Valentine’s Day falls in February, so this month I wanted to write about love and marriage. With people living longer these days, it’s quite common for people to fall in love and get married later in life. A marriage in one’s 60’s, 70’s, or 80’s is a little different than a first marriage in one’s 20’s. Those twenty-something’s probably do not have much in the way of assets, and they’re certainly not worried about long-term care expenses. They also do not have to worry about how well kids from prior marriages will get along. All of these issues are important in a second marriage.
Many couples who get married late in life understand that they will share the ordinary expenses of life. They usually do not intend that a healthier spouse will have to spend his or her assets to pay for the long-term care of an ill spouse. It is quite a shock for many older people to learn that, if one spouse needs long-term care, the assets of both spouses are considered available to pay for that care. With long-term care costs averaging over $7,000 per month, careful advance planning is necessary to avoid impoverishing both spouses. To get the best result, this planning should be done as much as five years in advance of one spouse needing long-term care.
Another issue in second marriages involves estate planning. Did you know that under Oregon law, marriage revokes an existing will? Many people get married and do not know they need to update their will. In most second marriages, the parties have a pretty clear idea of how they want their property distributed after they pass away. But if you do not get into the lawyer’s office after getting married and do a new will, you won’t decide where your property goes. The State of Oregon will decide for you. So it’s critical to see an experienced elder law or estate planning attorney to update your will immediately after getting married.
A prenuptial agreement is valuable tool for second marriages later in life. In a prenuptial agreement, the parties to the marriage can spell out their agreement about how property will be managed, how bills will be paid, and whose funds will be used to pay for long-term care costs. It can also be used to define the inheritance rights of each spouse and of children from prior marriages. Children from prior marriages are greatly reassured to know that their parents are thoughtfully considering these issues.
As in all matters related to aging, people in second marriages who plan ahead get a much better result in times of crisis. Ideally this planning is done prior to the marriage. If you are already married, updating your wills and planning for long-term care costs should be done right away. The greatest risk is impoverishment of both spouses due to long-term care costs, which can be avoided by careful advance planning with an experienced elder law attorney.
Showing posts with label public benefits. Show all posts
Showing posts with label public benefits. Show all posts
Tuesday, February 22, 2011
Wednesday, January 5, 2011
U.S. Alters Rule on Paying for End-of-Life Planning
By ROBERT PEAR, the New York Times
Published: January 4, 2011
WASHINGTON — The Obama administration, reversing course, will revise a Medicare regulation to delete references to end-of-life planning as part of the annual physical examinations covered under the new health care law, administration officials said Tuesday.
The move is an abrupt shift, coming just days after the new policy took effect on Jan. 1.
Many doctors and providers of hospice care had praised the regulation, which listed “advance care planning” as one of the services that could be offered in the “annual wellness visit” for Medicare beneficiaries.
While administration officials cited procedural reasons for changing the rule, it was clear that political concerns were also a factor. The renewed debate over advance care planning threatened to become a distraction to administration officials who were gearing up to defend the health law against attack by the new Republican majority in the House.
Although the health care bill signed into law in March did not mention end-of-life planning, the topic was included in a huge Medicare regulation setting payment rates for thousands of physician services. The final regulation was published in the Federal Register in late November. The proposed rule, published for public comment in July, did not include advance care planning.
An administration official, authorized by the White House to explain the mix-up, said Tuesday, “We realize that this should have been included in the proposed rule, so more people could have commented on it specifically.”
“We will amend the regulation to take out voluntary advance care planning,” the official said. “This should not affect beneficiaries’ ability to have these voluntary conversations with their doctors.”
The November regulation was issued by Dr. Donald M. Berwick, administrator of the Centers for Medicare and Medicaid Services and a longtime advocate for better end-of-life care. White House officials who work on health care apparently did not focus on the part of the rule that dealt with advance care planning.
The decision to drop the reference to end-of-life care upset some officials at the Department of Health and Human Services, who said the administration ought to promote discussions of such care. Such discussions help ensure that patients get the care they want, the officials said.
During debate on the legislation, Democrats dropped a somewhat similar proposal to encourage end-of-life planning after it touched off a political storm. Republicans said inaccurately that the House version of the bill allowed a government panel to make decisions about end-of-life care for people on Medicare.
