to go into a nursing home or a long-term care facility. While long-term care insurance can help alleviate some of the burden of the cost, it may not provide enough funds. After determining how the insurance coverage works, create a financial plan based on the remaining expenses.

Compare the Options for Long-Term Care

The cost of long-term care may vary based on the facility that is providing the service and the amount of care that is provided. Look into several options and discuss the costs with loved ones, an attorney and a medical professional.

Taking measures to compare the health-care options, obtain insurance coverage and set up a will before the disease can worsen will make the financial complications easier to manage. Financial planning must factor in long-term care, insurance coverage and the current financial situation before it is possible to make adjustments to ensure the future is secure.

Long-term Care Planning and the Responsibilities of Being the Family Caregiver

Contact Adam Tobin Law Offices for more information about Massachusetts Elder Law.It’s a subject that most of us don’t want to think about – end-of-life care for our loved ones. However, they depend upon us to make the correct decisions so they don’t worry about neglect or abuse in their final days. Before your loved one gets to the point that they need round-the-clock care, you should seek the services of a Massachusetts elder law attorney or estate planning attorney to help you with the important decisions and get them in writing.

Long-Term Planning

Some of the things that you need to plan for are housing, finances and funeral expenses. Ensure that you get your loved one’s wishes in writing, and have a trust set up to deal with these expenses. An elder lawyer can help you with the necessary documents. Your elder attorney can also advise you of any issues you need to be aware of, and trust laws in your state. You’ll also want to set up a living will so your loved one can be assured that their estate will be handled properly.

Responsibilites of the Family Caregiver

When your loved one enters the twilight years, you will be expected to carry out a few responsibilities as the family caregiver. You’ll be in charge of handling the finances – seek a living trust attorney to assist you with this. You’ll also be in charge of checking on your loved one and making sure they receive the proper care.

Massachusetts Elder Law Planning for Long-term Care

longtermcare-elder-lawElder law attorneys in Massachusetts can help you solve issues regarding long-term care arrangements. If you are not proactive and speak to a Massachusetts elder lawyer early on, long-term care costs can deplete the estate of you or your loved ones. Although insurance may help assuage some of the financial burden, an estate planning attorney can present different options to you.

Long –Term Care Insurance Policies

As part of your estate planning, you may decide to take out an insurance policy in the case you or a loved one requires extensive medical care in a long-term facility. Policies available cover nursing home care and assisted living costs. Your elder lawyer can include policy terms in your living will along with give you advice on how to select the best policy. Since you may not need long-term insurance for years, choose an established insurance provider with a long track record of honoring claims. A Massachusetts elder attorney is likely to point out the importance of an inflation rider that allows the benefit amount to increase each year. If you need long-term care in 10 or 20 years, you want to make sure the coverage you have is sufficient.

Getting Your Wishes Granted

An elder attorney ensures that you or your loved one gets the care you want and deserve. In your living will, you could instruct your loved ones on the type of facility you want to be placed. A list of facilities and nursing care providers can also be listed in a long-term care plan. Your attorney also helps you find the funds from your estate to pay for long-term care if required. All monies are reviewed during your consultation to make the smartest financial decisions. Monies used for long-term care can come from medical insurance, reverse mortgages, long-term care insurance, veteran’s benefits, income and savings.

Documents You Need

Telling your children or grandchildren your wishes for long-term care is not enough. A MA elder care lawyer assures all documentation is filed and legally-binding. Your attorney can draw up your last will and testament, living will and power of attorney documents. In your documents, you could also designate a personal care coordinator. This person is in charge of making the decisions when you are medically incapacitated due to old age or disease.

Speak to a MA elder lawyer early on to avoid financial disaster. Nursing homes and assisted living facilities cost hundreds of thousands of dollars if used for long-term care. Avoid losing your entire estate by planning for this possibility with an elder law attorney.

