What Do I Need to Know Before I have Mom Move in with My Family ?

What Do I Need to Know Before I have Mom Move in with My Family ?

Mom Move in with My Family ? Multigenerational living can help an aging parent avoid the sense of isolation and depression that may come with living alone. However, by this time in life, you have a set way of doing things. Your likes, dislikes, value, and personalities have also changed over time.

AARP’s article from 2018 asks “Considering Moving Your Loved One into Your Home?” This is still a timely article. It notes that, regardless of how close and loving your relationship may be, adding another person to your household changes the dynamics for the entire family. The journey will be smoother, if you and your loved one go in with some clear parameters.

First, prior to having Mom Move in with My Family, ask yourself a few questions:

  • How will the move impact my spouse, children and my siblings?
  • How will my parent’s presence impact my family routine, activities and privacy?
  • Will I need to remodel the house or add a bedroom or bath?
  • Will my siblings help with some expenses?
  • Can we afford to do this?
  • Should part of my parent’s income be used to help defray living expenses?
  • Will this change require me to alter my work schedule?
  • How will I create boundaries?
  • How does my parent feel about moving in with my family?
  • How do I feel about this change?

Next, your parent should consider these questions.

  • Will this move take me away from people or activities I enjoy?
  • Do I like being with this family for long periods of time?
  • Are they expecting me to contribute some of my income or savings to living expenses?
  • If the home requires remodeling to accommodate me, am I able to help pay for it?
  • Will my other children help out?
  • If I don’t like something my child does, am I comfortable talking to him about it?
  • What are my feelings about being dependent?

You should then have an open and frank discussion about expectations, fears, finances and any lingering issues. It may be as easy as telling each other what bothers you (since the other person may not otherwise know and would be happy to make a change).

After this, create a list of the positive aspects and refer to it when you have a bad day with the arrangement.

Next, conduct a pair of meetings. Let your children know that they’re not the cause of their grandparent’s possible negative reactions, such as anger, weeping or fear. Tell them that the whole family needs to contribute, but they aren’t responsible for caregiving or fixing their grandparent. Discuss ways that the children can help their grandparent.

The other meeting is with your siblings. In addition to acknowledging that your parent needs help and will likely need more, it can be an emotional realization for all of you. Talk it out. You also shouldn’t be shy about asking for help.

Gifts of time are important in helping you manage other responsibilities in your life. Let your siblings know about your anticipated needs, like serving as a back-up and respite care, help with chores, meals delivered, grocery and prescription pickup and money to offset increased living expenses or to hire an aide.

Reference: AARP (Jan. 22, 2018) “Considering Moving Your Loved One into Your Home?”


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Can an Elder Law Attorney Help My Family?

The right elder law attorney can counsel a family through the difficult details and requirements of the situations such as Paying for a Nursing Home that may come up to protect the rights and welfare of seniors and their families. An elder law attorney may help with issues, such as guardianship, conservatorship, power of attorney, estate planning, Medicaid planning, probate and estate administration and advanced directives.

The Senior List’s recent article entitled “What is Elder Law and How Can an Elder Law Attorney Help Me?” explains that because the laws on the care of the elderly differ in each state, and are always subject to change, it is essential to find an elder law attorney who is skilled, knowledgeable and up-to-date on elder law policy and legal issues.

Before meeting with an elder law attorney, create a list of the specific concerns for the present and foreseeable future, so you know what qualifications and capabilities your attorney will need. You want a lawyer who’s experienced and educated, as well as comfortable to speak with and relatable.

You can ask these questions of your elder law attorney to help you make your decision:

  • How long have you been practicing in elder law?
  • Do you stay up to date on this area of law, by ongoing study and attending seminars on this subject matter?
  • Take a look at the required services we think will be needed. Can you fulfill them?
  • Do you have litigation experience?
  • What type of fee schedule do you offer?

If you’d like to try to stay up to date on what’s happening within elder law, go online and search for “aging and disability” or The right elder law attorney can counsel a family through the difficult details and requirements of the situations such as Paying for a Nursing Home as well as the name of the state in which the senior lives. Every state government has a department in charge of these matters (the official names will vary).

