Category Archives: Home Health Care

Planning for Long-Term Care (Part 1)

Written by Evan Farr

Are you one of the millions of Americans over age 50 who has not yet started planning for long-term care?

As financially responsible adults, most of us are prepared for some unexpected disasters – we pay for health and property damage insurance, and many of us have taken some steps toward funding for our retirement. But very few of us have prepared for one of the most devastating of unexpected events – the need for long-term care. According to most estimates, more than 60% of us will need long-term care at some point in our lives. If you are a member of the “sandwich generation” – responsible for an older parent – the odds that either you or your aging parent will need such care are even higher, and the costs to your lifestyle, finances, and security can be catastrophic. Consider the following long-term care statistics:

• About 70% of Americans who live to age 65 will need long-term care at some time in their lives, over 40 percent in a nursing home.
• As of 2011, the average cost of a nursing home in Northern Virginia was over $100,000 per year.
• A recent insurance company study found that 46 percent of its group long-term care claimants were under the age of 65 at the time of disability.

Contrast the above long-term care statistics with statistics for automobile accident claims and homeowner’s insurance claims:

• An average of only 7.2% of people per year file an automobile insurance claim.
• An average of only 6.15% of people per year file a claim on their homeowner’s insurance.

The need for long-term care drastically alters or completely eliminates the four principal retirement dreams of elderly Americans:

1. Remaining independent in the home without intervention from others
2. Maintaining good health and receiving adequate health care
3. Having enough money for everyday needs
4. Not outliving assets and income

Unfortunately, the reality is that the majority of Americans make no plans for long-term care. Not only does this lack of planning affect older Americans, but it also often has an adverse effect on the older person’s family, with sacrifices made in time, money, and family lifestyles. The stresses of being a caregiver for an older parent often result in a deterioration of the caregiver’s own physical and emotional health. Because of changing demographics and improved health care, the current generation — more than ever — needs to actively plan for long-term care.

So what are basics of a good Long-Term Care Plan? First and foremost are two critical documents that need to be prepared by an experienced and knowledgeable Elder Law Attorney. These two essential documents are:

• A Financial Durable Power of Attorney containing Asset Protection Powers; and
• An Advance Medical Directive containing a Long-Term Care Directive.

The third essential document, which you can prepare on your own, is a Lifestyle Care Plan.

Part 2 of this article will explain and explore these three critical documents to give you a greater understanding of the need for and importance of these vital long-term care planning instruments.

These essential legal documents, however, are only part of the requirements for a good Long-Term Care Plan. The other important component is a sound financial plan for how to pay for good long-term care. There are three primary ways to plan in advance for how to pay for long-term care: (1) build up your income and life savings in order to be able to self-fund your future care needs; (2) protect your assets by purchasing long-term care insurance; or (3) protect your assets by using an asset protection trust designed to legally protect your assets and allow you to qualify for Medicaid, the governmental program that pays for about 70% of people living in nursing homes. For some families, a fourth way to pay for long-term care is a type of Veteran’s pension benefit called “Aid & Attendance.”

Unfortunately, option 1 (building up your income and life savings to self-fund future care) is not feasible for most Americans, especially in these troubled economic times. Accordingly, Parts 3 through 5 of this series will explain and explore these three methods of paying for long-term care. Part 3 will focus primarily on using long-term care insurance to protect your assets; Part 4 will explore the use of a special type of asset protection trust to protect assets and gain early access to Medicaid; and Part 5 will explain the Veteran’s Aid & Attendance benefit.

There are many things that you can do now to begin to put together a good Long-Term Care Plan. The most important thing you can do is to act now! You may have limited resources in the future or health problems that will prevent you from taking care of the things you can easily take care of today. The Farr Law Firm specializes in long-term care planning and we would be happy to assist you in your preparations. Please visit us at www.virginiaelderlaw.com or call 703-691-1888.

The Reverse Mortgage Saga Part 6: “How One Reverse Mortgage Lender is Helping Americans Stay at Home”

Written by Evan Farr

I have chronicled the ups and downs of the reverse mortgage industry for the past five years.  In 2010, I exposed two major problems with the reverse mortgage industry — the “competency problem” and the “expense problem.”

  1. I praised reverse mortgages in 2007 as a viable way for seniors to remain at home as long as possible in my article, Reverse Mortgage Home Equity Loans.
  2. I viewed reverse mortgages then as an excellent choice for various reasons, explained in detail in my early-2010 article, Using a Reverse Mortgage to Pay for Home Care.
  3. By mid-2010, I wrote about what I perceived to be discrimination in the lending industry. I completely explain why that was such a nefarious issue to my clients and the elderly at-large in the article, Huge Problems with Reverse Mortgage Industry.
  4. Merely a few months later I found myself writing about the “expense problem” in, Reverse Mortgage Rules Changing Again, noting Congress’ plan to increase HUD’s Mortgage Insurance Premium.
  5. In February, 2011, I reported on the fact that one of the reverse mortgage industry’s largest lenders, Bank of America, had dropped out of the reverse mortgage business in No More Reverse Mortgages, Announces Bank of America.
  6. Last week I explained how the Farr Law Firm has taken steps to help clients get around the “competency problem,” in The Reverse Mortgage Saga Part 5: “How the Farr Law Firm is Helping Clients Stay at Home.”
  7. This week I provide an update that may signal an end to the “expense problem.”

