Elder Law

How Caregiving Can Impact Older Women

When an older woman takes care of a loved one, it can be at the expense of the caregiver’s physical, emotional, and financial health. Many women end up in poverty in retirement because they had to leave the workforce at the peak of their careers to care for someone. With more than 40 million people in America serving as unpaid caregivers for family members and most of the caregivers being women, we need to understand how caregiving can impact older women.

Caregiving Affects Our Entire Economy

When you have tens of millions of workers or former workers who have to reduce their hours or drop out of the workforce because a family member needs care, the caregivers face poverty, but our overall economy suffers as well. Whenever significant numbers of people are unemployed or under-employed, the economy loses those wages, the income taxes and everything that the person would have bought, if fully employed.

Caregivers Take a Hit on Social Security Benefits

The amount you receive in monthly Social Security retirement benefits will depend on several factors, including:

  • Your average wages for your 35 highest-earning years. Making less money a year because of caregiving will lower your Social Security check when you retire. If you have to quit work to take care of a family member before working for 35 years, those missed years will count as zero earnings, which can slash the amount of your average wages. Since our last working years tend to be when we make the most money, missing out on these years will leave you with a check based on things like your jobs during college.
  • When you retire. If you start collecting benefits early, your monthly Social Security check will be much smaller than if you can wait until full retirement age. If you can wait beyond your full retirement age, you will get a bonus added to every Social Security check you ever receive. The bonus gets larger the longer you wait to start collecting benefits, until age 70, when there is no additional bonus. You will still collect the bonuses for the rest of your life, but they will not increase in size, except for things like cost-of-living adjustments (COLA).

The Physical and Emotional Toll of Caregiving

Being responsible for someone with fragile health puts a mountain of stress on your shoulders.  Unless you have a large, involved family nearby, you might be carrying this responsibility by yourself. Imagine what would happen to an ICU nurse who was on duty 24 hours a day, seven days a week, 365 days a year. Before long, her health would suffer.

The physical and emotional exhaustion would be unbearable, yet millions of Americans call that description everyday life. When a caregiver who had to leave her job gets sick, she often does not have health insurance. Her medical bills then add to her already overwhelming stress.

Are There Solutions to the Caregiver Problem?

Most developed countries offer better supports to families, who have a person with care needs. As a result, women can stay in their labor force in much higher numbers, which helps the family’s income and the country’s overall economy. Without additional supports, American caregivers face a bleak future.

Talk with our elder law attorneys to see if your state’s regulations differ from the general law of this article.

AARP. “The Trickle-Down Effect of Caregiving on Women.” (accessed January 8, 2019) https://www.aarp.org/caregiving/basics/info-2018/women-caregiving-trickle-down-effect.html

Professional Guardian Preys on Elderly in Nevada

Several people described their personal grief, and they read letters from several others who lost thousands of dollars and expensive heirlooms that would never be replaced because a guardian stole from elderly victims for whom she was supposed to care.

The Las Vegas Journal-Review reported in a recent article, “Ex-Nevada guardian to serve up to 40 years behind bars,” that as victims wept and told their stories of suffering during a court hearing, a shackled and seated April Parks kept her head turned and never looked their way.

Karen Kelly, Clark County’s public guardian, read through a long list of names of seniors who were victimized and lived under “intense anxiety and anguish” for the final years of their lives because of Parks and those who worked closely with her. Parks’ business partner, Mark Simmons, and her husband, Gary Neal Taylor, also were ordered to serve time in prison. The judge also ordered the three defendants to pay more than $500,000 to their victims. Parks, 53, pleaded guilty last year to exploitation, theft and perjury charges.

One woman, Barbara Ann Neely, said Parks separated her from family and friends, saying, “She was not a guardian to me.”

Neely said. “She did not protect me. As each day passed, I felt like I was in a grave, buried alive.”

Another victim compared Parks to Hitler.

The 53-year-old Parks told the judge that she accepted responsibility “but never intended harm,” adding that “things could have been done better. … We were a group practice, and honestly, I think some things got ahead of us.”

She claimed that she had a “great passion” for guardianship and took “great care and concern” in her work.

Parks was one of the most active private professional guardians in Nevada, and she frequently acted as the surrogate decision-maker for as many as 50 to 100 elderly and mentally incapacitated people at a given time. As guardian, she had total control of their finances, estates and medical decisions.

Las Vegas Journal-Review (January 4, 2019) “Ex-Nevada guardian to serve up to 40 years behind bars”

What Exactly is Long-Term Care Insurance?