While caring for a love done can be stressful, understanding what options are available to them and to you, can make it all much easier.

Reference: The Senior List (Oct. 10, 2019) “What is Elder Law and How Can an Elder Law Attorney Help Me?”


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C19 UPDATE: Name Someone Your Medical Power of Attorney and Do It Now

If you have not yet named someone with Medical Power of Attorney, stop procrastinating and get this crucial planning in place now.

What is a Medical Power of Attorney?

A medical power of attorney is a legal document you use to give someone else authority to make medical decisions for you when you can no longer make them yourself.  This person, also known as an agent, can only exercise this power if your doctor says you are unable to make key decisions yourself.

Other Terms for Medical Power of Attorney

Depending on the state where you live, the medical power of attorney may be called something else. You may have seen this referred to as a health care power of attorney, an advance directive, advance health care directive, a durable power of attorney for health care, etc. There are many variations, but they all mean fundamentally the same thing.

Be aware that each state has their own laws about medical powers of attorney, so it’s important to work with a qualified estate planning attorney to ensure your decisions will be enforced through legally binding documents. Also, some states may not honor documents from other states, so even if you made these decisions and created documents in another state, it’s wise to review with an estate attorney to ensure they are legally valid in your state now.

What Can My Medical Agent Do for Me?

Just like there are many different terms for the medical power of attorney, there also are different terms for the medical agent – this person may be referred to as an attorney-in-fact, a health proxy, or surrogate.

Some of the things a medical POA authorizes your agent to decide for you:

  • Which doctors or facilities to work with and whether to change
  • Give consent for additional testing or treatment
  • How aggressively to treat
  • Whether to disconnect life support

We are ready to help walk you through these decisions, understand the ramifications of your choices, and memorialize your plans in binding legal documents. We are currently offering no-contact initial conferences remotely if you prefer. Book a call now and let us help you make the right choices for yourself and your loved ones.


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Why Did VA Scrap Its Star Rating System?

Officials at the Department of Veterans Affairs recently announced that individual VA hospitals will not get star ratings anymore. Instead, the VA will provide measurements like wait times, patient satisfaction ratings and medical services, along with quality assessments on their individual websites.

This move will let vets compare VA facilities with nearby public and private medical centers, said Military Times’ recent article entitled “VA drops its star ratings system for hospitals.”

“Star ratings were developed as an Internal tool meant to compare one VA facility to another,” VA Secretary Robert Wilkie said in a statement. “These ratings do not provide insight as to how our hospitals stack up against nearby non-VA facilities and are therefore of little value in helping veterans make informed health care decisions.”

VA officials say the change to do away with the star rating system will improve transparency. The move was first made public in a series of articles in USA Today.

The Veterans Affairs Administration’s ratings were frequently “misinterpreted,” they said. The ratings compared VA facilities by ranking them across the department’s health care system, instead of by “geography, population characteristics or unique care offerings” of neighboring non-VA facilities.

Although the VA hospital ratings didn’t permit vets to compare VA facilities with local medical centers, they did provide patients with an idea of how their VA hospital compared with the others and if it was doing well or declining.

When the ratings were originally published in 2016, 10 medical facilities had a 1-star rating, while 90 had shown “significant improvement” over a set of baseline measures. By 2019, the number of medical facilities that received a 1-star rating was down to nine, including three that had been on the list since 2016: El Paso, Memphis, and Phoenix.

Former VA Secretary Dr. David Shulkin told USA Today that the ratings weren’t published as the VA didn’t want vets to think that if their hospital was awarded just a single one star, they wouldn’t receive quality care and would stop going.

While Shulkin had concerns about publishing the measures, by 2018, Secretary Robert Wilkie praised the results when they were made public. That year, the system showed improvements at 66% of VA medical centers. Only one location received a one-star rating.

“With closer monitoring and increased medical center leadership and support, we have seen solid improvements at most of our facilities,” Wilkie said at the time. “Even our highest performing facilities are getting better, and that is driving up our quality standards across the country.”

