Couples who are getting divorced should collect information about all of their retirement accounts, including IRAs, 401(k)s and pensions. Retirement account assets may be awarded to one party, or they may be divided between the divorcing spouses.

Pension plans are handled differently. The spouse who holds the pension has the option of either buying out the other spouse or giving a share of the benefits. To buy out the other spouse, the pension must be valued by actuarial analysis. A court order may order the pension to be split 50/50 or by some other ratio, depending on whether the couple were married for the entire duration of the pension.

If the couple was married for at least 10 years, and one spouse does not have work credits worth at least half of the other spouse’s, then that spouse can receive Social Security benefits. After one spouse’s death, the other spouse can claim the entire amount of the former spouse’s Social Security benefits.

In addition to overhauling one’s retirement plans, a divorced individual should review all estate planning documents to ensure that they reflect the individual’s current wishes.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

• A health care service, prescription drug, item or supply which you think you are entitled to
  receive;
• Payment for a health care service, prescription drug, item or supply that you already received;
• A change in the amount you are required to pay for a healthcare service, prescription drug,
  item or supply.

You can also file an appeal if Medicare or your plan ceases to offer or pay for your health care service, prescription drug, item or supply. If you are enrolled in a Medicare Medical Savings Account (MSA) Plan, you can file an appeal if you believe that you have satisfied your deductible or you think that a service or item should be applied toward your deductible.

In the event that you decide to file an appeal, request any information that could be helpful to your case from your physician, health care provider or supplier. The appeals process consists of five levels. If you do not agree with the decision reached at any level, you can usually proceed to the next level.

The first step in filing an appeal is to review your Medical Summary Notice (MSN), which lists all of the services and supplies that were billed to Medicare during a time frame of three months. It also reveals the amount paid by Medicare, and the amount you may be required to pay the provider. In addition, the MSN shows whether Medicare has denied your medical claim.

You will receive an MSN by mail every three months. Should you decide to file an appeal, you must do so within 120 days of the day on which you received the MSN in question.

Here are the three ways in which you can file an appeal:

1. Complete a “Redetermination Request Form” and mail it to the Medicare contractor.
2. On the back of the MSN, there are instructions for you to follow. You are required to mail your
   request for redetermination to the firm that manages Medicare claims.
3. Mail a written request to the firm that manages Medicare claims.

You can also consult an elder law attorney who can help you file an appeal of a claim or reimbursement that was denied.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

Some of the most important estate planning terms to understand include:

• Advance medical directive – A document that details a person’s health care wishes in case they become incapacitated. An advance medical directive also allows the individual to name someone to make health care decisions on their behalf.
• Estate – All of the money, real property and personal property a person owns.
• Estate planning – The process of taking steps to ensure that one’s wishes are followed after death, especially regarding the distribution of one’s wealth and assets.
• Intestate – Describes someone who died without making a will. When a person dies intestate, the state distributes their estate according to established rules of inheritance.
• Power of attorney – A document which allows another person to handle one’s financial affairs in the case of incapacitation, or sometimes even before one is incapacitated. The person granted power of attorney may have power over all financial decisions, or only certain tasks.
• Probate – A court-mediated process in which an estate’s assets are distributed. Probate is a public process that typically takes months. Wills go through probate, as do the estates of people who died without making a will.
• Trust – A document that establishes a situation where property is held by one party in the interests of another. Property that is held in trust does not have to go through probate. Trusts can also allow individuals to give some or all of their estate to charity in a charitable trust, to control how and when a younger family member receives their inheritance, and more.
• Will – A legal document in which a person outlines how their estate should be administered following their death.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

Current offerings include Lively, a wireless monitoring device with accelerometers to detect movement, as well as pill bottles that indicate when it is time to take medication. Even small changes in daily habits can represent significant changes in health, so the potential applications of such devices are substantial.

Experts envision a wide range of other smart devices in the future, such as furniture that monitors vital signs and carpets that analyze walking patterns to identify changes in physical health. Some such devices have already made their way into technology expos, but have some way to go until they are widely adopted. Keeping sensors unobtrusive and easy to install will be key to promoting widespread adaptation.

As 78 million Baby Boomers continue to age, there will be an increased demand for such devices, both from seniors and from their caregivers. Smart homes promise to provide a higher level of independence over a longer period of time, an appealing prospect for independent Boomers.

Supplementing in-person care giving with technology is also appealing from a practical perspective. According to a recent AARP report, in 2010 there were 7.2 middle-age caregivers for every 80-year-old. By 2050, that number will decline to 2.9. If the home is able to serve as an early detection system, alerting family and health care providers of key changes, it may be able to ease the strain on the health care system.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

The village serves as a protected, self-contained world for its inhabitants. It contains apartments, restaurants, a supermarket, gardens and more. Gates and security fences enclose the center, which provides both freedom and protection for residents who wander.

The goal is to create an environment that simulates normal life as much as possible, with dementia patients free to participate in activities they are capable of while receiving help with activities they can no longer perform. Residents can cook, clean and go grocery shopping, as well as go get their hair done or eat at a restaurant. At the same time, caregivers are on hand to help with activities of daily living as necessary.

Each apartment houses six to eight people, including caretakers who wear street clothes. The design of every department is unique, and each is geared toward a particular lifestyle, such as “cultural,” “artisan” or “Christian.”

A growing population of seniors and an increasing life expectancy means that the U.S. will be facing an unprecedented number of Alzheimer’s patients. This change may result in increased strain on both individual caregivers and the healthcare system as a whole in coming years. The number of people with Alzheimer’s has increased by 68 percent since 2000, and that trend will continue as the Baby Boomer population ages. The development of innovative solutions that promote independence and a fulfilling life is essential to the care of this growing population.

Already, a similar village has opened in Switzerland. In the future, it is possible that more such centers will open across Europe and in the United States, potentially improving the care and well-being of individuals with dementia.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

Having a Roth account can be especially beneficial for people who anticipate being in a higher tax bracket when they start making withdrawals than when they deposited the money into the account. In contrast, converting to a Roth may not be the right decision for people who expect to have a lower tax rate in the future.

Those who already have a traditional IRA can convert the funds into a Roth. In the year of the conversion, the individual must pay taxes on the full amount placed in the Roth. If necessary, the conversion can be done in smaller steps over the course of several years. One effective strategy is to convert just enough to reach the top of one’s current tax bracket.

Another advantage of Roth accounts is that withdrawals of earnings can be made with no taxes or penalties, as long as the person is over the age of 59½ and has had at least one Roth open for at least five years. Contributions can be withdrawn without taxes or penalties at any time.

In contrast to traditional IRAs, there is no minimum distribution requirement for Roth IRAs upon reaching the age of 70½. Account holders who do not need to withdraw from their Roth IRA can allow the money to grow in tax shelter until their death. Once the account passes to a non-spouse heir, that person is required to take minimum distributions. The taxes paid on a Roth conversion are not included in a person’s taxable estate.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

MyRA accounts are free to open and are sponsored by the government. Account holders can contribute directly from their paycheck. To qualify to open an account, an individual’s income must be less than $129,000, while a married couple’s household income must be less than $191,000.

The accounts will be especially beneficial for people who work part-time and those who work at small businesses that do not offer retirement benefits. However, anyone can sign up for a myRA, even those who do have an employer-sponsored retirement plan.

MyRAs are basically the same as Roth IRA accounts, in which after-tax dollars are invested so that earnings can be withdrawn without paying taxes in retirement. MyRAs will be invested in government bonds only, which means that they currently have lower returns than a typical IRA. However, there are no fees, and since the accounts are backed by the government, it is impossible to lose the original investment.

Because myRAs are intended to be a starter retirement savings account, there are some limitations on how they can be used. Account holders can contribute up to $5,500 per year. If the account balance exceeds $15,000, or if 30 years have passed, the account must be rolled over into a Roth IRA in the private sector.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

A record 2.2 million people age 60 and older now hold student loan debt — three times as many as in 2005. Collectively, older adults owed $43 billion in student debt at the time of the report.

Retirees may have student loan debt from a number of different sources. Some carry debt from their own educations, especially those who went back to school later in life. Others took out student loans to help pay for their children’s or grandchildren’s tuition. Either way, skyrocketing tuition rates make the burden high for those over sixty.

Additionally, a larger portion of older adults who have student loan debt are now having difficulty paying. Nearly 10 percent of older adult borrowers are at least 90 days behind on payments (as compared to about 6 percent in 2005).

Student loan debt can have devastating effects for seniors, as the government has the right to withhold a portion of a person’s Social Security payments to cover student loans. As of September 2014, 119,000 older adults were having their Social Security checks garnished.

Some older adults find themselves working long past their intended retirement age, sometimes on a part-time basis, to manage the educational loans.

Student loans are one of the longest-lasting forms of debt. Most student loans cannot be discharged during bankruptcy, although some lawmakers are pushing for reform.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

Employees who have registered for back-up elder care can call a care organization when they face an unexpected interruption in elder care. Within hours, the organization will send a home health care aide to the elderly person’s home. Employers work with agencies who screen and train their caregivers.

A sudden change in a parent’s health, logistical issues from the usual home health aide, or a family caregiver’s competing responsibilities can all lead to a gap in elder care. Without back-up elder care, workers are likely to miss work for days or longer. With back-up care, both the elder’s care and the employee’s work life can continue relatively seamlessly.

Plans vary, but most allow employees to use the service 10-20 times a year. Employees pay for part of the service — usually about $6.00/hour — while the company covers the rest.

This benefit makes fiscal sense for companies, as a growing number of American workers now care for aging parents. That trend will continue in coming years, as the Baby Boomer population reaches retirement age and life expectancy continues to stand at an all-time high.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

These “life settlement” companies purchase the policy from the policyholder, then continue to pay the premiums. They make a profit by collecting on the policy after the policyholder’s death.

In addition to acquiring cash that can help with the immediate costs of long-term care, selling one’s life insurance can make it easier to qualify for Medicaid. Once the policy is sold, it no longer belongs to the person who sold it, so individuals do not need to turn it over to qualify for Medicaid.

As people age and earn less income, it is not uncommon to allow life insurance policies to lapse, rather than pay the premiums. Most life insurance policies only have value after death, with no cash surrender value. That’s why selling the policy can make sense for seniors who face high care costs, do not have dependents who would rely on the life insurance after their passing, and do not have family members who can help out with the cost of the premiums.

Life settlement companies make an offer on a policy based on the person’s age and medical history, along with the face value of the policy. Depending on the company, this offer can be anywhere from 20 to 45 percent of the original face value.

