Life Care Planning

Health Car Decisions Day

2010-04-09T05:42:00.000-07:00

Annual National Healthcare Decisions Day Builds on Growing Awareness of Advance Care Planning.

The National Healthcare Decisions Day, is to ensure that all people regardless of age or current health are reminded of the importance of making their healthcare wishes known to loved ones and their care providers.

This year, The Law Office of David Wingate PC will be increasing awareness of advance care planning and educating their communities about the importance of making healthcare decisions by hosting an event to mark the annual National Healthcare Decisions Day.

This effort is to promote advance care planning and healthcare decision making. All Americans are encouraged to voice their wishes and take steps to ensure that their choices are known and protected. The process does not take long and it is free.

“I am so proud to raise awareness of healthcare planning,” said David Wingate, an Elder Care Attorney, in Frederick Maryland. “I have embraced this call to action to help Americans understand the importance of making and documenting healthcare decisions.”

An advance directive is a legal document that tells healthcare providers who it is that you wish to make medical decisions for you and what treatments you would want or not want, if you are ever not able to tell care providers what you would want in a medical emergency or life-limiting illness.

“The number of people who have actively sought out information about making their wishes known and then have taken the steps to request an advance directive form has been remarkable,” said Terri Mason of Senior Life Care Planning. “Just as important as putting this information into peoples’ hands is making sure they complete the directives and take time to talk about their wishes with their loved ones and healthcare provides.”

National Healthcare Decisions Day is an initiative to encourage patients to express their wishes regarding healthcare through conversations and the completion of advance directives. David Wingate is working with providers and facilities to ensure that individual wishes are respected, whatever they may be.

Individuals and organizations interested in learning more about the annual National Healthcare Decisions Day and advance care planning are encouraged to call the Law Office of David Wingate at 301 663 9230. Information is also available via email at terri@davidwingate.com

Reverse Mortgages: Money From Home

2009-07-13T09:29:00.000-07:00

Under our “system” of paying for long-term care, you may be able to qualify for Medicaid to pay for nursing home care, but in most states there’s little public assistance for home care. Most people want to stay at home as long as possible, but few can afford the high cost of home care for very long. One solution, which is growing in popularity, is to tap into the equity built up in your home. If you own a home and are at least 62 years old, you may be able to quickly get money to pay for home care (or for anything else) by taking out a reverse mortgage. Reverse mortgages, financial arrangements designed specifically for older homeowners, are a way of borrowing that transforms the equity in a home into liquid cash without having to either move or make regular loan repayments. They permit house-rich but cash-poor elders to use their housing equity to, for example, pay for home care while they remain in the home, or for nursing home care later on. The loans do not have to be repaid until the last surviving borrower dies, sells the home or permanently moves out.
In a reverse mortgage, the homeowner receives a sum of money from the lender, usually a bank, based largely on the value of the house, the age of the borrower, and current interest rates. For example, a 70-year-old borrower with a $200,000 house in County X, State Y, could receive a loan of $115,000. The lower the interest rate and the older the borrower, the more that can be borrowed. Homeowners can receive the money in one of three ways (or in any combination of the three): in a lump sum, as a line of credit that can be drawn on at the borrower’s option, or in a series of regular payments. The most popular choice is the line of credit because it allows a borrower to decide when he or she needs the money and how much. Moreover, no interest is charged on the untapped balance of the loan.
Although it is often assumed that an elderly person would want to use the funds from a reverse mortgage loan for health care, there are no restrictions--the funds can be used in any way. All borrowers must be at least 62 years of age to qualify for most reverse mortgages. In addition, a reverse mortgage cannot be taken out if there is prior debt against the home. Thus, either the old mortgage must be paid off before taking out a reverse mortgage or some of the proceeds from the reverse mortgage used to retire the old debt
Call us now for assistance (240) 453-0070. We can help you!

At Senior Life Care Planning, LLC we are dedicated to giving our clients the power to be informed individuals and to give peace of mind. We provide honest ways to protect your home, loved ones and independence in times of great need. We understand the emotional burden, confusion, anger, hopelessness, sense of injustice, fear and loneliness that come with long-term disability and end-of-life issues.
Every day we help and support families and individuals who are in crisis. We work with our clients to provide peace of mind and quality of life.

Senior Life Care Planning, LLC
One Research Court, Suite 450
Rockville MD 20850
240.453.0070
www.seniorlcp.com

Assisted Living Facility

2009-07-08T12:51:00.000-07:00

The idea of Assisted Living is tremendously appealing – an older individual receiving necessary care and services in a home-like environment, while retaining choice and autonomy.

Assisted Living, is the fastest growing form of residential housing for older Americans and has filled the space between nursing homes and the residential home. With the assisted facility, many people enter their Assisted Living homes with the expectation that this will be their home for the rest of their lives. Also, they develop friendships and relationships with other residents. Therefore, the facility becomes their primary community.

Most Assisted Living facilities are licensed to care for residents only up to a particular need of care. A generic multi-level system might designate three levels: low, moderate and high (excludes skilled nursing care - nursing home level). When a resident has low care needs, the resident may reside at any type of Assisted Living facility. When the resident's care needs reach the moderate level, the resident is allowed to reside only at a facility licensed for moderate or high care needs. When the care needs increase to the high level, the resident is allowed only to reside in a facility licensed for high care needs. Quality of care standards are set for each level to assure that residents receive care that is adequate to meet their needs.

However, momentum toward Assisted Living, should not lead one to assume that Assisted Living is always the right choice, or that any and all health care conditions can be accommodated within Assisted Living. Some Assisted Living facilities have been known to increase their acceptance and retention of residents with significant health care needs that for which the facility is not equipped. Therefore, there must be a balance between two compelling and sometimes competing goals – allowing residents to "age in place" and assuring that residents receive an adequate and appropriate quality of care.

"Assisted Living" is not defined in any meaningful way by federal law. Currently, the Federal Government plays no significant role in setting Assisted Living facilities standards, guidelines or rules. However, "Assisted Living" has been defined by the State of Maryland as “a residential or facility- based program that provides housing and supportive services, supervision, personalized assistance, health related services, or a combination thereof that meets the needs of the individuals who are unable to perform or who need assistance in performing activities of daily living in a way that promotes optimum dignity and independence for the individuals.” But what does this mean?

The definition does little to specify exactly what level of service is required. The specifics are limited. What does optimum dignity mean? Does the definition mean that staffs are awake around the clock? What staffs are awake? What health related services are provided? Does this mean only assistance with the self-administered medication? The definition intimates that extensive health care is available. But, in fact, nothing in the definition guarantees any health care beyond self-administration of medication. Therefore, the definition fails to state clearly what services are made available to residents. Generally, the Assisted Living provider has full freedom to provide extensive, individualized services, but that same freedom allows less conscientious providers to cut corners and force out residents who are considered undesirable for one reason or another.

Additionally, the Assisted Living definition is written in an idealized, attractive term, which is vague and practically unenforceable. Rather than establishing standards directly, the State anticipates, to a great extent, that standards will be established through negotiations between a facility and an entering resident. However, there is little protection for the residents because, as a practical matter, admission agreements often are not negotiated but presented to incoming residents on a take-it-or-leave-it basis. Additionally, a 1997 Report form the General Accounting Office ("GAO") noted "[assisted living] contracts had no standard format, varied in detail and usefulness, and in some cases were vague and confusing." The GAO subsequently examined agreements in four states, and found one-third of the reviewed agreements contained language that the GAO considered unclear or potentially misleading.

Also, discharge from a Maryland Assisted Living facility is authorized for violation of the admission agreement. Therefore, the Assisted Living facility sets discharge justifications in an admission agreement. The facility may limit discharge to legitimate situations such as endangerment of other residents and nonpayment. Or, on the other hand, the facility may write an admission agreement with unfair discharge justifications; i.e., use of a wheelchair in the dining rooms. Consequently, the facility has extensive discretion to discharge a resident. With the State granting such discretion, we have two potential discharge problems: that a resident will be discharged too soon, or too late. In a too soon discharge, a facility may discharge a resident because their needs have become too expensive or inconvenient, even though the facility, if it wanted, could provide adequate care. The too late discharge, is often the result of a facility retaining a resident for whom the facility is incapable of providing care.

All assisted facilities are not the same, and can vary within the State. Therefore, proper evaluation of the facility and their contracts must be performed, because the obligations and rights pertaining to the Assisted Living facility may not protect your rights, but the facilities. Consequently, unenforceable contract language can be devastating to a resident if the provider is less interested in a resident's health and satisfaction, and thus takes advantage of the vagueness of the contract to provide the bare minimum services.

If you would like further information, please call our office at 301 663 9230.

SOME COMMON NURSING HOME PROBLEMS

2009-07-08T12:50:00.000-07:00

Do these problems sound familiar?
1. “Medicaid does not pay for the service that you want.”
2. “The nursing staff will determine the care that you receive.”
3. “We don’t have enough staff to accommodate individual schedules. You will be woken up every morning at six am.”
4. “We don’t have enough staff. You should hire your own private-duty aide.”
5. “If we don’t tie your father into his chair he may fall or wander away from the nursing home. There’s just no way we can always be watching him.”
6. “Your mother needs medication in order to make her more manageable.”
7. “We must insert a feeding tube into your father because he is taking too long to eat,”
8. “Your children can visit you only during visiting hours.”
9. “We can’t admit your mother unless you sign the admission agreement as a “Guarantor” or “Responsible Party.”
10. “Please sign this arbitration agreement. It’s no big deal. Arbitrations allow disputes to be resolved quickly.”
11. “Medicare can’t pay for your nursing home care because we have determined that you need custodial care only.”
12. “We can’t give you therapy services because your Medicare reimbursement has expired, and Medicaid doesn’t pay for therapy.”
13. “Even though you’re now financially eligible for Medicaid payment, we don’t have an available Medicaid bed for you.”
14. “We don’t have to readmit you from the hospital because your hold-hold period has expired.”
15. “You must pay any amount set by the nursing home for extra charges.”
16. “We have no available space in which residents or family member could meet.”
17. “You must leave the nursing home because you are a difficult resident.”
18. “You must leave the nursing home because you are refusing medical treatment.”

Call us now for assistance (301) 663-9230
We can help you!

At Senior Life Care Planning, LLC we are dedicated to giving our clients the power to be informed individuals and to give peace of mind. We provide honest ways to protect your home, loved ones and independence in times of great need. We understand the emotional burden, confusion, anger, hopelessness, sense of injustice, fear and loneliness that come with long-term disability and end-of-life issues.
Every day we help and support families and individuals who are in crisis. We work with our clients to provide peace of mind and quality of life.

Senior Life Care Planning, LLC
1560 Oppossumtown Pike, Suite A-12
Frederick, MD 21702
301.663.9230
www.seniorlcp.com

IS YOUR LOVED ONE A 'SECOND-CLASS CITIZEN'?

2009-07-08T12:49:00.000-07:00

Family members face some tough and traumatic issues when a loved one reaches the point of needing long-term nursing care. Of course, there is the worry about the welfare and comfort of the patient. Often, there is also concern about finances--and with good reason, with nursing care costs averaging $8,000 to $12,000 per month.
For families whose loved ones have qualified for Medicaid assistance–or even for those thinking about applying for such assistance–there may be additional worries. Family members will often fear that as a Medicaid patient, their loved one will be a "second class citizen" and receive inferior care from the nursing facility compared with someone who is paying privately or through insurance. In my professional and personal experience, this fear is completely groundless. Moreover, as I always remind family members, it is against federal law for a nursing facility to discriminate among patients based on their source of payment. Any such discrimination carries a stiff penalty for the institution involved.
Secondly, a family that has preserved assets can tap into those funds to make the loved one more comfortable and content, to enhance his or her lifestyle in meaningful ways. Remember, Medicaid law permits the nursing home resident to keep only $68 of any income for his or her personal use; the rest goes to the nursing facility. With extra assets in your family’s pockets, your loved one can be given some extra "TLC." For example, a private-duty aide can be provided some of the time. Perhaps a grandchild dearly wants to fly down to visit with her incapacitated grandfather but lacks funds to pay for airfare. Conserved assets can underwrite this, too.
If all assets are depleted, dissension can sometimes arise among family members over who should pay for what. Who will pay for dental care? Who will pay for the cab that will take an aging father to a grandchild’s birthday party across town? The child’s parent or all the patient’s adult children? Do all the adult children agree Mom should be treated to a weekly hairset, and do they all pitch in equally? When the patient has assets preserved, they can be used to provide these extras to enhance their quality of life and alleviate family tension.

Call us now for assistance (301) 663-9230
We can help you!

At Senior Life Care Planning, LLC we are dedicated to giving our clients the power to be informed individuals and to give peace of mind. We provide honest ways to protect your home, loved ones and independence in times of great need. We understand the emotional burden, confusion, anger, hopelessness, sense of injustice, fear and loneliness that come with long-term disability and end-of-life issues.
Every day we help and support families and individuals who are in crisis. We work with our clients to provide peace of mind and quality of life.

Senior Life Care Planning, LLC
1560 Opossumtown Pike, Suite A-12
Frederick, MD 21702
301.663.9230
www.seniorlcp.com

Use of Trusts in Medicaid Planning

2009-06-30T12:56:00.000-07:00

If an individual is age 65 or older, the individual cannot create and fund a Special Needs Trust or a Pooled Trust account without incurring a transfer penalty. This does not necessarily mean that making transfers to fund a trust under these circumstances is always a bad idea. However, since the creation and funding of any trust to preserve the individual's assets would involve a transfer without fair consideration in any case, the individual may wish to use his or her assets to fund a trust that is not required to repay the State of Maryland for Medicaid benefits the individual may receive during his or her lifetime.

The regulations on self-settled trusts are such that a trust created by the individual and funded with the individual's own assets (other than one of the trusts exempt under OBRA '93) will prevent the individual from qualifying for Medicaid in the future, unless none of the assets or income in the trust can possibly be distributed to the individual or for the individual's benefit.

However, the individual may be able to create an irrevocable trust for the benefit of his or her children or grandchildren and fund that trust directly with his or her own assets, if the trust provides that:

The childrens' or grandchildren's trust shares will be funded with all trust income and principal. None of the trust income or principal may be distributed to the individual or for the individual's benefit during his or her lifetime.

Since none of the principal or income in that trust could be paid to or for the benefit of the individual, that principal and income would not be available to the individual for Medicaid eligibility purposes. Further, the trust can provide for distribution of the assets accumulated in the trust share after the grantor's death according to the grantor's instructions. The funding of such a trust would result in a transfer penalty, but no more so than if the assets used to fund the trust were transferred outright as part of a gifting plan.

Many individuals planning for future Medicaid eligibility may not wish to deprive themselves completely of the benefit of excess resources, as would be the case if these resources were transferred outright as gifts to others. Using excess resources to fund a self-settled, non-exempt trust for the individual's own benefit is not a good option if the individual ever wishes to qualify for Medicaid. However, any trust that is funded by a third party, with the individual as the sole beneficiary, would be exempt from the rules regarding self-settled trusts, so long as the trust is not created or funded at the individual's direction or request.

The assets in such a trust would not be deemed available to the individual by Medicaid, so long as the individual cannot force distributions from such a trust; the individual does not have authority to exercise discretion as a trustee; and the individual never transfers his or her own assets directly into the trust. Thus, the trust would not delay the start of the penalty period for transfers of assets, once the individual is in a nursing home or receiving long term care services at home.

As a result, an individual can provide for himself or herself indirectly by making gifts of remaining excess resources to his or her children, who, in turn, could voluntarily use those assets to fund a third party special needs trust for the individual's sole benefit. That trust would allow the individual to qualify for Medicaid, once the transfer penalty or look-back period has expired; the assets in the trust could be used to pay for the individual's long term care expenses during the penalty period or look-back period, and for the individual's supplemental needs after the individual begins receiving Medicaid benefits; and assets remaining in the trust after the individual's death would not be subject to Medicaid liens, estate recovery, or the type of state pay-back requirements applicable to Medicaid exempt special needs trusts or pooled trusts.

