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Healthcare

Virtual Care: The Changing Face of Telemedicine

Telemedicine is the digital information distribution of healthcare-related services. Not long-ago telemedicine was an innovative practice, primarily a supplement to hospitals’ information strategy managing patient care and their data more efficiently. During the coronavirus pandemic and its associated urgent healthcare needs, hospitals and medical offices are making telehealth capabilities more available than ever before. Long-distance patient and clinician contact, advice, reminders, care, education, intervention, monitoring, and remote admissions have become the norm.

Increasing Shift to Virtual Medical Care

The push for comprehensive virtual medical care quickly without a standardized platform has left many healthcare facilities struggling to meet demand with technological data integrity and consistent user interface. Just as individual’s panic led to purchasing toilet paper, hand sanitizer, and other essential household items creating shortages, hospitals “pandemic-purchased” telehealth solutions to ride out the crisis led to a hodgepodge of tech solutions. This situation led to medical information security breaches, dropped call and video conferencing, poor audio and video quality, and distorted or incorrect information relayed to patients and health insurance companies alike.

Patients who were sheltering in place and rather fearful at the outset of the pandemic were initially forgiving of technological glitches. Today, however, patients have higher expectations of telemedicine and seek seamless experiences. Patients are also taking advantage of the ability to test-drive options from home, exploring physician expertise, availability, disposition, and price point before committing to a particular doctor, health care practitioner, or hospital facility. Additionally, patients are enjoying the experience and are now more likely to seek virtual care. It turns out that a patient using telehealth is more likely to adhere to prescription and wellness regimes, which is an advantage to public health overall. On average, telemedicine saves a patient more than 90 minutes otherwise wasted in commuting to an appointment and waiting to be seen by a doctor.

Telemedicine Being Embraced by Clinics and Hospitals

Clinics and hospitals are also embracing the benefits of telemedicine. Virtual medicine has played a vital role in quickly flattening the curve by getting to as many patients as possible without compromising social distancing and urgent care only protocols. Patients with chronic conditions and other non-urgent care, including routine follow-ups, can still engage with their physicians, allowing medical care, decreased patient anxiety, and maintaining facility reputation through patient retention. This continuity of care is essential, especially for urgent non-COVID-19 related health issues.

Health care facilities and medical professionals are now able to reach a new demographic of patients through telemedicine, particularly those in rural areas or those who list time, convenience, and proximity as barriers to making an initial consultation. Fully 76 percent of hospitals now employ telemedicine services, and two-thirds of patients report a willingness to use telehealth in the future, even after the pandemic ends.

Telemedicine Saves Time and Money

Telemedicine also yields significant savings of time and money for healthcare organizations and patients. An average in-office visit is 121 minutes, including 101 minutes of commute and waiting time. Therefore, a patient is only experiencing about 20 minutes of interaction with their doctor. A full one-third of patients have left a doctor’s office because the wait was too long. Telemedicine reduces wait times, no-shows, and cancellations saving time and money. There are also flexible insurance benefits to take advantage of when using telehealth.

What Telemedicine Platforms and Service are Right for You?

How can you best assess your hospital or doctor’s office telemedicine platform and service? Medicaleconomics.com cites four questions that you must ask to find the service best suited to your needs. Telemedicine can vary drastically among categories such as compliance, quality, convenience, and features, so keep the following in mind as you search for the right fit.

  1. Look for easy to use technology. As a patient, you should have no trouble downloading and accessing a telehealth app. It should be easy to use and intuitive and be available on multiple digital devices such as a tablet, phone, or laptop.
  2. Is the software provide HIPPA compliant and secure? Privacy issues are a major concern when using non-healthcare specific solutions like Zoom, Skype, FaceTime, and others. Ensure your telehealth provider keeps your sensitive information digitally safe.
  3. Make sure that the platform provides quality audio and video transmission. You will feel more comfortable, and your session will yield the best results knowing that communication is clear. Miscommunication can lead to misdiagnosis and have tragic health consequences.
  4. Shop around before committing. Read online reviews and speak to others about their telehealth experiences. Finding reputable healthcare facilities doesn’t stop with a board-certified physician. Facility reputation can be the difference between ease of interaction, diagnosis, and follow-up regarding insurance.

Embracing telemedicine can open your healthcare to expert physicians, save you time, and maintain the significant benefit of social distancing. Look for a healthcare organization with the right telemedicine framework for you. It will help you stay current with your routine medical care despite the coronavirus pandemic.

If you have questions or would like to discuss your personal situation, please don’t hesitate to contact us. Please contact our Reno office by calling us at (775) 853-5700.

