Elder Law

Understanding Medicaid

Federal and state Medicaid programs offer comprehensive health insurance and financial protection to millions of Americans. The program helps low-income families, individuals, and people with disabilities receive adequate health care and provides nursing home or community long-term care services. As of August 2022, more than 90.5 million individuals were part of the Medicaid and Children’s Health Insurance Programs (CHIP).

States Follow Federal Guidelines But Have Some Autonomy

Although Medicaid funding is a federal-state partnership, states administer the programs and have some flexibility in determining who to cover, delivery models, and payment methods for physicians and hospitals. States may apply for a Section 1115 waiver to experiment with different implementation approaches as federal statutes require; however, the Secretary of the US Department of Health & Human Services (HHS) determines advanced program objectives.

Medicaid entitlement has two basic guarantees. First, all Americans who meet Medicaid eligibility requirements are guaranteed healthcare coverage. Second, states receive guarantees for federally matched funds without a cap for enrollees’ qualified services. Under current law, nearly all Medicaid federal funding is open-ended, but this may change for cost containment.

According to the Congressional Budget Office (CBO), the federal government pays anywhere from 54 percent to 79 percent of each state’s annual Medicaid outlays, with the states’ picking up the remainder. Beyond enrollment expansion due to COVID-19 for the fiscal year 2022, nearly one-third of states saw upward pressure on spending due to increasing costs for managed care and provider rate increases.

Medicaid Coverage Continues to Evolve

Medicaid began in 1965 and was a cash assistance program for qualifying individuals or families. In the following years, Congress expanded federal minimum requirements to provide more new coverage types, particularly for children, pregnant women, and people with disabilities. The broader health care coverage of the Affordable Care Act (ACA) in 2010 expanded Medicaid to non-elderly adults with qualifying low incomes and continues to meet changing needs.

A Broad Range of Health and Long-Term Care Services

In addition to the Medicaid federal law service requirements, many states provide optional services. These services include physical therapy, prescription drugs, eyeglasses, and dental care. Medicaid expansion for adults is part of the ACA’s ten “essential health benefits,” which include the following:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Pregnancy, maternity, and newborn care
  • Mental health and substance abuse disorders
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventative and wellness services
  • Pediatric services

Medicaid covers the cost of long-term care, including nursing homes and many community-based long-term services. Over half of all Medicaid long-term care spending is for home and community-based services (HCBS), enabling seniors and those with disabilities to live more independently. Emphasis is shifting away from institutional settings, although intermediate care facilities for adults with intellectual disabilities remain a priority.

Privately Managed Care Plans for Enrollees

More than two-thirds of Medicaid beneficiaries account for privately managed care plan enrollments contracting with states to provide comprehensive services. Other enrollees receive their care in a fee-for-service system.

Most states cover long-term services through risk-based managed care arrangements to contain costs. These managed care organizations (MCOs) are comprised of various entities, as some involve physicians while others combine physicians, hospitals, and other providers.

The blended approach of public and private partnerships to provide Medicaid care allows each participating group to function at their highest level, integrating efforts instead of trying to solve issues outside their expertise.

Medicaid beneficiaries have far better access to healthcare than the uninsured and seek medical care before health problems become severe and more costly. The satisfaction ratings of Medicaid recipients are comparable to those rates for individuals with private health insurance.

Conclusions

Despite experiencing low income, the rate of Medicaid enrollment is similar to those with private coverage. Medicaid covers preventative, rehabilitative, and acute health care in addition to costly long-term care for millions of Americans.

Medicaid services account for one-fifth of healthcare spending and receive a lot of attention regarding:

  • Capacity expansion to address addictions, in particular opioids
  • Refining payment and delivery systems
  • Lowering prescription drug costs
  • Refining eligibility requirements
  • Increasing community-based long-term care services

Medicaid funding is a major financial support for hospitals, doctors, nursing homes, and many other jobs in the healthcare sector. Federal matching funds guarantee an open-ended basis to provide flexibility in supporting each state’s population’s healthcare needs.

Medicaid is an extensive program and varies by state, making it difficult to know what is available to beneficiaries or potential enrollees. Attorneys specializing in Medicaid and disability can help you understand how to benefit from your state’s programs. They can guide your application process, ensuring you receive the necessary benefits.

