Mindy’s Speaking Engagement Comments

Hi Mindy,

Your presentation was wonderful. I cannot thank you enough. I have been scheduling talks for years (more than I would like to admit) and this was probably up there in the top 3. You explained everything in terms that we could understand. I keep hearing from people how much they learned and their hopes that you will return at a later date.

I know you will hear from many of the participants and just want to thank you again.
Lorraine
Lorraine Schack
Senior Citizen Support Services Supervisor
Dept. of Recreation & Parks
1150 Carnation Drive
Rockville, MD 20850
Phone: 240-314-8812
Fax: 240-314-8809
lschack@rockvillemd.gov

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Advance Directives

The following guest post was written by Marcia Goldmark, M.D. of Rockville Concierge Doctors.

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I recommend all adults have advance directives.  Advance directives are legal documents that allow you to express your wishes regarding end of life care if you are unable to make decisions for yourself.  The benefits of this are many.  It gives you a way to communicate your wishes to family, friends and doctors to avoid confusion later on.  It enables you to decide if you want to be resuscitated if your heart stops beating or you stop breathing.  It states whether you want to be on a breathing machine.  It states if you want artificial feeding. You should also name a durable power of attorney for health care who is someone who can make health decisions for you if you are unable to do so.

It is always better to make these decisions when there is time to examine one’s feelings without the stress of illness. I have seen too many situations where there is unnecessary family disagreement when one has not prepared these documents in advance.  Second guessing one’s wishes and personal philosophic and religious differences can be very complicated!  Mindy can certainly help you and your family prepare these essential documents.  This can ease an already stressful time.

Social Support Activities Lead to Better Quality of Life As One Ages

How important is social support as a person ages? This may seem like an easy question to answer. Most people would not choose isolation and loneliness versus spending time with companions. However, can lack of social support really hinder a person’s overall quality of life?

Lack of social support is related to negative impacts on health and well being, especially for older people. Having a variety of positive social supports can contribute to psychological and physical wellness of elderly individuals. Support from others can be important in reducing stress, increasing physical health and defeating psychological problems such as depression and anxiety.

When considering who provides social support for an elderly individual our first thoughts are of family members. While it is true that most support does come from family members, there are many circumstances in which family members cannot be supportive (stress due to responsibilities, illness, death, financial problems, job relocation). In the United States the fastest growing age group of individuals are those 85 years and older. Due to this fact, family supports will inevitable decrease for these older individuals. A need for community-based services is more important now then ever before.

Community-based services can be extremely useful for elderly individuals. Services for older persons can encompass many areas, but one of the most important areas as discussed previously is social support. Support for elderly persons can be found in many places including: senior centers, assisted living facilities, meal delivery, religious affiliations, adult day care centers, etc. These services can provide positive social supports that can help older persons defeat loneliness and isolation. However, social support must encompass more then physical presence or conversation. Studies have shown that social support services should contain quality activities. These activities should promote positive self-awareness.

Self-awareness is key to a person’s overall quality of life and satisfaction. Many leisure social activities can be used to help increase an individual’s self-awareness. Activities for elderly individuals may include reminiscence groups, journal writing, readings of favorite book passages, group exercise, singing groups, etc. Individuals may also feel more self-satisfied if they are part of the planning of social activities that take place.

Two of these community-based service centers that provide quality social support services for elderly individuals are discussed below.

Senior Citizen Centers

Today, there are estimated to be about 15,000 senior centers across the United States. Senior centers act as a focal point for older Americans to receive many aging services. The most common services offered at a senior center include health programs (including Zumba and Yoga), arts/humanities activities, intergenerational programs, employment assistance, community action opportunities, transportation services, volunteer opportunities, education opportunities, financial assistance, senior rights counseling/legal services, travel programs and meal programs. These programs and activities can help promote positive self-awareness.

Lori Beckle describes how participating in her local senior citizens center has given her the independence and life satisfaction she thought was lost when her husband died in 2009. “ I was devastated and so frightened for my future without Ed. He was my only friend and the one I turned to when I felt alone. My daughter invited me to attend our local senior center where a bereavement group was being held for those who had lost a loved one. I met Phyllis during the group and now I have a new friend I call when I become afraid. Phyllis has helped me develop the skills to get through the tough times and focus on my immediate happiness.”