All of these problems amounted to the beginning of the end for this national industry, because by February, 2011, Bank of America announced it was exiting the industry.  MetLife followed Bank of America’s footsteps as of April 30th, 2012.

Officially, Bank of America exited the reverse mortgage industry due to strategic business reasons.

Discussed in No More Reverse Mortgages, Announces Bank of America, the Bank cited “competing demand and priorities, [requiring resources to be allocated elsewhere.]”  However, as the article also explained:

“The Bank of America decision [came] in the wake of bad press related to its conventional mortgage business, and peaked recently when a temporary restraining order was issued January 20 of [2011] against ReconTrust, a subsidiary of Bank of America.  ‘ReconTrust is trustee on thousands of loans that are in some stage of foreclosure and approximately 8,920 of such loans have already been directly affected by this injunction,’ reported the Las Vegas Sun.   The order was issued based on a woman’s suit against Bank of America for “fraudulently trying to foreclose on her home,” as reported by The Street.”

When MetLife announced its’ plans to exit the industry on April 26, 2012, a press release was issued stating the following:

MetLife’s entire retail banking business, including mortgages, represented under two percent of [its’] 2011 operating earnings.  Given MetLife’s strategic focus as a global insurance and employee benefits leader, [it] decided in 2011 that a bank holding company structure was no longer appropriate.”  (Emphasis added)

However, just because MetLife’s retail banking business represented less than two percent of operating earnings in 2011 does not necessarily mean it was a miniscule part of its overall business, or business investments.  Was the MetLife decision truly a strategic one, or were there organizational problems beneath the surface of the press release??

After looking into the issue – that is, past the MetLife press release – it seems as if there are no such organizational distractions as may have been the case with Bank of America.  According to sources quoted by BusinessWeek, the banking sector of MetLife – including its reverse mortgage services – simply were not profitable enough to continue operations.    And the burden of increased regulatory standards may have also played a role, further tipping the scales to exit the industry, suggested The Wall Street Journal.  The bottom line is best summed up by Reverse Mortgage Daily, stating that the consensus is that unlike the Bank of America situation (where there were problems, perhaps, behind the scenes, “[The MetLife decision is] just another stop in a bigger exit strategy on the part of MetLife, which has been shedding business lines since last year and recently saw its CEO step down.”

Without Bank of America and MetLife, the national industry may be gone, but reverse mortgages are not, as they are still available through independent brokers.   The question thus becomes, whether reverse mortgages, as they currently are now offered, are worthwhile options for seniors who want to remain in their homes for as long as possible?  Furthermore, what will these institutions do to help senior citizens that the larger institutions did not?  I would say waiving the exorbitant fees is a good start.

The “Expense Problem” and one Lender’s Answer

All one needs to do is take a glance at the graph below to see how the “expense problem” affected many American’s decision-making processes when deciding whether to take a reverse mortgage, starting right around the beginning of the recession in 2009.  It is drastic, to say the least.  Although my article, Huge Problems with the Reverse Mortgage Industry mainly focused on the “Competency” problem, another lawyer aptly commented on the blog:

“[W]hat really convinced me [a reverse mortgage] was not right for my brother-in-law’s parents . . . were the very high fees charged on the mortgage.”

True to the back-and-forth nature of this entire saga, at least one lender is using a tactic to salvage the reverse mortgage home equity loan: no upfront fees!  The fees associated with a reverse mortgages have been a long-time sticking point for many people.  I received an email late last month from Ernie Castro, Director of Reverse Mortgage Finance for Mortgage Solutions, LTD.  In that email, Mr. Castro acknowledged the expense issue:

“Huge upfront fees . . . without a doubt . . . have been the #1 objection to the Reverse Mortgage during my career when discussing the product with financial professionals, elder law attorneys, and CPA’s.  Mortgage Solutions has negotiated with one of our lenders a fixed rate Reverse Mortgage with no upfront fees to the borrower…no origination fee, no upfront mortgage insurance fee, no service fee.”

The Reverse Mortgage Lenders Association shows just 73,000 reverse mortgages taken out in 2011, down from a high of 114,000 in 2009. 2012 numbers are not released in full because the fiscal year ends in October, but clearly they are on track to register the worst year since reverse mortgages became very popular in 2007, and the largest 1-year percentage-based decline in history.

What happened?  Speaking as an elder law attorney, if I were to chart my enthusiasm towards reverse mortgages for seniors as a way to remain at home longer, it would mirror this chart:

With those fees no longer a deterrent, will the industry come back to life?  Perhaps, but only if people are able to jump the “competency” hurdles.  If more elder law attorneys provide POA clients with Affidavits of Competency to get signed contemporaneously with the POA signing, then maybe, just maybe, we will see this graph reverse its’ current trend.

