Salt Lake City Estate Planning

Obama's Alzheimers Agenda

The Obama administration announced plans Tuesday for a two-year, $156 million cash infusion for Alzheimer’s research and care. The money will help solidify a still-developing national plan to better treat and even prevent the illness by 2025.

With budget plans just now coming to a head, it’s good news for many of us that Alzheimer’s has become one of the “we can’t wait” initiatives in President Obama’s plan.

Such measures still need to be passed through Congress, and positive advances may not be immediately forthcoming. However, it is heartening to see fiscal support for an issue that affects so many of us and our loved ones.

If all goes to plan and the approach makes it through Congress – a politically trepidatious journey these days even for the most common-sense and appealing legislation – then the budget will earmark an infusion of $156 million for Alzheimer’s research and care.

In many ways it’s the flesh and bones to an earlier announcement from the administration regarding a national plan toward treating Alzheimer’s that came out to some guffaws due it’s lack of a clear source of funding.  The full details on allocation are still forthcoming, but at least a small portion of that infusion, some $26 million, is intended for immediate use and care of Alzheimer’s patients. The rest is to go toward research and the hope of improving future care, and also perhaps systematic prevention.

How this news will affect us, and whether it will weather violent political and economic seas is yet to be seen, but it’s a powerful promise for many. 

Reference: The Kaiser Health News (February 7, 2012) “Alzheimer’s Research Gets Funding Boost”

Please visit the Elder Law & Long-Term Planning section of our website today.

 

You're Not Alone - Medicare Confuses Many Seniors

Most seniors on Medicare will pay $99.90 per month this year for Part B outpatient coverage. But how would you like to pay 10 percent more for that coverage, or 50 percent more?

As many readers will know, it’s fairly critical to understand the rules for filing for Social Security. Likewise, the rules for filing for Medicare benefits can make or break your retirement. Unfortunately, it’s also fairly easy to forget about the basics of Medicare filing, as a recent article out of Reuters highlights the importance of filing earlier rather than later.

For each full 12-month period that a senior could have had coverage but didn't sign up, the monthly Medicare Part B premium jumps 10 percent. The average monthly cost of Part B coverage is $99.90, so just a few years delinquency will result in $20, $30, or more a month; that adds up, is unnecessary waste, and is permanent.

Suffice it to say that the government really wants you do sign up when it’s time. But why is that difficult? Well, for one, the full retirement age for Social Security is no longer the age for Medicare enrollment. As a result, many otherwise forward-thinking people are waiting until age 67 to enroll in Social Security (for the maximum monthly benefit), but 65 is the age for Medicare.

In addition, with so few people actually leaving the workforce it’s easy to forget (or fail to realize, since you’re not really retired) that it might be time for Medicare. That also can depend on the nature of your employment. For example, if you are still working at age 65 and your employer has fewer than 20 employees, Medicare is the primary payor; at companies with more than 20 workers, the employer's plan is primary. In the latter situation, a senior can postpone filing for Parts A (hospitalization) or Part B, although many choose to enroll for Part A anyway, since it doesn't require premium payments. If you delay your Part B coverage, you can enroll without penalty when you do retire for up to eight months following that point.

The bottom line is to keep all of this on your radar, regardless whether you will be relying on Medicare. In fact, not relying on Medicare may be the source of the problem.

If you are employed it may be worth a visit with the company accountant to be sure on which side of the line the company falls, and therefore what your insurance ought to be like.

Reference: Reuters (January 20, 2012) “Big penalties await those who delay Medicare filing”

Visit the Elder Law section of our website to see how we can start guiding you through the medicare maze today.

Hospice: Medicare and Medicaid Profit Center?

A national hospice company improperly cycled patients through nursing homes and hospice with a goal of making as much profit as possible from Medicare, according to a whistleblower lawsuit announced this week.

Healthcare lawsuits involving the various ways that the elderly can be taken advantage of turn up in the news on a daily basis these days. Why? Well, partly for political reasons and partly for the sheer number of egregious situations that have been created.

