Michigan Estate Planning Lawyer Blog

National Health Care Decisions days is just around the corner. April 16th, 2010 will be the third anniversary of National Health Care Decisions day which helps increase awareness of advanced health care planning and educating Americans about the importance of making health care decisions.

As a Michigan elder law attorney and member of the National Academy of Elder Law Attorneys, I want to help spread the word. If you have any questions about National Health Care Decisions day, please contact me or visit the website: NHDD.

In the month of February we celebrate Presidents Day in honor of two great United States Presidents; George Washington and Abraham Lincoln. Both were heroes of wars fought on U.S soil for freedom and unity of our great country.

The United States has fought many wars throughout the world since that time to keep freedom here at home and continues to do so. From the beginning our country has established a program to care for the men and women of our military who fought in those wars.

The veterans assistance program goes back to 1636 when Pilgrims of Plymouth Colony fought with the Pequot Indians. The Pilgrims enacted a law from English law that reads, "If any man shall be sent forth as a soldier and shall return maimed, he shall be maintained competently by the colony during his life." In 1789 U. S. congress passed as law that pensions were to be provided to disabled veterans and their dependents and in 1811 the first domiciliary and medical facility for veterans was completed.

Since that time the Department of Veterans Affairs has opened a multitude of care facilities nationwide. An article from the US Department of Veterans Affairs website states:

"VA's health care system has grown from 54 hospitals in 1930 to 157 medical centers in 2005, with at least one in each state, Puerto Rico and the District of Columbia . More than 5.3 million people received care in VA health care facilities in 2005, a 29 percent increase over the 4.1 million treated just four years earlier.
VA operates more than 1,300 sites of care including nearly 900 ambulatory care and community-based outpatient clinics, 136 nursing homes, 43 residential rehabilitation treatment programs, nearly 90 comprehensive home-care programs, and more than 200 Veterans Centers."

State veterans homes have been built or are approved for future construction in many states. For a list of state veteran nursing homes go to http://www.longtermcarelink.net/ref_state_veterans_va_nursing_homes.htm#List

Here are some of the benefits provided for Veterans by the Department of Veterans Affairs:

* Health Care Clinics
* Mental Health
* Counseling
* Job training
* Burial and Memorial benefits
* Education
* VA Home Loan
* DIC
* Compensation
* Pension
* Care Management
* Home Renovation for Disability
* Assisted Living
* Prosthetics
* Rehabilitation
* Weight management
* Nursing Homes
* Prescriptions
* Hospitals
and much more

Thomas Day, founder and Director of the National Care Planning Council, has a deep gratitude for the services provided by the VA. He served as an Air Force pilot during Vietnam. Later he developed a crippling auto-immune disease. It was the doctors at the George A Wahlen VA Regional Medical Center who prescribed a new treatment that saved his life. Many of the VA programs continue to improve his life.

Tom is passionate about the Aid & Attendance Pension Benefit and the relief it brings to veterans and their families who need care services and ways to pay for it in their elder years.

"Aid and attendance" is a commonly used term for a little-known veterans' disability income. The official title of this benefit is "Pension." The reason for using "aid and attendance" to refer to Pension is that many veterans or their single surviving spouses can become eligible if they have a regular need for the aid and attendance of a caregiver or if they are housebound. Evidence of this need for care must be certified by VA as a "rating." With a rating, certain veterans or their surviving spouses can now qualify for Pension. Pension is also available to low income veteran households without a rating, but it is a lesser dollar amount.

Pension is an underused benefit.

There are different income categories for Pension, but the highest could pay as much as $1,949 a month in disability income to a qualifying veteran household. A study commissioned by VA in 2001 estimated, over the next 14 years, only about 30% of eligible veterans would apply for Pension. This is likely due to the fact that most veterans simply don't know about it. In fact, about a third of all seniors in this country, age 65 and older, could become eligible for pension under the right circumstances. That's how many elderly war veterans or their surviving spouses there are.

To receive Pension, a veteran must have served on active duty, at least 90 days, with at least one of those days during a period of war. There must be a discharge under conditions other than dishonorable. Single surviving spouses of such veterans are also eligible. If younger than 65, the veteran must be totally disabled. If age 65 and older, there is no requirement for disability. There is no age or disability requirement for a single surviving spouse.

