Medical Care at the End-of-Life

Medical Care Immediately Prior to Death

In the first half of the 20th century, most people who died had an accident or contracted a disease or they had physical disorders that inevitably lead to death. Life-saving medical interventions such as sophisticated resuscitation, complicated surgeries, life-saving treatments, ventilators, feeding tubes and other life-support were rarely used or even available. Nowadays there is great emphasis on curing medical problems sometimes to the exclusion of recognizing that death might be a more welcome outcome.

Surveys indicate that older people are often more afraid of death than younger people. But for all Americans — young and old — there is a great fear of death.  Oftentimes, the families of those near death will go to great lengths to try interventions that may be ineffective in prolonging life. Estimates are that about 30% of Medicare reimbursements are spent on people in the last year of their life. It is a fact that much of this medical care did little to prevent death and prolong life.

According to the Dartmouth Atlas study on death:

“The quality of medical intervention is often more a matter of the quality of caring than the quality of curing, and never more so than when life nears its end. Yet medicine’s focus is disproportionately on curing, or at least on the ability to keep patients alive with life-support systems and other medical interventions. This ability to intervene at the end of life has raised a host of medical and ethical issues for patients, physicians, and policy makers.”

The Dartmouth Atlas project uncovered some startling differences in what happens to Americans during their last six months of life. The level of hospitalization during those months varies greatly from one region to the next.

The Atlas researchers asked why this was so.  Why is someone living in Miami so much more likely to receive a great deal of high-tech, expensive medical services, while someone with the same condition who lives in Minneapolis receives so much less? The answer appears to have very little to do with religious or spiritual beliefs or personal preferences.  Rather, the answer appears to be that the capacity of the local health care system – the per-capita supply of hospital beds, doctors, and other forms of medical resources – is the dominating influence. Those who live in areas like Miami, where there are very high per capita supplies of hospital beds, specialists, and other resources, have one kind of end of life experience. Those who live in areas like Minneapolis or San Francisco, where acute care hospital resources are much scarcer, have very different kinds of deaths.

The question, then, is which is better? From the dying person’s perspective, more is not necessarily a good thing.  That is, more visits to doctors for someone who is very sick can be stressful and exhausting. For many people a hospitalized death is something to be avoided if at all possible. From the perspective of the health care system, much of the care being given is futile, and accomplishes little. People who live in areas with very high utilization of hospital resources do not live longer than people who die in areas where utilization is lower – and if extension of life is not the goal of intervention, what is?

Deciding How and When to Stop Curing and Start Caring

Some people are content to leave decisions regarding their death in the hands of others. By doing so, they may expose themselves to unnecessary and futile treatments as outlined above. They may experience numerous visits to the emergency room in the last stages of their life. And their dependency on others often results in great stress to family members when loved ones at the end-of-life lose their capacity and didn’t make their last wishes known. Families are often forced to make decisions about life-support and treatment without knowing whether their loved one would have wanted these interventions.

Advance Directives

These, are the minimum documents you need to make sure your wishes for health and medical care and end of life decisions are honored.

• Durable Power of Attorney for Health Care
• Living Will
• POST (Physician Orders for Scope of Treatment)
• HIPAA Release

A patient or his or her spouse or a family member will typically call 911 in the event of a life-threatening emergency. Very seldom will the advanced directives end up with anyone in the emergency room. Therefore, medical decisions are generally made by family members who show up at the hospital. The actual health treatment wishes of the patient may be at home in the desk drawer. It is therefore extremely important to remember to take these documents to the emergency room whenever a crisis arises. It is also critical that family members be made aware of your wishes and the existence of your advance medical directives as well as where they can be found.

When it comes to these very difficult questions timing is everything. In order to maintain control as long as possible and have an effect on your own end of life decisions you must choose to act now. Your decisions need to be made known and documented correctly. Good planning is no accident!

Call us today and let us help.

Idaho Estate Planning

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Aging Parents: Warning Signs of Failing Health

Aging parents are becoming a concern for a growing number of Idahoans. In an article originally published on www.MayoClinic.com we find some useful tips on monitoring our parent’s well-being while allowing them the independence they desire. Below are 5 items to consider.

