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Trust Administration in a Volatile Market

Thu, 30 Oct 2025 16:03:15 GMT

Essential Tips for Trustees

In today’s unpredictable financial landscape, trustees must navigate the complexities of trust administration with diligence and foresight. Here are several key tips to help trustees manage trusts effectively during volatile market conditions:

1. Be Proactive

• Review the Trust and Investments: Regularly assess the trust’s holdings to understand their diversity and alignment with long-term strategies. Evaluate the potential opportunities in the market, especially considering any liquidity available.

• Long-Term Strategy: Focus on the long-term goals of the trust, whether they pertain to investments or distributions. This helps in making informed decisions that align with the trust’s objectives. For example, if you are merely marshalling assets to distribute do you want to remain in the market or should you get out quickly?

2. Document All Decisions

• Record Keeping: Meticulously document every decision made regarding the trust. This includes reasons for retaining or purchasing assets, advice received from money managers or brokers, and the criteria used for selecting these professionals.

• Transparency: Clear documentation ensures transparency and accountability, which is crucial for maintaining trust with beneficiaries and complying with legal requirements.

3. Maintain Contact with Beneficiaries

• Regular Communication: Keep beneficiaries informed about the trust’s status and any significant decisions. Regular updates can boost their confidence and reassure them their interests are a priority.

• Empathy and Support: Show empathy towards beneficiaries’ concerns, especially in uncertain market conditions. Your proactive communication can foster a sense of security and trust.

4. Obtain Consent for Unusual Actions

• Seek Approval: For any actions that deviate from the norm but are still in line with the trust’s terms, obtain consent from the relevant parties. This ensures that all stakeholders are on the same page and reduces the risk of disputes.

• Legal Compliance: Adhering to this practice helps in maintaining legal compliance and upholding the trust’s integrity.

5. Adhere to the Prudent Investor Rule

• Objective Decision-Making: Make investment decisions based on what a prudent investor would do, rather than personal preferences. This rule is designed to protect the trust’s assets and ensure they are managed responsibly.

• Delegation of Authority: If uncertain, remember that you can delegate investment authority to qualified professionals. Ensure you document the selection process and monitor their actions to ensure they align with the trust’s objectives.

By following these tips, trustees can navigate the challenges of administering a trust in a volatile market, ensuring they fulfill their fiduciary duties and maintain the trust’s stability and growth.

VA Aid & Attendance

Wed, 08 Oct 2025 19:11:31 GMT

To care for him who shall have borne the battle and for his widow and his orphan. ~ Abraham Lincoln

Service to those who have served our country provides an opportunity to give back and potentially locate people who require our assistance. While the VA has very serious rules regarding who can represent Veterans, helping educate them and their spouse is something our profession should do.

Estimates range from 25 to 70 million Veterans who may be eligible for some type of veteran’s benefits. Many of whom have no idea of the various benefits potentially available to them. Obtaining accurate information unfortunately can be difficult for veterans and their spouses. This article is intended to provide information regarding a VA program many within the senior market continue to encounter. The program is commonly referred to as Aid and Attendance; however, it is actually an Improved Pension plus Aid and Attendance. (Aid and Attendance is also a term used for VA disability, which this article does not discuss.)

WHAT IS AID AND ATTENDANCE?

Aid and Attendance is a special monthly pension available to war time veterans and a surviving spouse of a war time veteran who are also 65 years or older or 100% disabled. It is considered a means tested program; meaning veterans or their spouses must meet certain eligibility requirements. Congress directed the United States Department of Veterans Affairs to establish a program for veterans and their surviving spouses to help defer certain medical expenses which pushed the veteran or spouse into poverty levels. The maximum monthly benefit for this is program each month is $2,085 for a veteran with a spouse; $1,759 for a single veteran; $1,130 for a surviving spouse of a veteran; and $2,790 if both are veterans. It is important to understand this is not a all or nothing benefit. To determine what the benefit will be one should have an understanding of the how one is determined eligible. The following are four stages that must be cleared.

WAR TIME VETERAN

Many people do not consider themselves war time veterans because they were never deployed to the battlefield. However, this program does not distinguish between service at home or abroad. To meet this element the veteran must have served 90 consecutive days in the military with one day of active duty during a period of war time. The war periods are for WWII December 7, 1941 through December 31, 1946; Korean War June 27, 1950 through January 31, 1955; Vietnam August 5, 1964 through May 7, 1965. In addition to meeting the service period, the veteran must also have received a discharge other than dishonorable.

MEDICAL ASSESSMENT

A Veteran or their spouses must meet a medical determination which can be accomplished in two ways. First, if the claimant requires assistance with their activities of daily living as evidenced by a physician showing the aid of another person to perform at least two activities of daily living, such as eating, bathing, dressing, transferring, dressing, toileting, or grooming; OR being a patient in a nursing home OR being blind or nearly blind.

The other way to meet this requirement is to demonstrate the claimant is housebound. Here evidence must demonstrate the claimant has a single permanent disability rated 100 percent.

Income Assessment

Aid and Attendance does not have an income limit per se; however, they do require the claimant have insufficient income to meet their needs. The VA is looking for the claimant’s “income for VA purposes” (IVAP). This is determined by taking the Gross income and deducting the unreimbursed medical expenses (UMEs). Then one subtracts the IVAP from the maximum amount the claimant would be entitled (MAPR) to receive if otherwise eligible. Assuming the IVAP is less than the MAPR this step is cleared. To illustrate consider a veteran who has an income of $3,000 per month and is paying $4,500 for an assisted living with memory care. The maximum the veteran would be entitled to would be $1,759. Therefore his IVAP would be approximately $-1,500. (There is a 5% set aside in determining the unreimbursed medical expenses which is not covered here.) Therefore the VA would determine the Veterans had insufficient income to meet his/her needs.

ASSET ASSESSMENT

This is the most often misrepresented part of the claimant’s assessment. Many have stated incorrectly there is an asset limit of $80,000. However, the rule states if the claimant has assets greater than $80,000 the case must be approved by a supervisor. Like the income assessment the VA is looking to see if the claimant lacks the ability to pay for their medical expenses. Here they are looking at the claimant’s need for care over their life time. They consider the claimant’s life expectancy, UMEs, income, and assets to determine whether they will run out of assets prior to their death. This leaves agents in a state of flux when asked whether they have sufficient assets. Generally one would consider a veteran over the age of 65 to be on a sliding scale. If they use the $80,000 as a measuring rod to start with at age 65 the claimant will need less and less as they age. For example an 85 veteran with a high income may be limited to $20,000 or if they have a very low income and high medical cost they may be allowed to have $80,000. To determine a firm number an Agent should work with a VSO or accredited agent with the VA familiar with this program. (Do not assume everyone who is a VSO or Agent understands this program. Determine their level of involvement.)

WHY LEARN ABOUT THIS?

Many will question why they need to understand this program if they can not represent or work directly on the client’s behalf with the VA. First, without the correct information you may lose your established client base as they get drawn to others who do have the answers (or worse yet scam artist looking to take advantage of them). Second, by being knowledgeable about this program you will be able to speak to more potential clients who have questions about how they will pay for their long term care regardless of whether they qualify. I have spoken to many veterans who had “the correct service record”; however, they could not meet the asset eligibility test without substantial loss. Still, I have been able to provide other benefits for them. Finally, the old saying you get what you give plays in; by helping these individuals be aware of benefits they are entitled to receive you are sowing seeds which over time will reap additional business for you.

THE TEAM

Many times the advisor’s most difficult task in this area is to organize a client’s assets in a way as to best demonstrate why the client meets the eligibility assessment and accomplish this without causing further problems down the road. Like Medicaid planning this often requires income, tax planning and the utilization of financial products such as annuities. The client’s advisors are going to be a mix of an Elder Law attorney, a CPA, a VSO, and a financial advisor. They must work together to determine the best combination of strategies and financial products that will gain eligibility for this special monthly pension, but do not disqualify the client from Medicaid in the future (a benefit many require prior to death for skilled care), cause an unreasonable tax liability, or place assets at risk by transferring to other family members. A client’s plan takes in professions beyond our own and avoiding over exposure to risk is accomplished through the team approach.

THE PROCESS

While the application process for special monthly veteran’s benefits can be very slow, taking over a year sometimes before the VA makes a decision, this benefit is retroactive to the month after the application was submitted. Having the proper documentations in place at the time of application is most important. Example, discharge papers, medical evidence, medical expense reports, death certificates, marriage certificates, and a proper and completed application can cut this process in half. Having a VSO you can speak with will help you understand what is needed.

CONCLUSION

Every advisor who specializes in working with retirees should understand this program. Advisors who do not wish to expand their knowledge of VA should still be able to recognize the opportunity to educate and if necessary refer prospects and/or existing clients to an Elder Law Attorney and/or Veteran Service Officer.

Top Ten Tips To Remember When Working With The VA

Jason A. Waddell

Board Certified Elder Law Attorney

Pensacola, FL

1. Only accredited agents can complete and apply for benefits for clients.

2. One can not charge for doing the application process.

3. Find, meet and befriend Veteran Service Officers in your area.

4. There isn’t a look back period for gifts but there is pending legislation to impose one.

5. Medicaid has a five year look back period and transfers made for the purpose of qualifying for Aid and Attendance can later disqualify the person for other benefits.

6. There are additional benefits given when one is approved for Aid and Attendance in addition to the monthly benefit; therefore, even if the claimant will only receive a small amount monthly through this program it may benefit them to proceed.

7. The home, car and personal belongings are non-countable in the application process.

8. If the application has been pending for more than 9 months I suggest they call contact their representatives (Senators and Congressional representative).

9. Watch out for UPL (unlicensed practice of law): drafting certain trusts, contracts, deeds, and other estate documents is a criminal act if done without a license in most states. Additionally, such action can lead to civil liability if problems arise.

10. Locate a qualified Elder Law attorney. The largest and most noted Elder Law Organization is the National Academy of Elder Law Attorneys. (NAELA). Their web site (www.naela.org) has a means of searching for an attorney in your area.

Beware of the Phantom Hacker Scam

Thu, 28 Aug 2025 13:26:05 GMT

What You Need to Know

In a world where we seem to now depend on technology for everything, the FBI has issued a warning about a new and sophisticated scam known as the "Phantom Hacker Scam." This alarming trend is targeting unsuspecting individuals and organizations, leading to significant financial losses and data breaches. In this blog post, we will delve into the details of this scam, how it operates, and what you can do to protect yourself.

What is the Phantom Hacker Scam?

According to the FBI, the Phantom Hacker Scam involves cybercriminals posing as legitimate IT professionals or cybersecurity experts. They often approach victims claiming to have detected a breach in their systems or that their accounts have been compromised. The scammers may provide false evidence of the breach, such as screenshots or alerts, to create a sense of urgency and panic.

Once they have gained the victim's trust, the scammers will offer to help them remediate the "breach" and request sensitive information, such as passwords and account numbers. They may also request payment for their services, which can range from hundreds to thousands of dollars.

How to Protect Yourself

Our advice as well as the FBI advises individuals and organizations to be vigilant and take the following precautions to protect themselves from the Phantom Hacker Scam:

1. Verify the Source: Always verify the identity of anyone claiming to be a cybersecurity expert. Contact your IT department or a trusted cybersecurity professional to confirm the legitimacy of the claim. If you do not work with an IT professional it is best to contact a family member to bounce this information against. Often by simply talking about what is being said it will help you realize something doesn’t add up.

2. Be Skeptical of Urgency: Scammers often create a sense of urgency to pressure victims into making quick decisions. Take your time to assess the situation and gather information before taking action. Again, talk to family and friends. Don’t be afraid to ask for help from those you know.

3. Do Not Share Sensitive Information: Never share passwords, account numbers, or other sensitive information with anyone you do not know personally. If it is a financial institution hang up and call that financial institution back on a number you have from their materials given to you. If you don’t have anything go to their location.

4. Report Scams: If you believe you have been targeted by a scam, report it to the FBI's Internet Crime Complaint Center (IC3) at www.ic3.gov.

Conclusion

The Phantom Hacker Scam is a reminder of the importance of cybersecurity and vigilance in today's digital landscape. By staying informed and taking proactive measures, you can protect yourself from falling victim to this and other online scams. For more information on the Phantom Hacker Scam and other cybersecurity threats, visit the FBI's website.

Stay safe and stay informed!

