Elder Law Vs Estate Planning

 

What is the similarity between the characters in the musical “Fiddler on the Roof” and attorneys? Tradition! 

All of my clients deal with estate planning issues: The majority of my clients

who have planned their estates have done so under the traditional notions of estate planning which, unfortunately, leaves them largely exposed to the threat of uncovered long-term care costs.

Traditional estate planning involves preparation of wills or trusts, powers of attorney, living wills and advance directives. These documents are generally

based on one of two notions. The first is that one day you will go to sleep and never wake up, and the biggest issue the estate plan needs to address is to make it easier for your loved ones to administer your estate. Alternatively, the plan will ensure that your appointed agents will be able to manage your

financial and health care affairs without missing a beat should you face

incapacity. But these solutions do not address the more urgent threat or the real issue of uncovered medical costs and depletion of the estate assets to support quality-of-life goals.

As discussed above, estate taxes no longer touch most estates. The real threat to an estate today, therefore, is not estate tax but rather the threat of

uncovered long-term care costs. Understanding that the role of the estate planning process is to evaluate potential threats that could erode your estate and afford appropriate protective measures to avoid such erosion, the process generally falls short unless it includes guidance and assistance

to your chosen fiduciaries on how they can approach the issue in a more reasoned and educated manner. The guidance and assistance is designed to aid in asset preservation through the employment of legal solutions and management of quality of life of you and involved family members.

Elder law attorney practising Life Care Planning addresses both these issues. They do so by understanding that most families dealing with disability or death of a family member seek not simply to protect assets, rather they seek to make sure that the protected wealth is used to address the care needs of the incapacitated and all those affected by the incapacity; or to bring peaceful closure to a chapter in their lives stemming from the demise of a loved one.

Through Life Care Planning much can be done to assure that should incapacity strike, quality of life of the incapacitated individual and that of others will be maximized and the affected family members will not be stressed to a breaking point dealing with the complications stemming from the incapacity.

Importance of Power of Attorney

How can a Power of Attorney help keep you out of a nursing home?

Power of Attorney is more powerful that you think and a document that is not given much thought. To clarify, a power of attorney is a document that you sign to name a person of your choice, who you wish to appoint as your surrogate to act on your behalf should you be unable to act on your own behalf. This may be because you are out of town or are physically or mentally incapacitated to a point that you cannot attend to your own affairs. 

Think about how you and I decide who to name as our surrogates. We simply choose the people we love and trust the most without giving much thought to the types of decisions they will have to make. In reality the most difficult decision our surrogates will make is to step in when they see us slowing down in life. 

We say to them that if you see that we cannot manage our own affairs, we trust you that you will make all the right decisions, including the decision about our housing needs. And when our surrogates find us not being able to address our own needs independently they will turn to the medical community for help. And our medical community views nursing homes and assisted living facilities like the rest of us view McDonalds. Cheap, convenient and available. Little attention is given to the effects and quality of the food.  Same way, the doctors and medical providers generally do not explore the issue in any detail because institutional care is an easy fix. 

This is the reason why many of us end up in nursing homes though we could well be able to stay at home. So, what you want your power of attorney to do is not just to give responsibility to your surrogate, but also to direct that your surrogate use the resources in your estate to seek out the assistance of a qualified geriatric care manager who can provide your surrogate options that should be considered about your care needs. Including whether you could stay at home and if so what services would be needed to accomplish the objective; if you could not stay at home what alternatives exist between home and nursing home and associated costs. 

With this information your surrogate could make the final determination, but at least it will be based on a thorough review of the facts by an objective independent professional. In the end, you are not a burden on your surrogate and your quality of life is much improved because of this directive. Not to mention the analysis of whether Medicare or Medicaid could cover some of the costs. 

Forced discharged from Hospital

As an Elder Law Attorney, I experience first hand  the same pain, anguish, struggle and frustration a family goes through while taking care of their loved one. Our health care system is so broken and complicated that it has simply forgotten the notion it was created on. Every one is treated as one fit size all regardless of individual necessities and requirements.

This week I received an email from one of my loyal radio show listener, who herself is a psychiatric nurse practitioner  for last 30 years & taking care of her elderly mother. Her mother is right now at a rehab facility and she has Group Health Insurance. Rehab facility and Group Health managed  care wants to discharge her mother even though she cannot transfer by herself and may even have torn her shoulder rotator cuff in the fall which had not even been addressed yet. 

Daughter thinks Group Health is not meeting their fiduciary duty  & wants to discharge her mom, even when it is not safe for her mom to be discharged.....Daughter is struggling & fighting with the system, simply to maintain the quality, safety and dignity of her mom's life.

Under the law, Group Health can only discharge mom if it is safe for her to be discharged. I suggested  the daughter to hire the services of a care mangers (social workers) to interface with the medical community and try and work with them in developing the discharge plan. If they are given a hard time then I will write a letter as an attorney requesting their cooperation and informing them that their planned discharge will place mom in physical jeopardy for which they may have liability. If they still insist in discharging then they have to give  a written notice to mom and mom will have the right to request review. While the review is pending, Group Health must pay for the care of mom. However, if the review is unfavorable to mom then mom would have to pay for the days out of her own pocket.

I also suggested daughter to have a backup plan that is to  work on Medicaid and or VA benefits while trying to push the Medicare days. The ideal way to deal with this situation will be to have care managers meet the Group Health folks and get an idea of what needs to be done to ensure the safety & quality of life for mom before discharging her and simultaneously review mom's estate for VA and Medicaid benefits......