Category: Elder Law

Considering Medicaid Asset Protection Trusts?

Considering Medicaid Asset Protection Trusts?

Medicaid, a joint state and federal program, provides health coverage to low-income individuals of all ages. Qualifying for Medicaid requires meeting strict income and asset limits, which vary by state and the type of Medicaid coverage sought. If you are considering Medicaid Asset Protection Trusts, there are a few things to know.

These limits pose a significant hurdle for many, especially those needing long-term care. According to an ElderLawAnswers article, this is where Medicaid Asset Protection Trusts (MAPTs) come into play. MAPTs offer a legal avenue to protect assets, while preserving eligibility for Medicaid benefits.

A MAPT is an irrevocable trust established during your lifetime that transfers ownership of assets to a trust, so Medicaid excludes them from the resource limit during eligibility qualification. Once transferred, you no longer own the assets directly, which helps you to meet Medicaid’s eligibility criteria. Appoint a trustee other than yourself to manage the trust and to transfer the assets, such as real estate or stocks, into the trust’s name correctly.

Key Considerations:

  • Timing is Crucial: A MAPT must be created and funded with Medicaid’s 60-month lookback period in mind. Assets transferred into the trust within this period may penalize your Medicaid eligibility.
  • Living Arrangements: Transferring your home into a MAPT doesn’t mean you have to move out. You can still reside in your home, although the trust technically owns it.
  • Income and Benefits: You can receive income from the trust’s assets. However, this income may affect your Medicaid eligibility.

Medicaid Asset Protection Trusts are a valuable strategy for individuals looking to qualify for Medicaid without sacrificing their assets. If you are considering Medicaid Asset Protection Trusts, work with an attorney to understand how these trusts work and the financial considerations involved, so you can make informed decisions about your long-term care planning. If you would like to learn more about elder law, please visit our previous posts. 

Reference: ElderLawAnswers: What Are Medicaid Asset Protection Trusts?

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Understanding how a Guardianship and Conservatorship Contrast

Understanding how a Guardianship and Conservatorship Contrast

Guardianship and conservatorship are two legal mechanisms designed to assist individuals who cannot manage their own affairs. While they share similarities, understanding how a guardianship and conservatorship contrast is vital. Guardianship typically pertains to personal and health care decisions, while conservatorship deals with financial matters. Both require court appointment and carry significant responsibility.

Guardianship involves the legal authority granted to a guardian to make decisions on behalf of a person who is unable to do so. This typically pertains to personal, health and welfare decisions. A court appoints a guardian when an individual is deemed incapacitated, and the guardian may have to make a wide range of personal decisions for them. A guardian has significant responsibilities, including making personal care decisions, overseeing living arrangements and ensuring the overall well-being of their ward. They must keep detailed records and report to the court regularly, demonstrating that they are acting in the best interests of the ward.

In cases involving minor children, guardianship becomes essential when parents are unable to provide care. The guardian, appointed by the court, assumes responsibility for the child’s personal needs and welfare, acting in their best interests. This is often seen when parents are unable or unwilling to care for their child or in the event of the death of the parents.

Conservatorship, on the other hand, is primarily focused on financial matters. A conservator is appointed to manage the financial affairs of an individual who is unable to do so themselves, due to incapacity or other reasons. This includes managing a person’s assets, making investments and handling financial decisions. In conservatorship proceedings, the court appoints a conservator to oversee the financial needs of the incapacitated individual. The conservator must act responsibly and is often required to provide the court with periodic financial reports.

While a guardian manages personal and medical decisions, a conservator handles the financial aspects, such as personal and financial records, asset management and financial planning. This distinction is crucial in understanding the roles and responsibilities each holds.

The legal authority granted to a guardian differs from that of a conservator. A guardian makes personal and medical decisions, while a conservator focuses on financial and asset management. This division ensures that all aspects of an individual’s life are cared for adequately. Both guardians and conservators are appointed by the court and must act in the best interests of their wards. They are supervised by the court and must provide regular reports to demonstrate their compliance with legal responsibilities.

