Elder Law, Estate Planning

Components of Life Care Planning

Estate planning and elder law are two terms that get used interchangeably often, however, there are significant differences between the two. While some overlap exists between the two, learning and implementing strategies from both law practice types is crucial to prepare for successful aging and preserving a family legacy. 

Estate planning lets families:

  • Name guardians for minor children
  • Manage and protect valuable assets
  • Distribute property according to specific instructions after you die
  • Minimize potential estate taxes
  • Simplify or avoid probate
  • Distribute property to beneficiaries
  • Create a business succession plan

Younger people tend to focus on asset protection in their earlier years. They are building their legacy.

Elder law primarily deals with later stages in life and an aging individual’s needs while they are still alive, like:

  • Retirement goals 
  • Paying for long-term care 
  • Protecting the family if they become incapacitated due to an accident, severe illness, or reduced cognitive function 
  • Accessing proper health care without depleting a senior’s resources 
  • Protecting the legal rights of aging adults 
  • Address the needs of persons with disabilities and war veterans, including their spouses, children, and caretakers

Seniors worry about protecting their legacy from medical costs, fraud, or abuse. They want to keep the family home for a spouse or the next generation.

What is Estate Planning?

Estate planning is for adults of all ages. An estate plan determines what will happen to assets upon death. An estate planning attorney can use wills and trusts to ensure your wishes are followed. If there are minor children, a will identifies a guardian to guide and protect them through life until they become adults. Naming a guardian for minors is a crucial aspect of a will.

Estate planning lawyers can structure assets and property to help an estate avoid probate. Various revocable and irrevocable trusts can save money on estate taxes, leaving more to beneficiaries. The probate process is slow, can be very costly, and is a public process, so it makes sense to keep as much of your estate out of probate as possible.

Several assets can pass to heirs without being addressed in a will or a trust through beneficiary designations. Insurance plans, IRAs, and 401(k)s are all examples of beneficiary designation account types. Reviewing your designations is crucial upon major life changes, particularly death or divorce. Update your beneficiaries. If they have changed or are deceased, a court will decide the fate of your funds.

If you have a small business, estate planning is also relevant to the business’s future success. A succession plan helps a future business owner or family member to run the business upon your retirement, incapacitation, or death. An estate planning attorney can help structure inheritance using life insurance policies to balance inheritable assets if one adult child is particularly interested in running the business and others are not.

What is Elder Law?

Focused on later stages of life, elder law anticipates future medical needs, including long-term care, to ensure a senior can live a long, healthy, financially secure life. The goal is to develop a plan to pay for future care that meets their comfort level while preserving as many assets as possible. An elder law attorney knows how to help you qualify for Medicaid or other government benefits while keeping a portion of your assets. In addition, they may support you through Medicaid hearings and appeals.

Elder law attorneys can help protect individuals from elder exploitation or abuse as they become older and caring for themselves becomes difficult. Designating a durable power of attorney (DPOA) for property and financial affairs and another for health and well-being permits representatives to oversee and protect seniors when they are no longer able. DPOAs are documents used in estate planning. Without a power of attorney, elder law and estate planning can assist with guardianship and conservatorship.

What is Life Care Planning?

As an estate grows in value and minor children become adults, it is important to revisit and amend your estate planning documents. Review them regularly as your life evolves, particularly after marriages, births, divorces, deaths, and substantial changes in finances. You may find yourself straddling the needs of children and aging parents. Estate planning shifts as estate planning attorneys consult with you on elder law matters.

Life care planning protects your assets, health, and legacy at every stage of life and addresses common concerns to avoid potential problems. Proactive planning is the key to living your best life, from raising a family to fears of declining health.

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

Elder Law

The Right to Appeal Has Been Granted to Medicare Recipients

As of a recent federal court decision, Medicare beneficiaries can now appeal previous patient status decisions.

The Underlying Issue

When Medicare patients go to a hospital, they often enter through the emergency department. The physician who attends to them must decide whether to admit them into the hospital as an inpatient, discharge them, or keep them in the hospital under observation status. A patient under observation services receives care virtually identical to inpatient care but is classified as an outpatient to qualify for traditional Medicare coverage.

If the patient receiving observation services must go to a nursing home to continue their recovery, traditional Medicare won’t cover the nursing home care because they were not classified as an inpatient for at least three consecutive days when they were in the hospital. This can have a serious financial effect on the patient since they must pay for the services on their own. What made the situation worse is that the Centers for Medicare & Medicaid Services would not allow patients to appeal the decision.

Observation Status

A patient in observation status is in limbo since a physician has determined that they are too sick to go home but not sick enough to be admitted into the hospital as an inpatient. They receive basically the same level of care as a patient who is classified as an inpatient, including mental and physical assessments, diagnostic tests, short-term treatments, medications, and feedings.