Sarah Palin, the 2008 Republican vice-presidential candidate, said in the summer of 2009 that “Obama’s death panel” would decide who was worthy of health care. Representative John A. Boehner of Ohio, the House Republican leader who is to become speaker on Wednesday, said the provision could be a step “down a treacherous path toward government-encouraged euthanasia.”
The health care bill passed by the House in 2009 allowed Medicare to pay doctors for discussions of end-of-life care, including advance directives, in which patients can indicate whether they want to forgo or receive aggressive life-sustaining treatment.
The provision for advance care planning was not included in the final health care overhaul signed into law by President Obama. Health policy experts assumed that the proposal had been set aside — until a similar idea showed up in the final Medicare regulation in November.
Published: January 4, 2011
WASHINGTON — The Obama administration, reversing course, will revise a Medicare regulation to delete references to end-of-life planning as part of the annual physical examinations covered under the new health care law, administration officials said Tuesday.
The move is an abrupt shift, coming just days after the new policy took effect on Jan. 1.
Many doctors and providers of hospice care had praised the regulation, which listed “advance care planning” as one of the services that could be offered in the “annual wellness visit” for Medicare beneficiaries.
While administration officials cited procedural reasons for changing the rule, it was clear that political concerns were also a factor. The renewed debate over advance care planning threatened to become a distraction to administration officials who were gearing up to defend the health law against attack by the new Republican majority in the House.
Although the health care bill signed into law in March did not mention end-of-life planning, the topic was included in a huge Medicare regulation setting payment rates for thousands of physician services. The final regulation was published in the Federal Register in late November. The proposed rule, published for public comment in July, did not include advance care planning.
An administration official, authorized by the White House to explain the mix-up, said Tuesday, “We realize that this should have been included in the proposed rule, so more people could have commented on it specifically.”
“We will amend the regulation to take out voluntary advance care planning,” the official said. “This should not affect beneficiaries’ ability to have these voluntary conversations with their doctors.”
The November regulation was issued by Dr. Donald M. Berwick, administrator of the Centers for Medicare and Medicaid Services and a longtime advocate for better end-of-life care. White House officials who work on health care apparently did not focus on the part of the rule that dealt with advance care planning.
The decision to drop the reference to end-of-life care upset some officials at the Department of Health and Human Services, who said the administration ought to promote discussions of such care. Such discussions help ensure that patients get the care they want, the officials said.
During debate on the legislation, Democrats dropped a somewhat similar proposal to encourage end-of-life planning after it touched off a political storm. Republicans said inaccurately that the House version of the bill allowed a government panel to make decisions about end-of-life care for people on Medicare.
Sarah Palin, the 2008 Republican vice-presidential candidate, said in the summer of 2009 that “Obama’s death panel” would decide who was worthy of health care. Representative John A. Boehner of Ohio, the House Republican leader who is to become speaker on Wednesday, said the provision could be a step “down a treacherous path toward government-encouraged euthanasia.”
The health care bill passed by the House in 2009 allowed Medicare to pay doctors for discussions of end-of-life care, including advance directives, in which patients can indicate whether they want to forgo or receive aggressive life-sustaining treatment.
The provision for advance care planning was not included in the final health care overhaul signed into law by President Obama. Health policy experts assumed that the proposal had been set aside — until a similar idea showed up in the final Medicare regulation in November.
Tuesday, May 4, 2010
A Mother’s Dilemma: Planning for the Special Needs Child
As an Elder Law attorney for over 15 years, I have worked with thousands of older people and their families. But some situations are especially memorable, and Elinor and Tommy’s is one of them.
When Elinor first came to see me, she told me that she and her husband had tried for some time to have a child, without success. They decided to adopt, and after a period of time, they were blessed to be able to adopt a healthy baby boy, whom they named Tommy. It seemed that their fondest wish had come true.
When Tommy reached age 3 months, Elinor took him to the doctor for a routine check-up. Tommy was pronounced to be in excellent health. He received the usual three-month immunizations, and went home.