As an informed citizen/taxpayer, it’s important to think about and understand the big picture. However, as a family member, it’s vitally important to remember them for the sake of your elderly loved ones.

A new legal battle has begun to churn, as recently reported at Kaiser Health News. Yet another healthcare company is being accused of taking advantage of the elderly and their families to draw the greatest yield from Medicare and Medicaid coffers. Here a large company, operating across several states, is accused of actively recruiting and cycling patients through nursing home and hospice services.

Such companies are compensated by Medicare based on the length of time patients receive care. Medicare picks up the entire nursing home tab for the first 20 days (after that the patient has to contribute), and conversely, if a patient spends too much time in hospice care, Medicare demands their money back since the patient was clearly admitted to end-of-life care under false pretenses.

Here’s the rub: If you cycle between nursing home regimens and then jump into hospice care as early as possible (but not too early), Medicare will pick up the entire tab and for the maximum amounts, and that’s the issue.

The legal battles, as well as the politics and economics aside, stories like these also demand a certain amount of attention since they could directly impact your family.

If you have a loved one in need of nursing home and/or hospice care, it’s important that they find and receive that care… and that they not be abused by an uncaring system.

Reference: Kaiser Health News (January 4, 2012) “Lawsuit Accuses Company of Fraudulently Cycling Patients through Nursing Homes, Hospice Care.”

Visit the Elder Law section of our website to see how we can start helping you today.

 

Deductibility of Long-Term Care Insurance Premiums

Can a tax deduction help you afford long-term care insurance? If you’re buying it as an individual, maybe. If you’re self-employed and buying it through your business, absolutely.

With the death of CLASS, the would-be first public option long-term care insurance policy, there are a good number of people left puzzling about how to protect themselves against the growing likelihood of needing long-term care in the future. How can it be made more affordable? For the self-employed, a recent article from Forbes has an idea worth investigating.

Any individual who purchases a long-term care insurance policy receives certain tax advantages based on their age group and the cost of the premiums (relative to their adjusted gross income (AGI)).

The premiums can be deducted as medical expenses when they exceed 7.5% of your AGI (or exceed 10% after 2013 when the relevant parts of the health bill come into affect). However, this amount also is limited by your age bracket and an effective cap in deductions. For example, in 2011, if you’re 41 to 50, it’s $640 a year; if you’re 51 to 60 it’s $1,270; if you’re 61-70 it’s $3,390; and if you’re 71 and older, it’s $4,240.

But what if you’re self-employed? You can purchase it though your business! As a business expense it can be 100% deductible. Note: Businesses already can do this with health insurance and, when you’re the sole owner and sole employee, you can direct the operations of the business to include these benefits.

The original article has at least one success story and, although there are certain problems to mixing your business and personal life, this may just be a solid way of securing a very important financial objective.

Reference: Forbes (December 6, 2011) “Uncle Sam Can Help You Pay for Long-Term Care Insurance”

 

 

 

Deductibility of Long-Term Care Insurance Premiums

Can a tax deduction help you afford long-term care insurance? If you’re buying it as an individual, maybe. If you’re self-employed and buying it through your business, absolutely.

With the death of CLASS, the would-be first public option long-term care insurance policy, there are a good number of people left puzzling about how to protect themselves against the growing likelihood of needing long-term care in the future. How can it be made more affordable? For the self-employed, a recent article from Forbes has an idea worth investigating.

Any individual who purchases a long-term care insurance policy receives certain tax advantages based on their age group and the cost of the premiums (relative to their adjusted gross income (AGI)).

The premiums can be deducted as medical expenses when they exceed 7.5% of your AGI (or exceed 10% after 2013 when the relevant parts of the health bill come into affect). However, this amount also is limited by your age bracket and an effective cap in deductions. For example, in 2011, if you’re 41 to 50, it’s $640 a year; if you’re 51 to 60 it’s $1,270; if you’re 61-70 it’s $3,390; and if you’re 71 and older, it’s $4,240.

But what if you’re self-employed? You can purchase it though your business! As a business expense it can be 100% deductible. Note: Businesses already can do this with health insurance and, when you’re the sole owner and sole employee, you can direct the operations of the business to include these benefits.