But in December, Wilkie commented that the new facility-based websites will “make it easier for veterans to choose the best possible care close to home, when and where they need it.”

Instead of the star system, the VA will still publish its Strategic Analytics for Improvement and Learning, or SAIL data, that provides an in-depth look of 14 metrics quality of care measures at all VA medical facilities.

Reference: Military Times (Jan. 2, 2020) “VA drops its star ratings system for hospitals”


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Planning for Long Term Care Before It’s Too Late

Starting to plan for long term care should happen when you are in your 50s or 60s. By the time you are 70, it may be too late. With the national median annual cost of a private room in a nursing facility coming in at more than $100,000, not having a plan can become one of the most expensive mistakes of your financial life. The article “Four steps you can take to safeguard your retirement savings from this risk” from CNBC says that even if care is provided in your own home, the annual median national cost of in-home skilled nursing is $87.50 per visit.

There are fewer and fewer insurance companies that offer long term care insurance policies, and even with a policy, there are many out-of-pocket costs that also have to be paid. People often fail to prepare for the indirect cost of caregiving, which primarily impacts women who are taking care of older, infirm male spouses and aging parents.

More than 34 million Americans provided unpaid care to older adults in 2015, with an economic value of $522 billion per year.

That’s not including the stress of caring for loved ones, watching them decline and needing increasingly more help from other sources.

The best time to start planning for long term care in the later years is around age 60. That’s when most people have experienced their parent’s aging and understand that planning and conversations with loved ones need to take place.

Living Transitions. Do you want to remain at home as long as is practicable, or would you rather move to a continuing care retirement community? If you are planning on aging in place in your home, what changes will need to be made to your home to ensure that you can live there safely? How will you protect yourself from loneliness, if you plan on staying at home?

Driving Transitions. Knowing when to turn in your car keys is a big issue for seniors. How will you get around, if and when you are no longer able to drive safely? What transportation alternatives are there in your community?

Financial Caretaking. Cognitive decline can start as early as age 53, leading people to make mistakes that cost them dearly. Forgetting to pay bills, paying some bills twice, or forgetting accounts, are signs that you may need some help with your financial affairs. Simplify things by having one checking, one savings account and three credit cards: one for public use, one for automatic bill-paying and a third for online purchases.

Healthcare Transitions. If you don’t already have an advance directive, you need to have one created, as part of your overall estate plan. This provides an opportunity for you to state how you want to receive care, if you are not able to communicate your wishes. Not having this document may mean that you are kept alive on a respirator, when your preference is to be allowed to die naturally. You’ll also need a Health Care Power of Attorney, a person you name to make medical decisions on your behalf when you cannot do so. This person does not have to be a spouse or an adult child—sometimes it’s best to have a trusted friend who you will be sure will follow your directions. Make sure this person is willing to serve, even when your documented wishes may be challenged.

Reference: CNBC (Jan. 31, 2020) “Four steps you can take to safeguard your retirement savings from this risk”


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What Do I Need to Know about Medicare in 2020?

CNBC’s recent article entitled “Here’s what you need to know about your 2020 Medicare costs” reports that Medicare in 2020 will have some higher costs this year that you may want to factor into your health-care budget.

The Medicare program has about 61 million beneficiaries, most of whom are 65 or older. These people will see certain costs are adjusted by the federal government each year that can impact their premiums, deductibles and other cost-sharing aspects of the program. These changes don’t really involve big dollars. However, those affected should plan for how any increases will make a difference in their household spending.

For a person on a fixed income, all of the small changes can add up. Basic Medicare consists of Part A (hospital coverage) and Part B (outpatient care). Roughly a third of beneficiaries opt to get those benefits delivered through an Advantage Plan that’s offered by private insurers. These types of plans generally also include Part D (prescription drug coverage), and other extras like dental or vision. They also limit what you pay out of pocket for Parts A and B services.

Other beneficiaries go with the basic Medicare and buy a standalone Part D prescription drug plan. About a third purchase a supplement plan (“Medigap”) that covers some of the costs that come with basic Medicare, like coinsurance or copays.