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

Elder Law

Ensuring Health and Safety for Nursing Home Residents

Baby boomers will require more care as they enter their golden years, some will be able to be cared for at home by family members or with hired help. Many will need to move into long-term care facilities, such as nursing homes, to get the level of care they need. This can bring extra costs and concerns. In addition to the growing costs of living in a long-term care facility, there is the concern that your loved one will not get the quality of care you imagined.

Health and Safety

According to a statement released by The White House on February 28, 2022, private equity firms have been buying struggling nursing homes, leading to a general decline in residents’ care. Between 2000 and 2018, investments in nursing homes by private equity firms increased from $5 billion to over $100 billion. Recent research has found that resident care and health are significantly worse in nursing homes owned by private equity firms.

A recent study of nursing homes that private equity firms acquired found that residents were 11.1% more likely to have preventable emergency department visits and 8.7% more likely to experience a preventable hospitalization than residents of for-profit nursing homes not owned by private equity firms. Additionally, COVID-19 infection rates were 30% above statewide averages, and the death rate was 40% above statewide averages in private equity-owned nursing homes.

The Biden-Harris Administration has tasked the Department of Health & Human Services (HHS) through its Centers for Medicarhealthcared Services (CMS) with improving the quality and safety of nursing homes. This effort is directed at protecting vulnerable residents and the health care professionals who care for them and cracking down on bad actors. CMS is launching new initiatives to help ensure nursing home residents get the quality care they need. These initiatives include establishing a minimum nursing home staffing requirement, reducing resident room crowding, and reinforcing safeguards against unnecessary medications and treatments.

Cost of Long-term Care

Baby boomers will start to enter their 80s in 2025, increasing the number of people needing extra support and services, including long-term care. According to estimates from the CMS, the number of people requiring long-term care will double by 2050.

In a 2019 survey, the insurance company Genworth found that the average annual cost of a private room in a nursing home was $102,000. The Insured Retirement Institute has discovered that 45% of baby boomers have no retirement savings, and more than a quarter of those who have some retirement savings have less than $100,000.

These statistics paint a bleak picture for those who are hoping to live their later years in comfort. Due in part to the high cost of professional health care and support services, most long-term care is provided by close family members, such as spouses and children. Often, though, there comes a point when the person being cared for needs a level of care that their family members are unable to provide.

Paying for Long-term Care

Once someone needs professional care, either in their home or at a long-term care facility, the cost of care increases dramatically. Finding a way to pay for this type of long-term care can be a stressful and confusing process. The earlier the process is started, the better chance one has of preserving assets for their loved ones.

Attorneys who are experienced in estate planning and elder law help clients navigate the often complex process of planning for long-term care. There are many ways to adequately prepare for long-term care while saving assets for heirs.

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

Elder Law

Married Couple’s Medicaid- Compliant Annuity

In general, an annuity pays a fixed amount annually to the owner for the remainder of his or her life. Most annuities are deferred, meaning the payout doesn’t occur until a later date. However, you can receive immediate payouts if you purchase a Medicaid-Compliant Annuity (MCA). When you buy a Medicaid annuity, you give a company a lump sum of cash in exchange for a guaranteed income stream. While only private insurance companies can issue annuities, you may purchase them through banks, financial planners, insurance agents, and brokerage firms.

The Benefits of a Medicaid Annuity

In what circumstances is a Medicaid annuity beneficial? Many Medicaid applicants are denied coverage for long-term care because they have too much money or too many assets. However, Medicaid applicants applying with insufficient funds to pay their nursing home bills can leave a healthy spouse destitute in the short term if paying out of pocket. A Medicaid-compliant annuity can accelerate eligibility for the joint state and federal Medicaid health insurance program, which pays for a person’s medical bills and nursing home care while providing reliable income for the healthy at-home spouse.

To properly plan for a Medicaid-compliant annuity, seek the advice of an elder law attorney who understands your state’s Medicaid rules. There are ordinary immediate payout annuities that are not Medicaid-compliant, so it is critical to receive the correct advice before your purchase. The goal for married couples is for the healthy spouse (the annuity owner) to collect the annuity income while the spouse needing medical benefits from Medicaid-funded extended care and nursing home benefits remains eligible.