The original article has at least one success story and, although there are certain problems to mixing your business and personal life, this may just be a solid way of securing a very important financial objective.

Reference: Forbes (December 6, 2011) “Uncle Sam Can Help You Pay for Long-Term Care Insurance”

 

 

 

When Medicine Becomes a Menace

An estimated 100,000 older Americans are hospitalized for adverse drug reactions yearly, and most of those emergencies stem from four common medications, a new study finds.

Seniors are increasingly reliant upon their medications. It’s a fact of life. Literally.

However, with so many different kinds of medications to do so many different things, sometimes the medications themselves can cause more harm than good. Nonetheless, according to a recent study from the Center for Disease Control, as reported here, two-thirds of drug-related emergency hospitalizations result from just four types of medications.

The four types of medicine are also very common. Listed below in order, from the greatest to the least percentage of adverse instances per drug, whether taken together or separately:

1. A blood-thinning medication called warfarin (Coumadin, Jantoven)
2. Insulin
3. Antiplatelet drugs used to prevent blood clots such as aspirin and clopidogrel (Plavix)
4. Oral hypoglycemic agents – a diabetes medicine

The most important fact, however, is that nearly two-thirds of all such cases were not just the drugs themselves; they were the result of unintentional overdoses.

It’s scary to see such common medicines listed, and if you or loved ones use them there is cause to take notice, but the real lesson is awareness and care. There are real consequences when care is not received properly or when an elderly person is not able to accurately gauge their medications. 

Reference: USA Today (November 25, 2011) “Four Common Meds Send Thousands of Seniors to Hospital”

 

 

The “Holiday Reality Check”

“I get these S.O.S. calls” from adult children visiting family at Thanksgiving, said Emily Saltz, who operates a practice called Elder Resources in Newton, Mass. “They’ve been talking with their parents all year, being told everything is fine. Then they get there, and it’s not fine. And the kids freak out.”

The Holidays bring families together, which is a great thing, especially for those family members separated by geography. But since the holidays also mean spending time with your parents and elderly loved ones, it can be a shock. The New Old Age Blog at the New York Times recently referred to this shock as the “Holiday Reality Check”.

All those months of checking in over the phone or getting reports from a sibling might have led you to believe that all was well with your elderly loved ones. Now, when you actually see them face to face, all is not well on the home front.

It hits in greater and lesser degrees: Finding a loved one to be fairly forgetful, much more than before. Perhaps it’s finding stacks of unpaid bills and old food filling the fridge, or discovering that the nursing home selected was the wrong choice. No doubt many readers already have encountered their own Reality Check during a Thanksgiving visit, but the important thing is that the holidays aren’t over yet. No, they are just ramping up.

As we venture deeper into the holiday season, you may seize the opportunity to pay more attention and begin to right some wrongs sooner rather than later. For many, this might mean an up-front and realistic discussion about what needs to happen, whether that be planning for the estate, writing advanced directives, or pursuing care.

However, there also are more gentle steps that can be taken and some pragmatic ones as well. Fixes that you can offer from afar might mean hiring helpers or even professional geriatric care managers to work in your stead.

The important thing is what the holidays mean about and for your family. Consider this a clarion call to be proactive while there still is time to plan, rather to be reactive when time to plan is past. 

Reference: The New York Times: The New Old Age Blog (November 25, 2011) “The Holiday Reality-Check”

 

 

Decision-Making Declines As Birthdays Increase

We ask older Americans to make complicated financial decisions about Social Security, Medicare, retirement distributions and more—just when they are losing their fastball. Regardless of gender or education level, Americans become considerably less literate about all things money after age 60, according to a new study.

Why do many of the most difficult decisions we face come later in life? I guess it’s just fact of life. Unfortunately, we’re not always at the top of our game when those decisions must be made. Therefore, it’s essential to make proper plans earlier, rather than later.

