by Jerrold Bartholomew on September 16, 2008
Mary Ellen Geist, formerly a high-powered New York radio journalist, has written about her experiences as a caregiver for her father. Her book, Measure of the Heart, tells her story of returning home to Michigan to care for her father suffering from Alzheimer’s. MSNBC recently interviewed Mary (video here) and provided a number of excerpts from her new book here.
Perhaps the most stunning aspect of her story is her first-hand account of the breadth of the care-giving generation. Statistics show that the population with Alzheimer’s or some other disabling condition is increasing with the aging of the population. The consequence is that the number of caregivers is also increasing. As Mary Ellen Geist writes:
It is safe to say that each day in the United States dozens of daughters and sons are contemplating transferring jobs or quitting them altogether to respond to the needs of aging parents.
She describes a hidden community of caregivers who know each other at first sight:
We find each other easily in crowds. The daughters — we look each other in the eye, as if to ask, Where’s your husband? Where are your children? Are you single, too? Did you leave your life in a big city to come home to help your parents, too?
We often have unkempt hair, no makeup, and a look of exasperation in our eyes. We are trying to hide the fact that we have just wrestled our parents into tennis shoes after coaxing them to finish their cereal and explaining to them what pills are and why they have to take them, and where we are going today. I see faces that look like my mother’s that seem to say, This shouldn’t be happening to me. I don’t deserve this. This was supposed to be the best time in our lives….
Mary Ellen Geist seems to be at her best when she relates how the time with her father is redeemed. Helping him to through his illness has its own unexpected, bittersweet rewards:
He’s always so glad to hear about the history of our family, and each time it is brand new. After I tell him that each of us went to college and what has transpired since then in our lives, he says, “Aren’t we lucky?”
Indeed, the title of the book is taken from the transformation of her own values and outlook that has taken place since she gave up her city life and moved back home to be with her family:
Some of us realize that we are coming home not only to help do the remembering for our Alzheimer’s-afflicted parents, but also to remember something very important about ourselves. We are coming home to learn how to measure our lives by new standards that we’ve never explored before, to measure our lives in a different way. Instead of defining ourselves by our careers, we’re defining ourselves by the amount of love our hearts can hold.
by Jerrold Bartholomew on August 1, 2008
Question: I approached my local Veterans’ Administration office for information about the Aid and Attendance Pension. They told me I had too much money to receive the pension. But I have reoccurring medical expenses of more than $1,000.00 per month. Is there anything I can do?
Answer: This is a delicate situation. On the one hand, some estate planning could allow you to qualify for the Aid and Attendance Pension. On the other, you would be mistaken to think that qualification for the Aid and Attendance Pension alone is sufficient. You need to be planning ahead for Medicaid long-term care at the same time that you are qualifying for veterans’ benefits. [click to continue…]
by Jerrold Bartholomew on July 5, 2008
Perhaps the most important lesson an estate planning attorney can convey to a client is that your end-of-life decisions will be made for you-and possibly expose your estate to significant and unnecessary expense-unless you create legally enforceable estate plan documents. Without a clear expression of your wishes, some of your most important decisions may be made by a family member, a stranger, or a probate judge who may have no idea what your real wishes were. This can lead to increased costs, family disagreements, and other forms of waste. Several types of legal documents can help you and your family avoid these problems:
- A medical power of attorney is used to appoint someone to make your medical decisions and provide that person with guidance regarding your wishes.
- A financial power of attorney appoints someone to make your financial decisions. There are many different types of financial powers of attorney with significant differences between them. For example, whether your agent has the power to make gifts to others can have tax implications, as well as expose your estate to risk. On the other hand, without gifting authority, Medicaid planning can become more difficult. [click to continue…]
by Jerrold Bartholomew on April 24, 2008
Sue Schiebel has written an excellent article on Medicaid Planning. While her article concerns MassHealth, which is the Massachusetts Medicaid program, the rules and ideas explained are the same in Michigan. She writes:
A lot of middle-aged people don’t realize Medicare, the federal health insurance program, pays for a very limited amount of skilled nursing home care. As we live longer, that means more of us will have to spend our own money for long-term care or must rely on MassHealth, the state health insurance for low income people. Many people wind up doing both — first using up many of their own assets to “spend down” to Medicaid limits so they are financially eligible for state help.