Incorporating guardianship and conservatorship into an estate plan is crucial. An estate plan can appoint a guardian or conservator in advance, providing clarity and direction in the event of incapacitation. Including a power of attorney in your estate plan can preempt the need for a court-appointed guardian or conservator. This allows you to choose who will make decisions on your behalf, if you become unable to do so.

An effective estate plan, including wills and power of attorney, can provide peace of mind and ensure that your wishes are honored. It prepares for scenarios where you might be incapacitated, ensuring that your personal and financial matters are in trusted hands. Navigating the complexities of guardianship and conservatorship can be challenging. A lawyer can help you understand how a guardianship and conservatorship contrast. The assistance of an estate planning or elder lawyer is invaluable in understanding your options, the legal process and ensuring that your loved one’s needs are met.

Each situation is unique, and a lawyer can provide tailored advice depending on your specific circumstances. They can help you navigate the legal system, ensuring the best outcome for you and your loved ones. If you would like to learn more about guardianship, please visit our previous posts. 

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Navigating Advance Directives in Dementia Care

Navigating Advance Directives in Dementia Care

Navigating the complexities of advance directives in dementia care is one of the biggest challenges for caregivers. The concept of advance directives in healthcare is both a cornerstone of patient autonomy and a source of profound ethical dilemmas, particularly in the context of dementia. This was poignantly illustrated in a recent New York Times article by Dr. Sandeep Jauhar, who shares his personal story about his father’s battle with dementia. This article delves into the complexities surrounding advance directives, especially for patients with dementia, and offers guidance for families grappling with these challenging decisions.

Understanding Advance Directives

Advance directives are legal documents that allow individuals to outline their preferences for medical care if they cannot make decisions for themselves. These directives are crucial in ensuring that a patient’s wishes are respected, particularly at the end of life. However, when it comes to progressive conditions like dementia, the clarity of these directives often becomes blurred.

The Dilemma in Dementia Care

Dementia uniquely challenges the concept of advance directives. As Dr. Jauhar describes, the person who made the directive may evolve into someone with different desires and capacities. This transformation raises the question: should we honor the wishes of the person who drafted the directive, or should we consider the current state and apparent desires of the patient?

Ethical Considerations

This situation presents a significant ethical dilemma. On the one hand, there’s the principle of respecting the patient’s autonomy as expressed in their advance directive. On the other hand, there’s the issue of non-maleficence — the duty to do no harm — which could conflict with a directive when a patient seems content in their current condition despite severe cognitive impairment.

The Role of Family and Caregivers

Families and caregivers often find themselves at the heart of this conflict. They must balance respect for the patient’s previously stated wishes with empathy for their current state. Effective communication among family members and healthcare providers is crucial in navigating these decisions.

Legal and Medical Perspectives

Advance directives legally are typically held as the definitive expression of a patient’s wishes. However, the medical community is increasingly recognizing the need for flexibility, especially in the context of diseases like dementia that significantly alter a patient’s cognitive and emotional state.

Rethinking Advance Directives

There’s a growing consensus that advance directives need to accommodate the possibility of changing perspectives, especially for conditions that affect cognitive function. This could involve incorporating specific clauses about cognitive decline or changing desires in the directive.

Practical Advice for Families

Families should approach advance directives as dynamic documents. It’s essential to regularly revisit and potentially revise these directives, considering the patient’s evolving health status and wishes. Open discussions about end-of-life preferences are crucial, as is seeking advice from healthcare professionals and legal experts.

Conclusion

The journey through a loved one’s dementia, as Dr. Jauhar’s story illustrates, is fraught with complexities and emotional challenges. While respecting a patient’s past wishes is crucial, so is recognizing their present state and evolving desires. The balance between these perspectives is delicate but fundamental in end-of-life care.

Empathy, understanding, and open communication remain our most powerful tools as we continue to confront these issues. It’s imperative to not only consider what was desired in the past but also to remain sensitive to the needs and happiness of the patient in their current state.

