Elder Law

The Benefit of an Elder Law Attorney

An elder law attorney specializes as a legal advocate for aging adults and their loved ones. Elder law encompasses a wide range of legal matters affecting an older or disabled person. Issues related to guardianship, retirement, health care including advance directives, long term care planning, Social Security, Medicare and Medicaid, and other relevant matters to aging all fall under the umbrella of elder law.

An older family member who legally prepares for their aging process helps their family members by addressing day to day issues that affect their actual care through proper legal documentation should the senior become incapacitated. Seniors often falsely assume that a close family member, including a spouse, will automatically be able to make decisions on their behalf if something goes wrong with their finances or health. Postponing legal document preparation through an elder attorney generally winds up being more problematic and expensive to a senior’s estate and wellness.

Many seniors find making legal preparations uncomfortable at first, as the task forces them to confront and assess their mortality. Further into the process, many aging adults experience relief, having removed the fear of the unknown of aging to the best of their ability. Legal preparation can keep a senior from health or financial ruin if they become incapable of making informed decisions regarding these matters. In the absence of legal documents, their family is left with the expensive and time-consuming process of petitioning the courts for legal authority to act on their loved one’s behalf – referred to as establishing a guardianship. By planning early and making sure the correct legal documents are prepared stress on the senior and the senior’s loved ones is greatly reduced.

Personal choices regarding end of life care and the disposition of assets and property outlined in legal documentation guarantees that your wishes will be respected by law. This documentation is especially important for seniors when a family member might seek control over the process, whether moral or self-serving, to follow their whims when handling your wellbeing when you are most vulnerable. Besides adhering to your expressed wishes, having your choices documented relieves family members from guessing what you want.

When preparing for your aging process, seek out a well-regarded attorney who specializes in elder law. While many general practice attorneys may have some experience with elder law topics, regulations are ever-changing and complex. It is best to find an attorney who specializes in elder law so that you get the best and most up-to-date advice.

Proactively address your aging process with a qualified elder attorney to ensure your wishes are carried out now and in the future, regardless of what happens with your health. Both you and your loved ones will garner invaluable peace of mind knowing that your wishes are known and legally documented. We would be happy to help you with your planning, and we look forward to hearing from you. Please don’t hesitate to contact our Reno office by calling us at (775) 853-5700.

Elder Law

Legal planning Related to Alzheimer’s Disease

Currently, there is no cure for the more than 5 million Americans who have Alzheimer’s disease. Projections by the Alzheimer’s Association (alz.org) are that by 2050 more than 14 million Americans will suffer from this disease. What can you do if you are medically diagnosed with Alzheimer’s? Aside from following the advice of your medical doctor an important step in your overall estate plan is an advanced directive to ensure your future wishes are met when you are no longer able to think or communicate clearly because of your disease progression. Having an advanced directive that accurately and legally reflects your financial and health care wishes allows you to focus on enjoying your life knowing you are doing all that you can to address your future circumstances.

You may already have advanced directives. It is a general term for various documents like a living will, instruction directive, health care power of attorney, and health care proxy. Now that Alzheimer’s disease is the 6th leading cause of death in the US, a newer advance directive specifically addressing dementia is becoming more common and is called the Alzheimer’s Disease and Dementia Mental Health Advance Directive.

An advanced dementia directive takes a comprehensive look at living with Alzheimer’s. Issues like where you will live, coping with profound changes in intimate relationships, how to finance your care, your preferred caregiver and healthcare agent, care of your pets, when you stop driving, and more. The essence of a dementia directive is to make life decisions that will span the course of time you survive with the disease. Life expectancy after a diagnosis of Alzheimer’s can range from as short as three years, with an average of eight to ten years, and as long as twenty years. Your advanced dementia directive provides you a measure of control and a sense of relief that your intentions are known when the time comes when you can no longer communicate them effectively. This document also serves as a detailed guideline for your loved ones to follow.

Some advanced dementia directives may even include an end of life strategy known as “voluntarily stopping eating and drinking” or VSED.  A VSED is considered a legitimate way to hasten death and is used in cases of terminally ill patients. Originally a VSED addressed a patient experiencing physical decline while maintaining cognitive function. In the case of Alzheimer’s, a VSED addresses the opposite issue of cognitive decline. Most people, when faced with a future of being mentally unfit in a body that will not quit, prefer to find an exit strategy they consider has a modicum of dignity. A VSED can prevent distressing situations for yourself and your family system.