Medicaid qualification is a complex area of the law. To highlight just one counter-intuitive aspect, consider that donations to a church or charity are treated as gifts under the law. One making such a gift is technically creating a period of ineligibility for Medicaid. Strictly speaking, a person making significant donations to a church could be ineligible for Medicaid for several months after all other assets have been spent down. An elder law attorney helps families cope with these bizarre rules and avoid such unfortunate results.
by Jerrold Bartholomew on April 24, 2008
Many of my clients are uneasy about placing their assets into a trust as part of an asset protection plan. In order to demystify the process and help you understand why you might consider having a trust drafted for your specific needs, I would like to explain some of the reasons you might consider having a trust and little bit of how a trust works.
Trusts are an important part of elder law and estate planning. Elder law is really the art and science of preserving personal and financial independence for seniors. Many forces threaten a senior’s independence, from ailing health to limited finances to extensive regulatory systems. The goal in creating comprehensive estate plans is to extend resources as much as possible and to create options. How is this possible? The right trust agreement is an important tool for achieving this goal.
[click to continue…]
by Jerrold Bartholomew on April 7, 2008
Retirement assets (401ks, IRAs, etc) are considered available assets for purposes of Medicaid qualification in Michigan. In simple terms, that means that those funds have to be spent down until the threshold for asset eligibility is met. In the case of a single person, asset eligibility is generally about $2,000.00, with some additional allowances for the homestead, modest life insurance and funeral expenses. In the case of a married person, the threshold is higher, and will be between $20,880.00 and $104,400.00, depending on the couple’s assets before entering the nursing home. For more details, see The Basics of Medicaid Qualification, below.
In order to avoid having to spend these assets on the cost of care, it is very common to annuitize the retirement assets. For a variety of reasons, I think this is something to avoid whenever possible. First of all, the return on such annuities is low. With inflation likely to increase in the present economic climate, it is difficult to recommend a long-term investment with a low return. An additional concern is that current law requires an annuity to pay out in level installments and in an actuarially sound manner. The days of the deferred annuity with a substantial amount held until after the passing of the owner are gone. Furthermore, under current law, the state of Michigan must be named as the remainder beneficiary after the community spouse or a disabled child. It is true that an annuity will provide secure retirement income for a community spouse, but it should be considered an alternative of last resort in light of these considerations.
[click to continue…]
by Jerrold Bartholomew on March 31, 2008
Retirement for many people is defined as the time when they are able to live off of the income from their assets combined with Social Security and perhaps a pension. But anything from a car accident to a stay in long-term care can quickly deplete retirement assets and jeopardize the fruits of a lifetime’s work. This can be particularly devastating for a married couple when one of the spouses falls ill and the assets of both must be devoted to the care of one. Medicaid law permits the Community Spouse (the spouse not in long-term care) to retain a maximum of $104,400.00 in non-exempt assets, but without planning, in many cases that amount can be lower.
[click to continue…]
by Jerrold Bartholomew on March 21, 2008
Yesterday, I learned of a case where a small insurance policy caused an extended period of ineligibility for Long Term Care Medicaid. This means it will be a long time before the nursing home bill gets paid, if ever.
by Jerrold Bartholomew on March 10, 2008
Mr. David Goldman has raised some interesting points regarding the free durable power of attorney posted here and free durable power of attorneys generally. There are many problems with such documents and I have mentioned them in the previous post. Above all, you should certainly understand that any decision you make to use such documents will be your own and cannot be based upon anything written here. Mr. Goldman takes the argument a bit further. The first point he makes is that one should read carefully to be sure “free” documents are in fact free. He found a “free” power of attorney form elsewhere that only revealed in the fine print that you would be charged $19.95 per month for downloading the document.
[click to continue…]
by Jerrold Bartholomew on March 7, 2008
The process is of applying for Medicaid long term care assistance can be somewhat difficult. The documentation requirements can be voluminous and the process will typically take at least 45 days. I have seen several recent cases take as long 4 months to be approved.
[click to continue…]
