What Happens if a Family Member Becomes Incapacitated?
The Unpopular Topic of Discussion Every Family Needs to Have
Just bringing up the possibility of someone in your family becoming mentally or physically incapacitated is often difficult. We tend to think of only the very elderly needing long-term, hands-on care, but a recent report by the Alzheimer’s Association found that one in nine Americans age 65 or older currently have Alzheimer’s. With the baby boom generation aging and people living longer, that number may nearly triple by 2050. Dementia isn’t the only reason for long-term care, of course, but almost everyone knows someone already affected by it.
Waiting too late to plan can throw a family into confusion about what the Mom or Dad would want, what options are available, and what resources can help pay for care. Rushed decisions are often the most costly. Having the courage to discuss the possibility of incapacity now can go a long way toward being prepared should that time come. By the way, because anyone can become incapacitated at any time due to illness or accident, the entire family would benefit from planning for every family member.
Care Options: Depending on the type and expected duration of care needed, options range from in-home care to adult daycare to assisted living facilities to nursing homes. Assistance with activities of daily living (ADL), which include eating, bathing and dressing, are generally not covered by health insurance. Professional care can be expensive; the national average for basic assisted living services is now about $42,000 per year. Care for those with dementia can last longer and cost more. Family caregivers, who provide the bulk of in-home care, are often unpaid, and the emotional and financial tolls can be considerable. Your discussions need to realistically consider family finances and circumstances.
Finances: Where will the money come from to pay these expenses? What resources will be available? Health insurance does not cover assisted living/nursing home facilities or help with ADLs. Medicare covers some in-home health care and a limited number of days of skilled nursing home care, but not long-term care. Medicaid, which does cover long-term care, was designed for the indigent; to qualify, the person’s assets must be spent down to almost nothing. VA benefits for Aid & Attendance may be available for veterans and their spouses. If there are significant assets, you can self-insure and pay the costs as you go. Home equity and retirement savings can also be a source of funds. If you want to protect these assets for your family, long-term health insurance may be an option. (Premiums are much lower when you are younger.)
Documents: Everyone over the age of 18 needs basic legal documents. These include an advance health directive or healthcare power of attorney (legally appointing another person to make healthcare decisions for you if you cannot make them yourself); a durable financial power of attorney (legally appointing another person to make financial decisions for you if you cannot make them yourself); and a trust and/or will.
Having the Discussion: Your parents may be harboring secret fears about what will happen to them if they need long-term care. Talking about this honestly, listening to their fears and desires, and putting a plan in place before it is needed can help reassure them (and you). If you want to talk to your children, reassure them that you are just being realistic. Starting with a story about someone you know or an article you read can be a good way to break the ice.
How to Get Help: An attorney who specializes in Elder Law has already helped many families in these same situations, and will be able to make recommendations that will save you considerable time, money, and stress. He/she can also work with other advisors (financial/investment, insurance, CPA, etc.) to help put together the best plan for your family’s circumstances.
Call me if you have any questions:
Greg McIntyre Elder Law Attorney McIntyre Elder Law 123 W. Marion Street, Shelby 704-259-7040
Special guest and financial planner, Jamie Richard brave the Blizzard of 2016 along with Hayden and Greg to deliver this compelling tribute and content about planning and The Greatest Generation. The depression era and WWII generation were simply an amazing group. Jamie talks about Long-Term Care products and how they can protect the money and property of this generation. As an added bonus, Greg plays an interview with his grandfather, WWII Veteran, JC Horne. You can access that video interview here: http://youtu.be/isOI6dejS3w
We’re talking crisis. We’re going to get down and dirty today.
We had a new article come out in the ‘Shelby Shopper’ this month called, ‘Are wills obsolete?’ I know a lot of people are talking about that, and the real problems with the probate and wills process okay. And we’re going to talk about that today, really centered around Medicaid planning, which is Medicaid Crisis Planning.
Are Wills Obsolete?
What happens if you find yourself a spouse, a mum or a dad, or a family member in a crutch where they’re
headed to a nursing home, or in a nursing home, or assisted living facility, and money is being spent down like crazy, it’s being thrown away like water.
What do you do? Well, you come to me.