Your coverage choices can play a part in the amount you pay in premiums, deductibles and copays or co-insurance. The frequency with which you use the health-care system can also add to your costs. Your income is another factor. Beneficiaries with limited income could be eligible for Medicaid or other programs that cover Medicare expenses. However, higher-income beneficiaries pay more for certain parts of coverage.

For those that fall in-between—a group who aren’t eligible for Medicaid or other types of assistance—every dollar is important.

Most Medicare beneficiaries pay no premium for Part A because they (or their spouse) have enough of a work history (10 years or more) of paying into the system through payroll taxes to qualify premium-free. If you don’t satisfy the minimum requirement, monthly premiums could be as high as $458 a month, based on whether you’ve paid any taxes into the Medicare system at all. That’s an increase from $437 in 2019. There are also cost-sharing aspects that go with Part A, despite whether you pay a premium.

As far as Part B, the standard premium in 2020 will be $144.60 monthly, an increase of $9.10 from $135.50 in 2019. Some recipients won’t pay the full standard premium due to a “hold harmless” clause that prevents their Part B premiums from increasing more than their Social Security cost-of-living adjustment (COLA). However, some people will pay more than the standard, due to income-adjusted surcharges.

The annual deductible for Part B will go up to $198 from $185 in 2019. Once you hit that deductible, you typically pay 20% of covered services. Note that beneficiaries in Advantage Plans may pay a different amount through copays, and Medigap policies either fully or partially cover that coinsurance. Even though Advantage Plan premiums differ among plans, the average for 2020 is $23. That’s a decrease of $27 from last year.

For Part D, the amount you pay for drug coverage depends partly on the plan you choose and your income. The average monthly premium for a standalone drug plan in 2020 will be $30— a few dollars less than the $32.50 in 2019. Higher earners will pay extra.

Those surcharges were set slightly downward.

Those charges are not included in your plan premium but instead come out of your Social Security check or through a bill. Although not everyone pays a deductible for Part D coverage (some plans don’t have one), the maximum it can be is $435 in 2020, up from $415 in 2019.

For those with high prescription costs, the amount that Part D enrollees pay out of pocket before qualifying for “catastrophic coverage” will go up to $6,350 in 2020 from $5,100 in 2019. In that phase of coverage, your share of prescription costs goes down.

Reference: CNBC (Dec. 30, 2019) “Here’s what you need to know about your 2020 Medicare costs”


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When Do I Need an Elder Lawyer?

Elder law is different from estate law, but they frequently address many of the same issues. Estate planning contemplates your finances and property to best provide for you and your family while you’re still alive but incapacitated. It also concerns itself with the estate you leave to your loved ones when you die, minimizing probate complications and potential estate tax bills. Elder lawyers contemplate these same issues but also the scenario when you may need some form of long-term care, even your eligibility for Medicaid should you need it.

A recent article from The Balance’s asks “Do You or a Family Member Need to Hire an Elder Law Attorney?” According to the article there are a variety of options to adjust as economically and efficiently as possible to plan for all eventualities. An elder law lawyer can discuss these options with you.

Medicaid is a complicated subject, and really requires the assistance of an expert. The program has rigid eligibility guidelines in the event you require long-term care. The program’s benefits are income- and asset-based. However, you can’t simply give everything away to qualify, if you think you might need this type of care in the near future. There are strategies that should be implemented because the “spend down” rules and five-year “look back” period reverts assets or money to your ownership for qualifying purposes, if you try to transfer them to others. An elder law lawyer will know these rules well and can guide you.

You’ll need the help and advice of an experienced elder lawyer to assist with your future plans, if one or more of these situations apply to you:

  • You’re in a second (or later) marriage;
  • You’re recently divorced;
  • You’ve recently lost a spouse or another family member;
  • Your spouse is incapacitated and requires long-term care;
  • You own one or more businesses;
  • You have real estate in more than one state;
  • You have a disabled family member;
  • You’re disabled;
  • You have minor children or an adult “problem” child;
  • You don’t have children;
  • You’d like to give a portion of your estate to charity;
  • You have significant assets in 401(k)s and/or IRAs; or
  • You have a taxable estate for estate tax purposes.