It would be very important to be able to demonstrate that the trust was not created at the individual's direction or request. Therefore, it is advisable for practitioners to prepare a statement for the individual to sign at the time the individual makes his or her gift transfers. This statement should provide that any gifts the individual makes are given freely and with the understanding that the individual will no longer need the property transferred to provide for his or her support or other needs; that the recipient of the gifts is under no obligation to ever use the property transferred for the individual's benefit or to return any of that property to the individual; and that the recipient is under no obligation to set the gifts aside in any trust or other arrangement for the individual's benefit.

Of course, this strategy does carry some risk. The person to whom the individual makes gift transfers could change his or her mind and decide not to create or fund the trust. Therefore, this strategy should only be used when the family relationships and other dynamics indicate that the recipient of the gifts will actually go through with creation and funding of the trust.
Call us now for assistance (240) 453-0070.
We can help you!

At Senior Life Care Planning, LLC we are dedicated to giving our clients the power to be informed individuals and to give peace of mind. We provide honest ways to protect your home, loved ones and independence in times of great need. We understand the emotional burden, confusion, anger, hopelessness, sense of injustice, fear and loneliness that come with long-term disability and end-of-life issues.
Every day we help and support families and individuals who are in crisis. We work with our clients to provide peace of mind and quality of life.

Senior Life Care Planning, LLC
One Research Court, Suite 450
Rockville MD 20850
240.453.0070
www.seniorlcp.com

Elderly Who Transfer Assets at Risk

2009-06-15T10:43:00.000-07:00

What do the following people have in common? {a} a woman who helps her granddaughter by paying $40,000 of her college tuition {b} a man who sells his home and donates 10% of the proceeds to his local church {c} a caring sister who gives $20,000 of her savings to help her needy sister stay in her home and {d} a widower who sends money to his daughter, a single mother, with two underage children, who is out of work due to an automobile accident. Answer: Each of them are at risk of being denied Medicaid eligibility if he or she is admitted to a nursing home within five years of making the gift.

On February 8, 2006 President Bush signed the Budget Reconciliation Act of 2005. The legislation changes several of the Medicaid rules.

The most significant change has to do with the manner in which the State will calculate the ineligibility period when the applicant has transferred assets for less than value. Gifts made prior to February 8 will result in a penalty period that will begin on the first day of the month in which the gift is made. So, if a single parent gifted $100,000 to her child on February 7, 2006 it would result in a 15 month penalty ranging from February 1, 2006 to April 30, 2007. If that parent had made the same gift on February 8, 2006, the penalty period would not begin until the parent entered a nursing home and was otherwise eligible for Medicaid benefits but for the penalty, which in Maryland means that she had spent all of her assets except for $2500. The Act also increased the look back period from three to five years for all transfers. Therefore, if the parent who gifted on February 8 goes in a nursing home prior to January 31, 2011, she will not receive assistance from the State under the Medicaid program until 15 months after her admission. The logical question is if the applicant is indigent and is faced with a penalty that renders her ineligible for government subsidization of nursing home care, who will pay?

The Statute does provide for hardship waivers where eviction of the nursing home resident would jeopardize health or life. But no one really knows how these waivers will work, particularly if the indigence resulted from gifting assets. Some critics of the Legislation have dubbed it the “Nursing Home Bankruptcy Act”, speculating that the nursing homes will take a financial hit. It is more likely that the nursing homes will screen applications for admission much more carefully, refusing to admit anyone who has no funds and who is ineligible for Medicaid due to gifting. So, it is vitally important that gifting be done only after diligent consideration of the risks associated with making such transfers.

It is, of course, best to make transfers at a younger age simply because the chance of making it through the five year look back period is better. If you are healthy, document it by seeing your physician at or around the time in which the transfer is made. Only transfers made for the purpose of gaining Medicaid eligibility will disqualify the donor. For example, if a gift is being made in conjunction with tax planning to reduce estate or capital gains taxes, ask the consultant to provide written instructions so that you may argue that the transfers were being made pursuant to the advice of your tax consultant. Remember, that the burden will be on you to prove that the gift was not made to receive Medicaid.

Even if a gift were made for Medicaid purposes, there are certain exceptions to the rule that such a gift results in a penalty. For example, there is no penalty when one spouse gifts to the other spouse. Neither is there a penalty when a parent gifts the home to a child who has lived with the parent for at least two years prior to the nursing home admission and who has provided a level of care which has kept the parent out of a nursing home during the two year period. No penalty is imposed where a parent gifts the home to a disabled child. In a case where two siblings hold title to their home together, there is no penalty if the sibling entering the nursing home transfers her interest to the other.

If you can afford and qualify for long term care insurance, consider purchasing a policy. According to one study, for every 1000 people in the United States, 7 will actually incur damage to their home which would be covered under their homeowner’s policy, 40 will be involved in an automobile accident and nearly 500 will require long term care. Do not rely solely on the advise of the insurance person selling you the policy. Seek advise from your attorney or accountant who has no financial interest in whether you purchase the policy under consideration. Ask the salesperson to provide you with a history of premium rate increases imposed by the particular company underwriting the policy. Make sure that the policy covers not only nursing home care, but assisted living facilities and in home health care personnel.

The federal government is clearly attempting to shift the paradigm from government subsidies for nursing home care to private financing. Toward that end, the government has encouraged people to purchase long term care insurance by providing certain tax advantages. Of course, long term care insurance is not the panacea the industry represents it to be. Many people do not qualify and/or cannot afford it. For those people, Medicaid eligibility can only be achieved by spending down their own funds. The chilling effect the new rules will have on gifting is intended to facilitate the conversion from public funding to private funding. The Legislation casts a wide net replete with traps for the unwary.
Call us now for assistance (240) 453-0070.
We can help you!

At Senior Life Care Planning, LLC we are dedicated to giving our clients the power to be informed individuals and to give peace of mind. We provide honest ways to protect your home, loved ones and independence in times of great need. We understand the emotional burden, confusion, anger, hopelessness, sense of injustice, fear and loneliness that come with long-term disability and end-of-life issues.
Every day we help and support families and individuals who are in crisis. We work with our clients to provide peace of mind and quality of life.

Senior Life Care Planning, LLC
One Research Court, Suite 450
Rockville MD 20850
240.453.0070
www.seniorlcp.com

A Guide to Veteran’s Benefits

2009-06-05T05:58:00.000-07:00

WHAT’S INCLUDED IN THIS GUIDE:

Veteran’s Benefits – Introduction
VA Compensation and Pension Benefits
Veterans Benefits at a Glance
More Details…
The Benefits Available
Who can help you file a claim?
Official Dates for Periods of War
Other Active Duty Qualifications
VA help lines found to regularly provide wrong information
VA Benefits Checklist
Listing of Possible Medical Expenses
The Wrap-up: You made it to the end!

Veteran’s Benefits – Introduction

Most people think of veterans’ benefits as being only for service men and women who were wounded or disabled while serving in the armed forces. By and large, that is true. But—we have learned that there are substantial benefits that may be available to wartime veterans who are now senior citizens and are facing the burden of long term care due to a host of diseases such as Alzheimer’s, Parkinson’s, MS, Lou Gehrig’s Disease, and many others. In fact, the Veterans Administration estimates that millions of wartime veterans and their spouses may be eligible for Special Monthly Pension benefits, and not even be aware of it!

Wartime veterans, or their surviving spouses, become eligible for the Special Monthly Pension benefit when they are over 65 years of age, are permanently disabled and unable to work, are homebound, or need the regular aid and attendance of another—whether at home, in assisted/supportive living, or in a nursing home. The program is based on actual financial need for assistance, so there are income and asset limitations.

Unfortunately, there is widespread misunderstanding regarding how to determine qualification for this important benefit. It is the goal of this Nuts and Bolts Guide to give you a start in understanding the ins and outs and the ups and downs of the VA benefit maze commonly referred to as “Aid and Attendance.” Even though finding your way through the maze can be extremely difficult, it is worth the effort to assist wartime veterans and their surviving spouses during times of great need.

The maximum benefit available can provide significant help in paying for long term care costs, either for the homebound and/or nursing home veteran/surviving spouse.

There are only three types of persons who are authorized to provide a veteran with assistance filing a claim for veterans’ benefits:
1. An attorney licensed to practice law in your state
2. A veterans service organization such as VFW, American Legion, Amvets, etc.
3. A state or county official of the Dept. of Veterans Affairs in your state

Unfortunately, there are few attorneys who have knowledge in this particular area of legal practice due to the fact that it is illegal to charge a veteran a legal fee for providing assistance in filing a claim for benefits. Veterans Service Organizations (VSOs) are often hard-pressed to have sufficient resources to assist multiple generations of veterans, so it is often difficult for a veteran or his/her surviving spouse to get help in filing a claim. Sadly, the Knight-Ridder Newspapers reported on December 30, 2005 that “a veteran who turns to the VA for information about veterans benefits might want to get a second opinion. According to the VA’s own data, people who call the agency’s regional offices for help and advice are more likely to receive completely wrong answers than completely right ones.”

The only other common source of information regarding this benefit generally comes from annuity salespeople who often offer to consult with veterans and their families for free. This “free” offer is based on the strategy of counseling the veteran to meet the asset and income limitations of the benefit by buying an annuity and giving away their assets to their children. The offer is that the annuity sales organization will assist the veteran in filing for the VA benefit claim. They also promise to provide any necessary estate planning work at no charge. In reality, the annuity salesperson is being compensated by the annuity company for selling a financial product to the veteran. An annuity may be an excellent financial decision or a poor one, depending on the facts and circumstances. All we are saying is this: You should seek independent advice before making a decision to purchase an annuity.

A Medicaid Trap…
Another important factor that one must consider when thinking about trying to meet the VA asset limitation test is that giving away cash or other things of value can create terrible problems for senior citizens if or when they later need to apply for Medicaid to assist them with skilled nursing home care. Giving away assets can create a long penalty period of ineligibility for Medicaid benefits. Any senior facing long-term care needs to seek capable legal advice from an attorney who is skilled in the areas of estate planning, Life Care Planning, Medicaid, Medicare, income tax, and gift tax, as well as having experience regarding VA rules.

The big question for many families will be, “What will it cost me to seek advice in this area?” Although an attorney who chooses to actually file a claim for veterans benefits must do that portion of his/her work for free, the attorney may charge the usual fees related to any estate planning, financial planning options, Medicaid, Medicare, income tax, or gift tax work, as well as the determination of the financial suitability of filing for a veterans benefit claim. No one should pay an attorney fee unless receiving a fair return on his/her investment.

After reading this Guide, we strongly recommend that you contact an elder care attorney such as those at Senior Life Care Planning to determine if you qualify. An elder care attorney can assist you and your family by explaining many difficult-to-understand things about long term care. Qualification for a VA benefit is only one of several concerns that must be considered. As you struggle to provide dignified long term care for a wartime veteran and/or surviving spouse, we can help you understand the options. We are your advocates, and we want to help you stretch your hard-earned dollars further. VA benefits are only one part of the puzzle. We will hold your hand and guide you every step of the way as we consider all of your family’s resources and needs.

VA Compensation and Pension Benefits

There are many types of VA benefits available to veterans through the Veterans Administration for things such as education, life insurance, health care, home loans and burial benefits. Two major categories of benefits, however, are compensation and pension.

Service-Connected Disability COMPENSATION

Compensation is a benefit that veterans receive when the veteran has a disability caused by, or exacerbated by, military service. Disability compensation is available to a qualified veteran regardless of his or her level of income. Once a veteran can show disability due to military service, a level of disability is rated by the Veterans Administration (for example, 20% disabled) and the amount of compensation paid depends on the rating assigned. A veteran can apply for increases in the percent rating should the condition worsen. A rating above 100% disabled will qualify the veteran for special monthly compensation that could more than double the normal benefit. During 2009, monthly compensation payments ranged from $123 for a veteran with no dependents and a 10% disability rating, to $2,673 for a veteran with a spouse and a 100% disability rating. Special monthly compensation benefits can raise the maximum monthly payments.

Dependency and Indemnity Compensation (DIC) is paid to survivors of deceased veterans if the death was due to a service-related injury or illness. Eligible survivors include spouses who have not remarried and unmarried children under 18. Disabled children are also eligible, as are children up to 23 who are attending school.

Non-Service-Connected Disability PENSION

A pension is a benefit for veterans with low incomes who are permanently and totally disabled, when that disability is not related to military service. This is sometimes referred to as a “Special Monthly Pension” (or sometimes an “Improved Pension”). A veteran will be considered permanently and totally disabled if they are, (1) a patient in a nursing home for long-term care because of disability; (2) receiving Social Security disability benefits; (3) unemployable as a result of a disability that is reasonably certain to continue throughout their life; or (4) suffering from any disease or disorder that renders them permanently and totally disabled as determined by the Secretary of the Department of Veterans Affairs.

In 2009, the maximum disability pension rate for a veteran with no dependents is $11,830, or $985 per month. The rate for a veteran with one dependent, or for two veterans married to each other is $15,493, or $1,291 per month. Each additional dependent child adds $2,020, or $168 per month, to the pension.

The VA pays a death pension to low-income surviving spouses and unmarried dependent children of deceased wartime veterans. In order to be eligible, a spouse must not have remarried, and a dependent must be under age 18, or must be under age 23 if attending a VA-approved school. Dependents who are permanently incapable of self-support because of disability before age 18 are also eligible for the death pension. For 2009, the maximum death pension for a surviving spouse is $7,932, or $661 per month. If the spouse has a dependent child, the maximum pension is $10,380, or $865 per month. If the spouse has more than one dependent child, the benefit for each dependent child is $2,020, or $168 per month.

The amount of the Special Monthly Pension will be increased if the permanently disabled veteran is also housebound. A person is housebound if they are permanently and totally disabled and, either (1) have an additional disability or disabilities ratable at 60% or more; or (2) are substantially confined to their residence or the immediate premises due to a disability that is reasonably certain to remain throughout their lifetime. In 2009, the maximum pension for a housebound veteran with no dependents is $14,448, or $1,204 per month. If the housebound veteran has one dependent, the maximum pension is $18,120, or $1,510 per month. If a surviving spouse is housebound, the maximum pension is $9,696, or $808 per month. With a dependent child, the maximum pension is $12,144, or $1,012 per month. Again, each additional dependent will increase the pension $2,020, or $168 per month.

If the veteran is in need of regular aid and attendance, the maximum Special Monthly Pension is increased further to $19,736, or $1,644 per month if the veteran has no dependents. With one dependent, the maximum pension is $23,396, or $1,949 per month. If the surviving spouse is in need of regular aid and attendance, the maximum pension is $12,681, or $1,056 per month. If the surviving spouse has a dependent child the maximum pension is $15,128, or $1,260 per month. Again, each additional dependent will increase the pension $2,020, or $168 per month. To be in need of regular aid and attendance, the veteran or spouse must be permanently and totally disabled and (1) a patient in a nursing home; (2) blind, or nearly blind; or (3) needing the regular aid and attendance of another person to perform basic activities of daily living, such as dressing, bathing, and attending to the wants of nature.

Attaining age 65 – Service Pension

A low-income, wartime veteran who attains the age of 65 is also entitled to a pension, known as a Service Pension, whether or not they are disabled. The amount of the maximum pension is the same as the Special Monthly Pension.

Low Income and Net Worth Requirements

In order to be eligible to receive any of the above non-service connected PENSIONS, the veteran must meet income and net worth requirements. First, the annual maximum pension amount is decreased, dollar for dollar, by the veteran’s countable income. Income that is countable is, in general: all of the veteran’s income, including that of any dependents, MINUS unreimbursed medical expenses. Unreimbursed medical expenses include doctor’s fees, dentist’s fees, prescription glasses, Medicare premiums and co-payments, prescriptions, insurance premiums, transportation to physicians’ offices, and the costs of assisted living facilities or in-home aides.

