Category: Assisted Living

Advance Care Planning a Benefit to Seniors

Advance Care Planning a Benefit to Seniors

Advance care planning (ACP) is an ongoing discussion that involves shared decision-making to clarify and document an individual’s wishes, preferences and goals regarding their medical care. This is extremely important to making certain that they get the medical care they want, if they become incapacitated and unable to make their own decisions. Advance care planning is a major benefit to seniors. Despite the importance of ACP, most Americans don’t have their medical wishes documented, according to Medical Life Sciences News’ recent article entitled “Comprehensive approach may promote Advance Care Planning for elderly adults.”

In the pandemic, too many families exhausted themselves attempting to address this issue, agonizing over what their loved one might have chosen for their care if they had been given the chance.

Dr. Angelo Volandes, MD, MPH, physician and researcher, Division of General Internal Medicine at Massachusetts General Hospital, and colleagues started the Advance Care Planning: Communicating with Outpatients for Vital Informed Decisions (ACP-COVID) pragmatic trial. This experiment was designed to see if ACP participation during the pandemic would increase following implementation of video decision aids and clinician communication skills training. They also looked at how these interventions would affect ACP documentation among patients from ethnic and racial minority groups, specifically African Americans and Hispanics.

The trial included a large, diverse patient population aged 65+ from 22 outpatient clinics at Northwell Health, the largest healthcare system in New York State. ACP documentation from three six-month time periods was compared:

  1. Pre-COVID-19
  2. The first wave of COVID-19; and
  3. An intervention period.

The findings showed that ACP documentation was significantly greater among all groups during the intervention period, with African American and Hispanic patients showing the most significant increases.

“The stark disparity in COVID-related outcomes for African American and Hispanic patients highlights a reality already known by many: our healthcare system routinely fails to meet the needs of minority patients. No one intervention or initiative is going to correct all those failings though advance care planning, through engaging and empowering patients, is one of the most effective, immediate ways to address disparities in care,” adds Volandes, who is also an Associate Professor of Medicine at Harvard Medical School.

“Fundamentally, advance care planning aims to empower patients. The results of our study demonstrate the importance of meeting patients where they are,” adds Volandes. “Whether that means providing information in their native language or sharing educational material via text rather than a patient portal, if advance care planning is to be about the patient and we need to find ways to ensure that they feel they have the knowledge and ability to make decisions alongside their clinicians when they deem the time is right. COVID-19 has made ACP more important than ever, and especially in communities that have been hardest hit by the pandemic.” The bottom line is that advance care planning can be a huge benefit to seniors and their caregivers. Work closely with an elder law attorney to begin the planning process. If you would like to learn more about long-term care and nursing home planning, please visit our previous posts. 

Reference: Medical Life Sciences News (Feb. 28, 2022) “Comprehensive approach may promote Advance Care Planning for elderly adults”

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costs of long-term care be challenging

Costs of Long-Term Care can be Challenging

The potential costs of long-term care be challenging for even a relatively prosperous patient if they are forced to stay for some time in a nursing home. SGE’s recent article entitled “How to Pay for Long-Term Care” explains that although long-term care insurance can be a good way to pay for long-term care costs, not everyone can buy a policy. Insurance companies won’t sell coverage to people already in long-term care or having trouble with activities of daily living. They may also refuse coverage, if you have had a stroke or been diagnosed with dementia, cancer, AIDS or Parkinson’s Disease. Even healthy people over 85 may not be able to get long-term care coverage.

However, there are a number of options for covering these expenses, including the following:

  • Federal and state governments. While the federal government’s health insurance plan doesn’t cover most long-term care costs, it would pay for up to 100 days in a nursing home if patients required skilled services and rehabilitative care. Skilled home health or other skilled in-home service may also be covered by Medicare. State programs will also pay for long-term care services for people whose incomes are below a certain level and meet other requirements.
  • Private health insurance. Employer-sponsored health plans and other private health insurance will cover some long-term care costs, such as shorter-term, medically necessary skilled care.
  • Long-term care insurance. Private long-term care insurance policies can cover many of the costs of long-term care.
  • Private savings. Older adults who require long-term care that’s not covered by government programs and who don’t have long-term care insurance can use money from their retirement accounts, personal savings, brokerage accounts and other sources.
  • Health savings accounts. Money in these tax-advantaged savings can be withdrawn tax-free to pay for qualifying medical expenses, such as long-term care. However, only those in high-deductible health plans can put money into health savings accounts.
  • Home equity loans. Many older adults have paid off their mortgages or have a lot of equity in their homes. A home equity loan is a way to tap this value to pay for long-term care.
  • Reverse mortgage. This allows a homeowner to get what amounts to a home equity loan without paying interest or principal on the loans while they’re alive. When the homeowner dies or moves out, the entire balance of the loan becomes due. The lender usually takes ownership.
  • Life insurance. Asset-based long-term care insurance is a whole life insurance policy that permits the policyholder to use the death benefits to pay for long-term care. Life insurance policies can also be purchased with a long-term care rider as a secondary benefit.
  • Hybrid insurance policies. Some long-term care insurance policies are designed annuities. With a single premium payment, the insurer provides benefits that can be used for long-term care. You can also buy a deferred long-term care annuity that’s specially designed to cover these costs. Some permanent life insurance policies also have long-term care riders.

While the costs of long-term care can be challenging, most people will not face extremely burdensome long-term care costs because nursing home stays tend to be short, since statistics show that most people died within six months of entering a nursing home. Moreover, the vast majority of elder adults aren’t in nursing homes, and many never go into them. If you would like to learn more about long-term care, please visit our previous posts. 

Reference: SGE (Dec. 4, 2021) “How to Pay for Long-Term Care”

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restructure assets to qualify for Medicaid

Restructure Assets to Qualify for Medicaid

Some people believe that Medicaid is only for poor and low-income seniors. However, with proper and thoughtful estate planning and the help of an attorney who specializes in Medicaid planning, all but the very wealthiest people can often qualify for program benefits. There are ways to restructure assets to qualify for Medicaid.

Kiplinger’s recent article entitled “How to Qualify for Medicaid says that unlike Medicare, Medicaid isn’t a federally run program. Operating within broad federal guidelines, each state determines its own Medicaid eligibility criteria, eligible coverage groups, services covered, administrative and operating procedures and payment levels.

The Medicaid program covers long-term nursing home care costs and many home health care costs, which are not covered by Medicare. If your income exceeds your state’s Medicaid eligibility threshold, there are two commonly used trusts that can be used to divert excess income to maintain your program eligibility.

Qualified Income Trusts (QITs): Also known as a “Miller trust,” this is an irrevocable trust into which your income is placed and then controlled by a trustee. The restrictions are tight on what the income placed in the trust can be used for (e.g., both a personal and if applicable a spousal “needs allowance,” as well as any medical care costs, including the cost of private health insurance premiums). However, due to the fact that the funds are legally owned by the trust (not you individually), they no longer count against your Medicaid income eligibility.

Pooled Income Trusts: Like a QIT, these are irrevocable trusts into which your “surplus income” can be placed to maintain Medicaid eligibility. To take advantage of this type of trust, you must qualify as disabled. Your income is pooled together with the income of others and managed by a non-profit charitable organization that acts as trustee and makes monthly disbursements to pay expenses on behalf of the individuals for whom the trust was made. Any funds remaining in the trust at your death are used to help other disabled individuals in the trust.

These income trusts are designed to create a legal pathway to Medicaid eligibility for those with too much income to qualify for assistance, but not enough wealth to pay for the rising cost of much-needed care. Like income limitations, the Medicaid “asset test” is complicated and varies from state to state. Generally, your home’s value (up to a maximum amount) is exempt, provided you still live there or intend to return. Otherwise, most states require you to spend down other assets to around $2,000/person ($4,000/married couple) to qualify.

Sit down with an experienced elder law attorney and your estate planning attorney. Together they can help restructure your assets to qualify for Medicaid. If you would like to learn more about Medicaid, please visit our previous posts. 

Reference: Kiplinger (Nov. 7, 2021) “How to Qualify for Medicaid”

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ways to reduce financial elder abuse

Ways to reduce Financial Elder Abuse

The numbers are chilling. One in ten Americans age 60+ has experienced elder abuse. One of the most common forms of elder abuse is financial, says a recent article from Forbes titled “What Is Elder Financial Abuse—And How Do We Prevent It?”  There are ways to reduce financial elder abuse.