Some people confuse Long-Term Care (LTC) with Long-Term Disability Insurance. The disability insurance coverage is designed to replace earned income in the event of a disability. Others think that LTC is a type of medical insurance.

nj.com’s recent article entitled “The benefits of long-term care insurance” explains that long-term care insurance isn’t meant to be disability income replacement, and it isn’t medical insurance. LTC insurance covers the varied personal needs of persons who are ill and (even temporarily) incapacitated. These needs include feeding, clothing, bathing, and driving to appointments and doing the extra washing.

Some people consider LTC insurance as what was once called “Nursing Home Insurance.” This evolved to include either care at home or care in a rehab or nursing home facility.

Married couples are especially susceptible, when one spouse becomes ill or injured because the extra costs of long-term care can eat up all their savings and bankrupt the caregiver spouse. For that reason, those in their 50’s should start to look at LTC insurance for several reasons:

  1. Annual premiums are lower when acquired at younger ages; and
  2. Aging may bring health issues in the future, which may prohibit the opportunity to buy LTC insurance coverage altogether.

There are many ways to tailor LTC coverage to make it affordable. The most critical components of an LTC insurance policy include the following:

  • The average period of need for most is three years.
  • The daily amount of coverage varies by geographical area.
  • Home care should be the same as that for care in a facility.
  • The waiting period, which determines when the coverage actually starts after the date the incapacity began.
  • Married individuals can get a combined policy with a discount.
  • An inflation rider: The daily cost of coverage will naturally increase over time with inflation, selecting a rate of inflation will ensure keeping up with rising costs in the future.

Every family should have an open discussion about potential illness or incapacity of family members, and LTC should be a part of that.

Reference: nj.com (January 6, 2019) “The benefits of long-term care insurance”

How Can I Protect a Loved One From Elder Abuse?

The (Lorain OH) Morning Journal’s recent article, “How to protect elder loved ones from abuse,” reports that the National Center on Elder Abuse says the 2010 census showed the largest number and proportion of people are 65 years old and older in the U.S. population with 40.3 million people, or about 13% of the population. By 2050, that number is expected to more than double to 83.7 million.

A 2010 national study found that financial abuse is the most commonly reported form of elder abuse followed by potential neglect, emotional mistreatment, physical mistreatment, and sexual mistreatment. With financial abuse and neglect, the courts often must get involved to limit the damage and try to get the elderly person the help they need.

When looking for elder abuse in family or friends, look for changes in their circumstances. A neighbor may become more isolated or is making decisions that are potentially harmful to themselves. There’s also self-neglect, where a senior isn’t taking good care of themselves. “New people” in their lives may also be a risk. They may want to assume control over the senior’s person’s life and exclude other people who have had longstanding relationships with the person.

Financial exploitation can take many different forms. Isolation is a critical component of financial exploitation. If a senior is isolated from the people who’ve helped them make financial decisions in the past, and then a new person comes along, that individual may try to make financial decisions for their own gain.

If you think a loved one or neighbor is suffering from elder abuse, start by just talking to them. Talk to them about some of the changes you’ve seen.

Some people are required by law to report elder abuse, and that list has recently expanded to include chiropractors, dentists, ambulance drivers, coroners and member of the clergy, among many others.

A judge can freeze a bank account and suspend powers of attorney. She can also order evaluations and require that Medicaid and Medicare applications be made for the adult. A judge can continue her orders up to six months and appoint guardians.

The best way to keep loved ones safe from this kind of elder abuse is to make sure that important legal documents like a will and powers of attorney are done while the person is still competent, and that people they trust are named to carry out those documents.

Reference: The (Lorain OH) Morning Journal (December 26, 2018) “How to protect elder loved ones from abuse”

How Companies Collect Information About You, Wherever You Are

If you are blissfully unaware of how frequently others track your everyday activities, you might be practically paranoid after you read this article. You might be surprised at how companies collect information about you, wherever you are. You might find that total strangers are electronically “looking over your shoulder” 24 hours a day.

Here are a few of the ways that companies collect information and eavesdrop on our health, shopping, and everyday activities:

  1. Discount cards. You know those cards they offer you at the register at some drugstores and other retail establishments that give you access to automatic discounts, points and other perks that seem to be freebies? Those stores do not give you those benefits out of the goodness of their hearts. Someone pays them to collect data on their customers, or they use your data for their own purposes. These cards typically track what you buy and who you are – your name and address.
  2. Public Wifi. Sure, you can save a bundle by using public wifi at the library, coffeehouse, or other hotspots, but you leave yourself highly vulnerable to hackers and people using “packet sniffers.” These devices can capture which websites you visit and the data that you send to them, like your name, address, date of birth, and credit card information.
  3. Medical gadgets. If you have a defibrillator or pacemaker implanted, the device could have a connection to your doctor or hospital and transmit your medical information to them. While your cardiac data might sound innocuous, cardiologists say that such devices collect information about you that can give your health insurance company a mountain of data.
  4. DNA kits for genealogy research. You want a definitive answer to the family lore about where your ancestors came from, so you order a kit, spit into a tube and send it off to a lab somewhere. Guess what? Law enforcement detectives can get access to your DNA information from those companies.
  5. Fitness trackers. Many people boast of losing weight and getting into better shape because of a gizmo they strap around their wrists. Fitness trackers can give you a wealth of information, like your heart rate (24/7), the number of steps you take every day, what you eat, your weight and BMI (body mass index), the route you take on your walks or runs and when and how long you sleep. Millions of Americans use fitness trackers that send their information to their employer and health insurance companies. Do you really want them to have that information?
  6. Rental cars. When you connect your cell phone to a rental car’s electronics system, subsequent users can scroll through the car’s system menus to see what phone calls you made. Some cars even allow them to access all of the contacts on your phone if the rental car’s electronics system downloads them.
  7. “Smart” gadgets and appliances in your home. You might love having Alexa order things for you or play music, but the companies that provide smart speaker services record everything people in your home say, whether you are talking to the gadget or not. Smart TVs, appliances, lighting, and anything else in your home that you can control with an app on your cell phone, gives companies access to what goes on inside what you thought was the privacy of your home, as well as your personal data. One expert calls smart speakers “a personal data fire hose squirting from your house.”

How to Protect Yourself

There are ways to help limit some ways companies collect information about you. Some browsers, like Epic Privacy Browser or Tor, prevent bystanders from harvesting your online activity and do not let websites track you. A Virtual Private Network (VPN) is another option for securing your online activity.

Some search engines do not allow others to access your search history and they block ad trackers. DuckDuckGo and StartPage are two examples of these search engines.

If an app that controls something in your house wants access to your contacts, photos, or other information, try to run the app without granting that access.

Talk with our elder law attorneys about how your state’s regulations might differ from the general law of this article since all states have unique rules.

References: AARP. “How Companies Are Tracking Your Data.” (accessed December 20, 2018) https://www.aarp.org/money/scams-fraud/info-2018/where-companies-are-tracking-data.html

How Do I Discuss Care With My Aging Parents?

Discussing the next steps for aging parents isn’t an easy conversation, but if you plan ahead it can be less painful for everyone involved, says KARE 11 in Minneapolis in the article, “Making the best care decisions for aging parents.”

Many families find this out the hard way. When an aging parent requires immediate urgent care, the family must jump into “go” mode. It can be overwhelming. There are many options, which range from various levels of in-home care, to independent living, to assisted living and even to skilled nursing care. You should understand the level of care you need and what you can afford.

Unless you qualify for Medicaid, you’ll need to pay for assisted living out of your own pocket. For most of us, this could drain assets in short order. Many people also aren’t planning for long-term care in retirement.

It’s best to plan early. If you’re going to buy a long-term care policy, the best time to apply is in your 40s or 50s, when your health is good and the cost is cheaper.

Sit down with our elder law attorneys, regardless of your assets, because the laws concerning Medicare and Medicaid are confusing. Every situation is also different.

Many people aren’t aware that Medicare doesn’t cover many long-term care services. In fact, that limited benefit is designed to get somebody back to independent living, not help them with basic activities of daily living. Therefore, if it becomes a situation where an aging parent is going to need help with such basics as dressing, bathing and other activities of daily life for the rest of their life, Medicare is not going to cover it.

If you believe gifting your estate away now will stop you from losing it in the future, remember that most states have a five-year look back period. Any gifts of money or property in the 60 months before applying for Medicaid, can be taken back to pay for the program or the applicant will be penalized.

It’s difficult enough to make the decision to place your aging parent in someone else’s care, let alone to fret about how you’re going to pay for it. Plan now, if you can.

Reference: KARE 11 (Minneapolis) (November 27, 2018) “Making the best care decisions for aging parents”

New Medicaid Bill Introduced on Spousal Impoverishment Rules

Typically, to financially qualify for Medicaid long-term services and supports (LTSS), a person must meet specific low-income and asset requirements. Marriage often makes working through those eligibility requirements more difficult. It can mean potentially placing a spouse in the position to “spend down” or bankrupt themselves to secure care support for their partner.

Home Health Care News reports in a recent article, “Medicaid Bill Would Prevent Spousal Impoverishment as Route to Home Care Coverage,” that as of August 2018, more than 73 million people combined were enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). Those numbers are from federal Medicaid data; more than 66 million individuals were enrolled in Medicaid, while about 6.5 million were enrolled in CHIP.

In order to prevent self-induced bankruptcy to keep a spouse eligible for Medicaid, Congress created spousal impoverishment rules in the late 1980s. Those rules originally required states to protect part of a married couple’s income and assets to give the “community spouse” adequate living expenses, when determining nursing home financial eligibility. However, states were also given the option to apply the rules to home and community-based services (HCBS) waivers.

