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Legal & Financial Issues In Caregiving for Older Adults


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Hello and welcome. My name is Debra Levy, and I am a social worker and a professional geriatric care manager. I have a Masters Degree in Social Work and a Masters Certificate in Aging, and am certified by the National Academy of Certified Care Managers. Perhaps more importantly, I have worked helping seniors and their families in various settings for the past 30 years. I have maintained a private practice in geriatric care management since 1988, which currently employs both registered nurses and social workers as professional geriatric care managers. Our mission is to offer seniors and families like you the very best in caring, individualized, and effective support as they face the challenges of aging and disability.

Right now and every single day, families all over the nation (and overseas) are struggling to care for their elderly loved ones. What they don’t know is that help is available. I’m so glad that you are listening to this presentation, which contains important information for care-giving families, and especially those of you who are long distance caregivers. By learning more about legal and financial planning for older adults, you will be prepared with increased knowledge and understanding to communicate with your family members, to minimize future conflicts, and to obtain the best solutions to the almost universal question, “What do we do about Mom or Dad?” Moreover, being prepared and planning ahead gives you more options and choices than just waiting and responding to crisis situations.

Before we start, I want to make it clear that I am not an attorney, although I have worked closely with families and attorneys on legal and financial issues for many years. In this video we will only have time for an overview, and I urge you to seek legal and other professional advice as you move along in your planning.

Legal planning for seniors can be divided into two categories: health care planning and financial planning. Let’s begin our discussion with planning for health care decision-making, something that should be completed by all adults, and especially seniors. If an adult becomes ill or disabled, they will need someone trusted to communicate their wishes regarding the care they will receive. The goal of health care planning for your elderly parents is to make sure that they will get the care that they want in the setting that they want, no more and no less, and to decide who will express their choices if they’re unable to do so. A health care power of attorney, part of an Advance Directive, names the person or persons who can talk to your parents’ doctors if they are incapacitated, and who can give consent to specific medical treatments or procedures. In this day of advanced medical technology, more and more life-sustaining procedures have become available. Many people do not want their life to be artificially continued when their quality of life is poor, and there is no chance of improvement. Advance Directives and Health Care Powers of Attorney, similar to a Living Will, help to ensure that a person’s wishes about the care they receive are honored, and make it easier for their loved ones to know that they are making the right decisions for them when that time comes. When people do not have a health care power of attorney, and are unable to communicate or make decisions about their well-being, state regulations may assign this responsibility to the closest relative, or the court may appoint a Guardianship of the Person. Guardianship is always an action of “last resort,” as it is intrusive, costly and time-consuming. It often requires the involvement of government Adult Protective Services. A guardianship proceeding can be a distressing experience, as it requires the person to be declared incompetent. This is why we emphasize that everyone should create Powers of Attorney to avoid the risk of a guardianship later on. Although regulations for Advance Directives differ across states, the website www.agingwithdignity.org provides a ‘Five Wishes ‘model for a legal document which helps people express in their own words their wishes for the kind of care they want in advance of a serious illness.


Now let’s move on to a discussion of financial planning. The goal of financial planning is to make sure that your loved one’s money will be managed according to their wishes, if they are unable to manage it themselves, and that their financial resources will cover their medical care and needs as much as possible. Families are understandably reluctant to discuss the issues of financial and legal planning, but by doing nothing, they put themselves at great risk for potential difficulties. It is hard for many of us to imagine a time when we would be unable to manage our regular bill-paying and other financial needs, but for most of us, it will happen sooner or later. Unfortunately, there is no shortage of criminals and scam artists who prey on the trust and vulnerability of seniors.

For example, a few years ago we were asked to help an older woman who had Alzheimer’s Disease to find a new home in an assisted living facility. Her only adult son lived across the country, and they had not been close for many years. Before we met her, this lonely woman had been befriended by a cab driver who helped her with many tasks such as grocery shopping and home maintenance. Eventually he started “handling” her investments, and by the time we met this client, she had lost $1 million. Apparently she thought the taxi driver was helping her purchase an apartment building. The police investigated, but the money was never recovered, as is often the case. At the point we were looking for a new home for her, her choices were greatly limited by lack of funds. This client should have been able to either stay in her home with 24-hour caregivers, or to live in the most elegant senior community in town. Instead we had to place her in a small and simple group home that was all she could afford. She did OK there, but she should have had her million dollars to pay for her care in the style in which she had lived all her life.