Although life settlement companies may benefit some seniors, they are still a relatively new and tiny industry, with little regulation in most states. Families considering life settlement should carefully weigh their options and financial situation before deciding to sell.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

By Thomas D. Begley Jr.

WHAT SHOULD YOU KNOW ABOUT LONG-TERM CARE?

Long-term care is an area of growing concern to older Americans and their families. Approximately 70% of individuals age 65 or older eventually require some form of long-term care. Whether that consists of home healthcare, assisted living or nursing home care, the costs can be substantial. Without adequate planning, long-term care costs can quickly deplete a lifetime of savings. That, in turn, can jeopardize the financial security of a surviving spouse and undo any plans for transferring wealth to children.

Given the complexity of long-term care planning and the potential for costly errors, it is important to retain an experienced Elder Law attorney to guide you through the process. 

HOW CAN YOU PLAN FOR LONG-TERM CARE NEEDS?

Generally, the long-term care planning process involves:

• Identifying and prioritizing goals.
• Tax planning.
• Considering funding alternatives.
• Choosing appropriate planning tools.
• Applying for Medicaid, as necessary.

WHAT ARE YOUR GOALS?

The first step in long-term care planning is identifying goals and priorities. Typically, individuals want to:

• Obtain the best quality of care for the person in need.
• Maintain financial security for the healthy spouse.
• Avoid becoming a burden on children.
• Preserve a legacy for children.
• Avoid Medicaid lien on homes.
• Understand and plan appropriately for taxes, including:
  • Income tax.
  • Gift tax.
  • Federal estate tax.
  • New Jersey estate tax.
  • New Jersey inheritance tax.
  • Capital Gains tax.

WHAT SHOULD YOU KNOW ABOUT TAX PLANNING?

As you consider which assets might be used to fund long-term care and which you would like to leave to your children, it is important to understand the income tax ramifications of the following:

• Medical deductions. It is possible to take a medical deduction for qualified long-term care costs. For nursing home care, the deduction usually is equal to 100% of the cost of care. For assisted living and home care, it usually is a portion of the cost of care.

• Carryover basis. If a parent transfers assets to a child, the parent’s cost, known as the basis, carries over to the child, becoming his or her cost basis. This exposes the child to substantial capital gains taxes when the asset is sold.

• Step up in basis. If a parent leaves a child an asset that has increased in value, the child’s cost basis “steps up” to the fair market value of the asset at the parent’s death. This saves the child a significant capital gains tax bill when the asset is sold.

• Retirement plans. The tax treatment of qualified retirement plan assets makes them a good source of funding for long-term care, if funds are needed. While distributions are taxable (since the funds have grown on a tax-deferred basis while in the account), taxes are at least partially offset by the medical deduction, provided the funds are used for long-term care. Since there is no step up in basis on these assets, passing them to children would have capital gains as well as ordinary income tax consequences.

• Deferred annuities. Annuities in which the income has been deferred provide another good source of long-term care funding. When the income is withdrawn, it is taxable at ordinary income tax rates. But those taxes can be at least partially offset by the medical deduction if income is used for long-term care. If the annuity is transferred to a child; however, the entire deferred income is immediately taxable, and there is no step up in basis.

• Interest on E, EE, H, and I bonds. Long-term care costs also may be funded with these types of bonds. To the extent that the bonds have deferred interest, which has not been taxed, that interest is taxable when the bonds are redeemed. But those taxes can be offset, at least partially, by the medical deduction, as long as the funds are used for long-term care. If these bonds are passed on to children, there is no step up in basis.

• Gain on the sale of a home. As a general rule, if you have resided in a home as your principal residence for two of the five years preceding the date of sale, you are entitled to a $250,000 exclusion from capital gains tax, if single, or a $500,000 exclusion if you are married.

• Capital gains tax. There is a federal capital gains tax levied at the rate of up to 20% on profit from the sale of appreciated assets, such as homes and securities. There is also New Jersey income tax on this profit.

HOW WILL YOU PAY FOR LONG-TERM CARE?

There are five ways to pay for long-term care: private pay, long-term care insurance, Medicare, Veterans Administration benefits, and Medicaid.

Private pay

Paying for long-term care privately is the least desirable option since few families can afford the $100,000+/- annual price tag over an extended period of time.

Long-term care insurance

While long-term care insurance is an excellent way to pay for care, only 6- 8% of the elderly have this type of insurance. There are four reasons people don’t buy long-term care insurance:

• Lack of awareness. The industry has not done an adequate job marketing this product.

• It is estimated that only 10- 20% of the elderly can afford the long-term care insurance.

• At age 65, 25% of long-term care insurance policy applicants are rejected for health reasons.

• Since most people are optimists and prefer not to consider unpleasant outcomes, they don’t think they’ll need it. This proves to be the wrong decision 60% of the time. Unfortunately, the consequences of this mistake can be financially devastating to individuals and their families.

When buying long-term care insurance, it’s important to consider these factors:

• The type of care covered.
• The amount of daily benefits.
• Elimination periods.
• Inflation riders.
• Pre-existing condition clauses.
• The length of coverage.
• Guaranteed renewability.
• Waiver of premiums.
• The financial strength of the insurance company.

Medicare

If you expect to have Medicare cover long-term care costs, you should know that it:

• Offers extremely limited payment for home care and no payment for assisted living.

• Will pay for a nursing home stay only under certain conditions. The patient must have had a Medicare-covered stay in a hospital lasting at least three days and must have entered a nursing home to obtain skilled care within 30 days of discharge from the hospital.

• Will not pay for custodial care. The patient must receive skilled care to qualify for Medicare. If that level of care stops, the Medicare payment will stop. Examples of needs requiring skilled care include insertion of a feeding tube, five day per week rehabilitation, and insulin dependence.

• Will pay for a maximum of 100 days. That amount of coverage is not guaranteed and is a maximum, not a minimum. There is a co-insurance from day 21 through day 100. For 2015, the co-insurance rate is $157.50 per day. That may be covered if the patient has the appropriate Medi-gap policy.

Veterans’ benefits

If you believe you are eligible to have Veterans’ benefits cover long-term care costs, you should be aware of the following:

• Federal VA nursing homes. A veteran whose disability is 70% or more service-related is entitled to free lifetime nursing home coverage, regardless of means. These individuals are given priority for admission to federal VA facilities. Veterans who do not have a service-related disability are means-tested to determine eligibility for payment. As a practical matter, these individuals are unlikely to gain admission to a federal VA facility.

• VA Aid & Attendance benefits. Veterans Aid & Attendance benefits are available to certain veterans. These individuals must have served for at least two years of active duty and one day must have been during a war. There are income and resource eligibility tests. Aid & Attendance is available to veterans and to spouses of deceased veterans. For 2015, the monthly benefit for a veteran with dependents is $2,120, for a single veteran $1,788, and for the spouse of a deceased veteran $1,149.

• State VA benefits. The New Jersey Veterans Administration operates three Old Soldiers’ Homes for New Jersey veterans and their families. They are located in Paramus, Edison and Vineland. Veterans, spouses of veterans, surviving spouses, and, in some cases, parents, may be eligible to enter these facilities. Space is limited, and there is often a long waiting list. The monthly rate for Veterans who are not financially qualified is much lower than that for private nursing homes. Financially-eligible veterans qualify for a subsidy, which further reduces the cost dramatically. In some instances, a spouse remaining at home is entitled to retain a portion of the resident’s income for certain expenses.

Medicaid

If you may need to rely on Medicaid to cover long-term care costs, you should be aware of the following:

• Income limits. For 2015, there is an income cap of $2,199 per month for Medicaid eligibility. However, if an individual’s income exceeds that cap, a Miller Trust can be established to obtain income eligibility. Under a Miller Trust, a portion the Medicaid applicant’s income is deposited into a trust to bring the remaining income under the income cap. This is a legal fiction that makes no sense, but it enables many individuals to obtain Medicaid in nursing homes, assisted living facilities, and at home who would not otherwise be eligible.

• The Minimum Monthly Maintenance Needs Allowance. Medicaid regulations provide that if the applicant is married, the spouse remaining at home is entitled to a minimum monthly allowance. In some situations, if there is a shortfall, the difference can be retained from the income of the spouse requiring care. For the period of July1, 2014, through June 30, 2015, the Minimum Monthly Maintenance Needs Allowance is $1,966.25 and the Excess Shelter Allowance threshold is $589.88 per month for certain housing expenses.

• Resource limits. Persons receiving Medicaid generally can have assets of no more than $2,000. Certain assets are excluded, such as a home (occupied by a community spouse or child who is under age 21, blind or disabled), an automobile, personal effects, prepaid funeral expenses, medical equipment, inaccessible resources (such as an estate in probate), term life insurance, whole life insurance with a maximum face value of $1,500, and a $2,000 personal needs account.

If there is a joint account owned by the applicant “or” another individual, Medicaid takes the position that the entire account is a countable resource for the Medicaid applicant. If the account is owned by the applicant “and” another individual, Medicaid assumes that there was a transfer of assets when the applicant(‘s/s’) child was added to the account, but that each joint owner owns a pro rata share of the account. If the child contributes the assets and later withdraws them, there is no transfer-of-asset penalty. The child bears the burden of proof regarding whether he or she made a contribution to the account.

• Pooling of assets. If a Medicaid applicant is married, the resources of both spouses are pooled to determine Medicaid eligibility. A snapshot of the couple’s resources is taken as the first moment of the first day of the first month in which one of the spouses receives an institutional level of care, even if that care is delivered at home. The well spouse is entitled to a Community Spouse Resource Allowance, but the remaining assets must be spent down prior to Medicaid eligibility.

The Community Spouse Resource Allowance is 1/2 of the countable resources with a maximum of $119,220 and a minimum of $23,844 for 2015.

• Transfer-of-assets rules. Medicaid has strict requirements regarding the transfer of assets from an applicant to his or her children or other parties.

• Medicaid imposes a 60-month (five-year) lookback for transfers of assets. This means that Medicaid will review the applicant’s relevant financial records going back five years to determine whether funds have been transferred during that time period.

• If assets were transferred during the lookback period, Medicaid imposes a penalty. That penalty, which is a period of ineligibility for Medicaid, is calculated by dividing the amount transferred by the average cost of a nursing home in New Jersey determined by the Division of Medical Assistance and Health Services. Unfortunately, this divisor is always less than the actual cost of care.

