The New Tax Law and You

The following links provide insight into the new tax law signed by the President in December of 2010.

• The following bulletin comes from the Partnership for Philanthropic Planning:
  Legislative Bulletin
  December 20, 2010
  
  President Signs into Law IRA Charitable Rollover Extension
  
  President Obama has now signed into law the Tax Relief, Unemployment Insurance Reauthorization, and Job Creation Act of 2010, which provides a two-year retroactive extension of the IRA Charitable Rollover. Specifically, the new law reinstates the Rollover for 2010 and allows any eligible gifts made by January 31, 2011 to be treated as a 2010 donation and be used to satisfy the taxpayer's minimum distribution requirement for 2010. The new expiration date for the Charitable Rollover is December 31, 2011.
  
  In addition to the Rollover extension, the new law contains a number of significant provisions that will impact the work of charitable gift planners. These include:
  • Two-year extension of all the 2001 and 2003 tax cuts.
  • Two-year adjustment of the estate tax with a $5 million individual exemption and 35 percent rate.
  • Two-year extension of the alternative minimum tax "patch"
  • Two-year extension of various charitable giving provisions such as enhanced deductions for contributions of food inventory, increased limits for contributions of capital gain real property for conservation purposes, and special rules for contributions of property by S corporations.
  For a detailed summary of the new law, click here. For background information and helpful articles on the specifics of IRA Charitable Rollover gifts, click here.
  
  
• New York Times article:
  “Estate Tax Will Return Next Year, but Few Will Pay It”
  
  
• IRS
  FAQs about the New Tax Rules for Executors for 2010

UMKC Communiversity Class

Samantha L. Shepherd will be teaching a class about Long-term Care Planning through the University of Missouri - Kansas City's Communiversity.

Course #5305 A
Estate and Long-term Care Planning for Seniors
Join us for a seminar to help you understand the basics of estate and long-term care planning.

CONVENER: Samantha Shepherd
CLASS FEE: $9
Sec. A: 1 session; Wednesday, February 9; 12:00 PM - 1:30 PM;
Plaza Library, Small Meeting Room, 48th & Main, KCMO;
LIMIT: 30
Register by phone at 816-235-1407.

Good News for Seniors in Jackson County, Missouri

Jackson County Real Estate Tax Bills can now be spread over four payments. It's called the Senior Citizen Quad Payment Program. If you were previously registered in the half payment program, you will be automatically registered in the new quad payment program. This is great news for seniors who are managing their budgets based on fixed incomes.

Quad Payment Deadlines For 2010 Tax Bills:
December 31, 2010
February 28, 2011
May 31, 2011
August 31, 2011

For more information about the Quad Payment Program or to download the application form, please click on the link below.

http://www.jacksongov.org/content/3971/4605.aspx

If you know of similar programs in other parts of the country, please let us know.

Missouri NAELA Elections 2011

Samantha L. Shepherd has been nominated for the position of Treasurer of the Missouri Chapter of NAELA, the National Academy of Elder Law Attorneys. Ms. Shepherd currently serves as a Director on the Board of Directors for Missouri NAELA and is the Chair of the Membership Committee.

New Leadership Position for Samantha L. Shepherd

Ms. Shepherd has been appointed as a Vice-Chair of the Elder Law Committee for the Missouri Bar and will serve during the 2010-2011 bar year.

Scam Alert: Taking Aim at Old Soldiers; Seminars Target Vets With Unwise Investments - AARP Bulletin

AARP published this brief, excellent article that explains how veterans are being exploited by unscrupulous investment advisors. This is a serious problem in Missouri, Kansas, and the rest of the United States. If you have questions about how to qualify for veterans benefits, contact your state's veterans affairs agency (nasdva.net) or contact an elder law attorney who has been accredited by the Office of Veterans Affairs.

Scam Alert: Taking Aim at Old Soldiers; Seminars Target Vets With Unwise Investments - AARP Bulletin

Elder Care Costs Surge - Life and Health Insurance News

"Nursing home and assisted living rates rose significantly from 2009 to 2010, the MetLife Mature Market Institute (MMMI) reports.
A market survey of long term care costs by MMMI, Westport, Conn., found private room nursing home rates rose 4.6% to $229 per day, or $83,585 per year. Assisted living facilities rose 5.2% on average to $3,293 per month, or $39,516 per year.
In contrast, the 2010 inflation rate reported by the Bureau of Labor Statistics was 1.1%."

