Category Archives: Senior Tips

Advanced Care Planning

Communicating your healthcare wishes will ensure that you get the care you want.

Most of us dislike thinking about the possibility of an accident or illness impacting us, especially if something is severe enough to impact our ability to communicate our wishes for medical care.

While it can be difficult to think about these scenarios, when events do occur, circumstances are made even more challenging if you have not discussed and documented your wishes and preferences ahead of time.

The term “Advanced Care Planning” is often used to describe the process of learning your options for healthcare intervention, discussing your desires and letting others know your decisions. Let’s first outline the types of decisions that you might need to make:

Emergency Care Decisions – If you did not have a pulse, would you want to have CPR (cardiopulmonary resuscitation); if you were having difficulty breathing, would you want a ventilator used (a machine that breathes for you); if you could not take food and water normally, would you want artificial nutrition and hydration (such as a feeding tube) given? Generally, these measures are implemented temporarily until you recover from your illness or injury.
End-of-Life Care Decisions – This relates to your desired level of medical care if you are unable to communicate and your doctor has determined that you are terminally ill and will not recover. In this situation, would you want aggressive interventions, such as a long-term ventilator or feeding tube to be used or would you want simply to receive comfort care?
Choosing a Healthcare Agent – You can choose someone you trust to make healthcare decisions on your behalf if you are unable to make those decisions for yourself.

After determining your preferences, you need to make your wishes known. There are typically two main components to an Advanced Directive–a Living Will and a Durable Power of Attorney for Healthcare.

Living Will – A Living Will goes into effect if you are unable to communicate your wishes and a physician has determined you will not recover. In the living will, you specify in writing what treatment you do and do not want, and under these conditions.

Durable Power of Attorney for Healthcare – A Durable Power of Attorney for Healthcare names someone to make medical decisions for you if you cannot communicate and are unable to make decisions for yourself.

Other Documents – If you or a loved one is in poor health and has a clear preference for no Emergency Care, such as not wanting CPR or a breathing tube under any circumstance, you may also want to consider completing a POST (Physician’s Order for Scope of Treatment) form with your physician. A POST allows you to obtain a doctor’s order for a DNR (Do Not Resuscitate) status, if you do not want to have CPR to restart your heart, or other interventions, to keep you alive.

We recommend that everyone complete a Living Will and Durable Power of Attorney for Healthcare while they are competent and capable of communicating their wishes clearly. Often when a crisis strikes, you may not be able to communicate your preferences and your physicians and family members are left with the decision-making burden. Completing these documents allows you to clearly communicate your wishes, and also provides a gift for your family members to alleviate their distress and know they are acting according to your wishes in difficult times.

We are here to help if you have questions, would like assistance with understanding more about this process or preparing these documents, or need additional information or referrals to resources in your community.

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

July 2019

Understanding Legal Planning

Procrastinating can lead to a situation where it’s “too late.”

Meeting with a lawyer to discuss your legal needs can be compared to meeting with your doctor for a wellness exam. Your doctor evaluates your current health situation and recommends actions that you can take to ensure as healthy a future as possible. If, on the other hand, you procrastinate and don’t have regular wellness exams, sometimes when a problem is discovered it is too late to do anything about it. Early detection is always best.

When you have a “legal wellness” exam, your lawyer can advise you concerning what legal documents you need to have in place and what actions you need to take to be as prepared as possible for any eventuality that might occur. Sometimes, if you have a chronic illness, planning for long-term care should also be part of the conversation. In law as in medicine, if you wait too long, once the problem becomes evident, you may not be able to do anything about it.

For example, sometimes individuals set up a Trust to avoid probate. After the Trust is set up, they buy and sale property but some of the property is mistakenly not put into the Trust. When the grantors of the Trust pass away, their failure to transfer the property to the Trust is discovered. So, their heirs must probate the estate to transfer title to the property into the Trust. The goal of avoiding probate has been frustrated. Meeting with a lawyer to review the Trust could have avoided this.