Though requests for VSED are currently uncommon there is a groundswell of patient-driven need. This need says that if incapacitated through dementia, their choice is not to endure what can be a long physical decline while cognitively absent. Most people do not want life prolonged beyond the point where they are participating in it. Still, state and federal laws have to catch up to VSED as, by law, long term care facilities are required to offer daily meals with feeding assistance if necessary.

A directive that addresses Alzheimer’s disease and other forms of dementia does not replace the more standard advance health care directive. Most conventional health care directives address cardiopulmonary resuscitation, the use of ventilators, artificial hydration (intravenous fluids) and nutrition (feeding tube), participation in research and clinical trials, organ donation, comfort care, and pain relief services. Having both advanced medical and dementia directives in place not only assures you but also provides relief to your family. Your clearly defined choices can lighten the suffering your own family will feel when you can no longer communicate with or recognize them. Reconciling end of life scenarios is always challenging, but once handled, it frees you up to get on with the joy of living. 

We would be happy to help you determine the correct advanced directives for your needs and desires. Please contact us if you would like to discuss this matter further. Please don’t hesitate to contact our Reno office by calling us at (775) 853-5700.

Elder Law

AARP Creates New COVID-19 Dashboard

As COVID-19 continues to spread among nursing home residents and staff, valuable and accurate data pinpointing areas of concern is often rife with haphazard data collection providing skewed information. The most recent Kaiser Family Foundation data analysis indicates that federal policymakers are slow in meaningful response to the nursing home coronavirus crisis. The increasing loss of life is often due to this inadequate federal and state response during this fall flu season. To better address the concerns, AARP has created a COVID-19 Dashboard that will standardize information collection and provide better data integrity. The 5-point plan aims to save lives by better protecting nursing home and long-term care facility residents at state and federal levels through more accurate data collection and its use in timely responsiveness.

  1. Ongoing testing and sufficient personal protective equipment (PPE) for residents and staff must be a priority. PPE must also be readily available for inspectors and any visitors.
  2. Create better transparency with a focus on the daily public reporting of COVID-19 cases and deaths in facilities. Improving communication with families about transfers and discharges and increase accountability for state and federal funding provided to facilities.
  3. Following federal and state guidelines for safety, ensure access to in-person visitation as well as the continuation of virtual visitation for all residents.
  4. Ensure residents’ quality care via adequate oversight, staffing, and access to in-person formal advocates known as long-term care Ombudsmen.
  5. Reject immunity as it relates to COVID-19 for long-term care facilities.

The AARP Nursing Home COVID-19 Dashboard is a collaboration between the AARP Public Policy Institute and the Scripps Gerontology Center at Miami University in Ohio. The dashboard is a four-week snapshot of the coronavirus infiltration into nursing homes and its impact on residents and staff. The goal is to promptly identify specific areas of concern at a state and national level.

A second dashboard will aggregate and analyze the self-reported data from nursing homes provided by the Centers for Medicare and Medicaid Services (CMS) that cover specific three 4-week time intervals from mid-summer into autumn. This dashboard will specifically gather five key measures from nursing homes: resident death per 100 residents, resident cases per 100 residents, staff cases per 100 residents, percentage of nursing homes without a one-week supply of PPE, and percentage of nursing homes with staffing shortages. There will also be an additional 33 data points providing more information about each category and updated every month. As tracking continues and trends present themselves, additional categories will evolve to follow other measures of interest.