Penalties may be for a period of months or partial months. The larger the transfer, the longer the period of ineligibility. The penalty does not begin until the applicant is eligible for an institutional level of care, is otherwise financially eligible for Medicaid (i.e. has spent down assets to $2,000) and has no other period of ineligibility outstanding.

For example, assume that a person transferred $50,000 within the lookback period, triggering a seven-month penalty or period of ineligibility for Medicaid. The penalty period would begin when that person was already in a nursing home, had spent down assets to $2,000 and had no other period of ineligibility outstanding. Consequently, the individual would have no money with which to pay for the nursing home care for seven months.

• Acceleration strategies. There are many strategies available to accelerate the date of Medicaid eligibility. These strategies fall into two categories spend down and transfers.

Spend Down. It is possible to spend down assets through:

• Repayment of debt.
• Payment for services.
• Purchase of personal effects.
• Making home improvements.
• Prepayment of funeral expenses.
• Purchase of an automobile for a healthy spouse.
• Purchase of a home for a healthy spouse.
• Purchase of a life estate.
• Establishment of a care agreement.

Transfers. Despite the five-year lookback, in many instances, it is still possible to transfer assets. For example, some transfers are exempt from Medicaid transfer-of-asset penalties. In some cases, tax advantages can be achieved by transferring assets. Additionally, assets may be transferred from one spouse to another through divorce.

Transfer alternatives. There are several ways to transfer assets.

• It is important to consider whether a transfer should be made outright to children or to a trust. Outright transfers have many risks. They can expose assets to the children’s creditors or make them available in a divorce settlement. If grandchildren plan to apply for college financial aid, the transferred assets will need to be disclosed on the application, potentially resulting in a reduction of elimination of aid. Additionally, when assets are transferred to the children, they will lose the step up in basis they would have received if the assets were passed after the parent’s death. The principal residence exclusion on the sale of the home will be lost as well.

If assets are transferred to a grantor trust, the trust can be designed so that, at the parent’s death, the assets will receive a step up in basis. That will result in significant tax savings for the children. The trust also can stipulate that the income tax on the trust assets will be paid by the parent. If a home is transferred to a trust and later sold, the trust can be established to preserve the $250,000 or $500,000 exclusion from capital gains tax on the sale of a principal residence. Additionally, trusts can eliminate risk factors associated with outright transfers to children. Even if a child is serving as trustee, the assets would not be subject to the claims of that child’s creditors or become involved in an action for divorce. These assets would not need to be disclosed on a grandchild’s application for college financial aid.

Several types of trusts are used when Medicaid planning is at issue. All of these trusts are irrevocable.

• Children’s trusts. Assets are transferred to a trust, and the parent does not reserve the right to receive income from those assets. If the parent receives Medicaid and transfers assets out of the trust, there is the risk that there may be a transfer-of-asset penalty. That penalty would be imposed by multiplying the parent’s annual income by his or her life expectancy and dividing the sum by the state divisor.

• Donee trusts. This type of trust is appropriate when a parent transfers assets to children, outright, but the children plan to later establish a trust to hold the transferred assets.

• Disability annuity trusts. If a parent has a disabled child, assets can be transferred to a disability annuity trust for that child’s benefit.

• Disability annuity special needs If a parent has a disabled child who is receiving SSI and Medicaid, assets must be transferred to a disability annuity trust wrapped within a special needs trust in order to preserve the child’s benefits.

Care agreements. In many cases, a child provides care to a parent. To accommodate such an arrangement, the child may move into the parent’s home or the parent may move into the child’s home. Alternatively, the child may provide care while retaining a separate residence from the parent if the parent resides in a nursing home or assisted living facility. It is possible for the parent to compensate the child for this care, effectively transferring assets to the child. This can be done without triggering a penalty, provided that three requirements are met:

• There must be a written care agreement.
• Payment can be made only for care provided after the date of the agreement.
• Compensation must be reasonable.

Note that the income paid to the child is taxable because it is for services. In some circumstances, the parent must withhold from the child for FUTA and FICA. Withholding from income tax is not required unless both parties agree. Medicaid resists these care agreements and great caution must be taken in properly drafting the documents and in delivering appropriate services.

There are several ways to transfer a home.

• Transfer outright to children. A common mistake is for parents to transfer a home outright to children. This results in a number of negative consequences.
  • Loss of control. The parent loses control over the home.
  • Gift taxes. Since the home is worth more than $14,000, it exceeds the allowable annual exclusion gift.
  • Carryover basis. The parent’s cost basis in the home carries over to the children. In some cases, the parent purchased the home many years before, and there has been significant appreciation. Eventually, the children will have to pay capital gains tax on that appreciation.
  • Loss of principal residence exclusion. The $250,000/$500,000 principal residence exclusion is lost since the parent no longer owns the home.
  • Loss of real estate tax benefits. The homestead tax rebate, Veteran’s deduction, senior citizen’s deduction, tax freeze, and ability to itemize deductions are all lost.

• Transfer, reserving a life estate/right to use or occupy. When the home is transferred to children, but the parent reserves a life estate or right to use and occupy it, the following occur:
  • The parent retains control. The children cannot sell or mortgage the house without the parent(‘s/s’) signature on the deed or the mortgage.
  • Gift tax exemption. A gift tax exemption can be filed as long as the value of the home does not exceed $5,430,000. In most cases, there will be no taxes due.
  • Step up in basis. At the parent(’s/s’) death, the children receive a step up in basis on the value of the home, which reduces their capital gains tax liability.
  • Real estate tax benefits. The homestead tax rebate, Veteran’s deduction, senior citizen’s deduction, estate-tax freeze, and ability to itemize deductions on income tax returns are all retained.
  • Loss of principal residence exclusion. The principal residence exclusion is lost. This is an important consideration if the home is sold during the parent’s lifetime.

• Transfer to a grantor trust. The home also may be transferred to a grantor trust, with the following outcome:
  • Control of the home vests in the trustee rather than the parent.
  • Gift tax exclusion. There is no gift tax due when the gift is to a grantor trust.
  • Step up in basis. The children receive a step up in basis at the parent(’s/s’) death.
  • Loss of real estate tax benefits. The homestead tax rebate, Veteran’s deduction, senior citizen’s deduction, estate tax freeze, and ability to itemize deductions on income-tax returns are all lost.
  • Principal residence exclusion. This can be maintained.

• Sell a remainder interest. A parent can sell a child a remainder interest in the home and retain a life estate. It is likely that Medicaid will require the parent to live in the home for one year for this strategy to be effective. The value of the remainder interest is determined by tables published by the federal government. The older the parent, the greater value of the life estate. At age 75, the life estate is worth approximately 52% and the remainder interest is worth approximately 48%. If the parent had a home valued at $200,000, the child would pay approximately $96,000 for the remainder interest. At the parent’s death, the child would own the $200,000 home.

• Purchase a life estate in the child’s home. The flip side of the sale of a remainder interest is for the parent to purchase a life estate in the home of the child. Again, the federal government’s life estate tables are used. If the child has a home with equity of $200,000 and the parent is age 75, the parent can pay the child $104,000 in exchange for a deed granting him or her a life estate in the home. The parent must actually move into the home and reside there for at least one year. If there is a mortgage on the home, this would reduce the equity purchased by the parent. Consideration also must be given to the “due on sale” clause in the child’s mortgage and to capital gains tax liability.

• Reverse mortgages. In many instances, children provide financial support to their parents to bridge the gap between the parent(’s/s’) income and the parent(‘s/s’) expenses. In order to ensure that these funds will be repaid if the parent ever requires long-term care, it is good practice to record a mortgage against the parent’s estate to secure the funds advanced by the children.

Medicaid estate recovery

At the death of a Medicaid recipient, the state is entitled to recover from his or her estate. In New Jersey, an estate includes all assets in the name of the decedent, as well as assets in which the decedent had an interest through joint tenancy, tenancy in common, right of survivorship, a living trust, or another arrangement. Effectively, this means that if a husband and wife own a home together and the husband is a Medicaid recipient, at his death, Medicaid can file a lien on the home. If the home is owned as tenants by the entirety, which is the usual way married couples own homes, the lien will be for 100% of the value of the home. In Pennsylvania, estate recovery is limited to the probate estate. The recovery will be for all Medicaid benefits received after age 55. No recovery will be made if there is a surviving spouse or a surviving child who is under age 21, blind, or permanently and totally disabled. Life estates established during the parent(’s/s’) lifetime are exempt from estate recovery. Recovery cannot be made against the estate of the surviving spouse. If a lien is placed against the home, the spouse will not be forced from the home, but Medicaid will want payment if the home is sold or the spouse dies.

WHAT TOOLS ARE AVAILABLE FOR LONG-TERM CARE PLANNING?

• Asset protection plan. An asset protection plan is designed to help you achieve your goals despite the barriers erected by Medicaid and tax laws.

• If you are married, you and your spouse probably have reciprocal wills, through which you leave everything to each other. When one spouse requires nursing home care, it is important to review existing wills. Generally, it is best to leave unchanged the will of the disabled spouse. However, the will of the other spouse should be revised so that, if he or she dies first, assets are not left to the disabled spouse.

• Living will. Your living will should be reviewed to ensure that it contains appropriate instructions regarding end-of-life decisions. Specifically, it should state the types of treatment you do or do not want in the event that you are either brain dead or terminal, and two physicians and a family member have agreed that there is no hope of your recovery.

• Power of attorney. Your powers of attorney should be reviewed for adequacy. Often, powers of attorney are missing such elements as the right to make gifts or do banking in accordance with the New Jersey Durable Power of Attorney Act. Additionally, many powers of attorney fail to include a reference to real estate that is to be sold. Prior to the sale of real estate, many title companies require that the street address and block and lot of the property be included in the power of attorney.

• Children’s trust. Establishing a trust for the benefit of children often offers tax advantages. It also can help to avoid the risk of making outright transfers to children, such as the risk of creditor actions or the loss of assets in a divorce.

• For most clients, the primary goal of long-term care planning is to protect their home. While many clients feel they should deed their home outright to their children, this often is not a good solution because of the risk factors and adverse tax effects. There are; however, a number of other strategies available to achieve this goal.

• Care agreement. If a child cares for a parent, it is possible for the parent to pay for that care, effectively transferring assets in a manner that will not trigger a Medicaid penalty. This must be done pursuant to a written care agreement.

WHAT SHOULD YOU KNOW ABOUT APPLYING FOR MEDICAID?