A Final Thought (for now)

As everyone knows in these days of financial volatility, market conditions can change quickly and without notice, so for anyone who has previously considered a reverse mortgage but balked at the unattractive fees previously associated with them, now would be a good time to speak with an elder law attorney about how to take advantage of a reverse mortgage if remaining at home for as long as possible is important to you or a loved one.

For even more elder law updates and news stories, please be sure to like our Facebook page and join the discussion!  Who knows, we may even feature your comments and opinions in a future blog post!

 

Image courtesy of FreeDigitalPhotos.net

Medicaid Benefits and At-Home Care

Written by Evan Farr

When it comes time for a child or parent to begin making plans for the beloved but aging senior in their life, the myriad of choices, paths, options and steps to take can seem endless and overwhelming–so much so that many dejectedly assume that nursing home care is the only option. But this isn’t always true! While some healthcare needs will eventually require the long-term care that a nursing home can provide, for others the goal is to stay in the comfort of their own home as long as possible. Fortunately, it IS possible to receive care at home and obtain Medicaid benefits. Medicaid application for a nursing home and for home-based care are somewhat different processes, but we regularly handle both at our Firm. In fact, home-based care is slowly becoming more popular with our clients as a means of staying in their comfort zone for as long as possible.

With this in mind, the Farr Law Firm is excited to announce a new relationship with American Care Partners @ Home Inc., a locally owned and operated at-home care agency based in Falls Church and serving the Northern Virginia area. This group offers a wide array of in-home care services, from a few hours of care a day to 24-hour round-the-clock supervision; from something as basic as simple companionship to assistance with household chores and errands. American Care Partners is unique in that their staff of physicians will conduct house calls to their patients right in their own homes, at no additional charge–“the 1940′s are back!” is what they say! And best of all, America Care Partners @Home Inc. are Medicaid approved and we look forward to working with them to attain the best possible care for our clients under Medicaid.

Another home-care company that we often recommend is HomeWell Senior Care, a nationwide organization with a very successful branch here in Virginia. HomeWell was founded by a caregiver in 1996 and focuses on “maintaining independence with quality home care for seniors.”

We at the Farr Law Firm enjoy working with these companies because they have a complete understanding of the Medicaid billing process, which makes things run smoothly. We strive to make the process of finding the best possible care for your loved one as stress-free and streamlined as possible for you and your family, and American Care Partners @ Home Inc., and HomeWell Senior Care are our integral partners in achieving that goal. If you have a parent or spouse in need of home-care, please contact the Farr Law Firm at www.farrlawfirm.com or by calling 1-703-691-1888 for your complimentary initial consultation. We can help you determine your financial options for long-term care and create the best possible care plan for your loved one.

For more information about American Care Partners @ Home Inc., visit them online at www.americancarepartnersathome.com or call at 703-261-4146.
For more information about HomeWell Senior Care, check out their website at www.homewellseniorcare.com or call 1-888-9-SENIOR.

New Medicare out-of-pocket home health care expenses for Seniors on the horizon?

Written by Evan Farr
The Medicare Payment Advisory Commission suggested Thursday one strategy to cut health care spending; the strategy would force Medicare recipients who receive home health care to pay an out-of-pocket cost.  The proposed cost is not yet certain, though sources suggest the amount may be around $150 for a series of visits.  Medicare home health care costs have steadily increased and have reached a point of about $20 billion per year, according to BusinessWeek.  Home health care can encompass home visits from care workers, nurses, therapists, and other health professionals. 
The strategy may come as unwelcome news for Medicare recipients who receive home health care.  Home health care has been free for patients, but amidst the pressures to control the federal deficit, the advisory panel is re-evaluating aspects of Medicare. 
If this suggestion becomes law, more than 3 million seniors will be affected. 
The rationale for paying for the home health care costs in the past has been based on the fact that it is cheaper to care for a person in their own home as opposed to in a hospital. 
For a description of various types of in-home care providers, AARP.org describes the similarities and differences between medical professionals, home health aides, and home care aides in this useful article.  The AARP Seniors lobby is one group opposing the proposed strategy outlined above.

A Mixed Bag in Virginia: Federal Law Prohibits 2011 Social Security Increases, but Federal Agency Grants Millions to Disadvantaged Groups

Written by Evan Farr

As Halloween approaches this year, I can’t help but draw an analogy between the nights I spent meandering my neighborhood as a kid looking for handouts, and our current economic times.  I recall my grade-school friends and I operating our minds at their collective capacities, as we planned the best streets to target and the best routes to take to get from house to house most efficiently. Some of the parents surpassed expectations and gave out the good stuff — like king size candy bars! Others doled out the less-desirable treats, such as candy corns, smarties, or the dreaded raisins.  Some neighbors, when they were gone for the evening, left out giant bowls of candy for us trick-or-treaters to help ourselves.  Other neighbors were always gone, and their houses completely dark.  But fortunately for us candy-loving kids, most or our neighbors participated in the fun of Halloween. In fact, many of our neighbors offered a variety of different candy to choose from each year.  We never knew how much candy we’d wind up with at the end of the night, or how much of the “good stuff” we’d have in our bag.

