EHDH Estate Planning

Special Needs Planning

When a family includes a disabled individual, sometimes referred to as a “person with special needs,” estate planning needs to address the complexities, as described in a recent article titled “Customize estate plan to account for disabled beneficiaries” from The News-Enterprise. Failing to do so can have life-long repercussions for the individual.

This often occurs because the testator, the person creating the estate plan, does not know the implications of failing to take the disabled person’s situation into consideration, or when there is no will.

The most common error is leaving the disabled beneficiary receiving an outright inheritance. With a simple will, or no will, the beneficiary receives the inheritance and becomes ineligible for public benefits they may be receiving. The disruption can impact their medical care, housing, work and social programs. It may also lead to the loss of their inheritance.

If the disabled beneficiary does not currently receive benefits, it does not mean they will never need them. After the death of a parent, for instance, they may become completely reliant on public benefits. An inheritance will put them in jeopardy.

A second common error is naming the caregiver as the beneficiary, rather than the disabled individual. This causes numerous problems. The caregiver has the right to do whatever they want with the assets. If they no longer wish to care for the beneficiary, they are under no legal obligation to do so.

If the caregiver has any liabilities of their own, or when the caregiver becomes incapacitated or dies, the assets intended for the disabled individual will be subject to any estate taxes or creditors of the caregiver. If the caregiver has any children of their own, they will inherit the assets and not the disabled person.

The caregiver does not enjoy any kind of estate tax protection, so the estate may end up paying taxes on assets intended for the beneficiary.

The third major planning mistake is using a will instead of a trust as the primary planning method. A Special Needs Trust is designed to benefit a disabled individual to protect the assets and protect the individual’s public benefits. The trust assets can be used for continuity of care, while maintaining privacy for the individual and the family.

Planning for individuals with special needs requires great care, specifically for the testator and their beneficiaries. Families who appear to be similar on the outside may have very different needs, making a personalized estate plan vital to ensure that beneficiaries have the protection they deserve and need.

Reference: The News-Enterprise (March 15, 2022) “Customize estate plan to account for disabled beneficiaries”

Court Victory for Adults Caring for Parents at Home

A New Jersey Appellate Division recently reaffirmed the state’s regulation that allows older adults to transfer their homes to adult caregiver children without Medicaid penalty, reports an article titled “Major Victory for Adults Who Provide Home Care for Parents” from The National Law Review. The regulation permits the home to be transferred with no Medicaid penalty, when the adult child has provided care to the parent for a period of two years. This allows the parents to remain at home under the care of their children, delaying the need to enter a long-term care facility.

New Jersey Medicaid has tried to narrow this rule for many years, claiming that the regulation only applies to caregivers who did not work outside of the home. This decision, along with other cases, recognizes that caregivers qualify if they meet the requirements of the regulation, regardless of whether they work outside of the home.

The court held that the language of the regulations requires only that:

• The adult child must live with the parent for two years, prior to the parent moving into a nursing facility.
• The child provided special care that allowed the parent to live at home when the parent would otherwise need to move out of their own home and into a nursing care facility.
• The care provided by the adult child was more than personal support activities and was essential for the health and safety of the parent.

In the past, qualifying to transfer a home to an adult caregiver child was met by a huge obstacle: the caregiver was required to either provide all care to the parents or pay for any care from their own pockets. This argument has now been firmly rejected in the decision A.M. v. Monmouth County Board of Social Services.

The court held that there was nothing in the regulation requiring the child to be the only provider of care, and the question of who paid for additional care was completely irrelevant legally.

It is now clear that as long as the child personally provides essential care without which the parent would need to live in a nursing facility, then the fact that additional caregivers may be needed does not preclude the ability to transfer the home to the adult child.

The decision is a huge shift, and one that elder law estate planning attorneys have fought over for years, as there have been increasingly stricter interpretation of the rule by New Jersey Medicaid.