Medicaid-Compliant Annuity Requirements

  • The MCA is for an individual and must be non-assignable and irrevocable
  • The annuity income payout must be based on the life expectancy table equivalent to the Social Security life expectancy tables Medicaid uses
  • The annuity terms can’t extend beyond the annuity owner’s life expectancy
  • All premiums will return to the client by the end of their life expectancy
  • The immediate irrevocable annuity must not have a cash value
  • The restricted annuity may not have balloon payments, and the distribution of annuity payments to the owner must be equal and actuarially sound
  • The Medicaid beneficiary structure must comply with the state’s Medicaid recovery rules
  • Guidelines and recovery rules vary by state law, often asking the State Medicaid Agency to be named as beneficiary

Drawbacks for Medicaid-Compliant Annuities

These Medicaid-compliant annuities are challenging to set up, may not cover all of your assets, and preclude you from accessing them if you require them for future needs. However, because of long-term care’s prohibitive costs, many married couples are willing to accept these potential risks because Medicare does not cover long-term care. The national average for long-term care insurance for a couple both 60 years old is $3,400, and approximately 30 percent of applicants between 60 and 69 are declined coverage.

While that may seem like a lot of money to pay in premiums, if you qualify for the insurance, it pales in comparison to the national estimates of long-term care costs out of pocket. According to Genworth, the cost of long-term care in a 2021 survey cites the following monthly average costs:

annuity.org

Non-Countable Income Stream

Purchasing a Medicaid annuity converts an asset into a monthly income stream for the healthy spouse, and this income does not count toward Medicaid eligibility. Purchasing this annuity type means the couple’s assets do not have to be “spent down” for one to be Medicaid eligible. However, the annuity payments must be completed before the end of the healthy spouse’s life expectancy so that the annuity purchase does not become giftable to heirs.

A Medicaid-compliant annuity will convert liquid assets into a lifelong income stream that helps a healthy spouse maintain their quality of life while the spouse in need of long-term care can still qualify for Medicaid. The Medicaid-friendly annuity requires that it be irrevocable (unchangeable) and non-transferrable to heirs upon your death. Since this purchase must be irrevocable to achieve the goals, it is crucial to meet with an elder law attorney to ensure your selection is the right financial product for your circumstances. A Medicaid-compliant annuity can help both spouses in a marriage to get the resources they need should one require long-term care.

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

Elder Law, Estate Planning

Components of Life Care Planning

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

Estate planning lets families:

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

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

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

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

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

What is Estate Planning?

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

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

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

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

What is Elder Law?

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

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

What is Life Care Planning?

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

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

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

Elder Law

The Right to Appeal Has Been Granted to Medicare Recipients

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

The Underlying Issue

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

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

Observation Status

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

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

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

Alexander v. Azar

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

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

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

Help with Medicare and Medicaid

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

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

Estate Planning

A Comparison of Elder Law and Estate Planning  

You may wonder what estate planning and elder law entail and how they differ as you plan for your future, both financially and in terms of health care. Estate planning and elder law also have some similarities.

Even though these two types of law are for different stages in life, they are often handled at the same time. This is because many people wait till later in life to start their estate planning process. When an older person creates an estate plan, they may also need some elder law counseling. To better understand the two areas of the legal field, we will look at the solutions they provide, questions they answer, and how they can work together.

Estate Planning

The main goal of estate planning is to choose legal documents that will determine what will happen to you and your assets once you have passed away or become incapacitated. An estate planning attorney will help you make important decisions, such as:

  • Who makes medical and financial decisions if you are unable
  • Who is allowed access to your medical records
  • How assets are distributed after you are gone
  • Who cares for minor children if you become incapacitated or die
  • Who manages money for your minor children if you are no longer able
  • How to handle your funeral arrangements and burial

Durable Powers of Attorney

By using a general durable power of attorney document, you can name a person, or persons, to make financial decisions on your behalf if you are no longer able to do so. Expressing your end-of-life wishes requires designating a person to make healthcare decisions for you by completing a health care directive. By completing a Health Insurance Portability and Accountability Act (HIPAA) form, you will give your health care providers permission to share your medical records with the people listed on your HIPAA form.

Wills and Trusts

In your will, you can name the beneficiaries of your estate as well as a guardian to care for any minor children you may have at the time of your death. You can also name a conservator to manage the money you leave for their benefit. Some people create a trust, or trusts, to hold their assets during their lifetime and after death. They then sign a pour-over will that moves assets into their trust(s) upon death. You can leave instructions concerning your funeral or memorial service and what you want to happen to your remains in your will or a separate document.