Digital Age and Retirees

Wed, 23 Oct 2024 13:47:43 GMT

What To Watch Out For

As retirees embrace the digital age, there are several important considerations and potential risks they should be aware of:

1. Online Scams and Fraud:

o Retirees may encounter phishing emails, fake websites, or fraudulent phone calls. These scams often target personal information, financial details, or even attempt to impersonate trusted organizations.

o Advice: Be cautious when receiving unsolicited emails or calls. Verify the legitimacy of requests before sharing sensitive information.

2. Weak Passwords and Security Practices:

o Using weak passwords or reusing the same password across multiple accounts can compromise security.

o Advice: Create strong, unique passwords for each online account. Consider using a password manager to securely store and manage passwords.

3. Privacy Concerns:

o Sharing personal information online can lead to privacy breaches. Social media platforms, online forms, and shopping websites collect data that may be used for targeted advertising or other purposes.

o Advice: Review privacy settings on social media platforms. Be mindful of what information you share publicly.

4. Tech Support Scams:

o Scammers may call claiming to be tech support representatives from well-known companies. They might ask for remote access to your computer or request payment for fixing nonexistent issues.

o Advice: Never grant remote access to unknown callers. Legitimate tech support won’t ask for payment upfront.

5. Health Information and Telemedicine:

o With the rise of telemedicine, retirees may share health information online. Ensuring the security and privacy of medical data is crucial.

o Advice: Use reputable telehealth services and verify their security protocols. Keep medical records secure.

6. Social Isolation and Mental Health:

o Relying solely on digital communication can lead to social isolation. Retirees may miss out on face-to-face interactions.

o Advice: Balance online interactions with in-person connections. Stay connected with family and friends both online and offline.

7. Financial Transactions:

o Online banking, shopping, and investment platforms are convenient but require caution. Unauthorized transactions or identity theft can occur.

o Advice: Regularly monitor bank statements, credit card activity, and investment accounts. Report any suspicious transactions promptly.

8. Digital Literacy and Learning Curve:

o Retirees who are less familiar with technology may struggle with navigating websites, apps, and devices.

o Advice: Seek assistance from family members, friends, or local community centers. Attend technology workshops to build digital skills.

9. Device Security and Updates:

o Outdated software and lack of security updates can make devices vulnerable to cyberattacks.

o Advice: Keep devices (computers, smartphones, tablets) updated with the latest security patches.

10. Elder Abuse and Online Harassment:

o Retirees may face online harassment, cyberbullying, or financial exploitation.

o Advice: Report any abusive behavior or harassment. Seek legal help if necessary.

Remember, staying informed, cautious, and proactive can help retirees navigate the digital landscape safely.

Is My Homestead Safe?

Wed, 29 Dec 2021 20:02:00 GMT

A common question I receive in my office is what will happen to my home when I pass away if I die in a nursing home? For Florida residents the answer is quite different than other states. In Florida if you pass away and your home is being left to your family then it is protected by our homestead laws. This is true whether it enters probate or not. Some would argue that going through probate is a more secure way to protect it because it would have an order declaring it as homestead where if it passed to the family through a trust there wouldn’t be an order. As most know I am not a fan of entering into a trust document when there is only homestead property; however, to be clear your home is protected so long as the family meets the definition of family.

This begs the question who is my family? The Florida Supreme Court has defined “heirs” in relation to homestead protection as “any family member within the class of persons categorized the Florida intestacy statute.” So, if you are like me then that answered absolutely nothing as it does not address a decedent’s deceased spouse’s family who in many cases closer to be related than others within the statute. Since that opinion by the Supreme Court there have been subsequent cases which have tackled the issue of children of a decedent’s deceased spouse and found they can fall within the protected class. Does that mean children from another marriage have a right to claim an interest in an estate? No, if there isn’t a Will devising the property to those individuals they will not take under the law of intestacy which is the law followed when one does not have a Will.

If you are reading this and concerned about your homestead, what action should you take? Well it depends (you have to love lawyers). You may consider altering your deed to name a beneficiary, or you may simply revisit your will to confirm that you didn’t put a charity in a place where they might receive the homestead. There are many things you might do depending on your circumstances. What I will caution you against doing is transferring an interest in your home to your children or others. Our firm has seen a pattern where parents transfer their home to their children but reserve a life estate. This is a very dangerous planning method for the vast majority of people in Florida. My reason(s) for saying this are so long they justify their own blog posting; for now just trust this is a bad technique, which has been abandoned by most attorneys for decades but still is followed by people who dabble in this type of work.

In the end the Medicaid recovery act is real, and there are families which may lose their homestead protection. However, those individuals were the ones who did not seek help with their estate plan. Florida protects homestead so long as you intend to leave your home to your family. If you have further questions regarding this post please let us know.

Nursing Homes and the Coronavirus (COVID-19)

Wed, 11 Mar 2020 16:21:00 GMT

Keep Our Loved Ones Safe

The following has been taken from several recent article s and announcements sent to facilities th roughout the country. This summarized version hopefully will provide some understanding of wh at to expect w hen visiting. Plea se keep in mind facilities are bound by their license to follow these guidelines. Everyone is attempting to protect the residents and staff. Patience and understanding by all is going to be necessary.

The Centers for Medicare & Medicaid Services (CMS) is taking action to protect the health and safety of our nation’s patients and providers in the wake of the 2019 Novel Coronavirus (COVID-19) outbreak. According to the latest data from the Centers for Disease Control and Prevention (CDC), seniors are at the greatest risk of serious illness due to COVID-19, which is why CMS is providing valuable information to providers who interact with patients in the hospice setting. To protect these vulnerable patients, CMS is amplifying its current health and safety requirements by delivering detailed guidance on the screening, treatment and transfer procedures healthcare workers must follow when interacting with patients to prevent the spread of COVID-19. CMS is also issuing additional guidance specific to nursing homes to help control and prevent the spread of the virus.

Limiting visitors and individuals: Expanded recommendations:

CMS is providing the following expanded guidance to prevent the spread of COVID-19 (in addition to the information above about restricting visitors).

• Restricting means the individual should not be allowed in the facility at all, until they no longer meet the criteria above.

• Limiting means the individual should not be allowed to come into the facility, except for certain situations, such as end-of-life situations or when a visitor is essential for the resident’s emotional well-being and care.

• Discouraging means that the facility allows normal visitation practices (except for those individuals meeting the restricted criteria), however the facility advises individuals to defer visitation until further notice (through signage, calls, etc.).

1. Limiting or Discouraging visitation:

a) Limiting: For facilities that are in counties, or counties adjacent to other counties where a COVID-19 case has occurred, we recommend limiting visitation (except in certain situations as indicated above). For example, a daughter who visits her mother every Monday, would cease these visits, and limit her visits to only those situations when her mom has a significant issue. Also, during the visit, the daughter would limit her contact with her mother and only meet with her in her room or a place the facility has specifically dedicated for visits.

b) Discouraging: For all other facilities (nationwide) not in those counties referenced above, we recommend discouraging visitation (except in certain situations). See below for methods to discourage visitation. Also see CDC guidance to “stay at home” https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-riskcomplications.html#stay-home.

2. Affirmative action Facilities should take:

a) Increase visible signage at entrances/exist, offer temperature checks, increase availability to hand sanitizer, offer PPE for individuals entering the facility (if supply allows).

b) Also, provide instruction, before visitors enter the facility and residents’ rooms, on hand hygiene, limiting surfaces touched, and use of PPE according to current facility policy while in the resident’s room.

c) Individuals with fevers, other symptoms of COVID-19, or unable to demonstrate proper use of infection control techniques should be restricted from entry.

d) Signage should also include language to discourage visits, such as recommending visitors defer their visit for another time or for a certain situation as mentioned above.

3. In addition to the screening visitors for the criteria for restricting access (above), facilities should ask visitors if:

• they took any recent trips (within the last 14 days) on cruise ships or participated in other settings where crowds are confined to a common location.

• If so, facilities should suggest deferring their visit to a later date. If the visitor’s entry is necessary, they should use PPE while onsite.

• If the facility does not have PPE, the facility should restrict the individual’s visit, and ask them to come back at a later date (e.g., after a 14 days with no symptoms of COVID-19).

4. In cases when visitation is allowable, facilities should instruct visitors to limit their movement within the facility to the resident’s room (e.g., reduce walking the halls, avoid going to dining room, etc.)

5. Facilities should review and revise how they interact with volunteers, vendors and receiving supplies, agency staff, EMS personnel and equipment, transportation providers (e.g., when taking residents to offsite appointments, etc.), other practitioners (e.g., hospice workers, specialists, physical therapy, etc.), and take necessary actions to prevent any potential transmission. For example, do not have supply vendors transport supplies inside the facility.

Have them dropped off at a dedicated location (e.g., loading dock). Facilities can allow entry of these visitors as long as they are following the appropriate CDC guidelines for Transmission-Based Precautions. For example, hospice workers can enter a facility when using PPE properly.

6. In lieu of visits (either through limiting or discouraging), facilities can consider:

a) Offering alternative means of communication for people who would otherwise visit, such as virtual communications (phone, video-communication, etc.).

b) Creating/increasing listserv communication to update families, such as advising to not visit.

c) Assigning staff as primary contact to families for inbound calls, and conduct regular outbound calls to keep families up to date.

d) Offering a phone line with a voice recording updated at set times (e.g., daily) with the facility’s general operating status, such as when it is safe to resume visits.

7. When visitation is necessary or allowable, facilities should make efforts to allow for safe visitation for residents and loved ones. For example:

a) Suggest limiting physical contact with residents and others while in the facility. For example, practice social distances with no hand-shaking or hugging, and remaining six feet apart.

b) If possible (e.g., pending design of building), creating dedicated visiting areas (e.g., “clean rooms”) near the entrance to the facility where residents can meet with visitors in a sanitized environment. Facilities should disinfect rooms after each resident-visitor meeting.

c) Residents still have the right to access the Ombudsman program. If in-person access is allowable, use the guidance mentioned above. If in-person access is not available due to infection control concerns, facilities need to facilitate resident communication (by phone or other format) with the Ombudsman program or any other entity listed in 42 CFR § 483.10(f)(4)(i).

8. Visitor reporting:

a) Advise exposed visitors (e.g., contact with COVID-19 resident prior to admission) to monitor for signs and symptoms of respiratory infection for at least 14 days after last known exposure and if ill to self-isolate at home and contact their healthcare provider.

b) Advise visitors to report to the facility any signs and symptoms of COVID-19 or acute illness within 14 days after visiting the facility.

For more information you may visit the following:

https://www.cms.gov/newsroom/press-releases/cms-issues-clear-actionable-guidance-providers-about-covid-19-virus

https://www.cms.gov/files/document/qso-20-14-nh-revised.pdf

https://www.ahcancal.org/facility_operations/disaster_planning/Documents/SNF-Guidance-Preventing-COVID19.pdf

The Importance Of Knowing What You Don’t Know

Thu, 23 Jan 2020 16:06:00 GMT

Many people make an incorrect assumption that I know more than I actually do know. When out socially, it is not uncommon for someone to ask me about a contract they are signing or for a relative to call and ask if they have a case against a neighbor. Even after years of explaining my expertise is in Elder Law, I continue to get these questions. I have explained I am on top of my field with Elder Law but that does not mean I am on top of the overall legal profession (only a fool would ever considering himself or herself there).

Many know I served on the Florida Bar’s Grievance committee for three years. There we would hear complaints about other attorneys and determine if there was probable cause for the Bar to proceed further against them. We would often hear an attorney say something along the lines of I thought something was better than nothing. A statement which is wrong far more than it is right. In the end the attorney should have never accepted the case and their license was now at risk for attempting to give the “something.”

This isn’t simply an attorney issue. I see many people coming into my office and show me documents they have “helped” their love ones create. I have extremely educated individuals come in and show me (somewhat proudly) that they went online and purchased an estate plan. What these people often learn during a meeting with me is the quick and easy document may work to open a bank account; however, for someone in retirement who has a progressive illness those documents fall well short of what is needed once we start working with the Federal Government, Pension companies, the IRS, and the like.

An all too common issue we see is with a poorly drafted Durable Power of Attorney (DPOA). People will slide it across the table and even before opening it I know it will not cover irrevocable trust planning which will be necessary even if the person is completely broke but has $2,349.01 in gross income each month and needs Medicaid. These DPOAs come from online sources; however, too often they come from attorneys who thought they were doing a favor for a friend (often under the assumption it is only a form right). Without a properly worded DPOA the fees often double well into the thousands. All is avoided in the majority of cases for a few hundred. Proving the old adage an ounce of prevention is better than a pound of cure.