In 2015, then-President Barack Obama signed the Notice of Observation Treatment and Implication for Care Eligibility Act, a.k.a. Notice Act. The Notice Act requires hospitals to notify patients if they have been receiving hospital services under observation status for more than 24 hours. Patients must be given both written and oral notifications if their observation status exceeds 36 hours.

The written notice must explain why the patient is not classified as an inpatient. It must explain how their observation status may affect the cost of their hospital care and their eligibility for skilled nursing facility care coverage. The written notice must be signed by the patient or someone acting on the patient’s behalf. If they refuse to sign the notice, then a staff member of the hospital must sign it.

Alexander v. Azar

A recent federal court decision in the Alexander v. Azar case sided with Medicare beneficiaries who had been admitted to hospitals as inpatients but then changed to observation status. If you were a patient in a hospital and switched from inpatient status to observation status, you may have the right to appeal Medicare’s decision. To appeal your observation status decision, you must have been:

  • Hospitalized since January 1, 2009
  • A Medicare beneficiary with traditional Medicare (not Medicare Advantage) during your hospitalization
  • Admitted to the hospital as an inpatient before your status was changed to observation status
  • Notified of Medicare Outpatient Observation status from the hospital or have a Medicare Summary Notice stating that you will, or did, receive observation services that are not covered by Medicare part A
  • Qualified for either both Medicare Part A and Part B or only Medicare Part A
  • Hospitalized for at least three consecutive days but fewer than three days as an inpatient
  • Admitted to a skilled nursing facility within 30 days of discharge from the hospital.

Stay up to date as this situation develops by checking in with the Center for Medicare Advocacy.

Help with Medicare and Medicaid

Navigating the complicated Medicare and Medicaid systems can be difficult and time-consuming. It is all too easy to make mistakes that will cause coverage to be denied. An experienced elder law attorney can guide you through the process to get the benefits you need.

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

Elder Law

Rejection Reasons for SSI and SSDI Claims

Before spending time and effort on the SSI or SSDI application process, you should consider some of the major disqualifiers. Eligible individuals can benefit from both programs though they have distinct differences. The major difference is SSI eligibility qualification relies on age, disability, and limited resources and income, while SSDI eligibility determination relies on disability and work credits. In most states, SSI recipients automatically qualify for Medicaid health care coverage, which could result in additional supplementary benefits through your state’s Medicaid program. However, both programs have some common reasons that can disqualify your claim. 

Typically most people think about the reasons they should receive benefits without ever considering why they may be denied. Some of the reasons are beyond your control, while other reasons are missteps you can avoid that result in denial. Things to consider include:

Your Income Earnings are Too High 

In the case of SSI, the disability benefit for low-income individuals, you cannot exceed the substantial gainful activity (SGA) threshold. However, it is permissible to earn more money after your approval. Still, there is a limit of about $1,600 a month on all earned and unearned income for SSI. This dollar amount applies to both application for and collection of benefits. Any time your monthly income exceeds $85, your SSI payment will receive a reduction based on a complex formula. Anything over $1650 per month, and you will no longer qualify.

When you apply for SSDI (the benefits program for workers who paid into the Social Security tax base over multiple years), your claim may be denied if you work above the threshold considered substantial gainful activity. Going over this amount means you earn too much money to be considered disabled. It is permissible to earn a small amount during your application and collecting of SSDI but not over the SGA limit. This limit (for non-blind individuals) was $1310 per month in 2021, and the figure is adjusted annually. It is worth noting income from investments does not count toward the SGA; only work income determines your ability to work.

Your Disability is Not Considered Severe or Won’t Last Long Enough 

Qualification for both SSI and SSDI benefits means the Social Security Administration (SSA) must believe your impairment is severe enough to continue for at least 12 months or result in your death. Blind SSI applicants are the only exception to the duration requirement.

Many claims based on bone fractures resulting from acute trauma from accidents are commonly denied since the disability is unlikely to last 12 months. Nearly all bone fractures heal in under a year. If your bone fractures are severe enough and have not healed after six months, you may resubmit your claim as the SSA will likely believe your impairment will last a year. Each case receives an individual evaluation.

If your medical condition is not trauma-related, it must still cause severe limitations of disability to qualify for SSI or SSDI. Most denied claims are due to the applicant’s impairment not being severe enough. You can learn about the disability determination for benefit claims here.

The Social Security Administration Can’t Reach You

Both the SSA and Disability Determination Services (DDS) agencies need to be able to communicate with you regarding your application. If they cannot reach you, schedule examinations, appointments, or communicate about critical matters, you will likely be denied benefits. Every day claimants are denied because the SSA cannot locate them. If you opt to name a representative (such as a disability lawyer) to handle your application, you may not have to contact the SSA. However, you most certainly must maintain contact with your disability attorney.