There’s crisis everywhere at the moment? It’s a blood red market right now. The Dow is down 300 points, crisis, panic, panic. That’s really troubling for a lot of retirees.
People have worked hard to acquire things and you don’t want to just give them up or lose them in the end, or at some point in the future.
Watch the full show here:
My grandfather always planned and saved so he could leave something to his children, so he could help them start out on their own. And my father always saved and invested.
We all want to leave a better lot in life for our children, give them a leg up. I think that’s just human nature, don’t you?
It’s something a lot of people don’t think about. They don’t think about it because they don’t realize what they can do. They also don’t know what will happen if they don’t do certain things to protect their assets.
This is something people should pay close attention to, because knowledge is power. If you don’t know what you don’t know, you can’t make the best decisions for your future.
That’s why you need to come and consult with someone who knows, like myself, like the people at our office.
Why is all this important to seniors? A lot of us have invested in the stock market, and 401Ks and IRAs that are going up and down like a rollercoaster.
Listen to the Full HD Podcast Here:
You’re watching your retirement go down but you know it always comes back up eventually, it’ll bounce back, you can’t afford to panic right? We’re in it for the long haul.
But what else can make your retirement disappear? It’s something much faster than the stock market.
Going into a nursing home is going to cost you somewhere around $50’000 to $75’000 to $100’000. That’s probably a lot more than you’ll lose on a 300 point drop on the stock market.
Watch that money disappear at a clip of $75’000 to $100’000 every year, year after year after year. That’s when I’m sitting with someones wife who is crying and upset because she believes she is going to be poor and destitute because of a long term health care situation that her husband has. Perhaps he has early onset dementia.
The sad thing is, they both worked their whole lives, just hard workers who worked to build their retirement, and it’s just disappearing like water over a waterfall. And it’s not their fault.
The Money Situation This elder couple have paid out 40 to 50 cent on every dollar they’ve earned through income tax and from sales tax. They pay 3 times what it cost to buy their house from the interest over 30 years on their mortgage. So, if they paid $100’000 when they bought their house, they end up paying the bank $250’000 to $300’000. Then in order to access a benefit like Medicaid for long term care, they have to spend down all the money from the 50 cents they got to keep, their dollars, and are potentially forced to sell their property or have a lien placed on their house, or taken away if it goes through a will or passes by a will. (??)
That is why you should read my article ‘Are Wills Obsolete,’ because that’s where liens are attached, that’s where that Medicaid lien attaches and takes that away from your family and from going to your children. That’s a college education for a grandchild right there.
I don’t like that in our system. I can’t reconcile that everyone doesn’t agree with me on those points.
Look, from my perspective you really have to get behind your clients position, you have to get those blinders on and be just die hard loyal to that person and their position. And that’s how I view my job.
The client in the hot seat is a senior, and I’m helping them have as many health care options as possible. I’m helping them if it’s a couple or family, protect their hard earned assets they worked their entire lives to get, and keep those assets in their control.
I hear a lot about what age should you start giving away your property or your land?
The normal person would say about 60 to 65.
The real answer is, absolutely never. NEVER.
A hundred percent, a hundred and fifty percent never ever ever ever ever should you give your property away. Maybe that’s the way our programs and our legislature have set things up but their wrong. And the system is wrong. And we need to fix it.
You do all that, and then? In the end you access the health benefit to help pay for long term care. That’s the same benefit that is causing all your assets to disappear. That’s the 50 cents on the dollar you got to keep, and the house that you paid 3 times as much for to the bank, you’ve got to give all that away in order to access that same benefit.
And who paid for that benefit in the first place? You did, with that other 50 cents that was taken away in taxes. And that’s the position that I take.
I am talking here about an emergency and crisis situation but I’ll lead into that by talking about wills.
So, what is a will?
It’s a document that’s created that designates, when you pass away, where your property is to go and/or to whom.
When you take a will to the court house to probate it, you have to wait a 90 day waiting period, whether it’s a small or regular sized estate, and possibly publish that in the paper to give the public notice and wait 90 days before you can do anything.
Why do they do that? Why do you open up that 90 day waiting period?
It’s in case you owe money to someone, if you have creditors or something.