Elder Care Costs Surge - Core Protection Products - Life and Health Insurance News

Fall Newsletter

Featured Article: Helping Veterans Pay for Long Term Care

Please click the link below to read our Fall Newsletter. Happy Thanksgiving from all of us at Shepherd Elder Law!

http://myemail.constantcontact.com/News-from-Shepherd-Elder-Law-Group--LLC-.html?soid=1102938290702&aid=mJHHvBPQdME

Holidays Without Cheer - Elderly Are Especially At Risk For Depression This Time Of Year

This is an article from several years ago, but it's still very relevant. What can you do to bring some holiday cheer to your elderly friends and neighbors?

http://www.cbsnews.com/stories/2002/12/02/earlyshow/health/main531415.shtml

CBS News Story - Alzheimer's and Money Problems

Wed., Nov. 17, 2010- On the CBS Evening News, Katie Couric highlighted a new report about Alzheimer's disease that suggests that the percentage of the US population with Alzheimer's is steadily increasing. CBS is beginning a new series about the medical, caregiver and financial impact that Alzheimer's has on patients and families. The first report is focused on Alzheimer's and Money Problems.

(CBS) The oldest of the Baby Boomers turn 65 next year. They have a lot on their minds, including health concerns like Alzheimer's. About five million American seniors are now battling the disease. That's expected to increase by 50 percent over the next 20 years. With no cure right now, spotting the early warning signs are so important to treating this disease. Dr. Jon LaPook begins a series of reports by CBS News and USA TODAY called "Senior Moment," exploring the aging of an iconic generation and the impact on the nation.

Alzheimer's and Money Problems
Suffering from Alzheimer's disease, Dr. Max Gomez lost his life savings and doesn't remember how it happened. Dr. Jon LaPook tells his story and how money problems can be a warning sign of the disease.

http://www.cbsnews.com/stories/2010/11/17/eveningnews/main7064638.shtml?tag=cbsnewsMainColumnArea

The "Sandwich" Generation

The "Sandwich" Generation

How to Balance Life in the Middle

Date: November 18, 2010

Time:
Registration 6:00 p.m.
Presentation 6:30 p.m. to 9:00 p.m.

Location:
Marriott Country Club Plaza - Grand Ballroom
4445 Main Street, Kansas City, Missouri

The event is being organized by Creative Care Consultants, and Shepherd Elder Law Group is one of the sponsors.

Please visit the event website at: www.gltoyne.com/Sandwich

How To Balance Life in the MiddlePresented By: Barbara E. Friesner, MBA

Helping your aging parents is one of the most loving things you can do. Unfortunately, as much as you’re trying to help, the life of a caregiver can be draining, stressful, overwhelming, frustrating, and for some, even filled with guilt, resentment or anger. As a result, a lot of family members will just drop difficult eldercare issues and hope that it will all resolve itself – or drop it until it becomes a crisis – ESPECIALLY IF YOU’RE A MEMBER OF THE SANDWICH GENERATION.THE GOOD NEWS IS THAT IT DOESN’T HAVE TO BE THAT WAY!

That’s why I’m so excited to be doing this program – to help you relieve some of the pressure of being caught in the middle.
In this program you will learn how to:
-Understand Why Your Parents Are the Way They Are
-Organize Eldercare
-Get Help That Helps
-Know What Your Aging Loved One Wants – And Help Them Get It
-And Much, Much More

REPORT ELDER ABUSE

Report Elder Abuse. You can make a difference.

The following is a Kansas telephone number to report suspected elder abuse:

1-800-842-0078.

Elder abuse comes in many forms. There are the more obvious scenarios, where an elder is physically mistreated or neglected. There are also the scenarios that are more subtle, but equally damaging.

One example of a subtle, yet extremely damaging, form of elder abuse is financial exploitation. Are the children acting in their own best interests rather than in the interest of their parents? Are the decisions of the children money motivated, resulting in inferior care for the elder? Both Missouri and Kansas offer 1 800 numbers for concerned citizens to alert state authorities to the possibility of elder abuse. If you suspect elder abuse, contact those who can assist.