I could continue with this right into other areas of my practice such as using financial advisors to do public benefits planning, which is something the Florida Supreme Court has ruled the unlicensed practice of law in the case (SC14-211); however, if you are reading this I know you are smart enough to know the limits of what you should attempt on your own. Let us just hope other professionals can follow our lead.

Until next time if you have a question about your estate or retirement plans and would like to discuss it with me please know we are accepting new clients.

Be good to your family.

Protecting Parents from Themselves

Wed, 07 Aug 2019 16:51:00 GMT

From time to time I receive the question “what can I do to protect my parent from themselves”. In situations such as this, the parent often is suffering from a dementia related illness, and while still competent for the most part is making snap decisions they would have previously never made. The adult child doesn’t want to file for Guardianship because of the direct challenge to the parent’s competency and high cost. At the same time, the child does not want Dad to go buy a new $60,000 SUV either. There are several steps I can recommend in this situation to protect a loved one from making poor decisions.

1. First a good Durable Power of Attorney (DPOA) is the cornerstone of a solid plan. What do I mean when I say “good”? One that is drafted by an attorney who works with people in your loved ones situation. This document while simple in appearance is actually very complex in the state of Florida. In 2011, the Florida Legislature enacted a new DPOA statue with specific requirements on what language should be included within a DPOA. The vast majority of online documents lack this information. Further, many general practitioners or non-elder and estate attorneys are unaware of the change in the law. Spend the extra few hundred dollars to obtain a Durable Power of Attorney that will work when the time comes. Otherwise, you may find yourself spending thousands to protect your loved one.

2. Establish an online account presence with their accounts. Many parents do not have online access to their accounts. With many children living in other areas from their parents, purchases can go unnoticed. Parents often have a feeling the decision they made was a poor one and will not mention it on calls. If you are monitoring purchases you can often catch where scams or poor decisions are being made. Of course you need to have your parents’ consent to access their account, which is why step-one was a DPOA.

3. If parents show signs of making large transactions on credit, place barriers between them and credit. Cancel credit cards or reduce balance to small amounts that if lost would not hurt the overall estate. Additionally, credit reporting agencies have the ability to freeze people’s credit. Equifax has just such a service and the link provided takes you to the sight where they walk you through the process. If the parent can’t obtain new credit, then spur of the moment decisions can’t be made.

4. Still, freezing ones’ credit does little for parents who are a little too trusting of people. It is common to see many seniors succumb to various scams by people who on the surface seem trustworthy. These people can be in social organizations, churches, or just strangers online or calling their home. Protection from these individuals can be extremely difficult. Our office has walked into cases from people who have deeded their home to a church, agreed to send large and small sums of money to fake charities, as well as many, many overseas internet scams. For many of these parents the issue is one of control. They do not want to have someone remove control of their accounts. Ironically, the more one pushes to help the more they may reach out to unscrupulous individuals. When we meet with clients we remind them that a family member acting through a Power of Attorney is not taking control. They are called an Agent because they work with and for the person signing the document. For these issues a conversation with a qualified attorney could help. If you have ever noticed law firm signs that say attorney and counselor at law then you will appreciate that Elder Law attorneys really are more on the counselor end of that spectrum. They understand the fears and anxiety that many feel and can help people understand what is being granted and what is not.

5. If the loved one’s sole asset is Social Security then you can become the representative payee Agent through the social security process. This will allow you to receive the Social Security check. You will become the fiduciary for the individual, which means you are liable for using the money for their care (you are as an Agent through a DPOA also). For more information you can visit Social Security .

If at the end nothing seems to be working to stop the parent and they either will not allow you to help or lack the capacity to give you the authority to help you may be forced to obtain a Guardianship. Working with an attorney whose practice handles Guardianships on a daily basis is key. Attorneys who practice criminal law, family law and Guardianships are likely going to lack the specific knowledge of techniques and services to make the process as respectful as possible. While strong advocacy is important in a litigation attorney, Guardianship is a mix bag of social work, legal knowledge, and advocacy. I handled contested and uncontested guardianships for 15 years (I stopped accepting new cases several years ago). I was always shocked at how litigation attorneys could seemingly divide a family while going through the process. It is not necessary. Work with the right attorney and you increase your odds of making it through without losing relationships.

Still the best policy is to plan prior to a problem arising. We can accomplish far more working together while everyone is competent and can explain their goals and desires. There is no cookie cutter way to plan estates. My office seeks to help families find the right plan for their unique situation.

What Is A Trust Protector and Do I Need One?

Wed, 13 Feb 2019 15:37:00 GMT

“Who will manage my estate when I am gone?” is a common concern for many. I can see the concern in my clients eyes as they say that they trust their child but worry over their in-laws influence. Others will tell me they love their children but simply cannot trust them with their estate. There are many reasons people will set up a trust to resolve their estate. For those individuals, many are finding comfort with the fact they can appoint an individual or group of individuals to act as a protector of their original intent.

A trust protector is simply a person or a group of people who follow a trust after a certain event (often the death or incapacity of the person who established the Trust). The powers vary as to what a trust protector may do. However, a general list would be audit the accounting, remove and name another trustee (rarely themselves), amend language to provide better tax protections, etc. The goal is to create a little check and balance within the trust to help insure the wishes are followed out.

Of course there are limits to the Trust Protector. First and foremost they should be acting as a fiduciary; meaning they are not acting in their own personal interest but in the interest of the trust. They likewise can’t remove a professional trustee and name their spouse as trustee. They can’t modify who is a named beneficiary (absent special circumstances such as the beneficiary becomes disabled and the funds would be better protected in another type of trust).

Most trust protectors are compensated in some form or fashion; however, their work shouldn’t be an ongoing matter. Further, many trust protectors are family and do not care about compensation. Generally the cost of a trust protector is low. The drafting attorney should be able to estimate what they would anticipate the cost to be, if any, on an annual basis.

You are likely wondering who acts as a trust protector? There is no simple answer to this question; however, often if the trust names a corporate trustee then the beneficiaries might serve as a trust protector. Many people will name their CPA firm as a Trust protector along with a beneficiary or two. On rare occasions people will name their attorney to this role. However, this normally will only occur when they require help with a specific part of their estate. The ongoing cost for an attorney to serve in this role traditionally make it impractical.

In the end a properly drafted trust can benefit from a trust protector when there is some uncertainty surrounding the trustee being appointed, the potential actions taken by beneficiaries, complex tax and public benefits being sought by heirs or family disagreements which may make administration difficult for the trustee. If you have a trust and believe your trust could benefit from a trust protector then you should schedule time to discuss this important matter with your attorney. If you are in the Pensacola region and would like to discuss the matter further with me, feel free to reach out as we are accepting new clients.

SNOPES for Your Estate Plan?

Fri, 11 Jan 2019 20:28:00 GMT

A common situation we find ourselves in is who to leave our estate to if there was a common accident. Take a recent client who came into our office. She has one daughter and no grandchildren. Her daughter is 55 years old, therefore, is not planning to start a family. The client explains that her siblings are financially stable and elderly themselves so she wouldn’t want to leave them her estate if her daughter passed prior to her or with her. She likewise doesn’t want to leave the funds to her friends. I then start asking questions such as what are you passionate about? What groups help you, inspire you, or make you feel more hopeful for a better tomorrow?

From time to time, clients will provide the name of a group I haven’t heard of, or worse yet, a group I have heard of but with a slightly different name. Red flags go up immediately and I go into protector mode. I know that scams on retirees is a 30+ billion dollar a year problem (yes that is a “b”) in the United States. Personally, I believe the problem is much worse as many seniors are afraid to report the scam out of fear their family will believe they are incapable of managing their affairs (back way to judge incapacity, by the way, but that is another topic). Therefore, when I hear of something I am unfamiliar with I go into action to research the group.

How can you better protect yourself and those you care about? A common method for debunking myths is to go to the website www.snopes.com . This is a site I forward to my mother on a nearly monthly (and during the holidays and election years weekly) basis due to Facebook. However, for charities it likely will not be the best place to research a group. AARP has many great tools to help you research groups. For example you can visit the AARP Fraud page for a list of different ways to spot a scam. They also have list of groups they have vetted. Another site I have used to research nonprofits is Charity Navigator . Here you will find the financial background of many charities. Groups such as this have helped expose how many charities look good with marketing but are merely fronts for high executive paychecks.

A general rule of thumb is a charity should be giving 80% of the amount they take in back to the mission of their charity. The fact that a CEO makes $500,000 isn’t disqualifying in and of itself. Look at the overall picture of the organization. If that 6 figure salary is 50% of the amount they raise in a year then you should avoid it; however, if that is less than 3% of the organizations gross receipts then it might be fine. Managing an international organization can be expensive; however, there are many groups which do it without milking the profits.

Therefore, in closing this post, I will remind you to listen with your heart but give with your mind and if you have trouble separating the two ask for help. We are accepting new clients and are more than willing to help you. Take care.

Memory Is the Scribe of the Soul. — Aristotle: Greek Philosopher

Wed, 01 Aug 2018 00:00:00 GMT

Advance Directives: Planning for One’s Life, Not Death

Wed, 21 Mar 2018 00:00:00 GMT

What is Daily Money Management?

Thu, 25 Jan 2018 00:00:00 GMT

Probate Problems: How to Steer Clear of Probate Court

Wed, 03 Jan 2018 00:00:00 GMT

Need Help Understanding Medicare? Here Are Tips and Resources for Assistance

Wed, 06 Dec 2017 00:00:00 GMT

What 2017 Has Brought for Seniors, Veterans and Persons with Disabilities

Wed, 29 Nov 2017 00:00:00 GMT

Something To Get STEAMED Up About

Mon, 23 Oct 2017 00:00:00 GMT

The Senate Releases its Health Care Bill…Now What?

Thu, 12 Oct 2017 00:00:00 GMT

Can Poor Sleep Increase Your Risk of Alzheimer’s?

Wed, 04 Oct 2017 00:00:00 GMT

The Costs of Dementia: For the Patient and the Family

Wed, 27 Sep 2017 00:00:00 GMT

VA Compensation Benefits for Veterans and Family Members

Wed, 20 Sep 2017 00:00:00 GMT

Veterans compensation is a tax-free benefit paid monthly to a veteran and/or eligible family members because of the veteran’s service-connected disability.

A service-connected disability includes an injury or disease incurred during active military service or a pre-existing injury or disease that is aggravated during active military service. Compensation may also be paid for post-service disabilities that are considered related or secondary to disabilities occurring in service and for disabilities presumed to be related to circumstances of military service, even though they may arise after service.

A disability can apply to physical conditions, such as a chronic knee condition, as well as mental health conditions, such as post-traumatic stress disorder (PTSD). Medical and service records that document the condition as chronic or continuous will need to be provided.

The benefit amount is determined on a case-by-case basis and is graduated, on a scale of 10% to 100%, according to the degree of the veteran’s disability. The degrees of disability are also designed to compensate for considerable loss of working time from exacerbations or illnesses.

Dependency and Indemnity Compensation (DIC) is a tax-free monthly benefit paid to a surviving spouse, child or parent of military service members who died in the line of duty or veterans whose death resulted from a service-related injury or disease. Other eligibility requirements must also be met. DIC for parents is an income-based benefit for a biological, adoptive or foster parent who also meets certain other eligibility requirements.

Special Monthly Compensation (SMC) is an additional tax-free benefit that can be paid to veterans, their spouses, surviving spouses and parents. For veterans, SMC is a higher rate of compensation paid due to special circumstances such as the need of aid and attendance by another person or a specific disability, such as loss of use of one hand or leg. For spouses and surviving spouses, this benefit is commonly referred to as aid and attendance and is paid based on the need of aid and attendance by another person.

Other Benefits: The VA provides additional housing and insurance benefits to veterans with disabilities, including Adapted Housing Grants, Service-Disable Veterans’ Insurance and Veterans’ Mortgage Life Insurance.

Note: These compensation benefits are different from, and should not be confused with, VA pension benefits, which are for veterans over age 65, their spouses and disabled children.

You can read more about VA compensation benefits, eligibility, documentation requirements, and how to apply on the VA’s website: http://www.benefits.va.gov/compensation .