Similar to the unpredictability of household Halloween generosity encountered by children, the Federal Government is providing the public with what can appropriately be called a “mixed bag” of economic solutions. It might just depend on what house, or rather, what state you live in.

Social Security and Supplemental Security Income recipients will not receive an increase in 2011 because there has been no increase in the federal Consumer Price Index.  Read the Social Security News Release Here (released October 15, 2010).

Though the federal Social Security Administration is not able to provide an increase for its beneficiaries because of long-standing federal law that ties Social Security and Supplemental Security to the Consumer Price Index, other federal agencies, and some state agencies, are doing what they can to help alleviate the financial struggles of the elderly and disabled.

One prime example:  the federal Administration on Aging and the Centers for Medicare and Medicaid Services (both part of the U.S. Dept. of Health and Human Services) recently awarded more than $2 million in grant funding to the Virginia Department for the Aging and the Virginia Department of Medical Assistance Services, the latter being the Virginia agency that runs our state’s Medicaid system.   Read the Commonwealth of Virginia Press Release Here (released October 6, 2010).

This grant funding to Virginia’s Medicaid system comes with high hopes and great expectations. The over $2 million in funding will be used to bolster services for two key underprivileged groups – the elderly and the disabled – by alleviating burdens in the following areas:

•    Prescription drug coverage
•    Long-term care services
•    Transition support from nursing homes to community based services
•    In-home support services for sufferers of Alzheimer’s disease

In providing these much-needed funds to Virginia for the improvement of Virginia’s Medicaid program and the development of additional services for the elderly and the disabled, the Federal Government has demonstrated its continuing commitment to improving and strengthening the Medicaid system throughout the United States.  As Senator Rockefeller wrote in 2005, on the 40th anniversary of the Medicaid program,  ”taking care of our most vulnerable people is a moral obligation . . . our representative democracy has a responsibility to do for the future what we have repeatedly done in the past: protect, preserve, and strengthen Medicaid.”

Medicaid is what pays for the vast majority of nursing home care in the United States. With both the Federal Governemtn and the Virginia State Goverment now strenghtening the Medicaid program, smart long-term care planning (i.e., Medicaid Asset Protection Planning) has never been as important as it is now. According to the Virginia Department for the Aging, the population of elderly adults in Virginia will double in less than 20 years — to the point where one in five residents of Virginia is expected to be aged 65 or older.

A statistic I cited in a previous article demonstrates the importance of Medicaid Asset Protection Planning — about 70% of Americans who live to age 65 will wind up needing long-term care at some point in their lives.  For the more than 40% who will require long-term placement in a nursing home, the cost of such care will be financially devastating without a smart Medicaid Asset Protection Plan focused on structuring assets in a way that protects those assets while allowing earlier Medicaid eligibility.

For most seniors over age 65, Medicaid is the equivalent of government-subsidized long-term care insurance, just as Medicare is governement-subsidized health insurance.  But remember — the fact that Medicaid is “government-subsidized” does not mean that it’s a “handout.” On the contrary, it’s your tax dollars that fund the Medicaid program, just as it’s your tax dollars that fund Medicare.  It’s also important to note that the Federal Government and Virginia State Government both encourage Americans to engage in smart Medicaid Asset Protection Planning — for example:  there are laws that protect spouses of nursing home residents; there are laws that encourage Americans to engage in Medicaid Asset Protection by purchasing Long-Term Care Insurance “Partnership” policies; there are laws that allow the exemption of certain types of assets when applying for Medicaid; there are laws that permit individuals to qualify for Medicaid even after transferring assets to a spouse, or to a disabled family member, or to a caregiver child.  To smartly plan and protect assets while accelerating qualification for Medicaid is no different than planning ahead to maximize your income tax deductions in order to minimize your income taxes.   It is no different than taking advantage of tax-free municipal bonds.  It is no different than planning your estate to avoid estate taxes (which, incidentally, a lot more people are going to be doing again next year when the Federal Estate Tax returns with a vengeance – with an Exemption Equivalent Amount of only $1 million – but that’s for another article . . . ).

At a time when much federal spending leads to controversy, Medicaid is an example of the government legitimately promoting the best interests of society.  Similar to how my mom always made sure I ate a well-balanced dinner before embarking upon my annual October 31st sugar binge, our Federal Government and State Government are truly looking after the citizens of America (even in these gloomy economic times) by directing funds to programs that benefit and protect our most fragile citizens — the elderly and disabled.

The Farr Law Firm specializes in Family Protection Planning (i.e., Estate Planning, Incapacity Planning, and Medicaid Asset Protection Planning), and we are here to help you.  If you have not yet done your Family Protection Planning, I encourage you to call us to take advantage of a free consultation to determine the planning solution that’s best for you and your family.

