Building Legacies that Last Estate Planning and Elder Law

Being Under Observation in the Hospital

Bigstock-Doctor-with-female-patient-21258332[1]Many elderly people face gigantic medical bills for hospital stays because of how they are classified by the hospital. This makes a big difference in how much Medicare will pay.

When an elderly person has an extended stay in the hospital, they are almost always under the impression that Medicare will cover most of the costs. However, many stay in the hospital for weeks and only later discover that they are responsible for most of the costs of their stay.

This is because Medicare is very particular about when it will pay for hospital costs.

For Medicare to pick up the bill, the patient must be classified as an inpatient. This means that the patient has been formally admitted to the hospital.

If the patient is an outpatient, Medicare will not pay and those patients who are in the hospital "under observation" are still considered to be outpatients, no matter how long they are actually in the hospital.

The story is picked up by The New York Times in "Under 'Observation' Some Hospital Patients Face Big Bills."

Elder law advocates have long pointed out that the rule is absurd.

The patient does not always get to choose what the hospital writes down in the file. The patient also does not always know the importance of being formally admitted, instead of just being under observation.

There has never been a way for the patients to challenge their designations later, until now.

A judge in Connecticut has recently opened the door for legal challenges.

Reference: New York Times (Sep. 1, 2017) "Under 'Observation' Some Hospital Patients Face Big Bills."


Elder Law Estate Planning

Most of the time, estate planning is not just about a deceased person’s estate. It is also about elder law options. MP900439352[1]

A long time ago, only wealthy people had estate plans prepared and the early estate planning options evolved to reflect their needs. They needed wills and trusts to pass down their wealth to their heirs.

Eventually, more and more people started getting estate plans and the planning needs of the non-wealthy began to receive more consideration.

One of the things they needed to address was how to pay for nursing home care, when a non-wealthy person needed it.

Elder law grew out of that concern, as the Times Herald-Record pointed out in “Plenty of reasons to do elder law estate planning.”

As a result of that history, when people do estate planning today, they normally take care of many of their expected elder law needs.

Elder law estate planning attorneys help people figure out how to pay for possible nursing home care.

Elder law estate planning attorneys get their clients general durable power of attorneys and health care powers of attorney, so their clients are prepared if they are ever incapacitated.

Elder law estate planning attorneys write living wills for their clients, so their clients can decide whether or not they want to live in a coma with no chance of recovery.

Elder law estate planning attorneys also help their clients avoid the possibility of being the victims of elder financial abuse.

If you are interested in any of those elder law options, and you should be interested in all of them, then visit an elder law estate planning attorney.

Reference: Times Herald-Record (July 5, 2017) “Plenty of reasons to do elder law estate planning

Medicare Penalty Waived for Some

Bigstock-Doctor-with-female-patient-21258332[1]People who are eligible for Medicare and who do not sign up on time can face stiff penalties. Some of them have been granted a small window to have those penalties waived.

The federal government has always been particular about Medicare. Eligible people either sign up at the right time or they face stiff penalties, if they attempt to sign up later.

Elder law advocates have always thought that this was a harsh way to penalize many people who simply made honest mistakes and were not aware of those penalties.

Advocates' complaints have typically fallen on deaf ears, since the government was more concerned about cost controls. However, an important victory has been won for some who would otherwise face penalties for not signing up for Medicare on time.

NPR reports on this latest development in "Feds to Waive Penalties for Some Who Signed up Late for Medicare."

People who purchased their health insurance through the Affordable Care Act's marketplaces were not made aware that they needed to sign up for Medicare, when they became eligible.

When looking at the marketplace website, it appeared they were doing everything properly as long as they continued to purchase insurance on the marketplace. They have been granted a waiver of the penalties.

People affected will need to apply for the waiver. They only have until Sept. 30, 2017 to do so.

This waiver is only being granted to those who continued to purchase insurance through the Affordable Care Act, but it is an important step for many elderly people.

Reference: NPR (June 6, 2017) "Feds to Waive Penalties for Some Who Signed up Late for Medicare."


Food Stamp Reductions Possible

Bigstock-Elder-Couple-With-Bills-3557267[1]It might not intuitively seem like an elder law issue, but President Trump's plan to cut federal food stamp assistance is definitely something that elder law advocates should monitor closely.

