GeriLaw | Robert Fleming, Tucson elder law attorney, and colleagues

LONG-DISTANCE CAREGIVERS RECEIVE HELP

Living in a different city or state, miles from aging parents, can be difficult. Keeping in touch by telephone and making long trips to help parents or aging relatives with their needs can be time-consuming and not nearly as effective as being available full-time in person.

 

According to a report by the Alzheimer's Association of Los Angeles and Riverside, California, there are approximately 3.3 million long-distance caregivers in this country with an average distance of 480 miles from the people they assist. The report also states that 15 million days are missed from work each year because of long distance care giving. Seven million Americans provide 80% of the care to ailing family members, and the number of long-distance caregivers will double over the next 15 years.

The long-distance caregiver is a new role that is thrust upon children and younger family members. Families used to live closer together, with children residing and working near their parents. But nowadays family members are more distant from each other. Society, today, is recognizing this. Some caregiver services have tweaked their programs to work as liaisons between long-distance caregivers, senior loved ones, and local medical professionals.

 

Professional care managers, also known as geriatric care managers, elder care managers or aging care managers, represent a growing trend to help full time, employed family caregivers provide care for loved ones. Care managers are expert in assisting caregivers, friends or family members find government-paid and private resources to help with long-term care decisions.

 

They are professionals who are trained to evaluate and recommend care for the aged. A care manager might be a nurse, social worker, psychologist, or gerontologist who specializes in assessing the abilities and needs of the elderly. Care manger professionals are also becoming extremely popular as the caretaker liaison between long-distance family members and their aging loved ones.

 

The most important thing is to find a geriatric care manager where your loved one lives. This geriatric care manager will have knowledge of all the services in the area and can be your eyes and ears.

 

The following is a partial list of what a care manager or geriatric care manager might do:

• Assess the level and type of care needed and develop a care plan.
• Take steps to start the care plan and keep it functioning.
• Make sure care is in a safe and disability friendly environment.
• Resolve family conflicts and other issues with long-term care.
• Become an advocate for the care recipient and the caregiver.
• Manage care for a loved one for out-of-town families.
• Conduct ongoing assessments to implement changes in care.
• Oversee and direct care provided at home.
• Coordinate the efforts of key support systems.
• Provide personal counseling.
• Arrange for services of legal and financial advisors.
• Provide placement in assisted living facilities or nursing homes.
• Monitor the care received in a nursing home or in assisted living.
• Assist with the monitoring of medications.
• Find appropriate solutions to avoid a crisis.
• Coordinate medical appointments and medical information.
• Provide transportation to medical appointments.
• Assist families in positive decision making.
• Develop care plans for older loved ones not now needing care.

 Services offered will depend on the educational and professional background of the care manager, but most are qualified to cover items in the list above or can recommend a professional who can. Fees may vary. There is often an initial consultation fee that is followed by hourly fees for services. Health insurance usually does not cover these fees, but long-term care insurance might.

 

When you take into account the time absent from work and time to find the right care resources for your loved ones, along with the cost of travel expenses to monitor their care, you will probably concur that using a caregiver is money well spent. Add to this the stress of handling your own life circumstances combined with being a caregiver, and you will probably wonder how you could have ever done without the care manager.

 

Andrew Hook

Oast & Hook

www.oasthook.com

 

Ethical Wills and Legacy Letters

A recent Investment News article by Kathleen M. Rehl discussed the value of parents leaving “legacy letters’ for their children and grandchildren to share after the parents are gone.  Traditional estate planning is important for everyone, but many people want to focus on more than just property or financial assets.  A legacy letter or ethical will is a good addition to an estate plan.

The author described the letter her mother had written shortly before her death.  “Please know how important you are to me and how much I love you.  Life has been such a fascinating and interesting adventure with you, my family, being a big part of this journey.”  She wrote about her values, lessons life taught her, and her love for each member of the family.  Ms. Rehl says that “[w]hat she experienced during her 84 years of life was much more valuable than the material stuff she left behind.”

Barry K Baines is the author of “Ethical Wills: Putting Your Values On Paper,” and his website is www.ethicalwill.com.  The website includes samples of ethical wills, written by people at various stages of their lives.  Theses transition times may include marriage, the birth of a child or grandchild, change of career, retirement, death of a spouse, health challenges or the end of life.  People may find that writing these legacy letters can help manage these transition stages better. 

Ms. Rehl says that writing a legacy letter not only helps loved ones by communicating the meaning of the author’s life, but is a gift for the writer.  “In reflecting upon the past and recording thoughts on paper, writers learn about themselves, ponder what they stand for and have the opportunity to articulate that which is closest to their hearts.”  People can write their initial letter and keep it updated each year.

Attorneys who may want to add legacy letters or ethical wills to their estate planning practice may want to write his or her own letter first.  This can help them understand the process and provide some guidance to the clients.

Andrew Hook
Oast & Hook
www.oasthook.com 

Life Estate and Medicaid

The basic rule for Medicaid eligibility is that an applicant, whether single or married, must have no more than $2,000 in countable resources in the applicant’s name. Countable resources generally include all bank accounts, stocks, bonds, life insurance, certain prepaid burial arrangements, and most real property.

A life estate in real property conveys to an individual certain property rights for the duration of this individual’s or someone else’s life.  Prior to August 2008, the Virginia Medicaid State Plan did not treat a life estate in real property as a countable resource, and the ownership of a life estate did not affect Medicaid eligibility.  This policy changed in September 2008, and was announced in Broadcast 5451.  Effective August 28, 2008, life estates created after that date were considered countable resources.  If the applicant or recipient lived in the home in which he or she owned the life estate, the life estate would be exempt.  If the recipient or applicant did not live in the property, then the life estate would not be exempt, unless the property was occupied by a spouse or dependent child, or the applicant or recipient was using reasonable efforts to sell the property interest.  The result of this policy change was that the eligibility for Medicaid became more restrictive.

The American Recovery and Reinvestment Act of 2009 (ARRA or Stimulus Bill) provides increased federal funding for Medicaid programs.  In order for a state to receive these increased funds, the Medicaid eligibility standards, methodologies or procedures under the Medicaid State Plan can be no more restrictive than the eligibility standards, methodologies or procedures that were in effect as of July 1, 2008.  States with Medicaid State Plans that are more restrictive now than they were on July 1, 2008, will not qualify for the increased amount of federal funding.  The new Virginia Medicaid policy regarding life estates was a more restrictive eligibility standard than was in existence on July 1, 2008.  Therefore, in order for the Commonwealth of Virginia to qualify for the increased federal funding, the new life estate policy needed to be changed.  On May 15, 2009, in Transmittal # 91, the life estate policy was rescinded.  As a result, the policy that is applied to a life estate now varies depending on the date that the life estate was created:

• Life estates created prior to August 28, 2008, are not counted as resources (except when determining eligibility for Qualified Working Disabled Individuals (QWID)).
• Life estates created on or after August 28, 2008, but before February 24, 2009, are to be treated in the same manner as real property, including the application of real property exclusions, if any.
• Life estates created on or after February 24, 2009, are not counted as resources (except when determining eligibility for QWDI).
• The transfer of a life estate must be evaluated under the asset transfer policy regardless of whether or not the life estate was counted or excluded as a resource.

The Medicaid eligibility rules are complex, and applicants and their families can easily make errors that will result in denied or delayed eligibility.  The attorneys at Oast & Hook can assist seniors in qualifying for Medicaid, while preserving assets and income for the senior’s community spouse, dependent children, children with disabilities, or other family members.

Andrew H. Hook
Oast & Hook
www.oasthook.com