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Why Veterans Benefits Planning is Vital for Aging Veterans

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

Veteran Aid and Attendance Benefit

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

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

Current Veteran Benefits

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

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

Other Veteran Benefits for Caregiving

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

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

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

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

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

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

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

The Right Steps for Handling Inheritance

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

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

Medicaid Rules and Inheritance Context

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

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

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

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

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Social Security Disability Income and Qualifications 101

Temporary or permanent disability can happen to anyone at any time. Do you understand the role social security can play? Some projections are estimating that Americans in their 20s today have an approximate 30 percent chance of experiencing a disability profound enough to cause them to miss three or more months of work before retiring. Despite the risks, most Americans do not carry short or long-term disability insurance. Close to half of all mortgage foreclosures are due to owners being struck with a disability, and fewer than 15 percent of people who purchase life insurance opt for disability insurance. The Social Security Administration (SSA) was tasked in 1956 to address disability and work income by creating a disability insurance program. Throughout its long history, additional rules have contributed to its complex regulations and eligibility requirements that make applying for disability benefits difficult.

What Are the Disability Benefits and Eligibility?

The disability benefits are in the form of monthly payments to provide a safety net for qualified individuals who have become too disabled to work. The benefits are paid through the Social Security Disability Insurance (SSDI) or the Supplemental Security Income (SSI) Programs. Both of the programs are intended for disabled workers, but they have different benefits and qualifying requirements as well as different funding sources.

To become eligible for the SSDI program, you will have worked a required number of years in a job where you paid into the social security taxes (FICA, Federal Insurance Contributions Act). You have to have accrued a certain number of work credits. You can earn up to 4 work credits per year. Workers that do not have the required number of work years and who also have low income and minimal assets can apply for SSI. In both programs, you are not eligible to be engaged in a substantial gainful activity (SGA), earning a certain amount of income from some other work.

The number of work credits required as a qualification for SSDI benefits depends on the age at which you became disabled. Generally, it is possible to qualify if you have earned at least 20 credits in the ten years before being disabled and if you have earned credits that total 40 or more. If you do not have enough work credits to qualify, there is a chance you can become qualified based on a spouse or parent’s work record. There are many regulations governing eligibility for SSDI, and each individual has a varied work history. To understand how to qualify and how much you should be able to receive, it is best to contact a legal professional for help.

Maintaining Disability Qualifications and Benefits

Once you qualify from a work history perspective for SSDI, then you must prove you meet medical eligibility requirements. SSDI benefits are available to those workers who have a severe, long-term, or total disability. A severe disability is a condition that interferes with general work-related actions. Long-term disability means you are unable to perform “substantial gainful activity” (SGA) for a minimum of one year. Total disability is a person’s inability to work in their own or any other occupation for which they are suited by training, experience, or education due to a sickness or injury.

SSI medical qualifications are similar to medical terms used in SSDI qualifications; however, these individuals must also have limited resources and a low income. The benefits from the SSI program are funded through general tax revenue and not dependent on your work history or having paid into the social security taxes known as FICA.

For either program, it can be challenging to qualify for the SSA’s definition of disabled. To be considered disabled by the SSA, your condition has to last a year or be expected to last a year. Or your condition should be expected to result in your death. Your condition must also significantly limit your abilities to do necessary work activities like walking, sitting, standing, or retaining and remembering information. Additionally, your condition must be listed in the SSA’s “Listing of Impairments” (Blue Book) or have medical equivalency to listed conditions. Finally, your condition must prevent you from doing any work for which you qualify before your disability.  

The Approval Process for Social Security Disability

Becoming approved for benefits is a lengthy and often frustrating process as many people are denied on their first application. A myriad of forms, doctors’ recommendations, personal medical history, work, and tax documentation all contribute to becoming accepted into either program. You can apply online or at your local social security office. It is best to contact the office to schedule an appointment to submit your application for benefits. Regarding financial qualification, be prepared with your work history and current earnings, household assets and income, your bank, and financial institution information. Also required is your current and past employers and up to five jobs you have held in the past 15 years, any other benefits you may be receiving, your status of citizenship, and, if applicable, any paperwork from a military discharge.  Pay stubs, proof of citizenship, W-2s or 1099s, information about your disability, and detailed medical records are all pertinent data to bring.