So, for example, if a veteran has $20,000 in income and $10,000 in unreimbursed medical expenses, their countable income is $10,000. Their $10,000 in countable income is deducted from the maximum annual Special Monthly Pension of $11,181 for a benefit of $1,181. As another example, suppose the veteran is in a nursing home (and so qualifies for the additional pension for aid and attendance) and has an income of $50,000. If their unreimbursed medical expense for the nursing home are $5,000 per month, or $60,000, the veteran’s countable income is negative $10,000. Any negative income is counted as an income of $0 and the veteran will be eligible for the maximum annual Special Monthly Pension for aid and attendance of $19,736.

In addition to low income, the veteran must also have a limited net worth. The VA has not specifically defined “limited net worth”—however, a general guide is that the veteran must have a net worth lower than $50,000 if single or $80,000 if married. A veteran’s net worth is calculated by adding all the value of all personal and real property owned by the veteran (and his or her spouse), not including a home and car. Items included in the calculation of a veteran’s net worth would include things such as CDs, savings accounts and bonds.

Veterans Benefits at a Glance

The focus of this Nuts and Bolts Guide is the “non-service-connected pension” which may provide money to assist a wartime veteran or surviving spouse who now faces substantial medical costs due to Alzheimer’s, Parkinson’s, MS or other “non-service-connected” diseases.

More Details…
Who is eligible for the non-service-connected pension?
Honorably discharged veterans, surviving spouses, or children of any military, naval, or air service.

Also includes certain other special groups such as:
o Women’s Army Auxiliary Corps (WAAC)
o Merchant Marines from WWII
o U.S. civilians of the American Field Service
o Plus 30 more! See list later in this guide.

Served in active duty 90 consecutive days, one of which was during a period of war

At least 65 years old OR Permanently and Totally Disabled

“Permanently and Totally Disabled” is defined as:
Receiving long-term nursing home care; or
Receiving Social Security disability benefits; or
Unemployable as a result of disability reasonably certain to continue throughout the life of the person.

The veteran’s current disability does not need to have any connection to the veteran’s actual time in the armed forces. (Non-service-connected disability can be Alzheimer’s, Parkinson’s, etc.)

Other requirements:
This is a needs-based program with income and asset tests.
Income limitation
Gross income MINUS certain expenses
Unreimbursed medical expenses of veteran and his/her household
Certain educational expenses
After reducing gross income by the above expenses, net income must be lower than $7,933 to $23,396, depending on your circumstances
Net worth limitation
In addition to your house, car, life insurance, burial policies, and annuities in payout status, you can generally have between $50,000 and $80,000 in assets, including CDs, stocks, bonds, etc.
If your net worth is higher, consult with a qualified attorney for an appropriate tax analysis to see if transferring some of your assets may qualify you.

Who can help you file a claim?

 Recognized Veterans Service Organizations, like the VFW or American Legion
 An accredited agent
 A licensed attorney

Only accredited agents and attorneys can receive fees for their services.

HOWEVER, no one can receive a fee for filling out forms or actually filing a claim for you once you have decided to make a claim!

Senior Life Care Planning, LLC offers pre-filing and asset protection consultation to veterans who may qualify for a pension.

Our consultation is part of our overall long-term care planning practice.

Contact us today!

Phone 301 663 9230 Frederick Office
240 453 0070 Rockville Office

www.seniorlcp.com

Official Dates for Periods of War

Mexican Border: May 9, 1916 to April 5, 1917

World War I: April 6, 1917 to November 11, 1918
April 1, 1920 if served in Russia

World War II: December 7, 1941 to December 31, 1946

Korean War: June 27, 1950 to January 31, 1955

Vietnam War: August 5, 1964 to May 7, 1975
February 28, 1961 if served in Vietnam

Persian Gulf War: August 2, 1990 to [date not yet determined]

Other Active Duty Qualifications

If you belong to any of these groups and received a discharge by the Secretary of Defense, your service meets the active duty service requirement for benefits:

 Recipients of the Medal of Honor
 Women Air Force Service Pilots (WASPs)
 WWI Signal Corps Female Telephone Operators Unit
 WWI Engineer Field Clerks
 Women’s Army Auxiliary Corps (WAAC)
 Female clerical employees of the Quartermaster Corps serving with the American Expeditionary Forces in WWI
 Civilian employees of Pacific naval air bases who actively participated in defense of Wake Island during WWII
 Reconstruction aides and dietitians of WWI
 Male civilian ferry pilots
 Wake Island defenders from Guam
 Civilian personnel assigned to OSS secret intelligence
 Guam Combat Patrol
 Quartermaster Corps members of the Keswick crew on Corregidor during WWII
 U.S. civilians who participated in the defense of Bataan
 U.S. merchant seamen who served on block ships in support of Operation Mulberry in the WWII invasion of Normandy
 American merchant marines in oceangoing service during WWII
 Civilian Navy IFF radar technicians who served in combat areas of the Pacific during WWI
 U.S. civilians of the American Field Service who served overseas under U.S. armies and U.S. army groups in WWII
 U.S. civilian employees of American Airlines who served overseas in contract with the Air Transport Command between 12/14/41 and 8/14/45
 Civilian crewmen of certain U.S. Coast and Geodetic Survey vessels between 12/7/41 and 8/15/45
 Members of the American Volunteer Group (Flying Tigers) who served between 12/7/41 and 8/14/45
 U.S. civilian flight crew and aviation ground support of TWA who served overseas between 12/14/41 and 8/14/45
 U.S. civilian flight crew and aviation ground support of Consolidated Vultee Aircraft Corp. who served overseas between 12/14/41 and 8/14/45
 Honorably discharged members of the American Volunteer Guard, Eritrea Service Command, between 6/21/42 and 3/31/43
 U.S. civilian flight crew and aviation ground support of Northwest Airlines who served overseas between 12/14/41 and 8/14/45
 U.S. civilian female employees of the U.S. Army Nurse Corps who served in the defense of Bataan and Corregidor from 1/2/42 to 2/3/45
 U.S. civilian flight crew and aviation ground support of Braniff Airways who served overseas in the North Atlantic between 2/26/42 to 8/14/45
 Chamorro and Carolina former native police who received military training in the Donnal area of central Saipan and were placed under command of Lt. Casino of the 6th Provisional Military Police Battalion to accompany U.S. Marines on active, combat patrol from 8/19/45 to 9/2/45
 The operational Analysis Group of the Office of Scientific Research and Development, Office of Emergency Management, which served overseas with the U.S. Army Air Corps from 12/7/41 through 8/15/45
 Honorably discharged members of the Alaska Territorial Guard during WWII
VA help lines found to regularly provide wrong information
By CHRIS ADAMS
Knight Ridder Newspapers - Posted on Fri, Dec. 30, 2005

WASHINGTON - A veteran who turns to the Department of Veterans Affairs for information about benefits might want to get a second opinion.

According to the VA's own data, people who call the agency's regional offices for help and advice are more likely to receive completely wrong answers than completely right ones.

To see how well its employees answer typical questions from the public, VA benefits experts in 2004 called each of the agency's U.S. regional offices, which process veterans' disability claims. The so-called mystery callers, saying they were relatives or friends of veterans inquiring about possible benefits, made a total of 1,089 calls. Almost half the time they got answers that the VA said were either completely incorrect or minimally correct.

According to an internal VA memo on the mystery-caller program that's buried deep in the department's Web site, 22 percent of the answers the callers got were "completely incorrect," 23 percent were "minimally correct" and 20 percent were "partially correct." Nineteen percent of the answers were "completely correct," and 16 percent were "mostly correct."

The program also found that some VA workers were dismissive of some callers and unhelpful or rude to others. One caller, for example, said, "My father served in Vietnam in 1961 and 1962. Is there a way he can find out if he was exposed to Agent Orange?" The VA's response, according to the VA memo: "He should know if they were spreading that chemical out then. He would be the only one to know. OK (hung up laughing)."

The memo said the response was "completely incorrect" because it gave no information - and also was "rude and unprofessional."

The 2004 survey found improvements in some categories compared with a similar study with identical questions in 2002. Timeliness improved, but scores on "willingness to help" and "courtesy/professionalism" dropped. VA workers also used "too much jargon," confusing to many veterans, the memo said.

VA officials acknowledge that the agency needs to do better. Daniel Cooper, the department's top benefits official, said in a memo to the VA regional offices that the results of the mystery-caller program "are below expectations and are disappointing to the organization. ... We must be able to provide prompt service and give correct answers with the courtesy and professionalism that our customers deserve."

This week, VA officials said they'd taken steps since 2004 to improve their performance, among other things setting up a small pilot program to monitor employees silently as they answered veterans' questions. While the VA said the pilot program improved performance, thus far it's been used in only four out of 57 regional offices. Other offices are scheduled to begin the silent monitoring by the end of fiscal 2006. Beyond that, the VA said it was working to improve its service by boosting training and using role-playing exercises for some phone calls with the public. Other quality-improvement programs are expected to be put into place in 2006 and 2007.

Veterans across the country said their experience with VA call centers suggested that there was still significant room for improvement. "The VA needs a change of attitude," said William B. Jones, a veteran from Greenville, S.C., who's been butting heads with the agency for several years. Jones, a semi-retired physician, said he'd received bad medical information and repeatedly had gotten the runaround in his attempt to get compensation for ailments that he said were linked to his military service.

"I often get no answer at all," said Jones. "I call their 1-800 numbers and generally you get a computer and talk to no one. I've had that not once but probably a dozen times. When you do talk to somebody, you get frustrated because you can't really find out if the case is proceeding. They say they are working on it, but they don't give any details."

Responding to Jones' complaints, the VA said it "takes very seriously any frustrations veterans may experience when attempting to contact us. ... VA continues to work on ways to provide better access and quality customer service."

The mystery callers also judged the courtesy, willingness to help and promptness of the people who answered the VA's phones. They found that many VA offices were helpful and friendly - even as they provided bum information.

Bum information, however, is the biggest problem. One mystery caller, for example, asked about benefits after a Vietnam veteran died of lung cancer. Many conditions have been linked to the herbicide Agent Orange, which was widely used in Vietnam. But the VA regional office said lung cancer was "not one of the conditions related to Agent Orange."

According to the VA's evaluation, that answer was "completely incorrect (wrong information given - lung cancer is one of the conditions related to Agent Orange.)"

Another mystery caller asked about a grandfather who'd been injured in the Korean War. "When he dies, is he eligible for burial in Arlington National Cemetery?" the caller asked.

Response: "I can't answer for Arlington. You can call your congressmen. They love doing those kinds of things for their constituents."

The VA's evaluation: "Completely incorrect. ... Unprofessional; unwilling to help."

Another mystery caller asked whether her husband could get help from the VA for a back problem he'd had for years. "I don't know," the VA regional office said. "He just has to file a claim."

The evaluator found that the response was completely incorrect because it didn't give an answer, and the VA official was "discourteous" and "unwilling to help."

Source: VA memo on “2004 Mystery Caller” program.

VA Benefits Checklist

Items you'll need if you are a:

Veteran Only:
DD-214 or Discharge Papers
Annual Social Security Award Letter received in January OR other documentation to verify your income
A printout from your pharmacy of 3 months of expenses
Copies of all your latest financial statements

Veteran and Spouse:
All of the above for you and your spouse, PLUS
Marriage certificate
Death certificate or divorce decree if either spouse was previously married

Widow/er of Veteran:
The veteran's DD-214 or Discharge Papers
Annual Social Security Award Letter received in January OR other documentation to verify your income
A printout from your pharmacy of 3 months of expenses
Marriage certificate
Veteran's death certificate
Death certificate or divorce decree related to any previous marriages of either you or the veteran
Copies of all your latest financial statements

Additional forms that will need to be filled out and filed with the claim for benefits:
Statement of Attending Physician
VA Form 21-0779 – Nursing Home Information Report
Authorizations and Consent to Release Information to the VA
for each physician of the veteran or spouse
Care Provider Report
Claimant’s Certification of Out-of-pocket Expenses
Statement Regarding Claimant’s IRA

Listing of Possible Medical Expenses

These can be deducted from your gross income to determine VA benefit eligibility.

Medicare Premiums deducted from Social Security
Supplementary medical insurance (Part B) under Medicare
Abdominal supports
Acupuncture service
Ambulance hire
Anesthetist
Arch supports
Artificial limbs
Back supports
Braces
Cardiographs
Chiropodist
Chiropractor
Convalescent home
(for medical treatment only)
Crutches
Dental services
Dentures
Dermatologist
Eyeglasses
Food or beverages prescribed by doctor for treatment of illness
Gynecologist

Hearing aids & batteries
Home health services
Hospital expenses
Insulin Treatment
Insurance premiums (medical)
Invalid chair
Lab tests
Lip reading lessons
(in connection with disability)
Neurologist
Nursing services
Occupational therapist
Ophthalmologist
Optician
Optometrist
Oral surgery
Osteopath
Pediatrician
Physical examinations
Physician
Physical Therapy
Podiatrist
Prescriptions and drugs
Psychiatrist
Psychoanalyst

Psychologist
Psychotherapy
Radium therapy
Sacroiliac belt
Seeing-eye dog
Speech therapist
Splints
Surgeon
Telephone/teletype for deaf
Transportation expenses (20 cents per mile)
Vaccines
Vitamins prescribed by doctor
Wheelchairs
Whirlpool baths for medical purposes
X rays

Note: Most medical expenses must be prescribed by a physician to be deductible from gross income for VA benefit qualification purposes.
The Wrap-up: You made it to the end!

After reading this Guide, you may have enough information to file a claim on your own. If you do decide that you need the help of attorneys who are concentrated in the area of assisting senior citizens, then please contact us at Senior Life Care Planning, LLC. Our goal is to make sure that our clients make the most of their financial and family resources so that they are never out of money and never out of options for as long as they live. If you are like most people, then we believe that you will need guidance to apply the information in this guide to your life or the life of your loved one.

We are here to provide guidance to you in the following areas:
 Care options available in the local community for both the Veteran and spouse
 A comprehensive understanding of availability and extent of personal and financial, as well as family resources to pay for care
 Basic estate plan documents such as powers of attorney, wills & possibly trusts
 Basic analysis of any income tax, estate tax, and gift tax issues
 A review of Medicare and Medicaid as it applies to your circumstances
 Analysis of financial suitability of any asset protection tools
 Analysis of both positive and negatives of all tools and planning options
 A calculation of the actual dollar benefit and/or cost of any helpful idea that is discussed
 Possibly completing and submitting the VA claim form

David Wingate, Elder Care Attorney

Legal Disclaimer

This information has been provided for informational purposes only. It does not constitute legal advice. The receipt of this information does not establish attorney-client privilege. Proper legal advice can only be given upon consideration of all the relevant facts and laws. Therefore, you should not act upon any of the information contained herein without seeking appropriate counsel. Copyright © 2009 by Senior Life Care Planning, LLC. All rights reserved. These materials may not be reproduced in any way without the written permission of Senior Life Care Planning, LLC.