While Medicaid is a federal program, each state has the legal right to set its own eligibility requirements. This New Jersey Appellate Court decision is expected to have an influence over other states’ decisions in similar circumstances. Since every state is different, adult children should speak with an elder law estate planning attorney about how the law of their parent’s state of residence would apply if they were facing this situation.

Reference: The National Law Review (March 22, 2021) “Major Victory for Adults Who Provide Home Care for Parents”

Preparing for the Impact of Alzheimer’s Disease

The impact of these diseases will not just be on the individuals, but on their spouses and families. Surveying 1,000 mass affluent and high net worth families currently caring for relatives with cognitive decline, the study found that the lifetime direct and indirect costs can be more than $750,000. A recent article from Think Advisor, “4 Things Advisors Should Know About Cognitive Disorder Caregiving,” explains how families can prepare for this challenge.

Expect expenses to grow over time. Most people with cognitive decline problems live for five to fifteen years, with an average cost of $750 per month early on. However, as the disease progresses, those expenses increase, to as much as $1,200 per month. Families need to work with an experienced estate planning attorney to apply for Medicaid as soon as the individual is diagnosed, or as soon as possible. Failing to plan may mean spending down all assets to qualify.

Cognitively impaired adults mismanage finances. This is often the first symptom that something is wrong. The study found that 80% of people with dementia experience financial mismanagement. Bills go unpaid, spending patterns change dramatically and they are often victims of financial elder abuse. If multiple calls concerning the same question are made to a family member, that should be treated as a warning signal that something is wrong.

Women continue to carry most of the caregiving responsibilities. Women make up about 66% of family caregivers. The impact on their ability to earn wages, from leaving the workplace for a time period, retiring early or leaving the workforce permanently, takes a huge toll on their income and savings. This also hurts future income, with losses to 401(k) plans, pensions and Social Security benefits.

Estate planning attorneys, CPAs and financial advisors are important resources for caregivers. The financial and emotional stress on caregivers, loss of income and pressure to avoid their own problems means that caregivers need support from family, friends and professionals. Planning for the legal and financial impacts of caregiving needs to happen proactively. Professionals are also in a position to help through their networks of colleagues, like geriatric social workers, nursing homes, etc.

Most people are happy to plan for college, retirement and vacations. No one likes to plan for difficult events, like disability and death. However, planning as early as possible allows the family to have more control during a difficult period of time. Allowing trusted professionals to become part of the support network can lessen some of the burden.

Reference: Think Advisor (Oct. 13, 2020) “4 Things Advisors Should Know About Cognitive Disorder Caregiving”

What Is a ‘Caregiver’ Agreement?

The idea that a family member or trusted friend may be paid to take care of an aging parent or sibling is a welcome one. However, most family members don’t understand the legal complexity involved in privately paying for care, says the recent article “Paying a family member for care” from The Times Herald. Payments made to a family caregiver or a private caregiver can lead to a world of trouble from Medicaid and the IRS.

This is why attorneys create caregiver agreements for clients. The concept is that the care and services provided by a relative or friend would otherwise be performed by an outside person at whatever the going rates are within the person’s community. The payment should be considered a fully compensated transfer for Medicaid eligibility purposes and should not result in any penalty being imposed if it is done correctly.

This is more likely to be avoided with a formal written caregiver agreement. In some states, like Pennsylvania, a caregiver agreement is required to be sure that the payments made to the caregiver are not deemed to be a gift under Medicare rules.

The caregiver agreement must outline the services that are being provided and the rate of pay, which can be in the form of weekly, monthly or a lump sum payment. This is where it gets sticky: that payment should not be higher than what an outside provider would be paid. An excessively high payment would trigger a red flag for Medicaid and could be viewed as a gift.

Medicaid has a five-year look back period, where the applicant’s finances are examined to see if there were efforts to minimize the person’s financial assets to qualify for Medicaid. If any transfers of property or assets are made that are higher than fair market value, it’s possible that it will be viewed as creating a period of ineligibility. That is why it’s so important to have a contract or written agreement in place, when a family member or other person is hired to provide those services and is paid privately.