An initial application that is denied has multiple stages of appeal. You can enter a request for reconsideration or even go up as high as an appeal to a federal court. If your condition has made you very sick and you are experiencing a severe medical condition, there is a streamlined process known as the SSA’s Compassionate Allowance List. This list primarily includes adult brain disorders, certain cancers, and several rare disorders that affect children. If and when you are approved for disability income through SSDI or SSI, there is a waiting period. Benefits will not be made available to you until you have been disabled for a full five months, and, likely, you will not be approved for six months to a year, including the likelihood for at least one level of appeal. Be prepared from the outset for a lengthy process and improve your chances for approval with a well thought out, legally reviewed application for disability income. If you have questions or would like to discuss your situation with us, please do not hesitate to contact our Reno office by calling us at (775) 853-5700.

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Is COVID-19 Putting Your Social Security at Risk

The recent pandemic has caused for many drastic changes in our economy including social security funding. The US Social Security Administrations funding trusts are known as the Old-Age and Survivors Insurance (OASI) Trust Fund and the Disability Insurance (DI) Trust Fund. In their 2019 annual report to Congress, the Board of Trustees released some startling detail about projected insolvency for the Social Security Program by the year 2035. The Social Security Administration (SSA) has been dipping into its “trust fund” to meet scheduled benefit payouts. Social Security program costs continue to exceed non-interest income.

The OASI has no authority to borrow money, and during the COVID-19 pandemic, the American workforce is severely reduced. Now there are far fewer workers paying into the Social Security system. The payroll tax is the cash liquidity needed to fund by far the single most significant source of federal spending, and it is drying up. Trust reserves will be depleted faster than the projection of 2035.

The situation became dire in what seems like an instant, but it is due to more than 22 million Americans losing their jobs in the past four weeks. Twenty-two million fewer people are propping up the Social Security system at a time when a lot more money will soon be going out. People who are now out of work will be able to draw benefits and may do just that out of sheer economic need.

According to Market Watch reporting, by columnist Alicia H. Munnell, a leading expert on Social Security “We are going to lose a lot of payroll tax revenue this year” as “expenditures keep at their regular pace, if not at an immediately  higher pace because older people can’t find a job might turn to claim early.” The gap between what the SSA takes in versus pays out will widen further, and the trust fund that fills this gap will be depleted faster than ever. Social Security trustees Labor Secretary Acosta, Health and Human Services Secretary Azar, and Treasury Secretary Mnuchin have yet to release their updated projections on just how quickly the trust fund will run out of cash.

With the advent of COVID-19 and ever-increasing expenditure to protect the unemployed and vulnerable people of America, it will behoove those who have retirement and estate plans to review and make appropriate changes to cover what may be shortfalls to their expected Social Security benefits. Also, consider any expected employee pensions you may have from businesses that may go bankrupt. Unfortunately, there is not a lot of time to get a good fix in place for you or the government because of the world-wide economic market crashes. The fix for Social Security has moved to a scale of monies not seen before this pandemic. The current solution of the SSA is for the American taxpayer to receive somewhere around 75 percent of their previously promised benefits. Still, that percentage was established before the loss of 22 million workers and their payroll tax contributions.

The perfect storm has come to pass. Americans are experiencing a pandemic that spurs massive unemployment, which in turn leaves, at minimum, 22-million fewer payroll tax contributors, which accelerates the timeline of a projected insolvent Social Security system. The Social Security solvency problem, coupled with the US Census Bureau reporting a declining US birth rate for the fifth straight year while people are living longer than ever before, and this perfect storm becomes cataclysmic.

The good news is American people want to go to work and get on with their lives. Successful retirement and estate planning are all about mitigating risk and expanding rewards. We can help with your planning. The sooner you start, the better, as we could remain in uncertain times for a while longer. We look forward to hearing from you, please contact our Reno office by calling us at (775) 853-5700.