1: Are your parents losing weight?

Losing a significant amount of weight without trying can be a sign of trouble. Perhaps they are having difficulty cooking whether because of a lack of energy, difficulty using utensils and appliances, or maybe they’re having difficulty reading or understanding the instructions.

As we age it is normal for our sense of taste to diminish this can also lead to a loss of appetite when foods just don’t taste as good as they used to. Smell is very important to our appetite and a decline in our ability to smell can also lead to problems with proper nutrition.

Of course there is always the concern of deeper issues such as dementia, cancer or even depression.

2: Are your parents taking care of themselves?

A direct quote from the Mayo Clinic article explains this concern:

“Pay attention to your parents’ appearance. Are their clothes clean? Do they appear to be taking good care of themselves? Failure to keep up with daily routines — such as bathing, tooth brushing and other basic grooming — could indicate health problems such as dementia, depression or physical impairments.”

It is also important to monitor the living conditions in the home. Look for big changes from the past. Are lights burnt out? How about the bathrooms, are they kept as clean as they used to be? Scorched cookware may indicate forgetfulness when cooking. Depression or dementia can be a cause of chronic problems in this area as well.

3: Is their home as safe as possible?

Safety around the home is very important. Are hallways and stairs well lit? Are falls becoming a problem? Are they having trouble reading prescriptions or instructions? Is there a concern of falling or slipping when coming in and out of the house? A malfunctioning water heater or furnace can be deadly. Periodic maintenance is critical to keeping the home safe.

4: Are they in good spirits?

Again we want to see consistency in their behavior. Are they as active as they would like to be? Do they need help getting out and participating in activities? Are they still interested in life-long hobbies and activities? If they are religious are they attending worship services?

5: How are they getting around?

We all slow down as we get older. Watch your parents as they are walking. Make sure they can still get where they need to without too much discomfort or pain. Aching joints and lack of energy can lead to difficulties walking and that can lead to depression. Do they need a cane or a walker? Perhaps they would benefit from chairs that are easier to get out of or higher toilets that are easier to use?

What to do?

• First, take care of any safety issues. Replace light bulbs; add bars or grips where necessary. If canes or walkers are needed take care of the issue.
• Talk to your parents, share your concerns with them. Open communication can go a long way towards taking care of these issues. It isn’t always easy to admit you need help. Therefore, be patient and understanding. Remember how important your independence is to you, it is just as important to them. Sometimes just knowing that someone cares and is paying attention can make all the difference.
• Encourage regular visits with health care professionals.
• Consider Home Health services. There are a number of very good services in Idaho that have experience serving the elderly while helping them to maintain their independence.
• Network with local agencies and support groups.

It is important to make sure your parents know of your sincere concerns and that you truly care for them. Quality of life is an important variable and they need to know that you are concerned about the same things they are.

Idaho Estate Planning is part of the Treasure Valley Care Planning Council, a non-profit network of elder care professionals available to provide information on the information discussed above and much more. Let us know your concerns and we will help you find the resources you need.

In addition to caring for your parents, it is also important to consider your own concerns for the future. How will you maintain your independence as you grow older? What effect would a costly health issue have on your quality of life? The more planning you do now the less difficulty there will be later. Good planning is no accident.

Call us today and let us help.

Idaho Estate Planning

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Hospice Care

Hospice Care

It is unfortunate that many people who died in a hospital emergency room or who received heroic treatments to prolong life in a hospital or nursing home may have had the alternative of dying at home in familiar surroundings, with family or other loved ones at their side.

Most often when it becomes apparent that there is really no hope for recovery, a family calls 911 and starts a process which can result in great stress and great emotional discomfort. The loved one who is dying ends up in a hospital or nursing home in a strange environment, frightened and confused and tied to tubes and monitoring devices. Given the option, this is not how most of us would choose to spend our last hours on earth.

Attending to a dying loved one in the peace and quiet of the home with caring family close at hand can be a comforting and even spiritual experience for all involved. Hospice can allow this to happen. Memories of a loved one passing in peace can provide great comfort for family members in years to come.

When there is no longer hope for prolonging life and especially when the decision is made months in advance, hospice is a viable alternative to other medical intervention.