Another example is when Mom and Dad are doing fine, so they aren’t thinking about their “legal wellness”. Then years go by and one of them unexpectedly becomes incapacitated. It’s now too late to put legal documents in place to appoint agents, who can act on their behalf. It makes sense to have regular “checkups”—medical and legal to take care of things while you still can.

Quality of life is important to each of us. Just as a wellness exam can catch physical problems while they are still treatable, legal exams can identify and solve problems while you are still able to do something about it.

June 2019

Staying in Your Home – A Review of Assistance Options

Don’t confuse Home Health with Home Care

Even when an older adult’s health declines, surveys show that the majority of Seniors want to live at home for as long as possible. Living at home provides a sense of independence and familiarity that is often not found outside the home.

However, Seniors often wonder about what options exist for in-home care and the terminology can feel confusing and overwhelming. To provide clarification, in-home care generally is divided into two distinct categories: Home Health and Home Care. Many people use the terms interchangeably, but they are two different services provided.

Home Health – Home Health is clinical, medical care provided by skilled, medical professionals, including registered nurses, physical therapists, occupational therapists, and speech therapists. It is not designed to be long-term and is often prescribed by a doctor following a hospitalization or surgery to aid in rehabilitation. Home Health services, for homebound individuals, may be able to provide a non-clinical caregiver to assist with basic personal care and bathing, but the focus of the services is skilled, medical care.

Typical services may include wound care, physical therapy, occupational therapy, medication administration, and nursing services.

Home Health services are covered by Medicare when prescribed by a physician. Medicaid also pays for qualified individuals.

Home Care – Home Care is provided by caregivers, or care aides, who are trained to assist Seniors with activities of daily living (ADL’s) and/or companionship. Home care aides may be Certified Nurse Assistants (CNA’s) but do not require certification. This is “non-clinical” care provided to Seniors who may need assistance to remain in their home. These services can be on-going for as long as they are needed.

Typical services may include meal preparation, house cleaning, assistance with dressing, bathing and grooming, transportation, companionship, and medication reminders.
Home Care services are not covered by Medicare. Payment options include private pay (typically approximately $20-$25 per hour), Long-Term Care Insurance, Medicaid for qualified, low-income individuals, and the VA Aide and Attendance pension.

Typically, Home Health services alone are not sufficient support for Seniors wanting to remain in their home, if they also need assistance with activities of daily living. However, many Home Care agencies exist that provide excellent service options to support Seniors and their family members. Additional supports, including Meals on Wheels for homebound individuals, and medical-alert devices, may also be utilized. A combination of Home Health services, Home Care services, community resources and family support is often the key to Seniors successfully and safely remaining in their homes.

We are here to help if you have questions, would like assistance with healthcare coordination, or need additional information or referrals to resources in your community.

WE WOULD LIKE TO INVITE YOU TO AN UPCOMING EVENT ON June 13, 2019:

Matt Rust, who specializes in wealth preservation & Tom Packer, Elder Law Attorney are presenting an EDUCATIONAL WORKSHOP about the cost and realities of long-term care. Thursday, June 13 at 6:00 pm at Tailwind Wealth Strategies – 3 NW Main Street, Blackfoot The biggest threat to your retirement income is related to longevity. There are benefits and options you may not be aware of.

We know it’ll be worth your time! (Refreshments!)

May 2019

Living Wills Specify Healthcare Wishes

Are you aware of these lesser-known facts?

Often, there is apprehension concerning end-of-life decisions. To make it easier, there are legal documents that you can put in place to carry out your wishes. One is a Living Will, which is an advance directive that sets forth your instructions for life-sustaining medical procedures if you are unable to communicate your wishes to your family and healthcare provider. Below are some lesser-known facts concerning a Living Will and Durable Power of Attorney for Health Care (DPOAHC) in Idaho.