Your Refusal to Cooperate

The SSA requires medical information about your impairment, and if you refuse to release these records, your claim of disability will likely be denied. If you provide medical records, but the SSA deems them incomplete, or you lack a regular doctor for treatment, they will schedule a consultative examination (CE) with an SSA doctor. Refusal to accept this exam(s) and requesting a determination of eligibility be based on existing medical records may be cause for denial due to inadequate medical data or failure to comply with a CE. Your attorney also helps you gather the correct medical information according to the requirements.

Your Failure to Follow Prescribed Therapy

If you receive medical treatment, failure to adhere to the doctor’s prescribed therapy when you are able to may cause a denial of disability benefits. Some acceptable medical excuses include:

  • The severity of your mental illness precludes your ability to comply with the prescribed therapy.
  • You elicit intense fears regarding surgery, making the procedure inappropriate. Your treating doctor will confirm the severity of your fears to the consulting DDS doctor.
  • You are physically unable to follow the prescribed therapy without assistance due to paralysis, cataracts, or other physical limitation.

Some acceptable non-medical excuses include:

  • You lack the money to pay for the treatment.
  • You have religious beliefs that prohibit receiving the proposed medical therapy.
  • Your doctor prescribes a treatment with which a second opinion doctor disagrees.
  • The proposed therapy will not result in the restoration of your ability to do substantial gainful activity.

Your attorney can review the details of your situation to see if any exclusions apply and collect the necessary documentation.

Your Disability is a Result of a Drug Addiction or Alcoholism (DAA)

If a contributing factor to your disability is DAA, the SSA will deny your claim for benefits. The DDS medical consultant will determine whether you would still be disabled if you ceased using drugs or alcohol. You can read more about DAA determining factors here.

You have a Criminal Conviction

Certain conditions relating to criminal conviction or imprisonment will prevent approval of SSDI.

  • You are in prison after your felony conviction without a court-approved rehabilitation program likely to result in employment upon release. That release expectation is within a reasonable amount of time.
  • You received an injury while committing a felony and are convicted of the crime. The resulting impairment, or worsening of an existing one, suffered during a felony crime is ineligible to use as a basis for disability benefits.
  • You became injured while in prison. The resulting impairment, or worsening of an existing one, suffered while incarcerated can’t be used to get benefits. However, you can likely receive benefits after your prison release.

If these conditions apply to your situation, it is still worth the effort to apply for SSDI benefits. Although you will not receive cash benefits, you may still be granted a benefit-free disability period that freezes your earnings record, preventing the decrease of eventual disability, retirement, or dependents benefits. Talk to a disability attorney if your claim is complicated by these circumstances.

The above conditions do not prevent your receiving SSI disability benefits, although you will be unable to collect them while incarcerated.

You Commit Fraud

Always apply for disability benefits honestly. If you receive them by dishonest means, the SSA may terminate your benefits and choose to prosecute you for fraud. Benefits obtained through fraudulent methods by your representative or someone working for the SSA also may cause the termination of your benefits.

These common reasons stop you from legally obtaining SSI and SSDI benefits. Before you become too involved in applying, be certain you meet the minimum standards for approval. A disability lawyer can help you sort out any issues, avoid missteps, and properly present your case for disability approval.

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

Elder Law, Estate Planning

Medical Advance Directives: Understanding the Different Types

A trauma or illness could incapacitate anyone, and no one likes to think about it. People experience it every day, unfortunately. With this knowledge, many people like to prepare in advance for the kind of treatment they want in the event of cardiac arrest, respiratory failure, stroke, and brain death. Some people would allow doctors to perform “heroic measures,” and others would rather die without significant medical intervention. Medical advance directives are legal documents that outline the details of your advance healthcare planning.

There are a few types of medical advance directives. A durable power of attorney names a person to act as your healthcare proxy or surrogate who can make medical decisions and follow those outlined in your living will if you are incapacitated. A living will tells medical professionals when they should and should not use certain interventions, like intubation, CPR, and IV nutrition. A living will only pertain to saving a life, but a power of attorney can make any decision. For example, if a person is unconscious but not in peril of death, a power of attorney could consent to minor medical treatment that is not life-threatening.

What Happens without Medical Advance Directives

Of course, many people without advance directives get into car crashes or have other accidents and need someone to make medical decisions for them. Without an advance directive, the state relies on a legal hierarchy of next of kin. Legal guardians make decisions for minors and adults with a conservatorship. The state usually recognizes a spouse or domestic partner as the next of kin for most adults. Without a spouse, the responsibility often goes to an adult child, sibling, or parent. For many people, this system works well.

The legal hierarchy presents major problems for others. Sometimes people remain legally married to someone who no longer represents their best interests. At other times your next of kin does not share the same values and would not make the right choices for you. Sometimes, you feel more aligned with a person who is a friend instead. In all of these situations, having an advance directive helps ensure that the medical decisions made on your behalf are the same or similar to those you would make for yourself if you were able.