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Keeping Loneliness Away from Seniors

The medically recommended protocols for social distancing and government mandates that restrict large gatherings of Americans to slow the spread of the coronavirus are minimizing our abilities to interact with each other. This isolation holds especially true for those seniors who live alone or in long term health care facilities. Human beings are, by nature, designed for close contact and social interaction. Maintaining human connection, whether it be family or casual acquaintances, can help boost immunity, combat anxiety and stress, and can even lower health risks that are exacerbated by stress like heart attacks and hypertension.

The Association of Health Care Journalists reports that it is critical for older adults’ wellbeing to maintain social ties. Those seniors who experience loneliness and social isolation are more likely to develop dementia, more likely to fall, have an increase in hospital readmissions, and an increase in mortality. Because of the COVID-19 pandemic, health care facilities and hospitals across the country have put a pause on in-person visitation. This separation will protect the most vulnerable populations, such as older adults and those individuals with chronic health conditions.

To help your loved ones in a facility or living on their own during this challenging time of COVID-19 Right at Home, a leader in the in-home senior care industry, has some ideas to stay connected to those you love who are isolated during this outbreak.

  • Set up phone dates. Scheduling a regular call at a prescribed time and date brings you closer through conversation and also gives a senior something to look forward to experiencing. Do not over-promise. It is better to have two calls a week that you always attend rather than to miss a promised chat session because you overscheduled your time.
  • Write letters to each other. Getting postal mail is fun for all ages, especially when it is a letter, filled with memories of shared times. Include self-addressed stamped envelopes back and forth to encourage continuing the exchange. Lonely seniors will usually re-read these notes and treasure them.
  • Set up chatty technology. Whether it’s a tablet, home device, or smartphone, you can use your digital device to use apps like Facebook Messenger, Alexa, FaceTime, Skype, and more to videoconference with your senior. If your senior needs some technical help, most health care workers will be able to help get them started as you will not be permitted to be onsite.
  • Virtually watch movies together. If you and your senior have a desktop computer or laptop that uses the Chrome browser, Netflix Party will synchronize video playback and add group chat capability to your chosen show or movie. It’s like having a long-distance movie night or tv watching party.
  • Attend online events and activities. Participating online is a big deal when faced with isolation. There are thousands of people online who have similar interests as you. Meetup.com is a free membership group that has 24 separate categories, like dance, language, and culture, photography, family, tech, health and wellness, music, and more. All of these categories host multiple online events in which your senior can participate.
  • Attend virtual religious services. Faith is so important right now, especially for some seniors. If your loved one has a worship service they used to attend, see if they are now providing their services online. Many houses of worship have Facebook pages where a service is a click away. It will lift your senior’s spirits immensely to see and listen to their familiar pastor, rabbi, or priest.
  • Make use of the public library online. More than ever, libraries are offering their services for things like movies, e-books, and audiobooks.
  • Stay physically active. Log into a virtual exercise class online. Most of the classes are free, and they are found everywhere on YouTube. Just be sure to search for an exercise class that is appropriate for your age and physical abilities. As with any new exercise regime, always consult your doctor first.
  • Get outdoors, even for 5 minutes. If at all possible to do safely, step outside on the porch, patio, or balcony and encourage your loved one to do the same. Take in some sunshine and fresh air, take a deep breath and see the bigger picture of life.

Prolonged loneliness can bring about depression and even dementia. However, social distancing does not have to bring about social disconnection. Employ some of these ideas in the world of your senior to protect them from isolation during this pandemic. It is crucial to your loved one’s wellbeing to have direction and routine, hope, and human connection.

We are also using video technology for our meetings so we can continue to help with planning needs of our community.

If you have questions or need guidance in your planning or planning for a loved one, please do not hesitate to contact our office by calling us at (775) 853-5700.