Hospice care is a valuable service and is generally underused except for terminal cancer patients. Most families wait too long to have their doctor prescribe hospice from Medicare. Doctors or families don’t often consider this care alternative for Alzheimer’s, degenerative old age or other debilitating illnesses where a person is going downhill fast. They should.

Good Hospice Care:

• Manages the patient’s pain and symptoms
• Assists the patient with the emotional and psychosocial and spiritual aspects of dying
• Provides needed medications, medical supplies, and equipment
• Coaches the family on how to care for the patient
• Delivers special services like speech and physical therapy when needed
• Makes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time
• Provides bereavement care and counseling to surviving family and friends.

A person can receive hospice from Medicare if:

1. He or She is eligible for Medicare Part A (Hospital Insurance), and
2. The doctor and the hospice medical director certify that the person is terminally ill and probably has less than six months to live, and
3. The person or a family member signs a statement choosing hospice care instead of routine Medicare covered benefits for the terminal illness, and
4. Care is received from a Medicare-approved hospice program.

A person may continue to receive regular Medicare benefits from his or her customary doctors for conditions not related to the hospice condition.

Good planning is critical. Good planning leads to more options, more control and greater peace of mind. However, good planning is no accident. All of these decisions and options are best discussed well in advance. To secure your peace of mind as well as your family’s future, get started now.

Idaho Estate Planning

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Medicaid Planning Part III

Introduction

In Medicaid Planning Part II we covered:

• Intent to Return Home
• Medicaid Treatment of a Home
• Special Home Exemption Rule
• Joint Tenancy

Transfer Title of the Property to the Community Spouse

Transfers to a spouse of any assets are exempt from Medicaid eligibility rules. An institutional spouse, anticipating Medicaid, can transfer title in the home to the community spouse and it has no effect on Medicaid eligibility. This can be done either with a quit claim deed or through a trust. With the asset no longer in the name of the care recipient, Medicaid recovery cannot use the house as a basis for recovering its costs. And the community spouse can transfer the house to a member of the family and as long as this is done beyond the five-year look back period, then Medicaid can’t assess a penalty period for a transfer of assets for less than value. It’s important to use a legal adviser to make sure you do this properly.

Trust to Avoid Probate

Common trusts to avoid probate are called “living” or “inter vivos” trusts. A trust never dies, thus it is not subject to probate. Most arrangements make the trust the owner of the property with the original owner(s) as trustee(s) (caretaker as it were) and beneficiaries(s). Thus, the property reverts to the estate at death. Most people initiate these trusts to avoid probate. Assets in these trusts, other than a primary residence, are transparent to Medicaid. These trust assets are subject to Medicaid spend down rules.

The trust can be used in states where Medicaid recovery only uses primary residences passing through probate as being subject to recovery. However, a growing number of states do not recognize these arrangements to avoid probate estate recovery and go after primary residences in revocable trusts regardless of ownership.  Idaho does not ignore the trust, however, Health and Welfare will require that the trustees of the revocable or living trust transfer the primary residence back out of the trust to the beneficiaries.  This, then, allows Health and Welfare to recover the value of benefits paid from the house now destined to go through probate.

To do it right for these states requires an irrevocable trust with no life interest, set up 5 years or more before a Medicaid claim. Very few people are willing to do these kinds of trusts.

Some people also include a so-called “life interest” in property in arrangements where property is gifted or in irrevocable trusts. The life interest gives them use of the property until their death even though they don’t own it. Medicaid in many states does not recognize life interest and the property is considered to be in the ownership of the person who gifted it and subject to look back rules and recovery.

Move Loved One Needing Care to Another State

A person needing Medicaid covered care in one state may not qualify under that state’s rules but might qualify under the rules of a neighboring state. Of particular concern are candidates suffering from dementia or Alzheimer’s. It’s difficult to quantify their need for care and in some states, those people who are cognitively impaired might not get help with Medicaid even though their needs might be greater than the needs of those who are physically disabled.

Families should consider moving loved ones who have been declined in one state, to live with a member of the family in another state and possibly qualifying in that state. In addition the new state may be more lenient with Medicaid recovery procedures.