Financial elder abuse is defined as when someone illegally or improperly uses an elderly person’s money for their own use. Elderly people are easy victims for obvious reasons. They may be mentally vulnerable, suffering from Alzheimer’s or other form of dementia. They may also be lonely and find the company of a new “friend” is so delightful that it impairs their judgement.

Financial elder abuse occurs most often from adult children, but also in nursing homes and assisted living facilities. Be on the watch for those new friends who enter senior’s lives, especially if they seek to limit contact with family members.

Caregivers or nursing staff have access to resident’s possessions, including checkbooks, ATM cards and credit cards. Monitoring an elderly parent’s bank accounts on a regular basis should be part of caregiving by adult children. Unusual transactions, large withdrawals or unlikely purchases by credit card should immediately be reported to their bank or credit card company.

Less obvious and harder to track, is when someone forces a nursing home resident to sign legal documents transferring ownership of homes, cars, bank accounts and even investment accounts. They may also be pressured into creating a new will.

Here are some red flags to watch for:

  • New names being added to bank accounts or on credit cards.
  • Finding unpaid bills, letters from collection agencies or past due notices from creditors, especially when the person has sufficient funds.
  • Relatives who suddenly show up and want to be involved with an aging senior, including estranged children.
  • The unexpected transfer of any kind of asset to someone who is not a family member.
  • Any change in habits concerning money, including someone who was never worried about money suddenly being concerned about paying bills.

The elderly are often scared to report being victimized. They may fear further loss of control over their lives or be embarrassed to have been scammed. If a caregiver is stealing, they may also be physically threatened, or frightened of losing their familiar care provider.

There are ways to reduce financial elder abuse. Talk to your estate planning attorney, speak with the local Adult Protective Services office, or contact the National Elder Fraud Hotline, if you are concerned about a loved one being financially exploited.  If you believe a loved one is in physical danger, contact the local police. Don’t hesitate to ask for help. If you are interested in learning more about elder abuse, please visit our previous posts. 

Reference: Forbes (Nov. 9, 2021) “What Is Elder Financial Abuse—And How Do We Prevent It?”

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When should You Consult an Elder Law Attorney?

When should You Consult an Elder Law Attorney?

Elder law attorneys assist seniors or their family caregivers with legal issues and planning that related to the aging process. These attorneys frequently help with tax planning, disability planning, probate and administration of an estate, nursing home placement and many other legal issues. When should you consult an elder law attorney?

Forbes’ recent article entitled “Hiring an Elder Law Attorney,” explains that elder law attorneys are specialists who work with seniors or caregivers of aging family members on legal matters that older adults face as they age. Many specialize in Medicaid planning to help protect a person’s financial assets, when they have Alzheimer’s disease or another debilitating illness that may require long-term care. They can also usually draft estate documents, including a durable power of attorney for health and medical needs, and even a trust for an adult child with special needs.

As you get older, there are legal issues you, your spouse or your family caregivers face. These issues can also change. For instance, you should have powers of attorney for financial and health needs, in case you or your spouse become incapacitated. You might also need an elder law attorney to help transfer assets, if you or your spouse move into a nursing home to avoid spending your life savings on long-term care.

Elder law attorneys can help with a long list of legal matters seniors frequently face, including the following:

  • Preservation and transfer of assets
  • Accessing health care in a nursing home or other managed care environment and long-term care placements
  • Estate and disability planning
  • Medicare, Social Security and disability claims and appeals
  • Supplemental insurance and long-term health insurance claims and appeals
  • Elder abuse and fraud recovery
  • Conservatorships and guardianships
  • Housing discrimination and home equity conversions
  • Health and mental health law.

The matters listed above are all issues that should motivate you to consult an elder law attorney. Certified Elder Law attorney Melissa Donovan at Texas Trust Law can help! If you would like to learn more about elder law, please visit our previous posts. 

Reference: Forbes (Oct. 4, 2021) “Hiring an Elder Law Attorney”

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Estate of The Union Episode 11-Millennials’ Mysteries Uncovered!