Healthcare

Understanding Gains in Alzheimer’s and ALS Research

Good news on the health front is so welcome these days. Now there is some, for the huge numbers of people suffering from Alzheimer’s dementia and ALS (Amyotrophic Lateral Sclerosis, commonly known as Lou Gehrig’s disease). Researchers have found links between those two dread illnesses, and the new understanding is showing promising results in the laboratory using drugs and genetic alteration.

New Insights on The Alzheimer’s Disease Research

The developments for both conditions center around relatively new insights into brain function. It seems that brain cells require a certain fluidity or agility to move between two rates of neuronal firing. Any further explanation plunges into the deep weeds of physics and neurology, but a recent interview on National Public Radio with researchers likened the healthy process as similar to the fluidity with which water changes from vapor to dewdrop to ice. In the case of the two illnesses, it seems that brain cells that should act with comparable fluency turn “sticky” instead. Dr. J. Paul Taylor, a neurogeneticist at St. Jude Children’s Research Hospital in Memphis and with the Howard Hughes Medical Institute, likened the disease process to what happens when honey is left in the refrigerator. Dr. Taylor won the 2020 Potamkin Prize for Alzheimer’s research.

Also quoted in the NPR interview was biophysical engineer Cliff Brangwynne, of Princeton and also with the Howard Hughes Medical Institute. He likened a healthy brain cell to acting like people coming and going at a party, chatting with each other, but the cells in ill brains have lost that ability to communicate fluidly.

Millions stand to benefit. According to the Alzheimer’s Association, one in three seniors dies with Alzheimer’s or other dementia. More than 16 million Americans provide unpaid care for such people. Between 2000 and 2018, deaths from heart disease have decreased 7.8% while deaths from Alzheimer’s have increased 146%.

New Insights on ALS Research

As for ALS, Johns Hopkins estimates that the illness affects as many as 30,000 in the United States, with 5,000 new cases diagnosed each year. Estimates suggest that ALS is responsible for as many as five of every 100,000 deaths in people aged twenty or older, most commonly in people over age sixty. The disease process causes terrible suffering.

Pharmaceutical company Bayer and Dewpoint Therapeutics are partnering to produce treatments using this new technology for dementia, ALS, and other cancer conditions as well.

Diseases like Alzheimer’s and ALS can cause not only emotional stress for families, but financial stress as well. We help families deal with legal and financial issues related to caring for a loved one with a serious disease. If you’d like to discuss your particular situation, please don’t hesitate to reach out. Please contact our Reno office by calling us at (775) 853-5700 with any questions.

Healthcare

Why You Should Have a Strategy for Your Aging Parents Before a Medical Crisis Hits

Many adult children in the US live far away from their parents. Managing aging parents or in-law medical events can be a serious challenge without proper preparation and understanding of what your parents’ strategy may or may not be, no matter where you live. Do you know what legal documentation your parents have in place regarding their medical care? Do they have advance directives that can help guide your medical decision-making process? Do you and your spouse openly discuss the situations of each other’s parents?

Medical advancements facilitate aging Americans’ longevity even with comorbidities such as high blood pressure, diabetes, kidney disease, atrial fibrillation, and other health issues. Hospitals can typically fix non-life-threatening conditions easily enough, but what happens when a parent is released to return home? Are you prepared? Is there a plan? Many adult children tend to practice avoidance, denial, and wishful thinking when thinking about their aging parents’ behalf in a potential medical crisis. It is advisable to organize and prepare for the changes that inevitably come to your parents’ health.

More than ever, seniors are choosing to live independently and with autonomy about their life decisions. Even if your parents are in a well-run continuing care retirement community, there will come a day when their health will force a change in their lifestyle and living arrangements. Many parents will resist “help,” which they may consider more as interference. Whether they believe they are being a burden to you or decline a geriatric care manager’s services due to “cost” concerns, most older people do not want others interfering in their private affairs. 

The goal is to find a way to help while still affording your parents the dignity and respect they want and deserve. To achieve a comprehensive plan on your parents’ behalf, travel to them for an honest discussion. If this is not possible due to COVID-19 restrictions, then virtual meetings are best, followed by phone calls as hearing loss typically makes communicating useful information difficult. Even on a screen, a face-to-face connection allows a parent to read lips, which is a typical strategy for older people experiencing hearing loss.

Review what legal paperwork your parents have and make sure it is in order. Many documents have a signature from many years ago, and things may have changed. If there is no designation of a medical power of attorney, be sure there is a document naming a “personal representative” to address restrictions outlined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This document allows the waiving of privacy concerns that permits access to a parent’s medical information while the parent is in the hospital.

