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Aging Veterans and VA Benefits

More than 18.2 million veterans live in the United States, and 38 percent of them are 65 and older according to the US Census Bureau. Additionally, the Census Bureau reports that more than 9 million veterans receive services from the Department of Veteran’s Affairs (VA) annually. If you are a veteran or have a loved one who is, it is important to understand all the VA resources and aid that is available. Beyond education programs, home loans, and job search and training resources, the VA also provides a host of other resources to assist you as you transition to your retirement years.

Wartime Veterans Supplemental Income (Veterans Pension)

Supplemental income is available for wartime veterans through the VA pension benefit. If you served at least 90 days of active duty before September 7, 1980, or 24 months after that date, or served the full period for which you were summoned or ordered to active duty with at least one day of wartime, you may qualify.  You must have also been discharged under conditions other than dishonorable. There are strict income and asset requirements attached to this benefit as well as the survivors pension and the housebound or aid and attendance allowance discussed below.

Survivors pension

If your late parent or spouse served during wartime, you might qualify for the survivor’s pension. This tax-free program provides relief for unmarried children or a widow or widower who has low income. The deceased military veteran must have served a minimum of 90 days active service with a minimum of one day served during a period of wartime before September 7, 1980, and been dishonorably discharged. After that September date, the deceased veteran must have served a minimum of 24 months or the full period summoned or ordered to serve active duty. Pensions are based on annual family income and under a designated amount set by Congress. More details regarding military pension eligibility are found on the VA website.

Housebound Allowance and Aid & Attendance Benefit

If you are eligible for or are already receiving a veterans’ pension, you may qualify for additional monetary benefits. If you are permanently disabled and must remain in your current home, the Housebound Allowance will increase your monthly pension. Aid & Attendance (A&A) will compensate a veteran who is either residing in a nursing home, bedridden, requires assistance for activities in their day to day life, or whose eyesight problems meet specific thresholds of degradation. More details for Housebound Allowance and A&A eligibility can be found on the VA website.

Veterans Life Insurance Options

There is a wide variety of life insurance offerings through the Veterans Administration. Servicemembers’ Group Life Insurance (SGLI, VA form SGLV8286) is a group term life insurance that is low cost and is automatic for most active-duty service members. It is also available for those veterans who serve at least 12 periods of inactive training per year with the Ready Reserve or the National Guard. Other automatic qualifiers include belonging to the Commissioned Corps of the National Oceanic and Atmospheric Administration or the Public Health Service, and for midshipmen and cadets of the US military academies and ROTC members. You can extend the coverage up to two years if you are fully disabled at separation. Veterans’ Group Life Insurance (VGLI, VA form SGLV 8286A) allows you to convert your SGLI to a civilian program of lifetime renewable term coverage after leaving military service.

Family Servicemembers’ Group Life Insurance

If you qualify for SGLI, your spouse and children are qualified for Family Servicemembers’ Group Life Insurance (FSGLI, VA form SGLV 8286A). This insurance covers your dependent children free of charge, although the coverage for your spouse cannot surpass your amount of coverage.

Servicemembers’ Group Life Insurance Traumatic Injury Protection

If you sustain a traumatic injury during your service that leads to amputation, blindness, or paraplegia, you qualify for benefit payments made through Servicemembers’ Group Life Insurance Traumatic Injury Protection (TSGLI, VA form SGLV8600).

Service-Disabled Veterans’ Life Insurance

The Service-Disabled Veterans’ Life Insurance(S-DVI, VA Form 29-4364) coverage is provided to veterans who have been given a VA rating for what is called a new service-connected disability within the past two years. Coverage is free for eligible veterans who are fully disabled, and you can purchase additional life insurance.

Veterans’ Mortgage Life Insurance

As a veteran, if you are disabled and approved for a VA Specially Adapted Housing (SAH) grant, you may receive mortgage life insurance coverage through the Veterans’ Mortgage Life Insurance (VMLI, VA Form 29-8636).

This link takes you to an overview of these VA insurance benefits. You can click on the insurance program by name and be automatically redirected to the appropriate VA web page for that benefit.

Disability Compensation

Tax-free Dependency and Indemnity Compensation(DIC, VA Form 21-534EZ) is available to veterans who sustain or aggravate an injury or disease during their active service. The disability may include physical and mental health issues and secondary or related items diagnosed after your discharge. Your child may be eligible for DIC if they are not included in the spouse’s DIC, and there is an income-based DIC for parents. A disability can also qualify you for a higher, tax-free Special Monthly Compensation if you are housebound and need special assistance or have trouble performing daily living activities. Additionally, housing and insurance benefits through the VA, like Veterans’ Mortgage Life Insurance, Service-Disabled Veterans’ Insurance, and Adapted Housing Grants may be available.

Geriatrics and Extended Care Services

The Geriatrics and Extended Care Services (GEC) provides help to veterans with life-limiting illnesses, multiple chronic conditions, or disabilities associated with aging, injury, or chronic disease. The GEC will assist a veteran living at home or in a nursing home, assisted living, or other residential community care facilities. GEC services include home health aide care, daily care, telehealth care, palliative care, respite care, hospice care, and even veteran-directed care.