A Living Will directs your family and healthcare providers on whether to continue or withhold life-sustaining treatments such as intubation, mechanical ventilation, or tube feeding for hydration and nutrition.
A Living Will takes effect only when a medical doctor certifies that you have a terminal and incurable illness, or you are in a persistent vegetative state.
In Idaho, the Living Will and DPOAHC are combined into one document.
A Durable Power of Attorney for Health Care allows you to appoint a person to make all decisions regarding your healthcare and takes effect only when you are not able to communicate.
If you can communicate, you will continue to make your own decisions concerning your healthcare, and what treatments you want. This includes making decisions about where you live—at home or in a facility.
There is a presumption in favor of cardiopulmonary resuscitation (CPR) if you do not have a pulse and are not breathing. This is a different condition than being diagnosed as terminally ill. If you do not want CPR you should indicate it in your Living Will and should fill out a Physician’s Order for Scope of Treatment (POST) with your doctor.
Living Wills created in other states that substantially conform to Idaho’s Living Will statutes, are recognized as valid.
Persons may give consent for their care to others, in the following order: a Guardian, the person named as an Agent in their Living Will, a spouse, a parent, a relative or any other competent individual representing himself or herself to be responsible for your healthcare.
If you have not made a prearranged funeral plan or if provisions relating to the disposition of your remains are unclear—for example, do you want cremation or a burial—the decision is made by the person designated as your Durable Power of Attorney for Health Care. If you want to make provisions relating to the disposition of your remains, you may want to prepare a document which specifies what you would like to have done.
A Living Will can be registered with the Idaho Secretary of State’s office, and if registered, your information will be available online to doctors, even if you are traveling.
If you change your mind, you can amend or revoke your Living Will and Durable Power of Attorney for Health Care.

When it comes to end-of-life decisions, there are things you can do to make it feel less daunting. Getting correct information and knowing what’s available, will help you make better choices.

April 2019

Veteran’s Benefits

Understanding the VA Aide and Attendance Pension

Veterans who have served on active duty during wartime are often unaware that they may be eligible for a VA Aide & Attendance Pension to help with the cost of assisted living, adult daycare, skilled nursing, and home care. A veteran’s surviving spouse may also be eligible for this assistance. The amount of this pension may be up to $1881 to $2230 per month, depending on the veteran’s family size, and the funds are given directly to the veteran or surviving spouse to help pay for his or her care.

The general qualifications include:

A veteran must have served on active duty for at least 90 days, with at least one day during wartime.
The veteran must have been honorably discharged.
The veteran must be at least 65, or officially disabled if younger.
A veteran must require help with activities of daily living.
A veteran must meet the income and asset guidelines.

There are three levels of VA Pensions: Basic Pension, Aid & Attendance, and Housebound. A veteran must be eligible for the Basic Pension in order to qualify for the Aid & Attendance and Housebound benefits and must have limited income and assets to be eligible. However, the income and asset guidelines are considered quite generous, given that the VA allows veterans to deduct their projected ongoing medical expenses from their income to reduce the amount of their countable income.

For example, if Bill has an income of $32,000 per year, but has assisted-living expenses of $36,000 per year, he would show a deficit and may be eligible for the full pension amount of $1881 per month, for a single person. With these additional funds, he could easily afford to pay for his assisted-living care. While the guidelines are far more complex than outlined in this brief example, it is helpful to see how a veteran could potentially be eligible. There is also an asset limit of $123,600, not including a primary home and vehicle, as well as a look-back period of three years for gifts and items sold.

Assistance is available for veterans interested in learning more about the VA Aide & Attendance Pension or for those interested in applying. Remember, you do not need to have a service-connected disability to be eligible for this pension. The Veteran’s Service Officers are able to assist with this process at 208-235-7890 or more information can be found online at https://www.benefits.va.gov/pension/aid attendance_housebound.asp. You are also welcome to call our office to obtain more information.