High Intensity Exercise for Seniors

Thu, 14 Sep 2017 00:00:00 GMT

The health benefits of exercise are well-established for people of all ages. The benefits from eating healthy and having a proper exercise routine are also well-established. However, only recently has research been conducted about which type of exercise best counters the aging process in senior citizens. A new study published in Cell Metabolism by researchers from the Mayo Clinic suggests the answer may be high-intensity interval training (HIIT). HIIT alternates short bursts of intense aerobic activity such as biking or walking with short periods of easing up on the same activity. This type of exercise method avoids the risk of injuries associated with non-stop, repetitive activity. Compared to other types of exercise, it appears to be dramatically more effective at boosting the activity of aging cells and even reversing age-related cellular damage. This exercise also led to improved insulin sensitivity, which is associated with a reduced risk of diabetes.

Most experts agree that many older adults can participate in an age-appropriate high-intensity interval training program that takes into account their physical limitations. Older adults are more likely to have an underlying health issue such as osteoporosis, arthritis, diabetes, hypertension or a history heart disease, heart attack, or stroke. So, it’s essential to consult with a primary care provider and take a cardio-stress test before beginning a new exercise program, especially one that involves vigorous activity.

Of course, there are other things to keep in mind before starting an HIIT regimen.

Alzheimer’s Stigmas

Thu, 07 Sep 2017 00:00:00 GMT

When a loved one starts to lose his or her memory, it can be a struggle for the entire family. The person who has been the head of the family may soon fade from the person they once were, leaving their loved ones to wonder what will come next. The stigma associated with Alzheimer’s disease has a significant negative impact on the lives of people with Alzheimer’s and their caregivers. Around 25% of dementia patients hide their diagnosis, and 40% said they have withdrawn from many everyday activities according to recent studies. There are many negative public images and stereotypes associated with dementia, which contributes to a lack of engagement with people with this condition. Many people with dementia experience social isolation due to withdrawal from friends and other important people in their lives.

Many misconceptions of Alzheimer’s exist. It is widely believed that Alzheimer’s and dementia are a normal part of aging. This is not true. It is a disease that develops from a wide variety of risk factors. Many people believe that Alzheimer’s patients become violent and aggressive. This only happens with some patients and is typically the result of a deep sense of confusion and fear. It is also widely believed that people with Alzheimer’s can’t function or enjoy activities. Stigma is the use of negative labels to identify a person with a disability or illness. Stigma around Alzheimer's disease exists, in part, due to the lack of public awareness and understanding of the disease, preventing people from:

Are Patients Leaving Hospitals Too Soon?

Thu, 31 Aug 2017 00:00:00 GMT

While most hospital discharges are agreed upon by doctors and their patients, there are some circumstances when there is disagreement about whether it’s time for the patient to leave. Most of those disagreements are with the insurance company or another payer who deems that patient’s time is up (and they will no longer pay.) But sometimes the situation is just the opposite. The patient feels as if he or she is ready to leave, but the doctors say no – they don’t believe that the patient is ready to go. If the patient does, indeed, walk out the door, it will be labeled, “Discharge Against Medical Advice (DAMA).”

The first reason is obvious. The longer you stay, the more money they make, as long as they can be reimbursed by your insurance, another payer, or from your own pocket. That time may be limited by your insurer, but the hospital will always do its best to maximize its reimbursement and income from every patient’s stay.

The second reason is less obvious. That is, the longer you stay in the hospital, the more things they can do to you – extra procedures, extra tests and so forth. Of course, the more they do, the more they can bill for. The third reason is relatively new. That is, through the Affordable Care Act, hospitals are penalized if Medicare patients are readmitted within 30 days of their discharge.

So, while their interest may not necessarily be in your improved health for your own sake, it’s definitely important to them that you be healthy enough when you leave so that you won’t have to come back (until day 31 anyway.)

A New York Times article published in early July details the story of Barbara Barg, a Chicago poet, who collapsed at a bus stop this spring. She suffered a heart attack in 2014 and had been feeling vaguely nauseated for several months. She was enroute to see her primary care doctor about nausea when a bystander who saw her falter called 9-1-1. Ms. Barg, 70, didn’t want to go to an emergency room but that was the only place paramedics would take her. “I was freaking out,” she acknowledges.

“I’d just gotten out of the hospital, and I didn’t want to go back in.” She’d had two recent hospital stays, one to replace a pacemaker lead, another to look for a blocked artery (none was found).

Now, “I just wanted to see my doctor.” Affiliated with the hospital, he had an office directly across the street. Refusing emergency care, Ms. Barg asked to be taken to his office. No. She asked the staff to call him. No. Twice, she walked out of the emergency department, “and they came after me and said, ‘We can’t let you leave.’”

Finally, after she agreed to sign a DAMA form, an aide wheeled her across the street; her doctor prescribed an anti-nausea drug that quickly resolved the problem.

People discharged against medical advice may be reluctant if problems develop or persist. A study at Highland Hospital in Oakland, California (where most patients were younger) has shown that when they leave against medical advice, they often do not get the appropriate follow-up appointments or medications needed.

“Reasonable people can disagree about whether a patient needs to stay one more day for an additional scan,” said Dr. Cordelia Stearns, a hospitalist, and the lead author. Fuller conversations about why patients want to leave might yield less contentious solutions, including outpatient treatment, home visits or drugs taken orally at home instead of being administered intravenously.

Alzheimer’s Disease Prevention

Thu, 24 Aug 2017 00:00:00 GMT

Alzheimer’s disease is one of the biggest concerns many of us have as we get older. While you may have been told that all you can do is hope for the best and wait for a pharmaceutical cure, the truth is much more encouraging. Promising research shows that you can reduce your risk of Alzheimer’s and other dementias through a combination of simple but effective lifestyle changes. By leading a brain-healthy lifestyle, you may be able to prevent the symptoms of Alzheimer’s disease and slow down, or even reverse, the process of deterioration. Experts agree that in the vast majority of cases, Alzheimer's, like other common chronic conditions, probably develops as a result of complex interactions among multiple factors, including age, genetics, environment, lifestyle, and coexisting medical conditions. Although some risk factors—such as age or genes cannot be changed, other risk factors—such as high blood pressure and lack of exercise — usually can be changed to help reduce risk. Research in these areas may lead to new ways to detect those at highest risk.

By identifying and controlling your personal risk factors, you can maximize your chances of lifelong brain health and take effective steps to preserve your cognitive abilities. There are six routines for a brain-healthy lifestyle that are within your control.

Are You Eligible for VA Disability Compensation?

Thu, 17 Aug 2017 00:00:00 GMT

If you were injured or became seriously ill while serving in the military, you may be eligible for VA disability compensation. In 2017, eligible veterans can receive up to $3,458 per month tax-free, depending on the level of disability and number of dependents.

According to the VA’s website , disability compensation is paid to veterans who are at least 10% disabled because of injuries or diseases that were incurred in or aggravated during active duty, active duty for training, or inactive duty training. A disability can apply to physical conditions, such as a chronic knee condition, as well as mental health conditions, such as post-traumatic stress disorder (PTSD). You must also have been discharged under other than dishonorable conditions.

Medical evidence of a current physical or mental disability and its relationship to an injury, disease or event in military service is required. However, under some circumstances, the VA may conclude that certain current disabilities were caused by service, even if there is no specific evidence for your claim. For example, the cause of a disability is presumed for veterans who:
* are former POWs;
* have chronic/tropical diseases that become evident within a specific period of time after discharge;
* were exposed to ionizing radiation, mustard gas or Lewisite while in service;
* were exposed to certain herbicides, such as by serving in Vietnam; and
* served in Southwest Asia during the Gulf War.

The benefit amount is determined on a case-by-case basis and is graduated, on a scale of 10% to 100%, according to the degree of the veteran’s disability. Compensation may also be paid for disabilities that are considered related or secondary to disabilities occurring in service and for disabilities presumed to be related to circumstances of military service, even though they may arise after service. The degrees of disability are also designed to compensate for considerable loss of working time.

If you have dependents, an additional allowance may be added if your combined disability is rated 30% or greater. Your compensation may be offset if you receive military retirement pay, disability severance pay, or separation incentive payments. More information about disability compensation benefit amounts can be found on the VA’s Compensation Rates page .

Claims can be submitted online, in person at a regional VA office, or through an accredited agent or representative. All supporting documentation should be submitted with your claim, including medical evidence and how the disability has affected your life; separation documents; and dependent records (such as marriage and children’s birth certificates). A change in family status can affect your benefits. B e sure to notify the VA immediately of a marriage, birth, divorce, death, parent moving in with you, or child aging out of dependent status.

Medicaid Reform: Are Block Grants Coming?

Wed, 09 Aug 2017 00:00:00 GMT

Medicaid, the single largest source of health coverage in the United States, provides health coverage to almost 75 million Americans, including children, pregnant women, parents, seniors and individuals with disabilities.

Medicaid is a federal program, but it is administered by the states. To participate in Medicaid, federal law requires states to cover certain groups of individuals, such as low income families and individuals receiving Supplemental Security Income (SSI). States may choose to cover other groups, such as individuals receiving home- and community-based services.

Funding for the Medicaid program comes from both the federal government and the individual state governments. Currently, the federal government gives each state a specified percentage of its program expenditures. This Federal Medical Assistance Percentage (FMAP) is based primarily on the per capita income of the state receiving assistance, so it can vary widely from state to state. For example, a rich state like New Jersey might receive $1 from the federal government for every dollar it spends on Medicaid while a poor state like Mississippi would receive $3 for every dollar it spends. The FMAP is adjusted every three years to account for changes in the economy.

Conservatives have long argued that Medicaid would be more efficient if states received a lump sum—a block grant—from the federal government and could then manage the programs as they saw fit. President Ronald Reagan proposed block grants in 1981, Speaker Newt Gingrich in 1995, and President George W. Bush in 2003. President Clinton agreed to block grants with the Temporary Assistance for Needy Families (TANF) program. Now that Donald Trump is President, and Republicans have control of both the House and the Senate, block grants are back on the table.

Proponents claim this could save the government billions of dollars and give the states more opportunity to be creative with their programs. Critics are afraid that people will not have access to the care they need. They are concerned that the states would cut benefits or force beneficiaries to take on more cost-sharing. Most of the Medicaid spending is on the elderly and disabled, with Medicaid paying for the care of almost two-thirds of the people in nursing homes, and critics are afraid they will suffer the most. In addition, they claim hospitals and clinics that treat large numbers of Medicaid beneficiaries will likely have to adjust their services and staff.

Of course, this is all speculation right now as no details on a block grant plan are available. But they may be coming soon. Republicans have placed a high priority on repealing and replacing Obamacare. That, and portions of a block grant proposal, could be accomplished through a process called budget reconciliation. Because it would only require 51 votes in the Senate, a Republican plan could pass without Democrat support. If a block grant plan for Medicaid is included, look for details on the implementation and see how the critics’ concerns are addressed.

U.s. Supreme Court Sides With Special Needs Student Over Service Dog Dispute (April 2017)

Wed, 02 Aug 2017 00:00:00 GMT

Last month, the U.S. Supreme Court unanimously sided with a 13-year-old Michigan girl with cerebral palsy who had been fighting with school officials for years over whether she could bring her service dog to school with her.

At issue are two federal disability laws. The school district claimed it could ban the dog under the Individuals with Disabilities Education Act, which allows a teacher’s aide to assist students instead. The law also requires families that contest school decisions to first go through administrative proceedings. But the family said it could sue for damages under a different law, the Americans with Disabilities Act , because the district refused to allow the dog for more than two years.

Ehlena Fry’s family asked to use her specially trained dog, Wonder, when she started kindergarten. At the time, Ehlena suffered from severe mobility problems. Wonder was trained to help open doors, pick up items and give Ehlena some independence. Initially, the school said the dog could not accompany her and insisted that adult aides could help her. Eventually the school relented, but placed so many restrictions on the dog that Ehlena’s parents decided to home-school her. They later transferred her to a different school that welcomed Wonder. (Ehlena’s mobility and independence have since improved and she now attends school without her dog.)

Writing for the court, Justice Kagan cited two scenarios. In one, a child who uses a wheelchair sues a school for discrimination because the building lacks access ramps. That case hinges on equality of access to public facilities, not whether a school’s special education program is adequate. In the other, Kagan described a student with a learning disability who sues the school for failing to provide remedial tutoring. In that case, the issue is whether the school offers an adequate education. Kagan said nothing in the Frys’ lawsuit suggests a conflict on the adequacy of her education. Rather, the family is asserting Ehlena’s right to bring a service dog to school regardless of alternatives the school district provided.