For those seeking guidance navigating advance directives, especially in the context of dementia care, it is advisable to consult with a local estate planning attorney. These professionals can provide invaluable assistance in drafting and updating advance directives to reflect your or your loved one’s evolving wishes and medical circumstances. Reach out to your local estate planning attorney today to ensure that your advance directives are consistent with your current desires and legal standards. If you would like to learn more about advance directives, please visit our previous posts. 

Reference: New York Times“My Father Didn’t Want to Live if He Had Dementia. But Then He Had It.” by Dr. Sandeep Jauhar.

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Estate Planning for the Sandwich Generation

Estate Planning for the Sandwich Generation

The sandwich generation, a term for individuals juggling the care of their children and aging parents, faces unique challenges. This demographic, typically in their 30s and 40s, is experiencing a rise due to later childbirth and an aging population, compounded by the recent pandemic’s impact on long-term care facilities. Effective estate planning for the sandwich generation is critical in managing these dual responsibilities.

Understanding the Demographics and Trends

Significant societal trends influence the increasing numbers of the sandwich generation. Understanding these trends is essential for tailored estate planning strategies.

The Importance of Estate Planning

Estate planning is crucial for the sandwich generation. It provides a structured approach to managing the complexities of caring for children and elderly parents. This planning can offer peace of mind and a clear path forward in challenging circumstances.

Key Strategies for Effective Estate Planning

  • Prioritizing and Reprioritizing Responsibilities
    • Estate planning for the sandwich generation starts with effectively managing daily tasks. Identifying urgent versus non-urgent tasks can help balance the care of children and elderly parents.
  • Self-Care as a Crucial Aspect of Estate Planning
    • Self-care is vital to avoid caregiver burnout. Individuals in the sandwich generation need to maintain their well-being to provide the best care for their loved ones.
  • Understanding Legal Rights and Workplace Benefits
    • Knowing workplace rights, such as those provided by the Family Medical Leave Act (FMLA), is an integral part of estate planning for the sandwich generation. This knowledge can help caregivers maintain job security, while caring for their families.
  • Communication and Support Networks
    • Open communication within the family and access to support networks and forums are key to managing the expectations and responsibilities of being part of the sandwich generation.
  • Financial Planning and Resource Management
    • A crucial aspect of estate planning for the sandwich generation is evaluating financial resources. This includes understanding the financial capabilities of aging parents and exploring public assistance or family contributions when needed.
  • Discussions with Aging Parents and Family Members
    • Conversations about care preferences and financial abilities with aging parents and family members are essential. These discussions should be part of the estate planning process.

Legal Documents and Decision-Making Powers

Estate planning include preparing legal documents that empower decision-making for aging parents and minor children. Powers of attorney and healthcare directives are examples of such documents.

Preparing for the Future

Long-term considerations, like home renovations for elderly care, professional services and retirement savings, are essential in estate planning for the sandwich generation. Insurance policies and emergency funds are critical to protecting the family’s future.

Regular Review and Update of Estate Plans

The dynamic nature of the sandwich generation’s responsibilities necessitates regular reviews and updates of their estate plans. This ensures that the plans stay relevant and effective in meeting the family’s changing needs.

Conclusion

Effective estate planning for the sandwich generation is essential in managing their complex role. With the right planning and resources, individuals in this generation can provide for their families, while caring for their elderly parents.

If you’re part of the sandwich generation, consider consulting with an estate planning attorney to develop a plan tailored to your unique situation. This step can be pivotal in securing your family’s future and navigating the challenges you face. If you would like to learn more about estate planning for caregivers, please visit our previous posts. 

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Tips to protect Seniors from Guardianship Abuse

Tips to protect Seniors from Guardianship Abuse

Issues Inherent in the Guardianship System

Elder law attorneys see firsthand the complexities and potential pitfalls of guardianship arrangements. The recent investigation into guardianship practices in Florida, as reported by the Washington Post, underscores the urgent need for vigilance and reform in this area. While guardianships are designed to protect the vulnerable, they can sometimes lead to significant abuses, including forced isolation and financial exploitation. This article aims to shed light on the complexities of the guardianship system, expose issues related to guardian-inflicted elder abuse. It will also provide practical tips to protect seniors from guardianship abuse by planning before becoming incapacitated.

