Articles Posted in Caregiving

There are many estate planning tools that should be considered when writing a will. While the obvious includable provisions are for assets and property distribution, you should also consider how you want your life insurance policy distributed as well as any retirement benefit accounts. The policies you have subscribed to and pay premiums on will administer a life insurance policy or benefits as you have provided, however, many people forget to amend these policies when they go through events such as a divorce or if they lose a loved one.

Life Insurance Policies

Failing to update life insurance policies can end up benefitting a party you no longer intend to provide for, such as a former spouse who has since remarried, or a family member or friend you have been estranged from. Thus, it is certainly a good practice to amend and update your policy after a major event or to make sure it aligns with your wishes every few years. Making reference to the life insurance policy and the intended beneficiary in your will just goes to further support your claim to show whom you wish to receive the proceeds of policy.

How property and assets are distributed when you pass can be a sensitive topic that many people do not like to address, in fact, more than half of Americans die without a will every year. This failure to plan for the distribution of assets and property can leave many interested parties at odds and may not reflect what your last wishes were for your legacy. Depending on what you are leaving behind, there are some considerations that must be made regarding your assets.

Depending upon the state you reside in, your property may pass subject to probate or it may pass outside due to pre-documented rights of survivorship or trust language. If you live in a community property state, which means that all property acquired by you or your spouse during the marriage, regardless of who bought it is property of the marriage, then your property will pass subject to probate court. However, passing through probate may be avoided if you have left rights of survivorship language in your will or property ownership documentation. Property is then subject to the estate tax, which may not be the main concern of dissolution, depending on the assets involved.

Additionally, a trust can be set up that will either avoid probate or will continue to be includable in your estate. If you seek to avoid probate, you can form what is called an irrevocable trust, which allows you to put your assets and property in a  trust, to be held and owned by the trustee, who works to administer the trust under the governing trust and also make decisions in the best interest of the grantor and any potential beneficiaries. However, if you wish to form a trust but still seek to maintain control of your assets and property by amending or revoking the trust during your lifetime, you can form a revocable trust.

As we continue to age, there are a number of ailments that develop and health issues that we are forced to address and adapt to. While we anticipate problems such as achy joints and the occasional stiff legs, we do often forget about the continued upkeep associated with dental hygiene. Dental checkups are easy to forget about and avoid, especially when you do not feel like anything is wrong, however, as soon as something starts to ache, the check up can turn into a very expensive visit. Many elderly individuals avoid going to the dentist due to the associated fear of costs and lack of coverage.

 

Medicare does not provide dental care coverage for their insured beneficiaries, which leads many to either go without coverage or to retain an independent plan that could cost them more than they can afford in their budget. Millions of elderly Americans rely on Social Security and Medicaid or Medicare to support them in their old age, however, these programs continue to shrink in size and will not be able to provide for all of those soon to be retirees. Medicare does provide dental care for some chronic medical conditions such as reconstruction following an accidental injury, or extraction due to radiation exposure for neoplastic diseases of the jaw, a very specific list. Even with those exceptions, the reimbursement rate is so low that some doctors will not accept Medicare coverage in their offices because they know how difficult it becomes to get paid.
The National Center for Health Statistics has found that 20% of Americans over 65 years old have cavities that are currently going untreated, with the numbers steadily increasing with old age. With teeth becoming more brittle and procedures performed decades earlier needing maintenance, many elders find themselves in the Emergency Room due to the pain. There are a number of nonprofits however across the nation that offer free or discounted dental cleanings for elderly patients that do not have dental coverage and cannot afford it. Additionally, many universities offer discounted cleanings as well as procedures by having elderly patients be seen by their class of graduating dentists. They will offer up front costs of services as well as payment plans in an effort to avoid having the individual rack up debt.

Meals on Wheels is a government program that started in the 1950s that has assisted elderly citizens by delivering food to them when in need, either by providing the meals in the elderly individual’s home or in a community senior center. They not only provide the meal but also provide safety checks and visit with the senior, critical actions that have been shown to help elders live longer. There are over 5,000 independent organizations across America that help administer the program, and it has for decades, had much success. In order to receive funding local communities as well as the Older Americans Act help to keep the program afloat.