If you have any of these situations, you should seek the help of an elder lawyer.

If you fail to do so, you’ll most likely give a sizeable percentage of your estate to the state, an ex-spouse, or the IRS.

State probate laws are very detailed as to what can and can’t be included in a will, trust, advance medical directive, or financial power of attorney. These laws control who can and can’t serve as a personal representative, trustee, health care surrogate, or attorney-in-fact under a power of attorney.

Hiring an experienced elder law attorney can help you and your family avoid simple but expensive mistakes, if you or your family attempt this on your own.

Reference: The Balance (Jan. 21, 2020) “Do You or a Family Member Need to Hire an Elder Law Attorney?”


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Planning Retirement with a Cognitive Decline

The Director of Volunteer Programs at the Alzheimer’s Association, Stephanie Rohlfs-Young, explains that families shouldn’t let a diagnosis disrupt proper financial, estate and retirement planning. She recommends several proactive and tactical steps that individuals and families can undertake to address issues related to cognitive decline.

Barron’s recent article entitled “Cognitive Decline Shouldn’t Derail Retirement Planning. Here Are Some Tips to Prepare Your Finances” provides some tips on navigating the financial aspects of cognitive decline. Let’s look at some of them:

Inventory. For budgeting and estate planning purposes, families should conduct a thorough inventory of the individual’s property and debts to create a list of those who have access to each account. Ask about and include online checking, savings, credit-card and investment accounts. These can be neglected, if they aren’t in paper form. Try to work with the individual in cognitive decline to ascertain this information, when they can still be helpful. You don’t want to lose all those assets. This task can be challenging, when children aren’t aware of their parents’ financial dealings. This can include savings, insurance, retirement benefits, government assistance, veterans’ benefits and more. Families should also pick a lead person to be in charge of financial or legal matters.

Calculating future costs. A diagnosis of this nature is the time to figure out and plan for care costs that may include adult day care, in-home care and full-time medical care. These can costs vary widely, and many times families underestimate the amount they’ll spend on care. Families often fail to factor in out-of-pocket expenses that can add up, like prescriptions not covered by insurance. When budgeting, families should see what insurance may be available and if they might add or amend coverage.

Leverage the skills of an elder-law attorney. Partner with an experienced elder law attorney to help get the family’s financial and legal affairs together. Issues can include the titling of assets, trusts, powers of attorney, advance health care directive and more. For some, there’s also Medicaid planning.

Automate finances. Families should devise a plan for routine financial tasks, like bill paying. These are things that will eventually become too difficult for the loved one experiencing cognitive decline. Consider signing up for online banking. That way, an adult child can have easy access to monitor the parent’s account. Monthly bills, including insurance premiums, can be set up for automatic payment to help minimize the possibility of errors.

Organize your important documents. It’s critical after a diagnosis of cognitive decline to name a health-care representative to allow healthcare decisions to be made by someone of the person’s choosing. You should also have a general durable power of attorney for finances in place. This allows the appointed agent to make financial and legal decisions in the individuals’ stead.

Reference: Barron’s (Jan. 11, 2020) “Cognitive Decline Shouldn’t Derail Retirement Planning. Here Are Some Tips to Prepare Your Finances.”


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Why was a Florida Caregiver Arrested? Financial Abuse.

Financial Abuse – Anna Bullinger of Florida was never licensed as a caregiver, and according to investigators has a criminal history that includes theft and violation of probation, according to Spectrum News 9’s recent article entitled “Investigators: Sarasota Woman Stole More Than $1M From 94-Year-Old Client.”

Authorities said that since 2015, Bullinger has been cashing checks every two weeks, all signed by Nardone.

In total, Bullinger collected about $1.1 million from Nardone’s trust.

“[Nardone] actually was pretty up to date with her accounts and stuff, so she didn’t really let people see her accounts,” said Detective Carlos Verdoni.