 

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protect loved ones from financial elder abuse

Protect Loved Ones from Financial Elder Abuse

In 2021, more than 6.2 million people in America live with some form of Alzheimer’s disease and need some type of memory care. At the same time, financial abuse and scams, especially those targeting people 65 and older, are on the rise, says the Better Business Bureau. It is important to protect loved ones from financial elder abuse.

Individuals suffering from Alzheimer’s and other forms of dementia face unique challenges when it comes to financial elder abuse and scams, according to a recent report “Protecting you or a loved one from financial elder abuse and scams” from Idaho News 6. The increasing number of Alzheimer’s diagnoses increases chances of needing in-home, memory care or skilled nursing care at some point, making it increasingly important to plan ahead. When there is no advance planning, financial devastation and the potential for financial elder abuse occurs.

Planning starts with an experienced estate planning attorney who can help the family prepare these four basic documents:

  • Last Will and Testament
  • Financial Power of Attorney
  • Health Care Power of Attorney
  • Living Will/Advanced Directive

There are additional documents, depending upon the individual’s situation, including a Durable Power of Attorney, used to give another person the ability to make decisions for property, business and financial matters. In cases of future incapacity, this is extremely important.

Power of Attorney: This appoints an “agent” who can make financial decisions on behalf of the “principal.” The POA creates a fiduciary relationship between the agent and their principal, wherein the agent must act in the best interest of the principal, above their own interest. The selection of a POA is very important, since it is a big responsibility.

The Principal should also name a successor agent, in case the primary agent is not able or willing to take on their role. Understand the possibility of abuse of power by the agent before finalizing any documents. An agent who abuses their powers or reaches beyond their powers can be prosecuted.  However, it is best to make a good choice from the start and try to avoid problems.

Most of us get all the right protection in place for our homes, cars and have health insurance in place. However, the chances of needing long-term care for a dementia are actually higher than having your house burn down.

Planning for incapacity and protecting loved ones from financial elder abuse can be accomplished with the help of an estate planning attorney. Have the conversations with your attorney and your family early and get going.

If you would like to learn more about elder abuse, please visit our previous posts.

Reference: Idaho News 6 (Sep. 14, 2021) “Protecting you or a loved one from financial elder abuse and scams”

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What should women know about long-term care

What Should Women Know about Long-Term Care?

A longer retirement increases the odds of needing long-term care. An AARP study found more than 70% of nursing home residents were women, says Kiplinger’s recent article entitled “A Woman’s Guide to Long-Term Care.”  What should women know about long-term care?

Living longer also increases the chances of living it alone because living longer may mean outliving a spouse. According to the Joint Center for Housing Studies of Harvard University, “In 2018, women comprised 74% of solo households age 80 and over.”

The first step is to review your retirement projections. It’s wise to look at “what-if” scenarios: What-if the husband passes early? How does that impact their retirement? What if a female client lives to 100? Will she have enough to live on? What if a single woman needs long-term care for dementia? Alzheimer’s and dementia can last for years, eating up a retiree’s nest egg.

Medicare and Medicaid. Government programs, such as Medicare and Medicaid, are complicated. For instance, Medicare may cover some long-term care expenses, but only for the first 100 days. Medicare doesn’t pay for custodial care (at home long-term care). Medicaid pays for long-term care. However, you must qualify financially.

Planning for long-term care. If a woman has a high retirement success rate, she may want to self-insure her future long-term care expenses. This can mean setting up a designated long-term care investment account solely to be used for future long-term care expenses. If a woman has a modest degree of retirement success, she may want to lower her current expenses to save more for the future. She may also want to look at long-term care insurance.

Social Security. Women can also think about waiting to claim Social Security until age 70. If women live longer, the extra benefits accrued by waiting can help with long-term care. Women with a higher-earning husband may want to ask the higher-earning spouse to delay until age 70, if possible. When the higher-earning spouse dies, the widow can step into the higher benefit. The average break-even age is generally around 77-83 for Social Security. If an individual can live longer than 83, the more dollars and sense it makes to delay collecting until age 70.

Estate Planning. Having a comprehensive estate plan is a must. Women (and men) should have a power of attorney (POA). A POA gives a trusted agent the ability to write checks and send money to pay for long-term care.