When the Trump administration recently released a proposed budget, one thing took many people by surprise. The budget proposed drastic cuts to the Supplemental Nutrition Assistance Program (SNAP), more commonly referred to as food stamps.

Much of the media coverage on the proposal has focused on new additional work requirements that are being proposed on the program, how it might affect children, or in CNBC's case, how it will impact retailers in "Trump's plan to slash food stamp assistance would be a major setback for these retailers."

However, there is another group of Americans that could be adversely affected, if the proposal becomes law: the elderly.

Millions of American seniors rely on receiving food stamps to make ends meet every month.  Since many of them are unable to go back to work, they do not have an obvious way to make up the difference, should they lose their assistance.

To be fair, the Trump administration is expecting the states to make up the difference from federal cuts. That might happen, but it will be a state by state battle to see that it does.

Elder law advocates need to pay attention to this issue to make sure seniors do not lose the assistance that many of them desperately need.

Reference: CNBC (June 2, 2017) "Trump's plan to slash food stamp assistance would be a major setback for these retailers."

Retiring in Your Home

MP900302913[1]Most people would prefer to stay where they currently live when they retire. That means that they need to do some planning.

Generally speaking, the longer elderly people can remain in their homes, the better off they will be. It is good for the elderly to stay where they are comfortable and where they have built up support networks of friends and family.

It is certainly what most people would prefer to a nursing home.  It is also normally better than moving to a new home that a person is not used to. Nevertheless, if aging in place is what you would prefer when you retire, then it is important that you take stock of your home to see if that will be possible.

The New York Times reported on this in "Planning to Age in Place? Find a Contractor Now."

Most homes are not designed and built with the elderly in mind. If nothing else, most homes have far too many stairs that are frequently difficult for elderly people to navigate.

Older homes can be even worse.

For example, many older homes have smaller doorways. Consequently, someone in a wheelchair cannot comfortably get through such doorways, if they can at all.

There are all sorts of things you might not even think about, that can make a home a bad place for an elderly person to live.

Therefore, if you would like to stay in your home in your later years, you need to plan for that now.

Your home most likely needs to be remodeled in some ways to make it safer and more livable. That should be done before the changes are absolutely necessary.

Reference: New York Times (May 19, 2017) "Planning to Age in Place? Find a Contractor Now."

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Handling Death in the U.S.

Bigstock-Doctor-with-female-patient-21258332[1]Studies continue to show that the how and when Americans would prefer to pass away, is not how they actually pass away. That needs to change.

Most of the time, the medical profession treats its patients in keeping with what the patients want. If someone has a broken leg, for example, then doctors set the leg, put a cast on it and let it heal.

That is what people want.

When we get sick, doctors give us the best known treatment for whatever disease we have and everyone is satisfied. However, this does not necessarily hold true when people are at the end of their lives.

What medical professionals do at the end of their patients’ lives, is not what studies suggest patients necessarily want, as The New York Times reports in “We’re Bad at Death. Can We Talk?

The disconnect at the end of life between doctors and patients, stems from the fact that doctors are trained to do everything they can to sustain life. On the other hand, most patients would prefer to be let go with the least amount of pain and discomfort.

This leads to terminally ill patients being placed in intensive care units on artificial life support, when they would prefer to be placed in palliative care or return home so that they can pass away in peace.

This is something that needs to be addressed by the medical community.

There is something you can do about it for yourself. You can get advanced medical directives to let doctors know what you want, when you are terminally ill. At Profit Law Firm, we prepare Advanced Medical Directives as part of basic estate planning.

Reference: New York Times (May 10, 2017) “We’re Bad at Death. Can We Talk?


Just Living Together After 50

Bigstock-Senior-Couple-8161132[2]More and more elder Americans are choosing not to get married to their partners. Instead, they are just living together.

The trend over the last few decades has been for people to get remarried late in life. This has created  many issues for estate planning and the families of the people who do get remarried.

That trend is starting to reverse, but that does not mean people are not finding companionship in their retirement years.

Today, rather than getting married, many elderly people are just moving in together and foregoing a marriage certificate, according to The New York Times in "More Older Couples Are 'Shacking Up'."