A fever is always a source of worry and sleepless nights for a parent. Thankfully, in most cases they are not serious and do not last long. But Elinor’s worry turned to dread as Tommy’s fever soared, and he became listless. She took him to the hospital, where he was diagnosed with a brain infection, a very rare, but serious complication from the immunization. Tommy survived. But the doctors had grim news: baby Tommy’s ordeal had almost certainly left him with brain damage. This was in the early 1970’s, and the doctors had no way to estimate the degree of damage. They would just have to wait and see.
As it turned out, Tommy’s illness had left him mentally retarded. His adoptive parents vowed to give him the best care and quality of life. But they could not know the toll it would take on them, and on their marriage. They ultimately divorced, and the father passed out of Tommy’s life.
As Tommy became a young adult, he expressed a wish to live independently. In his early 20’s he moved into a group foster home. The problem was, the cost of the group home was more than the monthly income he received from the vaccine injury settlement. So Elinor began to withdraw her retirement savings to pay Tommy’s care bill. And she had come to see me, she said, because as of the next month’s payment, her retirement savings would be completely gone. She had spent it all trying to fulfill her promise of quality of life for her son.
The solution lay in a special needs trust for Tommy. His monthly income from the vaccine injury settlement went into the special needs trust. From there, it could be used to pay for goods and services that would improve his quality of life. Using the trust, we were able to get him qualified for Social Security benefits and Medicaid to help pay the adult foster home. We were even able to reimburse Mom for some of her retirement savings. Tommy lives with dignity and independence. Mom has peace of mind. And I have the satisfaction of knowing I made a difference.
Do you know someone with a special needs child? If so, please give him or her a copy of this article. When quality of life is everything, Special Needs Planning can make all the difference.
Elder Law is Special Needs Planning
When Elinor first came to see me, she told me that she and her husband had tried for some time to have a child, without success. They decided to adopt, and after a period of time, they were blessed to be able to adopt a healthy baby boy, whom they named Tommy. It seemed that their fondest wish had come true.
When Tommy reached age 3 months, Elinor took him to the doctor for a routine check-up. Tommy was pronounced to be in excellent health. He received the usual three-month immunizations, and went home.
A fever is always a source of worry and sleepless nights for a parent. Thankfully, in most cases they are not serious and do not last long. But Elinor’s worry turned to dread as Tommy’s fever soared, and he became listless. She took him to the hospital, where he was diagnosed with a brain infection, a very rare, but serious complication from the immunization. Tommy survived. But the doctors had grim news: baby Tommy’s ordeal had almost certainly left him with brain damage. This was in the early 1970’s, and the doctors had no way to estimate the degree of damage. They would just have to wait and see.
As it turned out, Tommy’s illness had left him mentally retarded. His adoptive parents vowed to give him the best care and quality of life. But they could not know the toll it would take on them, and on their marriage. They ultimately divorced, and the father passed out of Tommy’s life.
As Tommy became a young adult, he expressed a wish to live independently. In his early 20’s he moved into a group foster home. The problem was, the cost of the group home was more than the monthly income he received from the vaccine injury settlement. So Elinor began to withdraw her retirement savings to pay Tommy’s care bill. And she had come to see me, she said, because as of the next month’s payment, her retirement savings would be completely gone. She had spent it all trying to fulfill her promise of quality of life for her son.
The solution lay in a special needs trust for Tommy. His monthly income from the vaccine injury settlement went into the special needs trust. From there, it could be used to pay for goods and services that would improve his quality of life. Using the trust, we were able to get him qualified for Social Security benefits and Medicaid to help pay the adult foster home. We were even able to reimburse Mom for some of her retirement savings. Tommy lives with dignity and independence. Mom has peace of mind. And I have the satisfaction of knowing I made a difference.
Do you know someone with a special needs child? If so, please give him or her a copy of this article. When quality of life is everything, Special Needs Planning can make all the difference.
Elder Law is Special Needs Planning
Tuesday, September 29, 2009
New York Times on Geriatric Care Managers
The New York Times ran a piece on September 26th that explores the value of geriatric care managers in caring for the elderly. http://www.nytimes.com/2009/09/26/health/26patient.html?_r=1
Let us know what you think of this article. What would you like the public to know about services provided by care managers? Are there other avenues families should explore to help them weed through the medical, housing, and legal complications that surround the elderly in crisis?
