If you have a beloved elder who currently needs or will eventually need long term, in-home health care, you need to know about new changes to federal labor laws that may not only raise the cost of these services but potentially alter quality aspects. In addition to federal labor and wage laws, state and even local laws may impact what you pay for in home health care and who provides it.

When a person suffers from dementia, alzheimer’s, or or another cognitive health condition, he or she will likely need the aid of a home health care aide to provide even the most basic of care needs. For many years, home health care providers who also lived in the patient’s home were subject to different portions of the federal Fair Labor Standards Act (FLSA) which made them exempt from overtime and would essentially earn less than minimum wage because the individual was expected to be on call even during the evening.

However, a recent legal decision determined these in-home health care workers were not overtime exempt and must be paid one and a half times their average hourly wage when working more than 40-hours per week. This meant that it became economically feasible for many families to maintain constant care to their loved one from a familiar person that could be counted on to provide attentive, individualized service to the patient.

The Trump administration recently issued a directive to revoke the Temporary Protected Status (TPS) for tens of thousands of immigrants from poverty stricken countries living in the country, many of whom who have found roles in the home healthcare market. With the cost of in-home and assisted living facility growing every year, the change could potentially add to those costs and put seniors and the disabled in a more difficult financial situation.

Approximately 59,000 Haitians came to live in the United States after the 2010 earthquake which devastated the country. Nursing homes and in-home care providers are already reporting staffing shortfalls as immigrants who found employment in their sectors have returned home for fear of forced deportation after losing their legal status. Even despite the threat of deportation, many immigrants working in nursing homes and as in-home health aides do not stay long in these jobs as they find professions in much higher paying sectors of the economy.

In Boston, Massachusetts for example, some elder care providers are speaking out about the selfless, hard work that their immigrant employees living on TPS status perform for long hours and modest pay. With many coming from nations where the witnessed humanitarian crises and seek to give back as part of the aid they themselves received in their times of need.

The dream of Americans is to age with dignity and independence while enjoying their golden years with family and friends and avoiding the need for any type of long term institutionalized care. However, trends in aging show that more and more Americans these days are relying on some type of intermediate institutionalized care before eventually moving into a nursing home to receive the attentive services they need.

However, despite receiving an estimated $10 billion in federal funding from the Centers for Medicare and Medicaid Studies (CMS), states encounter little oversight from regulators over the quality of care residents receive. Furthermore, over half the states do not report “critical incidents” to the federal government that include unexplained deaths, abuse, neglect or financial exploitation. All of that is according to a recent report from the Government Accountability Office (GAO).

Advocacy group Justice for Aging issued its own response to the GAO report to highlight the lack of accountability from many states and facilities receiving CMS funding. The directing attorney for Justice in Aging went as far as to point out that even among the 22 states that do provide the federal government with data on critical incidents the information is hard for the public to obtain and may not even illuminating enough.

The U.S. Department of Justice recently announced hundreds of indictments against individuals engaged in often elaborate schemes to defraud hundreds of thousands of elders across the country. The Justice Department said in a statement that it levied charges against over 250 defendants for their roles that contributed to an estimated $500 million in total financial damages against victims.

“Today’s actions send a clear message: We will hold perpetrators of elder fraud schemes accountable wherever they are,” Attorney General Jeff Sessions said in announcing the charges at a press conference. The Department of Justice coordinated with dozens of federal and local agencies to make the arrests, including working with Federal Bureau of Investigations, the Federal Trade Commission and state attorneys generals.

The perpetrators of the scheme allegedly used everything from mass mailing system and telemarketing schemes to identity theft to commit financial crimes against some of the most vulnerable portions of the population. In the past several years, the Senate Aging Committee received thousands of calls from individuals complaining they were either victims or an attempted target of some type of elder fraud.

Retirement is a time to relax and enjoy the things you have worked hard for all of your life. For many people, that means spending more time at the golf course or spoiling grandchildren. For others, it means adventure and traveling to places they have always wanted to go. In many cases, a person or couple’s objectives in retirement can best be met by retiring abroad. Whether you are doing so for the cost of living, to be closer to family, or just because you want to there are important considerations to keep in mind when it comes to your comprehensive estate plan.

Taxes

No matter what country they live in, citizens of the United States are still required to pay taxes to Uncle Sam. If you maintain residence in a state, that state may also continue to impose taxes on you. While you would likely be paying those taxes if you remained in the United States, living abroad could also subject you to taxes in the host country. That means you may face issues of double taxation, and that can have a significant impact on the assets you retain within your estate.

The New York Department of Financial Services recently published a proposal to add a “best interest” standard to insurance regulations that imposes suitability requirements on annuity recommendations by producers and insurers in New York. The move comes soon after the National Association of Insurance Commissioners (NAIC) suitability working group issued its own proposed guidelines for best interest standards for the NAIC Model Suitability Regulation which seeks to create a national standard for insurance regulations.