A second reason may be that the current state of residence has a very tight supply of Medicaid beds and there is a waiting list. Moving the loved one to a state where there are more available Medicaid beds may avoid the family having to temporarily cover the cost of a non-Medicaid nursing home bed while waiting for one to become available.

Give Away Assets

We have already discussed the moral implications of using Medicaid planning strategies for unfairly qualifying for Medicaid and shifting the burden of cost to the taxpayers. New look back rules under the Deficit Reduction Act have effectively done away with gifting strategies used in the past to accelerate eligibility for Medicaid. This does not mean that gifts cannot be used, but planning must be done many years in advance. Under these new circumstances the whole concept of gifting in order to qualify for Medicaid is much more complicated and consulting with a professional familiar with the Medicaid requirements is essential..

Good planning is no accident. All of the issues discussed above are best handled in advance. To secure your future care, get started now.

Idaho Estate Planning

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Medicaid Planning Part II

Introduction

In Medicaid Planning Part I we covered:

• Income Annuity in the Name of the Community Spouse
• Prepaid Funeral Instead of or in Addition to Burial Funds
• Use of Spend Down Resources

Intent to Return Home

If a single person receiving Medicaid care in a facility has a house, that property could be subject to sale to pay for Medicaid expenses. The house is only protected if a qualifying child or dependent lives there or if the recipient intends on returning home. Some states require a medical doctor to certify a return home, but in many states it only requires the signature of the recipient whether that recipient has justification or not. In the states that allow it, always have your loved one sign an intent to return home. At least you have use of the property while your loved one is still alive.

Most families sell the home and end up with a large amount of cash that must be spent down before the loved one qualifies for Medicaid. Keeping the home avoids losing the entire value of it to spend down. By retaining the home, Medicaid recovery may not seek the full value of the home when the loved one dies.

Potential rental income from the house would also go towards paying the facility cost and reduce the amount that Medicaid would have to pick up. This could mean that Medicaid recovery using this strategy might go after a smaller share of its cost in the recovery process.

Medicaid Treatment of a Home

If the community spouse lives in the home then the home is exempt from determining Medicaid eligibility. It does not count as an asset and prevent the institutional spouse from receiving Medicaid help. On the other hand, any other real estate property, not the primary residence, will have to be converted to cash and spent down before Medicaid will start paying the bill.

If the community spouse living in the home does not in turn need Medicaid help in the future then one of two things can happen to the house after the death of the institutional spouse. Legally Medicaid has a claim against the property for recovery services. And in some states a lien against the property, called a TEFRA lien, can be filed in anticipation of Medicaid’s cost. The lien can be filed before the death of the care recipient but only a few states actually do that. States that have authority to file these liens often don’t do it until after the death. At the death of the community spouse, the property cannot be sold until the lien is satisfied, or the lien is satisfied from the proceeds of the sale.

Even though few states are efficient at Medicaid recovery, especially when it comes to a primary residence, you will be miles ahead of the game every time to contact and work with a competent adviser when dealing with recovery issues. You can never assume what your state recovery program will actually do.

Special Home Exemption Rule

It is often the case that a daughter will move in to take care of Mom or Dad or both. In this case Medicaid has a special leniency rule to allow transfer of the home to the daughter and not result in a penalty for a transfer for less than value. If the child provides care for a parent in a parent’s home for at least two years, and that care kept the recipient out of a nursing home, the property can be transferred to the child without penalty and the property will not be a subject asset for Medicaid recovery. Medicaid will require some proof of this. Typically an affidavit from a third-party care provider such as a doctor or an agency stipulating that the care was given for at least two years and resulted in keeping the care recipient out of a long-term care facility, will be sufficient evidence. It’s important to use a legal adviser to make sure you do this properly.

Joint Tenancy

Many people anticipating Medicaid services are tempted to put a child’s or sibling’s name on property titles to avoid probate and Medicaid recovery. This may not be a good idea.

There are at least four problems.