There are income requirements, but a special provision does allow household income to be reduced by 12 months worth of future, recurring medical expenses. Normally, income is only reduced by medical expenses incurred in the month of application. These allowable, annualized medical expenses are such things as insurance premiums, ongoing prescription drug costs, out-of-pocket cost of monthly medical equipment rental, the cost of home care, the cost of paying adult children to provide care, the cost of adult day services, the cost of assisted living and the cost of a nursing home facility. These are all considered medical costs and they can be deducted from income to receive this benefit.

According to Mr. Day,

"I talk to a number of people every day who are inquiring about this benefit. In many cases they don't know that the benefit can pay members of the family to take care of the veteran, the veteran couple or the surviving spouse at home. I have literally had people who are sacrificing dearly to take care of their loved ones at home, break down and cry when they find they can receive some money from the government for that sacrifice."

Thomas Day has written two books for the National Care Planning Council to educate and help veterans obtain this long term care benefit. The first, "How to apply for the Aid & Attendance Pension Benefit" is to educate the public what the benefit is and how to get it. The claims process for pension is described and information is provided to help understand what documentation is necessary to provide evidence of recurring medical expenses. All forms necessary for filing a claim are included in the form support section of the book. Here is a link to the book. http://www.longtermcarelink.net/a16Veterans_standard_book.htm

Although this is a do-it-yourself book, Tom recommends if you have excessive assets and income or are not sure how to apply medical deductions, use the services of a qualified consultant.

The second book, "Aid & Attendance Handbook for Professionals & Consultants," is for the professional consultant. It is 782 pages of rules, forms, instruction on the submission process and Medicaid planning strategies as well as software for calculating income, benefit and medical expenses. Here is a link to that book. http://www.veteranbook.com

The secret for receiving a successful award for aid and attendance or housebound ratings is not in filling out the form but in knowing what documents and evidence must be submitted with the application. Knowing the secrets for a successful award -- with the special case of long term care recipients -- is 95% of the battle. Even though the form is challenging, filling out and filing a claim is a formality.

A knowledgeable consultant can provide information to shorten VA's decision window of 6 to 12 months to possibly 3 or 4 months. The consultant also understands how to maximize the benefit or avoid a denial. The consultant can also provide guidance for meeting the asset test. Finally, the consultant can provide the actual strategies for reallocating assets and he or she can arrange for trusts or income conversions to allow for the best possible accommodation of assets for beneficiaries thus avoiding or reducing taxes, family disputes and Medicaid penalties.

"I would like to see every eligible veteran obtain the Aid & Attendance Pension Benefit for their long term care needs." Thomas Day, Director, National Care Planning Council.

Many elderly persons rely entirely on their children, family members or other trusted individuals to help them. This dependence upon caregivers or family members makes an older person more vulnerable to abuse and financial exploitation. Legal arrangements and protective actions by family may be necessary to shield loved ones from making bad decisions or from being taken advantage of.

Though you wouldn't think a child could take advantage of his or her mother or father, there is no way to know what someone will do who is desperate for money or who feels entitled to an inheritance. For example:

David's parents' health was failing and living alone in their home was becoming a concern. His sister Jill wanted to look into assisted living for them. David immediately became upset at Jill for wanting to spend their money. He packed up his parents and brought them to his home. Being single and working, he was not available to them during the day, but left food and water on the table to sustain them until he returned home in the evening. Jill lived over 300 miles from David and when she could get to his house to visit; she found her parents' care was not acceptable. They could not remember if they took their medications or if they had even eaten a meal that day. David was also draining their savings account and when confronted about it, became angry and complained that he needed their money to pay expenses for their care. Clearly Jill felt her brother's care of their parents was abusive, but David's defense was he provided a home for his parents in which he could care for them. This family needs a professional advisor to help them understand and clarify the issues concerning their parents' care.

Making legal decisions about property, finances, power of attorney, and final wishes are important tasks to complete for the final years of life. Having legal documentation for a will, for medical treatment and for the person designated to be responsible for parents' welfare can avoid family disputes and financial abuse, and help to conserve assets that are needed for care.