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People of All Ages Must Plan for the Unexpected

The sudden rise of the coronavirus, COVID-19, has left many unprepared and confused. There are numerous reports of shortages of antibacterial hand sanitizer, disinfecting wipes, and even toilet paper. While we can’t predict when something like COVID-19 might strike, we can take steps to prepare for an unexpected crisis to help reduce the stress on ourselves and family members.

Designate a family member who will check on elderly relatives. Make sure everyone knows who will responsible for checking in with an elderly loved one each day. Also set up a process for notifying other family members of an elderly loved one’s condition – this may include sending an email, text messaging, or phone calls. The method is not as important as agreeing to a process and sticking to it so all family members stay informed.

Seek medical advice in the event of a health care crisis. There has been a great deal of reporting about COVID-19, and some of it has been inconsistent. Reach out to your trusted medical team to understand what you and your loved ones should be doing in this, or any, health care crisis.

Make sure someone knows how to get your bills paid if you are unable to. This type of power can be provided to an agent under a financial power of attorney. Powers of attorney can include numerous powers, so it is critical to talk with legal counsel before signing any type of legal document that gives someone else authority over your finances.

Be sure there is an accurate list of medical prescriptions readily available in your home. If you become ill, it is important that someone knows the medicines you take and the dosage. Keep this in your home where others can find it, and make sure the list is dated, noting any time it is updated. Many of us assume that our doctor has an updated prescription list, but if you are seeing multiple specialists, that may not be true.

Designate someone you trust to make medical decisions for you if you are unable to. This should not be a form that is downloaded from the internet. Deciding what type of treatment you want, where you want to live, and what should happen if you have a terminal illness are serious topics that should be considered carefully, then translated into a proper legal document.

Planning for an unexpected health care or financial crisis can help relieve a great deal of stress for you and your family. We would welcome the opportunity to help you come up with a plan that works for you.

If you have questions or need guidance in your planning or planning for a loved one, please do not hesitate to contact our office by calling us at (775) 853-5700.

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VA Closes Offices During COVID-19

All Veterans Benefits Administration (VBA) Regional Offices are closed to the public for veteran walk-in claim assistance, counseling, scheduled appointments, and other in-person services in response to the COVID-19 pandemic. The offices will remain open to essential personnel as services will be provided to veterans through the Veterans Administration website (VA). Specific claim question information can be addressed through the Inquiry Routing & Information System (IRIS) or via telephone at 1-800-827-1000. The VBA also has a presence on Facebook and Twitter that you can follow for updates. This social distancing effort will protect veterans who are older, who have underlying health conditions, or both, as well as on-site VA personnel. Though the delivery mechanisms to provide benefits and services are now focused via online services, veterans, families, and survivors will continue to receive assistance during the COVID-19 outbreak.

Hearings with a veteran’s law judge will continue in a videoconferencing format. Family members, outside advocates such as the American Legion’s service officers, as well as attorneys who may be representing a veteran, must now videoconference to guide veterans through their claim process. This process works very well except in the instances when a veteran does not have a smartphone or other internet device or has one but are uncomfortable or unfamiliar with using the technology. The VA is allowing veterans to cancel their meetings with the judge though it will delay the process. This delay, however, will not jeopardize their claim. Family, formal advocate groups, and attorneys, either for free or for a fee, must step in to assist the many veterans who are senior or near senior age who are unable to navigate benefits claims in these formats.

To make ends meet from layoffs and the national economic fallout due to the COVID-19 pandemic, many veterans who have been eligible but never filed for disability ratings are doing so now. All new disability claims require, at minimum, one examination by a physician. An appointment can be tough to schedule as doctors are currently prioritizing emergency and sick calls over non-emergency appointments. The important thing for a veteran to do is to schedule the appointment anyway because beginning the process identifies the start date for retroactive payment for their disability should the veteran become approved.

The Veteran Benefits Administration also handles GI Bill benefits, VA home loans, as well as disability claims. All of these services are being funneled into online, videoconferencing, and telephone formats until further notice. VA hospitals and clinics will remain open to veterans but have new restrictions, so be aware of what they are before trying to walk into a VA healthcare facility.