Lower courts had ruled against Ehlena, saying she first had to try to resolve her dispute with the school district. The Supreme Court ruled that federal disability laws might allow her to pursue her case in court without first having to go through an administrative process, and that the lower court must look more closely at the facts before deciding.

The National School Boards Association, which backed the Michigan school district, is concerned the court’s ruling may cause more confusion than help for lower courts trying to apply the law. But the ACLU, which represented the Frys, applauds the Court for “breaking down unfair barriers faced by students who seek to vindicate their rights under the Americans with Disabilities Act .”

Increased Use of Opioid Painkillers Can Lead to New Battle for Veterans

Thu, 20 Jul 2017 00:00:00 GMT

You may have noticed there is a massive heroin addiction in our country today, with fatal overdoses destroying far too many families. The use of opioid painkillers, relatively easy to obtain, is often the starting point for the addiction. If the prescription is no longer available, or the insurance company will not pay for it, people often resort to heroin, which is inexpensive and easily found on the streets.

Members of our military are typically prescribed opioid painkillers when they are injured, whether in training or in combat. Wars in Iraq and Afghanistan have contributed to injuries that require soldiers to be on prescription painkillers, including oxycodone, the main ingredient in Percocet and other addictive painkillers, and hydrocodone. By the time they are discharged, some are addicted. Once out of the military, they may no longer have access to the prescriptions or coverage, and some, like civilians, turn to heroin.

In a recent article in The Wall Street Journal, the U.S. Department of Veterans Affairs acknowledges its role in creating a large population of opioid-addicted veterans by overprescribing painkillers for injuries and post-traumatic stress disorder. According to the Department of Veterans Affairs, VA patients getting opioid prescriptions increased by nearly 77% between 2004 and 2012. In 2012, one in three VA patients received opioids to manage pain.

Recognizing they had a problem, the Department of Defense and the Department of Veterans Affairs began to de-emphasize opioid painkiller use by turning to other treatment options, including chiropractors, yoga and aquatic therapy. Active-duty soldiers are closely monitored and undergo random drug testing; only about 2% test positive.

While some programs are proving effective, others have created new problems. For example, last year the Drug Enforcement Administration began requiring veterans to refill painkiller prescriptions every 30 days instead of 90 days, to help ensure that the drugs are not being abused. But backlogs at the VA prevented many patients from being able to see a doctor before their medications ran out, causing some to fear more vets will seek heroin to relieve their pain.

The VA has established several opioid-addiction treatment programs. In 2012, it started a detoxification protocol for veterans with an opioid disorder. In 2013, the Opioid Replacement Therapy Program was created and provides vets with Suboxone, a medication-assisted treatment that is FDP-approved for opioid dependence. Veterans are also taught coping skills to achieve and maintain abstinence from opioids and other drugs. In 2014, the substance abuse treatment program expanded education to teach veterans and families how to prevent an opioid overdose, providing information on Naxolone, an FDA-approved medication to treat an opioid overdose. Another program educates veterans on the dangers of combining opiates with drugs and alcohol.

What Happens When There Are No Children to Provide Care for to a Parent

Fri, 14 Jul 2017 00:00:00 GMT

As we age, it is likely that many of us will need help for at least some period of time with life’s daily activities. (These include bathing, dressing, eating and using the bathroom.) And while we may not want to think much about being in that position some day, it would be a good idea to start thinking now about who will take care of us in our old age.

According to a 2011 study by the U.S. Department of Health and Human Services, about half of all informal caregiving is provided by adult children, with spouses providing another 20%. In addition to helping with daily activities, these informal caregivers navigate health care options and insurance benefits, manage medications, provide transportation to doctor appointments, and manage finances. Even when people go into nursing homes or assisted living facilities, their children or spouse still provide a lot of hands-on care.

But what if you don’t have a spouse or child who will be able to take care of you? Your children may live too far away, have health issues of their own, or have family and/or work obligations. Maybe your child or spouse predeceases you. Maybe you didn’t have children. According to a study by Urban.org, nearly one-fifth of women born after 1970 will not have any children.

You may find you need to rely on a sibling, niece or nephew, distant relative, friends or paid helpers. Assisted living facilities are an option for many people. Nursing homes are often regarded as the place of last resort, but people without caregivers are more likely to enter them.

Most of these options can be expensive, depending on the type of care you will need and how long you will need it. For example, the national average cost for a home health aide is $45,760 per year; for assisted living, it’s $43,200 per year; and for a semi-private room in a nursing home, it’s $80,300 per year. (Genworth has researched these costs in each state.) So, in addition to determining who will provide your care, you also need to consider how you will pay for it.

Medicare does not pay for assisted living and only pays for a limited number of days in a nursing home. Aid & Attendance benefits from the Veterans Administration will help pay these costs for wartime veterans and their spouses who qualify. Medicaid will pay for nursing home care, but you have to spend down your assets in order to qualify. Long-term care insurance is an option, but if you wait too long it may not be affordable and you may not qualify. If you have substantial savings and/or have equity in your home, those resources can be used to pay for your care.

The point is this: It is never too late to start thinking about who will care for you in your old age, in what setting you want to receive that care, and how you will pay for it. Don’t assume your first choice is willing to provide hands-on care for you. Have that conversation with your candidates to make sure they are on board with your wishes. If not, you’ll need to come up with Plan B or Plan C. Without a plan, you could end up having no say in your end-of-life care.

Contact our office for consultation.
850-434-8500

5 Common Nursing Home Medicaid Questions

Wed, 28 Jun 2017 00:00:00 GMT

1. Can the State take my house if I go into a nursing home?
Answer: Very unlikely; however, if you fail to properly plan your assets and estate when you apply for Medicaid, you could open the door for this to happen.

2. Can I transfer all of my assets to qualify for Medicaid?
Answer: If you transfer your assets to your spouse and the combined assets of you and your spouse are valued less than the required Medicaid asset limit, you may still qualify for Medicaid. You cannot transfer to anyone else without incurring a penalty. However, there are planning techniques an Elder Law Attorney can help you with.

3. Can a non-attorney help me qualify for Medicaid?
Answer: No. A recent Florida Supreme Court ruling found that work associated with helping a family become eligible for Medicaid is legal in nature. As such, it is the unlicensed practice of law for a non-attorney to offer this assistance. A non-attorney CAN provide assistance with the application once the individual is otherwise qualified.

4. How much can I own and qualify for Medicaid?
Answer:
A. If you are single or widowed, you can have the following:
1. Home and personal effects;
2. Vehicle;
3. Irrevocable funeral arrangements;
4. $2,000 countable assets;
5. Certain life insurance (i.e. less than $1,500 cash value);
6. Certain income producing properties
7. Certain retirement accounts
8. Will retain $105 a month in income
9. If your gross (pretax) income is greater than $2,205 an Income
Trust will be required.
B. If you are married, then you can have all of the above, plus
the spouse can have:
1. $120,900 in countable assets
2. Unlimited income if there is no need for support from the ill
spouse; otherwise, you may keep $2,030 and may appeal
depending on your circumstance to keep up to $3,023.
3. Certain retirement assets.

5. If I become incapacitated can my children make financial and medical decisions for me?
Answer: Depends. If you have signed advance directives then they may be able to make these decisions for you. Not all Power of Attorney's are the same. Some Power of Attorney’s work for estates with tax issues, some work for middle class estates, some for retirees, etc. You need one that is specific for your situation in life. The law in Florida changed in 2011 and many documents are still being used which do not comply with this new rule. Further, in 2015 the law changed regarding Designation of Health Care Surrogates; yet, still many sources continue to operate as if the law didn’t change. Be careful where you obtain your documents.

If you have not signed any advance directives it is unlikely they will be able to act. Without the advance directives, your family will likely be forced to open a guardianship, which has become an extremely expensive and tiring process for all involved.

Set the Table for Your Estate Plan

Tue, 13 Jun 2017 00:00:00 GMT

When I was a boy my mother would have me set the table every other day. My brother would take the days I wasn't given this task. She was fast to look over my shoulder to make sure the fork was on the correct side of the table. Today my wife and I do the same with our son. Knowing which side of the plate the fork goes on is not a core life skill one must have to function in society; however, we are teaching him to focus on little things.

Legendary Coach John Wooden once said "It's the little details that are vital. Little things make big things happen." Today we often hear people say you have to see the big picture. You have to think big, dream big, etc. The fact is the details matter. You can say I want to help my children and that is why I am cutting corners. When I die they will have something. But what are you wanting them to do with the money? How are you wanting to help? Do they want your help?

To answer these questions you have to get into the details which can become overwhelming for many people. Therefore, I have worked out a system to help you. This system is broken into three parts; your life goals, your children's (or heirs’) needs, and financial ability.

First, you must decide what you want your life to be. To decide this write out these five words: purpose, social, financial, community, and physical. Then write below each word what that means to you. Can you pay for that with your income and assets? If so go to step two.

Step two is not as simple. Here I want you to answer the question: what do your children need (not want)? For this I do not expect you to ask them. Asking them might give them a false belief you are about to give them something or that something is wrong with you. I suggest you spend time with them. Watch what they are interested in and what they would like to have more time doing. Is there something they are missing? Once you have done this you can answer the question.

Step three, can you afford to provide that help without giving up on what you wrote out in step one? I will tell you if you sacrifice your happiness to leave a small inheritance for your children it will not provide the happiness you desire for them to have. If the answer is yes, then you need to simply make sure you are clear in your estate work.

I once had a client request I draft his estate plan in such a way as to prevent his children from receiving a penny of their inheritance until they had reached the age of 65. He said, “even if they are on their death bed they get nothing unless they are 65”. He was a happy older man who was still somewhat active but who had, in his words, “slowed down in recent years”. The reason for this extreme request was his desire to leave a nest egg for their retirement. He told me that he knew he couldn't leave them much but if what he did have was left alone for 20 years or so then he could die knowing they would have one shot at not being homeless in retirement, which was his real goal.

He had paid attention to his children and knew they wasted money. He knew they weren't saving for retirement and needed to be. So while it would have been easy for him to say if my child is dying let them have it, in his mind someone dying didn't need extra money and that wasn't the purpose of leaving an inheritance for them. Is this father right? That isn't for me to say. But his estate is detailed and accomplishes his goal.

The reason I teach my son to say yes sir and no sir is because it helps him to pay attention to others and it is a little thing that can make a difference. Paying attention matters and if you want big results you must learn to pay attention to little things.

That, and knowing which is the dessert fork:)

Is My Estate Plan Fair, Just and Reasonable? No, and That Is Okay.

Fri, 19 May 2017 00:00:00 GMT

Even though I am approaching 18 years since my first day in law school I clearly remember Professor Stone lecturing us about his expectations. He summed up his philosophy of the law with one simple statement. He said never make a case based on what is fair, just, or reasonable as those words lack any true definition. Decisions made on what is “fair” will virtually always be seen as unfair to another person. You must make sure you are making the right decision for the right reason. A reason in which you can state with a clear purpose and meaning. Professor Stone lacked any tolerance for ambiguity. Through my practice and well as in my personal life I have determined in nearly all circumstances he is correct.

How do we apply this to our life or more directly to our estate plan? If you feel something would be unfair determine ask yourself why you feel that way. Is it your situation or asset to control? If it isn’t your situation or asset to control then you’re yelling likely means nothing. You can look to see if a rule or law has been broken for relief from that situation. On the other hand, if the situation is yours to control then pay attention to who thinks it is unfair. Better yet try to restate your reason or decision. For example say: I desire to leave equal amounts to all my children, or I desire to provide more for this child because I believe it is the right thing to do regardless of what others may think. This might not be seen as fair but this child has a disability, or this child received an 8-year education while this person paid for his education with scholarships. Know you have the right to determine where and how your estate will be administered.

We place so much pressure and guilt into situations which do not require it. Make a decision. Don’t worry if it is perfect because it will likely never be perfect. I bet you have heard the young couple who says they are waiting till they have “enough money” before having a child and yet they have been married for 8 years. When it comes to estate planning many people wait to have everything perfectly lined up before making a plan. What parents learn is there is never enough money, the time is never perfect, and the right amount normally has more to do with having the right amount of willpower to stand by your decision. I find more people stress over hurting someone’s feelings than they do over what the overall purpose of the gift is in the first place. So don’t worry if it is fair. Don’t worry if it is perfect. Few things in life are. If you later determine that it was incorrect then change it. You can change direction; you can change what you want to happen with your estate. Take a deep breath and know by following this tip you are being fair to yourself. In the end, that is better because it will allow you to release that weight and become a better parent, friend, or child.