Michigan Elder law attorneys specialize in legal issues affecting the elderly. They are knowledgeable about Medicare and Medicaid programs. They work with the elderly in assisting them and their families with all aspects of estate planning and implementing necessary legal documents for the final years of life. In addition, they help individuals to apply for and possibly accelerate coverage from Medicaid. An elder law attorney can also help with disputes with Medicaid. Below is a partial list of what an elder law attorney might do:

* Preservation or transfer of assets seeking to avoid spousal impoverishment when a spouse enters a nursing home
* Medicaid qualification and application and Medicaid planning strategies
* Medicare claims and appeals
* Veterans Benefits claims
* Social security and disability claims and appeals
* Disability planning, including use of durable powers of attorney, living trusts and living wills
* Help with financial management and health care decisions; and other means of delegating management and decision-making to another in case of incompetence or incapacity
Probate
* Administration and management of trusts and estates
* Long term care placements in nursing homes and assisted living
* Nursing home issues with patients' rights and nursing home quality
* Elder abuse and fraud recovery cases

A Certified Elder Law Attorney (CELA) is an elder law attorney who is highly proficient in meeting the legal needs of elders and in understanding and applying the rules of Medicaid. A CELA has successfully handled a requisite number of pertinent cases in order to receive that designation. This experience will make an attorney with this designation more competent with elder planning issues than other attorneys lacking this designation.

Most elder law attorneys do not specialize in all of the areas iterated above. When considering an attorney you will want to find one who has experience in the area you need help.

According to The National Academy of Elder Law Attorneys -- http://www.naela.org/:

"Ask lots of questions before selecting an elder law attorney. You don't want to end up in the office of an attorney who can't help you. Start with the initial phone call. It is not unusual to speak only to a secretary, receptionist or office manager during an initial call or before actually meeting with the attorney. If so, ask this person your questions.

* How long has the attorney been in practice?
* Does his/her practice emphasize a particular area of law?
* How long has he/she been in this field?
* What percentage of his/her practice is devoted to elder law?
* Is there a fee for the first consultation and if so, how much is it?
* Given the nature of your problem, what information should you bring with you to the initial consultation?"

A good way to choose an attorney is by referral from friends, family, clergy or other associations. Before you meet for your initial consultation, prepare the items you want discussed and taken care of. Bring pertinent documents and questions. Be sure you get clear answers and that you understand what your attorney is proposing.

Two-way communication is the best way your attorney can understand your needs and concerns. Does the attorney listen to what you say, appear to really care about your concerns or return your phone calls? If not find another attorney. Most Elder law Attorneys sincerely want to help make you or your parent's elder years a well planned for, peaceful experience for all involved.

There are a number of ways attorneys charge for their services. They may charge a flat hourly rate. Or they may charge hourly for some services and add on additional expense for out-of-pocket costs such as paperwork, stamps, phone calls, etc. Or they may charge a single fee for a mutually agreed-upon course of action or plan. Some attorneys who specialize in appeals for veterans benefits or Social Security may work on a contingency basis. It is important to understand how you will be billed so there will be no surprises in the end.

The National Care Planning Council lists elder law attorneys throughout the United States.
To find someone in your area go to http://www.longtermcarelink.net/

In Michigan, even after the passage of the Deficit Reduction Act and with Estate Recovery looming, we still have many techniques available to help Michigan seniors plan, even in crisis mode, for the large monthly Michigan nursing home costs.  The cost of a nursing home in Michigan can run between $6,000.00 to $7,000.00 per month.  Through proper planning this bill can be picked up by Medicaid if you meet the necessary requirements.

Our Michigan Elder Law Attorney office helps Michigan seniors plan for the cost of long term care, including assisted living and nursing homes, through various legal methods including "half-loaf" strategies, irrevocable trusts, proper gifting strategies, utilizing Michigan Veterans Benefits, and other legal tools.

It is important that you consult a Michigan attorney familiar with planning for long term care because there are many traps for the unwary and unfortunately quite a bit of misinformation out there.  If you were to make a mistake in planning it can lead to a disqualification or unattended penalty for your loved one.

If you would like more information on any of these long term care strategies, please contact our office.

There is a popular tune played this time of year called "Grandma Got Run Over by A Reindeer" which relates that Grandma -- after drinking too much eggnog -- went out into the winter cold to get her medication and was run over by a reindeer. The question is, "Who was supposed to be watching Grandma?"

Though this little tune is just for fun, it may very well raise alarms to many caregivers of the elderly. Caregivers know that even at a holiday party they cannot let down their diligent watch over their elderly loved one. As far-fetched as it may sound, with all the people and noise, an elderly family member with dementia or Alzheimer's may be enjoying the family gathering and then suddenly become confused and walk to the door and leave.