Detectives say that Bullinger’s attention to detail with Nardone’s accounts is how she was able to escape detection for so long.

However, red flags went up when she cashed a check for a very large amount from Nardone the day after the woman’s death.

“She wrote it for $90,000, which is kind of concerning,” Verdoni explained. “It was written as a gift and she placed it in her daughter’s bank account.”

Until her death, Nardone had the capacity to write checks and signed them herself to pay her own bills. Police are still not sure how Bullinger was able to persuade Nardone to sign all the checks.

Sarasota detectives called the case unusual, even thought there are numerus elder exploitation cases in Florida.

However, there are actions people can take, if they think someone is taking advantage of their loved ones.

The state has a hotline, and if called, an investigator will go and see if there’s a high-risk factor of exploitation. If there is, the case will be referred to law enforcement for further investigation.

“These people have worked all their lives. They’ve had their money saved up and suddenly it’s gone,” Verdoni added.

Bullinger was charged with one count of felony elder exploitation.

She was released from jail, after posting a $50,000 bond.

Reference: Spectrum News 9 (Jan. 3, 2020) “Investigators: Sarasota Woman Stole More Than $1M From 94-Year-Old Client”

Suggested Key Terms: Elder Law Attorney, Elder Abuse, Financial Abuse, Trust

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Pull the Plug – Why are Two Brothers Fighting Over Their Mother’s Life?

An elderly mom is at the center of a court battle between her two sons. Her eldest son is set to face off against his brother in Nassau County Court, arguing he wants to keep their mother on a ventilator and feeding tube, while his sibling wants to pull the plug.

The New York Post’s recent article entitled “91-year-old LI woman mouths ‘I want to live’ on video amid legal battle” reports that the older brother, Edward, submitted the video he says was taken in November. It shows their mother even mouthing the words, “I want to live.’’

The mom, Arline, has been physically incapacitated, since suffering a string of circulation and breathing problems over the past year, Edward said. His brother, Kyle, asked a judge to declare him her sole guardian, noting that he hopes to take her off life support. However, he contends that this is what their mom would want.

Kyle accuses Edward of keeping their mom alive against her will, so he can stay in her Long Beach home and “plunder” her assets, including the total $5,400 she collects every month from Social Security and her pension. Kyle requested that the hospital take Arline off life support pursuant to her 1999 living will, in which she’d asked not to be kept alive by machines and have her proxy pull the plug, if she ever became seriously ill.

Edward says that his mother clearly changed her mind and denies he has a financial stake in keeping his her alive. In fact, if her health improves enough that she can be moved from the hospital into a nursing home, as he hopes, her income and estate (and both sons’ inheritance) worth approximately a quarter million dollars to each of them, will soon be eaten up by nursing-home costs, Edward argues. Edward says that he gave up his career in Colorado as a mortgage and real-estate broker to come back to New York to care for her.

In his mother’s “I want to live” video, filmed in November from her hospital bed, Edward asks Arline, “You have no leg, right?” referring to a recent amputation of her left leg due to circulatory problems. She nods yes.

“You understand that?” he asks.

Again, she nods yes.

“You have a feeding tube in you, you understand that, right? You have a tracheotomy and you have the thing breathing for you?” Edward asks his mom.

His mother nods yes, each time.

Edward then urges her to mouth the words, “I want to stay alive,’’ just to be absolutely clear. She does.

“With everything wrong with you, do you still want to stay alive?” he asks again, gently.

Yes, she nods.

A week after the video was taped, she executed a living will, with the help of an elder law lawyer, that states, “I wish to be treated aggressively for all conditions” and directs doctors “to continue to prolong my life as long as possible, within the limits of generally acceptable health care standards.”

Edward said that the hospital staff conducted a competency hearing administered by a psychiatrist, and she was determined to be competent. He insists that there’s still a chance their mother’s health will improve.

Reference: New York Post (Jan. 5, 2020) “91-year-old LI woman mouths ‘I want to live’ on video amid legal battle”

Suggested Key Terms: Elder Law Attorney, Living Will, Elder Care, Capacity, Will, Inheritance

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