The second dashboard already presents five key findings, including:

  1. Nursing home resident and staff COVID-19 deaths and cases had been on the decline at a national level during the summer. The 2020 flu season brings an uptick to cases, and coronavirus community spread continues to rise rapidly throughout most of the country, increasing vulnerability to nursing homes, staff, and residents.
  2. State trends vary dramatically. Many states with previously high death and infection rates in the summer are improved in the most recent weeks; however other states, particularly in the Midwest, see rapidly increasing rates of cases and deaths in nursing homes.
  3. The variation across states can be as high as about 1 out of every 52 nursing home residents to no resident deaths in the four weeks between September 21 to October 18. Nationally, the same reporting period reported an average death rate of one in every 215 residents.
  4. Direct care staff continues to have infections at a very high rate during this same period from September to October. While more than one-quarter (26 percent) of nursing home residents had confirmed COVID-19 cases, twice as many (53 percent) had confirmed staff cases. More than 90 percent of the nursing home staff tested positive for the coronavirus in the hardest-hit states.
  5. All states indicate nursing homes have a PPE shortage, which is defined as not having a one-week supply of surgical masks, N95 masks, gloves, gowns, and eye protection. In the best-performing state, only 5 percent of nursing homes reported a PPE shortage, while the lowest-performing state had 53 percent of nursing homes reporting a PPE shortage.

Reliable, timely data regarding nursing homes and COVID-19 can help facility operators and personnel gain a better understanding of the crisis facing nursing homes and other long-term care facilities. The federal government has begun to require nursing homes to self-report COVID-19 cases and deaths at the national level and ordering testing, providing PPE, issuing guidance for the re-instituting of in-person visits, and more. However, as cases and deaths continue to rise, AARP and other organizations will continue to accumulate data and shine a light on the tragedy befalling nursing home residents to make policy and lawmakers accountable to the crisis. AARP has a webpage providing more information for you or a loved one in a nursing home.

If you have questions about anything you have read or would like to speak to us about planning for you or a loved one, please don’t hesitate to reach out.Please contact our Reno office by calling us at (775) 853-5700.

Elder Law, Healthcare

Creating an effective COVID-19 Vaccine for Seniors is a Challenge

Older Americans, who are the most at risk of COVID-19, are the least likely demographic to respond well to a vaccine. A vaccine shot works by fooling the body into believing it has been infected with a virus, thereby prompting its immune system to fight the intruding pathogen by making antibodies. Unfortunately, as we age, antibody production weakens, part of the process known as immunosenescence. A compromised immune system makes older adults more susceptible to viral and bacterial infections. The Wall Street Journal reports that 90 percent of flu deaths in the US every year are people over the age of 65.

What’s age got to do with the COVID-19 Vaccine?

The thymus, located center of your chest just below the neckline between the lungs, is a major source of pathogen fighting T-cells. Some of these specialized cells help the immune system make additional defenses against infection called antibodies. As we age, the thymus production of adaptable T-cells is depleted as the thymus fills with fatty tissue. The result is an old immune system that is ill-equipped to fight off new viruses. The Center for Disease Control and Prevention (CDC) posted a July 17 analysis of more than 50,000 COVID-19 deaths in the US, identifying that 80 percent were people age 65 or more.

An aging thymus also complicates the development of a COVID-19 vaccine. A vaccine’s design provides instructions to our immune system, which T-cells help to guide appropriately. However, the thymus has exhausted most of its reserve T-cells that adapt to recognize unknown pathogens by the age of 50; thus, the ability to “train” other immune cells to fight is lost. Many vaccines rely on the skill sets of fully functional T-cells.

A Shift from Traditional Methods of Developing Vaccines

Traditionally, the biopharmaceutical vaccine market has concentrated efforts on childhood vaccines. Martin Friede, a coordinator for vaccine and product and delivery research with the World Health Organization (WHO), states, “Up until very recently most of the focus of the vaccine community has been on saving lives of young children. The people who need the vaccine the most may actually be the people in whom the vaccine might not work.” Friede further comments that it isn’t solely about the thymus as individual vitality can translate into different vaccine responses. Some older people may be off to play a round of golf while others may be too frail to walk unaided.

Deputy director of clinical research for the Institute of Vaccine Safety at Johns Hopkins Bloomberg School of Public Health, Dr. Kawsar Talaat, echoes Friede’s sentiments, “We hadn’t been designing vaccines for the elderly for a long time.” Dr. Talaat is helping to facilitate coronavirus vaccine developers to test their shots in older adults. The Food and Drug Administration (FDA) is also working with drug and biotech companies easing restrictions for experimental vaccines to be tested earlier during clinical trials on older adults.