For family caregivers the added stress of the holidays with decorating, shopping, parties and keeping up with all the family traditions is an overwhelming quest. Feelings of isolation, depression and sadness come with this added stress. There are millions of Americans who are caring for elderly frail loved ones and most of these caregivers will go through some of these emotions, especially this time of year.

There are some things you can do as a caregiver to help you and those you care for enjoy the holiday season.

First take care of yourself. Try to eat right, get plenty of sleep and exercise. This will help reduce stress and strengthen your ability to cope with caregiving responsibilities.

Prioritize your holiday traditions. Perhaps instead of cooking a large family dinner, have everyone bring his or her favorite dish. Use paper plates. Forfeit the traditional outside light decorating for a lighted wreath on the front door. Choose one or two parties or concerts to attend instead of trying to do it all.

Arrange for help. Call on other family members to help with the caregiving while you do your shopping or go out for the evening. If family is not available, ask your church group or a neighbor if they would donate a few hours.

Use community services. Many senior centers provide meals for the elderly and supervised activities, onsite, at no charge or a minimal charge. For locating senior services in your state, call your state Area Agency on Aging or check the national locator website at http://www.n4a.org/

Use adult day care services. Some assisted living facilities provide day activities and meals for seniors on a day by day basis. Other organizations called "adult day service providers" specialize exclusively in this sort of care support at a reasonable cost. These support services provide respite for caregivers from their caregiving responsibilities as well as social interaction for their elderly family members. There is a cost for adult day services, but the benefit for all is worth it.

For example:

Jean had brought her mother into her home to care for her when mom's Alzheimer's made it impossible for her to be alone. When the Christmas season approached, Jean realized she had to make some choices. She did not want to give up the traditions she had set with her daughters in shopping and lunches, but it wouldn't be possible with her caregiving responsibilities. In searching for a solution, Jean visited an adult day services facility near her home. She found she could schedule the days she needed off for her mother to come in. The adult day services company also provided transportation and would pick up mom and bring her home in the evening.

Although Jean's mother was not sure she would like to go at first, she found she enjoyed the programs, meals and conversation with new friends and the activities provided.

The time it gave Jean to have for herself was worth the extra cost for the day care.

Technology to the rescue. Here is a solution that would have kept "Grandma" from going out in the winter cold and getting run over by a reindeer. Companies that have created monitoring systems, security alarms and other safety equipment are "tweaking" them to adapt to the needs of seniors and their care givers.

Here are a few examples:

* Ankle or wrist bands that monitor location and alert the provider when a person has gone beyond the designated perimeter, such as out the front door of the house.
* Motion detectors. Set throughout the home, motion detectors allow someone outside the home to follow a senior as he or she moves through the house.
* Smart medication dispensers. Live monitoring and dispensing of pills.
* Emergency response alert. At a touch of a button on a desktop monitor, bracelet or necklace, emergency help is summoned.

Whether providing care in your home or helping senior family members in their own homes, your use of monitoring and "tech" help aids can provide extra safety for your loved ones, and peace of mind for you.

You are not alone. Join a caregiving help group. Your local senior center may have one or go on the internet to find one. Hearing about other caregivers' problems and solutions and being able to share your own and ask questions is a great way to relieve stress and gain a new perspective. Check out websites like the National Family Caregivers Association at http://www.nfcacares.org/

Work with a Senior Care Professional. Recognize that you are doing the very best you know how. You are not a geriatric health care practitioner, geriatric care manager, home care nurse or aide, hospice provider or family mediation counselor, nor do you have the years of training and experience these professionals have, but you can definitely use their experience. In fact, using a senior care specialist will make caregiving easier for you and more beneficial for your elderly family member.

As an example:

Mark stopped by his father Dan's home every night after work to help with any errands or things he needed around the house. He began to notice that Dan was not showering, dressing or even fixing meals some days. Another concern was his father's growing confusion and disorientation. A trip to the family doctor only brought more concern to Mark, since the doctor claimed it was just the aging process that caused the confusion.

Wanting a second professional opinion on what was best for his father, Mark hired Shelly -- a Professional Geriatric Care Manger -- to do an assessment. Shelly arranged for Mark and Dan to see a geriatrician, who advised that proper meals and an increase in some vitamins, would help clear up the confusion and disorientation. Shelly arranged for a home care company to come in daily to help with personal needs and prepare meals.