 

As the new budget is proposed, many programs are in jeopardy of being cut. One program that is may see a threat to funding is Meals on Wheels, due to the program not providing results. However, the nature of the program is not a results oriented initiative. The program services 2.4 million Americans, a number that will undoubtedly grow in the coming decades due to the large number of baby boomers beginning the retirement age. These cuts are the result of discretionary spending decisions related to the Community Development Block Grant that allocates a portion of the block grant money to elderly through Meals on Wheels. There have been numerous studies conducted that have showed the effectiveness of Meals on Wheels decreasing loneliness scores and also decreasing reliance on traditional care, while allowing elderly individuals to remain in their homes longer.

 

However, there are conflicting opinions about how much influence this will actually have on the institution. From financial statements released last year, only about 3% of the total funding was made from the block grant. On a local level, there is much more monetary influence, with federal funds accounting for 30% of the expenses relating to the home delivered meals. While the program’s costs and returns are currently being debated, it is evident that although it may not be the most lucrative on it’s face, Meals on Wheels can provide a number of benefits. One study even found that if there was a 1% increase in elderly individuals receiving Meals on Wheels, states would saved over $109 million, due to reductions in need for nursing home care.

One of the biggest promises in the Trump candidacy was repealing Obamacare, a promise he attempted to follow through on within the first few months into his presidency. Speaker of the House, Paul Ryan, was a widely known proponent, who worked to rally votes and repeal Obamacare in order to get The American Health Care Act implemented in it’s place. While the vote was called off before a final count was made, the American Health Care Act still has some changes to make before there will be bi-partisan agreement. It is not a surprise that this program was one of the first to be reconsidered for funding, the program covers 74 million people alone.

 

Lawmakers were drastically divided on the topic, with those focused on public health benefits contesting the bill due to the cut in benefits that those most in need would experience, Once Obamacare was fully implemented, Medicaid programs across the nation greatly expanded, giving coverage to 11 million Americans opting for coverage under the federal program, which in turn assisted states who were not able to pay for the health care expansion for their citizens on their own. Medicaid was able to expand coverage to so many Americans by qualifying low income individuals for the program and paying through state and federal funding. Governors in Alaska, Arkansas, Colorado, Michigan, New Hampshire, Nevada, and Ohio all oppose any kind of restructuring for their Medicaid programs. Kansas and North Carolina are currently attempting to expand their Medicaid in light of the recent bill failure.

 

On the other side of the debate, critics of the mandatory health care system feel that it has left states and citizens ‘hooked’ on the federal government supplying funds for health care now. The states that receive federal assistance with Medicaid cannot sustain losing the funding while still providing coverage to all their citizens. While some states are starting to cover some costs associated with their Medicaid expansions, the federal government in 2017 is still covering at least 90% of the costs associated with the expansion, which is projected to continue through 2020.  Critics continue to note the declining insurance provider participation in Medicaid and Obamacare services which fails to provide medical specialists.

The demand for caregivers will begin to far exceed the amount of elderly individuals who need caring for in the United States, as our elderly population will grow substantially in size by the year. As the caregiver network continues to dwindle, there have been efforts made throughout the country to retain those caregivers leaving the field for other opportunities, regulate the field more to better advocate for caregivers rights, and to consider alternatives for care and treatment for the elderly community. This job of being a professional caregiver can be physically and emotionally taxing and for those who cannot afford assistance, these responsibilities can begin to fall on the loved ones that surround them.

The role of caregiver has been assumed by more than 65 million people who provide care for a chronically ill, disabled or aging family member in United States. Many of these family member caregivers care for their loved ones upwards of 20 hours a week, without compensation. This role can take a toll on their personal lives and impact their ability to perform at a full time job throughout the week. As a response to this, lawmakers in some states have begun to offer family members who act as caregivers compensation for their time spent with their elderly loved one. Compensating the family member helps offset the time set aside as well as the expenses incurred by traveling or giving time to other areas.

While the name varies between the states, programs that compensation family members include consumer directed care, cash and counseling, and family member caregivers. The regulations differ between the states as to who will qualify as a caregiver, what they are compensated, how much and what benefits they may possibly have. Those who have a loved one who is also a veteran may qualify for aid and the attendance pension benefits through the Veteran’s Administration. If you are in a state without these benefits or would like to form a private agreement, many families draw up a personal care agreement.

As we continue to age, it can be difficult to admit when you are no longer able to handle personal affairs and financial matters on your own. There are a number of alternatives available to those seeking to have their affairs managed by another party, depending upon the individual’s mental capacity to comply with assigning these rights. Those providing caregiver services to the individual, commonly a loved one, may seek retaining legal guardianship of the elderly individual, assigning durable power of attorney and health care power of attorney to specific individuals, or establishing a trust.