Medicaid applications are filed with the Board of Social Services for the county in which the care is being provided even if the applicant lived in a different county. Applicants must report all assets under penalty of perjury. The Board of Social Services has 30 days to approve or deny an application, but typically, the process takes about 60 days. Applicants have a right to appeal in the event of a denial. Medicaid can be granted retroactively for three months prior to the date of application if the Medicaid applicant was eligible at that time. Otherwise, eligibility begins on the first day of the month following the Medicaid application.

Medicaid eligibility rules are complex, and it is possible for errors to result in a delay in eligibility. In such cases, the facility must be paid by the family on a private-pay basis until Medicaid eligibility is granted. Given the potential for this outcome, many applicants choose to have an elder law attorney represent then during the application process. An elder law attorney also can help with periodic redeterminations for Medicaid eligibility. These occur annually for recipients on the Medicaid Only program and every six months for those on the Medically Needy program.

WORKING WITH BEGLEY LAW   GROUP

For over 70 years, the attorneys of the elder and disability law firm Begley Law Group have been dedicated to helping clients plan for long-term care concerns. We have expertise in all aspects of elder law and provide clients with the most up-to-date information and advice. The firm participates in the formulation of legislation related to elder law issues. We also advocate for the rights of seniors on both national and state levels.

Clients requiring long-term care planning can benefit from our Asset Protection Planning program, designed to help identify goals and find the best strategies and solutions for achieving them. At the initial meeting, we will discuss your situation and ascertain your needs. We will then advise you of our fee, which is a flat rate that covers everything within the scope of the service.

LONG TERM CARE SELF-DIAGNOSTIC TEST

Many clients involved in long-term care planning find it useful to complete the following Self-Diagnostic Test. Please take a few minutes to answer these questions.

1.  Am I willing to risk all that I have accumulated through a lifetime of hard work and disciplined saving, including my home, my car, and all of my liquid assets, rather than take the time to plan for the future?       □ Yes     □ No

2. Do I understand that the cost of planning is insignificant when compared to the cost of paying for long-term care?   □ Yes   □ No

3. Do I understand that the risk of my needing some form of long-term care (e.g., home care, assisted living, nursing home care) is roughly 70%?      □ Yes     □ No

4. Do I know what long-term care will cost? $________________

5. Do I know how I will pay for that care if I need it?____________________________________________

6. Do I know what the impact will be on my spouse and children if I spend $100,000 ± per year on long-term care?__________________________________________________________________________

7. Should I explore the possibility of buying long-term care insurance?     □ Yes     □ No

If no, why not?___________________________________________________________________________

8. Should I hope this problem never arises and ignore it?     □ Yes     □ No

9. Should I take steps to try to protect my life savings now?      □ Yes     □ No

What are my reasons for these decisions?____________________________________________________

________________________________________________________________________________________

10. Do I understand that if I become sick, it may be impossible for my spouse or children to care for me, regardless of how much they are committed to doing so?     □ Yes     □ No

11. Are my wills, trusts, living wills, powers of attorney and other legal documents up to date?   □ Yes     □ No

Traditionally, family conversations have led this process. Relatively few Americans have written advance health care directives. A recent study suggests that incentivizing physicians to discuss end-of-life care could boost participation in end-of-life care planning dramatically.

In the study, palliative care specialist Dr. Joshua Lakin and a team of his colleagues at the University of California, San Francisco (UCSF) Medical Center instituted an incentive program to improve documentation of patients’ advance care decisions.

The researchers developed a standard form, which was placed in patient’s electronic medical records. The form documented preferences, including whether the patient would like to be resuscitated, intubated, receive a feeding tube or receive all care in the case of major health decline. The forms also had room to list the patient’s health care agent and that person’s contact information, as well as a space for “expressed wishes” and any existing living will or health care directive.

Medical residents would receive a monetary bonus if, as a group, they completed preference forms for at least 75 percent of discharged patients during at least three out of the four quarters. Email alerts were sent to residents if they fell behind.

In July of 2011, 22 percent of the patients had documented preferences. By October of that year, 90 percent of patients had documented preferences, and the number stayed that high.

Although family conversations about end-of-life care remain important, this study suggests that in the future, a doctor-led approach may help ensure that these tough decisions are made and documented.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

Procrastination can affect one’s retirement plans dramatically. The earlier people start saving for retirement, the less they need to save, and the more they will have when retirement comes. For example, to have the same balance at 65, a person who starts saving for retirement at 40 will need to save more than three times as much each month as a person who started saving at 25. Every year of procrastination can impact the security of one’s retirement.

Sadly, such procrastination is quite common. The savings rate in the United States hit a low point in February 2013 at just 2.6 percent — compared to a high of 11 percent in 1973. The majority of Americans have less than $25,000 in savings and investments, and 28 percent of Americans said they were “not at all confident” that they were saving enough for retirement.

Debt also threatens security during retirement. Levels of credit card debt, student loans and mortgage debt are all on the rise, including among people of retirement age. From 1989 to 2010, debt among people 75 and older increased by 978 percent, and debt among people aged 65 to 74 increased by 384 percent. Some older individuals must tap into their retirement funds to pay down credit card and other debt, which means that those funds will not be available later on.

Many Americans have so much debt that they are unable to retire when they would like to. Others are less secure in their retirement because of debt.

Debt and procrastination can have a devastating impact on retirement planning, but it is never too late to start working towards a good retirement. As the saying goes, the best time to start was yesterday, and the second best time is now.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

As much of health care moves out of hospitals and into homes, caregivers are charged with providing care to increasingly ill loved ones in increasingly complex ways. At the same time, caregivers experience emotional stress from seeing the physical or cognitive decline of a loved one.

Anyone can be a caregiver, but caregivers are most likely to be middle-aged women who work and who may also be the primary caregivers for their children. The time commitment and physical commitment of providing care can be profound. In some cases, this mounting stress can be a contributing factor to the abuse or neglect of an elder.

Self-care is a key factor in reducing caregiver stress. Caregivers should develop healthy coping skills, such as taking time away from the elder, exercising, socializing or participating in hobbies.

A person’s family and community can also help reduce caregiver stress. For example, community respite programs can give caregivers a few hours to spend on their own needs. Family members can pitch in by becoming secondary caregivers and reducing the load on the primary caregiver.

One complex factor that can contribute to elder abuse and the stress of caregiving is the caregiver’s historical relationship with the elder. If the caregiver was abused by the elder as a child, the caregiver may experience a great deal of stress and complex emotions when caring for the elder now. The same is true for parent-child relationships that were marked by antipathy or apathy in previous years. For such individuals, professional assistance or other options for care may be best.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

The money saved for retirement should be earmarked only for retirement. A 401(k) is not an
emergency savings account; it is a retirement account, and withdrawals before the age of 59 1/2 are subject to penalties and income tax. To avoid the temptation to take early withdrawals, one may wish to keep emergency savings in a money market account.

Avoidable financial fees can have a substantial impact on a person’s retirement planning efforts. According to FeeX.com, the average American spends about $155,000 in unnecessary fees over the course of a lifetime. Fees that are easily avoidable include ATM fees, credit card fees, overdraft fees, late payment charges and termination fees.

Finally, missing out on a healthy lifestyle can lead to a less robust retirement. Being in good physical shape allows one to enjoy those golden years to which all that retirement planning has been leading. In addition, the financial cost of health care for preventable diseases can be substantial. Eating a diet rich in unprocessed foods, exercising several times a week, and visiting the doctor for routine check-ups can all help secure a happy, healthy retirement.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

Senior placement services are completely unregulated, and they do not require licensing or training. This means that anyone can start one, and that quality is not guaranteed. All nursing home placement services stay in business by working with a network of nursing homes,
assisted living facilities or retirement communities. These facilities pay a commission to the placement service when a senior moves in.

The quality of services offered by a nursing home placement service can vary widely. There are some national and franchise operations that work entirely over the phone or online. Often, the consultants at such companies have not actually been to the facilities they are recommending. These companies tend to simply provide a list of communities for the senior to visit.

There are some gems. Small, local companies are often home to experts in senior care who provide a more hands-on service. At these companies, consultants work with seniors in person, take seniors and their families on facility tours and have the expertise to identify a senior’s individual needs. A highquality firm will spend ample time with a senior and follow up once the senior has been placed.

Due to the risk of being misled by a nursing home placement company, seniors and their families should do their research before settling on a company. The company should offer in-person services and be embedded in the local community. Often, but not always, small firms provide better service.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

The pension is designed for veterans and surviving spouses who require help to perform activities of daily living (ADLs), such as dressing, eating, bathing or going to the bathroom. Individuals who are blind or live in a nursing home qualify for the pension.

Aid and Attendance is available to veterans who served for at least 90 days, with at least one of those days occurring during wartime, and to their surviving spouses. The disabilities do not need to be service-related.

To quality, the veteran or surviving spouse must own less than $80,000 in assets, with home and vehicle not included in this calculation. His or her income must also be lower than the Maximum Annual Pension Rate (MAPR), which is currently set at $21,107 for a single veteran. The income calculation does not include welfare benefits, unreimbursed medical expenses that have been paid or Supplemental Security Income.

Even veterans who have an income too high to qualify for a VA pension may qualify for the Aid and Attendance pension, so long as they have high medical costs that are not otherwise reimbursed.

The VA pays the difference between the veteran’s income and the MAPR, so the amount that a person receives from Aid and Attendance depends on his or her income.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

This is especially important today, when the number of childless Americans is higher than in the past. In 2010, nearly 19 percent of women ages 40 to 44 had not given birth, compared with about 10 percent in 1980.

A healthcare power of attorney allows a person to appoint someone trusted, whether natural child or friend, to make medical decisions on his or her behalf in case the person is incapacitated. This can be combined with a financial power of attorney, which appoints a trusted individual to handle a person’s finances. Without these documents, it can take time for the court to appoint a guardian. The guardian may not be someone the individual even knows.

In addition to designating a caregiver, it is important for childless older adults to use these documents to make their wishes clear. For example, some people prefer to receive in-home care, while others would like to move to an assisted living facility if long-term care became necessary.

Many childless adults appoint their partners or siblings as their health care agents. However, this carries some risk if the other person is close in age. It is best to also appoint a backup caregiver as well, such as a niece, nephew or friend. It is essential to discuss these issues with the person appointed.

If there is no one available to serve as a healthcare agent, a bank or other company with a trustee department can be employed to make the arrangements.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

Older adults often give gifts to children or grandchildren. Unfortunately, these gifts can affect a person’s Medicaid eligibility, so it is important that older adults carefully plan their gift-giving if they may eventually need Medicaid long-term care benefits.