Create an up-to-date list of all your parents’ doctors. The list should include medical contact information and all medicines (prescription or otherwise) that the parents take. If their general physician is not a geriatric specialist, it will help to find them one. Post-hospital fog and newly prescribed medications from an adverse health event can create confusion in an older parent. A geriatric doctor will know to look for and resolve these types of issues. Ask about the parameters for health care intervention, such as dialysis, post-hospital during the time of COVID-19?

Explain to your parents that being released from a hospital for a non-life-threatening, yet serious health episode is usually followed by the need for a care manager, at-home nursing care, or at least companion care. This additional care should not fall to a spouse if the parents live together. A spouse has their unique role to fill as well as personal health challenges with which to contend. Heaping an increased responsibility for spousal health care upon them may be damaging to their health.

Before an unforeseen medical crisis can occur, identify several qualified agencies in your parents’ hometown. Review each agency and candidate carefully. It is easier to integrate a suitable candidate at the outset than having the chaos of retaining and releasing multiple workers. Remember that a candidate who works for one parent may not be another parent’s preference in the future. Maintain a strong relationship with the agency provider. They are an essential resource, and you will probably need them in the future.

Take the time to learn the specifics of your parents’ healthcare and living arrangements. Coordinating your plan of response is contingent upon whether your parents live independently, in assisted living, or a retirement community. Wherever it is your parents live, their first desire will be to go home after an unexpected hospitalization. The desire to return home is a universal truth. Knowing the agencies that can quickly provide the type of care your parent needs in their home setting will go a long way to a successful transition. The road to recovery may require a few weeks of nurse visits, physical or occupational therapists, or simply companionship. The faster you can meet the need, the easier it will be on your parent.

If a full recovery is not possible, what will be your plan to address the new status of their normal? How much more medical oversight and assistance will they require? Know that in these instances, a parent can quickly spend through Medicare allotments afforded for temporary care. If they do not have long-term care, and many aging Americans do not, you will have to find ways to help them receive the care that they require.

If there are multiple adult children, is there an expectation that all siblings share information and work on the problems at hand, or is one in charge? Is this designation formally documented? Managing sibling relationships is key to avoiding family conflict. Also, understand your parents’ financial arrangements. Most parents will ask about the cost of any new healthcare service being arranged and decline using it. It is hard for a parent to spend down the money they worked their entire life to amass.

Knowing your parents’ aging strategies will not address every issue you might encounter because they may not have all the necessary decisions and documents in order. You can only work within the authority they choose to provide. As attorneys, we can help identify gaps in their planning and recommend ways to fill those gaps so everyone can have peace of mind.  If you’d like to discuss ways we can help, please don’t hesitate to reach out. Please contact our Reno office by calling us at (775) 853-5700 to learn more about your Medicaid planning needs.

Estate Planning

The Importance of Keeping Your Estate Plan Current

You should check your estate planning documents every so often, to make sure they’re still good, especially with big life changes like births, marriages, divorces, and moving to another state. Children grow up, marriages dissolve, property gets sold, residences change. That’s why we recommend that you consult us for an estate-plan check-up every five years or so.

What Happens If You Retire in Another State?

If you retire to another state, your will would probably be good, but powers of attorney vary from state to state. Documents from the “old” state might not work in the “new” one, and your documents would not be there for you when you need them.

How Does a Spouse or Ex-spouse Effect My Estate Plan?

Suppose you willed your property to your spouse and appointed that person to be your power of attorney. You got divorced, but you never got around to changing your plan. The law would usually step in to prevent your ex-spouse from inheriting, but you might be stuck with that person holding power of attorney over your property and health care.

Maybe you named your ex-spouse’s father as your executor and agent. Now he can’t stand you and blames you for the break-up.

How Do I Divide my Assets Equally to my Children?

Perhaps you willed your property to your two children equally – but now one child is addicted to opioids. Your will did not restrict how money should be spent. If your addicted child inherits a lot of money in one chunk, that money could vanish to drugs and your child’s survival might be at risk.

Or, you deeded your house to one child and made a will leaving money to your other child. Then you forgot about the deed and made another will, years later. That will split everything equally. The law would invalidate the second will as to the house, because deeds supplant wills. Consequently, one child might end up receiving more value than the other. That unfairness might sour the children against each other forever.

If you got divorced, sold property, moved to another state, or did your documents more than five years ago, come see us for an estate plan check-up.

When it comes to estate planning, “once is not done.” Please contact our Reno office by calling us at (775) 853-5700 to learn more about your estate planning options.