There are also income tax consequences. The caregiver is considered a household employee by the IRS. They are not considered to be an independent contractor and should not be issued a 1099 to reflect their payment. If that is done, it could be considered to be tax evasion.

Speak with an estate planning attorney about crafting a caregiving agreement and how to handle the tax issue, when privately paying for care. They will help avoid putting Medicaid eligibility in jeopardy, as well as avoiding problems with the IRS.

Reference: The Times Herald (Aug. 13, 2020) “Paying a family member for care”

Planning for Long-Term Care Before It’s Too Late

Starting to plan for elder care should happen when you are in your 50s or 60s. By the time you are 70, it may be too late. With the national median annual cost of a private room in a nursing facility coming in at more than $100,000, not having a plan can become one of the most expensive mistakes of your financial life. The article “Four steps you can take to safeguard your retirement savings from this risk” from CNBC says that even if care is provided in your own home, the annual median national cost of in-home skilled nursing is $87.50 per visit.

There are fewer and fewer insurance companies that offer long-term care insurance policies, and even with a policy, there are many out-of-pocket costs that also have to be paid. People often fail to prepare for the indirect cost of caregiving, which primarily impacts women who are taking care of older, infirm male spouses and aging parents.

More than 34 million Americans provided unpaid care to older adults in 2015, with an economic value of $522 billion per year.

That’s not including the stress of caring for loved ones, watching them decline and needing increasingly more help from other sources.

The best time to start planning for the later years is around age 60. That’s when most people have experienced their parent’s aging and understand that planning and conversations with loved ones need to take place.

Living Transitions. Do you want to remain at home as long as is practicable, or would you rather move to a continuing care retirement community? If you are planning on aging in place in your home, what changes will need to be made to your home to ensure that you can live there safely? How will you protect yourself from loneliness, if you plan on staying at home?

Driving Transitions. Knowing when to turn in your car keys is a big issue for seniors. How will you get around, if and when you are no longer able to drive safely? What transportation alternatives are there in your community?

Financial Caretaking. Cognitive decline can start as early as age 53, leading people to make mistakes that cost them dearly. Forgetting to pay bills, paying some bills twice, or forgetting accounts, are signs that you may need some help with your financial affairs. Simplify things by having one checking, one savings account and three credit cards: one for public use, one for automatic bill-paying and a third for online purchases.

Healthcare Transitions. If you don’t already have an advance directive, you need to have one created, as part of your overall estate plan. This provides an opportunity for you to state how you want to receive care, if you are not able to communicate your wishes. Not having this document may mean that you are kept alive on a respirator, when your preference is to be allowed to die naturally. You’ll also need a Health Care Power of Attorney, a person you name to make medical decisions on your behalf when you cannot do so. This person does not have to be a spouse or an adult child—sometimes it’s best to have a trusted friend who you will be sure will follow your directions. Make sure this person is willing to serve, even when your documented wishes may be challenged.

Reference: CNBC (Jan. 31, 2020) “Four steps you can take to safeguard your retirement savings from this risk”

What You Don’t Know About Caregiving Costs Could Cost You Plenty!

Here’s a number that will give you something to think about, if you are a caregiver or are about to become one: the value of friends and family caregiving amounts to about $470 billion per year, according to an AARP Public Policy Institute Report. Caring for a loved one has certain costs in time and money that are difficult to predict.

U.S. News & World Report says, in “7 Myths About Caregiving Costs,” you should sift through the financial details, as early as possible, to save time and money in the long term. Let’s look at some common misconceptions concerning the costs of caregiving, as well as the realities to expect.

Your relative will stay at home and not have caregiving expenses. While your aging relative may never move to an assisted living facility, other care-related costs could still arise because many adult children take on the responsibilities for their aging parent gradually. You eventually may need to bring in skilled nursing support or arrange for in-home care. Even if your senior never lives outside of his own home, responsibilities like these define the role of a caregiver, and the costs creep up over time.