Items to include in a Living Will

Your power of attorney can express end-of-life wishes that address the use or withdrawal of specific treatments. Likewise, some people may want to plan certain end-of-life decisions while they are still healthy. You can specify the types of medical treatment desired, such as:

  • Pain relief (analgesia)
  • Antibiotics
  • Intravenous hydration
  • Artificial feeding (feeding tube)
  • Cardiopulmonary resuscitation
  • Ventilators
  • Do not resuscitate orders (DNR)

Of course, addressing every possible scenario is impossible, but try to be explicit about your instructions for common life and death scenarios.

Items to Discuss with your Healthcare Proxy or Surrogate

Your power of attorney for medical advance directives affords the same rights to request or refuse medical treatment to the surrogate as if the individual at risk were capable of making and communicating decisions. With this in mind, you want to choose someone you trust and who shares your values. You also want to make your desires clear to that person so they can carry out your wishes. For example, let them know if you strongly oppose donating organs, having a blood transfusion, or certain hospital visitors. Explain your decision-making process to them so they can use that reasoning to figure out what you would want.

Creating Advance Directives

As advance directives are legal documents, lawyers are most effective at writing and reviewing them to reflect your wishes and hold up in court. Something is always better than nothing, so start with the basics and add details as they arise. An estate planning or elder law attorney can help create and review your advance directives. As experts in this area, we know the right questions to ask. We will listen to your wishes and help guide you in making important decisions about your care. If you have questions or would like to discuss your personal situation, please don’t hesitate to contact our Reno office by calling us at (775) 853-5700.

Elder Law

Taking Care of a Loved One’s Finances

Banking and payment of bills can become more difficult with age, but incapacity by accident or illness can strike anyone at any age, posing the same challenges. Incapacity is not just about mental cognition, accident, or illness. You may have a loved one who cannot drive themselves to the bank or has a distinct visual or hearing impairment. Without a plan, incapacity will jeopardize your loved one’s daily financial activity and preservation of wealth. Some possible solutions for financial oversight include:

  • Having a caregiver provide help
  • Selecting a power of attorney
  • Implementing trusts
  • Retaining a professional fiduciary
  • Combining some of these options

Creating a Financial Plan

Whatever you choose, careful thought and thorough planning are needed for the best outcome. To minimize family conflict, it helps to make plans together before experiencing an illness or accident that makes it impossible to handle financial transactions or decisions. Discussions among siblings, in particular, are important before assigning responsibilities. Openly discuss issues of health and financial oversight with trusted family members to minimize misunderstandings, reduce distrust, and prevent potential legal disputes. If a particular conflict seems unresolvable, a neutral third party, such as trusted clergy, a family therapist, or a mediator, can provide impartial counsel.

Protecting Loved Ones from Creditors and Fraud

A joint checking account may seem like a straightforward solution for a caregiver to write checks, make ATM cash withdrawals, track expenses, and perform other financial duties on behalf of their ward, but there are risks. The second party on the account may use their banking privileges to steal from your loved one. Creditors can seek payment from either individual on this account, so if your secondary party carries debt, your loved one may wind up paying for it. Finally, when either party dies, money in this account will belong to the surviving account holder, which may create conflict among siblings and heirs.

Setting Up a Convenience Account

About half of all US states now permit a “convenience account” where the second account holder only has permission to transact for the benefit of the original account holder. The account type is handy when the only need is to address paying bills and providing nominal amounts of cash. The secondary party will have no permission to use the money for self-interest or inherit the account upon the principal’s death. Financial stewardship on behalf of a loved one in a convenience account should include:

  • Written records of expenses paid from the account
  • Notes with the reason for all checks in the memo field
  • Money in the account is protected against being borrowed or claimed as an asset
  • Purchases can’t be made by the steward or a third party
  • A trusted family member acting as the second party to the account is preferred over a paid primary caregiver 

When financial oversight for your loved one needs to be more comprehensive, other fiduciary categories can address financial stewardship for aging or incapacitated loved ones.

Power of Attorney (POA)

This legal document sometimes referred to as a durable financial power of attorney, designates an individual to make financial decisions on behalf of the principal (the assignor of the POA) if they become incapacitated. The principal must be of sound mind to grant a power of attorney.

Naming a financial POA, also called an agent or attorney-in-fact, will prevent the risk of a family going to court to file for guardianship if their loved one becomes incapacitated. Establishing guardianship can be a lengthy, expensive, and potentially divisive process for family members.

Trusts and Trustees

Your loved one may have their elder law attorney create and transfer assets to a revocable living trust with a named trustee. In the future, if the trust grantor loses their ability to make sound financial decisions, the trustee becomes the responsible party for the management of the trust’s assets. 