The following is a Missouri telephone number to report suspected elder abuse:

1-800-392-0210.

Concert Series for Seniors

Concert Series for Seniors

Love in the Afternoon

Enjoy fine cuisine and music with friends.

shawneeheartlandal.com/pages/%5Cnewsletter%5CNEWSLETTER.pdf

Come out and see what everyone is talking about!

1-800-392-0210

In Missouri, the Department of Health and Senior Services investigates elder abuse. Please do not hesitate to call if you believe that an elder is the victim of abuse, whether it is financial abuse, physical abuse or any other abuse.

45th Anniversary of Older Americans Act: The birth of Medicare and Medicaid

The following is a Statement by Assistant Secretary Greenlee on the 45th Anniversary of the
Signing of the Older Americans Act.


"On July 14, 1965 President Johnson signed the Older Americans Act into law. Sixteen days later, on July 30, he signed legislation creating Medicare and Medicaid. These three programs, along with Social Security enacted in 1935, have served as the foundation for economic, health and social support for millions of seniors, individuals with disabilities and their families. Because of these programs, millions of older Americans have lived more secure, healthier and meaningful lives. The Older Americans Act has quietly but effectively provided nutrition and community support to millions. It has also protected the rights of seniors, and in many cases, has been the key to independence.

In 1965, there were about 26 million Americans age 60 and over. Today, there are 57 million older Americans 60 and over, with many more on the immediate horizon. Our senior population is not only growing larger, but becoming more diverse. Adults over 80 are our fastest growing group, and many will need long term care. Reliance on family members, who currently provide 80 percent of the long term care assistance for our nation's seniors, will increase.

The historic enactment of the Affordable Care Act (ACA) by President Obama on March 23, 2010 provides us with another tremendous opportunity to harness the successes and progress of the last four decades to further improve the health and lives of older Americans and support their caregivers. The ACA represents the biggest change in our national health care delivery system since 1965. And just as they were in 1965, the programs of the Older Americans Act - and our national aging network of state, tribal and community-based organizations, service providers, volunteers and family caregivers - will be called upon to complement, support and enhance these changes. How successfully we weave these multiple responsibilities together will say much for how we will care for seniors in the future. "

‘Doughnut hole’ checks go out to half a million Missourians

‘Doughnut hole’ checks go out to half a million Missourians

Donut Hole Checks: Beware of Scams

CMS (The Centers for Medicare and Medicaid Services) said checks will be mailed monthly, starting as early as this summer, and will continue throughout the year as Medicare beneficiaries hit the donut hole. Those who qualify can expect to receive their check within 45 days of reaching the gap.

Seniors beware of scams involving confidential information: Seniors who qualify for the $250 check will not have to give their social security number or bank account information. CMS does not need the Seniors to fill out any forms. The process is automatic: if the senior reaches the donut hole, a check will automatically be sent out in the mail.

The $250 check in the mail is the first tangible benefit the seniors will see from the March 2010 health care reform.

“One of the biggest ways the new law is going to help seniors is by gradually phasing out the Medicare prescription drug doughnut hole, which has made it hard for seniors to afford their medications,” Sebelius said.

What is the donut hole?

The context is seniors and their pharmacy costs.

The donut hole is the commonly used reference to the middle of the year for a senior, where she must pay the full cost of her monthly prescriptions without any assistance from Medicare. Medicare helps around the edges:

First, the senior receiving Medicare must pay her annual deductible. The deductible is $310. On a fixed income, the beginning of the year is not an easy time. Next, after paying the first $310 of pharmacy bills for the year, the senior must pay 25% of her drug costs until her total drug cost reaches $2,830 for the year.

Then, the senior falls into a coverage gap. In this coverage gap or "donut hole," the senior must pay for drugs out of pocket until her annual expenses exceed $6,440. In other words, while the cumulative annual drug costs are between $2,830 and $6,440, the senior is paying 100% out of pocket. Once the senior's drug costs exceed $6,440, she will only pays 5% of her drug costs for the rest of the year.

Eliminating the donut hole is one of the major benefits for seniors of the March 2010 Health Care Reform.