When it comes to long-term care, women should know their own health and the potential drain on the retirement savings. Work with a financial advisor and estate planning attorney to make sure your later years are secure.

If you would like to learn more about long-term care, please visit our previous posts.

Reference: Kiplinger (July 11, 2021) “A Woman’s Guide to Long-Term Care”

 

choosing between assisted living or memory care

Choosing between Assisted Living or Memory Care

When considering a long-term care facility, it can be difficult choosing between assisted living or memory care options. Forbes’ recent article entitled “Assisted Living vs. Memory Care: Which Is Right for You?” explains that assisted living is a long-term care facility that lets seniors remain independent, while providing help with daily tasks. It often provides a small apartment, housekeeping, community meals and activities.

It’s critical to thoroughly review the support needs and challenges facing the person you’re supporting and to try to look honestly at what’s working and what’s not.

The best candidate for assisted living is a person who needs assistance with their activities of daily living but still has their reasoning skills intact. Residents can enjoy socialization and activities with people their own age. This helps with isolation after spouses and friends are no longer with them.

Assisted living residents frequently require personal care support. However, these seniors are able to communicate their needs. Residents may receive help with taking medicine, bathing, toileting and other activities of daily living, or ADLs.

Memory care facilities are secured facilities that serve the needs of those with some form of dementia. These facilities typically have smaller bedrooms but more available, open and inviting common spaces. Research shows the way memory care facilities are designed can be helpful in easing the stressful transition from home to a long-term care community. This includes softer colors, a lack of clutter and clear signage.

Confusion and memory loss can cause anxiety. That’s why having a predictable routine can help. As dementia progresses, a patient may forget how to do normal activities of daily living, such as brushing their teeth, eating, showering and dressing. Memory care facilities ensure that these needs are met.

A memory care facility typically has a smaller staff-to-patient ratio than assisted living because an individual suffering from dementia has greater care needs. Staff will frequently undergo additional training in dementia care.

A memory care facility isn’t always a standalone community. Assisted living or skilled nursing homes may have a separate memory care wing where seniors get the same socialization and activities but with 24/7 protection.

Rather than choosing between assisted living and memory care facilities, having both options in one place can be a plus. The person can start in a less restrictive type of setting in assisted living with the option to transition to memory care as needs, abilities and interests are changed by the condition.

Both types of care have some autonomy but help with hygiene and medication management. However, staff in a memory care unit is specifically trained to work with people with cognitive impairments.

If you would like to learn more about long term care options, please visit our previous posts. 

Reference: Forbes (Aug. 16, 2021) “Assisted Living vs. Memory Care: Which Is Right for You?”

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women should plan for long-term care

Women should plan for Long-Term Care

Women face some unique challenges as they get older. The Population Reference Bureau, a Washington based think tank, says women live about seven years longer than men. This living longer means planning for a longer retirement. While that may sound nice, a longer retirement increases the chances of needing long-term care. Thus, women should consider how to plan for long-term care.

Kiplinger’s recent article entitled “A Woman’s Guide to Long-Term Care” explains that living longer also increases the chances of going it alone and outliving your spouse. According to the Joint Center for Housing Studies of Harvard University, in 2018 women made up nearly three-quarters (74%) of solo households age 80 and over.

Ability to pay. Long-term care is costly. For example, the average private room at a long-term care facility is more than $13,000/month in Connecticut and about $11,000/month in Naples, Florida. There are some ways to keep the cost down, such as paying for care at home. Home health care is about $5,000/month in Naples, Florida. Multiply these numbers by 1.44 years, which is the average duration of care for women. These numbers can get big fast.

Medicare and Medicaid. Medicare may cover some long-term care expenses, but only for the first 100 days. Medicare does not pay for custodial care (at home long-term care). Medicaid pays for long-term care, but you have to qualify financially. Spending down an estate to qualify for Medicaid is one way to pay for long-term care but ask an experienced Medicaid Attorney about how to do this.

Make Some Retirement Projections. First, consider an ideal scenario where perhaps both spouses live long happy lives, and no long-term care is needed. Then, ask yourself “what-if” questions, such as What if my husband passes early and how does that affect retirement? What if a single woman needs long-term care for dementia?