Housing Options for Senior Citizens

Is staying at home still the best option for your elderly parents? Certain circumstances may have made you realize that this is no longer the case. Perhaps they have grown incapable of taking care of themselves in addition to their home. This could be the result of changing physical, mental, or financial conditions. Now you’re faced with the decision of how to go about providing the best opportunity for your parents to lead a comfortable lifestMassachusetts Retirement Communityyle. Before you try to swoop in and save the day, make sure to include you parents in the decision-making process. Ultimately, it’s their life and you need to be sure to recognize and respect their personal wants and needs. Now that you’ve got the conversation started it’s time to evaluate the various alternatives:

Retirement Community. Otherwise known as an Independent Living Community or Congregate Living, this may be the best option if your parents are still fairly independent – meaning that they don’t need help with daily activities, such as getting dressed, bathing, feeding themselves, etc. – but desire the security and convenience of a community. Some of these communities offer organized social and recreational activities, while others offer amenities such as housekeeping and transportation. Other amenities may include swimming pools, exercise facilities, clubhouse, laundry facilities, and access to meals. However, be aware these types of communities do not offer medical care to residents and there is also usually an age requirement (typically 55).

Assisted Living Community. These living communities aim to provide as much independence to the residents as possible in a private setting. These communities are designed for senior citizens who cannot safely live completely independently, but do not require the high level of care of nursing homes. Although 24-hour support services and licensed nurses are often provided, assisted living communities are not considered medical facilities and do not accept Medicare or Medicaid as payment. Also, amenities such as housekeeping, social activities, transportation, aMassachusetts Home Carend meals are also usually offered.

Nursing Home. Nursing homes cater to elderly citizens who can no longer care for themselves and require 24-hour professional care. Long-term residents generally require a high level of care and may have complex medical conditions. Nursing home residents receive in-house medical care, rehabilitation, physical and other types of therapies. Some facilities concentrate treating those with Alzheimer’s Disease, cancer, dementia or other special health situations.

Home Care. Home care is designed to allow senior citizens to maintain a feeling of independence while still receiving the care that they require. Many home care nurses will come in on an agreed upon schedule, while others may live in the home in order to provide the highest level of care possible. This type of care typically includes help with daily activities, paying bills, making appointments, providing transportation, and providing companionship and emotional support to the individual.

After gathering all of the information about the best options in your area, your parents’ living preferences, and your financial position, you can make a decision. To help understand your parents’ rights and obligations throughout this process, consult an elder law attorney. Contact the law offices of Adam J. Tobin today for more information!

How to Cut Elder-Care Costs

Consult an elder law attorney for assistance on cutting elder-care costs

Consult an elder law attorney for assistance on cutting elder-care costs.

There is a generation that is sometimes referred to as “the sandwich generation;” these are the people who have to care not only for their children, but for their elderly parents as well. It is a hard and multi-dimensional job, with declining retirement savings and health care costs skyrocketing to worry about for their parents, and college tuition and all the additional costs that come with raising a child.

To help you better manage the costs of caring for an elderly loved one, follow these helpful tips:


It never hurts to ask. Try negotiating with a facility on pricing, especially if they are not filled to capacity. Donna Schempp, program director for the nonprofit, Family Caregiver Alliance, says it’s “worth the conversation, particularly if your parent is already there and they’d have to move out.”

Offer to Share a Room.

Some assisted-living facilities set aside a certain number of rooms to share for lower-income seniors who cannot afford the full fee. Mary Winners, owner of About Senior Solutions, knows of some facilities that could charge as low as $1,300 to $1,700 per person for a shared room, as opposed to those who spend $2,500 to $3,500 on a private room.

Hire a Geriatric-Care Manager.

A geriatric-care manager can do everything from assessing your parent’s long-term care needs and finding them a place to live, to helping you navigate the complicated health-care system. They can also save you lots of time and money in the long run, making their fees, which range from $80 to $200 an hour, seem a lot more satisfying.

A situation where a geriatric-care manager would be helpful would be if you did not live close to your aging parent and they needed regular assistance. A manager may be better able to find a high-quality assisted living facility near her home that’s financially supported by the community. They know what is out there and will be better equipped to negotiate on your behalf.

Managers can also serve as a mediator if family members are in conflict over an elderly relative, which on its own; can save you plenty of time and headaches.