Uncategorized

Why Veterans Benefits Planning is Vital for Aging Veterans

The COVID-19 virus is not going away as many had hoped. And studies have shown it is deadlier for those over the age of 65. Individuals living in senior living communities, such as independent living, assisted living, memory care, and nursing homes have the highest risk of becoming infected and possibly dying from the virus or a secondary illness, such as pneumonia, after being weakened from the virus. For many families, providing long term care for a loved one in the home has become an even bigger priority than normal. In-home care can be costly, which makes the Aid and Attendance Benefit provided by the Department of Veteran’s Affairs of critical importance to help pay for such care.

Veteran Aid and Attendance Benefit

The Aid and Attendance Benefit, technically called the Improved Pension Benefit, is a cash benefit paid to wartime veterans that are over the age of 65 and require another person to assist them with activities of daily living, such as bathing, dressing, feeding, and assistance with incontinence, or requires a protective environment due to mental decline. The Aid and Attendance Benefit is also available to similarly disabled spouses of deceased wartime veterans that are over the age of 65. It is this need for assistance with care or a protective environment that has the family looking into long term care facilities for their loved one.

The Aid and Attendance eligibility rules also require the person receiving the benefit to have limited income. Simply put, all income of the applicant and the applicant’s spouse must be offset by the medical expenses of the applicant and the applicant’s spouse. Any income not offset by medical expenses reduces the amount of the benefit. Under the Aid and Attendance rules, when the wartime veteran or surviving spouse requires assistance with activities of daily living or a protective environment, paying an in-home caregiver to provide that care is a medical expense. It does not matter whether the caregiver is a child or hired through an agency.

Current Veteran Benefits

For 2020, the maximum benefit paid to a married wartime veteran is $2,266 per month. The maximum benefit paid to a single wartime veteran is $1,911. The maximum benefit paid to a surviving spouse of a wartime veteran is $1,228. Working carefully through the math, if a married wartime veteran needs long term care and has a household income of $4,000 per month, he or she will need to spend $4,000 per month on medical expenses to receive $2,266 per month. That veteran likely already has medical expenses in the form of two Medicare and two Medicare supplement premiums, as well as possibly two Medicare prescription supplements. The remaining income needs to be spent on additional medical expenses, specifically an in-home caregiver.

The family must now decide the best way to navigate paying the in-home caregiver. If the couple has children, perhaps the remainder of the household income can be paid to a child, or split among the children, as payment for caregiver services. In many cases, using a child or children as a caregiver allows for flexibility in the amount a caregiver is paid. The income calculation can be manipulated to net out at exactly zero, instead of going into the negative. This allows the veteran to use the $2,266 per month benefit to pay for the couple’s non-medical living expenses.

Other Veteran Benefits for Caregiving

The other option is to hire a caregiver from an agency. This option is more expensive than using a child as a caregiver, but it comes with the added benefit of ensuring taxes are withheld and workers’ compensation insurance is provided in case of an accident. If the family wants the income calculation to net out at exactly zero, the veteran typically will not get as many hours of service from the caregiver hired through an agency compared to hiring a child since an agency typically charges a higher per hour rate. This would work well for a veteran that does not need a lot of care, or that has a wife and/or children that can cover the additional hours of care for free. Otherwise, the agency will need to be paid to provide the additional hours of service, which means the $2,266 benefit paid by the Department of Veterans Affairs will also be used to pay for the care and the couple will have to use assets to pay for the couple’s non-medical living expenses.

The Aid and Attendance Benefit also has an asset limit the applicant must meet, along with a penalty for giving assets away and a 3-year period to look back at the applicant’s assets to see if any gifts were made. These rules should not dissuade a wartime veteran or surviving spouse from seeking this benefit. The need for long term care will only increase. The cost of care will only increase. And now the COVID-19 virus makes it critical that everything possible is done to protect this vulnerable community.

If you have questions or would like to discuss whether you or a loved one may qualify for Veterans Benefits, please don’t hesitate to reach out. Please contact our Reno office by calling us at (775) 853-5700 to learn more about your VA planning options.

Elder Living

Understanding CMS Guidelines for Nursing Home Visitation

Revised guidance for nursing home visitation has been issued by the Centers for Medicare and Medicaid (CMS). It is now possible to have visitation with nursing home residents for reasons other than urgent end-of-life scenarios and, in some instances, may include physical touch. Additionally, communal activities and dining are permissible as long as the social distancing rule of 6 feet of separation, and other precautions are observed. Encouraging outdoor visits is desirable as long as the weather permits. Indoor visits are permissible if no new cases were identified in the previous two weeks, and the facility adheres to the core principles of resident and staff testing, screening, proper hygiene, social distancing, and facility cleaning. 