If you don’t have a will, don’t worry, the laws of NC already has a program set up to pass all your property any way the state sees fit.
I’m sure everyone trusts the state to pass that property the way you would want right? No absolutely not.
It benefits people to know how the state will administer your estate. Usually it’s a pretty fair deal. The state is usually going to split it up equally among kids. The problem comes in if there’s a spouse. It could pin the children and the spouse fighting against one another for assets. In a family where there are step fathers, step mothers, step brothers, or step sisters, it just gets crazy.
I’m going to be really clear. The state is doing what it can to anticipate a fair way, or try to think of a fair way to distribute your assets. But it might not be your way.
You may want your wife to get everything. You may want your children to get everything. You may want a church to get a portion, or a charity but it’s not necessarily going to happen that way. It’s rare that it happens just the way you want it to, unless you draft a will.
Why would Medicaid have to come in and pay for long term care for someone who requires nursing home or assisted living care?
This happens if you have exhausted your Medicare.
How long will Medicare pay?
And what happens after 20 days?
If you have a supplemental, it will pay up to 80 days. So 100 days in all if you have a supplemental. So you have a very short period of time from the time you actually walk into a facility, until the time you begin paying out of pocket, or your long term care insurance kicks in, if you have it. If you don’t have it, you should try to get it.
Why should you have a long term care policy? And why is this such a big issue?
What are the odds that people over 65 years old are going to need some form of long term care?
According to the current statistics, it’s just around 70%. 70 percent of seniors. That’s frightening.
Medicaid Crisis Planning Seminar That’s why I do a hard core Medicaid crisis planning seminars that you need to come and see. I’m giving seminars this year. I’m giving 6 in Cleveland County on Medicaid crisis Planning.
They are going to be limited to between 5 and 20 seats or 5 to 20 couples. If you want to come to a Medicaid crisis planning seminar we have one in February.
You have to qualify for these seminars. You have to have a loved one going into nursing home or assisted living long term care. We are going to sit down and talk about the secrets of Medicaid crisis planning.
You can save your money and property of your loved one and your family.
It could be a person whose parent is headed to or in a nursing home or assisted living facility, and their parents assets are quickly disappearing. It could be a wife or husband who is scared because all their retirement is rapidly going away.
And they’re scared because they have been told they can only keep $2000. Well that’s not true.
Monetary information. Generally a healthy spouse can keep $119,220 under the current rules in their name, or the community spouse as they’re called.
The person receiving care can keep around $2000 or less in their name. But we can save more than that.
There are strategies that can be employed, and there are spend downs that can be used correctly. That’s what we need to take a look at.
There is strategic deed planning, we talked about Medicaid Asset Protection Trusts last week in part 1 of this show, but moving on to a crisis, there is deed planning even in a crisis. There are Ladybird deeds we can employ to save property right now and avoid the 5 year look back period.
These are the things we need to talk about. And these are the things we will get down and dirty about at our Medicaid Crisis Planning seminars.
You need to see an attorney who knows about long term care and Medicaid and special assistance Medicaid.
For those who would like to call and talk about how to save your money and property, call my office and sit down with me for a free consult. Just mention you heard me on the radio show ‘The Elder Law Report.’
Our number at the office is 704 259 7040.
I’m Greg McIntyre, the elder law guy, lawyer Greg, and I have a firm called McIntyre Elder Law, that’s what we do.
We help seniors protect their assets and legacies.
Call me if you have any questions:
Greg McIntyre Elder Law Attorney McIntyre Elder Law 123 W. Marion Street, Shelby 704-259-7040
It’s a New Year again. Welcome to 2016 everyone. I’m totally jumping into 2016 this morning. It’s a new year, I can’t believe it’s a new year. Where’d the last year go man? I’m not ready. It went by quick. Maybe as we get older we sleep through a lot of it.
This is my year end review show or blog. I’m going to talk a little bit about resolutions and planning for 2016, and what that entails.
Resolutions are such a sensitive subject. “What are your resolutions?” They’re personal but general at the same time. Most of us throw out the same resolutions each year as if they’ve just become part of the tradition of New Year. Maybe that’s why so many of us fail to achieve our resolutions, and fail so quickly.