Adult Day Care

If you work during the day, and your elderly parent cannot be left at home alone, enrolling them in an adult day care program is a lot more affordable than private, in-home care. Fees for adult day services vary, but the national average rate is $64 a day, compared to the hourly rate of $20 (or $160 for an eight-hour day) for home health aides, according to a 2008 MetLife study.

Hire a Part-Time Caretaker

For seniors who do not require close or full-time supervision, hire someone to regularly check in and spend some time with your parent. It could be anyone from a neighbor to a friend or family member. If your mom or dad lives near a university, hire a student to do things such as grocery shopping, cleaning, and meal preparation, as well as provide companionship. It will only cost you about $15 an hour for such services.

Caring for an elderly parent can be emotionally, physically, and financially draining at times. By following these helpful tips, hopefully at least the financial burden will seem a little less intimidating. If you have any other questions regarding elder care or elder law, consult a qualified elder law attorney, like Adam Tobin, to assist you with any questions or concerns you may have.

Reasons to Create an Irrevocable Trust


An Irrevocable Trust is a trust that cannot be changed once it is created, and once you transfer an asset into that Trust, you usually cannot remove it. They are used for very specific reasons for the most part, and some of these reasons are:

You want to protect assets from having to be spent on long-term care costs.

The average cost of nursing home care in MA is about $10,000 per month with three ways to pay for it: 1)long-term care insurance; 2)private pay (writing a check each month); or 3)Medicaid, the state and federally-funded program that pays for long-term nursing home care if a person is both medically and financially eligible. In order to be considered financially eligible, a person cannot have more than $2,000 in so-called countable assets, and to prevent people from giving away their assets in order to qualify for benefits, Medicaid imposes a period of ineligibility following the gratuitous transfer of an asset. The ineligibility period for giving away assets is normally five years from the date of the gift. For those who feel confident that nursing home care will not be needed for more than five years, transferring assets to an Irrevocable Trust can be an effective way to preserve assets for children.

You want to keep life insurance proceeds from being taxable in your estate.

Although the new federal tax law enacted on December 17, 2010 exempts estates valued at less than $5 million from federal estate tax, Massachusetts imposes an estate tax on estates valued at $1 million or more. One common estate tax planning strategy is to buy life insurance so the surviving family members don’t have to liquidate real estate or borrow money to pay the estate tax. While life insurance proceeds are not taxable income to the person who receives them, life insurance is a taxable asset in the estate of the insured if that person is also the owner of the policy. If instead an Irrevocable Life Insurances Trust (otherwise known as an ILIT) owns the life insurance policy, the proceeds are not part of the insured’s estate.

You want to make qualifying annual exclusion gifts to minors.

Many people know they can make annual gifts of a certain amount each calendar year to any number of people without estate or gift tax consequences. Currently, the annual exclusions gift is $13,000 per calendar year per person. To qualify as an annual exclusion gift, it must be a “present interest” gift, meaning the recipient must have immediate access to and control over said gift. Parents and grandparents may want to give gifts to minor children and grandchildren, but don’t necessarily want the child to have access to funds at a young age. There is a special type of Irrevocable Trust allowed under the Internal Revenue Code that addresses this issue, which means if the Trust is properly drafted; the gifts to the Trust will qualify for the annual gift tax exclusion. However, the beneficiary’s right to gain access to the funds is restricted until the beneficiary reaches the age of 21.

You want to protect governmental benefits for a person with disabilities.

Individuals with disabilities may be eligible for a variety of governmental benefits that provide income and medical care; many of these benefits are needs-based, which means that a person may not have assets in excess of the program limit in order to qualify.

These are just a few specific reasons why using an Irrevocable trust may be appropriate for a certain situation. Everyone’s circumstances are different, and in every case, it is important to consult with a qualified estate planning or elder law attorney to develop a plan that works.

Long Term Care Facilities Overview

When trying to decide what level of assisted living or nursing home care is appropriate for yourself or a loved one, it can often to be difficult to understand the options available for you.

While many times it can be a simple decision (e.g. just an over 50 living facility with maximum independence is often the first step,) often is difficult to judge the level of care needed.  Many people make the decision to meet with a nursing home attorney or elder lawyer to help make the decision.