The CMS memo contains “Core Principles of COVID-19 Infection Prevention” verbatim as follows:

  • Screening of all who enter the facility for signs and symptoms of COVID-19 (e.g., temperature checks, questions or observations about signs or symptoms), and denial of entry of those with signs or symptoms
  • Hand hygiene (use of alcohol-based hand rub is preferred) 
  • Face covering or mask (covering mouth and nose) 
  • Social distancing at least six feet between persons 
  • Instructional signage throughout the facility and proper visitor education on COVID19 signs and symptoms, infection control precautions, other applicable facility practices (e.g., use of face-covering or mask, specified entries, exits, and routes to designated areas, hand hygiene)
  • Cleaning and disinfecting high frequency touched surfaces in the facility often, and designated visitation areas after each visit 
  • Appropriate staff use of Personal Protective Equipment (PPE) 
  • Effective cohorting of residents (e.g., separate areas dedicated COVID-19 care)
  • Resident and staff testing conducted as required.

CMS acknowledges that the previous months of severe visitor restrictions to slow the spread of COVID-19 were at a high cost to nursing home residents’ overall wellbeing. The revision of visitor guidance compassionately addresses resident care needs beyond protection from the coronavirus. CMS Administrator Seema Verma states, “While we must remain steadfast in our fight to shield nursing home residents from this virus, it is becoming clear that prolonged isolation and separation from family is also taking a deadly toll on our aging loved ones.”

CMS is also making available Civil Monetary Penalty (CMP) funds to ensure greater and safer access to outdoor and indoor visits. The money can purchase tents for outdoor interaction and clear dividers such as plexiglass can create physical barriers, reducing the risk of transmission during in-person visits. Funding through CMP can also provide communication aids such as tablet devices and webcams that enable virtual visits. However, each facility has a limit of $3,000 to ensure a balance in distributing CMP funds.

Compassionate care situations now include more than the end-of-life scenarios and are also included in the CMS memo. Verbatim they include but are not limited to:

  • A resident, who was living with their family before recently being admitted to a nursing home, is struggling with the change in environment and lack of physical family support.
  • A resident who is grieving after a friend or family member recently passed away.
  • A resident who needs cueing and encouragement with eating or drinking, previously provided by family and/or caregiver(s), is experiencing weight loss or dehydration.
  • A resident, who used to talk and interact with others, is experiencing emotional distress, seldom speaking, or crying more frequently (when the resident had rarely cried in the past).

In addition to family members, compassionate care visits may now also include clergy or laypersons offering religious or spiritual support that meet the resident’s needs. Personal contact is permissible during these and family visits but only when following all appropriate infection prevention guidance. This more humanized approach to nursing home care encourages facility staff to work with residents, families, caregivers, and resident representatives to identify those in need of in-person compassionate care visitation. Exceptions to compassionate visits occur when facilities have experienced COVID-19 infections within the past two weeks or when a county is experiencing a high positivity COVID-19 rate. In the absence of a reasonable safety or clinical cause, the Centers for Medicare and Medicaid make clear that failure of nursing homes to facilitate in-person visitations can be cause for citations and other penalties as CMS deems appropriate.

CMS understands that nursing home residents derive physical, emotional, and spiritual value and support through family and friend visitations, especially in trying times. No one should be made to endure this pandemic alone, least of all the most vulnerable among us. This new CMS nursing home visitation guidance is designed to help American seniors remain happier, stronger, and more resilient in the face of adversity through the personal support of those who love them most.

If you have a loved one in a nursing home, check with the facility to see how or whether their visitation guidelines have changed. It may take time for local facilities to consider these new guidelines and make changes that are consistent with the recommendations from CMS.

We would be happy to discuss any questions you have, including how to choose appropriate long term care and how to pay for it. We can recommend legal ways to help ease the cost of long-term care and protect your savings and home. Please contact our Reno office by calling us at (775) 853-5700 to learn more about your legal options.

Estate Planning

Understanding the Differences Between Wills and Trusts

Wills and trusts have specific and quite different benefits for estate planning purposes. Each state has specific laws and regulations governing these legal documents. You can have both a will and a trust; however, the information in each should compliment the other. As a standalone, it is not accurate to say one is better than the other. The better choice for you, or a blend of both documents, depends on your assets and life circumstances. Begin by assessing your situation, goals, and needs, and understanding what wills and trusts do to guide your decision making. Then, along with an attorney, you will be able to identify the solution that best suits and protects your family.