Soon Dan was back to his old self and able to function on his own.

You can find a wide variety of care professionals in your area on the National Care Planning Council website at www.longtermcarelink.net.

One more thing to remember. As a family caregiver, the greatest gift you are giving this holiday season is "Love."

The Department of Veterans Affairs has provided an update for what to expect in 2010 with regard to compensation & Pension Rate Information. Basically, there will not be an increase to the Veterans Administration compensation and pension benefits based on a cost of living allowance. You can read the full updated here: Veterans Benefits, What's New?

Did you know about the little known veterans benefit called the Aid and Attendance, also known as the Aid and Attendance Pension?  The Michigan Veterans Aid and Attendance pension provides veterans and surviving spouses of veterans with benefits for everyday needs such as eating, bathing, dressing, and other elder care needs that the veteran or their surviving spouse needs assistance from an individual in doing.

The Michigan Aid and Attendance benefits are generally available to veterans (and spouses) who are blind, reside in an assisted living facility or nursing home.  In addition their are certain asset limits that futher confuse applying for these benefits.  Often times, veterans need assistance in uncovering what exactly their benefit will be and how to meet the qualifications.  It is important to work with an Michigan Veterans Benfits attorney that is familiar with Michigan Veterans Benefits when doing any type of Michigan long-term care planning.

Visit our online resource at www.VeteransBenefitsMichigan.com

In the year 1919 President Woodrow Wilson proclaimed November 11 as Armistice Day to honor those Veterans who served during World War I. On November 11, 1954, Armistice Day was proclaimed a legal national holiday and the name was changed to "Veterans Day" to honor all veterans of all wars.

Every November 11, ceremonies are held throughout the United States honoring Veterans of wars. A National Ceremony is held at Arlington Cemetery at the Tomb of the Unknown Soldier, where the laying of the presidential wreath and military playing of "Taps" is presented.
Since its establishment in 1930, the Department of Veterans Affairs has evolved to supporting and aiding the nation's veterans in numerous ways. One of these services for example, the Veterans Health Administration, is the largest single provider of medical care in the United States. Its 22 regions with 154 hospitals and their associated 875 outpatient clinics offer the following services.

Hospital, outpatient medical, dental, pharmacy and prosthetic services
Domiciliary, nursing home, and community-based residential care
Sexual trauma counseling
Specialized health care for women veterans
Health and rehabilitation programs for homeless veterans
Readjustment counseling
Alcohol and drug dependency treatment
Medical evaluation for disorders associated with military service in the Gulf War, or Treatment for exposure to Agent Orange, radiation, and other environmental hazards
HISA grants
Other special benefits

The Department of Veterans Affairs provides three types of long term care services for veterans.

The first are health care benefits provided to veterans who have service-connected disabilities, who are receiving VA Pension or who are considered low income. These services include free medical care, possible free prescription drugs, orthotics and prosthetics, home renovation grants for disabilities, home care, assisted living, domiciliary care, nursing home care, and a possible host of other services or benefits.

The second benefit is state veterans homes. The majority of these homes offer nursing care but some may offer assisted living or domiciliary care. The Department of Veterans Affairs in conjunction with the states helps build and support state veterans homes. Money is provided to help with construction and a federal subsidy of $72.71 a day is provided for each veteran using state veterans nursing home services. These homes are generally available for most veterans and sometimes their spouses and in some cases for so-called "Goldstar parents." Veterans homes are run by the states, sometimes with the help of contract management. There may be waiting lists in some states.

The third benefit for veterans is disability income programs. The most familiar of these benefits is an income for service-connected disabled veterans called "Compensation." The least known of these is a program officially called "Pension" but popularly known as the "aid and attendance benefit."

*
All active-duty veterans who served at least 90 days during a period of war are eligible for Pension and the additional income from aid and attendance or housebound allowances. A single surviving spouse of such a veteran is also eligible.
*
All qualifying veteran applicants over the age of 65 are eligible for pension but must meet income and asset tests. Applicants under the age of 65 must in addition be totally disabled to qualify. Disability does not have to be service-connected.
*
A surviving spouse can be any age and there is no need for disability.