A trustee’s functions may include:

  • Maintaining an insurance policy
  • Paying taxes
  • Making investment decisions
  • Putting valuables in a safe deposit box

However, as long as the grantor is capable, they may change or revoke the trust.

Professional Fiduciary

If your loved one’s financial situation is complex, they may prefer to hire a professional money manager to oversee financial decisions. Not every family has a potential candidate that can manage extensive or complicated assets, or even if they can, they may not live close enough for proper oversight.

This professional may be a certified public accountant (CPA), a trust company officer (bank or investment firm) in the business of managing trusts, or your attorney. A professional fiduciary will charge a fee for service yet still permit family members a provision to relieve the fiduciary of their duties if there is dissatisfaction with performance.

Government Fiduciary

These are special fiduciaries appointed by a government agency to manage benefit payments or refunds issued by the agency, generally the Social Security Administration (SSA), the Department of Veterans Affairs (VA), and the Internal Revenue Service (IRS). These agents can be spouses, family members, court-appointed or professional fiduciaries, or another interested party as long as they receive government agency approval. 

A Social Security appointee is a representative payee and can assist with all types of agency benefits, a VA appointee is a VA fiduciary, and an IRS appointee is an IRS fiduciary. These government fiduciaries only have the authority to manage the corresponding agency’s benefits or refund checks. They have no other legal power to manage a loved one’s property, medical matters, or financial affairs.

Court-appointed Guardian

If your loved one took no action to implement a financial oversight strategy while competent and then becomes incapacitated, the court will conduct a hearing to appoint a guardian. A guardianship implies a profound loss of freedom, even dignity, so much so that less restrictive alternatives should be tried and proven ineffective before establishing a guardian. There are instances when guardianship needs implementation, but the court process can be lengthy and expensive when immediate decisions for your loved one are needed.

These wide-ranging options all require the appointed person to act with the utmost fiscal responsibility to properly manage their loved one’s financial well-being and protect them from elder financial abuse. Family conversations and an elder law attorney’s input will help define which options are best for your loved one to implement while they are capable. We hope you found this article helpful. If you have questions or would like to discuss your personal situation, please don’t hesitate to contact our Reno office by calling us at (775) 853-5700.

Elder Law

What You Need to Know About Qualifying for SSDI and SSI

If you are unable to work due to a serious health condition, there is a good chance you can qualify for free health insurance and monthly benefits from the United States government. About twenty million disabled Americans currently receive assistance from the Social Security Administration (SSA) for disability through SSI and SSDI. Although the medical eligibility requirements are the same, the two programs are different. Your medical condition must extend for a minimum of one year or result in death; however, you can also meet non-medical requirements to receive benefits. Before applying, understanding the qualification process for both SSI and SSDI will increase your initial chance of success and get you benefits quicker.

Supplemental Security Income (SSI)

The Supplemental Security Income (SSI) program pays monthly benefits to adults and children with blindness or disability whose resources and income are below a specific financial threshold. SSI also makes payments to those individuals aged 65 or more without disabilities who meet the financial qualifications. SSI disability benefits become available for the first full month after the date of filing your claim. Even if you are receiving SSDI or retirement benefits, you may still be eligible to receive SSI.

Social Security Disability Income (SSDI)

The Social Security Disability Insurance (SSDI) program pays benefits to you and specific family members if you qualify as “insured.” Insured means you have worked recently and long enough to pay Social Security taxes on your earnings. Benefits through SSDI have a five-month waiting period. Therefore your benefit payments do not begin before the sixth full month of disability. This waiting period begins on the first full month after the date the SSA decides your disability began.

Disability Attorneys

Statistical outcomes to receive SSI and SSDI benefits are greatly enhanced if you hire a disability lawyer. Your lawyer will develop a case as to why you meet eligibility criteria under the Social Security disability law.

lawyers.com

Physical conditions will have to meet either one or more of Social Security’s disability listings:

  • Residual Functional Capacity (RFC) precludes you from participating in jobs due to exertion levels
  • Non-Exertional limitations such as difficulty with concentration or memory prevent you from working.
  • Combinations of exertional and non-exertional limitations

Because of the complexity of disability law, rules and regulations, evidence points strongly to better outcomes with a disability attorney handling your application and claim.

Proving You Qualify for Benefits

Even if you have insufficient medical records, your attorney can help you arrange to have medical testing procedures before you apply for benefits to increase your chances of approval during your initial application. Suppose you have poor breathing due to Chronic Obstructive Pulmonary Disease (COPD) with conditions such as emphysema or chronic bronchitis. Your lawyer can arrange for an ejection fraction measurement test to gauge the heart’s blood flow. Your test data helps evaluate whether you meet Social Security’s COPD or the CHF listing criteria.