Be good to yourself.

Warning: An Alzheimer’s Tsunami is Coming and We Must Prepare

Thu, 04 May 2017 00:00:00 GMT

That’s the message from Andrew Tisch, chairman of Loews Corporation, co-founder of the political reform group No Labels, and Vice Chair of the U.S. Global Leadership Coalition.

In a recent article, Mr. Tisch describes how we are unprepared for the enormous costs we will soon be facing from a huge upswing in our aging population and the resulting number of Alzheimer’s patients.

As he points out, in 2010 there were 11.4 million Americans over the age of 80. By the year 2050, due to the power of modern medicine, there will be over 32 million. But amid that laudable success is a glaring problem: One in two people who reach their 80s will get Alzheimer’s, and the American health care system isn’t even remotely prepared to deal with that.

The annual cost to care for people with Alzheimer’s and other dementias is already $226 billion, with Medicare and Medicaid picking up 68% of the costs. If recent trends continue, he states, the annual cost of Alzheimer’s could reach $1 trillion, in current dollars, by 2050, costing Medicare and Medicaid almost $700 billion—about one-fifth of the federal government’s current budget.

Mr. Tisch calls for Washington to dramatically increase the amount of federal money going to Alzheimer’s research. While disease research of all kinds is worthy and important, he states, Alzheimer’s stands apart for the destruction it wreaks on families and finances. Five million Americans currently have Alzheimer’s and the disease’s impact spreads far beyond those who
have it. Every person with Alzheimer’s requires three people—children, spouses, friends and health care workers—to serve as caregivers. This can be a full-time job, and it often takes a financial, emotional and physical toll on the caregivers and their families.

The National Institutes of Health (NIH) allocated almost $1 billion to Alzheimer’s research last year, but funding is behind what researchers need and what other diseases already receive. The treatments available now only treat symptoms and do not prevent, slow or reverse the disease. Researchers believe a significant boost in funding could lead to breakthroughs in the coming
years. Dr. Greg Petsko of Weill Cornell Medical College states that “if NIH doubled research funding for Alzheimer’s tomorrow, it would kick the whole machinery of grant making and academic and pharmaceutical company research into a higher gear.”

President Trump’s budget proposal includes an 18% cut to the NIH budget as part of a broader effort to slash discretionary spending. However, a bipartisan group of a dozen senators have written a letter to President Trump asking him to increase funding for Alzheimer’s research. As Mr. Tisch puts it, a potential cure for Alzheimer’s should not go undiscovered for lack of a few billion dollars in a $4 trillion-dollar annual budget.

Understanding Probate

Wed, 19 Apr 2017 00:00:00 GMT

Is My Estate Plan Fair, Just, and Reasonable?

Wed, 12 Apr 2017 00:00:00 GMT

No, and that is OK.

Even though I am approaching 18 years since my first day in law school I clearly remember Professor Stone lecturing us about his expectations. He summed up his philosophy of the law with one simple statement. He said "in this class and in life you are never to make a case based on what is fair, just, or reasonable as those words lack any true definition."

Decisions made on what is “fair” will virtually always be seen as unfair to another person. You must make sure you are making the right decision for the right reason. A reason in which you can state with a clear purpose and meaning.

Professor Stone lacked any tolerance for ambiguity. Through my practice and in my personal life I have determined in nearly all circumstances he is correct.

How do we apply this to our life or more directly to our estate plan? Initially we need to determine if the situation is something that is ours to control. If it isn’t your situation or asset to control then your getting upset likely means nothing.

Let me illustrate this situation, you learn that your mother desires to leave her money in trust with income to you for life and the balance on your death to the University of Nacho (as in not-yo money) and this upsets you. Is it fair? A better question is why is she supporting the University? Is there undue influence or duress? If not then you should except it isn't your situation to control.

On the other hand, if the situation is yours to control then pay attention to who thinks it is unfair. Better yet try to restate your reason or decision.

For example say: I desire to provide more for this child because I believe it is the right thing to do regardless of what others may think. Such a statement might not be seen as "fair" depending on which child is reading it.

However you can reword it as: I desire to provide additional funds for my son Nacho because he (quit work to care for me, has a disability, paid for his own education while I paid for the other children, always used good table manners, etc). Know you have the right to determine where and how your estate will be administered. When you define your reason (which doesn't have to be in the actual documents) you will find your reason is fair in your mind and that is really all that matters.

We place so much pressure and guilt into situations that do not require it. Make a decision. Don’t worry if it is perfect because it will likely never be perfect.

I bet you have heard a young couple saying they are waiting till they have “enough money” before having a child and yet they have been married for 8 years. What parents learn is there is never enough money, the time is never perfect, and the right amount normally has more to do with having the right amount of willpower to stand by your decision.

I find more people stress over hurting someone’s feelings than they do over what the overall purpose of the gift is in the first place. So don’t worry if it is fair. Don’t worry if it is perfect. Few things in life are. If you later determine that it was incorrect then change it. You can change direction; you can change what you want to happen with your estate.

Take a deep breath and know by following this tip you are being fair to yourself. In the end, that is better because it will allow you to release that weight and become a better parent, friend, or child.

Be good to yourself.

Do I need to modify my estate plan because I moved?

Tue, 28 Mar 2017 00:00:00 GMT

Recently we had the daughter of a former client call and say her mother needed to modify her estate planning documents. Putting aside the red flag of the daughter calling for her mother, the change requested was her mother's address. It seems the mother had recently relocated to another state to be with the daughter. This is a common question for people moving into Florida and former clients who are moving away. Let's resolve this one quickly.

While you are a unique person, your name is likely not as unique as you might think; as such it is important to further define yourself. U.S. Census Bureau explains there are at least 151,671 different last names and 5,163 different first names in use in the United States. With over 300 million people in the U.S. alone it is common people will find others with their same name. As such, when drafting estate planning documents we are often looking to clearly identify a person. Using one's address is a means of accomplishing this.

It hasn't always been that way. It wasn't too many years ago attorneys would place a person's social security number within the document. For obvious reasons, attorneys no longer use social security numbers within estate planning documents to identify people. Today a birth date, address, or phone number is used.

Does that mean every time you move you need to modify your estate planning? For the vast majority of people the answer is no. You should have your documents reviewed every 5 years or so while you are in retirement; however, that does not mean you need to change them every time you move.

There are several factors to consider when thinking about changing your documents:

HUMAN'S GREATEST STRENGTH

Thu, 02 Mar 2017 00:00:00 GMT

What is the greatest strength human have? It isn't our ability to change. It isn't our ability to innovate and improve. It is in our ability to communicate. Communication is how we formed societies, governments, and armies to protect the best of our species.

Humans communicate in numerous ways beyond simply the spoken word. Most people (excluding my smart clients) ignore most forms of communication. They focus simply on the spoken or written word. HOWEVER THERE ARE MORE WAYS TO COMMUNICATE!!! Some, such as all caps, are very unnerving. Other, such as tear on a child's face convey an immediate emotional reaction.

That is why when we work with our families' long term care goals it is important to pay attention to more than simply the words being said or what is written. We need to pay attention to all the variances of those around us. Take a look at these ten ways of communication:

An assumption and a million dollar penny

Wed, 15 Feb 2017 00:00:00 GMT

There once was an old man who offered a boy either a million dollars today or a penny that would double its value each day for the next 30 days. The boy seeing the million dollars makes the easy choice and takes the cash. 30 days later the boy learns his friend was offered the same deal but took the penny and now has over 5 million.

The boy became very upset and went back to the old man and demanded to know why his friend received more than he did. After all he yelled his friend should only have some change not actual money! The old man responded that he should have listened carefully to what was offered and not simply taken the first thought that popped into his mind. He said it was easy to look at a penny and assume it could never reach a million dollars in such a short time; however, his friend spent the extra time to find out how much such a penny could actually produce if it doubled each day for 30 days. The fact is with the effects of compounding it would take nearly 29 days for the penny to catch the million dollar mark, but there in those final days all the difference was made.

Making life altering decisions on assumptions can result in outcomes we didn't anticipate or desire. Author Andy Andrews often says "you cannot believe everything you think," and he is absolutely correct.

Far too often people approach their retirement years and estates in a similar fashion as the young boy. We believe the easy answer, the common way of doing things, must be the right way. This assumption leads families into poverty, hurt feelings, or worse. While taking the extra time and money to learn the actual facts is harder.

We can only process answers with the information we have obtained over our lifetime. If we use assumptions to form facts and then use these "new" facts to make decision then we cannot complain when the outcome isn't what we anticipated. In short, life and fairness are not connected; the world will not always provide you with all the facts and answers. It is up to you to research, ask questions, and seek guidance before making important decisions.

If you need answers to your estate questions I hope you will seek help from our office.

BTW: The math comes out to one million vs. $5,368,709.12 (how many believe the one million would actually still be one million at the end of the first 30 days?)

Beneficiary audit - is it time?

Thu, 26 Jan 2017 00:00:00 GMT

Keeping a list of your accounts and beneficiaries goes at the start of any Estate Planning 101 course. If you don't know what you have and where it is located, how will anyone else? For my clients knowing what they have and where it is located is normally not the problem. However, I am often a surprised when they are unable to tell me the last time they performed a beneficiary audit.

What is a beneficiary audit? This would be the simple act of confirming, with each asset you own, who the listed beneficiary and secondary beneficiary are on your accounts. This homework, while easy, does take some effort, which is why I believe most people put it off. To complete an audit you would contact each bank, investment firm, insurance company, etc you have money with and ask them to mail you a current list of your beneficiaries.

Why do this? In the past I have seen families surprised to find their ex-spouse still listed; friends (who at one time would have been trusted to care for children who are now fully grown), deceased children, estranged children, children with poor judgment (likely to abuse themselves with money), etc… The stories are nearly endless. Certain changes in the law have helped such as the change regarding prior spouses; however, complete reliance on even the new statute would be naïve due to 10 clear loopholes in that law.

In the end your best protection of your goals for those to follow behind you is to know what you have, where it is located, and who stands to receive it when you pass. A beneficiary audit is a simple (free) way to help you become organized and informed.

Do you need help getting organized? We have a free organizer to help you get started. Let us know if you would like a copy.

Shingles Can Lead to Stroke and Heart Attack

Thu, 19 Jan 2017 00:00:00 GMT

Shingles is a painful skin rash that affects about a million Americans every year, and one in three people will develop shingles during their lifetime. According to a recent study published in PLOS Medicine, shingles can also lead to strokes and heart attacks.

Previous studies had suggested an increased risk of stroke and heart attacks following shingles. In this study, researchers from the London School of Hygiene and Tropical Medicine looked at more than 67,000 U.S. Medicare patients (age 65 and older) who had shingles and subsequently suffered a stroke or heart attack during a five-year period afterwards.

They determined that elderly patients who suffered from shingles were more than twice as likely to have a stroke and almost twice as likely to have a heart attack. Most of the incidents occurred in the first week after being diagnosed. The risk decreased gradually over the next six months.

Researchers suspect that the shingles virus causes dysfunction within the blood vessels, in which plaques rupture in the artery wall, increasing the risk of blood clots. Also, the pain in acute cases may be so severe that the stress can increase blood pressure to unhealthy levels.

If you had chickenpox, which is caused by the varicella zoster virus, you are at risk of having shingles. Although recovery from chickenpox is usually quick, the virus can live throughout a person’s lifetime inside the nervous system. The dormant virus causes no symptoms, but if it becomes activated, it causes herpes zoster (also known as shingles or zoster).

Anyone who has had chickenpox can develop shingles. It is not clear what causes the virus to reactivate, but it may be due to lowered immunity to infections as we grow older. The condition is most common and most severe in elderly people, with half of the episodes occurring in people over age 60. Multiple episodes are not uncommon.

Early signs of shingles include burning or shooting pain, tingling and itching. Blister-like sores, which last 1-14 days, develop on one side of the face or on one side of the body in a horizontal band. The pain, which can be debilitating, can continue for years after the rash disappears. This condition, called post-hermetic neuralgia (PLN), greatly reduces quality of life.

A person with shingles is contagious while the blister-like sores are present. However, a person who has direct contact with the shingles rash and has not previously had either chickenpox or the vaccine can develop chickenpox but not shingles.