Section 2404 of the Affordable Care Act (ACA) changed that and required the spousal impoverishment rules to treat Medicaid HCBS and institutional care the same way. That law is set to expire at the end of December. That means that individual states would once again be the decision-makers, when it comes to spousal impoverishment in home care.

In 2018, all 50 states were applying the spousal impoverishment rules to HCBS waivers, and five states (Arkansas, Illinois, Maine, Minnesota, and New Hampshire) plan to stop applying the spousal impoverishment rules to some or all of their HCBS waivers, if Section 2404 expires at the end of the year.

With support from LeadingAge, the National PACE Association, the National Council on Aging and several other groups, U.S. Representatives Debbie Dingell (D-Mich.) and Fred Upton (R-Mich.) on Friday introduced the Protecting Married Seniors from Impoverishment Act. If the bipartisan piece of legislation passes, it would permanently extend spousal impoverishment protections for Medicaid beneficiaries receiving long-term care in a home or community care setting.

“Our long-term care system is broken,” Rep. Dingell said in a statement. “Seniors and their families already face too many challenges when navigating long-term care, and they should not have to get divorced or go broke, just to be eligible for the care they need.”

It’s not known the level of Congressional support the Protecting Married Senior from Impoverishment Act will get, but the fact that most states plan to continue protections on an optional basis is encouraging, LeadingAge President and CEO Katie Smith Sloan said in a statement.

“As a national organization, LeadingAge has consistently supported federal law establishing protections against spousal impoverishment,” Sloan said. “We support the legislation to extend the current protection.”

LeadingAge in Washington, D.C is an industry association that represents more than 6,000 not-for-profit senior care providers. If the Dingell-Upton bill fails, LeadingAge members in states that don’t plan to continue impoverishment protections will likely be negatively affected.

The National Academy of Elder Law Attorneys, Inc., the National Association for Home Care & Hospice, and AARP are the three organizations lobbying on issues, such as “spousal impoverishment” in the past two years.

Reference: Home Health Care News (November 19, 2018) “Medicaid Bill Would Prevent Spousal Impoverishment as Route to Home Care Coverage”

Will My Medicare Premiums Go Up Next Year?

The Centers for Medicare & Medicaid Services has recently announced that most seniors will pay $135.50 per month for Medicare Part B in 2019. That’s a bit of a nudge up from $134 per month in 2018.

Kiplinger’s recent article, “What You’ll Pay for Medicare Premiums in 2019,” reports that a few Medicare beneficiaries (about 3.5%) will pay somewhat less because the cost-of-living increase in their Social Security benefits isn’t big enough to cover the full premium increase. The “hold-harmless provision” keeps enrollees’ annual increases in Medicare premiums from rising above their cost-of-living increases in Social Security benefits, if their premiums are automatically deducted from their Social Security payments. Social Security benefits are increasing by 2.8% in 2019, which will cover the increase in premiums for most seniors.

Premium increases are also pretty slight for most higher-income beneficiaries. Who are they? Those with adjusted gross income plus tax-exempt interest income of more than $85,000, if single or $170,000, if married filing jointly. These people already pay a high-income surcharge. However, a new surcharge tier will apply in 2019 for people with the highest incomes. Thus, monthly premiums for higher-income beneficiaries will be between $189.60 to $460.50 per person, based on their income.

If your income is $85,001 to $107,000 (or $170,001 to $214,000 if filing jointly), your monthly premium will go from $187.50 to $189.60. Monthly premiums for singles with an income of $107,001 to $133,500 (joint filers with income of $214,001 to $267,000) will be $270.90 (that’s up from $267.90).  Premiums for singles earning $133,501 to $160,000 ($267,001 to $320,000 for joint filers) will increase from $348.30 to $352.20.

If your income was greater than that, your monthly premium for 2018 was $428.60. In 2019, again, there’ll be an extra surcharge tier for people with the highest income. These high-income surcharges for 2019, are typically based on 2017 income. You can contest the surcharge, if you’ve had life-changing events that may have dropped your income since then. This includes retirement, divorce or the death of a spouse.

If your income is in the range of $160,001 to $499,999 ($320,001 to $749,999 for joint filers), you’ll pay $433.40 per month. Single filers with income of $500,000 or more ($750,000 or more for joint filers) will pay $460.50 per month.

Deductibles will also go up in 2019: the deductible for Medicare Part A, which covers hospital services, will increase from $1,340 in 2018 to $1,364 in 2019. The deductible for Medicare Part B, which covers physician services and other outpatient services, will see a small increase from $183 to $185.

Reference: Kiplinger (October 12, 2018) “What You’ll Pay for Medicare Premiums in 2019”
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