How Health Care Reform Affects Older Americans



On March 23, 2010, President Obama signed a comprehensive health care reform bill (H.R. 3590) into law. On March 25, Congress passed the Reconciliation Act of 2010 (H.R. 4872) which modifies H.R. 3590. Taken together, these two bills comprise the health care reform package. Important provisions for older adults and people with special needs include:

SOME OF THE MEDICARE CHANGES

*The new law provides a $250 rebate to Medicare beneficiaries who reach the Part D coverage gap in 2010 (Effective January 1, 2010).

*The new law also gradually eliminates the Medicare Part D doughnut hole by 2020:

***For brand-name drugs, the new law requires pharmaceutical manufacturers to provide a 50% discount on prescriptions filled in the Medicare Part D coverage gap beginning in 2011, in addition to federal subsidies of 25% of the brand-name drug cost by 2020 (phased in beginning in 2013)

***For generic drugs, provides federal subsidies of 75% of the generic drug cost by 2020 for prescriptions filled in the Medicare Part D coverage gap (phased in beginning in 2011)

*Under the new law, Medicare will cover an annual wellness visit and creation of a personalized prevention assessment and plan. There is no co-payment or deductible for the annual wellness visit and the assessment. Prevention services include referrals to education and preventive counseling or community-based interventions to address risk factors.

*The new law eliminates Part D cost-sharing for full-benefit, dual eligible beneficiaries receiving home- and community-based services.


The changes to Medicare extend by nine years the life of the Medicare Trust Fund, which was projected to be depleted in 2017.


For a full version of this article, please see the NAELA website. The authors are Brian Lindberg and Gail MacInnes.

HIPPA RELEASE AND AUTHORIZATION

In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA). Access to our health records is now regulated through this piece of federal legislation.

If you would like some person other than yourself to have access to your medical records and information, and you would like health care providers to release your medical information to that person, you must authorize the release of the information in writing.

Q: Is it a good idea to include a specific “HIPAA release” in the health care proxy/ power of attorney or to have a stand-alone HIPAA release version?

A: Either will work. In fact, it’s not legally required to have specific language related to HIPAA. Practically speaking, it is a good idea to either have a stand-alone HIPAA release or HIPAA specific language in your health care proxy.

THE HEALTH CARE PROXY ROUTE:

The federal law does not require a separate HIPAA release document; however, the health care providers and those whose job it is to release or not to release information are more comfortable when they have a HIPAA release in hand. In addition, a power of attorney for health care becomes effective after you lose your capacity to make or communicate decisions. That means that, unless the draftsperson clarifies otherwise, the power of attorney does not authorize release of medical information to the person named while you remain competent. To clarify, a good, well-written health care proxy or power of attorney authorizes the agent or attorney-in-fact to have access to medical records and personnel of the principal.

THE STAND ALONE HIPAA RELEASE ROUTE:

The primary reason to have a stand-alone HIPAA release is simplicity.

In our experience, a stand-alone HIPAA release document that accompanies the health care proxy is the simplest means of gaining access. It’s a page or two and it’s drafted for lay people to read; in other words, it’s simple and intelligible and gets the job done.
-----------------
If you want some person other than yourself to have access to your medical information and records while you remain competent, you need to complete and sign a HIPAA release or ensure that your attorney has drafted your Health Care Proxy with the correct legal language enabling immediate access.

Veterans Benefits: Aid and Attendance (Basic Eligibility Part II)

Periods of War: What does this mean? In order to be eligible for Aid and Attendance (or the lesser included pensions) the veteran must have served for 90 consecutive days, and one day must have been during a Period of War.

Our senior population participated in World War II, the Korean conflict and Vietnam. The history book dates are perhaps not an exact match with the dates set forth in the law establishing VA pension benefits. Here are the pivotal dates:

World War Two (WWII): December 7, 1941 through December 31, 1946.

Korean conflict: June 27, 1950 through January 31, 1955.

Vietnam: February 28, 1961 through May 7, 1975 (if the veteran was physically in the Republic of Vietnam) or August 5, 1964 through May 7, 1975 (if the veteran was serving outside of the actual Republic of Vietnam.)

Authority: 38 U.S.C. 101(29)

Special Needs Trusts- Do you Have An Early Termination Provision?