All home help will be paid for by insurance. You may think that health insurance or Medicare will pay for all of the costs. However, in most instances, you'll need to find other funds for daily help at home. Health insurance and Medicare never pay for custodial care.

It’s easy to figure out how much assistance at home will cost. The precise amount your loved one or family will spend on bringing in home assistance can vary significantly. It really depends on the level of care needed, along with whether a patient has long-term care insurance or any other form of long-term insurance, where they live, and if they qualify for Medicaid. The cost can also vary, based on the family situation where relatives are available to help on certain days, reducing the amount needed to pay for professional caregiving assistance.

The cost of caregiving is merely financial. If you’re taking hours every week of your days caring for a loved one, you may experience struggles in other areas of your life. This could mean you have little time for other family and friends, sleep, or exercise. These can lead to non-financial costs like increased stress, your own health problems and the emotional strain of caring for an aging loved one.

You can’t afford a caregiver, so you're not going to get one. If your aging parent has few financial resources or other family members can’t help pay for professional care, you should look at what other resources may be available.

Caregiving won’t affect your own finances. Sorry, but helping a loved one may entail additional physical demands that can affect your career and your financial status. Caregivers often work less hours, forfeit promotions, change jobs and even leave the workforce.

A discussion about finances can wait until care is warranted. Not so. If your loved one is now in good health and living at home, it can still be a wise idea to plan, so that if a crisis such as an accident occurs, everyone is ready.

You need to have this discussion, but you also need to be sensitive to your loved one. Try starting with some simple questions, to find out what they know about available resources. Do they know what services they might be eligible for? Find out who they would want to have as Power of Attorney and who they would want to make financial and health care decisions on their behalf if they can’t. Starting the conversation may be hard, but these are important topics and you’ll be in a better position to help, if you have the necessary information.

Reference: U.S. News & World Report (Dec. 12, 2018) “7 Myths About Caregiving Costs”

What’s a Good Gift for Someone Who Gives So Much to Others?

You’re just now catching your breathe—so much rushing about for the holidays! However, one gift that you would never overlook would be that for the person (or people) who gives of themselves, all year long. The family caregivers on your list deserves a special consideration during the holiday season.

In its recent article, “5 Gifts To Give a Family Caregiver This Holiday Season,” The Good Men Project reminds us that family caregiving quickly becomes a never-ending day of to do’s for the sake of another person.

Caring for a family member involves an exhaustive amount of paperwork, and an equally exhaustive amount of time coordinating all the financial crunching and logistical planning. At the same time, the caregiver’s own life and responsibilities still need to be addressed.

Take care of a chore. A caregiver may not have time to arrange for some of the basic chores around that house. You could pay for a lawn service, snow removal, meal delivery or an oil change. Be creative and thoughtful. You might even do these chores yourself!

Hire an elder pro. With caregiving, the idea that “knowledge is power” takes on a significant role. An hour with an elder attorney, insurance specialist, or geriatric specialist can assess where the patient is now and how to help them plan for the future—that’s an invaluable gift that keeps on giving.

Professional Respite. Not everyone qualifies for this, unless they meet the eligibility factors. Even if you do qualify, funding and availability can be scarce. Call a home health agency and ask them if they’re willing to create a respite package, that would include a block of weekly respite visits.

Gift card. It is a bit impersonal, but it’s like a tiny nugget of indulgence that a caregiver rarely gives themselves hidden away for a special day.

The gift of time. If you have this kind of relationship with the caregiver, give that person the most precious resource of all—your time. That may be an afternoon together, a walk in the nearby park, or something you both enjoy. Perhaps you both enjoy crafting or baking. Make time to let them know, just how much you appreciate them.

Reference: The Good Men Project (December 12, 2018) “5 Gifts To Give a Family Caregiver This Holiday Season”