Vaccinations for the virus are available for children (chickenpox) and for adults (shingles). Researchers had hoped to determine the effectiveness of the vaccines, but not enough of the patients in the study had had the vaccine. There is no cure, but vaccination can prevent the condition or lessen its effects, and early treatment with antivirals may prevent lingering pain.

Late-life anxiety

Fri, 06 Jan 2017 00:00:00 GMT

Anxiety occurs in older Americans with surprising frequency. Some reports estimate between 10 and 20% of seniors have generalized anxiety. This number could be even higher, as many often deny having psychological issues when asked by their doctors, focusing more on the physical symptoms anxiety can cause.

In a recent article , Hany Abdelaal, President of VNSNY Choice Health Plans, describes late-life anxiety this way. “It’s a pattern familiar to many of us with aging parents: the overwhelming worry or constant nervousness over day-to-day tasks, from taking medications to parking the car. Left untreated, this anxiety-related agitation in the elderly can disrupt sleep and eating, exacerbate chronic medical conditions, and ultimately contribute to a downward spiral of fear and isolation.”

As his article explains, older adults may have anxiety or worry about physical health (illness, changes in vision or hearing), cognitive difficulties, finances, and changes in life status (widowhood, care-giving responsibilities, retirement). They may feel anxious about keeping medications straight (sometimes to the point of giving up and stopping them altogether), not having enough groceries in the house, driving, and falling.

Anxiety is often accompanied by symptoms that mimic physical illness and may include muscle tension or pain, GI symptoms, shortness of breath, and heart palpitations. Symptoms can also include sleeplessness, an inability to concentrate, irritability, and lack of focus. As a result, complaints are often more about these physical symptoms than the anxiety causing them.

The good news is that anxiety can be treated. Stress can be reduced with social support, communication, education and, if needed, counseling and medication.

Social Support: When there is no one around to provide support or an alternate point of view, anxiety can cause irrational fears to grow. It’s critical to have a support system of family, friends and neighbors who can provide social contact by telephone, email and personal visits. Religious organizations can provide community and a place to visit regularly; most have visitation for those who are homebound. Senior centers can also provide social support.

Communication and Education: Living with chronic medical conditions and managing multiple medications can often trigger anxiety in elderly people, especially if they do not fully understand their situation. Medications should be routinely evaluated and, if possible, reduced. Patients need to understand what they are taking and why, what the desired effect is, and possible side effects. A caregiver or family member should accompany an older person to each doctor’s visit, prepared to ask questions and take notes. A family member can also “join” the appointment via Facetime or speaker phone. Upon request, the doctor’s office can provide a written care plan and prescribed medications at the end of each appointment.

Counseling and Medication: Many anxiety sufferers can benefit from psychological counseling in which they learn to reframe thoughts and behaviors, and challenge their irrational fears. Stress management techniques may be helpful. There are also a number of medications that can help reduce anxiety symptoms. Before adding another medication to what may be an already stressful multi-drug program, a doctor should fully evaluate the patient’s overall situation, reducing or streamlining medications where possible. That said, the addition of one of these medications can make a major difference in the life and outlook of an older person suffering from anxiety.

Preventing dehydration in the elderly

Thu, 15 Dec 2016 00:00:00 GMT

Our bodies become dehydrated when we lose more water than we take in. Staying hydrated allows the body to regulate temperature through perspiration, maintain blood pressure and eliminate waste. Dehydration may show only small signs outwardly, but it can have dire consequences on the body, especially in the elderly.

Severe dehydration can lead to confusion, impaired cognition, falling, urinary tract infections, constipation, pneumonia, bedsores in bed-ridden patients, and even death. It can accelerate or cause emergency hospitalization and/or increase the length of hospital stays.

Why Dehydration is Common in the Elderly

No, the Internet is Not Your Best Source of Legal Advice

Sun, 11 Dec 2016 16:31:00 GMT

An increasing number of people are turning to the internet for all sorts of advice. Fashion advice. Medical advice. Marriage advice. Here are Premium Law, we certainly won’t dissuade you from getting fashion advice online, but we strongly recommend that you don’t turn to Google for legal advice. Because it could end up costing you a whole lot more than you expected.

Wills & Estates - Latest Updates

Sun, 11 Dec 2016 16:31:00 GMT

No one really wants to talk about their last will and testament, but this is one legal issue you don’t want to leave unattended. After all, it could lead to a major rift in your family, one which you are not around to mend. The importance of having a very clear will and testament takes on even greater magnitude if you have children from more than one marriage, if you have adopted children, and if you don’t have any children at all. Getting expert advice can save your loved ones heartache and grief at a time when they really need to focus on grieving and recovery.

Most Americans on Social Security Will See Increase of $4 to $5 in 2017

Tue, 29 Nov 2016 00:00:00 GMT

Yes, you read that right. There will be a 0.3% cost of living adjustment (COLA) for those receiving Social Security and Supplemental Security Income (SSI) benefits in 2017. That means most Americans will receive an increase of just $4 to $5 per month.

The COLA goes into effect in January 2017 for Social Security benefit recipients and on December 30, 2016 for those who receive SSI benefits. More than 60 million Americans receive Social Security benefits and another 8+ million receive SSI benefits.

For some recipients, this increase may be offset by an increase in Medicare premiums. The premiums for Medicare in 2017 have not been released yet, but we do know that Medicare costs have been going up dramatically. The June Medicare Trustees Report projected that a 22% increase in Medicare B premiums is needed to balance the Medicare Part B trust fund in 2017.

About 70% of Social Security beneficiaries will not see an increase in Medicare premiums because of the “hold harmless” provision. This basically says that Medicare premium increases cannot exceed a rise in Social Security benefits. With the low COLA of .03% for 2017, the hold harmless provision will apply.

But by law, all other Medicare recipients must absorb the majority of the Medicare Part B cost increase for 2017. Those who may see an increase in their Medicare premiums include high-income individuals, new Medicare enrollees, and people who are on Medicare but are not yet taking Social Security.

If you fall into this category, be sure to review the verification letter you receive in November that notifies you of surcharges for 2017. Social Security uses tax returns from 2015 to determine 2017 high-income surcharges. If your income has been reduced since 2015 due to a life-changing event, such as retirement or reduction in work hours, you may be eligible to apply for a lower bracket premium. Congress may also provide some relief as it did in 2015.

Another annual adjustment (effective in January each year) is the amount of earnings on which Social Security taxes are paid. Based on the increase in average wages, the maximum amount of earnings subject to the Social Security tax will increase in 2017 to $127,200 from $118,500. It is estimated that about 12 million of the 173 million workers who pay Social Security taxes in 2017 will pay more because of the increase.

Information about Medicare changes for 2017 will be available at www.Medicare.gov .

Who Will Make Decisions About Your Health Care If You Cannot?

Mon, 17 Oct 2016 00:00:00 GMT

A Health Care Power of Attorney, also called a Health Care Proxy or Durable Power of Attorney for Health Care, lets you give legal authority to another person (a proxy or agent) to make decisions about your health care if you are unable to make them yourself. This prevents the courts from getting involved if there is disagreement between family members and/or the medical community as to what actions you would want taken.

Keep in mind that you will continue to make decisions about your care for as long as you are able. You are only naming someone as a successor, to step in and act for you when you cannot. This document can be valuable even for short periods of time, such as if you are recovering from surgery.

But it is more associated with end-of-life decisions. The person you name as your agent or proxy may make decisions that will extend your life for as long as possible or bring your earthly life to an end. These decisions may include whether or not you should have surgery, if life support should be initiated, and/or if nutrition should be stopped. The legal document includes your wishes on these and other end-of-life issues.

This is a difficult subject for some people to even think about, but it is important that you do, and that you discuss these matters with your physician, family members and friends. The more people who know about your preferences, the easier it will be for your agent/proxy to carry out your instructions. Of course, you might change your mind over time, so let others (especially your agent/proxy) know what you are thinking.

Whom should you name as your agent/proxy? Here are some considerations:

Elder Law Begins at 18!

Wed, 21 Sep 2016 00:00:00 GMT

It’s true! Elder law is a misnomer. When we hear the word “elder” we think about our grandparents or our grandparents. We don’t think about the eighteen year old who just delivered our pizza and is set to graduate high school next week.

The simple truth is elder law planning is just as relevant for your grandchild as it is for you.

Think about just some of the reasons why you go to an elder law attorney:

You want to protect yourself in the event of a sudden disability or death.
You want to name a decision maker for your important health care decisions in case you can’t speak for yourself.
You want to make sure the power bill is paid if you can’t write checks.

These are the same concerns the eighteen year old has, although he may not realize it yet. The real truth is in most situations, once we turn eighteen we are on our own. No one can make our decisions for us. We have to name someone through a legal document (and have that document properly witnessed and notarized to be effective). With it, we end up at risk of ending up in a guardianship proceeding should we no longer have capacity to make our own decisions.

If you want to talk about your own potential elder law needs or concerns, call or email to schedule an appointment.

Jason A. Waddell
Board Certified Elder Law Attorney

Power of attorneys are like gumbo?

Thu, 25 Aug 2016 00:00:00 GMT

Moving to the Gulf Coast over a decade ago there was little culture change from my prior homes in Athens, Georgia or Birmingham; however, small cultural differences such as how gumbo is made have arisen from time to time. Gumbo along the Gulf Coast is as diverse as the people who live along the Gulf Coast. There is the battle over how dark the roux should be or how to best use okra, what seafood works best, etc.. Basically it is far from a simple dish.

Which brings me to the point, a person’s power of attorney is like a pot of gumbo in that what goes into it depends largely on your situation. This document which seems like a generic form is far from simple. For those unfamiliar with it a power of attorney is a document that directs the public to who may act in your place for matters dealing with your assets and income. It may also deal with health care; however, today most are encouraged to designate a health care surrogate (more on that another time). The power of attorney will nominate a person The Florida Statute governing power of attorneys has over 30 provisions with many subdivisions within each of those provisions. This is because what applies to one family will likely not apply to another person’s family.

A good durable power of attorney should provide your Agent (person the power is given to) with the appropriate authority considering your assets and income to handle your affairs. A power of attorney that provides extensive provisions for avoiding estate taxs when you total estate is worth less than $1 million does about as much good as Oyster gumbo for someone who hates oysters.

As of October 1, 2011 Florida residents have a new power of attorney statute that seeks to help people understand certain powers such as gifting, creation of trust, etc. The change in the statute provides for certain enumerated powers to be specifically granted. Many attorneys now refer to these powers as super powers. If you attorney uses the straight statutory language your estate could be at risk. The attorney should be taking the language and making it unique to your circumstance. At Waddell & Waddell, P.A. we have taken the time to work with the new language to protect our clients as few of our clients have estates subject to an estate tax (estates greater than $5 million per individual).

While I appreciate seeing an attorney to draft a power of attorney might not be as appealing as a bowl of good gumbo, taking the time to meet with an attorney who isn’t just trying to do you a favor but who is listening to your unique set of facts and creating a Power of Attorney to match your circumstance can provide you greater protection over the course of your life. Therefore seek out a qualified attorney to help guide you through the process.

Behavior changes are often first signs of dementia

Fri, 19 Aug 2016 00:00:00 GMT

New checklist helps catch symptoms earlier.

Researchers presenting at the Alzheimer’s Association International Conference 2016 (AAIC 2016) in July introduced and described a new condition known as mild behavioral impairment (MBI) that may be a forerunner of dementia.

They also proposed a new MBI checklist that physicians and research professionals can use to help recognize and measure sharp changes in mood and behavior that may precede the memory and thinking problems of dementia. Eventually, a similar checklist may be used by caregivers and family members to document the nature and extent of symptoms, and measure changes over time.

MBI would be a clinical designation that precedes mild cognitive impairment (MCI), a diagnosis that is used to describe people experiencing some cognitive problems but who can still perform most daily functions. Individuals with MBI would typically be functionally independent and younger than typical dementia patients. For a diagnosis, changes in behavior and mood must be present for at least six months and be a change from the person’s longstanding pattern of behavior.

The checklist contains 34 questions in various categories of behavioral symptoms, including: becoming agitated, aggressive, irritable or temperamental; becoming more easily frustrated or impatient; hoarding objects; saying rude or crude things the person would not have said before; becoming suspicious of intentions or motives of others, often to the point of believing they are in danger or that others are planning to harm them or steal their belongings; becoming apathetic or more impulsive.