At its most basic level, a will allows you to appoint an executor for your estate, name guardians for your children and pets, designate where your assets go, and specify final wishes and arrangements. A will is only enacted upon your death. It has some limitations regarding the distribution of assets, and wills are also subject to a probate process (which occurs in court and is overseen by a judge) and, as such, are part of public records.

Types of Wills for Your Estate Plan

The last will and testament designates a person’s final wishes about bank accounts, real estate, personal property, and who should inherit these items. A personal will outlines how to distribute possessions, whether to another person, a group, or donate them to charity. It also deems responsibility to others for custody of dependents and management of accounts and other interests. Accounts can include digital assets with a tangible or monetary value associated with it, such as funds in a PayPal account.

A pour-over will ensures an individual’s remaining assets will automatically transfer to a previously established trust upon their death. This type of will always accompanies a trust.

A living will or advance directive specifies the type of medical care that an individual prefers if they cannot communicate their wishes.

A joint will and mutual will is meant for a married couple to ensure that their property is disposed of in an identical manner. A mirror will is two separate but identical wills, which may or may not also be mutual wills.

A holographic or handwritten will is valid in about half of the states and must meet the specific state’s requirements. Authentication of this will type for acceptance to the probate process also varies by state. There is always the possibility that a court will not accept a holographic will. Even if you have limited assets, your best strategy is to have your will professionally documented by an attorney. A video of your final wishes does not create a valid will.

Trusts are somewhat more complicated than wills, and the many different trust types can greatly benefit your estate and beneficiaries. Generally, a trust provides for the distribution and management of your assets during your lifetime and after death. Trusts can apply to any asset you hold inside the trust and offer more control over when and how your assets are distributed. There are many different trust forms and types, far more than wills.

However, the creation of a trust is only the beginning of the process. You must fund your trust by legally transferring assets into it, making the trust the owner of those assets. This process makes creating a trust a bit more complicated to set up; however, a trust is often enacted to minimize or completely avoid probate, thus keeping personal records private. Avoiding probate is a huge advantage for some people and often justifies the additional complex legal work of setting up a trust. There are nearly as many types of trusts as issues to address in your estate planning, and each offers different protections. However, trusts generally fall into three basic categories.

Basic Trust Types For an Estate Plan

A revocable living trust is, by far, the most commonly implemented trust type. The person who creates and funds the trust is known as the grantor and will typically act as the directing trustee during their lifetime. The grantor may undo the trust, change its terms, and move property and assets in and out of the trust’s ownership as they deem desirable. Revocable living trusts are designed to switch to an irrevocable trust upon the death of the grantor.

An irrevocable living trust is legally binding on its date of designation and allows very few provisions for change. The trust grantor funds the irrevocable living trust with property and assets, and the trust property is then under the care and control of the individual the grantor names as trustee. The grantor cannot change their mind and “undo” the trust. There are unique tax implications and other benefits to an irrevocable trust, including protecting a person’s home and savings from the high costs of long term care. These benefits can make relinquishing control worthwhile.

A testamentary trust is a provision within a will, appointing a trustee to manage the deceased’s assets. This trust is often used when the beneficiaries are minor children or someone who is receiving public benefits. This trust type is also used to reduce estate tax liabilities and ensure professional asset management. A testamentary trust is not a living trust. It only exists upon the death of the testator (the writer of the will). The executor of the deceased’s estate would follow the terms of the trust (called administering the trust) as part of the probate process.

Things to put into a trust include but are not limited to:
·      Stocks, bonds, mutual funds
·      Money market accounts
·      Brokerage accounts
·      Patents, copyrights, and royalty contracts
·      House and other real estate
·      Business interests and notes payable to you
·      Jewelry and precious metals
·      Works of art or other valuable collections
Assets that are not affected by trusts include but are not limited to:
·      Life insurance proceeds
·      Payable on death bank accounts
·      Retirement accounts
·      Jointly owned assets
·      Real estate subject to transfer-on-death deed

The many benefits that proper estate planning with wills and trusts can provide to your family are worth some thoughtful contemplation, legal counsel, and properly drafted documents.  We would be happy to meet with you and discuss which options are best for your particular situation. Please contact our Reno office by calling us at (775) 853-5700 to learn more about your estate planning options.

Elder Living

Among Elderly Americans, Isolation is Increasing Self-Neglect

Because of the coronavirus, our elder population is experiencing isolation from their family and extended community interaction, increasing the likelihood of neglect. With the flu season fast on approach this isolation and the possibility of a resurgence of COVID-19, older Americans will likely continue living 2020 in mostly solitary circumstances. Rising instances of loneliness can give way to clinical depression and foster feelings of hopelessness.