Elder Law

Whereas estate planning focuses mostly on what happens after a person dies, the area of elder law focuses on a person’s last years or months. This can include planning for long-term care and applying for government assistance, such as Medicaid, Medicare, and veterans’ benefits, if applicable. Using elder law tools and strategies, an elder law attorney can help you find ways to preserve your assets while preparing to apply for benefits.

Like estate planning, it is best to start the elder law planning process well in advance. To qualify for benefits, such as Medicaid, you may have to sell or transfer ownership of some assets years before applying for benefits. Gifting or transferring assets out of your name must be done according to government requirements, so applying for benefits can be a complicated process. Hiring a skilled attorney can make the difference between receiving benefits quickly or not at all.

Since seniors are at a greater risk for discrimination, neglect, and abuse, elder law attorneys can help seniors and their family members recognize when a senior’s rights are being violated and take legal action to counter and remedy the situation.

Tying Estate Planning and Elder Law Together

It is best to start your estate planning process as soon as possible since the decisions involved could come at any time due to an accident or an illness. Planning for end-of-life care and the benefits associated with it may come later in life, but preparing well in advance lets you legally reduce assets for an extended period to qualify for benefits, like Medicaid. 

Even younger families just starting their estate planning process may look at elder law planning at the same time for senior family members’ needs. Some estate planning tools, such as trusts, are often used when helping a parent plan for Medicaid and other government benefits for long-term care expenses. An attorney experienced in both estate planning and elder law can advise you in these areas and help you navigate complicated processes. We hope you found this article helpful. If you have questions or would like to discuss your personal situation, please don’t hesitate to contact our Reno office by calling us at (775) 853-5700.

Veterans

An Act to Protect Veterans Becomes Law

It is the largest expansion in healthcare and benefits for veterans for more than thirty years since the Sergeant First Class (SFC) Heath Robinson Honoring Our Promise to Address Comprehensive Toxics (PACT) Act was passed on August 10, 2022. The cumbersome name stems from the story of SFC Heath Robinson, who died from a rare form of lung cancer due to toxic exposures after serving as a combat medic. This bill honors his name and the memory of all those lost to toxic exposure during service. The law comprehensively addresses the risk of toxins impacting the health of veterans, their families, and caregivers. 

Often, it can take years for these illnesses to manifest due to the increased health risks military servicemembers assume in locations all over the world. This time lag between exposure and disease can make it difficult to establish a direct connection between a veteran’s service and resulting illnesses and disabilities from multiple military environments. The PACT Act charter will bring about the following changes:

  • Expand and extend veteran eligibility for VA health care due to toxic exposure during the Vietnam, Gulf War, and other post-9/11 eras
  • The addition of more than twenty new “presumptive conditions” as they relate to military burn pits and other toxic exposures
  • The addition of more presumptive-exposure locations for radiation and Agent Orange
  • Requirements for the VA to provide toxic exposure screenings to every veteran receiving care in the VA healthcare system
  • Increase funding for and improve research efforts, staff education, and treatment as it relates to toxic exposures

Presumptive Conditions

What exactly is a “presumptive condition” due to toxic exposure? A VA disability rating typically connects your military service with proof that your service is directly responsible for your condition to qualify for benefits. However, in some situations, there is now an automatic presumption that your service is responsible for your condition. Laws or regulations determine whether a condition is considered presumptive. Under these circumstances, there is no need to prove your service is responsible. You only need to meet the service requirements for the presumption.

The eras and wars in which a veteran served and their associated benefits eligibility are detailed on this US Department of Veterans Affairs PACT Act resource link. The website also outlines claim filing processes to receive these benefits. If the VA previously denied your claim but now considers your condition falls into the presumptive category, you can submit a supplemental claim for VA review under the PACT Act.

Extended Healthcare Enrollment Periods

In particular, for post-9/11 combat veterans, the PACT Act extends the time period to enroll in VA health care from five to ten years post-honorable discharge. Additionally, there is a one-year open enrollment period for those combat veterans who do not fall within this window of time. These enrollment changes increase the number of veterans able to participate in VA PACT Act benefits without demonstrating a direct service-connected disability. By establishing presumptive conditions and expanding the list of other illnesses, the VA greatly reduces the paperwork and need for medical exams to qualify for and grant access to health care and disability compensation. These changes streamline the process of receiving earned benefits when the timing of this help is everything due to a debilitating illness(es).