Reverse Mortgage Rules Changing Again

Written by Evan Farr
money-question-markI’ve written several times over the years on the topic of Reverse Mortgages.  My first article explained the concept and requirements of a Reverse Mortgage and how seniors can use a reverse mortgage.  My second article, entitled Using a Reverse Mortgage to Pay for Home Care, explained how the Reverse Mortgage can be used as a tool to help seniors stay in their homes and age in place.  My most recent article, entitled Huge Problem with Reverse Mortgage Industry, raised a nationwide alarm about how the reverse mortgage industry is “shooting itself in its collective foot” (and, I believe, discriminating against disabled and incapacitated adults) by routinely second-guessing the legitimacy of every power of attorney document and therefore imposing unnecessary obstacles for, and sometimes turning away, the very people who need a reverse mortgage the most — those frail elders who are unable to care for themselves but wish to remain at home and age in place rather than being forced to sell their homes and move into a long-term care facility.  Here’s the link for the ElderLawAnswers article which picked up on my concerns and confirmed the enormous scope of this problem.
 
Now, having already maimed itself with the power of attorney fiasco, the reverse mortgage industry seems intent on digging its own grave.   According to Stephen Pepe, JD, a Reverse Mortgage Consultant with MetLife Bank, there are big changes coming soon to the HECM Reverse Mortgage programs, changes which for many seniors are going to significantly increase the expenses of obtaining a reverse mortgage after October 4, 2010, while also making the reverse mortgage counseling process “much longer and more involveddue to significant changes in HUD’s HECM counseling protocol.”
 
In an email sent to the members of the National Academy of Elder Law Attorneys, Pepe explained as follows:
 
“Congress and HUD have made some significant changes to the Home Equity Conversion Mortgage (HECM) reverse mortgage program that take effect on October 4, 2010. These changes impact any applicant that does not have an FHA Case Number assigned to his or her HECM application before that date.”

Specifically, Pepe says that HUD’s ongoing Mortgage Insurance Premium will be increasing from 0.5% to 1.25% (a 150% increase!), and that the size of new HECM reverse mortgages will shrink anywhere from 1% to 5% depending on the applicant’s age.

However, Pepe also points out that homeowners will soon have a second HECM reverse mortgage option, called the “HECM Saver.” According to Pepe, the HECM Saver is a smaller and less expensive reverse mortgage. Under the HECM Saver, a reverse mortgage applicant will gain access to significantly less money, but in return, says Pepe, “HUD will waive its pricey Initial Insurance Premium, saving the applicant up to $12,510 in initial costs.” 

Pepe did not mention whether HUD will be waiving or reducing the ongoing Mortgage Insurance Premium, so I’m guessing it won’t be.
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Using a Reverse Mortgage to Pay for Home Care

Written by Evan Farr

Many of my clients ask me how I feel about reverse mortgages, and even more so this past week because of a favorable story that appeared in last week’s Washington Post entitled “Reverse Mortgages are Not the Next Subprime.”  This excellent article was written by the ”Mortgage Professor,” a Professor of Finance Emeritus at the Wharton School of the University of Pennsylvania (incidentally, my Alma Mater), and clears up much of the confusion and myths and fears surrounding the reverse mortgage.  I encourage all of you to read it.  Another good source of information about reverse mortgages is the Federal Trade Commission Fact Sheet

As a Certified Elder Law attorney, one of my primary goals is to help preserve the dignity and enhance the lives of my elderly clients.  For many of my clients, remaining in their homes as long as possible is one of their highest priorities.  I have been a long-time fan of reverse mortgages because they help my clients do exactly that — remain in their homes as long as possible.  

Why? Because in order to remain in your home as long as possible, you will most likely at some point need some home care.  “Home Care” can be health care and/or supportive care provided formally in your home by health care professionals (typically referred to as home health aides) or by paid or unpaid family members or friends (typically referred to as caregivers).  Often, the term “home care” is used to mean non-medical care, or custodial care, which may be provided by persons who are not nurses, doctors, or other licensed medical personnel.  The term “home health care” typically refers to care that is provided by a licensed health care professional — most often a Certified Nurse Assistant (CNA).  However, the terms are often used interchangeably, and for simplicity in this article I will use the term “home care” to refer to both types of care.

The goal of home care is typically to to allow you to remain at home and age in place, rather than being forced to move to an assisted living facility or nursing home.  Home Care providers render services in your own home. These services typically include a combination of health care services and life assistance services.

Health care services may include services such as wound care, administration of medication, physical therapy, speech therapy, and occupational therapy.  Life assistance services typically include help with daily tasks such as meal preparation, medication reminders, laundry, light housekeeping, errands, shopping, transportation, companionship, and help with the activities of daily living (ADLs), which typically refers to six activities (bathing, dressing, transferring, using the toilet, eating, and walking). 

Although some home care is provided by family members for free, most family caregivers need to be paid, and these payment arrangements should always be made pursuant to a written caregiver contract (prepared by an Elder Law Attorney) between the caregiver and the care recipient.  Because home care is quite expensive, having the proceeds from a reverse mortgage is often one of the  only ways that elders can afford to pay for appropriate home care. According to The 2009 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and Home Care Costs, the 2009 national average hourly rate for home health aides increased by 5.0% from $20 in 2008 to $21 in 2009. The national average hourly rate for homemaker/companions increased by 5.6% from $18 in 2008 to $19 in 2009. 