I want to change that.
I want to make a difference because your resolution should be something that can make a difference to you and even others in the new year.
And maybe that should be the first step to achieving your resolutions:
So my first point is this: Have a resolution (or resolutions) that make a difference, not just for you but for someone else also.
I know, resolutions are supposed to be or usually are self-centered or ego-centric. They’re supposed to be about how I can change something about myself that I don’t like, or improving something like finances, health, job or whatever.
Let me explain my thinking.
So that’s another year. We reflect on the year, we do the new years celebration thing, and then we set out to make new years resolutions for next year right. And that’s what everyone is doing right now or has already done.
Just a short while ago, I was looking at Time magazines top ten of all time broken new year’s resolutions. I chopped that down to the top five.
No.1- Lose weight and get fit.
No.2- Quit Smoking.
No.3- Learn something new.
No.4- Eat healthier and diet.
No.5- Get out of debt and save money.
I think those are the top resolutions made and broken.
Most resolutions as I mentioned are self centered or ego-centric. That’s not that we’re deliberately trying to exclude other people, we just want to make improvements for ourselves.
And it occurred to me that if you make resolutions that include others, that can benefit another person, you’ll be more likely to succeed in those resolutions. That brings me to my second resolution point: Accountability.
Having a resolution that can benefit another, even if that benefit is secondary to your own, will push you to follow through. You will feel accountable.
So if you want to get fit, start riding bikes with your kids. Or resolve to do something where you have support from others, who support your goals.
If you want to resolve financial goals, bring your spouse in on it. If you have someone who is an advocate with you, you won’t want to let them down. You become accountable to them, which pushes you to succeed.
Hayden who works in my office said on our New Years Radio Show that, “the best exercise program I ever did, I did with a friend and I would feel I let her down if I didn’t do it. It helps your plan if you make a commitment to someone else.”
So, what are your resolutions for 2016 and how are you planning on keeping to them. Figuring that part out is as important as the resolution itself, if not more so.
For me, I grew a lot this year, personally and professionally. I really focused on estate planning and elder law services. I didn’t spread myself thin. And that’s really amazing, I call it the X factor, I’ll write a book about it one day.
Doing this allowed me to take action. I mean real action
And that brings me to my third resolution point: Don’t spread yourself thin. Don’t have 20 wildly differing resolutions all going at the same time in different directions.
Having just a few resolutions to focus on will allow you to achieve the next point much more effectively. So point four is: Take action. “Actions speak louder than words.”
So, here they are:
• Choose your top two or three resolutions and commit to them. Just a couple of them. Focus on those only.
• Then make sure you bring someone in with you. Someone who will maybe benefit from your resolution also, who will support your goal, and hold you accountable. Who will keep you on track.
• Take action. Don’t let your resolutions just be words. Put action behind them.
And finally and possibly the most important point of all, make sure you really want to achieve your resolution. I know how that may sound. What I mean is, choose the resolutions closest to your heart.
Example: If you need to lose a few pounds but you’re only doing it because people are telling you that you should, the chances are you will drop it like a stone at the first opportunity. Choose from your heart.
What are the most important things to you that you want to resolve this New Year?
Good luck and Happy New Year everyone.
Call me if you have any questions:
Elder Law Attorney
McIntyre Elder Law
123 W. Marion Street, Shelby 704-259-7040
For this very special episode, I was honored to be able to interview expert on Alzheimer’s and Dementia, Teepa Snow. During our discussion, Teepa and I spoke about everything from care to causes and what needs to change in the systems to allow for more humane treatment of loved ones with Alzheimer’s and Dementia.
How did you come to be the expert’s expert in Alzheimer’s and Dementia?
It’s interesting, I would have never thought that. But I started off doing a lot of work with the USD School of Medicine and I was part of a team when I graduated and got my Occupational Therapy degree. I have worked in long-term care, so when they were looking for somebody it seemed like a good match and I had the good fortune to work with a good nurse, a good social worker, and then a couple of really good strong, family practicing general internal medicine physicians who understood geriatrics really well. That allowed me to learn the art of working with lots of disciplines, but to work with people that have Dementia.