Adult Day Care Centers

According to the National Adult Day Services Association (NADSA), there are currently more than 4,600 adult day care centers nationwide. Adult day care is a program in which activities are provided to promote social support and health services to an older adult during the daytime. Most centers operate Monday through Friday during daytime hours. Social support services at an adult day care can consist of musical entertainment and singing groups, group games such as cards, gentle exercise, discussion groups (books, films, current events), holiday/birthday celebrations and local outings. Not only are these social activities provided, but participants of the program can also develop lasting relationships with staff and other participants. Adult day care centers also provide meals and health services. Adult day care centers differ from other programs for elderly individuals, because they allow the participants to develop and increase self-awareness by encouraging independence.

Amanda describes her experience as a volunteer at her local adult day care center. She stated, “ I was involved in planning the activities for Thursday afternoons. I wasn’t sure what kind of activities my older friends would enjoy so I had them share their favorite activities they participated in when they were my age (23). I soon realized that I was hearing the most fascinating stories of hopping trains, college dances, swimming in the lake, etc We decided Thursday afternoons would be spotlights of each individuals’ lives as a twenty-something. One of the participants told me that Thursdays became a highlight for her week.”

Adult Day Care Centers and Senior Citizen Centers help to provide an elderly individual the opportunity to participate in social support activities. Social support activities found in these programs can be beneficial to a person’s quality of life and overall satisfaction. With a higher self-awareness and quality of life an individual can reduce the risks of mental and physical health problems as they age.

Medicaid Planning – Income Annuity in the Name of the Community Spouse

Please note, Medicaid rules vary from state to state.  I can provide legal guidance for your situation if you reside in Maryland, the District of Columbia or Florida.

An income annuity in the name of the community spouse relies on two Medicaid rules.

First, income between couples is attributed to the spouse who owns the income. Unlike assets which have to be shared for Medicaid eligibility, income does not have to be shared. For example, a Medicaid recipient has a total income of $625 per month and the community spouse has a total income of $3500 per month.   There is no Medicaid requirement for the community spouse to contribute any income towards the care of his or her spouse. In this example, Medicaid will cover the bill less the $625 a month, which less a monthly allowance, must be spent towards the cost of care.

In the second rule, a spouse is allowed to transfer any amount of assets to their spouse without penalty of losing Medicaid eligibility.

Here’s how a Medicaid annuity strategy works.  The institutional spouse, which is the person in need of long-term care, applies to receive Medicaid services. For example, let’s suppose the couple has $150,000 of cash equivalent assets and owns a home and a car. As long as the community spouse, which is the healthy spouse, lives in the home they can keep their home and the car.  Those assets do not prevent the institutional spouse from receiving Medicaid help. In this example, Medicaid will take over after the institutional spouse has spent $75,000 of the couple’s assets down to less than $2000 and then has an income insufficient to cover the cost of care.

Once the Medicaid application has been approved, instead of starting the spend down to $2,000 and then having Medicaid pick up the balance of the cost, the institutional spouse transfers their $75,000 to their spouse. This is allowable and will not disqualify the Medicaid approval process but it does not yet take away the responsibility to spend down the cash.

The community spouse would then use the money to purchase an immediate income annuity for a period equal to or less than the allowable life expectancy in the HCFA transmittal 64 table. Assets have now been converted to about $1000 a month in income. The income belongs to the community spouse and does not have to be shared with the institutional spouse. Therefore, the spend-down is avoided. Medicaid will start paying its share of the bill after evidence of this transaction is presented to Medicaid and because the institutional spouse no longer has any attributable assets.

This strategy serves two purposes.  First, it may give the community spouse a larger income than they otherwise would have had under Medicaid rules. Second, the community spouse has managed to keep $75,000 that would normally have to be spent, even though it represents income.