Mood and behavior changes have long been known as early warning signs of some kinds of dementia, and research has shown that Alzheimer’s can, indeed, start as a behavioral issue.
“While memory loss is a hallmark of Alzheimer’s, early symptoms such as anxiety, confusion and disorientation are often more common, troubling and obvious to family members,” according to Maria C. Carillo, PhD, chief science officer, Alzheimer’s Association.

Studies have shown that a person with mild cognitive impairment who also experiences mood or behavior changes develops full-on dementia faster than one who does not have behavior changes and, over time, experiences worse symptoms.

Not everyone who is diagnosed with MBI will develop dementia. But catching behavior changes early can lead to an earlier diagnosis of dementia and/or effective treatment that will allow the person to live a more normal life longer. Some behaviors, like anxiety and depression, can be helped with therapy and medication. There are also clinical trials these patients might qualify for.

What Happens When There are No Children to Provide Care to a Parent?

Mon, 06 Jun 2016 00:00:00 GMT

As we age, it is likely that many of us will need help for at least some period of time with life’s daily activities. (These include bathing, dressing, eating and using the bathroom.) And while we may not want to think much about being in that position some day, it would be a good idea to start thinking now about who will take care of us in our old age.

According to a 2011 study by the U.S. Department of Health and Human Services, about half of all informal caregiving is provided by adult children, with spouses providing another 20%. In addition to helping with daily activities, these informal caregivers navigate health care options and insurance benefits, manage medications, provide transportation to doctor appointments, and manage finances. Even when people go into nursing homes or assisted living facilities, their children or spouse still provide a lot of hands-on care.

But what if you don’t have a spouse or child who will be able to take care of you? Your children may live too far away, have health issues of their own, or have family and/or work obligations. Maybe your child or spouse predeceases you. Maybe you didn’t have children. According to a study by Urban.org, nearly one-fifth of women born after 1970 will not have any children.

You may find you need to rely on a sibling, niece or nephew, distant relative, friends or paid helpers. Assisted living facilities are an option for many people. Nursing homes are often regarded as the place of last resort, but people without caregivers are more likely to enter them.

Most of these options can be expensive, depending on the type of care you will need and how long you will need it. For example, the national average cost for a home health aide is $45,760 per year; for assisted living, it’s $43,200 per year; and for a semi-private room in a nursing home, it’s $80,300 per year. (Genworth has researched these costs in each state .) So, in addition to determining who will provide your care, you also need to consider how you will pay for it.

Medicare does not pay for assisted living and only pays for a limited number of days in a nursing home. Aid & Attendance benefits from the Veterans Administration will help pay these costs for wartime veterans and their spouses who qualify. Medicaid will pay for nursing home care, but you have to spend down your assets in order to qualify. Long-term care insurance is an option, but if you wait too long it may not be affordable and you may not qualify. If you have substantial savings and/or have equity in your home, those resources can be used to pay for your care.

The point is this: It is never too late to start thinking about who will care for you in your old age, in what setting you want to receive that care, and how you will pay for it. Don’t assume your first choice is willing to provide hands-on care for you. Have that conversation with your candidates to make sure they are on board with your wishes. If not, you’ll need to come up with Plan B or Plan C. Without a plan, you could end up having no say in your end-of-life care.

Early-Onset Alzheimer’s Hits Hard

Thu, 19 May 2016 00:00:00 GMT

An estimated 5.3 million Americans have Alzheimer’s disease—an irreversible, degenerative disorder of the brain that affects problem-solving abilities, behavior and speech. It is typically associated with old age, and many of us have older family members who have been affected. As baby boomers age, the number of Alzheimer’s victims is expected to increase.

But approximately 200,000 of those diagnosed with Alzheimer’s are under age 65. Known as early-onset Alzheimer’s, the disease can even strike people in their 30s or 40s—at a time when they are beginning to build their careers, their savings and their families, and are least likely to have the financial and emotional abilities to cope.

A diagnosis of early-onset Alzheimer’s can be devastating. The person with Alzheimer’s will become unable to work. The spouse often has to work less or even stop working to become the caregiver. Savings can be wiped out quickly. With an average life expectancy of just 8-10 years after diagnosis, dreams of a long life together fade as the Alzheimer’s patient slips away.

Early-onset Alzheimer’s is difficult to diagnose, primarily because it is not expected at such a young age. And because it progresses gradually, it is often confused with other conditions. It’s easy to blame stress, depression and menopause (in women) for early symptoms, which can include fatigue, disorientation, not being able to find the right words, inability to focus and engage, and forgetfulness. Practically everyone has forgotten where we put something or why we came into a room, and we don’t give these lapses much thought. Medications, a brain tumor, even a urinary tract infection, can cause similar symptoms.

Often, co-workers may be the first ones to spot that something is truly wrong. Reports and tasks that were routine may become extremely difficult, take much longer and/or have errors. At the same time, it’s important not to assume that these changes in performance mean that someone has Alzheimer’s.

That’s why it’s important to get the proper testing. Early-onset Alzheimer’s often has a genetic component, with several members of the same family having it. Cognitive testing is also recommended. Ultimately, it may take a brain scan to confirm the diagnosis.

While there are no cures yet, there are medications that can slow the progression of Alzheimer’s, but they need to be taken early to be most effective. That’s another incentive to have the testing done as soon as you suspect something may be wrong.

Home Improvements to Consider for Aging in Place

Wed, 27 Apr 2016 00:00:00 GMT

Home Improvements to Consider for Aging in Place

Americans are getting older, and most want to stay in their homes and communities as they age. As a result, many homeowners are taking steps to modify their homes so they will be able to safely and comfortably remain in their homes for as long as possible. This is called “aging in place.”

With the average annual cost of assisted living at $43,200 and nursing home care at $80,300 you will likely save money over the long run by investing in aging-in-place home improvements. Also, if you have long-term care insurance, it may help cover some of the costs.

Here are some of the most popular home improvements to consider if aging in place is important for you or a parent. You’ll notice that many are designed to help prevent the risk of falls, which dramatically increases with age.

In the bathroom:

Install a shower with a zero threshold entry (no curb) to minimize tripping and to make accessible for a wheelchair.
Add a shower chair (for those not in a wheelchair) and a hand-held showerhead.
A comfort-height toilet (17-19 inches off the ground) will make getting on and off easier. (You can also buy a toilet seat extender, which sits on top of the existing toilet seat.)
Install grab bars near the toilet and in the shower.

In the kitchen:

Create counters at multiple heights to have the option to sit or stand when preparing meals.
Install an under-the-counter microwave instead of one overhead.
Add pull-out shelves in cabinets.

Throughout the home:

Install nonslip floors, such as textured stone or linoleum.
Increase lighting.
Install remote controls for lights and window coverings.
Lower electrical switches and raise outlets.
Change doorknobs to lever-style handles and cabinet knobs to handles.
Move the master bedroom to the first floor and install a bathroom if necessary.
Add a ramp to the entrance and widen hallways/doorways to accommodate a wheelchair.

Many of these options, and more, are thoughtfully being included in new construction for those who want to purchase aging-in-place-ready homes. Custom homes being built for some of our disabled veterans are filled with innovative ideas. You can also consult a design or home improvement specialist who has experience with aging-in-place features.

What Happens if a Family Member Becomes Incapacitated?

Tue, 19 Jan 2016 00:00:00 GMT

The Unpopular Topic of Discussion Every Family Needs to Have

Just bringing up the possibility of someone in your family becoming mentally or physically incapacitated is often difficult. We tend to think of only the very elderly needing long-term, hands-on care, but a recent report by the Alzheimer’s Association found that one in nine Americans age 65 or older currently have Alzheimer’s. With the baby boom generation aging and people living longer, that number may nearly triple by 2050. Dementia isn’t the only reason for long-term care, of course, but almost everyone knows someone already affected by it.

Waiting too late to plan can throw a family into confusion about what the Mom or Dad would want, what options are available, and what resources can help pay for care. Rushed decisions are often the most costly. Having the courage to discuss the possibility of incapacity now can go a long way toward being prepared should that time come. By the way, because anyone can become incapacitated at any time due to illness or accident, the entire family would benefit from planning for every family member.

Planning/Discussion Considerations

Care Options : Depending on the type and expected duration of care needed, options range from in-home care to adult daycare to assisted living facilities to nursing homes. Assistance with activities of daily living (ADL), which include eating, bathing and dressing, are generally not covered by health insurance. Professional care can be expensive; the national average for basic assisted living services is now about $42,000 per year. Care for those with dementia can last longer and cost more. Family caregivers, who provide the bulk of in-home care, are often unpaid, and the emotional and financial tolls can be considerable. Your discussions need to realistically consider family finances and circumstances.

Finances : Where will the money come from to pay these expenses? What resources will be available? Health insurance does not cover assisted living/nursing home facilities or help with ADLs. Medicare covers some in-home health care and a limited number of days of skilled nursing home care, but not long-term care. Medicaid, which does cover long-term care, was designed for the indigent; to qualify, the person’s assets must be spent down to almost nothing. VA benefits for Aid & Attendance may be available for veterans and their spouses. If there are significant assets, you can self-insure and pay the costs as you go. Home equity and retirement savings can also be a source of funds. If you want to protect these assets for your family, long-term health insurance may be an option. (Premiums are much lower when you are younger.)

Documents : Everyone over the age of 18 needs basic legal documents. These include an advance health directive or healthcare power of attorney (legally appointing another person to make healthcare decisions for you if you cannot make them yourself); a durable financial power of attorney (legally appointing another person to make financial decisions for you if you cannot make them yourself); and a trust and/or will.

Having the Discussion: Your parents may be harboring secret fears about what will happen to them if they need long-term care. Talking about this honestly, listening to their fears and desires, and putting a plan in place before it is needed can help reassure them (and you). If you want to talk to your children, reassure them that you are just being realistic. Starting with a story about someone you know or an article you read can be a good way to break the ice.

How to Get Help : Jason Waddell is a Board Certified Elder Law attorney has already helped many families in these same situations, and will be able to make recommendations that will save you considerable time, money, and stress. He can also work with other advisors (financial/investment, insurance, CPA, etc.) to help put together the best plan for your family’s circumstances. Contact Waddell & Waddell at 850-434-8500

Feeling Squeezed in the Middle of a Generational Sandwich?

Tue, 19 Jan 2016 00:00:00 GMT

How to Take Care of Yourself as You Take Care of Others

Raising your kids, working, trying to take care of yourself, and now caring for an aging parent? That makes you part of the Sandwich Generation. You are not alone—almost half of America’s 40- and 50-year olds are in the same boat.

Most of us have adjusted to balancing children, work and finding some time for ourselves. But when we add caring for an aging parent, it often becomes too much. And usually it’s the “me” part that is sacrificed…until you hit burn out.

Here are some ways to leverage your time and resources so you can also take care of yourself.

Enlist Your Kids
Even the smallest child can spend charming one-on-one time with a grandparent. If your parent lives with or near you, they can spend time together in person. If your parent is not near you, they can Skype on the computer, use FaceTime or play multi-player online games. Your children, no matter what their ages, will benefit from spending time with Grandma or Grandpa, they will see how you value and care for aging family members—and you will get some extra time to return phone calls, make dinner, or even catch a quick nap!

Ask About Options at Work
Check with your employer’s human resources department about resources that might be available to you. Depending on how long you expect to be caring for your parent, there may be a multitude of options available to you, including elder care research and referral services, flex time, even working from home options. The Family and Medical Leave Act (FMLA) calls for eligible employees to receive 12 weeks of unpaid job-protected leave. (Private employers with less than 50 employees are exempt.)

Seek Assistance
There are legal and community resources that can help you make the best care and financial decisions for your parent. A local Elder Care attorney can prepare the necessary legal documents and help you maximize your parent’s income, long-term care insurance and retirement savings, and qualify for VA or Medicaid benefits, if applicable. He/she will also be familiar with various living communities in the area and in-home care agencies. You can also hire someone to review and verify/dispute insurance claims and medical billing.

Find Your “Me” Time
Stress is your biggest enemy and you have to find ways to reduce it. Joining a caregiver group, in person or online, will let you share your questions and frustrations, and learn how other caregivers are coping. Don’t be afraid to ask favors of friends and other relatives, such as picking up your kids while you go to the doctor with your parent. You could also learn to order in dinner every now and then without feeling guilty. Learn what you need to maintain your stamina, energy and positive outlook. That may include regular exercise (a yoga class, walk or run), a weekly outing with friends, or time to read or simply watch TV.