VA Benefits

2009-05-21T06:19:00.000-07:00

VETERAN'S BENEFITS - Federal Benefits for Veterans and Dependents

There are a variety of federal benefits available to veterans and their dependents. Eligibility depends upon individual circumstances. Anyone who has access to the internet can check Department of Veterans Affairs at www.VA.gov. Also one can contact the nearest Veterans Affairs Benefits Office at 1-800-827-1000 to apply. Counselors can answer questions about benefits, eligibility and application procedures. They may also make referrals to other VA offices and facilities, such as medical centers and national cemeteries. You may find telephone numbers of VA offices and facilities in the Federal Government section of your local telephone directory under "Department of Veterans Affairs."
Veterans' Health Care Benefits

For most veterans, entry into the VA healthcare system starts with enrollment at a VA healthcare facility. Veterans with Internet access may apply for enrollment on-line at www.VA.Gov. Once enrolled, a veteran is eligible to receive services at VA facilities anywhere in the country. VA healthcare facilities also provide information on medical care. Veterans who have enrolled at the VA are eligible for a benefits package of in-patient and outpatient services. These include: limited nursing home care, adult day healthcare and homeless programs, preventative medicine services, primary care, surgery, mental health and substance abuse treatment, home healthcare, respite and hospice care, emergency care in VA facilities and drugs and pharmaceuticals.

Eligibility for hearing aids, eyeglasses and dental care is determined by whether the veteran has been given a disability rating by the VA which is a percentage rating of "service connected". "Service connected" means that the veteran has been given a disability rating by the VA which is for an injury or illness related to their military service. In many cases, veterans are receiving compensation for that disability. A Means Test is also imposed as a measure of the veteran's family's annual income and assets and used to determine if non-service connected and zero percent connected veterans need to make co-payments for medical care.

Co-payments are charged by the VA for in-patient and out-patient medical treatment, daily charges for in-patient treatment and for medication co-payments. The VA pharmacy will only fill prescriptions written by VA clinicians. In some instances, some co-payments may be as low as two dollars or may be waived for certain cases of veterans.

Caregiving Affects Marriages

2009-04-30T13:00:00.000-07:00

In previous years, family caregiving responsibilities outweighed worries about job security and savings. However, with the economy in recession, job security and finances are now equally, if not more important.

In a recent survey, one-third of caregivers who work outside the home believe that caregiving responsibilities have affected their job performance, and 30 percent of those who are married report that their responsibilities have strained their marriage. The survey found that caregivers spend an average of 10 hours a week coordinating or actively providing care. Despite their sacrifices, 48 percent of the caregivers surveyed lack confidence in the quality of their caregiving arrangements.

Most caregivers are time-starved and overwhelmed by the complexity of their caregiving responsibilities.

80 percent of the survey respondents work full-time outside the home and are juggling caregiving, childcare and job responsibilities. At the same time, many are caring for patients with increasingly serious physical and cognitive impairments – conditions such as Alzheimer’s disease and debilitating arthritis, which are on the rise due to longer life expectancies.

While care recipients in the study receive, on average, 16 to 20 hours of care from all caregivers combined – paid and unpaid – half of the surveyed believe that there are additional hours of care that are required but not provided.
Perhaps as a result of this shortfall, half of the survey respondents report that care recipients have missed meals or suffered from poor nutritional intake, while an additional one-third have visited an emergency room or sustained injuries from an accident. Another 22 percent have been alone at home when an emergency occurred.
As the time demands and costs associated with caregiving escalate, many caregivers feel they have no choice but cut back on care and supervision.

The result, unfortunately, is a sharp increase in nutritional problems, injuries and drug noncompliance. All too often, there is no care coordinator in place who is responsible for ensuring a comprehensive and consistent level of caregiving.
Among the survey’s other key findings, caregivers overestimate the percentage of caregiving costs covered by Medicare. While only 3 percent of the survey respondents expect Medicare to cover all of current and future caregiving costs, 26 percent expect to be reimbursed for most of their care-related expenses and half expect half or more of costs to be covered. In reality, Medicare will typically cover only a portion of the cost of caregiving.

Nearly half of caregivers surveyed report that they worry six or more times per week about the well-being of the person for whom they care.

Call us now for assistance (301) 663-9230
We can help you!

Senior Life Care Planning, LLC
1560 Oppossumtown Pike, Suite A-12
Frederick, MD 21702
301.663.9230
www.seniorlcp.com

NINE SIGNS OF FAMILY DISTRESS

2009-04-22T12:44:00.000-07:00

If you observe anyone talking about any of the following issues, we can help:

1. Caregiver burnout, frustration or guilt
2. Disabled elderly with children who are out of state, out of town or out of touch
3. Elderly adults or couples who are afraid that the nursing home will be their only long-term care option
4.Children who voice concerns about a parent’s diagnosis that marks the beginning of physical or mental decline even though it could be years before long-term care outside the home is needed
5. Caregivers or family members who seem uncertain about care options, what to do next, or where to get help
6. An elder who has been hospitalized and the family has been told that he or she can no longer live independently
7. An elder who has recently experience a catastrophic event such as a fall, medication mishap, fire, accident in the home, or car accident
8. Children who are voicing concerns about an elderly loved one who is wandering, malnourished, dehydrated or unable to care for him/herself; or a medical event such as a stroke, heart attach or aneurism`
9. A spouse living in the community at risk of being impoverished by long-term care bills

Call us now for assistance

We can help you!

At Senior Life Care Planning, LLC we are dedicated to giving our clients the power to be informed individuals and to give peace of mind. We provide honest ways to protect your home, loved ones and independence in times of great need. We understand the emotional burden, confusion, anger, hopelessness, sense of injustice, fear and loneliness that come with long-term disability and end-of-life issues.
Every day we help and support families and individuals who are in crisis. We work with our clients to provide peace of mind and quality of life.

Senior Life Care Planning, LLC
One Research Court, Suite 450
Rockville, MD 20850
240.453.0070
www.seniorlcp.com

CAREGIVING AFFECTS WORK AND FINANCES

2009-04-20T06:39:00.000-07:00

Although caregiving has a big impact on work and life, most caregivers are also feeling financially burdened. Almost one-quarter of households in the United States contain a caregiver, and most of those households provide care for someone who is age 50 or older.

Most caregivers are financially burdened by their caregiving duties. Caregivers with more caregiving responsibilities and those who did not feel they had a choice in becoming a caregiver reported greater financial hardship.

While caregiving creates a financial burden, caregiving has a big impact on work and life. Caregivers provide care an average of 21 hours per week. A majority of caregivers say they are working, either full or part-time, or have worked at some point while caregiving. More than 60 percent of working caregivers have made adjustments to their work schedule, such as leaving early, arriving late, or taking time off. With the current financial situation, can you afford to loose your job because you are worried about your loved one? Not surprisingly, the jobs of caregivers with the most caregiving responsibilities are the most affected; one-third of caregivers who had to provide constant care had quit their job to perform their caregiving duties and 12 percent had retired.

Caregivers also report they have less time for family or friends, have given up vacations or hobbies, and have less time to exercise. Caregivers said they need more help finding time for themselves, balancing work and family responsibilities, and managing stress.

Continuing Care Retirement Communities (CCRCs)

2009-04-08T11:47:00.000-07:00

Continuing Care Retirement Communities (CCRCs)

Introduction

CCRCs offer the entire residential continuum—from independent housing to assisted living to round-the-clock nursing services—under one "roof". Residents pay an entry fee and an adjustable monthly rent in return for the guarantee of care for the rest of their life. Because CCRCs maintain an assortment of on-site medical and social services and facilities, residents can enter the community while still relatively healthy and then move on to more intensive care as it becomes necessary. Nursing care is often located within the CCRC or at a related facility nearby. In addition to health care services, CCRCs also typically provide meals, housekeeping, maintenance, transportation, social activities, and security.

CCRCs are diverse in their offerings and personality. The CCRCs run the gamut from urban high-rises to garden apartments, cottages cluster homes, or single-family homes. Some CCRCs provide units that are designed for people with special medical needs, such as Alzheimer's disease.

Most importantly, CCRCs guarantee a life-long place to live. Assisted living and even skilled nursing facilities make no such guarantees, and in fact they may ask you to leave if they believe they cannot provide the care you require. However, bear in mind that virtually no CCRC will guarantee an individual entry into the skilled nursing facility that is a part of the CCRC. If all the nursing units are filled (by either other residents or non-residents), the CCRC may place the ailing resident in another nursing home in the community. This can come as a rude shock to most elders, who believe precisely the opposite.

The downside of CCRCs is the cost, which can be more than those with low or moderate income and assets can afford. Prices depend on the amount of care provided, the type of contract, and the unit’s size and geographic location. Entry fees can be more than $500,000, with monthly charges in excess of $3,000.
Generally a refund will no longer be available after a specified period of residency. Some refundable fees revert to your estate when your unit is sold, while others do not. Therefore, before you expend a large some of money immediately and commit future monies, you need an assurance that the CCRC will be able to provide the promised services for the period of time stated in the contract. Consequently, review the annual CCRC disclosure statement.

CCRC fee arrangements

Although the entry and monthly fee arrangement is the most common, some CCRCs offer rental or equity arrangements. Under a rental arrangement, residents pay only a monthly fee, which typically covers housing and designated services (sometimes including health care services). Under equity arrangements, residents purchase their residence in the same way they would a cooperative apartment or condominium, although the resale of the unit is usually limited to those who meet the community's eligibility criteria. Residents then may purchase service and health care packages for an additional fee.

CCRCs often allow you to choose from three different fee schedules:
• Extensive contracts, which include unlimited long-term nursing care at little or no increase in the monthly fee. This arrangement requires residents to pay a higher fee initially;
• Modified contracts, which include a specified duration of long-term nursing care, beyond which fees rise as care increases; and
• Fee-for-service contracts, in which residents pay a reduced monthly fee but pay full daily rates for long-term nursing care.

The Maryland Department of Aging ("MDA") issues certificates to CCRC's. However, this certification is not an endorsement or guarantee of the community. Also, the MDA maintains financial and other records on all CCRC,s, which are accessible to the public. Consumer packets may be obtained by calling 1-800-AGELINE.

CCRC entry requirements

Most CCRCs require that a resident be in good health, be able to live independently when entering the facility, and be within minimum and maximum age limits. As a prerequisite to admission, facilities may also require both Medicare Part A and Part B, and perhaps Medigap coverage as well. A few are now even requiring long-term care coverage as a way of keeping fees down. Some CCRCs are affiliated with a specific religious, ethnic or fraternal order and membership in these groups may be a requirement. Of course, applicants will have to demonstrate that they have the means to meet the required fees. Also, you may be placed on a waiting list, since CCRCs are often sought after.

Many CCRC residents usually fund their care out of their own pockets. However, Medicare, and at times Medicaid, can be used to pay for certain services, and most CCRCs accept either Medicare or Medicaid. Although Medicare does not generally cover long-term nursing care, it often covers specific services that a CCRC resident might receive, such as physician services and hospitalization. Because the financial requirements for residence are fairly strict and the costs are relatively high, very few CCRC residents are eligible for Medicaid.

How to evaluate a facility and contract

Deciding on a CCRC is a once-in-a-lifetime choice, and it is a decision that should be made carefully. Many communities allow prospective residents to experience life at the facility. Each community has an agreement or contract that lays out the services provided. You should make sure you understand the contract before signing, and you would be well advised to seek legal or financial counsel before entering into any agreement.

Twenty Questions for a Continuing Care Residential Facility

1. What is the CCRC's background and experience?
2. Review the facility's financial, actuarial, and operating statements. Does it have sufficient financial resources?
3. What levels of care are provided? Licensed or certified by the State of Maryland?
4. How much is the entrance fee, monthly fee, processing fee, and other fees?
5. Can you get a refund of all or part of it?
6. What is the monthly fee?
7. Can the monthly be increased?
8. What happens if you cannot afford the monthly fees?
9. Do the fees change when your level-of-care needs change?
10. What happens if your marital status changes? Will your payments change, or will you be asked to move?
10. What if spouses require different levels of care?
11. What services are included in my regular fees?
• Meal services?
• Special diets/tray service?
• Utilities?
• Cable television?
• Furnishings?
• Unit maintenance?
• Linens/personal laundry?
• Housekeeping?
• Recreational/cultural activities?
• Transportation?
12. What kind of assessment is done to determine your needs? Is a plan prepared for meeting those needs? How is it reviewed?
• Physician services?
• Medications?
• On site nursing care facility services: Are they on-site? Who pays?
• Nursing services outside a nursing unit?
• Private duty nursing?
• Dental and eye care?
• Personal care services?
• Homemaker/companion services?
• Drugs, medication and medical equipment/supplies?
• Emergency call system?
13. What happens if a nursing bed is not available when you need it?
14. Can the facility ask you to move if you become too sick or impaired to be cared for by the facility?
15. Can you receive Medicare and Medicaid coverage in the facility? Do you need to buy private insurance or participate in a special group insurance program?
16. Who is involved in making the change of level of care decisions?
17. What are the staffing levels and professional qualifications of the staff?
18. Is there a resident council? How are complaints and disputes handled?
19. What are the grounds for eviction? What happens if you break a rule? What conditions can the CRCC terminate the contract?
20. What happens if you are injured? Does the contract release the facility from liability for injury resulting from negligence? What are you rights under the law?

10 Signs That Families Need Help

2008-12-08T12:09:00.001-08:00

10 Signs That Families Need Help

Are you, family members or your clients struggling to meet the needs of an elderly loved one with a chronic illness/disability?

If, YES, to any of these, Senior Life Care Planning, LLC can help:

• Worries about long-term care costs: Do you have a home or assets in excess of $50,000 – enough to finance a short stay in a care facility but not enough for an extended stay?

• Catastrophic event: Has someone experienced a stroke, heart attack, or fall with an injury?

• Chronic decline: Has someone been diagnosed with Alzheimer’s, Parkinson’s, ALS, MS etc?

• Hospitalization: Is being discharged and returning home not an option?

• Incapacity: Is someone incapacitated (housebound, bedridden, in an assisted living or nursing home facility)?

• Coordination concerns: Do you need coordination and advocacy for quality care?

• Caregiver burnout: Is a caregiver struggling with burnout, frustration, guilt or ill health?

• Stress of family members: Are family members confused or overwhelmed about care options?

Call us now for assistance. (301) 663 9230. We can help you!

At Senior Life Care Planning, LLC we are dedicated to giving our clients the power to be informed individuals and to give peace of mind. We provide honest ways to protect your home, loved ones and independence in times of great need. We understand the emotional burden, confusion, anger, hopelessness, sense of injustice, fear and loneliness that come with long-term disability and end-of-life issues.
Every day we help and support families and individuals who are in crisis. We work with our clients to provide peace of mind and quality of life.

Senior Life Care Planning, LLC
1560 Oppossumtown Pike, Suite A-12
Frederick MD 21702
301 663 9230
www.seniorlcp.com
Listen to Frederick Senior Issues on 930 am WMFD Sunday mornings at 7.00 am

Crime Prevention Tips

2008-12-08T11:49:00.000-08:00

Crime and the fear of crime create special problems for the elderly. Crime prevention is everyone's responsibility, not just a job for law enforcement. Seniors can learn how to protect themselves from crime by following these simple, commonsense suggestions. Share these tips with your neighbors and friends, to make it tough for criminals to work in your neighborhood.

AT HOME . . .

• Never open your door automatically. Install and use a peephole.
• Lock your doors and windows. (Three quarters of the burglaries involving older persons involved unlocked doors and windows; and, less than one half of these robberies are reported.) Keep your garage doors locked.
• Vary your daily routine.
• Use "Neighbor Watch" to keep an eye on your neighborhood. A concerned neighbor is often the best protection against crime because suspicious persons and activities are noticed and reported to police promptly.
• Don't leave notes on the door when going out.
• Leave lights on when going out at night; use a timer to turn lights on and off when you are away for an extended period.
• Notify neighbors and the police when going away on a trip. Cancel deliveries such as newspapers and arrange for someone - a neighbor's child, perhaps - to mow the lawn if need be. Arrange for your mail to be held by the Post Office, or ask a neighbor to collect it for you.
• Be wary of unsolicited offers to make repairs to your home. Deal only with reputable businesses.
• Keep an inventory with serial numbers and photographs of resaleable appliances, antiques and furniture. Leave copies in a safe place.
• Don't hesitate to report crime or suspicious activities.
• Install deadbolt locks on all your doors.
• Keep your home well lit at night, inside and out; keep curtains closed.
• Ask for proper identification from delivery persons or strangers. Don't be afraid of asking . . . if they are legitimate they won't mind.
• If a stranger asks to use your telephone, offer to place the call for him or her yourself.
• Never let a stranger into your home. Do not leave notes on your door when you are gone, and do not hide your keys under the mat or in other conspicuous places.
• Never give out information over the phone indicating you are alone or that you won't be home at a certain time.
• When you are gone for more than a day, make sure your home looks and sounds occupied . . . use an automatic timer to turn on lights, radio or TV.
• If you arrive at home and suspect a stranger may be inside, DON'T GO IN. Leave quietly and call 911 to report the crime.