Then I did some work with head injury, and I did that for three years. I also went back and worked again with Dementia in a psychiatric setting. Then I did home care and community care, and I worked at the VA. During all this time I kept building expertise in geriatrics and I find more and more I understood Dementia and could work with those with Dementia and show improvement while working with their caregivers a lot better than most of my colleagues. I found it interesting and exciting, not scary and awful. During that time I’d also be doing in-services and training, so as time went by people would start going with me to do things. Then I worked for the Alzheimer’s Association as the Education Director in the eastern North Carolina area. We made a couple of training videos because we were doing workshops, which lead people to want more and more workshops. So we thought, “Okay, let’s develop a video now.” The video became the video used nationally by many groups that addressed the issues one would face when trying to care for someone with Dementia. From there it snowballed.
Listen to the full interview here:
What would you say has been your experience with patients with Alzheimer’s and Dementia? And what is the difference between the two?
That is the most common question I am asked. Think about Dementia as a great big umbrella, and under that umbrella, one of the boxes is Alzheimer’s disease. But there’s other boxes: there’s frontal temporal lobe Dementia, there’s alcohol-related Dementia. So we’ve got a lot under that umbrella, but if it is under the umbrella it means four things: 1.) that at least two parts of the brain are starting to die, and what’s causing it will vary. 2.) as of right now, if it truly is Dementia, there is nothing we can do to slow it, stop it, or turn it around. We don’t have anything to rid of it; none of the drugs change the disease. 3.) if it’s truly Dementia, it’s going to get worse, it’s going to progress. All sorts of Dementia are neuro-degenerative, meaning they kill off the nerve cells in the brain. 4.) they’re all terminal illnesses, and once you have it, if nothing else kills you first then it will kill you. It will destroy so much of your brain that your brain can’t run your body anymore. So if you make it to the end, you’ll die of pneumonia because you can’t coordinate your swallowing and your breathing and your ability to fight infection, so you’ll get an infection in the blood stream that you can’t fight. If you get dehydrated and your brain says, “You don’t need any fluid”, your brain then says that you’re done.
We didn’t used to keep track of that as Dementia, but it’s actually the Dementia that’s causing your body to shut down. And now it’s the 5th leading cause of death for people over 65 and the 11th leading cause of death for all ages.
And the only one we don’t have a cure or treatment for.
That’s right, nothing that does anything for the disease. The only thing we have is some people benefit from some of the medications some of the time for a short period of time. That’s it, that’s all we have. Care therefore becomes the critical feature, and yet if we look at our care patterns and what the government support is, it’s nothing. We do nothing for people living with Dementia, we manage their acute medical illnesses poorly because primarily we don’t know what to do with Dementia but I can fix the UTI. So what I’ll do is tie you down and give you antibiotics. Well, what’s going to happen the next time? We’ll do it again and again, but where are we going with that? So we unfortunately put people through a lot of distress because no one really understands what the disease looks like. Doctors think, “I can treat that” but yet they can’t treat the Dementia.
Does a living will help in these situations in any way?
Well, let’s say I have an advanced directive that with any other health condition would be honored. The only state in the nation right now if I developed Dementia would be Oregon. In every other state, Dementia precludes me from having my directive followed.
You unveil an important point, which is the living wills apply to when someone is terminally incurable, brain death has occurred and they’re being maintained by respirators. That doesn’t count for this situation where the mind is not coordinating with the body.
This idea of competence is really complicated when it comes to Dementia because although I may not be competent to handle financial affairs, I might be competent to decide whether or not I want turkey or chicken for dinner. But that’s not how we’ve divided the pie here; it’s all black and white.
So the legislature needs to work with people like you that are on the front lines in developing laws and directives to account for situations like Dementia and Alzheimer’s. Yes, because they don’t exist. With feeding tubes, they came to the realization that actually we weren’t improving anybody’s life and the value of doing that was actually nil. It actually didn’t change the quality or quantity of life, it made people more likely to have bad things happen.
You deal in the healthcare industry on a regular basis. How much abuse of those directives is present?
It’s possible, but let’s figure out what’s going on, and I would think the abuse that goes on to the people who have Dementia is much worse right now because they are put through things that I don’t know how anyone can do to another human being. And they call it “care”.