VA Secretary Denis McDonough encourages those veterans who think they may be eligible for these benefits to learn more about the PACT Act by visiting this VA resource link or phoning 1-800-MY-VA-411. Benefits associated with the PACT Act became effective on August 10, 2022, when the bill was signed into law.

Claiming Your VA Benefits

Like many VA benefits claims, the process can be daunting even though this law seeks to simplify its approach while increasing the pool of eligible veterans. Correctly filing out and filing forms is crucial to initial application success. Retaining the services of an attorney specializing in veterans’ benefits can help ensure you submit your claim accurately, streamlining receipt of your benefits. This law will deliver much-needed benefits to millions of veterans and their survivors. Upon reviewing the information in the VA links provided, if you are a veteran that falls within these timeframes of war and other post-9/11 combat services, talk to a veterans attorney today.

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

Elder Law, Estate Planning

Medical Advance Directives: Understanding the Different Types

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

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

What Happens without Medical Advance Directives

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

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

Items to include in a Living Will

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

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

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

Items to Discuss with your Healthcare Proxy or Surrogate

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

Creating Advance Directives

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

Elder Law, Estate Planning

How Can an Elder Law Attorney Help You?

With the aging Baby Boomer generation and the increased number of international migrants, the senior population of the United States is growing rapidly. Although the US average life expectancy has seen a slight three-year decline, many Americans, men, and women live well into their 80s, 90s, and beyond. An elder law attorney works with seniors, taking a holistic approach to the legal issues people commonly face as they age. These include matters of housing, physical and financial health, estate planning, and more. There are as many issues as there are seniors, as life circumstances are different for everyone. An attorney who specializes in the host of the problems senior citizens face can be a wise investment.

Whether you have a lucrative business and many assets, or a small home with a modest bank account, estate planning can be overwhelming. However, having your affairs in order is a final gift to your family. An estate plan is much more than creating your will though it is generally the first step. There are multiple types of wills, and while most people think of their last will and testament, there are also living wills, joint wills, pour-over wills that work in conjunction with trusts, and more. The type of will(s) you need to best control what happens to you and your assets throughout your life, and your death, are best explained by an elder law attorney. An elder law attorney specializing in estate planning helps you navigate wills, trusts, guardianships, advance medical directives, and the financial management of life insurance policies, annuities, IRAs, and 401ks. All of these can have tax implications for managing and settling your estate.

Government programs on federal and state levels may be available to seniors. Individual qualifications and the application processes can be complicated and confusing, especially when enrolling for the first time. An elder law attorney can help you understand Medicare Part A (hospital, skilled nursing, some home health, and hospice), Part B (medical insurance covering certain services by doctors, preventative services, medical supplies, and outpatient care). Medicare Part C (Medicare Advantage Plans, a private company insurance plan you purchase that dovetails with Medicare) and Part D (covering prescription drugs). If you are a veteran, programs are available through the Veteran’s Administration and can provide you with further and more specialized assistance because of your military service. Veteran program qualifications can be highly complex, so look for an elder law attorney who is accredited by the Veterans Administration.

Medicaid provides health care benefits for low resource and low-income adults, pregnant women, elderly adults, children, and people with disabilities. If you qualify, you may receive both Medicare and Medicaid benefits. Medicaid qualifiers have their healthcare premiums and out-of-pocket medical expenses covered through the program. Medicaid also includes custodial care and addresses long-term care expenses if you begin living in a nursing home. An elder law attorney understands how Medicare and Medicaid can work to your best advantage.

Social Security benefit amounts change depending on the age range you choose to receive your benefit. You can currently apply and qualify for your benefits at 61 and nine months of age; however, the full retirement age for social security is 67, and cashing in early has long-term consequences for your payout. An elder law attorney can help you determine the best age to receive your social security benefits based on your health and financial situation. Suppose you also receive disability benefits before full retirement age or become disabled at that age. In that case, an elder law attorney can ensure you receive the proper benefits based on your condition. 