Most of my clients, when they start out needing home care, will typically start with receiving 4 hours of care 3 days a week, which costs about $1,000 per month and is easily affordable for many people.  But over time, most of my clients progress to the point of needing upwards of 12 hours per day of home care, costing over $7,000 per month, and very few people can afford to pay for this type of care without eventually tapping into their home equity via a reverse mortgage.

The most common type of reverse mortgage is the Home Equity Conversion Mortgage (HECM), which completely protects your ability to remain in your home. So long as you pay your property taxes and homeowners insurance, and maintain your property, you can remain in your home forever. If the reverse mortgage lender fails, any unmet payment obligation to the borrower will be assumed by FHA. 

According to the Mortgage Professor’s article mentioned in my first paragraph, in 2009 about 130,000 HECMs were written, and feedback from borrowers has been mostly positive. In a 2006 survey of borrowers by AARP, 93% said that their reverse mortgage had a mostly positive effect on their lives.

For many of my clients, a reverse mortgage is the best way, and often the only way, for them to be able to afford to remain at home, despite the fact that reverse mortgages are expensive to obtain.  However, reverse mortgages are not for everyone, as there are other programs that may be able to help you remain in your home.  For instance, many of my clients are eligible for the Veterans Aid and Attendance benefit or for home-based Medicaid, or can be made eligible for these benefits through our process of Asset Protection

Whether you own your home outright or in a Revocable Living Trust or in my proprietary  Living Trust PlusTM Asset Protection Trust, if you think a reverse mortgage might be the solution you need, please contact me for a free consultation so I can evaluate your specific situation and advise you as to whether a reverse mortgage is your best option for allowing you to live comfortably in your home.

Who Was Supposed To Be Watching Grandma?

Written by Evan Farr

There is a popular tune played this time of year called “Grandma Got Run Over by A Reindeer” which relates that Grandma — after drinking too much eggnog — went out into the winter cold to get her medication and was run over by a reindeer. The question is . . .  “Who was supposed to be watching Grandma?”

Though this little tune is just for fun, it may very well raise alarms to many caregivers of the elderly. Caregivers know that even at a holiday party they cannot let down their diligent watch over their elderly loved one. As far-fetched as it may sound, with all the people and noise, an elderly family member with dementia or Alzheimer’s may be enjoying the family gathering and then suddenly become confused and walk to the door and leave.

For family caregivers the added stress of the holidays with decorating, shopping, parties and keeping up with all the family traditions is an overwhelming quest. Feelings of isolation, depression and sadness come with this added stress. There are millions of Americans who are caring for elderly frail loved ones and most of these caregivers will go through some of these emotions, especially this time of year.

There are some things you can do as a caregiver to help you and those you care for enjoy the holiday season.

First take care of yourself. Try to eat right, get plenty of sleep and exercise. This will help reduce stress and strengthen your ability to cope with caregiving responsibilities.

Prioritize your holiday traditions. Perhaps instead of cooking a large family dinner, have everyone bring his or her favorite dish. Use paper plates. Forfeit the traditional outside light decorating for a lighted wreath on the front door. Choose one or two parties or concerts to attend instead of trying to do it all.

Arrange for help. Call on other family members to help with the caregiving while you do your shopping or go out for the evening. If family is not available, ask your church group or a neighbor if they would donate a few hours.

Use community services. Many senior centers provide meals for the elderly and supervised activities, onsite, at no charge or a minimal charge. For locating senior services in your state, call your state Area Agency on Aging or check the national locator website at http://www.n4a.org/

Use adult day care services. Some assisted living facilities provide day activities and meals for seniors on a day by day basis. Other organizations called “adult day service providers” specialize exclusively in this sort of care support at a reasonable cost. These support services provide respite for caregivers from their caregiving responsibilities as well as social interaction for their elderly family members. There is a cost for adult day services, but the benefit for all is worth it.

Technology to the rescue. Here is a solution that would have kept “Grandma” from going out in the winter cold and getting run over by a reindeer. Companies that have created monitoring systems, security alarms and other safety equipment are “tweaking” them to adapt to the needs of seniors and their care givers.

Here are a few examples:

  • Ankle or wrist bands that monitor location and alert the provider when a person has gone beyond the designated perimeter, such as out the front door of the house.
  • Motion detectors. Set throughout the home, motion detectors allow someone outside the home to follow a senior as he or she moves through the house.
  • Smart medication dispensers. Live monitoring and dispensing of pills.
  • Emergency response alert. At a touch of a button on a desktop monitor, bracelet or necklace, emergency help is summoned.

Whether providing care in your home or helping senior family members in their own homes, your use of monitoring and “tech” help aids can provide extra safety for your loved ones, and peace of mind for you.

You are not alone. Join a caregiving help group. Your local senior center may have one or go on the internet to find one. Hearing about other caregivers’ problems and solutions and being able to share your own and ask questions is a great way to relieve stress and gain a new perspective. Check out websites like the National Family Caregivers Association at http://www.nfcacares.org/

Work with a Senior Care Professional. Recognize that you are doing the very best you know how. You are not a geriatric health care practitioner, geriatric care manager, home care nurse or aide, hospice provider or family mediation counselor, nor do you have the years of training and experience these professionals have, but you can definitely use their experience. In fact, using a senior care specialist will make caregiving easier for you and more beneficial for your elderly family member.

