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How Seniors Can Give Care When They Need it Too

When Jeanette’s mother was hospitalized, Jeanette’s father begged her, with tears in his eyes, to take care of mother if he ever couldn’t. Of course, Jeanette said “yes.”

Years later, when Jeanette’s father had gone and mother’s hearing and eyesight failed, she could no longer drive, and she had fallen several times, Jeanette remembered that promise.

Jeanette’s first step in keeping that promise is to make sure that if mother hasn’t already done so, she should visit us, your friendly elder-law counselors. We will check to see that mother has done the financial planning and powers of attorney that every adult needs, especially older adults, particularly those in mother’s situation.

As Jeanette keeps her promise, she will join a community of millions who are taking care of aging parents. The challenge is enormous. Caregivers can feel the loss of freedom keenly.

Family emotional issues left unaddressed for years, may re-emerge. Jeanette might be spending money she’s not sure she has. She can’t sleep for worry. She is wrestling with the demands of caregiving, at the same time she’s striving to meet commitments to her own family and workplace. Her or another family member’s health can act up. Time off from work is harder and harder to come by, yet she may face daily demands and frequent emergencies.

The great numbers of people in Jeanette’s situation pose a substantial public-health issue. Congress has recently passed the RAISE Family Caregivers Act, to establish a national strategy to provide assistance to so many of us.

It’s very important that caregivers also take care of themselves. Time-honored flight attendants’ advice is good here, too: Put on your own oxygen mask first. For advice on self-care and how to manage caregiver stress, visit the Mayo Clinic website, here.

Then, take full advantage of the numerous resources listed below. Remember:

Keep the home fires burning – but don’t you burn out yourself.

Area Agencies on Aging

This is a national association of nonprofit agencies serving as a clearinghouse for information on public long-term support and benefits. Services include elder transportation, emergency assistance, respite care (temporary supervision of the elder to provide rest for the caregiver), individual counseling and support groups, and caregiver education classes and training.

Caregiver Action Network

This website provides advice organized by the stage of the process the caregiver is in, helpful care checklists, and advice on cost management and juggling work and family obligations with caregiving responsibilities.

Caregiving.com

Here find podcasts, a story-telling project, a directory of caregiving consultants, an extensive free webinar library covering numerous topics including “decision fatigue,” plain old fatigue, boundary-setting, respite care, and many others.

Family Caregiving Alliance

This is the first community-based nonprofit in the country to address the needs of families and friends providing long-term care for loved ones at home. The site provides information, support, and resources state-by-state, as well as sponsoring research initiatives for caregiver programs and policies.

National Alliance for Caregiving

This site provides a long list of resources, including government programs for family caregivers, care locators, caregiving calendar to coordinate group volunteer efforts, financial information, and organizations that address caregiving for specific conditions like cancer and Alzheimer’s.

Parenting Our Parents

Peer-to-peer networking, family coaching, videos, and website compendiums.

If you have questions on anything you have read or would like additional information, please don’t hesitate to contact us for a consultation.

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Medicaid and Planning for When Your Ill Spouse Leaves Home

You may see it coming: Much as you want to and hard as you try, you just can’t take care of your ill spouse at home anymore. At this emotionally difficult time, the last thing you need is the stress of not knowing where to find the money to pay for the steep costs of institutional care.

Advance planning is a must. As as soon as you can – ideally at least five years before serious health problems arise – take advantage of many elder attorneys’ willingness to talk with you for free, or for a modest initial-consultation charge.

We are here to help you navigate the complexities of the Medicaid program. This is a governmental fund available to meet the staggering expense of institutional care, but the ins and outs of the qualification rules are complicated and mistakes can be costly. Here’s a thumbnail to help you grasp what your attorney will be telling you.

The Difference Between Resources and Income

Medicaid assistance is available only to those who own very little. The Medicaid rules determine what “owning very little” actually means. A person can only own around $2,000.00 of what Medicaid calls “resources.”

Resources include cash in the bank, CDs, the cash value of insurance policies, investments, and the like. Income includes regular paychecks, Social Security, or payments received for child support. Both income and resources are potentially “counted” by Medicaid as “available.” To qualify for assistance, available income and resources must be carefully spent or transferred away.

Exempt Resources

Some resources are not counted or, in other words, are exempt. This means the Medicaid rules exclude them from adding up to the $2,000.00 limit. These resources are sheltered from Medicaid’s requirement that the applicant must spend down almost everything before assistance will be available.

A married couple’s residence, one motor vehicle, household goods and furnishings, medical equipment, jewelry, and other items are exempt. This means that an ill spouse can still qualify for Medicaid assistance even if the couple owns those resources. There’s no need to give them away or sell them to qualify.