What Is Guardianship?

Guardianship is a legal process where a court appoints an individual (the guardian) to make decisions for someone deemed unable to make decisions for themselves (the ward). This arrangement is often necessary for seniors who can no longer manage their affairs due to health issues like dementia or stroke. It’s estimated that more than one million Americans are in a guardianship, a number that will only grow as the U.S. population ages and elderly people no longer have family living nearby to provide the care and protections they need.

A Cautionary Guardianship Case

Douglas Hulse, a former pilot from Florida, was hospitalized due to a stroke. After his recovery period ended and his condition did not improve, Orlando Health South Seminole Hospital could not discharge him without having an assigned caretaker. Therefore, the hospital petitioned the court to assign him a guardian due to the inability to locate his family. His loss of control over his assets and personal decisions to a court-appointed guardian is a stark reminder of guardianship risks. His guardian, responsible for 19 other wards, made questionable decisions like selling his home without seeking to locate his family.

What Role Do Hospitals have in Guardianship Appointments?

Hospitals often play a significant role in initiating guardianship proceedings. Cases like Hulse’s in which the hospital petitions for a court-appointed guardian are becoming more common nationwide, especially when elderly patients have no known family or friends to care for them. While this process is meant to ensure the patient’s well-being, it can inadvertently lead to the appointment of guardians who may not act in the best interest of the ward or, worse, will exploit the senior ward through financial abuse or other ways.

Why Is the Adult Guardianship System Allowing Abuse and Exploitation of Wards?

The discrepancies in the guardianship appointment and training process further complicate this issue. There is often a lack of standardized procedures for appointing and monitoring guardians, leading to inconsistent practices and an increased risk of abuse. This situation calls for a more rigorous and standardized approach to guardianship appointments at the state level, ensuring that only qualified and ethical individuals are entrusted with such significant responsibilities.

How Do Guardianships Put Seniors at Risk of Abuse?

The Hulse case highlights several risks associated with guardianship:

  1. Loss of Personal Freedom and Fundamental Rights: Once under guardianship, individuals may lose basic rights, such as voting, consenting to medical treatment, managing their finances, or deciding where to live.
  2. Financial Exploitation: Guardians have significant control over the ward’s assets, allowing them to access financial accounts directly and conduct financial transactions without oversight. This access can lead to mismanagement or outright theft.
  3. Lack of Oversight: Guardianships often lack sufficient legal or administrative oversight, allowing unscrupulous guardians to take advantage of their wards. Because a judge appoints guardians, they often do not face punishment or legal recourse for abusive behavior.

How to Protect Yourself From Court-Ordered Guardianship

  1. Advance Planning: The best defense against guardianship abuse is advance planning. This includes setting up durable powers of attorney for health care and finances, which allow you to designate someone you trust to make decisions on your behalf if you become incapacitated.
  2. Regular Monitoring: If guardianship is unavoidable, family members should stay involved and monitor the guardian’s actions. Regularly reviewing financial statements and staying in close contact with the ward can help detect any irregularities.
  3. Choosing the Right Guardian: If a guardian is necessary, choose someone trustworthy and capable. This could be a family member or a professional with a good reputation and credentials.
  4. Legal Oversight: Courts should have robust systems to monitor guardianships. This includes regular reporting by guardians and audits of their financial management.
  5. Awareness and Education: Seniors and their families should be educated about the risks of guardianship and the importance of advance planning. Community programs and legal clinics can provide valuable information and resources.
  6. Advocacy and Reform: Advocacy for better laws and policies around guardianship is crucial. This includes pushing for reforms that increase transparency, accountability and oversight in the guardianship process.