Under federal law, people who transfer certain assets within five years of applying for Medicaid may be ineligible for benefits for a period of time. This rule is designed to prevent people who are financially secure from improperly transferring assets in order to qualify for Medicaid.

Gift tax law and Medicaid law are different in their requirements. Individuals can give up to $14,000 per year without paying a gift tax, but those gifts are still treated as a transfer under Medicaid law. There is also no exception for gifts to charities.

Some transfers are, however, exempt from this issue:

• Gifts to one’s spouse

• Gifts to one’s blind or permanently disabled child

• Transfer to a trust for the sole benefit of a person under the age of 65 who is permanently disabled

• Transferring a home to a child under age 21

• Transferring a home to a child who provided live-in care for at least two years

With proper planning, it is possible to preserve assets while still qualifying for Medicaid. Consult with an experienced elder law attorney to learn more.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

Depression and anxiety are common among caregivers, who often provide hours of care each week for years on end. Caregivers face about twice the risk of developing depression and anxiety as the general population.

Caregivers often face social isolation due to the time commitment associated with caregiving. Even caregivers who take their elder into their own home still experience financial strain as a result of the caregiving. Caregivers often neglect their own physical and mental health because of the numerous other demands they face.

Addressing these stressful issues can help prevent elder abuse from occurring. Self-care methods like eating well, exercising and using stress reduction techniques can help give caregivers the energy to provide good care for their loved ones. Support groups and counseling can help caregivers to manage stress and other emotions in healthy ways.

Additionally, caregivers should be willing to ask for help. They should be aware of resources in the community and make use of them as needed. Friends and family may be able to stay with the elder for a few hours, or a local respite care agency can provide temporary care. Elders can also spend the day at adult day care. Caregivers should be able to reach out when overwhelmed. That ability reduces the likelihood of elder abuse.

Friends and family members of caregivers can help to take the stress off overextended caregivers. Regular visits and offering to stay with the elder so that the caregiver can get a break can have a profound impact.

The attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

A new wave of high-tech gadgets could make keeping seniors safe while living in their own homes more feasible than ever. Among the latest developments are:

• Motion sensors – Motion sensors on the wall, front door, chair or refrigerator can detect whether there is too little activity over a period of time, then alert a family member. Advanced motion detectors can even identify changes in gait.
• Mattress monitors – These devices can spot restlessness or frequent trips to the bathroom. Respiratory and pulse rates can also be monitored.
• Smart pill bottles – New gadgets can make pill bottles sound an alarm when it is time for a dose and text the senior’s caregiver if the pill is not taken.
• Appliance safeties – Special devices can turn off the stove if it is left on for too long, preventing burns and fires.

Research from the University of Missouri suggests that automatic monitoring can spot the subtle changes, like nighttime restlessness or lower daytime activity, that occur 10-14 days prior to a fall or trip to the hospital.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

Each year, around 7,000 elderly people die in accidents at home, while millions more sustain serious injuries there. Falls are the most common cause of injury. Drowning in the tub and being burned by the stove or by hot water are also significant risks.

A home that is optimized for safety can allow older adults to continue to live independently for as long as possible. Visiting MySafeHome.net and taking the house tour is a great start for identifying potential home hazards. People with medical issues, such as poor vision or rheumatoid arthritis, can benefit from a home assessment by an occupational therapist (O.T.).

Many safety improvements are very simple and affordable. For example, removing any unsecured rugs and maintaining good lighting throughout the house and yard can prevent falls, as can maintaining a clutter-free home.

Other common safety improvements include the installation of stairway lifts for indoor stairs and threshold ramps and railings for the approach to the house. It may be necessary to install bars and a specially designed shower or bathtub.

Although health insurance should cover home assessment by an O.T., it will not usually cover home upgrades. However, people with long-term care policies may be able to get coverage for home modifications.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

Reports presented at the 2014 Alzheimer’s Association International Conference in Copenhagen revealed that eye exams could be used to identify build-up of beta amyloid in the brain, while a decreased ability to identify odors may be an early sign of cognitive impairment.

Alzheimer’s disease is characterized by the development of brain plaques, and beta-amyloid is their primary component. Plaques start to develop years before cognitive decline and memory loss. In two of the studies, measuring the level of beta-amyloid in the eye correlated with brain beta-amyloid levels and was accurate in identifying people with Alzheimer’s.

In the other two studies, loss of brain cell function and the progression to Alzheimer’s disease was associated with a decreased ability to identify smell.

These findings point to potential avenues for early detection of Alzheimer’s through biomarkers. However, more research is needed to develop these tests.

Currently, Alzheimer’s can only be detected late in the disease, after significant cognitive decline and memory loss has already occurred.

There are no effective treatments currently available for any stage of the disease, although some drugs are effective for a few months for some of the people who take them. Alzheimer’s treatment is primarily symptomatic, aimed at helping patients maintain their quality of life and keeping them safe.

If early detection tests were developed, their primary purpose would be to identify patients early on in the disease process for participation in clinical trials for treatment and prevention of Alzheimer’s.

As effective treatments are eventually developed, early detection could be used to intervene and provide treatments early in the development of Alzheimer’s, before significant memory loss and cognitive decline has occurred.

The attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

Caring for a loved one with Alzheimer’s can take an immense toll on caregivers. From the emotional impact of watching a parent or spouse slowly decline as the disease takes hold, to the time commitment and financial impact of caregiving, caregivers often develop anxiety or depression.

Caregivers for people with Alzheimer’s need care to be able to cope with their situation, and getting care benefits both the caregiver and the patient.

The Strategies for Relatives (START) program educates participants about managing dementia patients, emotional support and planning for the future. A recent study presented at the Alzheimer’s Association International Conference in Copenhagen found that even years later, participants had lower levels of depression and anxiety, as well as lower costs for care.

Some strategies for self-care when caring for an Alzheimer’s patient include:

• Finding time for breaks – is there a time when your loved one can attend an activity or care center?

• Joining an Alzheimer’s Association support group

• Maintaining your physical health by cooking healthy meals and taking walks

• Learning techniques for managing Alzheimer’s patients and experimenting with what works for your situation

• Letting others in your life know what they can do to help

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

Caring for a loved one with Alzheimer’s can take an immense toll on caregivers. From the emotional impact of watching a parent or spouse slowly decline as the disease takes hold, to the time commitment and financial impact of caregiving, caregivers often develop anxiety or depression.

Caregivers for people with Alzheimer’s need care to be able to cope with their situation, and getting care benefits both the caregiver and the patient.

The Strategies for Relatives (START) program educates participants about managing dementia patients, emotional support and planning for the future. A recent study presented at the Alzheimer’s Association International Conference in Copenhagen found that even years later, participants had lower levels of depression and anxiety, as well as lower costs for care.

Some strategies for self-care when caring for an Alzheimer’s patient include:

• Finding time for breaks – is there a time when your loved one can attend an activity or care center?

• Joining an Alzheimer’s Association support group

• Maintaining your physical health by cooking healthy meals and taking walks

• Learning techniques for managing Alzheimer’s patients and experimenting with what works for your situation

• Letting others in your life know what they can do to help

In order to qualify for Medicaid, it is sometimes prudent to “spend down” assets in order to reduce their value. Spending down should be done carefully, ensuring both continued financial security and the receipt of Medicaid.

Not all assets influence whether an individual can receive Medicaid, and these assets do not need to be spent down. A person’s home, car and physical possessions may not be counted. Prepaid funeral and burial arrangements and some cash may also be exempt. However, exemptions are determined on a case-by-case basis.

Medicaid programs allow individuals to spend down their assets on certain expenses. Assets may be used to pay off credit cards, mortgages or loans, including prepayment. They may be used for the prepayment of certain burial and funeral expenses.

The applicant can also use their existing assets to purchase an exempt asset, such as a home or automobile that meets the requirements for exemption. Assets can be used in the upkeep of non-countable assets, such as home repairs.

For people who are married, purchasing an annuity for the spouse can be an excellent way to spend down assets. An annuity guarantees the spouse a fixed income for a given number of years. Annuities purchased for the purpose of spending down must be non-transferable, and Medicaid must be listed as the primary beneficiary after the spouse’s death.

There are certain expenses that should not be used for spending down. For example, prepayment of caregiver services or other services is considered a gift and will actually cause the applicant to be ineligible for Medicaid for a period of time.

The process of spending down to quality for Medicaid can be complex. An estate planning attorney can assist in developing Medicaid planning strategies that are compatible with Virginia’s Medicaid regulations.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

Americans’ life expectancies have risen considerably. A male who has reached age 65 is now expected to live to age 86.6, and a 65-year-old female is expected to reach age 88.8. With more people living longer, there is more time to enjoy the golden years — but also a greater possibility that the elderly will need long-term care and the danger that they will outlive their retirement savings.

Insurers offer a number of policies to cover such situations, including stand-alone long-term care insurance policies and the option of adding a long-term care rider to one’s existing life insurance. Critical care riders are yet another option.

A critical care rider, also known as a chronic illness rider, can be added to a life insurance policy, allowing the policyholder to tap death benefits to reimburse a health care facility that provided care or family members who paid for it. The benefits are tax-free, usually up to $330 per day, and the remainder of the death benefit goes to one’s beneficiaries.

Critical care riders are becoming more popular. In part, this is because the riders can be paid out for any costs related to a medical condition, without the need to qualify expenses or provide receipts; such ease is not available with long-term care insurance. 

Policyholders may expect to pay an additional 10 to 20 percent of their premiums for a critical care rider.

To learn more about estate planning or long term care planning, visit http://www.elderlawnewyork.com/.

People approaching retirement age have a choice to make regarding Social Security retirement benefits. Many people choose to start receiving retirement benefits early, which is possible starting at age 62. However, the earlier a person begins receiving benefits, the less he or she gets — up to 30 percent less than the amount the person would receive if he or she waited until full retirement age (66 for current retirees). Then, the longer someone delays retirement up to age 70, the more of a benefit bonus that person gets.

Generally, if a person is in good health and financially secure, postponing benefits as long as possible makes the most economic sense. Some experts say that, all other factors being equal, retirees should think of age 70 as their actual retirement age.