Guardianship

Guardianship is a legal status given by the court to create a relationship between someone who is incapacitated or unable to care for themselves and a person determined to be suitable to administer and manage the incapacitated person’s affairs. In order to get a guardianship order, a person must file a petition with the court to review the case at hand. The court assesses the situation, the petitioner, as well as the elderly person to determine what will be the least restrictive method of guardianship. The appointment may include only managing financial affairs, but may also assign responsibility for day to day decision making including support, maintenance, and personal care.

Dementia and Alzheimer’s Disease affects more than five million Americans today. While a large majority of those affected are over the age of 65, it is not just a disease for the elderly. Symptoms of Dementia and Alzheimer’s Disease can occur in individuals as young as 30 years old, and currently affects an estimated 200,000 people in America. The diagnosis can often be missed or misdiagnosed as another condition or an association with the changes both men and women go through during their 40s and 50s, however, a comprehensive medical examination is required in order to properly diagnose those with early onset dementia. While the cause of the disease is not yet known, it is important to look to your family history as a way to determine if you or your loved one should be monitoring specific behaviors and changes in personality.

The thought of losing your memories, ability to perform basic tasks, as well as ability to think clearly, remember the time, date, or place, is a very scary feeling for anyone. As these functions start to go, it is important that the loved person, either elderly or young, has in place a comprehensive medical and estate plan, when the day comes that he or she is no longer able to make decisions for themselves. The unfortunate reality of this disease is that it is not a question or if, but of when they will no longer be able to make their own decisions based on a lack of capacity.

First, the individual in question must have their legal capacity assessed to determine if they are able to understand and appreciate the consequences of their actions in signing documents that give specific power to named individuals. In doing so, you should also consult a medical professional if you have doubt as to their ability to understand and make decisions. Also, if the individual has previously executed any wills, trust, or power of attorney documents, those should be revised as necessary to accommodate their current condition while still respecting their wishes.

Caregivers are in high demand and that demand is ever increasing as the aging population continuously grows every day. However, caregiving can be a difficult and underappreciated job that has left it with little public desire to go into the field, due to the lack of benefits, support and adequate pay. As a way to motivate those seeking employment to explore the field of caretaking and to help provide for those who are currently caregivers, new technology is being established in order to help support and ease communication between caregivers and the elderly they support.

Seeing the struggle for adequate communication measures between caregivers, their elderly client, the elderly client’s family, one technology company is seeking to establish a smartphone application that will hopefully increase that transparency. When caregivers sign up through the application, they will be able to directly communicate with their client and their client’s family members, log all appropriate information in one place on the application , as well as request time off, similar to many corporate structures. Caregiver are able to leave detailed notes about events of the day as well as medication schedules.

Another issue with caregiving is the inability of the caretaker to take time off due to lack of backup support. This application is aimed at offering that back up support, along with paid time off and many other benefits, if properly certified through the company. In order to receive these benefits, the caregiver must be trained through Care Pros, the official caregiver network, which will come with a number of additional benefits.  Caretakers can also opt for workers’ compensation benefits in the event that they sustain an injury on the job, which can be a real possibility when a fair amount of heavy lifting is required. Additionally, caretaker are offered stock options as well as pay that is at least 10% above the market rate in their area of employment.

There are a variety of different types of trusts that an individual can use to their benefit while they are alive or in order to preserve their wealth for their family after they pass. Depending on it’s purpose, the grantor of a trust will make either a irrevocable or revocable trust. Irrevocable trusts cannot be modified without permission of the beneficiary since the grantor is giving up rights to their assets to the trust, versus a revocable trust where the grantor can modify the trust terms as they desire during their lifetime and upon their death, the assets transfer to the trust.

One unique type of trust that a grantor can establish for their benefit and for the benefit of a charity is a charitable remainder trust unitrust. Charitable remainder unitrusts are a type of irrevocable trust with specific characteristics setting it aside from other trusts. This type of trust distributes a certain percentage of the value of the assets in the trust to a beneficiary that is not a charity, usually a grantor of the trust or whomever the grantor has named to receive the named distribution. The grantor sets a specific timeline for the distributions to the beneficiary, and upon the termination of that timeline, the remaining assets are distributed out to the charity named.

In order to determine how much the non-charitable beneficiary will receive, the trustee must use a formula that requires minimum distributions from the trust annually. The trustee will first determine the fair market value of the trust at the end of the given year by obtaining a valuation of the assets in the trust and then will distribute out the percentage of that asset value named in the document.

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