You can find a wide variety of care professionals in your area on the National Care Planning Council website at www.longtermcarelink.net and on our website at http://www.virginiaelderlaw.com/TrustedReferrals.htm.

One more thing to remember. As a family caregiver, the greatest gift you are giving this holiday season is “Love.”

Helping Your Older Parents Stay Happy and Healthy

Written by Evan Farr

by Robert Stall MD, Geriatrician

If you’re fortunate enough to have one or both parents still living, you may have noticed a role reversal taking place in your relationship. Remember the days when Mom shuttled you to the doctor whenever you were sick? Now, it may be you who’s driving her to her medical appointments. Perhaps you’ve become even more involved in managing her healthcare needs – serving as her healthcare proxy, moving her into your home to care for her, or even having to select a nursing home for her to live in.

Whatever the case, it’s natural to feel challenged – and, yes, intimidated – in the role you’ve undertaken. But if you stay positive and proactive, you’ll be in a great position to advocate for your parents’ optimal care. And, really, what better way is there to say “Thank You” for all they’ve done for you over the years?

The following six recommendations will help you understand what may be happening to your parents as they age – and what you can do to help.

1. Stay vigilant to sudden changes.

Typically, sudden changes arise from sudden problems. Your elderly father who becomes confused one week but was alert and oriented the week before, or becomes unsteady walking and starts falling, is likely experiencing an acute problem – an infection, medication side effect, or perhaps, a heart attack or stroke.

If you pay attention to your parent’s baseline health and behavior, you’ll be alert to sudden, and subtle, fluctuations. Being attuned to what’s “normal” for your parent is critical in advocating for his care. By informing his physician of these changes, you help ensure that he receives a proper diagnosis and timely treatment – especially important in acute conditions.

2. Investigate the source of gradual decline.

Several years ago, I met an elderly woman living in a nursing home. Her family, assuming she had dementia, had moved her there after she had gradually stopped speaking.

After performing a brief procedure on her, I asked how she was doing. “I’m OK,” she replied.

A miracle? Not exactly. I’d removed bullet-sized pieces of wax from her ears. She’d stopped speaking because her ears were too plugged to hear.

A host of conditions can cause gradual decline. Before jumping to the conclusion – as many people do – that Alzheimer’s disease is the culprit, recognize that your parent may be experiencing an altogether different problem: a vitamin B12 deficiency, an underactive thyroid, Parkinson’s disease or depression, to name a few.

When discussing your parent’s decline with her physician, make sure the two of you consider all the possibilities. To prepare for the appointment, make notes detailing how her decline has manifested itself – loss of appetite, a failing short-term memory and so forth – and how long you’ve noticed these changes. That way, you won’t leave anything out. To help you, I’ve created a free checklist that either you or your parent can complete at seniorselfassessment.com – make sure you print or email the “Test Result Details” at the bottom of the page to analyze your responses and give you advice based on your answers.

3. Know thy parent’s medicine cabinet.

Familiarize yourself with the medications your parent takes: what each one is for and how often he takes them. Make sure you notify each doctor your parent visits of all the medicine he takes, including over-the-counter products. Ask what side effects you might observe from each medication and whether it’s potentially dangerous if your parent takes them together. You also want to tell the doctor whether your parent drinks alcohol or caffeinated drinks and whether he smokes, as these substances can affect some medications’ efficacy and safety. To recognize which medications might cause the symptoms your parent experiences, check out drugscanmakeyousick.com .

4. Discourage ageist attitudes.

Simply put, ageism is prejudice against the elderly. It exists in many forms but can be particularly damaging to an older person’s self-esteem when it assumes that all of her woes are age-related. Here are a couple of ways of expressing ageism to an elderly parent:

“What do you expect at your age?”

“You’re not getting any younger.”

If you’re ever tempted to utter something similar, remind yourself that by chalking up everything that ails her to her age, you sell your parent short. If she’s depressed, it may have nothing to do with the fact that she’s 80 and everything to do with a biological predisposition to depression. And remember that right-knee pain in a 90 year-old can’t be just from age if there’s no problem with her left knee. (More about Dr. Stall and a more in-depth article on the attitude of society towards medical care for the elderly can be found at http://www.longtermcarelink.net/eldercare/medical_care_issues.htm )

5. Address not just symptoms—but emotions, too.

There is disease and then there is “dis-ease” – that is, a lack of ease, security or well-being. “Dis-ease” can manifest itself as myriad emotions in an elderly person: fear, grief, boredom, embarrassment and sadness among them. The fact is, these emotions can be every bit as debilitating as disease.

Take the case of a parent who’s incontinent. Too embarrassed to socialize, she cuts herself off from friends. Without companionship, she becomes lonely. Instead of allowing her to become a hermit, discuss with her doctor how to address the incontinence. Together, you can consider different solutions that will ease her embarrassment and reinvigorate her social life.