However, there are a number of personal factors that may influence the decision to begin taking benefits. Some may not have the option of waiting due to financial or health concerns, and others argue that taking benefits early allows people to invest their savings wisely, rather than having to use them for living expenses. Ultimately, the decision is the choice of each individual.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

In response to this need, the American Bar Association’s Commission on Law and Aging has introduced an app that allows advance directives to be stored electronically. My Health Care Wishes is a convenient way for you or family members to present such documents to medical professionals via email or Bluetooth. Other information, including contacts and health information, can also be stored within the app. The electronic documents have the same legal authority as the paper originals. The app is available in a basic free version, and a $3.99 version offers additional features. Before launching, the Bar Association tested the app with health insurers and health care providers with solid results.

There are other options to store important documents in accessible electronic formats, including Dropbox and Docubank. Whichever method you use, make your documents available so that they can be useful when a problem appears.

The attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

Owning pets can provide health improvements for some seniors.

According to a recent study by the Purdue University School of Nursing, pets can reduce depression and help keep seniors on a regular eating schedule, improving nutrition. Other studies have found that seniors who own pets have greater self-esteem and are less lonely and fearful, improving their mental well-being.

At the same time, it is important to be aware that pets and pet toys may increase the risk of falls, which can be a danger to older people. And while taking care of pets is a joy for many seniors, some may find it difficult to keep up with their care, adding to stress. With those caveats in mind, many seniors’ health and well-being are improved by animal companionship.

The Virginia Beach SPCA participates in the activities of the Pets for the Elderly Foundation, a public charity that promotes pet ownership for seniors. For more information, visit www.petsfortheelderly.org.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

However, consumers should consider the contract terms and other aspects of the community carefully, as there are potential risks involved.

Residents of a California CCRC have filed a class action lawsuit against the company that owns it, claiming misrepresentation and breach of fiduciary duty. The community, Vi at Palo Alto, charges a high entrance fee that is refunded if the resident moves out or passes away. The refunds naturally become part of the estate plans of the residents. However, the plaintiffs in the lawsuit claim that the company has no reserve fund to pay refunds and has moved money from entrance fees to a parent company that has no responsibility to pay refunds. For its part, the company says the refunds will be paid, and that it follows standard business practices.

The dispute is a reminder that consumers should be fully informed before entering into any long-term care contract. For more information about CCRCs in Virginia, visit the Virginia Division for the Aging, at www.vda.virginia.gov/ccrc.asp.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

Thankfully, the VA has implemented several new policies to bring the system up to date, including mandated overtime for claims processors and a transition to computerized records. And the efforts appear to be paying off.

The VA recently announced that the backlog of pending claims, which peaked at about 611,000 in March 2013, has fallen by 44 percent. Now, 344,000 claims remain. The current average wait time is 119 days shorter than it was a year ago, the agency says, and the accuracy of decisions has risen as well.

The VA continues to prioritize “fully developed claims.” These are applications in which the veteran submits all relevant records at once and certifies that he or she has no other evidence to submit. Claims from homeless veterans, those facing extreme financial hardship, the terminally ill, former prisoners of war and Medal of Honor recipients will also receive priority.

In 2010, the VA established a goal of processing all disability claims within 125 days.

As veterans’ attorneys, we have seen worthy disabled veterans wait far too long for their compensation, and we are pleased to see progress being made.

The attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

Opportunities for higher education and employment are severely limited for those with disabilities. But a new project in Indiana will be of great interest to those attracted to the hospitality industry.

Construction will soon begin on a teaching hotel in Muncie, Indiana. Developers say the hotel will both employ and teach individuals with developmental and other disabilities, who will compose at least 20 percent of its staff. The 150-room Marriott Courtyard hotel and restaurant will help human resources students and professionals gain a better understanding of special needs employment.

Developers state that the guest experience at the hotel will be the same as at any other Marriott, with the exception of its high levels of accessibility that exceed ADA standards.

The project is expected to break ground later this year, and completion has been estimated for the summer of 2015.

The special needs community needs more national corporations to set examples like this. Such projects teach people of all abilities how to work and learn together.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

Perhaps that is because home care can be a relative bargain. According to the firm, the median wage for a home health care aide is just under $20, an amount that has increased 1.3 percent annually in the past five years. The median annual costs of assisted living and a private nursing home room are $42,000 and $87,600, respectively. Those costs have risen 4.3 and 4.2 percent per year, respectively, over the past five years. Long-term care is more expensive outside the home, and the gap is widening.

However, a recent change to the Fair Labor Standards Act may turn the trend and shrink that divide. Home care aides will soon be covered by the law, making them eligible for minimum wage and overtime pay. Most already earn more than minimum wage, but most do not earn overtime pay.

To control the cost of home health care, many families hire independent caregivers, including friends and neighbors, for assistance. But the changes in labor standards may encourage the long-term care insurance industry to require caregivers to be hired through agencies.

Insurers say that the agency requirement would ensure reliability and consistent quality of care. That may be true, but an agency could also act as a middleman, ultimately driving up the cost of care.

If you are in the market for long-term care insurance, consider whether a given policy will permit you to hire a caregiver directly. Or, if you already have insurance, find out what is permissible under your policy before making hiring decisions. You do not want any surprises in either coverage or care.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

Trusts must have trustees, or managers. Many trust holders hire their estate planning attorneys as trustees, while families of more limited means often turn to a relative or close family friend with the applicable know-how. A pooled trust may be a good option for those who cannot come up with a logical choice for a trustee, or for those without enough assets to justify an individual trust.

Pooled trusts are run by nonprofit organizations for the benefit of multiple beneficiaries. Assets from multiple families are pooled and invested together, and the funds are spent for the benefit of the individuals in proportion to their share of the entire trust.

Pooled trusts vary widely in terms of fees, available services, and contracts. Some provide complete care of beneficiaries, while others provide only appropriate money management.

Managers of pooled trusts must be knowledgeable about laws governing public benefits, and directors usually have relatives with special needs and understand the community’s needs. Pooled trusts give you the benefits of special needs trusts even if you do not have a lot of money to leave to a loved one.

On the other hand, pooled trusts can be expensive, and it can be difficult or impossible to move assets from one pooled trust to another. Also, they are only as good as their managers, and the nonprofits that run them may decline in quality of service or even go out of business if they face financial problems or changes in management.

The attorneys at Hook Law Center can help you decide what kind of special needs trust best suits your family.

Hook Law Center assists Virginia families with with guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To contact a Virginia Beach special needs planning lawyer or to learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

Long-term care planning is also important for older adults with disabilities; their numbers will also increase to roughly 21 million by 2040. By 2050, it is estimated that there will be at least 25 million people in the U.S. who are using long-term care, either at home or in an assisted living or skilled nursing facility. How will those 25 million people pay for their care?

Many of them hope to rely on Medicare or Medi-Cal, but Medicare only pays for up to 100 days of care in a skilled nursing facility after three days in a hospital, and only if that skilled care has been deemed necessary. After the first 20 days, Medicare also has a co-pay which must be met.

Simply stated, Medicare is not a meaningful source of assistance when long-term care services are needed.

The average cost of a nursing home stay in California is $250 per day. Assisted living facilities in California cost an average of $2,900 per month. Adult day services typically run at least $80 a day. Hourly home care costs run between $15 and $30 for a home health aide, who assists with activities of daily living (bathing, dressing, etc.), but is not a registered medical professional and cannot meet more than basic health care needs.

If a more skilled home care provider is needed, the cost is typically between $20 and $40 per hour.

Medicaid, known as Medi-Cal in California, can pay the cost of skilled nursing care, but only after careful planning steps are taken and eligibility is achieved.

Good long-term care sidesteps complete reliance on federal support. A person’s plans may include long-term care insurance, which covers care typically not covered by “regular” health insurance, Medicaid or Medi-Cal. Long-term care insurance helps cover care for someone who cannot perform at least some of the activities of daily living — bathing, dressing, restroom use, eating and moving from chair to bed and back again.

If you are considering a long-term care policy, know that not all insurance agents are aware that you will need a policy that covers both in-home and assisted living care for at least three years (and longer, if possible).

There are multiple long-term care policy options, including policies that provide life insurance benefits if long-term care coverage is never needed. Consult with your estate planning attorney to determine what policy best fits your estate needs for the future.

Pioneers of Elder Law – For over 30 years, Gilfix & La Poll Associates LLP has innovated creative legal solutions to help you manage and plan the future of your estate.
To contact an estate planning lawyer visit http://www.gilfix.com/ or call 800.244.9424.

Many seniors use reverse mortgages to tap into their home equity in order to maintain their standard of living during retirement. Those who do so need to make sure their heirs are aware of the mortgage, because when the borrower dies, they will have to decide on a course of action quickly.

The heirs can keep the property, sell it, or turn it over to the lender. That decision is usually determined by whether there is equity left in the property.

Reverse mortgages are “nonrecourse” loans, which means that if the loan balance exceeds the home’s value, the lender cannot take possession of the estate’s or the heirs’ other assets.

After the lender is notified of the borrower’s death, an appraiser will determine the home’s market value. The amount due to the lender is the lesser of the loan balance or 95 percent of the home’s appraised value. (The remaining 5 percent is paid by government insurance.) The heirs may sell the house or keep it by paying off the loan with cash or other financing.

Heirs initially get six months to pay off the loan. While they work out the details, interest and monthly insurance premiums continue to accrue. Those who wish to keep or sell the home may request up to two extensions of 90 days each by showing they are actively trying to sell the home or to arrange financing to pay off the loan.

On the other hand, if the home has little or no potential equity, the heirs may choose to simply hand it over to the lender rather than go through the hassle of selling it. This is known as “deed in lieu of foreclosure.”

Hook Law Center assists Virginia families with with guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To contact a Virginia Beach special needs planning lawyer or to learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

A third-party special needs trust is the most common type. The trust is created by a third party, using that person’s assets, and names the special needs individual as the beneficiary. These assets are commonly transferred into the trust upon the death of the trust’s creator, or grantor, through a will, life insurance or beneficiary designation.

Less widely known, but equally important, are first-party special needs trusts. Such a trust is created by the special needs individual, using his or her own assets for his or her own benefit. These assets could be the result of a personal injury award, a divorce settlement, a life insurance policy or other circumstances.

In both cases, the trustee — the individual in charge of administering the trust — uses the funds within the trust to support the person with special needs. The rules governing the trust’s expenditures must be followed closely, as any improper use of the funds could endanger government benefits. But the rules do allow a wide variety of life-enriching purchases, including personal services, hobbies, luxury items and vacations.

There are many different varieties of trusts. The help of an experienced special needs attorney is very important in properly creating and administering a special needs trust.