Here is an overview of the structured facilities for long-term care:

nursing home assistance

ECF (Extended Care Facility): Includes assisted living and both levels of nursing home care.

SNF (Skilled Nursing Facility): As these are only for short term stays that are covered by Medicare and other GMOs, they aren’t a long-term option. Once the allotted number of days under the resident’s insurance plan are used for the year, you will be given the option to pay privately or you must be approved to receive Medicaid long-term to continue to receive care.  You must also have a specific need for short-term occupational and/or physical therapy to stay at a SNF.

ICF (Intermediate Care Facility): This type of facility is for long-term residential care for residents that need 24-hour supervision and care but not at a skilled level.  These types of facilities can be paid for out-of-pocket or through Medicaid.

AL (Assisted Living): This type of facility is not covered by insurance; they are paid for out-of-pocket.  Assisted Living facilities offer minimal care and are not meant for seriously ill patients.  Medicaid will cover the expense if you can qualify for an Assisted Living Waiver – to start that process, get in touch with elder law attorney Adam J. Tobin.

IL (Independent Living): Independent Living facilities are essentially senior communities with meals and activities provided.  It is the lowest level of care offered and is not meant for those with illness or serious mental ailments. These facilities are also paid for out-of-pocket.

If you are trying to figure out the level of care you or a loved one needs, or if you have any questions about the process of selecting a facility, please contact us and arrange a free consultation with Massachusetts estate planning attorney Adam Tobin.

The Options for Power of Attorney

In regards to estate planning, a power of attorney is a crucial asset. However, there are a few different dimensions to power of attorneys, and it’s important to understand and utilize them appropriately.
So what exactly is a power of attorney? By definition, it determines who will act for you gl_feb_art_2008in the instance that you become incapacitated, and someone needs to make financial (or other) decisions. There are four different types of power of attorney:
•    Limited. A limited power of attorney gives someone else the power to act on your behalf for a very limited purpose.

•    General. A general power of attorney is comprehensive and gives your attorney-in-fact all the powers and rights that you have yourself. A general power of attorney ends on your death or incapacitation unless you rescind it before then.

•    Durable. A durable power of attorney can be general or limited in scope, but it remains in effect after you become incapacitated. Without a durable power of attorney, if you become incapacitated, no one can represent you unless a court appoints a conservator or guardian.

•    Springing. Like a durable power of attorney, a springing power of attorney can allow your attorney-in-fact to act for you if you become incapacitated, but it does not become effective until you are incapacitated.
Even with all of these options, choosing an individual to act as your power of attorney is an important decision. They will have much control over your finances, and should thus be someone that you trust completely.

While many pre-packaged do-it-yourself power of attorney forms are available, it is a good idea to have an elder lawyer draft the form specifically for you. There are many issues to consider and one size does not fit all. Contact an elder law attorney, like Adam Tobin, to learn more.

(Article source: Elder Law Answers)

The Financial Health of Aging

With our current economic challenges, those of us looking forward to retirement need to be well-informed about our financial needs in coming years. And not only pre-retirees, but individuals already in retirement need to be wise to the changing economic environment. The good news is there are trained professionals who keep abreast of changes in the current economy, changes in laws and changes in government programs for the elderly. Professionals in this field are equipped to handle everything from help with retirement savings accounts, investment advice, guidance on government programs, estate planning or even new funding options such as reverse mortgages. A little planning prior to retirement will allow you to maintain your current lifestyle; whereas, a lack of planning may require you to live on an extremely tight budget. For those already retired, taking time right now to deal with financial problems instead of waiting for a crisis to happen is well advised.

A large number of retired individuals felt that they had planned well for the future only to find that rising medical costs, damage done to investment portfolios (by the current economy) and many other factors have caused them to go into debt. According to an article in “USA Today”, seniors are racking up debt like never before. Elderly individuals who are in debt live with a constant burden over their heads. Most of these people are on fixed incomes and have no way of paying off credit cards and home equity loans that continue to mount to cover household budget deficits. In order to meet ongoing payments, seniors often forego purchasing medications and skimp on food budgets. They live like hermits — never going out and pinching every penny — in order to pay their obligations.