6. Strive to maximize your parent’s quality of life.

No matter our age, we all want to enjoy life to the fullest and have the capability to do the things we want to. Improving the enjoyment of life and a patient’s functional ability are the cardinal goals of geriatric care. But you don’t need a medical diploma on your wall to help your parent achieve either of those goals.

Being there to solve a problem or provide company are tremendously worthwhile services you can provide – no expertise required. Remember, as your parent gets older, his quality of life becomes more important to him than how much longer he lives. And he doesn’t necessarily need medications or surgery to ensure that he’s living the latter part of his life to the fullest.

If he enjoys books but has difficulty reading regular-sized type, check out sight-saving titles at the library. If he’s grieving the loss of his best buddy, introduce him to new acquaintances at the senior center. If he’s living in a nursing home, bring your kids there to share a meal with him.

Sometimes, it’s the small gestures that have the most profound impact. As the child of an elderly parent, you are uniquely positioned to deliver these life-changing gifts.

Dr. Robert Stall is a geriatrician practicing in Tonawanda, New York and a clinical associate professor at the University of Buffalo’s School of Medicine and Biomedical Sciences.  To learn more about senior care issues, visit his website at stallgeriatrics.com.

Did you see last Sunday’s Washington Post article?

Written by Evan Farr

Did you catch last Sunday’s Washington Post article by David Hilzenrath, about the October bankruptcy filing of Erickson Retirement Communities? My phone has been ringing all week with people concerned about this news, because Erickson is a major developer and manager of Continuing Care Retirement Communities (CCRCs) for senior citizens.

In the Washington area, Erickson communities include: Greenspring in Springfield, Virginia; Ashby Ponds in Ashburn, Virginia; and Riderwood in Silver Spring, Maryland. I spoke with the author prior to the article and gave him some of the information that he referenced in the article. As he explained, the recession and the real estate crisis have raised concerns for people who paid significant money — often hundreds of thousands of dollars — to enter CCRCs such as these.

It’s important to understand that the deposits that senior pay are simply for the privilege of moving in; at most CCRCs, the deposits generally do not confer any ownership in the real estate, and the deposits are in addition to the regular monthly fees for the facility, which increase as the level of care increases — from independent living up to assisted living and eventually nursing home care. Here’s a link for the article in case you missed it: http://tinyurl.com/EricksonBankruptcy.

In a companion article (http://tinyurl.com/ScrutinizeContracts), headlined Scrutinize any contract to avoid nasty surprises at continuing care community, the author points out that the entrance agreements for these facilities should always be reviewed by an attorney. “If you are considering moving to a continuing care retirement community,” the author says, “you would do well to consult a lawyer and read the fine print of any contract to determine whether the potential benefits outweigh the risks.” I have recommended this to my clients for years, and encourage everyone in the Northern Virginia area moving into a CCRC to have me review the contract.  But please note — it is very important to have me review the contract prior to signing the contract. For many of the people calling me this week who read the article and are concerned, there’s nothing I can do because they already signed their contract. These folks I referred to a real estate litigation attorney to discuss the possible results of what might happen if they fail to go through with their contract. Those results could include being sued for breach of contract by the owner of the facility, and possibly being forced to pay significant monetary damages.

One risk in connection with the entrance contract is that most CCRC contracts require you to agree not to give away any assets that would bring your net worth below a minimum requirement (in order to help assure management that you have the ability to pay their ongoing charges). The author quotes me in article, saying “Evan H. Farr, a Fairfax lawyer who specializes in issues facing the elderly, recommends putting any extra assets in an asset protection trust before you move in.” 

I’m very glad that the author included this quote in his article, because far too many people move into these types of facilities without giving asset protection a second thought. If you are considering moving into a CCRC, it behooves you to not just have me review the contract, but to also have me create the proper type of asset protection trust for you to put your extra assets in before you move in to the community.  What is the proper type of asset protection trust?  It’s my proprietary Living Trust PlusTM Asset Protection Trust — the trust that protects your assets from the expenses of probate PLUS lawsuits PLUS the catastrophic expenses of nursing home care. 

As the creator of the Living Trust PlusTM and the leading expert on this type of trust in the country, I’ve taught thousands of attorney across the country about the benefits of these trusts, and I’m actually teaching another course on this subject to attorneys tomorrow at an annual conference of the National Academy of Elder Law Attorneys.  If you want to find out more about the  Living Trust PlusTM, please come to a free class I’m teaching for members of the public on Saturday, November 14, 2009 at 10:00:00 AM, at the Tysons Corner Mariott, 1960-A Chain Bridge Road, McLean, VA 22012. 

By coming to this FREE class, you’ll learn what thousands of attorneys and clients already know . . .

- That a Will puts your assets through probate, and is a very poor estate planning document.
- That a regular living trust protects your assets from probate, but offers you no asset protection.
- That my Living Trust PlusTM Asset Protection Trust protects your assets from the expenses of probate PLUS lawsuits PLUS the catastrophic expenses of nursing home care.

To register, just go to http://evanfarr.com/seminars.html.

I hope to see you soon!