Hook Law Center assists Virginia families with with guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To contact a Virginia Beach special needs planning lawyer or to learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

The U.S. Department of Justice recently announced that a federal grant program that provides electronic tracking devices for adults with Alzheimer’s disease has been expanded to apply to children with autism.

The announcement came after tragedy struck Queens, New York, where the remains of Avonte Oquendo, a 14-year-old autistic boy, were recently discovered. Avonte wandered away from his school on October 4, 2013. A massive search, lasting over three months, resulted in the discovery of the boy’s body in the East River on January 16.

The voluntary program will allow parents of children with autism and other developmental disorders to obtain a tracking device through local law enforcement agencies and nonprofit groups. The devices may be worn as bracelets or anklets and attached to belt loops or shoelaces.

A recent study showed that 49 percent of children and teens with autism have attempted to run or wander from their caretakers. Recovery time of an individual wearing a tracking device averages as much as 95 percent less than that of an individual without a tracking device.

The attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

The Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees those programs, recently announced new rules to strengthen the Community Living Initiative — a program launched in 2009 to develop strategies to increase Medicaid recipients’ opportunities for care in home- and community-based settings (HCBS).

The new rules set definitions for HCBS and specify that Medicaid will support HCBS programs that offer an alternative to care in institutional settings and that take into account a patient’s quality of life. States will be granted a transitional period during which they can ensure their HCBS programs meet requirements. During this period, states will be provided with technical assistance.

The new rules give states more options for expanding HCBS and for targeting specific segments of the population. They also streamline regulatory and documentation procedures for more efficient operations.

The elderly, ill, disabled and low-income populations are all vulnerable to marginalization. Institutionalized care, while necessary and beneficial for some, can be a prime example of such marginalization when not medically necessary. Those who will become able to receive care in their homes and communities because of these changes stand to benefit immensely from the CMS’s new rules.

The attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

Durable power of attorney: Using this document, an individual (like your parent) grants another (like you) the legal authority to manage his or her financial affairs. Unlike a regular power of attorney, a durable power of attorney remains in effect if the grantor becomes incapacitated.

Health care proxy: This document grants a person the authority to make medical decisions on another’s behalf. It is sometimes called a “power of attorney for health care.” You should discuss what constitutes an acceptable quality of life (one that is worth prolonging) for your parent. For instance, if a feeding tube became necessary to keep your parent alive, would he or she want that? Doctors may balk at carrying out a health care proxy’s instructions if another family member disagrees. As such, it is important for your parent to keep other family members informed about the decisions you have discussed.

Medical information release: Patients use this form to give their doctors permission to share their medical records with third parties. These forms can be obtained from the doctors themselves. There is no widely accepted standard form. As an alternative, an experienced elder law attorney, such as those at Hook Law Center, can draft one for your parent. The releases designed at Hook Law Center are called Authorizations for the Release of Protected Health Information, and they comply with the federal law protecting patient privacy (Health Insurance Portability and Privacy Act (HIPPA)). An attorney-drafted document can apply to any doctor/health professional who is treating your parent. In many cases, multiple doctors will be involved in a patient’s treatment. In an emergency, there may not be time for your parent to give individual authorizations to each doctor/health professional involved.

Living will: A living will specifies what medical treatments a person is willing to accept if he or she becomes incapacitated and cannot communicate his or her wishes. Common inclusions and exclusions include the use of resuscitation, feeding tubes and mechanically assisted breathing. The laws concerning living wills vary from state to state, and the documents often contain language that is too broad to apply to many medical conditions. Consult with your elder law attorney to decide whether your parent should have a living will in addition to a health care proxy.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

The new regulation takes effect on January 15, 2014. It will affect some veterans with TBI who are also diagnosed with Parkinson’s disease, depression, certain diseases of the pituitary and hypothalamus glands, certain types of dementia or unprovoked seizures.

For certain veterans with service-related TBI who also suffer from one of the named illnesses, the second illness will also be considered as service-related for purposes of disability compensation.

The rule change was prompted by a report by the Institute of Medicine of the National Academy of Sciences linking moderate to severe TBI with the listed ailments.

Eligibility for additional compensation will depend on the severity of the brain injury and the length of time between the injury and the onset of the second illness. Veterans who do not meet eligibility requirements may still file a claim to establish the ailment as service-related.

“We decide veterans’ disability claims based on the best science available,” Eric K. Shinseki, Secretary of Veterans Affairs, said in the announcement. “As scientific knowledge advances, VA will expand its programs to ensure veterans receive the care and benefits they’ve earned and deserve.”

Current treatment for TBI is usually limited to mitigating the damage it causes in the short term following the injury. Extensive further study is needed to better understand TBI and its connection with various neurological disorders. In the meantime, the VA is helping many deserving veterans by compensating for TBI-related illnesses.

The attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

Since it peaked in March 2013, the backlog has been reduced from 611,000 to just under 401,000 — a 34 percent decrease. The agency also reported that it has concurrently increased its decision accuracy. The three-month average accuracy rate for complete claim files stands at 90 percent, an improvement of five percentage points and seven percentage points over the accuracy rates for 2011 and 2010, respectively.

In April 2013, the VA announced an initiative to expedite decisions on claims that had been pending for more than one year. The following month, the agency mandated 20 hours of overtime per month for all claims processors through the end of 2013. If funding permits, the VA anticipates a continuation of the mandatory overtime policy into 2014.

Eric Shinseki, Secretary of Veterans Affairs, reiterated the agency’s goal of eliminating its claims backlog by the end of 2015 and praised VA employees for their hard work.

The VA said that as it works to reduce its backlog, it will continue to focus on those veterans whose claims have been pending longest, who are homeless or terminally ill, who are former POWs, who are Medal of Honor recipients and on those who file fully-developed claims.

It is encouraging to see a coordinated effort to get benefits to our deserving veterans in a timely manner.

The attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

In 2013 alone, federal special education funding was reduced by $579 million as a result of budget sequestration — a process of automatic, across-the-board spending cuts that began in March 2013 as a result of the Budget Control Act of 2011.

Among those parents who reported changes, nearly one third reported an increase in class size, 27 percent said their child’s school had fewer service providers and some 30 percent said their child’s services decreased. Further, 13 percent blamed budget cuts for a change in their child’s school placement.

The survey was conducted by the National Center for Learning Disabilities. The group’s director of public policy, Lindsay Jones, said that service levels were changing based not on children’s needs, but on the availability of funds — and that such policies were contrary to the law.

Generally, previous polls concerning the effect of budget cuts have focused on the opinions of school administrators and other professionals. This survey is among the first to gauge parents’ perceptions.

Unless Congress intervenes to avert them, further across-the-board budget cuts are expected for 2014.

Hook Law Center assists Virginia families with with guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To contact a Virginia Beach special needs planning lawyer or to learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

If the employee is likely to die first, a joint pension is usually the prudent choice. But some professionals will advocate a strategy known as “pension maximization,” or “pension max.” The strategy involves taking the higher single-life payout and using part or all of the extra income to purchase life insurance. If the employee dies first, the spouse gets a death benefit that, assuming proper planning, is large enough to generate the same income as a joint-and-survivor plan. If the spouse dies first, the worker cancels the life insurance and enjoys the higher income.

Pension max strategies often involve a combination of term and whole life insurance. If only term life were purchased, and both spouses survived beyond the term, additional life insurance would have to be purchased at that time, at an advanced age that would make the insurance quite expensive. On the other hand, it is also expensive to purchase whole life insurance on its own in quantities sufficient to afford the same quality of life as a pension.

In certain cases, a pension max strategy may make sense, but properly weighing the alternatives entails crunching a lot of numbers. When deciding what type of pension plan will work best for you, speak with an experienced estate planning attorney.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

One area in which there is still work to be done is in the way children with special needs are enabled to play with their peers. Specifically, playgrounds are often completely impractical for children with physical disabilities. Their ground surfaces may be impossible for wheelchairs to roll over, and their play areas may not have activities appropriate for children lacking in upper-body mobility, strength, and balance.

Last year, accessibility standards for playgrounds were made mandatory under the ADA so that children of differing abilities could play alongside each other. They include rules on the types of equipment, designs, and materials used in public playgrounds. But those inclusive standards can add significantly to the cost of building playgrounds.

A recent NPR report told the story of a family in Pocatello, Idaho, that led a fundraising effort to build a community playground that was accessible and fun for kids of all ability levels. It is Brooklyn’s Playground, named after the family’s wheelchair-bound seven-year-old daughter. Its wide ramps and smooth rubber ground coverings allow wheelchairs to reach all areas, and its swings have back support for children with upper-body disorders.

At 15,000 square feet and a cost of just over half a million dollars, most municipalities could not afford to build such a playground, but Brooklyn’s family spent eight months soliciting donations and organizing bake sales to make it happen.

When advocates and families work together to give special-needs children every possible opportunity, the entire community benefits.

The attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

One year of retroactive benefits is available to veterans who file a Fully-Developed Claim for service-connected disability. The policy is in effect from August 6, 2013, to August 5, 2015.

Through various policies, the VA is strongly encouraging veterans to file fully-developed claims. When filing FDCs, veterans must provide all supporting evidence in their possession at the time of submission. This may include information the veteran already has, but which the VA is otherwise obligated to track down, and evidence easily obtained by the veteran, such as private medical records.

A traditional claim gives the veteran time to gather evidence while the VA begins to process the claim. An FDC allows the VA to decide the claim more quickly than a traditional claim while still tracking down needed federal records on behalf of the veteran. The VA says it processes FDCs in half the time required for a traditional claim.

After having unconscionable backlogs and waiting times for disability claims for years, the VA appears to be getting its act together. It is switching from paper to computerized records and has implemented an online portal, eBenefits, to allow electronic submission of initial claims, creating an all-electronic process for a portion of cases. And as part of its effort to eliminate its claims backlog in 2015, the VA announced mandatory overtime for all claims processors through the end of the fiscal year.

The attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

On June 26, 2013, the Supreme Court invalidated Section 3 of DOMA, which denied federal benefits to legally married same-sex couples. On August 9, 2013, the SSA issued a statement from Carolyn W. Colvin, acting commissioner, announcing the administration “is now processing some retirement spouse claims for same-sex couples and paying benefits where they are due.” The statement encouraged all individuals who believe they may be eligible to apply for Social Security benefits.

Most same-sex couples who are married reside either in the state in which they married or another state that recognizes their marriage. Others relocated after marrying to states that do not recognize their marriage. For now, it is only certain that the former group will be eligible for federal benefits. It remains to be seen whether those in non-recognizing states will receive equal treatment by the federal government.