WALKING . . .

• If you are attacked on the street, make as much noise as possible by calling for help or blowing a whistle. Do not pursue your attacker. Call 911 and report the crime as soon as possible.
• Avoid walking alone at night. Try to have a friend accompany you in high risk areas . . . even during the daytime.
• Avoid carrying weapons . . . they may be used against you.
• Always plan your route and stay alert to your surroundings. Walk confidently.
• Have a companion accompany you.
• Stay away from buildings and doorways; walk in well-lighted areas.
• Have your key ready when approaching your front door.
• Don't dangle your purse away from your body. (Twelve percent of all crimes against the elderly are purse snatchings and street robberies.)
• Don't carry large, bulky shoulder bags; carry only what you need. Better yet, sew a small pocket inside your jacket or coat. If you don't have a purse, no one will try to snatch it.

WHILE SHOPPING . . .

• Carry your purse very close to you . . . don't dangle it from your arm. Never leave your purse in a shopping cart. Never leave your purse unattended.
• Don't carry any more cash than is necessary. Many grocery stores now accept checks and automatic teller cards instead of cash.
• Don't display large sums of cash.
• Use checks where possible.

IN YOUR CAR . . .

• Always keep your car doors locked, whether you are in or out of your car. Keep your gas tank full and your engine properly maintained to avoid breakdowns.
• If your car breaks down, pull over to the right as far as possible, raise the hood, and wait INSIDE the car for help. Avoid getting out of the car and making yourself a target before police arrive.
• At stop signs and traffic lights, keep the car in gear.
• Travel well-lit and busy streets. Plan your route.
• Don't leave your purse on the seat beside you; put it on the floor, where it is more difficult for someone to grab it.
• Lock bundles or bags in the trunk. If interesting packages are out of sight, a thief will be less tempted to break in to steal them.
• When returning to your car, check the front and back seat before entering.
• Never pick up hitchhikers.

BANKING . . .

• Many criminals know exactly when government checks arrive each month, and may pick that day to attack. Avoid this by using Direct Deposit, which sends your money directly from the government to the bank of your choice. And, at many banks, free checking accounts are available to senior citizens. Your bank has all the information.
• Never withdraw money from your bank accounts for anyone except YOURSELF. Be wary of con artists and get-rich schemes that probably are too-good-to-be- true.
• You should store valuables in a Safe Deposit Box.
• Never give your money to someone who calls on you, identifying himself as a bank official. A bank will never ask you to remove your money. Banks need the use of your money, and they don't want one of their customers to invite crime by having large amounts of cash around.
• When someone approaches you with a get-rich-quick-scheme involving some or all of YOUR savings, it is HIS get-rich-quick-scheme. If it is a legitimate investment, the opportunity to contribute your funds will still be there tomorrow-after you have had time to consider it.
• If you have been swindled or conned, report the crime to your local police or Prosecuting Attorney's office. Con-artists count on their victim's reluctance to admit they've been duped, but if you delay you help them get away. Remember, if you never report the crime, they are free to cheat others again and again and you have no chance of ever getting your money back.

Working Caregivers - loss of production

2008-11-25T10:25:00.000-08:00

I'm sure it wouldn't surprise you to learn that the annual cost to U.S. businesses due to lost productivity of working caregivers is a whopping $17.1 to $33.6 billion dollars*[1]

As Boomers grow older, the number of workers raising kids while simultaneously caring for aging parents is skyrocketing. When they are torn between caring for elderly loved ones and the demands of their job, the impact on work performance can be staggering. Missed deadlines. Loss of productivity. Absenteeism. It all adds up. It's estimated that businesses lose $2,441 per employed caregiver each year.

David Wingate is president of Senior Life Care Planning LLC. Since launching this company his vision has been to be the preferred and trusted leader in elder law/senior care, respected for providing the most effective, compassionate and innovative care possible. The experience of his staff, which, unlike other elder law providers, includes social workers, is unparalleled.

As a speaker and writer, Mr. Wingate lends his expertise to such topics as life care planning. He has been addressing issues that impact the healthcare industry, especially as they relate to the aging population's urgent need for pro-active strategies regarding health and finances and the engagement of quality caregivers.

[1] *Figures courtesy of Private Duty Insider, Feb.2008

David Wingate #1 Elder Law Attorney

2008-11-25T10:17:00.000-08:00

The Elder Law Office of David Wingate has been selected by the Frederick County Bar Association as the Number One (#1) Elder Law Attorney.

Mr. Wingate is also the founder of Senior Life Care Planning, LLC, a senior care and advocacy organization, that has enjoyed much success and high regard in our community. Speaking on his reputation in the community, Mr. Wingate states "Helping people has always been a priority in my life. Clients come to see us because we have been recommended. I couldn't be more proud."

Senior Life Care Planning is a senior advocacy provider that boosts an elite team of care managers.

David Wingate has led the company since its inception towards a vision of being "the preferred and trusted leader" in the senior community. His success is not by luck, he is an experienced business leader, recognized in the senior community as a leader, and lends his expertise to those who require it.

Mr. Wingate considers his selection as the #1 Elder Law Attorney as an "honor" and says of his commitment to the community "I believe that helping others isn't something that stops after work, it's a way of life."

Home for the Holidays

2008-11-25T10:12:00.000-08:00

The annual trek to the family homestead can bring more stress than joy for adults with elderly, disabled or chronically-ill parents. Mom’s chronic condition is getting worse. Dad can barely take care of himself, let alone manage mom’s needs. The bills aren’t getting paid. The house is a wreck.

“The holiday season is the time when many adults are forced to confront the reality of parents’ declining health,” says David Wingate, an elder law attorney. “We get many calls this time of year, mostly from adults from out of the area who come home to attend a holiday gathering and discover that mom or dad can no longer function on their own. It’s terrifying to go home and find out that parents need help with basic, care, especially when both spouses are already working outside the home.”

When the holidays reveal the truth about a parent’s health, finding someone to look after mom or dad becomes an urgent priority. Senior Life Care Planning, LLC provides the most comprehensive guide to services and support available in Frederick County. They offer helpful tips on a wide variety of subjects, including legal issues, housing, Medicare, caregiver support, VA benefits, health benefits, financial issues and long-term care. Also, information for social services and government agencies, long-term care facilities, home care services, legal and financial resources and more.

“Most people don’t know where to begin to support their parents who are struggling with illness or disability,” said Wingate. “The challenge is even greater when you’re only in town for a few weeks or less and don’t have much time to locate the care your parents need. We help to make it easier for families to find the help they need and regain peace of mind.”

Residents of Frederick and the surrounding area can get their free copy of Life Care Planning guide by calling 301 663 9230.

For more information, call 301 663 9230 or visit www.seniorlcp.com.

10 Elder-Friendly Bills in Congress That May Now Have New Life

2008-11-24T19:13:00.000-08:00

Fresh from their recent electoral victories, Congressional Democratic leaders are vowing to pursue an aggressive agenda when the 111th Congress opens in January. While the economy will doubtless be the top priority, health care will not be far down the list. Over the past year and a half, lawmakers have introduced a number of bills that address long-term care financing, nursing home care and elder abuse. With a strengthened Democratic majority and a Democratic president, a number of these measures now have a good chance of being enacted into law.

Following are summaries of ten promising bills:

Improving Nursing Home Care

Fairness in Nursing Home Arbitration Act (S. 2838)

Introduced: April 9, 2008

Sponsor: Sens. Herb Kohl (D-WI), Mel Martinez (D-FL)

Description: Provides that a pre-dispute arbitration agreement between a long-term care facility and a resident (or anyone acting on the resident's behalf) shall not be valid or specifically enforceable.

Status: Approved by Senate Judiciary Committee. Placed on Senate Legislative Calendar for a full Senate vote.

Nursing Home Transparency and Quality of Care Improvement Act of 2008 (H.R. 7128)

Introduced: Sept. 26, 2008

Sponsor: Rep. Pete Stark (D-CA)

Summary: To amend titles XVIII and XIX of the Social Security Act to increase the transparency of nursing home ownership, ensure that residents and their families have information about the quality of care at these facilities, and strengthen enforcement of nursing home compliance with quality of care standards.

Status: Introduced.

Companion or related bills: H.R. 5799, S. 2641

Combating Elder Abuse

The Elder Justice Act (H.R. 1783)

Introduced: March 27, 2007

Sponsor: Rep. Rahm Emanuel (D-IL)

Summary: To provide states with resources to prevent elder abuse, increase prosecution of those who mistreat the elderly and provide victim assistance. It will also improve long-term care and support for senior citizens dubbed "at risk." Note that the bill was introduced by the new White House Chief of Staff in the incoming Obama Administration. Esquire magazine reports that a woman's story about her father's abuse at a local nursing home led to Emanuel's introducing it.

Status: Reported out (amended) by House Judiciary Committee, 6/11/2008

Companion bill: S. 1070

Patient Safety and Abuse Prevention Act of 2007 (S.1577)

Introduced: June 7, 2007

Sponsor: Sen. Herbert Kohl (D-WI)

Summary: A bill to amend titles XVIII and XIX of the Social Security Act to require screening, including national criminal history background checks, of direct patient access employees of skilled nursing facilities, nursing facilities, and other long-term care facilities and providers. The bill also would expand a seven-state pilot program established under the 2003 Medicare law, providing as much as $160 million in grants over three years to states wishing to participate in the program.

Status: Reported out (amended) by Senate Finance Committee 9/22/08. Placed on Senate Legislative Calendar for a full Senate vote.

Companion bill: H.R. 3078

Fostering Alternatives to Institutionalization

Independence at Home Act of 2008 (S. 3613)

Introduced: Sept. 26, 2008

Sponsor: Sen. Ron Wyden (D-OR)

Summary: A bill to amend title XVIII of the Social Security Act to provide certain high-cost Medicare beneficiaries suffering from multiple chronic conditions with access to Independence at Home services in lower-cost treatment settings, such as their residences, under a plan of care developed by an Independence at Home physician or Independence at Home nurse practitioner.

Status: Referred to the Committee on Finance

Companion or related bill: H.R. 7114

Empowered at Home Act of 2008 (S. 3327)

Introduced: July 24, 2008

Sponsor: Sen. John Kerry (D-MA)

Summary: A bill to make it easier for states to provide home and community-based services (HCBS) to Medicaid recipients. Revises the income eligibility level for HCBS for elderly and disabled individuals. Authorizes a state to offer HCBS services under a waiver to eligible individuals that differ in type, amount, duration, or scope from the HCBS waiver services offered to other such individuals

Status: Referred to the Committee on Finance

Companion bill: H.R. 7212

Community Living Assistance Services and Supports (CLASS) Act (S. 1758)

Introduced: July 10, 2007

Sponsor: Sen. Edward M. Kennedy (D-MA)

Summary: A bill to amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence. The measure creates an insurance program for adults who become functionally disabled, providing a cash benefit to help obtain services and supports, while providing those with disabilities more choices on community participation, education, and employment.

Status: Hearings held by Committee on Health, Education, Labor, and Pensions, 7/10/07

Companion bill: H.R. 3001

Community Choice Act of 2007 (S. 799)

Introduced: March 7, 2007

Sponsor: Sen. Thomas Harkin (D-IA)

Summary: A bill to amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports.

Status: Hearings held by Committee on Health, Education, Labor, and Pensions, 7/10/07

Companion bill: H.R. 1621

Making Long-Term Care More Affordable

Long-Term Care Affordability and Security Act of 2007 (S. 2337)

Introduced: Nov. 13, 2007

Sponsor: Sen. Charles Grassley (R-IA)

Summary: Would allow employees to pay long-term care insurance premiums with pre-tax dollars and employers to offer long-term care insurance under so-called cafeteria plans, which allow employees to select from a number of tax-exempt benefits, as well as flexible spending accounts. Bill also would improve consumer protections for long-term insurance.

Status: Referred to the Committee on Finance

Companion bill: H.R. 3363

Comprehensive Long-Term Care Support Act of 2008 (H.R. 7095)

Introduced: Sept. 25, 2008

Sponsor: Rep. Stephanie Herseth Sandlin (D-SD)

Summary: Amends the Internal Revenue Code to allow a deduction from gross income for the cost of long-term care premiums for the taxpayer and certain family members, including the taxpayer's spouse, ancestors, or lineal descendants. Phases in the deduction over three years. Allows long-term care insurance as a benefit under tax-qualified cafeteria plans and flexible spending arrangements. Allows a $3,000 tax credit for caregivers of individuals with long-term health care needs, with the credit phased in over five years. Reduces the amount of the credit for taxpayers with adjusted gross incomes over $75,000 ($150,000 for joint returns). Rep. Sandlin introduced the same bill in each of the two previous Congresses, both of which died in committee.

Status: Referred to the House Ways and Means and House Education and Labor Committees

Grandparents: The Dos and Don’ts of Planning for Your Grandchild(ren) with Special Needs.

2008-10-21T13:07:00.000-07:00

Grandparents want the best for their children and grandchildren. They often give gifts while alive, or make provisions for their loved ones after they are deceased. Grandparents who are in a position to leave money to grandchildren often want to do something for their grandchild(ren) with special needs. They often worry about a severely handicapped or disabled grandchild, who may need additional assets or assistance to lead a quality life. Grandparents are sometimes told not to leave their grandchild(ren) with special needs anything because the child(ren) may lose government benefits. People are often confused as to what to do or not to do.

Grandparents can leave money to their grandchild(ren) with special needs.

There are very special ways to do it!

Money has to be left in such a way so that government benefits are not lost.

Assets in excess of $2,000 will cause the loss of certain government benefits for the person with special needs.

Money should not be left to the grandchild directly, but should be left to a special needs trust.

The special needs trust was developed to manage resources while maintaining the individual's eligibility for government benefits. The trust is maintained by a trustee on behalf of the person with special needs. The trustee has discretion to manage the money in the trust and decides how the money is used. The money must be used for supplemental purposes only. It should only supplement, or add to benefits (food, shelter or clothing) that the government already provides through Supplementary Security Income (SSI). It must not supplant or replace government benefits. If properly structured by a knowledgeable special needs attorney, the special needs trust assets will not count towards the $2,000 SSI limits for an individual.

Brief Summary of Do’s and Don’ts!

Do’s:

Make provisions for your grandchild(ren) with special needs. Leave money to the child’s special needs trust.

The special needs trust is the only way to leave money without losing government benefits.

Coordinate all planning with the child’s parents or other relatives.

Notify the parents when you plan for grandchild(ren). Plan with others.

Leave life insurance, survivorship whole life policies and annuities to the child’s special needs trust.

The special needs trust can be named as the policy beneficiary. When the insured or annuitant dies, the death benefit is paid to the special needs trust. The special needs trust then has a lump sum of money to be used in caring for the grandchild(ren) with special needs.

Consult with trained financial and legal professionals with specialties in special needs estate planning.

Don’ts:

Do not disinherit your grandchild(ren) with special needs.

Money can be now left to a properly drawn special needs trust. It does not make sense to disinherit any of your grandchild(ren) with special needs.