Key Takeaways:

  • Guardianship can lead to significant abuses, including loss of autonomy and financial exploitation.
  • Hospitals often initiate guardianship proceedings for incapacitated patients without family, which can lead to inappropriate guardian appointments.
  • Advance planning, such as establishing durable powers of attorney, helps prevent guardianship abuses.
  • There is a need for increased legal oversight and reform in the guardianship system to protect the rights and well-being of the elderly.

Utilize these tips to protect the seniors you love from guardianship abuse. Work with an experienced elder law or estate planning attorney to ensure that someone you love does not fall prey to abuse but has a legally documented estate plan to protect them and their financial well-being. If you would like to learn more about guardianship issues, please visit our previous posts. 

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Tax Planning may Impact your Medicare Costs

Tax planning may impact your Medicare costs. How much retirees pay for Medicare Part B premiums is based on income levels, and an income increase of even $1 can trigger higher tax rates, explains the recent article, “Year-end tax strategies may affect how much retirees pay for Medicare. Here’s what to know” from CNBC.

Social Security beneficiaries will receive a 3.2% increase in benefits in 2024 based on the annual COLA (Cost of Living Adjustment). According to the Social Security Administration, this will result in an estimated increase of more than $50 per month, bringing the average monthly retirement benefit for workers from $1,848 in 2023 to $1,907 in 2024.

How much beneficiaries will actually receive won’t be known until December, when annual benefit statements are sent out. One factor possibly offsetting those benefit increases is the size of Medicare Part B premiums, which are typically deducted directly from Social Security monthly benefits.

Medicare Part B covers physician services, outpatient hospital services, some home health care services, durable medical equipment and other services not covered by Medicare Part A.

Medicare Part B premiums for 2024 have not yet been announced. However, the Medicare trustees have projected the standard monthly premium possibly being $174.80 in 2024, up from $164.90 in 2023.

Some beneficiaries may pay more, based on income, in what’s known as IRMAA or Income Related Monthly Adjustment Amounts. In 2023, it is the standard Part B premium for those who file individually and have $97,000 or less (or $194,000 or less for couples) in modified adjusted gross income on their federal tax return in 2021.

Monthly premiums can go up to as much as $560.50 per month for individuals with incomes of $500,000 and up, for couples with $750,000 and up.

Beneficiaries receive the same Medicare services regardless of the monthly Part B premium rate.

In 2024, the monthly Part B premiums will be based on 2022 federal tax returns. Beneficiaries need to pay attention to how their incomes may change when implementing year-end tax strategies.

For instance, if you do a Roth conversion, taking pre-tax funds from a traditional IRA or eligible qualified retirement plan like a 401(k) and moving them to a post-tax retirement account, you’ll trigger income taxes, which may trigger higher Medicare Part B premiums later.

Tax planning may impact your Medicare costs. People who do end-of-year tax loss harvesting, selling off assets at a loss to offset capital gains owed on other profitable investments, may reduce adjusted gross income and future Medicare premiums.

If you’re taking distributions from IRAs and want to make charitable donations, you might want to make those donations directly from your retirement account, known as a qualified charitable distribution. These funds don’t appear on your tax return and won’t increase income taxes or future Medicare premiums. If you would like to read more about Medicare and tax planning, please visit our previous posts. 

Reference: CNBC (Oct. 12, 2023) “Year-end tax strategies may affect how much retirees pay for Medicare. Here’s what to know”

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Selling the Family Home when a Loved One needs Nursing Care

Selling the Family Home when a Loved One needs Nursing Care

When an aging relative decides the time is right to move into an assisted living or continuing care facility, families face many decisions. This is often a difficult but necessary step for older individuals with trouble living independently or planning for their future needs. Selling the family home when a loved one needs nursing care can be a challenge. A recent article from Herald—Standard, “How to handle selling a home when moving into an assisted living facility,” offers suggestions to help families navigate the process.