While this might solve some problems, such as getting around the laws of intestate and spousal election to make sure that any assets go to the children and remain in the family, it does not solve all of the problems. Instead, it creates a different set of problems that need to be worked through in an estate plan.

If two elderly people are living together, it becomes important to create estate plans that do not leave one of them in a bad position when the other passes away.

You do not want to create a situation where a partner is unable to afford the rent after you pass away or gets kicked out of the property you own by your heirs.

These do not need to be major problems with proper estate planning, but they can be without that planning.

Reference: New York Times (May 8, 2017) "More Older Couples Are 'Shacking Up'."


Death Has Changed A Lot

MP900407501[1]How, when and where people pass away has changed in the last 100 years. Evidence suggests that people are not entirely happy about that.

A long time ago, most people passed away in their homes. There were not many hospitals or hospices for people to go to, when they were terminally ill.

There are now many of those places and most people pass away in some sort of facility.

That has been both good and bad.

People generally like that they do not die as young and from as many diseases as people used to, but most people would still rather die in their homes than in a facility, as the Economist reports in "How to have a better death."

In fact, the majority of people are not happy that they cannot choose when and where to die.  People are often given life-saving treatment by doctors that they do not want.

It is important that people take some matters they can control into their own hands.  Maryland, the District of Columbia and Virginia and other states allow people to choose living wills that specify when and what type of treatment, if any, they should receive, under different circumstances.  These states also allow people to designate a person who can make personal healthcare decisions for them, if they are unable to do so, for example if they are in a coma.

Everyone should have advanced medical directives, at a minimum, that dictate what procedures doctors can and cannot use to prolong their lives. Maryland living wills are called advance medical directives and they allow people to control healthcare decisions in catastrophic situations, where they can't communicate.

Reference: Economist (April 29, 2017) "How to have a better death."


Mary Kills People

Bigstock-Doctor-with-female-patient-21258332[2]If you have ever wanted to watch a television drama about physician-assisted suicide, you now have your chance.

A normal television show about a brilliant emergency room doctor who kills people in her off hours, would probably be a very dark drama about a serial killer, if there was such a show at all.

Normally, doctors are treated on television as nothing but heroic and rarely involved in anything too controversial. However, a drama from Canada now airing in the U.S., seeks to tell a different story.

In this show, the brilliant doctor is killing people who wish to pass away. She moonlights by performing euthanasia, also known as physician-assisted suicide.

The New York Times recently reviewed the show in "Review: 'Mary Kills People,' but It's for a Good Reason."

While the Times review is somewhat mixed, that this show exists at all highlights the changing attitudes about euthanasia.

It was only a couple of decades ago when Dr. Kevorkian was seen as the evil "Doctor Death." Now, many people are taking the idea of physician-assisted suicide seriously.

A few states have recently legalized the practice and many more are considering it as part of the dying with dignity movement, which seeks to allow terminally ill people the choice of when they want to pass away and under what circumstances.

The concept, however, is still controversial since not everyone agrees it is a good idea.

This new television show is certain to draw more attention to the concept and get people talking about it even more.

Reference: New York Times (April 21, 2017) "Review: 'Mary Kills People,' but It's for a Good Reason."


Social Security Myths

MP900442211[2]A recent survey found that most Americans think they know how the Social Security program works. The same survey found that most actually have some important misunderstandings about the program.

The Social Security program seems simple enough. When you reach retirement age, you can stop working and the government will send you a check, the amount of which is based upon your income during your working years.

People understand that much which leads them to believe that they know all they need to about the program.

However, a recent survey found that most people between the ages of 55-61 believe some myths that need to be corrected, as CNBC reported in "The three biggest myths about how Social Security works." The myths include:

  • Many people think that when they become eligible for Social Security, the government will know and automatically start sending them a monthly check. That is not true. You need to apply for Social Security and you need to do so, three months before you plan to receive it.
  • Another common misconception is the retirement age to receive full benefits. It depends on when you were born.
  • People also believe that if an ex-spouse claims Social Security benefits under their work history that it will decrease the amount of their benefits. This is also a myth. An ex-spouse's claim will result in no changes to any benefits that you will receive.

Reference: CNBC (April 25, 2017) "The three biggest myths about how Social Security works."