If you have questions or would like to discuss your current legal needs, please don’t hesitate to reach out by calling our office at (775) 853-5700.

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The Hybrid Long-Term Care Insurance Policy

You have probably heard about the astronomical costs of nursing-home care if you become seriously ill or injured. You might also know that Medicare would cover only a minimal amount of those costs. Private insurance doesn’t seem like a good bet either, if you’ve heard horror stories about skyrocketing premium costs and difficulties in even obtaining long-term care (LTC) insurance in the first place.

There may be a better way. “Hybrid” policies essentially combine life insurance or an annuity with LTC coverage. (The benefits can be known as “accelerated death benefits” or “living benefits,” or the coverage can be called “life/long term care,” “linked benefits,” or a “combo” policy.)

This type of policy will pay if you need nursing care, but, if you never need that, then the policy functions like standard whole-life coverage. It’s a win-win. Say, for example, you buy a hybrid policy with a $100,000 death benefit. You eventually need $50,000 of that coverage to pay for LTC. Then, when you pass, your beneficiary would receive a $50,000 payout from what’s left of the original $100,000 coverage.

Some plans offer tax-free death benefits to your heirs if your LTC benefits are not fully used or needed. They may return your premiums if you change your mind down the road. Premiums can be locked in from the initial purchase date, with a guarantee that they will never increase. Those who already hold a legacy policy with a large cash value may be able to roll that value over, tax free, into a new hybrid policy.

For those who can afford to pay premiums in a lump sum in advance, LTC coverage could amount to as much as twice the face value of the policy. Compare that with simply setting money aside for LTC expenses at a rate of five percent interest. It could take as long as thirty years to save for what this policy offered on its face.

There is a wide range of coverage, depending on the policies. They may cover different services, delivered at-home, in a facility, or both. The monthly or daily benefits can vary. Some policies require an elimination period (a delay between the time a doctor qualifies you for coverage, and actual payment); some do not. Some provide inflation protection. Some provide adjustable rates, depending on how much the insured might need LTC as against the death benefit.

Always also remember that the carrier must have the long-term financial stability to pay claims, and to remain in business, for decades to come.

To sort through all these intricacies, the National Association of Insurance Commissioners has issued a free and comprehensive Shopper’s Guide to LTC Insurance. It provides especially helpful shopping tips at pp. 31-36. Find the publication here.

We can create a long-term care plan that incorporates a hybrid plan like this with an irrevocable trust that will protect all of your bank accounts and real property (like your home) in the event you need long term care. If you are interested in protecting your savings and your home, we would welcome the opportunity to discuss a plan that works for you.

Please contact our office by calling us at (775) 853-5700.

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Estate Planning with a Family That is Blended

Couples often bring children into a marriage from a prior marriage or union and then have children together. This is often referred to as a blended family. Blended families highlight the need for careful estate planning to make sure the needs of each spouse are met, as well as the needs of each parents’ children.

If one spouse is significantly younger, this sometimes means that the older spouse’s children are close in age to the younger.  There can also be sibling rivalry between children of a parent and stepchildren. These relationships can cause more than friction between the stepparent and stepchildren.

Most parents want to ensure that their assets will pass to their children and/or grandchildren, and maybe not their stepchildren.  However, without careful estate planning, there is no guarantee that their children will inherit their assets.  In fact, if the couple creates identical wills such that their assets pass to the survivor of them, there is a significant likelihood their children will be disinherited.

This is because all of their assets will pass to the surviving spouse to do with as he or she pleases. This can result in the surviving spouse excluding the stepchildren, who then receive nothing.

Poor planning can lead to a race for survival between spouses. A will can be changed at any time; therefore, a surviving spouse could change his will after the death of the first spouse, leaving nothing for the first spouse’s children.

Another common occurrence is for each spouse to name the other as a beneficiary on accounts or pieces of real property. Doing so will not allow the bank account, piece of property or other type of asset to pass to anyone else, regardless of what their estate planning documents provide.