• If the other person on the title becomes subject to a judgment, even one arising from an accident, then at least 50% of the property can be lost to the judgment.  This would also the case in a bankruptcy and there could a similar issue in a divorce proceeding.
• The other person on the title must consent to any disposition of the property. He or she might not agree with what the original owner wants to do.
• Re-doing the title must occur at least 5 years prior to claim in order to avoid look back rules and a sanction on a gift to a non spouse owner.
• The person assuming joint ownership has received a gift and loses the step-up in basis at death. Capital gains taxes may have to be paid. And if the property is not the principal residence of the new tenant, the capital gains exclusion cannot be used either.

Good planning is no accident. All of the issues discussed above are best handled in advance. To secure your future care, get started now.

Idaho Estate Planning

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Medicaid Planning Part I

Introduction

A person facing the prospect of long-term care with moderate income and assets may eventually have to rely on Medicaid to pay part or all of the cost of care.

Medicaid planning, using a qualified elder law attorney, allows you to correct inequities in the system. Medicaid planning has gotten a bad name because some individuals, who would normally have too many assets to ever qualify for Medicaid, deliberately use it, many years in advance, to give away everything to their family to qualify for Medicaid. It is wrong to abuse the system in this way and to use taxpayer dollars to insure an inheritance for the family. And if that person is not anticipating immediate care, this strategy is just plain dumb.

Income Annuity in the Name of the Community Spouse

This technique relies on two Medicaid rules. The first rule is that income between couples is attributed to the spouse who owns the income. Unlike assets which have to be shared for Medicaid eligibility, income does not have to be shared. For example if the Medicaid recipient has a total income of $500 a month and the community spouse has a total income of $4,000 a month the community spouse is not required to contribute any income towards the care of his or her spouse. Medicaid will cover the bill less the $500 a month, which, less a monthly allowance must be spent towards the cost of care. The second rule allows a spouse to transfer any amount of assets to another spouse without penalty of losing Medicaid eligibility.

Using these two rules, here is how a Medicaid annuity strategy works.

The person needing long-term care — the institutional spouse — applies to Medicaid in order to receive Medicaid services. In this case suppose the couple has $100,000 of cash equivalent assets and owns a home and a car. As long as the healthy spouse — the community spouse — lives in the home she can keep the home and the car and those assets do not prevent the institutional spouse from receiving Medicaid help. In this example, the institutional spouse must spend $50,000 of the couple’s assets down to less than $2,000 and have an income of roughly less than $2000 per month and then Medicaid will take over.

Once the Medicaid application has been submitted, instead of starting the spend down to $2,000 and then receiving approval and having Medicaid pick up the balance of the cost, the institutional spouse transfers his $50,000 to his wife. This is allowable and will not disqualify the Medicaid approval process but it does not yet take away the responsibility to spend down the cash. The community spouse then uses the money to purchase an immediate income annuity for a period equal to or less than the allowable life expectancy in the HCFA transmittal 64 table. Assets have now been converted to about $800 a month in income. The income belongs to the community spouse and does not have to be shared with the institutional spouse. Therefore the spend down has been avoided. Evidence of this transaction is presented to Medicaid and because the institutional spouse no longer has any attributable assets, Medicaid starts paying its share of the bill.

This strategy serves two purposes. First, it may give the community spouse a larger income than she otherwise would have had under Medicaid rules. Second, even though it represents income, the community spouse has managed to keep $50,000 that would normally have to be spent.

In the past, some planners have set up annuities that provide a remainder payout should the community spouse die too soon. This is usually paid to the children and in the past was used as a way to transfer assets to the children without penalty. Under the Deficit Reduction Act of 2006, the state must be named as beneficiary for any remainder payout. This new rule discourages the use of these annuities to transfer assets to the next generation.

It is important for the planner to follow Medicaid guidelines in order to avoid a penalty. If the payout period of the annuity exceeds the life expectancy in Medicaid tables, then the excess amount of total income payment over the life expectancy becomes a transfer for less than value and represents a penalty. This in turn results in a penalty period equal to the amount of excess divided by the monthly Medicaid rate in that state. Medicaid will not start paying for care until this penalty period has been met with someone else paying for that care. It’s important to use a qualified adviser to make sure you do all of this properly.