The distinction between “exempt” and “non-exempt” assets can be tricky, though, and should first be assessed by a qualified elder-law attorney before any action is taken.

What the Well Spouse Can Keep

The Medicaid rules permit a spouse who remains at home to keep a portion of the couple’s resources. This is known as the “community spouse resource allowance” (CSRA). Of course, you’d like to see the healthy spouse keep as much as possible within the CSRA limits. Planning can arrange the distribution of resources to make that happen.

Here is where the difference matters between “resources” and “income.” Medicaid distinguishes between the healthy spouse’s income and the couple’s resources. Resources over the CSRA limit must be spent down or carefully transferred. As to income, the healthy spouse can keep it up to a certain level, so he or she will have enough money to live on. The Medicaid rules call this the “monthly maintenance needs allowance” (MMNA).

For example, if the healthy spouse gets Social Security benefits of only $500.00 a month, but her allowed MMNA is as high as $2,000.00, it makes sense to convert some of the couple’s resources into raising her income up to the MMNA limit. This is not a simple matter, though, and should be done only on the advice of a qualified elder-law attorney.

Planning for Medicaid eligibility can be complicated. Please consult an elder-law attorney as soon as possible. The sooner you plan, the more strategies are available to protect your resources. An initial consultation with a qualified elder-law attorney, for free or for a modest amount, could save you many thousands of dollars.

Don’t delay. If you’re in need of a long-term care plan, or maybe you’ve started and don’t quite know what to do next, contact our office for a consultation today.

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Medicare Launches App to Help Beneficiaries Find Out What’s Covered

At the doctor’s office and want to know if a procedure is covered by Medicare? There is an app for that. Medicare has launched a free app that gives beneficiaries a quick way to see whether the program covers a specific medical item or service. 

The “What’s Covered” app allows you to search or browse to learn what’s covered and not covered under Medicare Parts A and B, how and when to get covered benefits, basic cost information and other eligibility details. You can also see a list of covered preventive services.  The app does not give results for extra benefits that Medicare Advantage plans may cover but that Original Medicare does not, such as certain vision, hearing or dental benefits. 

Examples of the types of questions the app can answer include:

               When are mammograms covered?

               Is home health care covered?

               Will Medicare pay for diabetes supplies?

               Can I get a regular cervical cancer screening?

               Will my Medicare benefits cover a service to help me stop smoking?

Although the app provides beneficiaries with basic information, it doesn’t provide personalized information. It doesn’t ask details about each user’s specific insurance information, so it doesn’t take into account the user’s supplemental insurance, co-insurance, and deductibles. Essentially, the app provides another way for Medicare beneficiaries to get the same information that is available online and in the Medicare handbook.

The app is part of an initiative by the Centers for Medicare and Medicaid Services (CMS) focused on modernizing Medicare and empowering beneficiaries. Other initiatives include:

  • Enhanced interactive online decision support to help beneficiaries better understand and evaluate the coverage options and costs of original Medicare compared to Medicare Advantage plans.
  • New price transparency tools that let consumers compare the national average costs of certain procedures between settings, so people can see what they’ll pay for procedures done in a hospital outpatient department versus an ambulatory surgical center. 
  • A new webchat option in the Medicare Plan Finder.  
  • New easy-to-use surveys across Medicare.gov so consumers can tell CMS what they want.

To get the new “What’s Covered” app, go here: https://www.medicare.gov/blog/whats-covered-mobile-app.

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A Final Retirement Account Distribution Must Still Be Made After Death

Federal law requires that beginning on April 1 of the year after you reach age 70 1/2, you must begin withdrawing a minimum amount from your non-Roth individual retirement account (IRA) or 401(k) accounts. These withdrawals are called required minimum distributions (RMDs).

But what if you die after age 70 1/2 and before all the account funds have been distributed? In the eyes of the law, death is no excuse not to take RMDs from an IRA or 401(k). Your heirs must take the final RMD before they can take control of the account.  

The rules for inheriting an IRA as a spouse are different than the rules for a non-spouse beneficiary, but regardless of who is inheriting the IRA, the heir must take the RMD for the year the account owner died. The full RMD must be taken by December 31 in the year the account owner died, even if he or she died at the beginning of the year. To take the RMD, beneficiaries must contact the custodian of the account and submit a death certificate. If the account owner died before he or she was required to begin distributions, then the beneficiaries do not need to take an RMD. 

The money from the RMD will go directly to the beneficiary listed on the account, not the estate. That means it will be taxable income for the beneficiary. If there is more than one beneficiary, it will be split evenly. 

To find out the best way to deal with an inherited IRA, contact an elder law attorney. To find one near you, go here: https://www.elderlawanswers.com/elder-law-attorneys