The aid and attendance benefit can pay additional income to provide for the costs associated with home care, assisted living, nursing homes, adult day care and other unreimbursed medical expenses. It can also pay for a family member other than a spouse to be the care giver. The amount of payment varies with the type of care, recipient income and the marital status of the recipient. Here are some examples of how this benefit can help veterans.

Example #1
The National Care Planning Council receives many calls from family members of veterans, asking if there is any help available to them. One such call came from a woman who had been juggling her job and caring for her father in her home for over five years. She had just lost her job and with no income, did not know how she would keep her home or give her father the care he needed. She read an article that had been written by the National Care Planning Council and published in her local newspaper and called their phone number. The article mentioned that a member of the family -- not including a spouse -- can be paid through VA to provide care for a loved one at home who is either a war veteran or the surviving spouse of a war veteran. Her father is a war veteran. When told that she could get an additional $1,644 a month through her father by providing her father's care she was shocked. She was also extremely grateful and ended up sobbing into tears over the phone when she found out about the benefit and realized it would help her keep her home and her father may probably get a check for her retroactive previous care from VA worth tens of thousands of dollars.

Example #2
Another recent caller's mother is 89 years old and has been in assisted living for four years. As a widow of a veteran she did not qualify for the Aid & Attendance Pension 4 years ago because her assets were too high. In the meantime she has been using up her assets along with her income to pay for the assisted living. The local veterans service office has not been helpful in getting this claim approved even though she had reached the allowable asset limit over two years ago. The family was considering putting her in a less desirable facility under Medicaid. The family knew this would be devastating for their mother. Her health was still good and she had many friends and comforts at the assisted living.

The National Care Planning Council directed the caller and his family to a more cooperative veterans service office that will submit the claim and likely get it approved retroactively so that this woman can get a check for roughly $40,000 worth of previous care costs for which she was not reimbursed. In addition, she will likely get the full benefit of $1,056 a month to help pay the cost of the assisted living where she is happy.

These types of claims require medical evidence in order to receive a rating for aid and attendance or housebound allowances. These ratings must be received or certain non-medical expenses associated with long term care are not deductible from income. Special rules also allow for deducting the annual anticipated cost of month-to-month long term care from household income in order to meet the income test. This special treatment requires special documentation and evidence. In addition, those households with substantial assets will be denied for a Pension income unless those assets are below a certain level determined for each case by VA. The personal residence, personal vehicles and personal property are exempted from this asset test. Finally, evidence must be supplied every year in January that the anticipated costs for the previous year were actually incurred or VA will likely demand for its money back.
The National Care Planning Council has compiled the necessary forms, rules and information about claims together in one book titled "How to Apply for the Veterans Aid & Attendance Pension Benefit."

This book contains information about how a typical applicant receives a successful pension award. VA often tells callers to go ahead and fill out the application but generally provides no information on the special treatment of annualization of anticipated recurring medical costs. The claims form also contains no information on this important issue. One simply has to know how to do it. This crucial information can make the difference between a successful award and being declined. All necessary forms for filing a claim are in the book.

Veterans who have substantial assets may need to do some estate planning and realigning of assets to qualify. An expert in this area should be sought to help with the application in order to avoid lengthy delays in awarding a benefit or a possible denial of benefits. For a list of individuals or companies in your area who understand how to get this benefit go to http://www.longtermcarelink.net/ref_veterans_consultants.htm

To learn more about this benefit go to http://www.veteransaidbenefit.org/

If we were to ask an older person what his or her most important concerns for aging are, we would probably get a variety of different answers. According to surveys frequently conducted among the elderly, the most likely answers we would receive would include the following three principal concerns or life wishes:

1. Remaining independent in the home without intervention
from others

2. Maintaining good health and receiving adequate health care

3. Having enough money for everyday needs and not outliving
assets and income

To address these concerns or wishes and maintain the quality of life wanted in the elder years, it simply takes a little preplanning.

Few people do this kind of planning.

It is human nature not to worry about an event until it happens. We may prepare financially for unexpected financial disasters by covering our homes, automobiles and health with insurance policies.

However, no other life event can be as devastating to an elderly person's lifestyle, finances and security as needing long term care. It drastically alters or completely eliminates the three principal lifestyle wishes listed above.

The majority of the American public does not plan for this crisis of needing eldercare. The lack of planning also has an adverse effect on the older person's family, with sacrifices made in time, money, and family lifestyles.