President Obama weighed in following the Supreme Court ruling, saying, “It’s my personal belief – but I’m speaking now as a president as opposed to as a lawyer – that if you’ve been married in Massachusetts and you move someplace else, you’re still married, and that under federal law you should be able to obtain the benefits of any lawfully married couple.”

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

The people who were surveyed were “Baby Boomers,” a demographic defined by the post–World War II “baby boom,” born between 1946 and 1964. They consistently estimated long-term care costs to be just under $79,000. But Nationwide Financial Services projects costs for nursing-home care will reach $265,000 per year by 2030.

Costs for nursing home care have consistently increased at least 4 percent every year since 1974, according to John Carter, the president and CEO of Nationwide Financial. He believes that current nursing home costs cannot “even come close” to what that care will cost by the time the youngest Boomers reach retirement age. And those Boomers, like so many before them, are not prepared.

Though most survey respondents reported that they have some sort of plan in place for retirement, a shocking 57 percent admitted that they did not have any plans in place for long-term care.

Odds are not in their favor. At least 44 percent of people who reach 65 find themselves in a nursing home at least once in their lives. How that care will be financed can and does make a significant difference in the quality of care, and personal savings and retirements funds are often drained to cover those costs. But with long-term care planning, that does not have to be the case.

Christopher J. Berry is an elder law attorney Dedicated to helping seniors, veterans and their families navigate the long-term care maze. To learn more visit http://www.theeldercarefirm.com/ or call 248.481.4000

The women bicycled 1,500 miles through nine states and over two dozen cities, pedaling through sweltering summer afternoons and drenching rains for the first-ever women’s Bike 4 Friendship. Men’s cross-country Bike 4 Friendship trips were held in 2011 and 2012, and a third is currently underway.

The events are organized by The Friendship Circle, a Jewish organization for special-needs children and families with 79 locations around the world.

The cyclists set out on June 30, 2013, from Friendship Circle of Miami in Pinecrest, Fla. At 10 a.m., Pinecrest mayor Cindy Lerner cut the starting-line ribbon, and the cyclists began their journey. Lerner also issued a proclamation naming June 30 “Bike 4 Friendship Day.”

Before the cyclists set foot to pedal, the event had already raised $100,000. The trip was scheduled to end on July 28 in Manhattan’s Upper West Side.

Special-needs children face huge challenges in dealing with aspects of daily life that many of us take for granted. Community resources like The Friendship Circle are indispensable. It is difficult to overstate the benefits that children and families can receive from networking and socializing with others who face similar challenges.

Individuals who go to such great lengths to raise funds and awareness for special-needs children deserve great respect. Their selfless actions do a great deal for struggling families.

The attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

The results did not come as a surprise to researchers. When compared with the life of a retiree, working life tends to provide more social connections, physical activity, and mental challenges – all factors shown to help prevent a decline in mental faculties.

Researchers at INSERM, a health research agency of the French government, analyzed the health records of 429,000 workers. They averaged 74 years of age and had been in retirement an average of 12 years.

The study showed that each additional year of work reduced the risk of developing dementia by about 3 percent. On average, an individual who had retired at 65 had about 15 percent less risk of dementia than someone who had retired at 60.

Sometimes declining mental abilities force people into early retirement, and researchers knew they had to control for that possibility. To do so, they ran separate analyses of their data that eliminated subjects who had developed dementia within 5 years of retirement and within 10 years. The trend was the same, demonstrating that work had affected dementia and not the other way around.

About 5 million people in the U.S. have Alzheimer’s – 1 of every 9 people who are 65 years or older. While the cause remains unknown and no treatments exist to slow its progression, scientists recommend certain lifestyle changes that are likely to lower the risk of developing it. They include: exercise and general physical activity; social connections, including volunteer work and joining clubs; healthy eating, including lots of vegetables; and mental challenges, such as crossword puzzles.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

A fully-developed claim is an application for benefits in which all available medical records and other evidence to support the claim is submitted at the time of the initial filing. The veteran certifies upon filing that he or she has no additional evidence to submit. The VA says that it is able to process a fully- developed claim in half the time required for a traditionally-filed claim.

Because private veterans service organizations assist many veterans with their claims, the VA is partnering with two of them – the American Legion and Disabled American Veterans – to steer applicants toward this more efficient process.

The initiative is part of the VA’s plan to eliminate the current massive backlog of claims in 2015 and, thereafter, process new claims within 125 days. The wait for new applicants in major urban areas averages more than 18 months in some cases.

In April 2013, the VA announced that it would expedite decisions on claims that are more than one year old. That plan involves issuing provisional decisions, which are eligible to be revised following the submission of additional evidence or appealed for a period of one year.

And on May 15, 2013, the VA announced that claims processors in its 56 regional benefits offices were required to work overtime for the remainder of fiscal year 2013.

These recent efforts, combined with the VA’s transition to computerized claims processing, should bring some much-needed relief to veterans awaiting the benefits they deserve.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

Last year’s day-long event hosted over 400 elder law attorneys and professionals, who gathered to learn about the latest changes in elder law as well as gain practical insights from fellow elder law professionals.

Mr. Begley will speak at two different sessions including a presentation about the impact of the Affordable Care Act and SSA policy changes on Special Needs Trusts.

Other topics at the Institute include Medicaid estate recovery, long term care planning for married couples and Social Security 101.

For more information about this evet, visit the Pennsylvania Bar Institute web site.

Ethan Ordog and Karyn Van Buskirk will open the day with a presentation about Fiduciary Accountings.  In the following session, Dana Bookbinder will review basic Long-Term Care Planning and later that morning, Thomas Begley Jr will walk attendees through some of the elements of Medicaid Planning Trusts.  Rounding out the morning, Kristen Behrens will discuss Special Needs Trusts with the group.

Location: New Jersey Law Center

One Constitution Square
New Brunswick, NJ
732-214-8500

For more information about the event, you can follow this link to the NJICLE page. 

Medicare Advantage patients are generally subject to a small copayment whenever they see a doctor, after which the visit is completely covered. This is in contrast to having to pay a deductible and then coinsurance – typically 20 percent – which is usually the case under regular Medicare. This generally eliminates the need for a supplemental Medigap policy.

Another attractive feature of Medicare Advantage plans is that they usually cover products and services not covered by regular Medicare, such as prescription drugs and custodial care. Some also cover hearing and vision care, gym memberships, and other services.

These perks do not come without a cost. The primary method by which Medicare Advantage plan providers reduce expenses is limiting the doctors and other providers that a patient can see to a particular network. If a patient voluntarily sees out-of-network providers, they must pay the full cost. However, if a patient’s in-network physician orders medical services not offered by any in-network provider, the Medicare Advantage plan is required by law to pay for those services at an out-of-network provider as long as those services are normally covered by Medicare.

Another cost-cutting measure is to prohibit patients from seeing specialists on their own; patients must be referred to specialists by their primary care physicians. However, plan administrators strongly discourage physicians from referring patients to specialists unless it is absolutely necessary.

These are the primary differences between regular Medicare and Medicare Advantage. If you need to reduce your medical costs and do not mind having to see only in-network health care providers, Medicare Advantage may be right for you.

The attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

If you never have an issue with the care your loved one receives in a nursing home, you are one of the lucky few. If, on the other hand, you have a concern that must be addressed, you may be unsure how to proceed.

The following list explains actions you may take in making your concerns known and getting the level of care you expect for your family member. Significant and pervasive issues – and those involving injury or suffering – often are best handled with the assistance of an experienced elder law attorney. Fortunately, many issues are easily resolved with simple communication.

In all cases, keep careful written records of the observations you made that led to your concerns and your communications with facility staff, including their names. And at all stages, make it known what attempts you have already made to resolve the matter.

1) Talk to staff and explain to them what concerns you and what you expect of them and the facility. Avoid using an accusatory manner.

2) Talk to a supervisor. Again, explain the problem you are having and how you want it resolved.

3) Hold a meeting with nursing home personnel, including a supervisor. If you have regular care planning meetings, that is a good time to raise your concerns. Otherwise, you may request a special meeting.

4) Contact the ombudsman assigned to the nursing home or, if the issue constitutes a regulatory violation, contact your state licensing agency.

5) Hire a lawyer. If communication and appeals to authorities have not resolved the matter, an attorney has the tools to force facilities to follow regulations.

6) Move your relative. While this may be difficult, it is available as a last resort. This does not prevent you from taking legal action against the current facility.

The attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

A grant from the National Science Foundation was awarded to North Carolina State University and Georgia Tech; they were interested in studying whether playing computer games could slow mental decline, and if so, whether games had common elements that could be incorporated into cognition-enhancing “brain games.” Researchers have long wondered whether memory games and problem-solving games could be beneficial to seniors.

More than 200 seniors were tested for cognitive abilities before and after playing a spatial puzzle game to see if playing produced any change. The findings will be shared with Georgia Tech experts, who will incorporate the data into new game development focused on helping seniors retain or improve their cognitive skills. But according to the National Science Foundation’s abstract on the grant, World of Warcraft was not part of the experiment.

Interested in improving your own reasoning skills, memory and processing speed? Experts suggest you play games, work on crosswords, brain teasers and puzzles, and pick up a new hobby or craft.

The elder law attorneys and estate planning lawyers at the Hook Law Center in Virginia Beach and Suffolk, help Virginia families with trust & estate administration, guardianships, long term care planning, special needs planning, veterans benefits, and more. Learn more at http://www.hooklawcenter.com/

The Salute to Senior Service program by Home Instead Senior Care celebrates seniors 65 and older who contribute to their community by volunteering at least 15 hours each month. The organization is inviting the public to nominate outstanding senior volunteers. Do you know someone who has made a significant contribution? You may even nominate yourself. Nominations are being accepted between February 1 and March 31, 2013. The state winners will then be chosen by popular vote on the program’s website between April 15th and April 30, 2013.

A national Salute to Senior Service honoree will then be chosen from the group of state winners by a panel of senior care experts. Home Instead has announced that it will donate $500 to the nonprofit organizations of choice as selected by each of the state winners, and their volunteer stories will be included on the online Wall of Fame. The national winner’s chosen nonprofit will receive $5,000.

The nomination form and official rules of the contest can be found online at
http://www.salutetoseniorservice.com/

The elder law attorneys and estate planning lawyers at the Hook Law Center in Virginia Beach and Suffolk, help Virginia families with trust & estate administration, guardianships, long term care planning, special needs planning, veterans benefits, and more. Learn more at http://www.hooklawcenter.com/