Planning for Long-Term Care. If a female client has a modest degree of retirement success, she may want to decrease current expenses to save more for the future. Moreover, she may want to look into long-term care insurance.

Waiting to Take Social Security. Women can also consider waiting to claim Social Security until age 70. If women live longer, the extra benefits accrued by waiting can help with long-term care. Women with a higher-earning husband may want to encourage the higher-earning spouse to delay until age 70, if that makes sense. When the higher-earning spouse dies, the surviving spouse can step into the higher benefit. The average break-even age is generally around age 77-83 for Social Security. If an individual can live longer than 83, the more dollars and sense it makes to delay claiming benefits until age 70.

Estate Planning. Having the right estate documents is a must. Both women and men should have a power of attorney (POA). This legal document gives a trusted person the authority to write checks and send money to pay for long-term care.

Living longer means women should plan for long-term care. Work with your estate planning attorney and financial advisor to craft a plan that ensures you are well cared for should long-term care be needed.

If you would like to learn more about long-term care, and other related issues, please visit our previous posts.

Reference: Kiplinger (July 11, 2021) “A Woman’s Guide to Long-Term Care”

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Episode 6 of The Estate of The Union podcast is out now

 

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protect assets and maintain Medicaid eligibility

Protect Assets and maintain Medicaid Eligibility

Medicaid is a welfare program with strict income and wealth limits to qualify, explains Kiplinger’s recent article entitled “You Can Keep Some Assets While Qualifying for Medicaid. Here’s How.” This is a different program from Medicare, the national health insurance program for people 65 and over that largely doesn’t cover long-term care. There are a few ways to protect assets and maintain Medicaid eligibility.

If you can afford your own care, you’ll have more options because all facilities don’t take Medicaid. Even so, couples with ample savings may deplete all their wealth for the other spouse to pay for a long stay in a nursing home. However, you can save some assets for a spouse and qualify for Medicaid using strategies from an Elder Law or Medicaid Planning Attorney.

You can allocate as much as $3,259.50 of your monthly income to a spouse, whose income isn’t considered, and still maintain Medicaid eligibility. Your assets must be $2,000 or less, with a spouse allowed to keep up to $130,380. However, cash, bank accounts, real estate other than a primary residence, and investments (including those in an IRA or 401(k)) count as assets. However, you can keep a personal residence, non-luxury personal belongings (like clothes and home appliances), one vehicle, engagement and wedding rings and a prepaid burial plot.

However, your spouse may not have enough to live on. You could boost a spouse’s income with a Medicaid-compliant annuity. These turn your savings into a stream of future retirement income for you and your spouse and don’t count as an asset. You can purchase an annuity at any time, but to be Medicaid compliant, the annuity payments must begin right away with the state named as the beneficiary after you and your spouse pass away.

Another option is a Miller Trust for yourself, which is an irrevocable trust that’s used exclusively to maintain Medicaid eligibility. If your income from Social Security, pensions and other sources is higher than Medicaid’s limit but not enough to pay for nursing home care, the excess income can go into a Miller Trust. This allows you to qualify for Medicaid, while keeping some extra money in the trust for your own care. The funds can be used for items that Medicare doesn’t cover.

These strategies are designed to protect assets or income for couples; leaving an asset to other heirs is more difficult. Once you and your spouse pass away, the state government must recover Medicaid costs from your estate, when possible. This may be through a lien on your home, reimbursement from a Miller Trust, or seizing assets during the probate process, before they’re distributed to your family.

Note that any assets given away within five years of a Medicaid application date still count toward eligibility. Property transferred to heirs earlier than that is okay. One strategy is to create an irrevocable trust on behalf of your children and transfer property that way. You will lose control of the trust’s assets, so your heirs should be willing to help you out financially, if you need it. Work with an estate planning attorney to craft a plan that protects assets and maintains Medicaid eligibility.

If you would like to learn more about Medicaid planning, please visit our previous posts. 

Reference: Kiplinger (May 24, 2021) “You Can Keep Some Assets While Qualifying for Medicaid. Here’s How”

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Information in our blogs is very general in nature and should not be acted upon without first consulting with an attorney. Please feel free to contact Texas Trust Law to schedule a complimentary consultation.
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