Don’t give money to your grandchild(ren) with special needs under UGMA or UTMA (Uniform Gift or Transfer To Minors Act).

Money automatically belongs to the child(ren) upon reaching legal age. Government benefits can be lost!

Don’t leave money directly to a grandchild with special needs through a will.

Money left will be a countable asset of the child and may cause the loss of government benefits.

Don’t leave money to a poorly set up trust.

Money left in an improperly drafted trust can result in the loss of government benefits.

Do not leave money to relatives to “keep or hold” for the child with special needs.

The money can be attached to a lawsuit, divorce, liability claim or other judgment against the relative.

Attorney Launches Care, Advocacy Program for Senior Citizens

2008-10-20T13:27:00.000-07:00

Maryland Elder Law Attorney Launches Care, Advocacy Program for Senior Citizens

By Ed Waters, Jr., The Frederick News-Post, Md.

Jul. 26--The "graying of America" is in full force, according to David Wingate, an elder law attorney.

A Baby Boomer turns 60 every 7 seconds, and people are living longer than ever before. By the time adults reach the age of 85, one out of every two requires nursing home care.

According to the U.S. Census Bureau, in 2030 some states will have more people 65 and older than younger than 18. As the Baby Boomers slowly become senior citizens, by 2011, the population of 65 and older will grow faster than the total population in each state. To deal with this evolving social trend, Wingate has developed a care and advocacy program called Senior Life Care Planning LLC.

The first of its kind in Maryland, it is a comprehensive program of staff and resources designed to assist individuals every stop of the way as they place an aging loved one in a nursing home or make other care arrangements.

Senior Life Care Planning LLC has staff to consult on long-term care options based on a loved one's medical needs, and help evaluate nursing homes and monitor the care nursing home residents receive.

"We are committed to educating seniors and their families about how to make their golden years as enjoyable and comfortable as possible," Wingate said. "We are keenly aware that the news today is full of reports of elder abuse and care conditions that are less than adequate. We work to empower families so that they can take steps to make sure their loved ones are properly cared for."

New Resource Available for Seniors and Their Families

2008-09-02T07:45:00.000-07:00

Seniors now have a new resource to help them age successfully. Attorney David Wingate, CSA, with the Law Office of David Wingate, PC, recently completed a comprehensive course through the Society of Certified Senior Advisors (SCSA) and earned the designation of Certified Senior Advisor (CSA). SCSA is an international organization that has trained more than 20,000 professionals to meet the changing needs of a growing senior population, Wingate says

“The health, financial and social needs of seniors are different and more complicated than those of any other age group. SCSA keeps professionals from awide variety of fields abreast of all these issues by providing education, training, support and communication resources to those of us dedicated to serving seniors,”

The explosion in growth of the senior population is one of the most important demographic developments of the 21^st century. Two-thirds of the people who have lived past the age of 65 are alive today. In the United States alone, seniors (age 65 and older) number 35 million and will come to increase (with women being the largest segment), leading an unprecedented shift in the age of the population. By 2030, the U.S. Bureau of Census predicts there will be about 70 million people who are 65 and older - one in five Americans will be seniors.

This demographic shift requires an educated response in how professionals work with seniors and the challenges and opportunities they face. Wingate said, “With more people living longer, we are already beginning to see changes in how seniors function in our society, from retirees who choose to start a second or third career, to various forms of alternative senior housing and new approaches to diet, exercise and overall health care for seniors.”

The Aging Driver

2008-08-29T08:05:00.000-07:00

For many, driving is a source of independence and self esteem. The car is the only transportation for most of us. It allows us to operate on our own schedules, get to the doctor’s office, get groceries, pick up the grand kids from school, and participate in all types of recreational activities. To maintain your standard of driving, however, you need to be aware of how physical changes associated with aging can ultimately affect your ability to drive.

Often, as we age, our eyesight and reactions change. Does driving make you feel nervous, scared, or overwhelmed? Do you feel confused by traffic signs, cars in traffic? Do you take medication that makes you drowsy? Do you get dizzy, have seizures, or losses of consciousness? Do you react slowly to normal driving situations? If you said yes to any of the above questions, then these are some warning signs of unsafe driving.

No one wants to stop driving and give up control over the things they do in their life. However, a time may come when it may not be safe for you to drive. This is an issue that you and your family must confront. Discussing this with your family will allow your family members to appreciate that driving is very important to you. Also, it is extremely important that you talk to your physician about your driving ability. Your physician is one of the most, if not the most, influential person that you can talk to about your decision to stop driving.

In the State of Maryland, an individual may not drive or attempt to drive an automobile on any State highway without a driver’s license. The State of Maryland does not have an age-based suspension or revocation of a driving license. However, a vision test is required for renewal of your license.

The Motor Vehicle Administration (“MVA”) may refer a driver to the Medical Advisory Board (“Board”), for an advisory opinion. This is done if the MVA has good cause to believe that the driving of a vehicle would be contrary to the public safety and welfare because of a known existing or suspected mental or physical disability. The Board is an advisory panel consisting of physicians and optometrists. The MVA, based on the Board’s advisory opinion, may suspend, revoke, refuse to issue or renew the license if the licensee is unfit, unsafe, habitually reckless or negligent.

Once the MVA receives a referral, the driver in question is notified that they must appear for an examination. Failure to do so may lead to automatic suspension of your license. At the review examination, the medical advisory board may perform tests.

Remember, driving is a privilege in the State of Maryland. The State can and will suspend or revoke your license if you are unfit to drive. Additionally, police officers have the right to stop your car if they have probable cause because they suspect you of reckless or negligent driving. You may then have to appear in Court or in a MVA hearing regarding your driving ability.

To maintain your high standard of driving, you need to be aware of how your body changes as you age. Changes to vision, peripheral vision, depth perception, night vision, clarity of vision, reaction times, medications and mobility can interfere with your driving performance. These changes can lead to inappropriate driving speeds, failing to observe and follow signals, poor judgment of distances and speeds of other areas, frustration; confusion; getting lost in familiar areas, weaving in and out of traffic lanes, and near misses or accidents. Therefore, you may benefit from a driver refresher course before functional decline presents problems. Mature driver courses are offered by a variety of organizations i.e., AARP Driver Safety program. This refresher course may even lead to a discount in your insurance.

When you do have to drive, remember these safe driving tips:

- Try to avoid left turns. If possible, make several right turns to get where you want to go.

- Always slow down and signal, in advance of your turn.

- Allow plenty of time and room to make your turn.

- Keep a safe distance between you and the car ahead.

- Sit high in your seat.

- Avoid driving at dawn, dusk, rush hour and at night.

- Always wear your current prescription glasses.

At some point you may need to stop driving for your safety and the safety of others on the road. You may come to this decision yourself, or by the recommendation of the doctor, or MVA. When you or someone close to you retires from driving, there are several things you can do to make it easier for you and your family.

Create a transportation plan:

- Come up with a list of names and telephone numbers of friends, relatives, or volunteers who are willing to give rides.

- Have handy the phone numbers of taxi cabs / shuttle bus services.

- Contact the Department of Aging in Frederick at

- Contact the Commission on Aging in Hagerstown at

- Encourage social activities.

- Be there for your loved one.

- Arrange to have groceries and/or delivered.

- Order medications by mail.

- Shop by catalogs.

Should you have to give up your car, look on the bright side of things. You will no longer have to pay the cost of fuel, car maintenance, insurance, car payments, etc. which may result in savings to you.

Driving issues are complex, especially with the dependence of the car in our society today and limited public transportation in may areas or communities. However, failure to act responsibly may force the State of Maryland to act on your behalf.

Q&A- Special Needs Estate Planning

2008-07-30T05:51:00.000-07:00

Q.- What is a Special (also called Supplemental) Needs Trust (“SNT”) and when do I need it?

A.- Various government benefits like Medicaid, SSI cash payments, housing subsidies, mental health care, and Department of Social Services (DSS) group home or other housing are provided free, or at minimal cost, to disabled people, who have little or no money. Whether paid directly to a disabled person, or into an ordinary trust, most gifts and inheritances and accident, workers compensation, divorce, and other litigation recoveries jeopardize government aid and even may have to repay prior benefits. However, these amounts won’t disqualify a disabled person for government aid, if they are paid into an SNT, for the disabled person, instead of being paid directly, or an ordinary trust. Thus, an SNT should be part of the estate plan of every parent and grandparent of anyone who may be too disabled to work. A SNT should be created, even if your loved one doesn’t yet receive benefits, because government aid may be needed later, especially, if disabilities worsen with age. Also, many children can’t qualify for disability aid until age eighteen.

Q.- Why do I Need a Special Needs Trust to Protect Divorce and Personal Injury Recoveries?

A.- A divorce settlement may jeopardize SSI, Medicaid and other benefits unless alimony and child support are paid into a Special Needs Trust. A disabled person who has a personal injury claim, divorce award, or worker compensation recovery should ask his lawyer to arrange for an SNT before the claim is resolved. Don’t rely on your attorney to provide for an SNT, as many general attorneys aren’t familiar with this area of the law.

Q.- How Can a Special Needs Trust Minimize DSS & Mental Health Fees & Liens?

A.- Government agencies may recoup the cost of some public benefits (e.g. group home and other residential placements and certain mental health care) from a gift, inheritance, or other amount payable to a disabled person or an ordinary trust for a disabled person. In contrast, gifts and inheritances payable to a well designed Special Needs Trust need not repay public benefits. Consequently, dying without a will or leaving amounts to a disabled son or daughter outright or through an ordinary trust, may be equivalent to leaving your estate to the Government.

Q.- Why do I Need a Special Needs Trust Even If My Disabled Child Lives at Home?

A.- Even though your disabled child lives with you now, he or she eventually may be placed in a DSS or mental health placement or otherwise require long term care. Consequently, your estate may be forced to fund group home, medical, and other costs that would be covered by government programs if your estate plan included a Special Needs Trust.

Q.- When and How do I Set Up a Special Needs Trust?

A.- To create a Special Needs Trust, you typically sign a written trust instrument when you sign your will. Although you don't have to fund your SNT until you pass away, you must sign the trust instrument during your life time. If you don't, your child will face substantial costs, which wouldn't arise if an SNT were in place when you die. Because an SNT must comply with complex and arcane government benefit rules, an SNT should only be drafted by a lawyer familiar with SSI, Medicaid, DSS and other government program rules.

Q.- How Can Special Needs Trusts Reduce Costs If I Need Nursing Home Care?

A.- Medicaid generally pays nursing home costs for people with minimal resources except that a temporary Medicaid disqualification period usually applies to a person who makes gifts to reduce resources to Medicaid limits. However, an individual may qualify for Medicaid immediately by making gifts to a “sole benefit” SNT. Gifts to a “sole benefit” SNT are exempt from gift disqualification penalties and also avoid jeopardizing the SNT beneficiary’s government aid. A “sole benefit” SNT must satisfy special rules not applicable to ordinary SNTs.

About Senior Life Care Planning, LLC

2008-07-25T06:48:00.000-07:00

Senior Life Care Planning, LLC ("SLCP) is limited exclusively aging options and issues, finding the best places to live, the care you neeed and to protect your assets to ensure you quality of life. David Wingate, President of SLCP, is a recognized leader in the community in this important and demanding area of elder issues. He is Vice President of the national organization of Life Care Planning Law Firms Association, a member of the National Academy of Elder Law Attorneys, the State of Maryland Bar Association – Elder Law section, Elder Provider Council, Elder Task Force, and numerous other senior organizations.

Under a holistic approach, not only do we in counsel clients about planning, but we also assist our clients in Life Care Planning for possible long-term care needs. Locating the appropriate type of care, coordinating private and public resources to finance the cost of care, and working to ensure our client’s quality of life is what we do at Office.

Identity Theft: Tips on Combating a Growing Crime

2008-07-24T08:53:00.000-07:00

What is identity theft? Identity theft occurs when someone uses your personally identifying information, like your name, Social Security number, or credit card number, without your permission, to commit fraud or other crimes. The FTC estimates that as many as 9 million Americans have their identities stolen each year.
In fact, you or someone you know may have experienced some form of identity theft. The crime takes many forms. Identity thieves may rent an apartment, obtain a credit card, or establish a telephone account in your name. You may not find out about the theft until you review your credit report or a credit card statement and notice charges you didn’t make—or until you’re contacted by a debt collector.
Identity theft is serious. While some identity theft victims can resolve their problems quickly, others spend hundreds of dollars and many days repairing damage to their good name and credit record. Some consumers victimized by identity theft may lose out on job opportunities, or be denied loans for education, housing or cars because of negative information on their credit reports. In rare cases, they may even be arrested for crimes they did not commit.
How do thieves steal an identity? Identity theft starts with the misuse of your personally identifying information such as your name and Social Security number, credit card numbers, or other financial account information. For identity thieves, this information is as good as gold.
Skilled identity thieves may use a variety of methods to get hold of your information, including:
Dumpster Diving. They rummage through trash looking for bills or other paper with your personal information on it.
Skimming. They steal credit/debit card numbers by using a special storage device when processing your card.
Phishing. They pretend to be financial institutions or companies and send spam or pop-up messages to get you to reveal your personal information. Changing Your Address. They divert your billing statements to another location by completing a change of address form. Old-Fashioned Stealing. They steal wallets and purses; mail, including bank and credit card statements; pre-approved credit offers; and new checks or tax information. They steal personnel records, or bribe employees who have access.
Pretexting. Pretexting is the practice of getting your personal information under false pretenses. Pretexters sell your information to people who may use it to get credit in your name, to steal your assets, or to investigate or sue you. Pretexting is against the law. Pretexters use a variety of tactics to get your personal information. For example, a pretexter may call, claim he's from a research firm, and ask you for your name, address, birth date, and social security number. When the pretexter has the information he wants, he uses it to call your financial institution. He pretends to be you or someone with authorized access to your account. He might claim that he's forgotten his checkbook and needs information about his account. In this way, the pretexter may be able to obtain other personal information about you such as your bank and credit card account numbers, information in your credit report, and the existence and size of your savings and investment portfolios.

What do thieves do with a stolen identity? Once they have your personal information, identity thieves use it in a variety of ways:
Credit card fraud: They may open new credit card accounts in your name. When they use the cards and don't pay the bills, the delinquent accounts appear on your credit report. They may change the billing address on your credit card so that you no longer receive bills, and then run up charges on your account. Because your bills are now sent to a different address, it may be some time before you realize there's a problem.
Phone or utilities fraud: They may open a new phone or wireless account in your name, or run up charges on your existing account. They may use your name to get utility services like electricity, heating, or cable TV.
Bank/finance fraud: They may create counterfeit checks using your name or account number. They may open a bank account in your name and write bad checks. They may clone your ATM or debit card and make electronic withdrawals your name, draining your accounts. They may take out a loan in your name.
Government documents fraud: They may get a driver's license or official ID card issued in your name but with their picture. They may use your name and Social Security number to get government benefits. They may file a fraudulent tax return using your information.
Other fraud: They may get a job using your Social Security number. They may rent a house or get medical services using your name. They may give your personal information to police during an arrest. If they don't show up for their court date, a warrant for arrest is issued in your name.