Prepaid Funeral Instead of or in Addition to Burial Funds

Federal rules allow a person on Medicaid to keep up to $1,500 for funeral expenses. Most states allow a recipient to buy a prepaid funeral plan. The limit for such a plan is usually higher than the $1,500 allowed by Federal rules. As an example, if your state allows $7,000 for a prepaid funeral plan then you should use the full amount you have money for to buy a plan.  At the present, Idaho does not have a limit on a prepaid funeral plan.

Your state may also allow additional costs such as the burial plots, caskets and vaults to be tacked on, thus raising the limit.  These prepaid assets are an excluded resource in Idaho and the regulations do not list a limit on the value permitted for the plots, caskets and vaults.

Use of Spend Down Resources

People assume money being spent down for Medicaid eligibility needs to be applied to care costs. In reality, Medicaid is only interested in seeing the potential Medicaid recipient’s resources reduced to less than $2,000. How the money is spent is only questioned if there has been a transfer for less than value.

In order to qualify for Medicaid more quickly, you may want to use some of the spend down money to pay off debt, trade in the old car and buy a new one. (Medicaid typically allows a community spouse to retain just one car), or fix up the house.

Planning is the Key

The techniques listed above are often used when no other advanced planning has taken place. One of the goals of these techniques is to provide the community spouse with as much  security as possible. Future blogs will address additional strategies for providing security when there is more time to plan.

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The Problem with Government Long Term Care

Public Misconception Provides a False Sense of Security

Surveys by organizations that support long term care planning, such as the AARP, consistently reveal that a majority of the American public thinks the government will provide long term care services when the time comes for needing those services.

A recent national survey by the AARP, of people 45 years and older, discloses that 59% of respondents think Medicare will pay for extended nursing home costs and 52% believe Medicare will cover assisted living costs. In reality, Medicare coverage for nursing homes is very short-term (the average is 27 days) and Medicare does not cover the cost of assisted living at all.

Another recent survey by America’s Health Insurance Plans –AHIP — also supports these findings. If we add on another 25% or 30% of respondents who simply don’t know how their long term care costs will be covered or who erroneously believe they have insurance for long term care, about 80% of the American public is laboring under a false sense of security. These people think they are covered for long term care when they are not.

Cost-of-care reports released by the government also appear to support the myth that the government provides the bulk of care. Quoting a recent Government Accounting Office study for Congress:

“Presently, the majority of long term care services — about 80 percent — is paid for by governmental programs with private pay and long term care insurance making up the difference. In June 2007, according to the Centers for Medicare & Medicaid Services(CMS), which overseas nursing facility care, 65 percent of all nursing home residents relied on Medicaid and an additional 14 percent depended on Medicare for their care and services.”

It is no wonder that the public is confused. How can some sources claim that government provides little long term care if the government itself claims payment for 80% of long term care costs? The answer lies in the fact that the majority of long term care services in this country are provided free of charge by family members, friends or volunteers.

In order to put things into perspective, the National Care Planning Council did a study that estimates the number of yearly hours provided for long term care by various private and government care providers (the study focuses on hours not dollars). Based on this study, the National Care Planning Council estimates that only 16% of all long term care services are provided by the government. The other 84% is provided free of charge or paid for out-of-pocket by private funds. In addition, the vast majority of these care hours are provided in the home or in assisted living and not in nursing care facilities.

Because many family caregivers are in the workplace and have difficulty providing help for loved ones, Americans should realize that planning for long term care is an important issue when planning for retirement. The government does not provide the amount of care the public thinks it does.

Government Programs Can Stifle Innovation and Limit Freedom of Choice

Medicare and Medicaid contract directly with private providers who are certified to provide care on behalf of these agencies. These eldercare companies are reimbursed directly for the services they provide. Payments to providers from Medicare are based on performance of certain predetermined activities defined by Medicare. Each type of activity has a different reimbursement rate depending on the level of care required and the cost of care in the geographic area. Unlike Medicare, Medicaid typically provides an average per capita payment for each Medicaid recipient receiving long term care in a facility or in a community setting.

Both Medicare and Medicaid require evidence of certain services provided by doctors, nurses and aides and detailed logs of these completed services must be kept. Any services rendered by a Medicare or Medicaid approved provider that are not preauthorized by regulation are generally not be covered.