March 2019

Testamentary Special Needs Trust

By setting up a Special Needs Trust for your spouse in your Will, you can improve their quality of life.

If your spouse is disabled and receiving Medicaid or if there is a concern that your spouse may become disabled and need to apply for Medicaid to help pay for care, you may want to set up a Testamentary Special Needs Trust (a Trust created in your Will) to supplement your spouse’s needs beyond what is paid for by Medicaid.

Assets transferred into a Testamentary Special Needs Trust do not trigger the Medicaid asset transfer penalty, nor are they counted for eligibility purposes.The Trust is used to supplement the needs of your spouse over and above his or her care, support and maintenance.

A Special Needs Trust provides for material goods, services and experiences that will make your spouse’s life as pleasant and comfortable as possible. For example, expenditures for travel, companionship, cultural experiences, recreational activities and sporting activities may be paid for out of the Trust. The Trustee may use the income and principal of the Trust to pay for medical or dental treatments for which there are no private or public funds available. Supplemental care (nursing care, for example) rehabilitative services or assistance programs that are not otherwise provided for, may also be considered by the Trustee. In addition, Trust funds may be used to pay for the difference in cost of a private room, rather than a shared room, in institutional settings. All these things can greatly enhance your spouse’s life.

If you pass away before your spouse, and you don’t have a Special Needs Trust, the assets in your estate will go directly to your spouse and he or she would lose eligibility for public assistance programs. Your spouse would have to spend down the assets they received to $2,000 and then reapply for Medicaid. In that case, there would be no funds available to provide for the additional needs of your spouse, as mentioned above.

Supplemental Needs Trusts are legal, appropriate and encouraged by state law and statutes. These Trusts are set up by caring family members to provide for the extra needs of a disabled spouse, beyond what is provided by public benefit programs.

February 2019

Medicaid – Estate Recovery

What to expect when Medicaid pays for your long-term care.

Medicare, which pays for hospital, doctor and medication expenses, does not pay for long-term care. Medicare is an entitlement program that you do not have to pay back. Medicaid funds long-term care services for individuals who meet the qualifying criteria. However, when an individual, 55 years or older, has received Medicaid funds to pay for his or her healthcare, the Department of Health and Welfare, IDHW, is required by federal law to recover the cost of their care through Estate Recovery.

If a married individual, who received Medicaid funds, passes away, IDHW will not make a claim against that person’s estate until the surviving spouse has also passed away. During the surviving spouse’s lifetime, there are no restrictions on how the assets in the estate are used, as long as they are used for the surviving spouse’s benefit, and not given away. In addition, the surviving spouse can continue to live in the house or sell it and make other living arrangements. Whatever is left in the estate when the surviving spouse passes away, is subject to Estate Recovery.

When both spouses have passed away, the Personal Representative of their estate is required to provide written notice of the probate to the Estate Recovery division of IDHW. Estate Recovery is made against real and personal property in the estate. It is also made against property held in a revocable trust or property held in joint tenancy. However, IDHW does not make a claim against the death benefit of a life insurance policy.

There are some exemptions from Estate Recovery. One is, the decedent’s surviving spouse or adult children are allowed to keep any tangible, personal property such as household items, furnishings, automobiles, family heirlooms and personal effects, up to $10,000. Also, if an adult child pays fair market value for any item of property in the estate, they can keep it in the family.

Sometimes, I use this analogy to explain Estate Recovery. When I was in law school, I didn’t have enough money to cover all the expenses, so I took out a student loan. When I graduated, I received a letter from the bank with my loan repayment schedule. Similarly, when a person who received Medicaid “graduates,” or passes away, their estate will receive a claim from Estate Recovery to pay back the money they borrowed to pay for their care.

These are complex laws and regulations. Make sure to speak with someone who has experience in this area before making any decisions.

January 2019

A Gift for You!

This Booklet helps you know how to be more prepared for the future.