Updates on Testing COVID-19 Vaccine Options

The New York biopharmaceutical giant Pfizer is currently conducting tests for potential COVID-19 vaccines in older people. The company is studying whether increasing the vaccine dosage could better protect the elderly as higher doses in existing flu vaccines make them more effective in older populations. At Moderna Therapeutics, results from a phase-one trial of its novel mRNA vaccine are in; however, a second phase two trial is being conducted specifically for adults age 55 and older. Many biotech and pharmaceutical companies are eager to be the first to introduce a successful FDA approved COVID-19 vaccine.

If the development of a COVID-19 vaccine specifically for the elderly remains elusive, scientists are hopeful that immunizing others around them can make a difference. Vaccinating children, health care workers, and potentially silent coronavirus carriers, could create enough herd immunity and would lower the risk of older people becoming infected. Sometimes it is possible to protect a vulnerable group by targeting other groups around them. Meanwhile, the work continues to find a workable COVID-19 vaccine for the most vulnerable Americans, the elderly.

We help seniors and their families deal with challenges around appropriate care and how to pay for it. If you would like to discuss your situation with us, please don’t hesitate to reach out.

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.

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.

Elder Law

Debunked Myths of Long-term Care

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

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

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

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

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

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

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

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

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

Elder Law, Elder Living, Estate Planning, Healthcare

Will the Cost of Long-Term Care lead to the Loss of My Home?

People work hard all their lives to own a home, and it is often their most valuable and significant possession. Homeownership is the American Dream. So, when health begins to fail and the need for long-term care arises, we often get this fear-filled question from our clients: will they take away my home?

The enormous and on-going costs of nursing-home care are astronomical, on average around $8,500.00 a month depending on location. The joint federal and state Medicaid program foots the bill for one in four of around 75 million recipients in this country. This is an enormous drain on government funds. To recoup some of those costs, then, the Medicaid rules permit states to take the value of a recipient’s home in some cases, to reimburse the program for funds it has expended.

Yet, because a home is such an essential family possession, the rules treat a primary residence as exempt – that is, its value is not counted as available to pay for nursing-home care from the home-owner’s pocket, before Medicaid kicks in. The home is protected, to a certain extent, for the benefit of Medicaid recipients and their close relatives.

That protection can be lost, however. The value of the house can be counted against a Medicaid applicant, and benefits denied or curtailed, when:

*     A home-owner has no living spouse or dependents, and

*     The owner moves into a facility permanently, with no intent to return home, or

*     The owner dies.

In other words, as long as the owner expresses the intent to return home, and the owner’s spouse or disabled or blind child live in the home, the home will not be counted against the owner for Medicaid-eligibility purposes.

Once the owner passes, however the state may place a lien on the home, to secure reimbursement of the value of the Medicaid services the owner received. This lien makes it impossible to sell the home or refinance a mortgage, without first paying the state what it may be owed.

As elder law attorneys we know a number of ways to protect homes from this kind of attachment. If you come to us at least five years before you anticipate needing nursing-home care, we can preserve your home or its value such that Medicaid will not count it, or lien against it, at all.

Or, if a child moves into the home and cares for an ailing parent for two years, permitting the parent to stay home and out of a nursing home, the house can then be given as a gift to that child without any Medicaid penalty or disqualification. Ordinarily, Medicaid heavily penalizes giving away property, but this is one exception.

There are other strategies available. The home can be given to a disabled child without penalty or disqualification. Or, you might keep the right to live in the house for your lifetime and deed the remainder interest to others, who will then own the house after you pass. However, each strategy comes with risks that must be fully explored before determining the correct one.

An overall plan that is tailored to suit each individual, and to meet as many contingencies as possible, requires juggling a number of puzzle-pieces. There is no one cookie-cutter solution. The key is to plan before you or your spouse may need nursing-home care.

As one piece in the overall picture of a balanced estate plan, we can help you save your home. We welcome the opportunity to work with you, please contact our Reno office by calling us at (775) 853-5700.

Elder Law

The Importance of a Living Will

It is important to lay out your preferences for life-sustaining medical treatment with a living will. It is often accompanied by a health-care proxy or power of attorney, which allows someone to make treatment decisions for you if you are incapacitated and the living will does not have specific instructions for the situation at hand.  “Living will” and “advance directive” are often used synonymously, but a living will legally only applies after a terminal diagnosis, whereas an advance directive is much more comprehensive and includes the health care proxy.