How can you find out if your identity was stolen? The best way to find out is to monitor your accounts and bank statements each month, and check your credit report on a regular basis. If you check your credit report regularly, you may be able to limit the damage caused by identity theft.
Unfortunately, many consumers learn that their identity has been stolen after some damage has been done. You may find out when bill collection agencies contact you for overdue debts you never incurred. You may find out when you apply for a mortgage or car loan and learn that problems with your credit history are holding up the loan. You may find out when you get something in the mail about an apartment you never rented, a house you never bought, or a job you never held.
What are the steps I should take if I'm a victim of identity theft? If you are a victim of identity theft, take the following four steps as soon as possible, and keep a record with the details of your conversations and copies of all correspondence.
1. Place a fraud alert on your credit reports, and review your credit reports. Fraud alerts can help prevent an identity thief from opening any more accounts in your name. Contact the toll-free fraud number of any of the three consumer reporting companies below to place a fraud alert on your credit report. You only need to contact one of the three companies to place an alert. The company you call is required to contact the other two, which will place an alert on their versions of your report, too. If you do not receive a confirmation from a company, you should contact that company directly to place a fraud alert.
Equifax: 1-800-525-6285; www.equifax.com; P.O. Box 740241, Atlanta, GA 30374-0241 Experian: 1-888-EXPERIAN (397-3742); www.experian.com; P.O. Box 9532, Allen, TX 75013 TransUnion: 1-800-680-7289; www.transunion.com; Fraud Victim Assistance Division, P.O. Box 6790, Fullerton, CA 92834-6790

Once you place the fraud alert in your file, you're entitled to order one free copy of your credit report from each of the three consumer reporting companies, and, if you ask, only the last four digits of your Social Security number will appear on your credit reports. Once you get your credit reports, review them carefully.
Look for inquiries from companies you haven't contacted, accounts you didn't open, and debts on your accounts that you can't explain. Check that information, like your Social Security number, address(es), name or initials, and employers are correct. If you find fraudulent or inaccurate information, get it removed. When you correct your credit report, use a cover letter explaining your request, to get the fastest and most complete results. Continue to check your credit reports periodically, especially for the first year after you discover the identity theft, to make sure no new fraudulent activity has occurred.

2. Close the accounts that you know, or believe, have been tampered with or opened fraudulently. Call and speak with someone in the security or fraud department of each company. Follow up in writing, and include copies (NOT originals) of supporting documents. It's important to notify credit card companies and banks in writing. Send your letters by certified mail, return receipt requested, so you can document what the company received and when. Keep a file of your correspondence and enclosures. When you open new accounts, use new Personal Identification Numbers (PINs) and passwords. Avoid using easily available information like your mother's maiden name, your birth date, the last four digits of your Social Security number or your phone number, or a series of consecutive numbers.
If the identity thief has made charges or debits on your accounts, or has fraudulently opened accounts, ask the company for the forms to dispute those transactions: For charges and debits on existing accounts, ask the representative to send you the company's fraud dispute forms. If the company doesn't have special forms, use the sample letter to dispute the fraudulent charges or debits. In either case, write to the company at the address given for "billing inquiries," NOT the address for sending your payments.
For new unauthorized accounts, you can either file a dispute directly with the company or file a report with the police and provide a copy, called an “Identity Theft Report,” to the company. If you want to file a dispute directly with the company, and do not want to file a report with the police, ask if the company accepts the FTC’s ID Theft Affidavit. If it does not, ask the representative to send you the company's fraud dispute forms. However, filing a report with the police and then providing the company with an Identity Theft Report will give you greater protection. For example, if the company has already reported these unauthorized accounts or debts on your credit report, an Identity Theft Report will require them to stop reporting that fraudulent information. Use the sample letter to explain to the company the rights you have by using the Identity Theft Report. Once you have resolved your identity theft dispute with the company, ask for a letter stating that the company has closed the disputed accounts and has discharged the fraudulent debts. This letter is your best proof if errors relating to this account reappear on your credit report or you are contacted again about the fraudulent debt.

3. File a complaint with the Federal Trade Commission. You can file a complaint with the FTC using the online complaint form; or call the FTC's Identity Theft Hotline, toll-free: 1-877-ID-THEFT (438-4338); TTY: 1-866-653-4261; or write Identity Theft Clearinghouse, Federal Trade Commission, 600 Pennsylvania Avenue, NW, Washington, DC 20580. Be sure to call the Hotline to update your complaint if you have any additional information or problems. By sharing your identity theft complaint with the FTC, you will provide important information that can help law enforcement officials across the nation track down identity thieves and stop them. The FTC can refer victims' complaints to other government agencies and companies for further action, as well as investigate companies for violations of laws the agency enforces. Additionally, you can provide a printed copy of your online Complaint form to the police to incorporate into their police report. The printed FTC ID Theft Complaint, in conjunction with the police report, can constitute an Identity Theft Report and entitle you to certain protections.

This Identity Theft Report can be used to (1) permanently block fraudulent information from appearing on your credit report; (2) ensure that debts do not reappear on your credit report; (3) prevent a company from continuing to collect debts that result from identity theft; and (4) place an extended fraud alert on your credit report.

4. File a report with your local police or the police in the community where the identity theft took place. Call your local police department and tell them that you want to file a report about your identity theft. Ask them if you can file the report in person. If you cannot, ask if you can file a report over the Internet or telephone. See below for information about Automated Reports.
If the police are reluctant to take your report, ask to file a "Miscellaneous Incident" report, or try another jurisdiction, like your state police. You also can check with your state Attorney General's office to find out if state law requires the police to take reports for identity theft. When you go to your local police department to file your report, bring a printed copy of your FTC ID Theft Complaint form, your cover letter, and your supporting documentation. The cover letter explains why a police report and an ID Theft Complaint are so important to victims. Ask the officer to attach or incorporate the ID Theft Complaint into their police report. Tell them that you need a copy of the Identity Theft Report (the police report with your ID Theft Complaint attached or incorporated) to dispute the fraudulent accounts and debts created by the identity thief. (In some jurisdictions the officer will not be able to give you a copy of the official police report, but should be able to sign your Complaint and write the police report number in the “Law Enforcement Report” section.)

How long can the effects of identity theft last? It's difficult to predict how long the effects of identity theft may linger. That's because it depends on many factors including the type of theft, whether the thief sold or passed your information on to other thieves, whether the thief is caught, and problems related to correcting your credit report. Victims of identity theft should monitor financial records for several months after they discover the crime. Victims should review their credit reports once every three months in the first year of the theft, and once a year thereafter. Stay alert for other signs of identity theft. Don't delay in correcting your records and contacting all companies that opened fraudulent accounts. Make the initial contact by phone, even though you will normally need to follow up in writing. The longer the inaccurate information goes uncorrected, the longer it will take to resolve the problem.

What can you do to help fight identity theft? A great deal. Awareness is an effective weapon against many forms identity theft. Be aware of how information is stolen and what you can do to protect yours, monitor your personal information to uncover any problems quickly, and know what to do when you suspect your identity has been stolen. Armed with the knowledge of how to protect yourself and take action, you can make identity thieves' jobs much more difficult. You can also help fight identity theft by educating your friends, family, and members of your community.
The FTC has prepared a collection of easy-to-use materials to enable anyone regardless of existing knowledge about identity theft to inform others about this serious crime.

SAMPLE DISPUTE LETTER FOR EXISTING ACCOUNTS
Date] [Your Name] [Your Address] [Your City, State, Zip Code] [Your Account Number] [Name of Creditor] Billing Inquiries [Address] [City, State, Zip Code]

Dear Sir or Madam: I am writing to dispute a fraudulent [charge/debit] on my account in the amount of $___. I am a victim of identity theft, and I did not make this [charge/debit]. I am requesting that the [charge be removed/the debit reinstated], that any finance and other charges related to the fraudulent amount be credited, as well, and that I receive an accurate statement. Enclosed is a copy of my Identity Theft Report supporting my position. In addition, I am enclosing a copy of sections 605B, 615(f) and 623(a)(6) of the Fair Credit Reporting Act (FCRA), which detail your responsibilities as an information furnisher to consumer reporting agencies in response to the Identity Theft Report I am providing. These enclosures also detail your responsibilities that apply in the event you receive from a consumer reporting agency notice under section 605B of the FCRA that information you provided to is the result of identity theft. Please investigate this matter and correct the fraudulent [charge/debit] as soon as possible.

Sincerely, [Your Name]
Enclosures: Identity Theft Report FCRA Sections 605B, 615(f), 623(a)(6)

Crime Prevention Tips for Seniors

2008-07-23T13:35:00.000-07:00

Crime and the fear of crime create special problems for the elderly. Crime prevention is everyone's responsibility, not just a job for law enforcement. Seniors can learn how to protect themselves from crime by following these simple, commonsense suggestions. Share these tips with your neighbors and friends, to make it tough for criminals to work in your neighborhood.

AT HOME . . .
1. Never open your door automatically. Install and use a peephole.
2. Lock your doors and windows. (Three quarters of the burglaries involving older persons involved unlocked doors and windows; and, less than one half of these robberies are reported.) Keep your garage doors locked.
3. Vary your daily routine.
4. Use "Neighbor Watch" to keep an eye on your neighborhood. A concerned neighbor is often the best protection against crime because suspicious persons and activities are noticed and reported to police promptly.
5. Don't leave notes on the door when going out.
6. Leave lights on when going out at night; use a timer to turn lights on and off when you are away for an extended period.
7. Notify neighbors and the police when going away on a trip. Cancel deliveries such as newspapers and arrange for someone - a neighbor's child, perhaps - to mow the lawn if need be. Arrange for your mail to be held by the Post Office, or ask a neighbor to collect it for you.
8. Be wary of unsolicited offers to make repairs to your home. Deal only with reputable businesses.
9. Keep an inventory with serial numbers and photographs of resaleable appliances, antiques and furniture. Leave copies in a safe place.
10. Don't hesitate to report crime or suspicious activities.
11. Install deadbolt locks on all your doors.
12. Keep your home well lit at night, inside and out; keep curtains closed.
13. Ask for proper identification from delivery persons or strangers. Don't be afraid of asking . . . if they are legitimate they won't mind.
14. If a stranger asks to use your telephone, offer to place the call for him or her yourself.
15. Never let a stranger into your home. Do not leave notes on your door when you are gone, and do not hide your keys under the mat or in other conspicuous places.
16. Never give out information over the phone indicating you are alone or that you won't be home at a certain time.
17. When you are gone for more than a day, make sure your home looks and sounds occupied . . . use an automatic timer to turn on lights, radio or TV.
18. If you arrive at home and suspect a stranger may be inside, DON'T GO IN. Leave quietly and call 911 to report the crime.

WALKING
1. If you are attacked on the street, make as much noise as possible by calling for help or blowing a whistle. Do not pursue your attacker. Call 911 and report the crime as soon as possible.
2. Avoid walking alone at night. Try to have a friend accompany you in high risk areas . . . even during the daytime.
3. Avoid carrying weapons . . . they may be used against you.
4. Always plan your route and stay alert to your surroundings. Walk confidently.
5. Have a companion accompany you.
6. Stay away from buildings and doorways; walk in well-lighted areas.
7. Have your key ready when approaching your front door.
8. Don't dangle your purse away from your body. (Twelve percent of all crimes against the elderly are purse snatchings and street robberies.)
9. Don't carry large, bulky shoulder bags; carry only what you need. Better yet, sew a small pocket inside your jacket or coat. If you don't have a purse, no one will try to snatch it.

WHILE SHOPPING . . .
1. Carry your purse very close to you . . . don't dangle it from your arm. Never leave your purse in a shopping cart. Never leave your purse unattended.
2. Don't carry any more cash than is necessary. Many grocery stores now accept checks and automatic teller cards instead of cash.
3. Don't display large sums of cash.
4. Use checks where possible.

IN YOUR CAR . . .
1. Always keep your car doors locked, whether you are in or out of your car. Keep your gas tank full and your engine properly maintained to avoid breakdowns.
2. If your car breaks down, pull over to the right as far as possible, raise the hood, and wait INSIDE the car for help. Avoid getting out of the car and making yourself a target before police arrive.
3. At stop signs and traffic lights, keep the car in gear.
4. Travel well-lit and busy streets. Plan your route.
5. Don't leave your purse on the seat beside you; put it on the floor, where it is more difficult for someone to grab it.
6. Lock bundles or bags in the trunk. If interesting packages are out of sight, a thief will be less tempted to break in to steal them.
7. When returning to your car, check the front and back seat before entering.
8. Never pick up hitchhikers.

BANKING . . .
1. Many criminals know exactly when government checks arrive each month, and may pick that day to attack. Avoid this by using Direct Deposit, which sends your money directly from the government to the bank of your choice. And, at many banks, free checking accounts are available to senior citizens. Your bank has all the information.
2. Never withdraw money from your bank accounts for anyone except YOURSELF. Be wary of con artists and get-rich schemes that probably are too-good-to-be- true.
3. You should store valuables in a Safe Deposit Box.
4. Never give your money to someone who calls on you, identifying himself as a bank official. A bank will never ask you to remove your money. Banks need the use of your money, and they don't want one of their customers to invite crime by having large amounts of cash around.
5. When someone approaches you with a get-rich-quick-scheme involving some or all of YOUR savings, it is HIS get-rich-quick-scheme. If it is a legitimate investment, the opportunity to contribute your funds will still be there tomorrow-after you have had time to consider it.
6. If you have been swindled or conned, report the crime to your local police or Prosecuting Attorney's office. Con-artists count on their victim's reluctance to admit they've been duped, but if you delay you help them get away. Remember, if you never report the crime, they are free to cheat others again and again and you have no chance of ever getting your money back.

My Story

2008-07-22T07:38:00.000-07:00

DAVE'S STORY

My life changed in the early to late 1990's, although I didn't recognize it at this time. That is, when my wife's grandfather was living independently in Chevy Chase, Maryland.

One night I received a call from my mother-in-law. It was late at night. It was unusual for the phone to ring that late, so I answered the phone, with a feeling of foreboding, only to hear my mother-in-law's voice say that her father, my wife's grandfather, had fallen. Shortly after that, he was taken to the hospital. After medical treatment at the hospital, he was taken to a nursing home.

I was the attorney in the family, so everything was left to me. During this time, I had lots of questions: what options were available; what if granddad had to stay in the nursing home, would we be able to find a good one and would he get good care there; and if so, how were we going to pay for it? I tried to find answers to these questions, that I now answer for others. But I could only catch glimpses of the big picture. That research was my first act into the practice of elder law and life care planning.

After granddad was in the nursing home, I read about a meeting of the National Academy of Elder Law Attorneys. I attended the conference and at the end of the first day, I knew I had found my new profession – the practice of elder law. When I returned home, I threw myself into learning about elder law. I researched the area using law books and materials from the conference and I started putting together what later turned out to be the beginning phases of my new life care planning practice and my calling.

Should we use computer software to draft a will?

2008-07-22T05:33:00.001-07:00

People often wonder whether they would be taking a risk by using a computer software program to create their estate planning (wills, power of attorneys and living wills) documents, rather than consulting with a qualified attorney. A recent case shows how relying on comport software can produce unforeseen legal complications.

Ms. X had a life insurance policy that named her half-sister, as the beneficiary. Therefore, at her death the half sister should obtain the proceeds of the life insurance monies. However, using a legal software program she had obtained, she prepared three documents: (1) will; (2) an attachment; and (3) a living trust. She was not trained in the legal field. The attachment provided that the proceeds of the life insurance policy should be used to pay funeral costs and other debts normally paid by an estate.

Following Ms. X’s death, the court removed the half sister as personal representative (executor) and appointed a new personal representative for the estate. This new personal representative asked the court to interpret the estate planning documents that Ms. X had prepared and signed. The question was whether the attachment was a part of the will and, if so, whether it created a trust that held the insurance proceeds. If so, the insurance proceeds would be under the control of Ms. X's estate to pay its debts. If the attachment was determined not to be incorporated into the will, then Ms. X would receive all the life insurance proceeds.

The Court ruled that the attachment was part of the will and that it did create a trust to hold the insurance proceeds. This may not have been the wish of Ms. X but the problem was, the attachment clearly indicates that Ms. X intended the attachment to be part of her will. As the court states "[T]he inartful drafting of the will and [the attachment] certainly led to confusion and dissention between the parties."

Therefore, if you use computer software, there is the potential that your wishes may not enacted.

MEDICAID MYTHS - A Collection of Plausible, but False Propositions.