The Trusts and Special Needs Section of the National Academy of Elder Law Attorneys recently advised NAELA members of a change to the POMS (the Social Security Program Operations Manual). While the change to the manual appears now, the actual implementation date is not until later this year.

Effective October 1, 2010, First Party Trusts (D4As and D4Cs) must undergo another test to pass muster with Social Security. Very often the goal of an SNT is to ensure that the assets of the SNT are not considered countable resources by Social Security and thus passing muster is pivotal.

The Social Security manual directs the field officer to review all d4a and d4c trusts established after January 1, 2000. First Party Trusts (in other words, those established with the monies of an individual) drafted over ten years ago need a second look.

A d4c or a d4a trust with a clause that allows a trust to terminate before the individual (the beneficiary) dies are under scrutiny. The clause allowing for a trust to terminate is called an early termination clause, or an early termination provision. The typical clause states that the trust may terminate when the individual is no longer disabled. Another typical clause states that the trust may terminate when the trust fund runs so low on assets that it is not economical to continue the trust.

What to look for in your d4a and d4c trust:

If there is a provision in the trust that permits the trust to terminate before the beneficiary dies, look for these 3 points:

1. All remaining $ in the trust must first be applied to Medicaid debt.

2. After the State has been paid, all remaining $ must go to the beneficiary (OR directly to another d4c trust, per specific limiting language.)

3. The beneficiary CAN NOT have the power to terminate the trust him/herself.

First Party SNTS will be considered countable resources if the early termination clauses gives the beneficiary authority to terminate the trust.

Veterans Benefits: Aid and Attendance (Basic Eligibility Part I)

There are three basic components to eligibility for the Aid and Attendance benefit for WWII, Vietnam and Korean War Veterans:

1). Active duty of 90 days.

2). One day of service during a period of wartime.

3). Honorable Discharge.

Veterans of our more recent conflicts have different eligibility criteria, and the emphasis in this blog post is eligibility for seniors who have served in the military.

Each of the eligibility criteria requires an in depth analysis, as the complexities and nuances are the nature of the law. For example, a "period of wartime" is an artificial, VA created, set of dates that does not entirely match the history books. It is best to confirm your dates of service against the list of VA dates.

I would like to set forth a basic primer for those people exploring VA benefits for themselves or for their loved ones.

I will start by addressing some general scenarios that arise in my practice regarding a little known benefit called Aid and Attendance.

Aid and Attendance is a needs based program. It is there to help those Americans who served our country during a period of war time, who now find themselves in need.

As you walk through your day, I challenge you to look around you and query whether there are these veterans in your life that you could be helped by this benefit.

What do these Veterans look like?

They are your neighbors. They are your parents. They are your friends. They own homes. They are not penniless; they just have exceedingly high medical costs.

Example:

Bill is a WWII veteran. He has worked hard all of his life to provide for his wife, Sara, and family. Together they have raised four children. He is now 90 years old and she is 88. A recent fall sent Bill to the hospital. He fractured his hip, requiring surgery and extensive rehabilitation. He has now been in a skilled nursing facility for three months and is ready to come home. He has no intention of dying in the nursing home and Sara is eager to have him home. Bill has an easy smile and a sweet sense of humor. He is really a great guy and someone you would find easy to like.

Sara is fairly healthy; but at 100 lbs she can hardly help lift Bill into his wheelchair or into the shower. Sara can feed Bill and do the laundry, but she can't bathe him by herself. She can't take care of his toileting needs either. This upsets them both. Bill and Sara need help in their home. It's hard to ask for help and it's hard to pay for help. This is not an easy time for either of them. If Bill is like most veterans I know, he does not want to ask for money and he certainly doesn't want hand-outs. He would, however, love to hear from the VA that his time served in WWII now draws a benefit for Sara. He feels awful about the pressure she is under to provide for his care and if cost were not a factor he feels sure she would be open to having help.

Please tell Bill that the Aid and Attendance benefit can step in at this crucial time. While there are income limitations that often deter people from applying for Aid and Attendance, there is significant confusion in this area. Bill's income may seem high, but costs for his care are subtracted from his income.

May is National Elder Law Month

Elder Law attorneys throughout the country contribute to their communities by educating seniors and people with disabilities about their legal options and by providing pro bono services.