Long-term care is known to be an expensive proposition whether you are trying to afford long-term care insurance upfront or pay for it out of pocket if you require it in the future. Not addressing the issue of long-term care is a big gamble to your financial well-being. Morningstar reports that 52 percent of Americans turning age 65 will need some long-term care services in their lifetime. An elder law attorney can help you understand policy premiums and how they can increase if you purchase long-term care insurance. They can also guide you through Medicaid planning or estate planning that can help you qualify for the best financial arrangements for long-term care. Sometimes, it is beneficial to spend down your estate to be eligible for Medicaid, and your elder law attorney will know what is required by law to do it properly.

Other issues, such as employment discrimination, elder abuse, elder fraud, even grandparent visitation rights, fall under an elder law attorney’s scope. An attorney who practices elder law has a more comprehensive list of capabilities to help you through your senior years than those attorneys without expertise in this area.

We focus on elder law.  We would be honored to speak to you about how we can help you come up with a comprehensive legal plan covering many of the topics above so you can enjoy your senior years without unnecessary worry. Please contact our Reno office by calling us at (775) 853-5700. We look forward to hearing from you.

Estate Planning

Retirement Planning and Saving

Many Americans are saving nothing or very little in their day to day lives for retirement. While the unemployment rate has previously been  low and wages are seeing an increase the American worker is not saving enough of their income which will inevitably lead to short falls of operational cash during an unexpected crisis and in their retirement years further down the road. (https://www.cnbc.com/2018/03/15/bankrate-65-percent-of-americans-save-little-or-nothing.html)

Bankrate maintains that half of all Americans will not be able to maintain their standard of living once they have stopped working. GoBankingRates corroborates these findings citing that over forty percent of Americans have less than $10,000 dollars saved for their retirement. These statistics point to a dismal retirement future for nearly half of all Americans.

This doesn’t have to be your future. It doesn’t matter how little you currently save. You don’t have to become the horror story of retiring and meeting financial ruin like so many do. What matters is that you change the trajectory of your retirement life by proactively examining how you are spending and saving. The sooner you begin the better your chances of success.

The first and most important strategy to implement is learning to live beneath your means. That translates into saving money: probably more than you currently do. Saving money is an underestimated survival skill. To save begin by tracking your spending habits for thirty days. Once you have the data create a realistic and doable budget. Fluid expenditures like groceries, eating out, clothing, gasoline and auto maintenance need to have a set monthly budget. Create a simple two columned sheet of paper with budgeted and actual expenditures to monitor your progress. Typical categories where you can reduce expenditures include; cable packages, phone plans, groceries, entertainment costs, gym memberships, clothing and dining out. Start asking yourself over and over “Is this a need or a want?” and if it is a need, how can you make the cost lower. The game is how much money you can save, not spend.

Consolidate your non essential debt and pay it off, completely. Make it a primary goal to get out of debt. Stop being a debt slave. In the credit card industry there is an insider term used for people who fully pay their credit cards off each month. Guess what it is? It is a deadbeat. Companies cannot make money off of you if you stop becoming a slave to debt. If you can’t afford it then find a way to live without it.

Double check your insurance rates on your car, homeowner, and health. Do not purchase flight insurance, extended warranties, and disease insurance. Check this site for fifteen insurance policies you don’t need. (https://www.investopedia.com/insurance/insurance-policies-you-dont-need/). Get rid of the policy all together or find wiggle room for reduced premiums or get a more competitive provider to save money.

Get rid of automatic payments attached to your banking accounts. Most people can eliminate expenditures they forgot they are even locked into. This also forces you to take control of your bill/payment cycles. Being involved in the day to day of bill payment keeps you far more aware of your financial situation and keeps your mind active.

Consider downsizing your home. If you are in a two story house it is inevitable that one day you will not be able to climb those stairs. A one story home or a first floor condo or apartment can help you purge your life of ‘stuff’ you no longer need. Some of those things can be sold and the proceeds can be saved. Any profit left over from downsizing immediately goes into savings or a financial investment vehicle to provide and protect your senior years.

These are some but not all of the ways it is possible to change your savings habits. Guidance from a trusted professional is key to the pathway of success because there will always be roadblocks and setbacks that you must make adjustments for.  Structuring a legal plan in connection with a retirement plan can provide added protection and allow you to enjoy retirement more thoroughly.

Contact our office today and schedule an appointment to discuss how we can help you with your planning. Please contact our Reno office by calling us at (775) 853-5700.