As of 2017, only around one in three American adults had an advance directive for end-of-life care prepared. Those who are older than 65 are more likely to have an advance directive prepared than those who are younger, as are those have chronic illness more likely than those who are not. People may be unwilling to prepare these documents because they fear that they won’t necessarily reflect their wishes at the time they become relevant; sometimes patients become more willing to undergo treatments they rejected when they were younger as they age and develop medical problems. However, the documents can be changed as long as they are witnessed and potentially notarized (depending on current law). And if you continue to communicate your values with your proxy, they can make decisions based on your most recent preferences.

So why is a living will important? It reduces ambiguity which can prevent family disputes during what is already a difficult time. It may seem like something that can be put off, but life is unpredictable; one never knows when these documents could become relevant. Furthermore, it needn’t be a hassle. A living will is a straightforward document, however it’s important to work with legal counsel to make sure your beliefs are properly stated. Other health care documents should also be prepared at that time, like a health care power of attorney that designates a person to make health care decisions for you if you are unable.  Once you have signed any documents make sure you keep them updated, especially if you change states, and be diligent in communicating with whomever you named to act on your behalf.

If you need a living will or health care power of attorney or already have one that you would like reviewed, contact our Reno office by calling us at (775) 853-5700.

Read more at:

Elder Law

Living Trusts Can Help Seniors

It’s an unfortunate fact that seniors can be prime targets for financial abuse and scams. Sadly, the elderly are often taken advantage of by strangers — and sometimes even their own family members. That’s why it’s important that planning is in place to help seniors protect themselves and their assets.

As we age, it can become increasingly difficult to manage our assets. Most of us will, at some point, need assistance with these details to help ensure that our financial and other assets aren’t depleted. If you or an aging loved one are looking for ways to safeguard assets, a Living Trust is often the best way to do so. Living Trusts allow seniors to rest assured that their finances and assets are managed by a trusted person.

What is a Living Trust?

Living Trusts help to protect and manage the assets of those who cannot do so themselves due to age, illness, or disability. Many seniors assume that a will is the only protection they need. However, trusts are designed to safeguard the assets of the living, while Wills only outline what happens to a person’s assets when they pass away. Furthermore, wills must go before a probate court and taxes must be paid on inheritances, while Living Trusts allow beneficiaries to avoid probate after their loved one’s passing.

To establish a Living Trust the owner, or grantor places assets within the trust. The grantor then appoints a trustee to manage it and names beneficiaries to receive the assets of the trust when the time comes.

There are different types of Living Trusts. Let’s take a look at each and the ways these trusts can benefit seniors.

Testamentary Trust

A Testamentary Trust protects an elderly person’s assets when a spouse dies. Assets of the deceased are transferred into a trust — enabling the appointed trustee to make all financial decisions regarding those assets. This helps a surviving spouse by protecting him or her from fraud or mismanagement of assets. Trustees can help the surviving senior generate income from remaining assets via sales or investments and take advantage of tax benefits.

Revocable Living Trusts

A Revocable Living Trust safeguards seniors by making it more difficult for non-trustee family members to mismanage money or assets. The grantor (senior) can amend or revoke the trust at his or her own discretion without the consent of the beneficiary. This type of trust allows the grantor to stay in control of assets by either serving as a trustee or appointing one. In this case, the grantor, serving as trustee and beneficiary of the trust, appoints a successor in the event he or she becomes incapacitated or dies. This appointed person is then responsible for disposal of the trust’s assets.

Irrevocable Living Trusts

An Irrevocable Living Trust is one that cannot be changed or revoked by the trust maker. This means that the grantor/trust maker gives up his or her rights to the assets once they are transferred. Seniors over 65 who are eligible for Medicaid often choose to transfer assets into an Irrevocable Living Trust to avoid having to dispose of assets in order to remain eligible for Medicaid coverage or long-term care benefits.  Once assets are in an irrevocable trust, they cannot be counted for Medicaid eligibility purposes, but there could be a penalty for transferring assets to an irrevocable trust.