A Guide To Women's Health: Fifty and Forward

From Harvard Medical School:

For both men and women, many of the things we need to do to stay healthy are one and the same: Eat right, exercise, don't smoke. But women have health concerns that are unique to them: Mammograms, bone density tests, menopause, ovarian cancer. Some medical conditions—like heart disease—may present different symptoms, or different degrees of risk in women. And for a woman at midlife, medical decisions are changing and need to be made more frequently.

That's why the experts at Harvard Medical School have created A Guide to Women's Health: Fifty and Forward, a comprehensive report to help women take stock of their health at midlife, understand their health risks, and discover the things they can do to stay healthy and strong. Women's health studies have shown that it's never too late to feel better by living better. Whether you're just entering midlife, or are in your 80s and beyond, there are steps any woman can take today to ensure the best possible health tomorrow.

This report also includes a Special Bonus Section: 10 steps to a longer, healthier life, which outlines ten things a woman can do to reduce her risk of many major degenerative diseases.

A Guide to Women's Health: Fifty and Forward is every woman's blueprint for good health today, tomorrow, and for the years ahead. It can help you make important health decisions, improve your quality of life, and greatly reduce the likelihood of landing in a nursing home

Health Care Reform Provisions Affecting Older Adults and People with Special Needs

The National Association of Elder Law Attorneys has modified their document "Health Care Reform Provisions Affecting Older Adults and People with Special Needs" to include information on Medicaid maintenance of effort provisions. You can access the updated document at the link above and by visiting the "Health Care Reform Information" section on the "Government Affairs" page of the NAELA website. Other helpful resources released in the last few days are: The Scan Foundation Policy Brief Kaiser Family Foundation Summary of the New Health Reform Law Small Business Administration Health Care Reform Resources Chris Jennings' article on health care reform implementation in the New England Journal of Medicine Register now!: Thursday, April 15 from 2:00 - 3:30 p.m. ET NAELA will host a telephonic training entitled "The New Health Care Reform Law: Understanding Its Impact on Older Adults and People with Special Needs"featuring presentations by experts on the Medicare, Medicaid andlong-term care provisions of the new law. UPDATED: Health Care Reform Provisions Affecting Older Adults and People with Special Needs (March 30, 2010) Text of H.R. 3590 (Now P.L. 111-148) Text of H.R. 4872 (Now P.L. 111-152)

FIve Big Myths - Free Podcast Series from ABA

Health Law Section Podcast Series | Free to the General Public

Five Big Myths of Advance Care Planning and How to Stay Anchored in Reality (4/13/10) | Podcast
Click here to download slides and materials for the teleconference.

This program addresses the five biggest myths that plague advance care planning and how to steer clear of them and make advance care planning more effective.

Myths:

1. People should use their state’s official advance directive form(s).
2. Your advance directive should include as specific instructions as possible.
3. Advance Directives are legally binding so doctors have to follow them.
4. Doing everything possible for dad means keeping dad alive at all costs.
5. A written advance directive is better than talk.

National Healthcare Decisions Day

On the eve of National Healthcare Decisions Day, President Obama issued a memorandum that asked his administration, among other things, to:

Ensure that all hospitals participating in Medicare or Medicaid are in full compliance with regulations, codified at 42 CFR 482.13 and 42 CFR 489.102(a), promulgated to guarantee that all patients' advance directives, such as durable powers of attorney and health care proxies, are respected, and that patients' representatives otherwise have the right to make informed decisions regarding patients' care.

You may find the full Memorandum here: http://www.whitehouse.gov/the-press-office/presidential-memorandum-hospital-visitation While this Memorandum was specifically directed at dealing with GLBT patient visitation issues, the reference to advance directives is important for all patients.

Improving the Lives of America's Elderly Poor

The National Senior Citizens Law Center advocates before the courts, Congress and federal agencies to promote the independence and well-being of low-income elderly and disabled Americans.

Since 1972, the National Senior Citizens Law Center has worked to promote the independence and well-being of low-income elderly and disabled Americans, especially women, people of color, and other disadvantaged minorities. Because we believe in publicly-funded safety net programs, we work to preserve and strengthen Medicaid, Medicare Part D, Social Security and SSI. To guarantee fair treatment, we work for greater access to federal courts for citizens and for better enforcement of consumer’s legal rights in safety net programs.