Financial planning, like health care planning, involves the preparation of documents. A Durable Financial Power of Attorney appoints a representative to manage someone’s finances if they are unable to do so. Trusts are another effective vehicle for the purpose of financial planning and management, and can fulfill other goals regarding tax savings and planning for eligibility for government benefits. Because the regulations for trusts are complex and ever changing, we recommend that you consult an Elderlaw attorney (ELA) to review all trust documents. Just as with health care planning, failure to name a financial power of attorney and/or create a trust may put you at risk of the court’s appointment of a Guardianship of Finances, sometimes called a Conservator. Also a method of last resort, a Guardianship of Finances will be appointed by a court if needed to safely manage your finances, and it will be costly, intrusive, and inconvenient. It is also wise to use an Elderlaw attorney to draw up your relative’s powers of attorney, to make sure they are done in accordance with state regulations and cover all intended purposes. Elderlaw attorneys can also provide advice regarding reverse mortgages, long-term care insurance, and contracts for continuing care, assisted living, or nursing homes. You can find a directory of Elderlaw attorneys on the website of the National Academy of Elderlaw Attorneys, www.naela.org.

Another big financial concern for many families is how to pay for the care their loved ones may need. The majority of the services for seniors in this country are paid for privately, not by the government or health insurance. This can be a shocking realization for families facing eldercare needs. Long-term care insurance, for those who have it, is very helpful in paying for care either at home or in a facility. For low-income seniors, most states also have some subsidized programs, but resources are limited and waiting lists can be long. To find out more about programs for low income and other seniors, contact the federal government’s Office on Aging Eldercare Locator at 1-800-677-1116 or www.eldercare.gov.

Medicare and other types of health insurance do not cover long-term care. They primarily cover only short term, acute, skilled care in a hospital or nursing home. Although limited, short-term care at home may be covered as well. Medicaid or Medical Assistance for long-term care mainly covers nursing homes, and requires proof of medical and financial need. Medicaid Waivers in some states can also cover home care and assisted living. When one spouse goes to a nursing home under Medicaid, there are legal provisions to protect the “community spouse” from impoverishment. Particularly where a couple with some financial means is involved, consulting an Elderlaw attorney can help with planning to maximize eligibility for government assistance. Additional help and information for Foreign Service members is available from the American Foreign Service Association, the American Foreign Service Protective Association, and especially the Senior Living Foundation of the American Foreign Service www.slfoundation.org.

To plan for financial management for your parents, gather information before it is needed. Become familiar with your loved ones’ income, assets, investments, and usual expenses. Locate important documents and records. Review their bank accounts, and if possible, secure your access to their bank accounts and safe deposit boxes. Many banks and brokerage firms have their own specific Powers of Attorney for your parents to complete.

Furthermore, it is wise to periodically monitor checkbooks, bills, and bank statements. You can arrange for direct deposit and payment of regular bills, and monitor them on-line. If moving your parents to a new location, be sure to complete a change of address for Social Security, Medicare, pensions, and other benefits. If changing states, you should check the new state’s guidelines for Medicaid. You may need to apply to be Representative Payee for your loved ones’ Social Security Benefits or other benefits, if they become unable to manage them alone.

You will also want to review your parents’ health insurance, to ensure they have enrolled in the best coverage, including Medicare D for prescription drug coverage, and that claims are being processed correctly. Lower income seniors are eligible for help with Medicare premiums.

I want to remind you that help is available in addressing your parents’ financial needs. In addition to Elderlaw attorneys, there is a relatively new profession known as Daily Money Managers, who help seniors with day-to-day bookkeeping (American Association of Daily Money Managers www.aadmm.com). A government program called SHIP (www.shiptalk.org) provides free advice on health insurance concerns. For low-income seniors, the Eldercare Locator can connect you with Volunteer Representative Payees for retirement benefits, as well as publicly funded case management services available. Some of you may want to hire a professional geriatric care manager to advise and assist you. A nationwide directory of care managers like myself is available at www.caremanager.org.

Thank you for spending this time with me today. I have given you a broad overview of the legal and financial concerns in eldercare. I salute you for your efforts to educate yourselves about resources for seniors, and wish you well in your journey of caregiving.

WEBSITES FOR DVD:

www.care-manager.com Debra Levy Eldercare Associates
www.naela.org National Academy of Elderlaw Attorneys
www.eldercare.gov Eldercare Locator
www.slfoundation.org Senior Living Foundation of the American Foreign Service
www.aadmm.com American Association of Daily Money Managers
www.shiptalk.org State Health Insurance Assistance Project
www.caremanager.org National Association of Professional Geriatric Care Managers




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