The proposals would require that an annuity purchase and replacement recommendation not only be suitable but also be in the best interest of the consumer at the time the recommendation is made. The proposal defines “best interest” as “acting with reasonable diligence, care, skill and prudence in a manner that puts the interest of the consumer first and foremost” and does not necessarily mean the cheapest policy available.

Although the proposed NAIC models are only recommendations to state regulators overseeing their respective insurance markets, they are nonetheless important because many professional organizations rely on these private interest groups for guidance on how to conduct their business. New York is one of the majority of state that already have adopted laws requiring insurance producers to make “suitable” annuity purchase recommendations and require insurers to maintain supervision systems designed to ensure compliance with regulations.

The new tax laws taking effect in 2018 give both individuals and couples even more flexibility to plan for their estates and ensure the largest possible part of their estate goes to beneficiaries on a tax-free basis. While the changes will remain in effect until 2025, families should start formulating estate plans now in order to take the greatest advantage possible of the reforms and craft the best possible plan for the future.

The tax reform bills substantially increases the individual estate and gift tax exemption from $5.6 million to approximately $11.2 million and up to $22.4 million for a married couple. After December 31, 2025, the numbers will revert back to their 2017 numbers adjusted for inflation. However, law makes no changes to the 40 percent tax rate currently imposed on transfers in excess of the exemption amount.

With the new changes, wealthy individuals and couples should consider immediately making large gifts or create trusts to maximize their federal estate and gift tax exemptions. Having the ability for married couples to transfer up to $22.4 million can benefit multiple generations of family members and avoid any future additional wealth transfer taxes. Furthermore, those who have already expended their gift tax exemptions prior to the end of 2017 will now have an additional $11.2 million to work with.

Promising statistics recently came out early this year indicating the mortality rate for older Americans is down from 2015 to 2016, perhaps due in part to the greater access to healthcare our elders enjoy now that insurance companies cannot deny individuals with pre-existing conditions. For Americans age 75 to 84, the mortality rate improved by 2.3 percent between 2015 and 2016, or twice the rate of improvement seen between 2011 and 2016. The figures come from the Society of Actuaries and is based on data provided by the Centers for Disease Control.

Mortality also improved for those 85-years and older by 2.1 percent, which is more than three times the rate of improvement between 2011 and 2016, according to new analysis from the Society of Actuaries. However, Americans aged 25 to 34-years old saw their mortality rates increase by 10.5 percent in 2016 which represented the highest of all age brackets.

The Society of Actuaries believes the uptick in mortality rates for younger Americans is due to a spike in accidents and the nationwide opioid epidemic. According to the report, opioid deaths are up almost 25 percent across the country in 2016, which constituted the highest increase for any single type of death.

The White House recently announced it planned to scale back initiatives put in place by the previous administration to reduce wasteful spending created by the complexities of the country’s healthcare system. As a result, officials from the Center for Medicare and Medicaid Studies (CMS) said they will no longer be operation on an aggressive timeline put in to place which sought to link increases in Medicare payments based on the quality of care patients received from hospitals which received the funding.

The objective of the direction taken by the Obama administration was to overhaul the nation’s largest health care program by altering payments to doctors and hospitals so that these providers would be incentivized to reduce unnecessary services that can put a drain on resources. The hope was that doctors would coordinate patient care, resulting in lowering healthcare costs while still maintaining vital revenue streams from Medicare that providers rely upon to do business.

To reach that goal, officials announced back in 2015 that in just three-years, half of Medicare payments to hospitals would be tied to standards on patient quality of care. However, White House officials recently told some news outlets that the new administration would instead conduct a review of how well the plan did or did not work at achieving this goal. While the Trump administration is not likely to fully do away with the initiatives, it is unlikely the proposed timeline will remain in place.

A recent audit conducted by the Social Security Office of the Inspector General found that the program has failed to fully pay the overwhelming majority of surviving spouses entitled to receive survivor benefits in addition to the regular Social Security benefits. According to the report, the Social Security Administration shorted $131 million to over a combined 9,000 widows and widowers aged 70 and older, or about 82 percent of those eligible.

The issue stems from a provision passed in the Bipartisan Budget Act of 2015 which ended the so-called “file and suspend” strategy which activates one spouse’s monthly benefit and suspends the other’s in order to increase payments on the delayed account after the individual reaches 70-years old. The members of Congress who passed the bill did so under the assertion those types of provisions constitute loopholes that unfairly increase payments to married couples.

However, the law was never meant to impose restrictions on couples filing a restricted application for survivor benefits where beneficiaries elect to claim their survivor benefits and delay taking their own Social Security benefits until the age of 70. This allows the widow or widower to grow their own Social Security benefits by 8 percent annually up until he or she reaches the age of 70. For those who are aware of the opportunity and take advantage of it, the increased benefits can make a tremendous difference in quality of life.

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