Dear valued client,

We are sending you the attached Booklet entitled “A Senior’s Guide to a Well-Planned Future.” This booklet is designed to help you plan today for a better tomorrow, by putting legal documents in place and communicating your desires to your family. We hope that you find it interesting and informative. You may also view the Booklet or download it from our website listed below.

We believe that life is good, and that we can choose to make it even better. Having the opportunity to ‘connect’ with you each month through our Senior Tips is enjoyable for us and we hope it has been helpful to you. Often, we receive comments back from you which makes our day! We hope you have a very Merry Christmas, and we look forward to a happy New Year!

Sincerely, Tom Packer, Sandy Packer and Becca Freeburne

Click here to view & download the booklet

December 2018

Social Security Benefits – When a Family Member Dies

How to handle that final check.

We frequently hear from clients after their spouse has passed away, wondering if they have to return the final Social Security benefit paid to their spouse. It can be a confusing process to figure out Social Security rules, but in this case, the guideline is quite simple, although it can feel unfair.

Here are two things to remember:

Social Security benefits are paid a month behind. For example, the check you receive in December is November’s benefit.
A person must live the entire month to receive the benefits for that month, per Social Security regulations.

For example, if your husband passed away on December 20^th, his estate is entitled to keep the Social Security payment that arrived in December. The payment arriving in December is for November’s benefit, since benefits are paid a month behind.

However, his estate is not entitled to keep the December benefits that would be paid in January, since he did not live the full month of December. In fact, if he dies anytime within the month of December, even if he passes away on December 31^st, his estate is not entitled to December benefits. Putting it simply, the estate will receive a check from Social Security for the last full month that he lived.

What happens if you receive an extra monthly benefit?

In many cases, the funeral home will report the person’s death to Social Security, but if Social Security was not notified prior to the payment being processed, you may receive an extra payment. If the funds are directly deposited into your bank account, you can contact the bank and request that the funds be returned to Social Security. If you receive a paper check, you should return the check to Social Security and do not cash it. To report a death or to apply for benefits, you can call 1-800-772-1213.

As the surviving spouse or as a minor child, you may be eligible for a one-time death benefit of $255. Some spouses are also entitled to widow or widower benefits, although additional regulations apply. However, knowing at least the basic regulations can help you make some sense in a confusing system! We are here to help if you have additional questions.

November 2018

Signatures on Legal Documents

Does it really matter how you sign your name?

When signing legal documents, this question frequently comes up—how should I sign my name? There is not a black and white answer to this question, but here are some guidelines.

There are good reasons to sign your name on legal documents the same way your name is listed on government documents, such as your Social Security card or your Driver’s License. If the document is going to be notarized, a notary public may ask to see your identification card to identify you and compare signatures. The goal is to sign your name in a way that will avoid confusion.

There is no law that I am aware of that says you must sign your name a certain way. But title companies, banks and county assessor’s offices often get particular about how documents are signed, especially documents that transfer title to real property.

Below are some general rules that court clerks and title companies have suggested to me. I realize that sometimes these suggestions might conflict with each other. You can choose the one that fits your situation the best.

Sign your name the way it is listed on government documents that identify you.
Sign your name the same way that it is listed in the heading, the body of the document or the signature line.
If you are signing a deed, sign your name the same way that it was written in the deed that transferred the property to you. Sometimes when your name has been written multiple ways on previous deeds, you can state your name and then state, “also known as”, then write your name the other ways that it was written previously.
If you have a common name or the same name as a parent, use your full name, with your middle name, or Jr. or Sr. if applicable, to avoid confusion.

Generally speaking, a person is not going to escape liability, or on the other hand a contract or other legal document is not going to be invalidated because you didn’t use your full name, your name is misspelled, or you signed Bill Smith when your name is William Smith.

Signing your name as indicated above will avoid confusion and make it easier for title companies and assessor’s offices to verify your signature.

October 2018