By LESLEY ALDERMAN
Published: September 25, 2009
CARING for an elderly parent is emotionally and mentally draining. There are diagnoses to decipher, housing issues to consider, health aides to vet and a raft of legal documents to complete. It can seem overwhelming, even when families are in complete agreement on how to care for an elderly relative. And often they are not.
Last week, my colleague Walecia Konrad offered advice on how to find “respite care” — someone to temporarily help you tend to an elderly parent or loved one so you can have some time for your own life. This week, I am writing about what to do when you feel the situation calls for the equivalent of a case worker.
Happily, such case workers can be found. They are called geriatric care managers.
Yes, you must pay these professionals out of your own pocket. Regular insurance does not cover them, although some long-term care policies do. But a good care manager can buy you time and some peace of mind so you can concentrate on your job, your family and your own health.
Let us know what you think of this article. What would you like the public to know about services provided by care managers? Are there other avenues families should explore to help them weed through the medical, housing, and legal complications that surround the elderly in crisis?
By LESLEY ALDERMAN
Published: September 25, 2009
CARING for an elderly parent is emotionally and mentally draining. There are diagnoses to decipher, housing issues to consider, health aides to vet and a raft of legal documents to complete. It can seem overwhelming, even when families are in complete agreement on how to care for an elderly relative. And often they are not.
Last week, my colleague Walecia Konrad offered advice on how to find “respite care” — someone to temporarily help you tend to an elderly parent or loved one so you can have some time for your own life. This week, I am writing about what to do when you feel the situation calls for the equivalent of a case worker.
Happily, such case workers can be found. They are called geriatric care managers.
Yes, you must pay these professionals out of your own pocket. Regular insurance does not cover them, although some long-term care policies do. But a good care manager can buy you time and some peace of mind so you can concentrate on your job, your family and your own health.
Tuesday, September 1, 2009
Salute Our Veterans With Quality Care
When families come to see me regarding the long-term care needs of a loved one, we always identify two goals. The first, and most important goal is good quality care. The second is to obtain that care in a manner that does not completely impoverish the older person and his or her spouse. In developing a plan to pay for good care, we have to identify all sources of funds to help pay for that care. The most overlooked source of help with long-term care costs is a Veteran’s Administration (VA) benefit that pays monthly income to veterans and their spouses, and to the surviving spouses of deceased veterans. This benefit is commonly known as “Aid and Attendance Benefits.”
Tuesday, August 25, 2009
Have You Been Told Your Loved One Needs a Guardianship?
We often receive calls from potential clients who have been told that their loved one needs the assistance of a legal guardian. In the most common situation, the person has been living independently, but is showing signs of dementia, and has been doing things that put themselves or others at risk of harm. Examples include leaving the stove burners on, locking themselves out of their home, wandering out of their home and getting lost, and mixing-up their medications. Other times a senior will have a behavioral disturbance, such as striking out at care center staff and fellow residents, and a guardian is needed to consent to psychiatric medical treatment and consent to placement in a secure care facility.
When Should You Refer to an Elder Law Attorney for Medicaid Planning ?
Elder Law attorneys help older people and their families with all of the legal consequences of aging. These consequences tend to fall into three categories: surrogate decision making for finances and health care; estate planning; and long-term care cost planning. We use powers of attorney for finances and advance directives for health care, wills and trusts, and a variety of strategies to help people get and pay for good care. When an older person lacks the ability to pay for care over their life expectancy using private savings or long-term care insurance, an elder law attorney will advise him or her on qualifying for long-term care assistance through the Medicaid program.
Wednesday, July 29, 2009
A Mother’s Dilemma: Planning for the Special Needs Child
As an Elder Law attorney for over 16 years, I have worked with thousands of older people and their families. But some situations are especially memorable, and Elinor and Tommy’s is one of them.
When Elinor first came to see me, she told me that she and her husband had tried for some time to have a child, without success. They decided to adopt, and after a period of time, they were blessed to be able to adopt a healthy baby boy, whom they named Tommy. It seemed that their fondest wish had come true.
When Elinor first came to see me, she told me that she and her husband had tried for some time to have a child, without success. They decided to adopt, and after a period of time, they were blessed to be able to adopt a healthy baby boy, whom they named Tommy. It seemed that their fondest wish had come true.
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