According to a recent study, reported on here by the Wall Street Journal, the decline starts around age 60. The scores on a test measuring knowledge of investments, insurance, credit and money basics fell about 2% each year starting after age 60. In fact, they fell from about 59% correct for those in their 60s to a dismal 30% for those 80 and older. What’s almost as bad is that these very people actually grew more confident in their decisions and knowledge.

Problem: These are the very same people who are attempting to sift through the messy and confusing programs like Medicare and Social Security, at the very same time they are undergoing this dramatic change in their mental agility. These also are the people who will want to take care of their loved ones in their estate plans in an era of constantly changing laws and regulations.

If you are the adult child of older parents, this is something to bear in mind when seeking to help them, perhaps especially when your assistance is unwanted. Likewise, as a parent, fact of life will necessitate a bit of self-understanding. And for everyone, this means that proper estate planning should be done earlier, rather than later. 

Reference: The Wall Street Journal (October 30, 2011) “Financial Acumen Declines After 60”

Please visit the Elder Law section of our website to see how we can help.

 

 

Hospital-Induced Delirium Hits Seniors Hard

What my family didn’t know at the time, because the doctors did not tell us, was that this frightening transformation was a classic case of hospital delirium — a brain dysfunction characterized by sudden confusion and inattention. It’s one of the most common, dangerous and costly complications of hospital stays for the elderly.

When the elderly visit the hospital it’s simply not the same as when they were younger. No, everything is more dangerous.

The New Old Age Blog at the New York Times recently discussed a danger that is all too common, but still under the radar screens of medical and the everyday worlds alike. It’s the problem of elderly delirium.

Usually, when we talk about an elderly person no longer being themselves, we think of dementia. Nevertheless, another dramatic neurological problem is delirium and it is often, ironically, brought on by hospital visits. Here’s what happens: When the elderly are put under such heavy medication it can generate a neurological imbalance that results in dramatic disorientation, sudden confusion, and loss of attention. The list of medications that can have this affect is fairly long, including sedatives, sleeping pills, narcotic painkillers and some allergy, blood pressure and incontinence drugs. As a result, it’s not a surprise that delirium is common.

Each year 20 percent of the 11.8 million elderly patients in hospitals develop delirium. This includes some 60 percent to 85 percent of those in intensive care on ventilation and more than half of postoperative surgical patients.

The problem is that delirium also can have long-term affects, according to recent research. In the end, many hospitals may be doing long-term damage to their patients. For more information and a stirring example, read the original story here. Be sure to take a look at the checklist to help determine the difference between dementia and delirium. 

Reference: The New York Times (November 2, 2011) “Another Hospital Hazard for the Elderly”

 

Old Age Costs Rising

U.S. long-term health-care costs rose as much as 5.6 percent this year, led by assisted-living expenses, and are climbing at a steeper rate during a weak economy, MetLife Inc. said.

Are you planning for your old age or perhaps the old age of a loved one? If yes, then you know that such planning is all about getting a handle on healthcare. Unfortunately, the most recent study from MetLife indicates that the costs for long-term care and assisted living are rising at an even faster rate than in previous years despite the weak economy.

According to the MetLife study:

• The national average daily rate for a private room in a nursing home rose 4.4% from $229 in 2010 to $239 in 2011.
• The national average monthly base rate in an assisted living community rose 5.6% from $3,293 in 2010 to $3,477 in 2011.
• The national average daily rate for adult day services rose 4.5% from $67 in 2010 to $70 in 2011.
• The national average hourly rates for home health aides ($21) and homemakers ($19) were unchanged from 2010.

 

Businessweek offers some coverage of the development, along with the words of the director of the MetLife Mature Market Institute, Sandra Timmermann. According to Timmermann, “The state of the economy, combined with rising health-care and energy costs, are having a significant impact on long-term care rates.”

Indeed, even though MetLife is the largest life insurer in the U.S., it also has discontinued its long-term care insurance policies for these very reasons. Likewise, the CLASS Act (the first public-option long-term care insurance) recently shut down. In the end, this is rather grim news for those planning for their old age or an elder loved one.

Reference:  Businessweek (October 26, 2011) “Long-Term Care Costs Rise at Faster Pace, Metlife Says”