A trust, however, can allow a spouse/parent to “rule from the grave.” At the death of the first spouse half of the trust assets can be locked down. With this type of planning, each spouse can have the assurance that their share of the trust assets (or one half) will pass to their children, grandchildren or any other person they wish. The remaining assets are used for the surviving spouse and will then pass as that spouse wishes.

We help families of all types plan so that their savings, home and other property passes the way they intend. This involves getting to know you and your family and having a complete understanding of each spouse’s wishes. If you’d like to discuss your particular situation, please contact our office by calling us at (775) 853-5700.

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A Blood Test for Alzheimer’s Disease

Alzheimer’s disease is becoming more prevalent among aging Americans, and there are more aging Americans than ever before. Alzheimer’s disease has three typical biomarkers: plaques of beta-amyloid protein, tangles of tau protein, and loss of connections in the synapses that communicate information between brain cells. Now a simple blood test may be able to detect early signs of Alzheimer’s years before any symptoms, like memory and thinking decline, become apparent. The test involves the identification of changes in levels of NfL a neurofilament light chain protein found in the brain. This protein is part of the internal skeleton and resides inside neurons and brain cells, but when damaged or dying NfL leaks into the cerebrospinal fluid (CSF), it becomes circulated into the bloodstream.  CSF provides essential mechanical and immunological protection to the brain inside of the skull.

Prior testing to determine elevated levels of NfL in the cerebrospinal fluid involved a lumbar puncture or a spinal tap which is a procedure many people are reluctant to undergo. Still, this raised level of NfL is a reliable indicator that brain damage has occurred and that the person is at an elevated risk of Alzheimer’s presymptomatic stages. Testing of NfL “…could be,” says co-first study author Stephanie A. Schultz, who is a graduate student at Washington University, “a good preclinical biomarker to identify those who will go on to develop clinical symptoms.”

Recent data from the National Institute on Aging Alzheimer’s disease fact sheet estimates Alzheimer’s may rank as the third leading cause of death for older people following heart disease and cancer. It is also the most common form of dementia among seniors aged 65 or more. A simple blood test can detect the future state of you and Alzheimer’s, but do you want to know? Currently, there is no cure for the disease, and depending on the levels of optimism an individual displays, knowing their NfL status could be a blessing or a curse.

The blood test gives pre-diagnosis years ahead of the onset of symptoms. There is a percentage of seniors who would find this information disheartening and feel burdensome and full of worry for what is about to come. These individuals can receive protection from knowing at their request if the information would make them fearful and angst-ridden. Other seniors might want to have a pre-diagnosis to relish the time that they have left with full faculties. They may want to get their affairs in order, handling day to day living choices and extension of life choices when they are no longer mentally competent to do so. Many components divide the two camps of thought; wanting or not wanting to know. Family structure, faith, financial independence, education level, and general health and well-being typically play a factor in the decision.

What of the family who may want or may need to know of the future advent of Alzheimer’s to plan for the care of their spouse or parent? As a spouse and as a child, it is crucial that medical directives be in place for when their loved one can no longer make a sound decision but can be comforted by the fact that they participated in the planning years before. A spouse must prepare when their loved one enters a full-time care facility, they may no longer recall their marriage and their spouse and unknowingly, may strike up a “relationship” with another resident. Retired Supreme Court Justice Sandra Day O’Connor encountered this with her husband and famously became involved in raising awareness of Alzheimer’s disease. Subsequently, she was diagnosed with Alzheimer’s disease in 2018 and retired from public life.

Outside of the emotional realm of not having an Alzheimer’s stricken spouse or parent recognize who you are there is a substantial financial component to caring for individuals with Alzheimer’s. For practical and economic reasons, a family should be able to establish the biomarker for a loved one’s likelihood to develop the disease through this simple blood test. To that end, health information is private and protected by law. To ascertain your spouse or parents’ risk of Alzheimer’s requires conversation, acceptance of the blood test, and careful planning with elder counsel for proper legal documentation.

If you have questions or need guidance in your planning or planning for a loved one, please don’t hesitate to contact our Reno office by calling us at (775) 853-5700.