Filling out your disability application and supporting documentation must clarify to a claims examiner that your conditions meet these medical listings or that limitations preclude you from working. A properly filed application at the outset of your claim for disability benefits greatly enhances your chance of success.

A Disability Case has Minimal Upfront Costs

A disability attorney typically receives payment on contingency. Legally this means payment is due only if you win your case. Your representing disability lawyer is keen on presenting important medical records, test results, doctor evaluations, and proper paperwork to ensure they will be successful for you and thus receive payment. The federal government oversees the fee structures a disability attorney can charge. Federal law typically limits a Social Security disability attorney’s fee to twenty-five percent of your back pay or $6,000, whichever is less. SSDI back pay refers to benefits you would have received from the time of your application to when your claim receives approval, minus a five-month waiting period.

A survey of readers of lawyers.com finds the average fee Social Security lawyers collected was $2,900 for SSI and $3,750 in the case of SSDI. Overall this money is well spent because statistics show the claimant may not have received SSA approval or may have been approved but with a reduced monthly benefit.

Hiring a disability attorney to help you become qualified to receive SSI and SSDI benefits is a smart move. While it is not unheard of that self-representation can meet with success, the intricacies of the qualification process and the information required to become eligible are daunting. There are many great reasons to retain a disability lawyer to protect your disability application claim for SSI and SSDI benefits. We hope you found this article helpful. If you have questions or would like to discuss your personal situation, please don’t hesitate to contact our Reno office by calling us at (775) 853-5700.

Elder Law

Stigmas Surrounding Alzheimer’s Disease

It can be difficult for the entire family when someone is losing their memory. The person who has been the head of the family may soon fade from the person they once were, leaving their loved ones to wonder what will come next. The stigma associated with Alzheimer’s disease has a significant negative impact on the lives of people with Alzheimer’s and their caregivers. Around 25% of dementia patients hide their diagnosis, and 40% said they have withdrawn from many everyday activities according to recent studies. There are many negative public images and stereotypes associated with dementia, which contributes to a lack of engagement with people with this condition. Many people with dementia experience social isolation due to withdrawal from friends and other important people in their lives.

Many misconceptions of Alzheimer’s exist. It is widely believed that Alzheimer’s and dementia are a normal part of aging. This is not true. It is a disease that develops from a wide variety of risk factors. Many people believe that Alzheimer’s patients become violent and aggressive. This only happens with some patients and is typically the result of a deep sense of confusion and fear. It is also widely believed that people with Alzheimer’s can’t function or enjoy activities. Stigma is the use of negative labels to identify a person with a disability or illness. Stigma around Alzheimer’s disease exists, in part, due to the lack of public awareness and understanding of the disease, preventing people from:

  • Seeking medical treatment when symptoms are present 
  • Receiving an early diagnosis or any diagnosis at all 
  • Living the best quality of life possible while they are able to do so 
  • Making plans for their future 
  • Benefitting from available treatments 
  • Developing a support system 
  • Participating in clinical trials


Stigma and lack of awareness also impacts Alzheimer’s disease research. The government funds Alzheimer’s research at lower rates than other diseases, even when the cost of caring for Alzheimer’s disease is significantly higher. Stigmas and stereotypes are significant obstacles to the well-being and quality of life for those with dementia and their families. Here are some examples of the stigma those with Alzheimer’s may experience:

  • A diagnosis may test friendships. Friends may refuse to believe the diagnosis or withdraw, leaving a feeling of abandonment or isolation.
  • Relationships with family may change. Family members may not want to talk about the disease, assuming a low quality of life, or may avoid interaction all together.
  • Others may approach the care partner to inquire how one with Alzheimer’s is doing rather than approaching the individual directly.
  • The reaction of some friends and family to the diagnosis may prevent seeking help from others.

With proper assistance, people with Alzheimer’s can enjoy meaningful activities and maintain relationships. There are plenty of reasons why we need to fight Alzheimer’s stigma. Stigma can prevent people from seeking medical treatment when symptoms are present. It can prevent people from receiving an early diagnosis or any diagnosis at all. It can prevent people from developing a support system and benefitting from available treatments allowing them a high quality of life which is absolutely possible with Alzheimer’s disease.

What Can You Do?

  • Watch your loved one for changes.
  • Do not pass judgment on the changes you observe.
  • Talk to the individual who exhibits the symptoms; do not talk around the person.
  • Encourage the individual to seek treatment. Make sure the person understands there is possible treatment available with a diagnosis.
  • Do not exclude the individual from activities, do the opposite, include the individual in activities.

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

Elder Law, Healthcare

Caregiving From Afar

A long-distance caregiver is someone who provides care to someone who lives at least an hour away. This type of caregiving takes many forms – from arranging for in-home care, money management, bill paying, and information coordinator. You may also provide respite care for a primary caregiver, conduct safety reviews, create emergency plans, or any combination of these tasks. Legal publisher Nolo cites more than seven million adults in the US acting as long-distance caregivers for elderly parents or relatives.