There are a number of new models for nursing care and for community-based care that have proven successful in improving the health, functionality and mobility of long term care recipients. Unfortunately, these innovative efforts are typically not reimbursed by Medicare or Medicaid because they are not predetermined services. Because close to 80% of all nursing home residents rely on Medicare or Medicaid reimbursement for their care, certified providers are forced to offer the prescribed government services for all their residents. This high dependency on government funding means facilities must conform to government mandates or go out of business. In turn, the reliance on government-mandated reimbursement essentially stifles any efforts to provide better and potentially more effective alternative care in nursing homes or in other community settings.

The rigid reimbursement model from Medicare and Medicaid also limits freedom of choice for care recipients. Government long term care beneficiaries must choose a government-certified provider for their care. Government programs also favor nursing home care over other settings such as assisted living or home care. There are reasons for this bias and we will discuss these limitations in a future article. However, the result of a nursing home bias is that care recipients generally have little choice but to receive their care in a nursing home.

Government program directors are aware of the shortcomings in the system and an effort is being made to improve delivery and offer more choice, but it appears to be moving glacially slow. The fault really lies with the reimbursement model for care services and that needs to be changed in order to encourage innovation and provide more choice in care settings.

Needless to say, good Care Planning takes into account the weaknesses mentioned in this article. The professionals at Idaho Estate Planning have the tools and expertise necessary to help you avoid these pitfalls. Call us today to set up a consultation. The appointment is free of charge. Let us help you plan for your future needs.

Idaho Estate Planning

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4 Steps of Long Term Care Planning Part II

Step 1-Knowledge & Preparation are the Keys to Success

This step requires an understanding of the variety living arrangements and different settings under which care is provided. In addition, understanding the provisions and limitations of government programs is essential because the public generally has a misconception that the government will step in and provide care when the time is needed.

Take time to investigate the options for short and long term care in your area. Knowledge of the choices available to you and the annual costs involved will make the steps that follow easier.

Government programs are limited and according to research by the National Care Planning Council, only 16% of all long term care services are provided by government programs. The other 84% is provided free of charge by family members, friends, charity, church groups or volunteers or paid for by private funds.

Step 2-Funding the Cost of Long Term Care

Much emphasis is being placed on purchasing long term care insurance or arranging for reverse mortgages in order to fund the cost of care. These can be useful tools for providing funding but in reality, this approach for planning is not working that well.

After 30 years of being touted as the ultimate solution, less than 2% of the American public and only 9% of seniors own long-term care insurance policies and using reverse mortgages may be a good strategy but in practice, few seniors are using them to pay for care.

Financial planning is an important part of being prepared for long term care if and when it becomes necessary. The scope of investment tools available to Americans has dramatically increased over the last few decades. Consult with an experienced professional to determine the best course of action.

Step 3-Using Long Term Care Professionals

Long term care services are complicated and provider contacts are fragmented throughout the community. For the majority of Americans, eldercare becomes a frustrating do-it-yourself process. This approach is unnecessary. Using care professionals is the most cost effective and efficient way to provide help for a loved one.

Those people who need help with long term care and use the services of professionals often find they save money over doing it themselves. They also reduce their stress and they free up a considerable amount of their personal time. Another benefit with using professional help, such as a care manager, elder law attorney or mediator, is to help you alleviate or avoid family conflicts that often arise as a result of caregiving.

Hiring professional advisers or providers to help with long term care is no different than using professionals to help with other complex issues such as investing, car repairs, dealing with taxes or legal problems. With their education and training, long term care professionals also bring experience that only comes from dealing with countless hands-on, caregiving challenges.

Step 4-A Written Plan that is Accepted by All Involved

The first three steps in the planning process are designed to give you a wealth of information about long term care. It is important for you to have an understanding of care systems and the resources you can turn to when the need arises. However, knowledge of long term care systems is not enough. You must take some tangible action now to prepare for the day when you will need to deal with eldercare for your loved ones or for yourself.

The final fourth step in the planning process is making a care plan. You need to prepare a written plan for you or a loved one. The challenge of dealing with long term care will unfold for you in a more manageable manner if you make a plan and put it in writing. You will experience less stress, have fewer costs, require less time committed and have fewer family conflicts.