In the past, some planners have set up annuities that provide a remainder payout should the community spouse die too soon. This is usually paid to the children and in the past was used as a way to transfer assets to the children without penalty.

Of note, under the deficit reduction act of 2006, the state must be named as beneficiary for the payout of any funds remaining upon the death of the institutional spouse. This new rule discourages the use of these annuities to transfer assets to the next generation (I.e., children).

Lastly, it is important to always follow Medicaid guidelines.  Otherwise, penalties may be applied.  Give me a call to further discuss Income Annuities, Medicaid Planning, Estate Planning or Veterans’ benefits.

Veterans – Aid, Attendance and Housebound Benefits

A veteran, who is eligible for a veteran’s pension, may also be eligible for Aid and Attendance Benefits.  These benefits are in addition to the monthly pension payments.

A veteran may be eligible for Aid and Attendance Benefits when:

>  The veteran is a resident in an assisted living / nursing home due to mental or physical illness.

>  The veteran is bedridden beyond the course of their prescribed convalescence or treatment.

>  The veteran needs assistance from another person in performing routine daily functions or from protecting themselves from risk of hazard or injury.

>  The veteran is legally blind or nearly blind.

Household Benefits are also paid to the veteran in addition to their monthly pension benefits, when eligible and approved.  A veteran may be eligible if:

>  Is evaluated as 100% disabled which substantially or permanently confines them to their residence.

>  Has a 100% disability and has an additional disability evaluated as 60% or more disabling.

For detailed information on these benefits, contact Mindy Felinton at Felinton Elder Law & Estate Planning Centers at 301.610.0055.

Medicaid Planning – Mindy Felinton’s Interview on It’s A Woman’s World

Mindy Felinton was recently interviewed on It’s A Woman’s World discussing the importance of Medicaid Planning.  The interview can be viewed on Mindy’s web site or her YouTube page, Felinton Law.

THE HIGH COST OF LONG-TERM CARE has made planning a critically important issue for seniors and their families. In fact, most seniors will likely require some form of long-term care. Sadly, many are unprepared for the significant financial burdens it places on their family’s hard earned savings. A family facing a monthly rate of $10,000 or more for the long-term care of a loved one can be financially devastated.

Long-Term Care Options

WHILE SOME SENIORS ARE ABLE TO AFFORD PRIVATE PAY CARE, the cost of long-term care will wipe out the savings of all but the wealthiest families in a matter of years. Those who have planned ahead by purchasing long-term care insurance have a degree of certainty and peace of mind, knowing that they have a lesser need to rely on other sources in the future. Unfortunately, many can’t afford the high cost of long-term care insurance or worse, because of age or medical condition, cannot qualify for long-term care insurance coverage.

IF YOU DO HAVE LONG-TERM CARE INSURANCE, you should be aware of what your policy covers. Many policies have high deductibles or provide for only a short period of care in a facility. In fact, many who have long-term care insurance still have to resort to Medicaid to pay for their care.

Medicaid Eligibility

THE OTHER OPTION TO PAY FOR CARE IS MEDICAID. A joint federal-state program, Medicaid provides medical assistance to low-income individuals, including those who are 65 or older, disabled or blind. Medicaid is the single largest payer of nursing home bills in America and serves as the option of last resort for people who have no other way to finance their long-term care. Although Medicaid eligibility rules vary from state to state, federal minimum standards and guidelines must be observed.

WHILE MEDICAID ELIGIBILITY with respect to long-term care was not difficult in the past, there has been a steady drift towards more complex and restrictive rules, the latest being the Deficit Reduction Act of 2005 which went into effect in 2006. These changes have resulted in complex eligibility requirements for those in need of Medicaid benefits. It’s no longer as easy as reviewing one’s bank statements. There are a myriad of regulations involving look-back periods, resource limits, transfer penalties and waiting periods requiring extensive planning.

FELINTON ELDER LAW & ESTATE PLANNING CENTERS has the experience and the expertise to help avoid the financial ruin associated with the high cost of long-term care. Contact us today to start the process of understanding the issues surrounding Medicaid eligibility and to implement the planning and application process.