Because of changing demographics and potential changes in government funding, the current generation needs to plan for long term care before the elder years are upon them.

Let us look at some facts.

*
The population of the "very old,"--older than age 85--is the
fastest growing group in America. This population is at
highest risk for needing care. (Statistical abstract of the United States,
2008, population)
*
Medical science is preventing early sudden deaths, which
means living longer with impaired health and greater risk of
needing long term care.
*
The Alzheimer's Association estimates the risk of
Alzheimer's or dementia beyond age 85 to be about 46% of
that population.
*
It is estimated that 6 out of 10 people will need long term
care sometime during their lifetime.
*
Children are moving far away from parents or parents move
away during retirement making long distance care giving
difficult or impossible.
*
Government programs--already stretched thin for long term
care services--will experience even greater stress on
available funds in the future.

One of the important things for planning is how to maintain your lifestyle as you age. You may be healthy enough to stay in your own home with help provided for the following activities of daily living:

maintaining a home,
providing meals,
supervision,
companionship,
transportation and
shopping services.

This type of care at home is non-medical and must be provided free of charge by family, friends, or volunteers or the care must be paid for out-of-pocket by the family.

Government programs, in most cases, will not pay for this kind of care. It is estimated that 80% of all long term care is non-medical, with 90% of that care provided in the home. It is most likely that your long term care will begin with home care.

It is wise to plan now how you will pay for care when it is needed. In evaluating your future income you may find it necessary to add some resources such as long term care Insurance to pay for assisted living or nursing home costs. Long term care insurance must be purchased while you are younger and healthy. Failing health, stroke or other aging issues will not allow you to qualify for this insurance.

A reverse mortgage will also help pay for home care if staying in your home is an option.

Consider where you may want to live in your elder years. Many assisted living facilities offer complete care alternatives with a nursing home wing if needed. Senior retirement communities also offer many amenities with some including home care options.

Now is the time to do estate planning. A professional estate planner will give you direction on how best to protect your assets for future needs and for Medicaid planning.

Do your paper work. Now is the time to create your trusts, will, medical directives in a living will and any other documents you want noted for future use. Gather Insurance policies and bank records where they can be found by family members in case you are not able to get them yourself.

We don't like to think of our elder years in terms of health problems, but a sudden stroke, heart failure or onset of dementia could make it impossible to carry out our own wishes if preparation was not made ahead of time.

The process of long term care planning involves the following four
principles:

1. Knowledge and preparation are the keys to success.
2. Having funds to pay for care expands the choices for care
settings and providers.
3. Using professional help relieves stress, reduces conflict, and
saves time and money.
4. Success is assured through a written plan accepted by all
parties involved.

(The above excerpt is quoted from "The 4 Steps of Long Term Care Planning," National Care Planning Council)

The National Care Planning Council' s website -- www.longtermcarelink.net -- provides over 700 pages of information for long term care planning and lists services of professional care providers in estate planning, long term care insurance, reverse mortgage, home care and many other important long term care services.

The National Care Planning Council' s book, "The 4 Steps of Long Term Care Planning," provides information on what Medicaid and Medicare will cover as well as an overview of professional long term care service providers and how their services can help you create and execute your long term care plan. A check list of what to do to create a plan and forms for creating necessary paperwork are also included in the book.

"My parent is currently on Medicaid and is about to receive a windfall from an inheritance that will disqualify him from Medicaid, what can we do?"

Well, as a Michigan elder law attorney, my first response is that "it depends."  It depends on more facts.  Some possible ideas include, basically, converting the new assets into exempt assets in the month the windfall or inheritance was received.  For example, the Medicaid parent could purchase a prepaid funeral, buy a car if he doesn't own one, by medical equipment, or furniture. 

What Michigan Medicaid planning strategies we can use depends on more facts.  But, basically, one of the easiest and best options is convert the assets into exempt assets.

Christopher J. Berry, Esq., A Oakland County Medicaid Planning Attorney, is a Partner with Witzke Berry PLLC, which practices in the areas of Estate Planning, Michigan Long-term Care Planning, and Michigan Medicaid Planning.

There are many tools in the Michigan Medicaid planner's tool box when assisting elder law clients. One of those tools is the SBO Trust ("Soley for the Benefit of" Trust).