First, speak with an estate planning attorney to have a trusted, responsible family member be named Power of Attorney. Individuals moving into assisted living may not have any cognitive problems at the time of the move. However, selling a home for a family member who develops dementia can present complex challenges. Only a person with legal capacity may transfer their home to a new owner. Having a Power of Attorney allows a family member to step in and manage the transaction without needing to go to court and have a guardian named.

Talk about the situation and the sale with the aging family member. They will need time to process the idea of selling their home and moving. Homeowners make untold sacrifices and compromises to buy and maintain their homes, so the decision to sell a beloved home is almost always very difficult and brings out a range of emotions.

Throughout this process, an open and honest dialogue about what can be achieved by selling the home and improving their quality of life will be helpful.

Sorting through belongings is an extremely hard task. A lifetime of memories and a loss of their independence are all wrapped up in the contents of a home. It will be impossible to take the entire contents into a one or two-bedroom apartment. Take the time to sort through belongings with your family members and select certain items to give them a sense of home in a smaller space.

If possible, try to pass on some items to younger family members. Most importantly, handle this process with as much compassion as possible.

Keep all relevant people involved and current throughout the process. This is particularly important if the family members are scattered in different states. Adult children who live far away and can’t be active participants in this process shouldn’t be dismissed and left out. Open communication with other family members will minimize the chances of objections when the sale and move take place.

Finally, because this is perhaps the largest and last financial transaction, make sure the sale of their home is done with an eye to their estate plan. Selling the family home when a loved one needs nursing care may cause tax issues. There may be ways to minimize tax exposure for the individual and their estate plan. Confer with an estate planning attorney to avoid any missteps. If you would like to learn more about managing property in your estate plan, please visit our previous posts.

Reference: Herald-Standard (Oct. 27, 2023) “How to handle selling a home when moving into an assisted living facility”

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The Difference Between Guardianship and Power of Attorney

The Difference Between Guardianship and Power of Attorney

Navigating the intricate landscape of elder law can be daunting, especially when faced with the decision between guardianship and power of attorney for elderly parents. This article sheds light on the difference between guardianship and power of attorney, providing clarity on which approach might be the best fit for your family’s unique situation.

What Exactly Is a Power of Attorney?

A power of attorney is a legal document that empowers an individual, often referred to as the “agent” or “attorney-in-fact,” to act on behalf of another, known as the “principal”. This authority can span a myriad of areas, from handling financial matters to making pivotal medical decisions.

  • Deciphering the Power of Attorney Document: The power of attorney document delineates the extent of the agent’s authority. For instance, a medical power of attorney focuses on health care decisions, while a financial power of attorney pertains to managing financial assets, like bank accounts.
  • The Significance of Durable Power of Attorney: This variant of power of attorney remains valid even if the principal becomes incapacitated due to conditions like dementia or Alzheimer’s disease. It’s imperative that this durable power of attorney must be prepared with precision, ensuring the agent’s ability to act remains unaffected by the principal’s mental state.

Guardianship: An Overview

Guardianship establishes a legal relationship where a guardian is court-appointed to make decisions for someone unable to do so themselves.

  • Guardianship Proceedings: Initiating guardianship requires one to file a petition in the probate court. If the court ascertains that the individual is no longer able to care for themselves or their assets, it may appoint a guardian.
  • Differentiating Guardian of a Person from Guardian of an Estate: While the former is tasked with personal and medical decisions, the latter oversees financial matters. The guardian’s responsibilities, whether it’s a duty to provide care or manage financial assets, hinge on the terms of the guardianship.

Power of Attorney or Guardianship: Which Path to Choose?

The choice between power of attorney and guardianship is contingent on the specific needs of the elderly individual.

  • Comparing Decision-Making Power: Both the agent (under power of attorney) and the guardian have a shared duty to provide for the best interest of the individual. However, a guardian typically possesses a more expansive level of decision-making power.
  • Flexibility and Autonomy: With a power of attorney, the principal gets to choose the person who will act on their behalf. In contrast, in a guardianship proceeding, the court has the final say, which might not always resonate with the individual’s preferences.

When Is Guardianship the Answer?