Common Signs of Self-Neglect

Some of the common signs that an older adult is self-neglecting include changes in how they communicate and a lack of interest in family or community events. A loved one who always presented themselves in a put-together manner may suddenly stop bothering to dress for the day, or perhaps they have gained or lost a startling amount of weight. A once tidy home may now be piled high with unopened mail and heaps of garbage. They may stop or have difficulty managing their medications. Their demeanor and mood may change, and often there is the incidence of a fall.

ASA

Neglect is often a person depriving themselves of necessary care, whether it be adequate nutrition and hydration, medical care, hygiene, and a suitable living environment. In some instances, neglect may be an extension of diminished capacity of physical or mental ability to provide self-care. In some cases, negligence can be the precursor to abuse by an active or passive negligent caregiver. As reported by the American Society on Aging (ASA) outside of financial abuse, the National Association of Professional Geriatric Care Managers identifies self-neglect as the more commonly encountered situation than physical or sexual abuse or neglect by others.

Each state has a mandatory reporting law requiring certain people to provide information about suspected abuse to the proper authorities. Typically, these people are nurses and doctors, as well as wellness check programs through CMS services. Some states require any person who suspects elder abuse to report the situation. Know your state law for reporting and be mindful that your elder loved one is isolated from medical professional groups who report signs of neglect.

What to Do if you Are Suspecting Elderly Abuse

If you have not already implemented virtual strategies to combat loneliness for your older adult, do so immediately. There are many communication, safety, health, and entertainment apps designed specifically with seniors in mind. If your loved one cannot manage a smartphone, use a larger tablet device. If that is unachievable, get a smart speaker where voice communication can provide the sorts of contact options, safety, and activity your senior needs.

Contact your loved one routinely. Implement fall detectors and set up video surveillance to identify any problems. Be sure not to create an overly invasive system allowing your senior some degree of privacy to protect their dignity. Always use firewalls, passwords, and other security options to address privacy concerns.

Take advantage of community programs such as Meals on Wheels or identify programs that check-in on independent living older adults or high-risk households. If they are so inclined, set up the technology for your family member to participate in the many religious services currently being conducted live on Facebook. Connect with their neighbors or local friends to request they occasionally check in on your family member.

AARP recommends whatever the legal obligation in your state to report any sign of elder neglect or abuse. If you believe the person may be in imminent danger, call 911 immediately. If not, address the concern with the person directly or with their caregiver or family member. Remember, you may be misinterpreting the situation. After you have raised your concerns, listen carefully to the other person’s point of view. There may be a quick fix for a small problem, or it could be something more profound. Act deliberately but with compassion. If you meet with resistance to change but still believe help is needed, learn how you can report your concern. Your local police department may have an Elder Affairs unit. Nationally, you can contact support through a public service of the US Administration on Aging called the Eldercare Locator (800-677-1116), connecting you with local protective service agencies.

If you believe your loved one can no longer manage their health, safety, and wellness needs, we can help by providing advice on legal options to protect your loved one. We would be honored to talk with you. Please contact our Reno office by calling us at (775) 853-5700 to learn more.

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How to Plan Ahead for You or a Loved Ones Inheritances and Medicaid

How to Plan Ahead for You or a Loved Ones Inheritances and Medicaid

Mistakes can be made when it comes to inheritances and Medicaid. Those mistakes can be costly.

When a person is drawing Medicaid benefits and inherits money or property, that inheritance jeopardizes the benefits. The inheritance must be handled carefully to minimize expensive penalties. What “careful” means, though, can be misunderstood without the necessary expertise.

The Right Steps for Handling Inheritance

The first and best idea is to call experienced elder law attorneys like us. (An even better idea is to call us well before any inheritance becomes a “problem.” The sooner you call us, the more money we can likely protect for you.)

An Ohio attorney was recently suspended partly because he mishandled this Medicaid-inheritance issue. The mistaken advice was that to protect the benefits, the person who stood to inherit should “disclaim” or “renounce” the inheritance – in other words, give it away to someone else.

Medicaid Rules and Inheritance Context

That advice would have been OK in the tax context. It was not OK in the Medicaid context. The Medicaid rules count inheritances regardless whether the recipient keeps them or passes them on to someone else. The bad result, in such cases, is that the person receiving Medicaid would be charged just as if he or she had taken the money, even if he or she gave it away, and the person’s benefits would be docked accordingly. This can be a very expensive misstep.