I’ve said before, we treat animals in end of life situations better than people.
Right, where is that going to take somebody? And to get people to take that step back and go, “Guys, this is not euthanasia like you’re talking about. I’m not taking somebody’s life away from them, I’m helping them do the things that they really value.” And yet we are more than willing to restrain people, tie them up, give them additional medications to make them protest so that I can deliver the “treatment” I believe they should have so they can live three more days.
With zero quality of life and lots of pain. That’s ridiculous.
How many times are we going to put somebody through this before we say, “You know, they said no.” Okay, let’s people together and work through this before we get to this place so that we’re really acting in the person’s best interest. Not working from anyone’s opinion, but what the patient clearly asked for before this started.
This is going to be a movement from the ground up. I think Wisconsin and Minnesota are dealing with the issues, and they’re dealing with the issues because they, like North Carolina, have a large rural aging population. The resources are changing, the care situations are problematic. And people would rather die on their farm than move into a facility and lose their sense of identity and purpose. So how are we going to deal with this? Something needs to change about how care is delivered; people would never choose that. You walk into these places and you go, “Yes, better than it used to be”, but would I live here? Absolutely not.
People pay phenomenal sums of money for an intensive care stay at the end of life for no decent outcome whatsoever, no quality of life during the process. And yet we will not pay a penny for the person to be cared for in a different situation.
With 2/3 of the population being over 65 since 2010, Dementia and Alzheimer’s on the rise, you have to be able to identify it and then know how to react to it to give proper medical care.
And yet there is no requirement at all for hospitals to have any kind of training in Dementia, for EMS services to have any kind of specific training in Dementia or police and fire departments, yet they’re the front lines, they’re the people out there in the community.
The civil rights issue for people living with Dementia is finding that balance between what support and care I do need, and people making decisions about me without me, and me being able to be incarcerated for the rest of my life without a trial. If you put me in a secure unit, I may never get out again. Who’s to say that I’m there by virtue of what’s best for me versus what’s best for my oldest son who decided that I was causing a lot of trouble and it would be easier for him to manage my estate without me being present.
Right now across North Carolina, it is permissible to lock people up and it doesn’t matter what they want or what they think. It’s rampant, and it’s a knee-jerk reaction. At a national level, the conversation is happening regularly. Yet nobody wants to address this because you’d actually have to address this.
That leaves a good question on the civil rights issue: who’s going to fight that issue, and how do you fight that issue when you really don’t have a client that’s competent to be had?
What I think we’re going to see is more and more younger onset patients say, “No, you’re not going to put me here.” And what happens is they typically get kicked out to the psyche unit and back because they get in trouble. So people are not sure what to do with the young onset people, and I think some will end up being lawyers and judges and someone is going to say, “I’ll take you to court.” I think we’re getting to that point where there are enough higher profile people who are getting this condition who are smart people, and they’re going, “Wait a minute, you can’t just do this to me.” And up until now there’s been just a few of them, but I think the numbers are starting to rise a little bit.
Has this always existed throughout time with humanity? Or is this something new? It seems like this wasn’t the case when I was little; it was senility. But were we just calling it something else?
Some of it has been around but not the amount and not the intensity. Our lifestyle is dramatically changing and our environment is changing, not only the environment of the brain but our environment and how we live our lives is very different than it was a generation and a half ago. I think when you start doing that over time, what we’re finding is high stress, sleep deprivation, and high sugar intake with limited opportunities to socialize and engage leads to certain types of Dementia in that umbrella. Certain types have become much more prevalent than what we used to see. We never saw it like we’re seeing it now. We’re also seeing more young onset situations. So I think we have lots of different things happening, but now we’re seeing an increased number of survivors who live long enough to whom the things that wouldn’t have happened because they were gone, are now happening. If you look at many of the young onset folks, you’re going to see the high intensity people, and they worked really hard to the point where they never gave themselves a break. We know that with people who are high-risk worriers – worrying is a bad habit because you can’t let it go – the risk goes up.
It’s been a pleasure to interview you. Thank you
Call me if you have any questions:
Greg McIntyre Elder Law Attorney McIntyre Elder Law 123 W. Marion Street, Shelby 704-259-7040
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