Military Burial

Veteran burial benefits include a gravesite in a national veteran’s cemetery, a government marker or headstone, the opening and closing of that grave and its perpetual care, and a Presidential Memorial Certificate. The marker, headstone, burial flag and certificate are provided at no cost the veteran. Additionally, dependents and spouses buried in a national veteran’s cemetery may also qualify for some benefits such as burial with the veteran, inscription on their headstone, and perpetual care. For a complete description of your veteran benefits, check this VA website link.

Percentages of veterans receiving benefits:

  • 25-34 years 24.7 percent
  • 36-44 years 21.5 percent
  • 45-54 years 25.8 percent
  • 55-64 years 19.8 percent
  • 65-74 years 5.0 percent
  • 75+ years 1.3 percent

If you are a veteran or have a loved one who is, it is crucial to understand that veteran resources go far beyond career and end-of-life issues. Many veterans are not taking full advantage of VA offerings. Many VA age-related programs can benefit a veteran’s life beyond simply planning their future care. Become acquainted with the many options available and determine which programs you qualify for and best serve your interests. With so many benefits available through the VA, you can improve your living situation during your retirement.

The overview is just a summary of what may be available to a wartime veteran or a veteran who is disabled as a result of their prior service. If you or a loved one would like to explore whether you are eligible for benefits, please don’t hesitate to reach out. Please contact our Reno office by calling us at (775) 853-5700 with any questions.

Elder Law, Elder Living

Seniors Stay Socially Engaged While Socially Distancing with the help of Technology

We have come to know that successful, healthy aging is contingent upon connection to those around us. The opportunities for people to laugh, move, and learn together is foundational to aging success. Enter the coronavirus pandemic to change all of that. Now aging Americans must stay socially engaged while maintaining a physical distance. This issue touches us all from senior wellness professionals, medical staff, families, inter-resident connections, and those aging in place at home and alone. The internet of things, and the virtual links it creates, is a great solution to implement in a socially distanced, troubling pandemic world.

Virtual technology tools were becoming more ubiquitous before the coronavirus. Yet, the need for emotional well-being as the especially vulnerable aging population of America became isolated was the accelerant solution to address the problem. Fitness classes ranging from tai chi to yoga and other forms of movement became available in droves of senior online classes. Connecting with family members or health professionals through telemedicine also became crucial as regular visitations and routine medical appointments became impossible.

Virtual tools provide a great advantage for social distancing as no meeting space is required. Senior interaction with tech tools has brought new learning and skills opportunities, providing a sense of connection, purpose, and pride. Older adults share their newfound prowess in video messages, multi online person chats, and more. Grandparents and grandchildren find common ground in a technological world, and grateful parents/adult children are happy for the means to address the social isolation problem and create stronger inter-generational family ties.

Beyond the connection of friends and family, technology brings email, instant messaging, social media sites, brain games, wellness bingo cards, music, even virtual cruises with daily ports of call to keep seniors connected in isolation. Many aging adults associate full-length feature films with a movie theater and do not realize they can watch nearly anything they want via streaming services, 24 hours a day, whenever they choose.

While the internet and these technology tools provide virtual interaction and entertainment, not every senior who needs it can afford a tablet computer or laptop. Many communities are holding campaigns to raise funds for those in need of these digital devices. Nursing homes can receive a stipend from the Centers for Medicare and Medicaid (CMS) through the Civil Monetary Penalty (CMP) fund. Funding through CMP provides 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. Because these items may be shared among negative COVID-19 residents, it is critical to avoid entering highly personal information into device applications or programs. Shared tablets are not a good way to check bank accounts, shop online, or have your senior pay bills.

Be wary of too much learning too quickly for a senior. Don’t overwhelm the aging adult with the technology, rather focus on what it provides. Slowly introduce different aspects of the technology and be certain the senior has a firm understanding of how to repeat the process to get online or risk creating frustration. Also, educate them that even though they can Skype, Zoom, et al. with others does not mean their loved ones or friends will be available at all times for them. Set a schedule for meaningful connections, managing their expectations to keep them from cycles of disappointment. Share successes, experiences, even failures with residential staff, other family members, and residents. Find out what works the best overall. Keep the strategy simple for the best results.

Be aware that seniors without strong social connections before covid-19 may feel incredibly left out. The technology connecting people doesn’t work if there is no one to communicate with on the other end of the virtual line. Residents without existing social networks typically rely on the now non-existent shared dining room and community events for interaction, and they may now be left behind. These residents need more assistance in learning how to join online classes and interactive communities that share like interests. Senior Americans unfamiliar with the internet of things do not understand the scope of what is available to them. 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.”  Help your loved one to leverage digital technology and the internet to stay connected during the coronavirus pandemic. There is still hope and human connection available, and vulnerable and isolated seniors are in desperate need of both.

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

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.