NSCLC works toward an America in which elderly people and people with disabilities can live in dignity and safety, free of the worries and pain of poverty, able to afford health care to the end of their days, and able to contribute to their families and societies to the best of their abilities.

Check out more at www.nsclc.org/consumer.

When Harry Met Sally

The Today show recently interviewed a national elder law expert, Hy Darling, about the topic of Divorce and Medicaid. How do those topics align, you wonder? As unsavory as it may sound to any of us, divorce is sometimes the chosen course for a couple when one of the two faces long term care.

Before passing judgment on this choice one must fully grasp the scenario. What does this situation look like? Well, when Harry met Sally they were both young and healthy and very much in love. Time has passed. Sally is now 68. Sally was diagnosed with Alzheimers five years ago. Her decline progressed rapidly. She now requires 24 hour supervision. Harry is a devoted husband; he has had 40 wonderful years with Sally. He is suffering on many levels. He misses his wife; he is terribly lonely and he is riddled with guilt. The Sally he knew is no longer there; there are many days when Sally does not even recognize Harry, but still he goes to visit her with the hope that she will be having a "good" day. He tried to keep Sally at home, but this became unsafe for Sally and extremely stressful for Harry: Sally would go for walks and get lost. Sally would take three days worth of her medications on one day because she forgot she had already taken the first and then the second dose.

Harry and Sally are "upper middle-class" Americans. They worked hard during their working years and were frugal with their spending. They own a modest home and had other assets, including IRAs, retirement funds, CDs and savings accounts totalling $600,000. Will it be enough? Sally's monthly cost for care in the long-term care facilitytops $6000 a month. Long term care is not paid for by Medicare. Long term care is not paid for by Medical insurance or Supplements. Harry and Sally, like most Americans, do not have Long Term Care Insurance. After five years of paying for Sally's care in the Alzheimer's unit of the Long-term care facility, Harry and Sally's funds are nearly depleted--they have spent $400,000 on care and prescriptions. Sally is only 68 years old. She has a life expectancy of 78. What is Harry to do? He needs the support and guidance of an elder law attorney who will guide him through his options for paying for Sally's care.

Married couples are legally obligated to support one another. Medicaid will not help Harry and Sally until they are broke. Is this true? Yes, sadly, this is accurate. Harry can go through a Division of Assets process to prevent complete impoverishment; the question of whether this is the chosen course is Harry's decision. The most that Medicaid rules permit Harry to retain is approximately $100,000---and this assumes that Harry is sufficiently savvy to fully utilize the Division of Assets process to its fullest. And in addition, Harry can live in his house, but when Harry dies Medicaid will have to be repaid from the sale of Harry's house. As attorney Hy Darling mentioned in the Today Show interview, on rare occasion divorce is the answer. I think Harry would rather poke out his eye and go broke, but I believe in love over money.

Alzheimer's to Double Every 20 Years

Alzheimer's Disease International released a new report indicating that the number of people with Alzheimer's or another dementia, currently 35 million worldwide, is expected to nearly double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050.

According to the 2009 Alzheimer's Disease Facts and Figures report, issued by the Alzheimer's Association, someone in the United States develops the disease every 70 seconds, and an estimated 5.1 million Americans over age 65 have the disease. This report also states that about 2.7 million people over age 85 have Alzheimer's, and that by the time the first of the baby boomer generation reaches 85 in 2031, an estimated 3.5 million seniors in that age group will have disease.

These statistics highlight the need for estate planning in general and incapacity planning in particular, as well as disability, long-term care, and special needs planning.

The Quest for a Satisfying Career

Rachel Brimm, a second year student at the University of Missouri Kansas City Law School, recently interviewed Samantha as part of a class project called "The Quest for a Satisfying Career." With Rachel's permission, here's a synopsis of the interview:

Last week, I interviewed Samantha Shepherd for this project. She is a solo practitioner who specializes in Elder Law. Samantha graduated from Boston College Law School in 1994. She began her legal career working with children’s legal issues while in college and law school. Her first job as an attorney was working as in-house counsel for a bank. However, she did not feel that this job fed her soul. Under the tutelage of a mentor, Samantha embarked on a rewarding career helping the elderly, those with disabilities and their families.