The greatest success in long-distance caregiving happens when there is a foundation of planning and preparation. If there is a primary caregiver for your parent, ask how you can be most useful. Also, talk to friends who provide care to see if they have helpful suggestions. You will need to identify local resources that can help provide care for your parent. Local providers can include Meals-on-Wheels, senior centers, elder transportation, and more. The National Institute on Aging offers several good websites to use as a starting point. It is best to visit your parent before planning to assess their current living situation, identify their health issues, and gather important information.

Things to consider as you go through each room of the home, the garage, and the yard include

  • Safety – Is there anything that poses a safety problem in the location? Poor lighting, area rugs, clutter, or whatever else might stop your senior from moving safely around the space should be removed or improved.
  • Accessibility – Are things accessible to the senior? Are they within easy reach? Are switches, doors, plugs, and cabinets readily at hand to perform the room’s desired or necessary tasks?
  • Adaptability – Are there ways to adapt things in the room to provide greater accessibility, safety, or ease of use? Will brighter lights or additional railings, grab bars, and even a stairlift help your parent?

Check to see if your loved one is taking proper care of themselves including

  • Home care – Is their living space clean? Is food properly stored and the kitchen clean? Is there any clutter posing a safety hazard?
  • Food – Can your parent prepare themselves a nutritious meal? Are the pantry and refrigerator stocked with good food that is not out of date? Are they drinking enough water? If they have a pet, do they properly provide them with water, food, and outdoor activity?
  • Medical care – Is your loved one taking all of their medications in the right dosages and at the right time? Can they fill their prescriptions at the drug store? Are they able to transport themselves to doctor appointments and labs for blood workups? Do they calendar, remember, and go to their doctor appointments? If they have a pet, do they take them to see a veterinarian for routine examination?
  • Finances – Are there stacks of unopened mail around the house? Are bills left lying around? These warning signs are a good time to take over their bill payment or set them up on auto payments through their bank.
  • Driving ability – If your parent is still operating a car, truck, or even a golf cart, are they doing so safely? If you find increasing numbers of traffic tickets or warning violations, they frequently become lost or experience fender benders while parking, or easily become nervous, angry, or frustrated while driving; it may be time for your parent to hang up the keys.
  • Lifestyle – Does your parent drink alcohol to excess? Do they smoke? Do they participate in medical or recreational marijuana? These activities can cause negative interactions with medications, create mental confusion, and increase the risk of falling.

Gather contact information for neighbors, friends, clergy, or anyone your parent is in contact with regularly. While these relationships are informal, these are people you can rely on to help out in an emergency. Review medical care records, remembering to get doctors’ names, emails, and phone numbers. Include medical insurance information, medications, and other important data on a comprehensive list. Update the list quarterly or anytime you know there is a change. Does your parent live in a “smart home?” Learn the passwords and interact with the audio-video and health monitoring functions to watch for potential problems and communicate with them.

At a bare minimum, know where your parents store their financial information. If it is online, request the passwords. Suppose you need to manage their money remotely. In that case, you will need details about income sources, checking and savings accounts, monthly bills and expenses, social security benefits and other government assistance programs, and investment accounts. Contact information should include accountants, tax preparers, or other people who know about your loved one’s finances.

Get copies of relevant legal documents and know where your parent keeps the originals, including wills, house deeds, and advance health care directives. If your parent has an attorney, get their contact information and introduce yourself to them. If your parent needs an attorney we would be happy to set up a meeting.

Once you conclude your initial assessment, regularly speak with your parents and visit as much as you are able. Build your network of local contacts and coordinate with them to assess changes. Know that your plan is going to change often. Even if your parents can remain in their home, they will require more services and care as they age, and you will need to be responsive to these changes. There is no one solution for every living situation. Begin with a solid assessment of your parent’s current needs and prepare and plan with that information as your starting point.

We help seniors plan for the possibility of needing long-term care, and we ensure the proper legal documents are in place so that their wishes regarding their finances and their care will be carried out.  If you or your parents would like to discuss the possibility of long-term care and how to access financial resources to pay for that care, we would be happy to speak with you. We hope you found this article helpful. If you have questions or would like to discuss your personal situation, please don’t hesitate to contact our Reno office by calling us at (775) 853-5700.

Elder Law, Estate Planning

A Power of Attorney Allows Another Person to Act On Your Behalf

While he awaited the closing on his Texas house, Michael was enjoying his time in Florida. Unfortunately, he took a bad fall and ended up in a Florida hospital. He had his Texas powers of attorney, but the problem was that they were “springing” powers. They were only effective if Michael lost capacity. Michael’s capacity was fine, it’s just that he wasn’t in Texas when an offer on the house came through.