An elder law attorney can assist in determining the best way to set up this type of trust and how to best transfer assets based on Medicaid stipulations. An Irrevocable Living Trust can provide income for seniors and their spouses. It also protects their property and other assets from being seized to pay for medical costs, without impacting Medicaid eligibility. This type of trust can also remain in place for a surviving spouse after the grantor’s death.

The sooner assets are placed in an Irrevocable Living Trust the better, as a penalty will be assessed by Medicaid during the first 5 years the trust is in existence (if Medicaid is required during that time).

Ultimately, Living Trusts give seniors more control over their assets than a will, allowing them to set parameters and stipulations and appoint a trusted advisor to help them make decisions.

If you or your loved one would like more information about setting up a Living Trust, we can help.

Contact our firm today to discuss how we can tailor a trust to your specific situation and needs. Or give us a call directly at (775) 853-5700.

Elder Law, Elder Living, Healthcare

Lawmakers Discuss the Future of Healthcare

In June, Washington, D.C. political publication, The Hill hosted a Future of Healthcare Summit to address critical issues in healthcare, from the Medicare for All proposals made by Democratic presidential hopefuls to the opioid crisis. Speakers included policymakers, health officials, and industry leaders, on both sides of the aisle.

Sen. Joe Manchin (D-W.Va.), for example, took a critical stance on the idea of Medicare for All at the summit. His statements are summarized here. His concerns are practical; “We can’t even pay for Medicare for some,” he said, referring to an earlier report that Medicare will exceed its hospital insurance fund by 2026. Manchin, accordingly, prefers to fix the Affordable Care Act rather than create an entirely new system.

Another issue discussed at the summit was that of data security. As health care becomes increasingly digitized, the risk to people’s privacy rises, as evidenced by recent data breaches. Lawmakers are responding to these breaches, Sen. Mark Warner (D-Va.) by reaching out to health care groups for input on strategies to improve cybersecurity, and Sens. Amy Klobuchar (D-Minn.) and Lisa Murkowski (R-Alaska) by introducing the Protecting Personal Health Data Act. Read more about this here.

High-cost drugs are another upcoming issue in the health care world, discussed in this The Hill article. Innovative cures may merit a high price, but some companies are asking such massive sums for potentially life-saving solutions that they are inaccessible to the people who need them. Accordingly, lawmakers are trying to come up with solutions to make these drugs more affordable, such as Sen. Chuck Grassley (R-Iowa), who has considered allowing Medicaid to pay for drugs over time.

In the same vein, Rep. Tom Reed (R-NY.) called for the cost of insulin to be lowered in an op-ed in The Hill, available here; he notes that insulin prices have doubled in the last seven years, and tripled in the decade prior, that out-of-pocket insulin costs can exceed $300 a vial, and that patients are often racking up debt or skipping doses with serious health consequences. Reed is pushing for transparency from insulin manufacturers and has introduced the SPIKE Act, which would require justification for price hikes. Likewise, Rep. Buddy Carter (R-Ga.) has expressed his concern in a recent op-ed about the prices for drugs which treat cancer and is also pushing for transparency to lower costs.

Meanwhile, Reps. David Trone (D-Md.) and Donald Norcross (D-N.J.) wrote into The Hill, responding to issues of addiction raised at the conference. Trone drew attention back to the opioid crisis and its ongoing effects and described the steps being taken to combat it. Norcross called for enforcement of the 2008 requirement that insurance cover mental health and substance-use disorders to the same extent physical ailments are covered, and for continued funding and new strategies to deal with substance abuse.

Finally, Sen. Tammy Baldwin (D-Wis.) criticized the Trump administration as “sabotaging our health system” by destabilizing the health care market and creating difficulties in accessing it. She cites specific efforts the administration has made to reduce access, including supporting attempts to overturn the Affordable Care Act. Baldwin has responded by supporting the ENROLL Act to restore funding for the Navigator, which had previously been reduced by the Trump administration and by introducing the No Junk Plans Act to reel back the administration’s expansion of junk insurance plans.

From data security to drug prices, The Hill’s Future of Healthcare Summit covered a lot of ground. These issues in health care and the responses proposed to solve them continue to develop.

The Schulze Law Group can help you or a loved one create a thorough medical plan for the later years in your life. If you live in the Reno, Nevada area, and you have any questions, please give us a call at (775) 853-5700, or click here to message us through our website.