2008-07-18T10:55:00.001-07:00

Many people want to know how to have Medicaid cover nursing home costs that can run over $72,000 a year. Few can pay the cost out of their regular income. It doesn’t take long to lose all one’s savings. Long-term care insurance is not available if the person is already sick. It is too expensive for many older people.

So, folks will ask friends and neighbors how to get Medicaid to pay and hold on to precious dollars for the rest of the family. But, does the question presume the nursing home is the only choice? My goal in dispelling the Medicaid Myths is to help elders and their families arrive at the best long term care plan.

Informed families can budget and allocate their resources to alternatives to nursing home care such as, caregiver aid, professional in-home care and residential assisted living. When they must so place they will get the best care for their loved one. Medicaid is a complicated area of the law.

1. Myth: “Medicare will cover my nursing home bill."
The Truth: Medicare only covers a small amount of the nursing home care provided in this country. Many older people are surprised to learn this. Medicare provides 20 days of full coverage if you spent at least three days in the hospital and need skilled care (not intermediate level care). Then, if you still need skilled care, you can get up to 80 days of partial coverage from Medicare, the co-pay will usually be picked up by your supplemental insurance. After that, you will either pay by your savings, your long-term care insurance or get Medicaid.

2. Myth: “Only substandard nursing homes participate in Medicaid.”
The Truth: Only a few Maryland nursing homes do not have Medicaid certified beds. The vast majority do.

3. Myth: “I will get better care if I private pay.”
The Truth: It is illegal to treat Medicaid patients less well than private pay patients and it is illegal to discriminate against Medicaid patients. There may be no “Medicaid wing” and no public identification of a “Medicaid bed.” Typically, the staff does not know which patient is a Medicaid recipient.

4. Myth: “If I enter a nursing home as a private pay resident, I must use up my assets before I can get Medicaid.”
The Truth: You are not required to “spend down” your assets to pay for the nursing home care. However, some nursing homes might try to make you believe that you do. You do have legal options. Informed people seek advice from an elder law attorney to decide if they wish to have Medicaid pay the bill before having spent a significant part of their assets.

5. Myth: “I can only ‘spend-down’ my assets on medical or nursing home bills.”
The Truth: See # 4 above. Nursing homes may tell you that you have to spend your savings on the nursing home bill before applying for Medicaid, but this is not true. In fact, it’s against the law for them to tell you this!

6. Myth: “I can find out all I need to know about Medicaid from the nursing home or the Medicaid agency
The Truth: The Medicaid law is very complex and counter-intuitive. It was written by Congress, after all! The nursing homes and Medicaid agencies do not have lawyers to interpret the law in your favor.

7. Myth: “I have to lose my home and everything I own to get Medicaid assistance.”
The Truth: A person is permitted to own “exempt property” and be eligible for Medicaid. This includes a home, even if return is unlikely, and a car, even if the patient will not drive. In addition the “community spouse” is entitled to keep a share of the assets. Further, some other assets are simply not counted by Medicaid. The trick comes in knowing what is “countable” under the Medicaid rules. The bottom line is, you don’t need to lose everything to be Medicaid eligible.

8. Myth: “I can keep all of my separate property when my spouse gets Medicaid.”
The Truth: When a married person applies for Medicaid, assets in either or both spouse’s name are considered by the Medicaid agency.

9. Myth: “If I put my property into my spouse’s name, I will be eligible for Medicaid.”
The Truth: All assets are counted, regardless of which spouse’s name they are in. If either spouse’s name is on the property, it is included. This includes IRAs, inheritances, property jointly owned with children and insurance policies for example.

10. Myth: “I must spend half of our assets before I can get Medicaid for my spouse.”
The Truth: A community spouse can keep half, up to approximately, $100,000, in countable assets. Any more than that will either spent or converted into non-countable assets. This is the “spend down” process.

11. Myth: “I can hide my assets and get eligible for Medicaid.”
The Truth: Intentional misrepresentation in a Medicaid application is a crime and can be costly. The IRS shares any information concerning income or assets you have with the Medicaid agency. These reports include interest income and the sale of stocks or bonds. You or whoever applied may have to pay Medicaid back to avoid prosecution.

12. Myth: “I can give away $10,000 per year under Medicaid rules.”
The Truth: This is a rule under federal gift tax law, not under Medicaid law. (Actually, the amount has changed to $12,000.) In 2008 a person may give $12,000 per year without liability for gift tax. However, since taxpayers have a $1 million lifetime exemption for the gift tax most do not need to be concerned paying the tax. And, millionaires should not worry about getting Medicaid.

13. Myth: “I can’t give anything away and get Medicaid.”
The Truth: The Medicaid rules provide that a person can be disqualified for giving away property. It depends on what is given away, to whom, and when. So, again, it’s complicated. Some asset transfers are not penalized under the Medicaid rules. Consult with a lawyer who knows the law.

14. Myth: “I have to wait 5 years after giving anything away, to get Medicaid.”
The Truth: The disqualification isn’t always 5 years long and sometimes there is no disqualification at all. True, there is now a 5-year “lookback” for some asset transfers under the Medicaid rules. This means that the Medicaid agency will look back at all transfers of property, including sales for less than market value.

How do I qualify, financially, for Medicaid?

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If you have no assets or money, then Medicaid (“Medical Assistance”) will usually pay for your care. In the nursing home setting, Medical Assistance covers room and board, pharmacy and incidentals. Basically, Medical Assistance provides for your basic care, but does not cover certain expenses like haircuts, beauty shop charges and clothing. However, if you qualify for Medical Assistance, you can retain sixty-two ($62) dollars per month from your income / social security to meet any of these needs.

Medical Assistance planning is to offset the concerns of seniors regarding the high cost of long term nursing care. Generally, the purpose behind Medical Assistance planning is to make the individual eligible for Medical Assistance, while preserving as much of the individuals resources for the benefit of his or her loved ones. Medical Assistance planning occurs in a pre-planned stage or in a crisis stage. The pre-planning stage occurs when you are expected to enter a nursing home at sometime in the future. Generally, pre-planning techniques include: long term care insurance, gifting, and utilizing trusts. Medical Assistance crisis planning occurs when you enter a nursing home without any planning, and you are not expected to return home or to the community and you are paying the nursing home out of your own pocket. Medical Assistance crisis planning is more common because the majority of seniors are of the opinion that a nursing home stay will never happen to them. When the nursing home stay becomes a reality, you or your family, realizing the cost of nursing home care, will have to address the situation.

To qualify for Medical Assistance, you must be over sixty-five, or blind/disabled and have limited income and assets. If you are a single person, the only assets that you can maintain (non-countable assets) are basically, twenty-five hundred ($2500) dollars, some life insurance and your burial plot. Every other asset is considered available to pay for the nursing home costs (countable assets). Non-countable assets for a married couple are some savings, your home, household goods, a motor vehicle, some life insurance and burial plots. Savings accounts, checking accounts, 401K, pensions and CD's, life insurance policies, in excess of the non countable allowances, second homes, and other motor vehicles are all considered countable assets. Therefore, if you have assets in excess of the resource limitation, you will not qualify for medical assistance. Consequently, you must “spend-down” the excess amounts.

In lieu of giving all your money to the nursing home, you can “spend-down” your assets, with some proper planning techniques such as: purchasing prepaid funeral arrangements, paying off some debts, purchasing a new car and making home improvements. Additionally, the remaining “spend-down” amount can be eliminated through the purchase of a Medicaid Annuity. The Medicaid Annuity is designed to convert the “spend-down” amount into a stream of income. With the “spend-down” amount now eliminated, you become eligible for Medical Assistance benefits.

Put Caregiving Arrangements in Writing

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When one family member becomes a caregiver for another, it's important to put in writing the terms of the arrangement. AARP estimates that more than 20 million Americans currently care for ill parents, other relatives or friends. Problems can arise if the caregiving arrangement is not clear to all involved. For example, a caregiver may be providing care without compensation, counting on an inheritance that never materializes.

A formal caregiver contract can outline the responsibilities of a caregiver, and specify the payment he will receive for services rendered and expenses, the article states. A contract ensures that the cost of care is paid at the time it is received and is not left for family members to wrangle over as part of a later division of assets.

Such a contract can also help the person receiving the care transfer assets as a way of qualifying for Medicaid. Payments for contracted services are not viewed as gifts to the care-giving relative, but reimbursement checks without a contract to support them may be.

A good caregiver contract also should:

Delineate the rights and obligations of both care-receiver and caregiver.

Be written as soon as possible, when the care-receiver is unquestionably of sound mind.

Specify what services are to be provided and at what cost. If the care-receiver is in the caregiver''s home, expenses might well include a share of those utilities, laundry, food and housing costs.

Fix the caregiver''s compensation at a reasonable rate, comparable to what an outside party would receive for the same services, and specify reimbursement for the caregiver''s out-of-pocket expenses.

How to Make Retirement Savings Last

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You have saved all your life for retirement. Once you have finally reached retirement, you want

to get the most out of your savings. There are many different retirement plan options to keep

track of and manage: IRAs, 401(k)s, investment accounts, and Social Security.

To maximize savings, keep the following things in mind:
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Avoid penalties by taking the required distributions from your IRA or 401(k). You have until

April 1 after you turn 70 ½ to begin taking the minimum distribution or face a penalty. If you

take distributions after that date, you will pay 50 percent on the amount that should have been

distributed, but wasn't. To calculate your minimum distribution, take the total of account

balances divided by the distribution period calculated by the IRS.

Decide when to take your Social Security. You can begin taking it any time after age 62. The

longer you wait —- up until age 70 -- the more money you will get in each check. Whether to

wait or not depends on your individual circumstances. You may want to consider your life

expectancy. If you have a long life expectancy and you can afford to, you may want to wait until

age 70 to begin getting benefits.

Look at your IRA and make sure you have the best account for your needs. If you have a

traditional IRA, you may want to convert it into a Roth IRA. You will pay taxes on the

income earned to date, but then it will be able to grow tax-free.

Make the most of your investments. Many financial advisors advise that investments be

60 percent in stocks and 40 percent in bonds or other fixed-income vehicles, but the right

mix for you depends on your circumstances and risk tolerance. In addition, the general rule

of thumb is to spend about 4.5 percent of retirement investments each year.

Consider consulting a financial planner. If you have a lot of investments, a professional

financial planner could help you determine the best way to manage the accounts.

Caregiving Affects Work and Life But Not Finances, Study Finds

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A new study of caregivers in the United States finds that although caregiving has a big impact on work and life, most caregivers don't feel financially burdened. Almost one-quarter of households in the United States contain a caregiver, and most of those households provide care for someone who is age 50 or older, according to the new study by The National Alliance for Caregiving and the AARP, which looked at caregivers aged 18 and older who provided unpaid care for another adult aged 18 or older.

According to the study, only 12 percent of caregivers said they felt financially burdened by their caregiving duties. Caregivers with more caregiving responsibilities and those who did not feel they had a choice in becoming a caregiver reported greater financial hardship.

While it generally doesn't create a financial burden, caregiving has a big impact on work and life, the study found. Caregivers provide care an average of 21 hours per week. A majority of caregivers said they were working, either full or part-time, or had worked at some point while caregiving. More than 60 percent of the working caregivers reported having to make adjustments to their work schedule, such as leaving early, arriving late, or taking time off. Not surprisingly, the jobs of caregivers with the most caregiving responsibilities were the most affected; one-third of caregivers who had to provide constant care had quit their job to perform their caregiving duties and 12 percent had retired.

Caregivers also reported they had less time for family or friends, had given up vacations or hobbies, and had less time to exercise. Caregivers said they needed more help finding time for themselves, balancing work and family responsibilities, and managing stress.

What is Life Care Planning?

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The Life Care Plan is a roadmap for planning your long-term care, designed with your individual and family needs in mind. The Life Care Plan includes a strategy for managing
your life utilizing all the necessary services and resources available in the local community.

Based on a thorough understanding of your long-term health care goals and needs, the
Life Care Plan provides recommendations for care regarding residency, personal lifestyle
and more, consistent with these goals and needs. Like traditional Estate Plans, the Life
Care Plan includes the legal protections and provisions you need to safeguard your assets,
honor your wishes, and care for loved ones. However, a Life Care Plan provides a more comprehensive and caring approach because it incorporates both your legal protections
and provisions and your health care goals and needs.

The Life Care Manager

A family crisis represents a difficult and frightening period in a family’s life.
Therefore, you need someone who is not only knowledgeable and experienced with
dealing with such crisis situations, but is also compassionate and empathetic to your
emotional needs.

A Life Care Manager is employed to be your support line, your advocate, your
confidant, and your friend. In conjunction with an attorney, the Life Care Plan is
developed by a Life Care Manager. Your Life Care Manager is knowledgeable about
the many services and resources available to the elder community and will assist
with the selection of home care services based on your needs, intervene when special
care situations arise, offer assisted living and nursing home options, act as a liaison,
and more.

The Ultimate Goal

The ultimate goal of the Life Care Plan is to ensure the best quality of life for you today and throughout the rest of your life. Your Life Care Plan should continue to evolve throughout your life to accommodate changes in your care situation.

15 TOPICS TO DISCUSS WITH YOUR HEALTH CARE AGENT

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A health care agent is a person you appoint to make medical decisions on your behalf if you are incapacitated or unable to make any decisions.

A Living Will (Advanced Directive) expresses your wishes about your health care including, but not limited to, resuscitation, life sustaining treatments (respirator, feeding tube, etc.) and withholding / withdrawing of life sustaining treatments. The Living Will is only effective when you are terminally ill or unconscious and unable to communicate your wishes.

When it comes to making decisions regarding end of life issues, do you know your wishes or have you communicated those wishes to your health care agent?

Do you want to be resuscitated should your heart stop? Do you want to be hooked up to a life support system, feeding tube or respirator? What are your feelings about certain medical treatments?

There are no right or wrong or “preferable” answers to these questions. However, you should be able to communicate these answers, based on your own beliefs, wishes and desires, to your health care agent.

1. You’re seriously ill, and doctors are recommending chemotherapy; would you be willing to endure very severe side effects, such as severe pain, nausea, vomiting or weakness that could last for months, if the chance that you would regain your current health was very low?

2. What do you need for comfort and support as you journey near death?

3. If you had Alzheimer’s disease, and it progressed to the point where you could no longer recognize or converse with your loved ones; when spoon-feeding was no longer possible, would you want to be fed by a tube, into your stomach?

4. If you were terminally ill with a condition that caused much pain, would you want to be sedated, even to the point of unconsciousness, if it were necessary to control your pain?

5. Imagine that you were physically frail and needed help with most routine daily activities such as dressing, bathing, eating and going to the toilet. You were living in a nursing home although still mentally capable most of the time and became sick with pneumonia for the third time this winter causing hospitalization and pain, would you want aggressive antibiotic treatment again or just comfort care until death?

6. Would you want the following medical treatments?

a. Kidney Dialysis (if kidneys not working)

b. CPR (used if heart stops working)

c. Respirator (unable to breathe)

d. Artificial nutrition (unable to eat food)

e. Artificial hydration (unable to drink fluids)

7. Imagine that you are in a permanent coma and dependent on a feeding tube. Would your medical decisions be guided by any particular religious beliefs or spiritual values?

8. Are some conditions worse than death? If you are housebound, in severe discomfort or pain most of the time, would you want medical treatments to keep you alive?

9. Discuss your current health status and, if any medical problems, how do they affect your ability to function?

10. Do you think that your own doctor should make the final decision about any medical treatments you may require?

11. Would you want to have a hospice team or other palliative care (i.e., comfort care) available to you?

12. Do you have any fears regarding health care and/or death?

13. Do you want to donate parts of your body for transplantation or medical research?

14. What are your thoughts about a memorial or religious service? Where would you like your remains placed? Do you want to be buried or cremated?

15. What else do you feel is important for your agent to know?