Most of these people worked hard their entire lives and managed their debt. They never anticipated the rising costs of prescriptions, expensive medical care or depletion of savings by living too long. The good news is there is help for these individuals. Here are just a few examples of some relief options that could be available. There are many more besides these.

Reverse mortgagesAging and financial planning

A reverse mortgage is a risk-free way of tapping into home equity without creating monthly payments and without requiring the money to be paid back during a person’s lifetime. Instead of making payments the cash flow is reversed and the senior receives payments from the bank. Thus the title “reverse mortgage”. For those seniors who are less fortunate financially but own a home, a reverse mortgage can allow them to remain in the home by creating extra income.

Life settlements

A life settlement enables older individuals, businesses and other organizations to sell life insurance policies they currently own – but no longer want or need – for an amount greater than the cash surrender value. In some cases the value can be 2-3 times the cash surrender value. Even some term life insurance policies with a conversion option to permanent coverage can qualify for a life settlement.

Government Programs

Some government programs such as food stamps provide temporary financial help for food. Other programs provide subsidized housing, help with medical expenses and provide tax credits. For veterans there is free health care, inexpensive prescriptions and disability income. Area agencies on aging offer individual counseling, legal help and advice with Medicare costs. (National Care Planning Council, www.longtermcarelink.net)

For some, living on a fixed income and dealing with debt can be an overwhelming burden. There are knowledgeable professionals and debt relief strategies that can assist in easing this burden. The National Care Planning Council keeps a list of financial advisers and attorneys who specialize in this area of planning at www.longtermcarelink.net.

Want to explore these financial issues further for you or a loved one? Be sure to contact an elder lawyer, like Adam J. Tobin today!

Caring for the Caregivers

This blog excerpt is from The New York Times, where author Pauline W. Chen, describes the difficulties caregivers go through for their loved ones.

For all our assertions about the importance of caring in what we do, doctors as a profession have been slow to recognize family members and loved ones who care for patients at home. These “family caregivers” do work that is complex, physically challenging and critical to a patient’s overall well-being, like dressing wounds, dispensing medication, and feeding, bathing and dressing those who can no longer do so themselves.

Many of these caregiving tasks were once the purview of doctors and nurses, a central component of the “caring professions.” But over the past century, as these duties increasingly fell to individuals with little or no training, doctors and even some nurses began to confer less importance, and status, to the work of caregiving.

It comes as no surprise, then, that physicians now rarely, if ever, learn about what a family caregiver or health care aide must do unless they are faced with caring for their own loved ones. We doctors don’t know or aren’t always fully aware of what it takes to care for a patient after we leave the room.

In other words, for the 37 million people attending to the health care needs of a relative, partner, friend or neighbor, our best care goes only so far.

“If you look at the amount of time devoted to actual caregiving, the physician contributes a very modest amount,” said Dr. Arthur Kleinman, a professor of medical anthropology and psychiatry at Harvard Medical School and now a family caregiver himself.

“We’ve had outstanding diagnoses and very careful attention to defining the problem,” Dr. Kleinman said, referring to his own experience. “But once the problem is defined and the limited pharmacological interventions prescribed, there has been neither interest nor knowledge about the rest of the aftercare, even in the most simple parts like finding a home health aide or getting a needs assessment by a social worker.”

But our profession’s indifference may hopefully soon be a thing of the past.

In January 2010, the American College of Physicians, the country’s leading professional organization of internal medicine physicians,

issued its first position paper on working with caregivers. Endorsed by almost a dozen other professional medical organizations, the paper, published in The Journal of General Internal Medicine, highlights the challenges that can arise from the complex interaction among patient, doctor and caregiver and offers guidelines for providing the best care.

Using a framework of broad principles, like the need to respect and maintain a primary focus on the patient’s rights, dignity and values, the paper explores specific issues that are likely to arise in a given patient-doctor-caregiver relationship. How, for example, should physicians approach long-distance family caregivers? What should they consider when working with the caregiver of a terminal patient? How can they best support the caregiver who is convinced that he or she can never do “enough”?

(Entire article can be read here)