The better result would be to consult us immediately. We can advise you on necessary  techniques to split the inheritance between the recipient and somebody else, like a child. If the right strategies are used, Medicaid would count the inheritance to an extent, but not as much as it would have if the recipient had simply given away the whole sum.

An even better result would be if the person leaving the inheritance had consulted us first. We know how to structure that person’s financial arrangements, to protect the people to whom the person wants to leave his or her legacy.

Elder law is a law unto itself. We know that complicated area of the law well and we have helped many people successfully meet the challenges it poses. Please contact our Reno office by calling us at (775) 853-5700 to learn more about your planning options.

Elder Law

Debunked Myths of Long-term Care

According to the U.S. Department of Health and Human Services, someone turning age 65 today will have a 70 percent chance of requiring some long-term care (LTC) service and support during the remainder of their life. In the case of women, the typical LTC need will last about 3.7 years compared to men who will need about 2.2 years of care. While approximately one-third of today’s 65-year-olds may not ever need long-term care 20 percent of those who do will require it for more than five years.

The statistics are clear; older Americans should be carrying a long-term care insurance policy to protect their future but only about 7.2 million Americans 65 years or older currently own a traditional long term care policy, and this number has held steady for the last seven years. While LTC insurance is overall considered expensive and finding the right plan for you in the myriad of insurance products available can be confusing and vary from state to state. According to A Place for Mom, there are seven myths about long term care that anyone age 50 or more should understand.

One myth is that a person has to get rid of all of their assets to receive Medicaid which will qualify them for federally available LTC benefits. In general, the rule is a person is not allowed to keep more than $2,000 in countable assets to be eligible for Medicaid. Exemptions in some states can include your home (if a spouse, minor or disabled child still lives there), assets that cannot be converted to cash, and burial plots or spaces. Also, personal property, one vehicle, and prepaid funerals generally qualify as exemptions. The Community Spouse Resource Allowance rules permit the non-applicant spouse to keep a portion of the couple’s countable assets to prevent them from becoming destitute. Before making any attempt to spend down assets to qualify for Medicaid speak to an elder law attorney as the federal five year “lookback” rules have penalties and exceptions.

No, Medicare will not pay for long term care expenses except in the most specific and narrow of circumstances. Medicare will cover skilled in-home care from a nurse, occupational therapist, physical therapist, speech therapist or social worker for up to 21 days if ordered by a physician. In the case of a skilled nursing facility, Medicare pays for the first 20 days with no co-pays but if the stay is between 21 to 100 days, Medicare only pays a portion, and the beneficiary must pay the balance. 

Another myth is that a person thinks they are too young to think about long term care insurance let alone the need to pay for it. The truth is that even under the age of 65 if the person has a chronic illness like diabetes or high blood pressure or in the event of an accident, long term in-home or residential care services may be needed. According to the US Department of Health and Human Services on average, about 8 percent of people age 40 to 50 have a disability that may require long term care services.

Relying on the hope that family will take care of a long term care need is often a myth. While many older Americans are successfully aging in place, in part due to the benefits of technology, unpaid family member caregivers and community organizations are typically not willing and available for long term, intensive caregiving. A family discussion is needed if there is an expectation that a family member is willing and able to take on a long term caregiver role. While many family members are eager to provide oversight through the use of technology, the intensive requirements of long term care are usually more than they are willing to accept. 

Most health insurance policies will not cover long term care expenses to any meaningful degree. Some plans will have minimal home care and skilled nursing benefits; however the nature of the plan is short term and is intended to produce recovery and rehabilitation while long term care is generally custodial in nature for the safety, maintenance and well being of a person with a chronic condition. Even some long term care insurance policies will not cover all long term care expenses. There are elimination periods which function as a deductible or after a policy benefit has been exhausted. Specific coverage in long term care varies widely from policy to policy.

Finally, many aging Americans feel that their retirement savings will cover the costs of their long term care. The website A Place for Mom has a financial calculator to help individuals understand their specific needs to cover long-term care costs. Currently, the average US national median long term health care cost is about $50,000 for a home health aide which is above and beyond all other living costs. In many situations, in particular with residential care, costs can run hundreds of thousands of dollars over a few short years. Unless a person is independently wealthy, most retirement savings will be spent down very quickly.

Chances are you will need long term care during your lifetime. Being educated about what is best suited to meet your personal financial and health background needs is a significant first step. Next, understand what legal options are available to help you in the event you need significant long term care and may run out of money trying to pay for it. We are here to help. Contact our office today and schedule an appointment to discuss how we can help you with your planning. Please do not hesitate to contact our Reno office by calling us at (775) 853-5700.