When asked to define success, Samantha replied that success occurs when one can go home at night and feel good about what they did. She elaborated by explaining that the law gives her the power to help people navigate the legal system. It was evident from talking with her that she was able to successfully retain autonomy over her work. She gets involved with clients to the extent that she wants to be involved. For example, the day I met her she was planning to meet a client’s daughter to tour a nursing home. This had nothing to do with the legal work she was performing for her client, but because she had developed a positive relationship with the client’s family they had invited her to join the tour and she happily agreed. Another way she retains autonomy over her work is her choice to only go to court when there is no adversary. For example, she assists clients with uncontested guardianships but chooses not to get involved in disputes.

Overall, Samantha radiated happiness with her chosen profession. She is truly passionate about what she does and believes she is pursuing good for other people. I think one source of her happiness is the close relationships she is able to develop with not only her clients, but also their families. On a day-to-day basis, she receives hugs from clients. This really struck me because it must feel wonderful to have clients express on a daily basis how much they appreciate you.

She also talked about how the nuances involved with high-net-worth can be intellectually stimulating. She said that clients are so relieved to give her their problems involving estates, trusts and Medicaid planning. And while some aspects of her job can be more tedious than others, the key is that she has found her passion and purpose in life.

In addition to her law practice, Samantha is also the mother of four and very committed to her family. When asked about maintaining the work/life balance, she gave the following advice: It helps to remember that until your kids are completely grown, there is no right answer. When you are at home, you think you should be at work and vice versa. Having these thoughts is the norm. She also said it is helpful to realize that we are fighting against the cultural assumption that moms will be more involved in their kids’ lives than dads. For Samantha, her purpose of practicing law is helping other families. Thus, in order to effectively help others it is important that her own family comes first.

She elaborated by explaining that sometimes this means she does not get as much sleep as she would like. Other times, things like getting her nails done takes second place to spending time with her kids. She also talked about the importance of accepting help. She hires someone to clean her house because it is efficient and frees up time for her to spend time with her kids. These are just some of the personal choices that she has made to maintain the balance between her work and family life.

I am personally interested in the area of elder law and asked Samantha for advice on finding happiness in that specific area. She advised that it was a relatively young area of law and encouraged me to seek out a mentor in the field. She cautions young attorneys not to start their own practice until they have had both a mentor and years of experience in practice. She said there are two ways of learning: (a) find someone whose expertise you find valuable and has a good reputation to mentor you or (b) learn by trail-and-error which is very painful for the client.

Samantha impressed me with her ability to find happiness within the legal profession. She admitted that she did not know anyone from her law school class who is happy doing what they are doing. However, her own story showed me that it is possible to find happiness within the field of law. Her ability to retain control over her work and the amount of gratitude she receives on a daily basis from her clients inspired me. Hopefully, one day I too will have a career in which I am truly passionate.

Free Seminar Feb 21st - Medicaid, Nursing Homes & You

How do I pay for a nursing home? Do I qualify for Medicaid? Can planning ahead save me money? Shepherd Elder Law Group is holding a free seminar February 21st.

The recent downturn in the nation's economy has created a crisis for state Medicaid programs. Do you know the rules? Medicaid is a joint federal and state program that provides payment for medical care for persons unable to afford to pay. Medicaid covers physicians' services, hospital care, supplies and other necessary services once a person has been made eligible for the program. It also pays for the expenses of long–term care in a nursing home.

The Medicaid program is administered independently in each state. While the
basic eligibility standards are the same throughout the United States, there are
significant differences between the state Medicaid programs. Despite these
differences, eligibility is generally based upon the amount of assets a person has along with the income that the person receives. Eligibility is determined at state Medicaid offices and, in the case of married individuals, the assets and income of both spouses are considered in the determination process.

Medicaid is often of importance to middle-income Americans because Medicare does not cover the costs of longterm care for illnesses such as Alzheimer’s disease or paralysis caused by a stroke. Most people who need such care for extended periods will eventually deplete their assets and become unable to pay the costs of their care.

Shepherd Elder Law Group is dedicated to providing solutions for the elderly, the disabled and their families. No matter what your situation, we listen to the needs of our clients and provide information, advice and most importantly, support.