A power of attorney is a legal document that allows someone else to stand in your shoes, to speak, and act on your behalf. A document that is effective immediately – even if you’re perfectly capable of managing your own affairs at the time – is the better choice. Michael should have designated a Texas agent with immediate powers, in a document that was comprehensive enough to authorize the agent to conduct real-estate transactions on Michael’s behalf.

A document like Michael’s, however, that “springs” into life only on incapacity, would not serve him as he needed. And even if Michael had lost capacity, a doctor would still have to certify that he could no longer make his own decisions. This would cause delay and uncertainty when swift action was required instead.

Many are concerned that if they have a power of attorney that is immediately effective, their agent will abuse privileges that aren’t even needed at the time. This is a sign, however, that they don’t trust that person. And after all, it’s better to be alert and aware if such a thing should happen, instead of discovering the problem only when you’ve lost capacity and it’s too late.

An experienced attorney can help you find your way through many such pitfalls. 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.

Elder Law, Estate Planning

A Comparison of Irrevocable Versus Revocable Trusts

For estate planning, a wide variety of trust types are available; the most common are revocable and irrevocable trusts. While there is some similarity, these two major categories of trusts have different purposes in your estate plan. Both can substitute for a last will and testament as an alternative way to distribute property, though a trust and a will often exist concurrently. Whether a revocable or irrevocable trust works better for your estate plan depends on what you need the trust to do for you.

The most striking difference between the trust types is as defined in the names. A revocable trust permits changes, amendments, and revocations at any time while you are alive and mentally capable of doing so. In contrast, an irrevocable trust does not permit amendments or revocations of any type while you are alive. The only changes to the terms of the trust are as the trust agreement itself defines and allows.

Both trusts, when properly implemented, permit the bypass of the probate process. A revocable and irrevocable trust will survive your death, and your named successor trustee will be able to distribute trust property free from court interference after you die. The trustee may only distribute assets that the trust owns in title to avoid probate.

Why seek to avoid probate? The process is slow and time-consuming, taking anywhere from six months but in most instances one to three years to complete. Although it varies by state, probate can be costly as the court takes a portion of the gross estate in probate fees even before the deceased’s debts are paid. The fee can be as substantial as ten percent. Finally, probate is a public process, and all documents and information will become part of the public record. Estate debts and assets become public records, as are the distributions of assets. Anyone who cares to look up this public record can know which beneficiary received what and often make targets of inheritors for scams or burglaries.

Both trust types help you control property after you die with conditions you outline as to how to use trust assets once you pass away. Conditions are usually age restrictions, punishments for bad behavior, and incentives to promote good behavior. These conditions must not violate public policy. Revocable and irrevocable trusts can set up conditions regarding distribution while you are alive. However, in a revocable trust, if you create the trust, control the trust as trustee, and are the trust beneficiary, you will NOT receive protection from creditors or others who may have a claim against you. This lack of credit protection in a revocable trust is significantly different from an irrevocable trust.

An irrevocable trust can prevent the distribution of assets to certain entities or people, like a long-term care facility or a creditor. The irrevocable trust must be in place and active before protection from the debt accrued to be effective or be within certain time limits to qualify for government programs such as Medicaid. The irrevocable trust creates a legal wall separating you and your assets permitting the shielding from creditors or long-term medical care costs. Asset protection is one of the most useful aspects of an irrevocable trust.

An irrevocable trust is also a vehicle to shield your multi-million dollar wealth from excessive federal estate taxes to preserve generational wealth. 2022 tax exemptions include:

  • $12,060,000 federal estate tax exemption with a 40 percent top federal estate tax rate
  • $12,060,000 Generation-Skipping Transfer (GST) tax exemption and a 40 percent top federal GST tax rate
  • Lifetime gift tax exemption is $12,060,000 and a 40 percent top federal gift tax rate
  • An annual gift tax exclusion amount increase to $16,000

In summary, both trust types can provide estate planning benefits depending on your needs.

Revocable Trust

  • Permits control of your assets, their distribution, and how they are spent after you pass
  • Permits bypassing the probate process
  • Limits probate if you have properties in multiple states and want to avoid probate in each state
  • You desire to simplify the distribution of your property to your heirs and children when you pass away.

Irrevocable Trust

  • Permits control of your assets, their distribution, and how they are spent after you pass
  • Permits bypassing the probate process
  • You have concerns about future long term medical costs
  • You have implicit trust in your children or other family members to take care of your property
  • You want to preserve generational wealth by protecting your assets from creditors or long-term care facilities
  • You want to protect your assets from potential future lawsuits
  • You want to limit federal estate taxes on your estate

Trust types in estate plans are as varied as those individuals seeking to enact them. To best protect your interests and those of your beneficiaries, meet with a qualified estate planning attorney who can explain the type of trust that best suits your needs. We hope you found this article helpful. 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.