Guardianship becomes indispensable when an elderly parent is incapacitated and lacks a power of attorney.

  • The Process of Seeking Guardianship: If there’s a belief that an elderly parent is vulnerable, it becomes imperative to file a petition for guardianship. Consulting an elder law attorney can streamline the guardianship proceeding.
  • Guardianship vs Power of Attorney Post-Incapacitation: In the absence of a durable power of attorney, guardianship emerges as the sole recourse if an individual becomes incapacitated.

Can Power of Attorney and Guardianship Coexist?

Indeed, it’s possible to have both mechanisms in place, although their interplay can be intricate.

  • Roles and Boundaries: An adult child might be designated as the agent for financial matters under a power of attorney, while a professional guardian could be entrusted with medical decisions.
  • Harmonious Operation: Both the agent and guardian must act in the best interest of the individual, ensuring their comprehensive well-being.

Making the Right Choice for Your Family

Deciding between power of attorney and guardianship demands careful contemplation.

  • Engage with an Elder Law Attorney: Their expertise can offer tailored guidance, helping you traverse the complexities of elder law.
  • Factor in the Elderly Parent’s Desires: Their voice is paramount in the decision-making matrix, ensuring that their autonomy and dignity are preserved.

Key Takeaways:

  • Power of Attorney is a legal instrument allowing individuals to designate someone to act on their behalf.
  • Guardianship is a court-sanctioned role for those incapacitated and unable to make decisions autonomously.
  • The distinction between the two hinges on the individual’s circumstances and the extent of decision-making power required.
  • Both mechanisms can coexist, though their roles might differ.
  • Engaging with an elder law attorney is pivotal to making an informed decision tailored to your family’s needs.

Work closely with your estate planning attorney to ensure you understand the difference between power of attorney and guardianship. If you would like to learn more about guardianship, please visit our previous posts.  

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Consider using a Trust Be for Long-Term Care

Consider using a Trust Be for Long-Term Care

More than a few seniors who are retired or nearing retirement lose sleep worrying over being able to afford the expense of long-term care, including nursing home care, which can cost thousands monthly. The fallback option for many Americans is Medicaid; according to a recent article, “Long-Term-Care planning using trusts,” from the Journal of Accountancy., Medicaid is a joint federal-state program requiring spending down assets. One option is to consider using a trust for long-term care.

To be eligible for long-term care through Medicaid, a person’s “countable” assets must fall below an extremely low ceiling—in some states, no more than $2,000, with some provisions in some states protecting the “well” spouse. States vary in terms of which assets are counted, with many exempting a primary residence, for example.

For many people, planning for Medicaid for long-term care may consider the use of an irrevocable trust. The basic idea is this: by transferring assets to an irrevocable trust at least five years before applying for Medicaid for long-term care, the Medicaid agency will not count those assets in determining whether Medicaid’s asset ceiling is satisfied.

If the planning is done wrong, there is a risk of not qualifying, thereby defeating the objective of creating the irrevocable trust. In addition, any tax planning may be undone, causing liquidity and other problems.

Some people plan to qualify for Medicaid even though they have asset levels as high as $2 million or more. Much of this may be the family’s primary residence, especially in locations like New York City, with its elevated real estate market. Costs at nursing homes are equally high, with nursing homes costing private-pay patients upwards of $20,000 a month, or $250,000 per year.

Timing is a key part of planning for Medicaid. Many estate planning attorneys recommend clients consider planning in their mid-to-late 60s or early 70s to move assets into a Medicaid Asset Preservation Trust, also called a Medicaid Asset Protection Trust.

This is because of Medicaid’s five-year lookback period. Most states have a five-year look-back period for both nursing home and home health care. If any transfer of countable assets has been made within the preceding five years of applying for long-term-care Medicaid, there will be a penalty period when the person or their family must pay for the care. The penalty is typically measured by the length of time the transferred assets could have paid for care, based on the average costs of the state or the region.