For purposes of Michigan Medicaid planning, the SBO Trust is an irrevocable trust that holds assets entirely for the benefit of another. The assets are held for the benefit of the community, non-Medicaid applicant, spouse. Through this type of planning assets which would have been considered countable by Medicaid, now become unavailable. This allows the Medicaid applicant to qualify sooner for Medicaid and defray the Michigan nursing home costs, which can be well over $6000.00 per year.

There are certain requirements for the SBO Trust. For example it must be irrevocable, in writing and established after the admission to a nursing home by the Medicaid Applicant, and must distribute an annuitized portion of trust corpus to the community spouse on an actuarial sound annual basis.

The Michigan SBO Trust is just one Michigan Medicaid planning technique in an elder law lawyer's tool box.

Christopher J. Berry, Esq., A Bloomfield Hills Elder Law Attorney, is a Partner with Witzke Berry PLLC, which practices in the areas of Estate Planning, Michigan Long-term Care Planning, and Michigan Medicaid Planning.

Alzheimer's Disease is a progressive, degenerative brain disease. One of the issues when a loved one has Alzheimer's Disease is the prevention of injury around the house.

Cari Nierenberg at ABC has a post with expert tips on how to adapt your home for a loved one with Alzheimer's Disease. It is worth a read if you have a loved one affected. Read it here: Making Your Home Safer for a Loved One with Alzheimer's.

The first step?  "Increasing the lighting around the home because at mid stage Alzheimer's patients need 50 percent more light to see at the same level of acuity..."

Christopher J. Berry, Esq., A Bloomfield Hills Elder Law Attorney, is a Partner with Witzke Berry PLLC, which practices in the areas of Estate Planning, Longterm Care Planning, and Medicaid Planning.

Many individuals receiving governmental assistance will be receiving a $250 stimulus payment from the Federal Government as part of the American Recovery and Reinvestment Act of 2009 according to an Elder Law Answers blog post, which you can read here.

A questions that many Medicaid participants will have is whether this payment will counted as income and thereby place the Medicaid participant over the Michigan income limit.  The answer to the question is no, additionally the amount will not be gross income for tax purposes.

-Christopher J. Berry, Esq.
Michigan Elder Law Lawyer | Michigan Medicaid Planning

Michigan Medicaid planning is a consistently changing and very technical area of law.  Before you begin gifting things away in preparing for a Medicaid application, it is important to speak with a Michigan Medicaid planning attorney or Michigan elder law lawyer.

Here are some of the common strategies that Michigan elder law and Michigan Medicaid planning lawyers are utilizing.

First, marriage opens up some great avenues for Medicaid planning with the Sole Benefit of Trusts (or SBO Trusts) along with using the community spouses asset allowance.  Second, if there is a disabled member in the family the SBO Trust could be utilized.  Next, we can convert countable assets into excluded assets.  Another technique is the Half a Loaf strategy that uses short term annuities and gifting.  A great option for real estate is using the Ladybird Deed.

If you or a loved ones is contemplating filing for Medicaid, please contact our office.  We can help you navigate the confusing system.

-Christopher J. Berry, Esq.
Witzke Berry PLLC
Michigan Medicaid Planning Lawyers | Michigan Elder Law Lawyers

As Oakland County Estate Planning lawyers, our clients often ask us how to approach their parents to make sure their aging parents are properly planned for.  Especially in terms of nursing homes, long term care, and estate planning.

Having a conversation with your elderly parents about their future is not an easy topic to approach.  It often times makes adult children nervous because they fear resistance, conflict and silence.  However, according to www.talk-early-talk-often.com, you should fear the crisis that could occur if you don't start this conversation.

They recommend that you start beginning the talks with your aging parents by starting out small.  However, topics that need to be covered include long term care options and estate planning goals.

To avoid crisis, www.talk-early-talk-often.com recomend focusing on TEMPO as an acronym for the talks

• T-iming: It is important to approach the subject at the right time.
  
• E-xperiences: It is often best to tie the conversation to direct experciances, such as if you just completed your estate plan with your  estate planning lawyer.
  
• M-otivation: Make sure to be clear about your motivation for the discussion.  Your motivation should be for the benefits of your parents.
  
• P-lace:  Make sure that you have created a "safe space" to have these discussions.  Privacy is important, so having this discussion in a public place may not be the best idea.
  
• O-utcome: Your outcome should be to establish a safe, honest, open dialogue on the future long term care and estate planning needs of your parents.
  

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