While there is no way to know when a person will need long-term care, statistically speaking, a person in their mid-to-late 60s or early 70s can expect to be healthy enough to satisfy the five-year lookback.

Why not simply make gifts to children during this time to become eligible for Medicaid? For one reason, there’s no way to prevent a child from spending money given to them for safekeeping. A trust will protect assets from a child’s creditors, and if the child should undergo a divorce, the assets won’t end up in the ex-spouse’s bank accounts.

Using a trust for Medicaid planning could be combined with gifts made to children or assets placed in trust for children, depending on the individual’s financial and familial circumstances.

The creation of a Medicaid Asset Preservation Trust is critical. The estate planning attorney must seek to accomplish two things: one, to say to Medicaid that the settlor, or creator of the trust, no longer owns the assets. At the same time, the IRS must see that the settlor still owns these assets and, therefore, receives a basis step-up at death.

If you are considering a trust for long-term care, an experienced estate planning attorney will be needed to advise you and create a Medicaid Asset Preservation Trust to meet the Medicaid and IRS requirements. If you would like to learn more about long-term care planning, please visit our previous posts. 

Reference: Journal of Accountancy (Oc. 9, 2023) “Long-Term-Care planning using trusts”

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RLT can Help with Planning for Incapacity

RLT can Help with Planning for Incapacity

Planning for potential disability and mental incapacity is part of a comprehensive estate plan. Women, in particular, are at a higher risk of becoming disabled, with 44% of women 65 and older having a disability. Most people understand the value of an estate plan. Nevertheless, few know how to that a Revocable Living Trust, or RLT, can help with planning for incapacity, as explained in the article “Incapacity Planning: The Hidden Power Of A Revocable Trust” from Financial Advisor.

Revocable Living Trusts are highly effective tools to protect assets against failing capacity. Although everyone should have both, they can be more powerful and efficient than a financial Power of Attorney. An RLT offers the freedom and flexibility to manage your assets while you can and provides a safety net if you lose capacity by naming a co-trustee who can immediately and easily step in and manage the assets.

Cognitive decline manifests in various ways. Incapacity is not always readily determined, so the trust must include a strong provision detailing when the co-trustee is empowered to take over. It’s common to require a medical professional to determine incapacity. However, what happens if a person suffering cognitive decline resists seeing a doctor, especially if they feel their autonomy is at risk?

Do you need an RLT if you already have a financial Power of Attorney? Yes, for several reasons.

You can express your intentions regarding the management and use of trust assets through the trust. A POA typically authorizes the agent to act on your behalf without specific direction or guidance. A POA authorizes someone to act on your behalf with financial transactions, such as selling a home, representing you and signing documents. The co-trustee is the only one with access to assets owned by the trust, while the POA can manage assets outside of the trust. Having both the POA and RLT is the best option.

Trustees are often viewed as more credible than a POA because RLTs are created with attorney involvement. POAs are often involved in lawsuits for fraud and elder abuse.

Suppose there is an instance of fraud or identity theft. In that case, RLTs provide another layer of protection, since the trust has its own taxpayer ID independent of your taxpayer ID and Social Security number.

Your co-trustee can be the same person as your POA.

Adding a trusted family member as a joint owner to accounts and property provides some protection without the expense of creating a trust. However, it does not create a fiduciary obligation, enforceable by law, for the joint owner to act in the original owner’s best interest. Only POAs or trustees are bound by this requirement.

Once a POA is in place, it is wise to share it with all institutions holding accounts. Most of them require a review and approval process before accepting a POA. Don’t wait until it’s needed, when it will be too late because of incapacity, to have a new one created.

If you know that planning for incapacity is in your family’s future, consider how an RLT can help. Talk with your estate planning attorney about planning to create an RLT and POA to ensure that your assets will be protected in case of incapacity. If you would like to learn more about incapacity planning, please visit our previous posts. 

Reference: Financial Advisor (Oct. 18, 2023) “Incapacity Planning: The Hidden Power Of A Revocable Trust”

Photo by Gustavo Fring

 

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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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