At Idaho Estate Planning we have all the resources you need to put a plan together. We have the experience and expertise to help you maintain your options and protect yourself as well as your loved ones now and into the future. The best time to plan is always now!

Make Sure Your Summer ‘Toys’ Are Covered

With summer in full swing, it’s a great time for outdoor recreation.  Are you protected?  Do you have the appropriate coverage for your motorcycles, vacation trailers, campers, motor homes, boats, personal watercrafts or recreational vehicles such as ATVs, mini-bikes, trail bikes, or golf carts?

Here are some examples of coverage’s that you may want or need: 

Liability coverage while using your unlicensed recreational vehicle off your own property. (New Idaho State law requires unlicensed RV’s to carry liability insurance)

• Expense reimbursement up to $35 each consecutive day a vacation trailer is uninhabitable due to loss or damage while you are on vacation.
• Affordable coverage for contents of the motor home.  Included in the standard contents coverage for a trailer is the option to purchase more coverage if needed.
• Total loss to a motorcycle. Under certain conditions, your motorcycle will be replaced with a new motorcycle or the original purchase price will be paid.

Intermountain Insurance is not just a competitive market for private passenger automobiles, we can also offer all of the above coverage’s and more for your outdoor recreational vehicles.  We can even offer you the convenience of including these items either on your homeowners or auto policies.

Along with offering great coverage’s, Intermountain Insurance also applies all policy-level discounts that apply to personal passenger autos—such as the Paid-in-Full and multi-policy discounts—to your outdoor recreational items included on your auto or homeowner’s policy.

Call us or stop by our office to learn more!

4 Steps of Long Term Care Planning Part I

The Importance of Planning for Eldercare

According to some sources, 60% of us will need long term care sometime during our lives. It is important for all of us to prepare for that day when we will need to help loved ones with care or we will need long term care for ourselves.

We may prepare financially for unexpected disasters by covering our homes, automobiles and health with insurance policies. But no other life event can be as devastating to an elderly person’s lifestyle, finances and security as needing long term care. It drastically alters or completely eliminates the three 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 and not outliving assets and income

Sadly, the majority of the American public does not plan for the devastating crisis of needing eldercare. This lack of planning also has an adverse effect on the family, with sacrifices made in time, money, family lifestyles and even affecting the family’s or caregiver’s medical and emotional health.

Because of changing demographics and potential changes in government funding, the current generation, more than any before them, needs to plan for long term care before the elder years are upon them.

What Is Long Term Care?

The need for long term care arises when an individual requires, from someone else, assistance with medical care, daily living activities, comfort, supervision or advice. This need for care may be caused by an accident, disease process, or frailty. Such conditions may require help with the ability to move about, dress, bathe, eat, use a toilet, medicate, and avoid incontinence.

Also care may be needed to help the disabled person with household cleaning, preparing meals, transportation, shopping, paying bills, visiting the doctor and answering the phone. Oftentimes, long term care in the form of supervision or confinement is needed due to cognitive impairment from stroke, mental retardation, depression, dementia, Alzheimer’s, Parkinson’s Disease and so on. Most long term care is provided at home by family members.

What Is Long Term Care or Eldercare Planning?

For seniors, the terms “long term care” and “eldercare” are synonymous. For younger people, “long term care” is the more appropriate phrase.

For the uninformed family member, eldercare or long term care might appear to be a very straightforward and easy-to-understand process. Unfortunately, the reality is that long term care is very complicated and finding care systems and providers is a frustrating and time-consuming process. There is no one single source to help caregivers find services or solve problems with a simple phone call or a single community contact. For this reason, planning for care requires a great deal of prior knowledge in order to avoid operating in a crisis mode trying to find help when the need for care suddenly arises.

However, knowledge of long term care systems is not enough. Because it can happen suddenly, at any time, you must take action now to prepare for the day when you will need to deal with eldercare for your loved ones or for yourself. This action involves

• Determining the care settings and services you or a loved one most likely would want.
• Providing funding for paying the cost of care, especially when government support programs are lacking or require sacrifice of assets.
• Completing a survey to determine necessary financial and legal arrangements to be made.
• Completing a written long term care planning document to provide instructions to caregivers and to your care coordinator in advance of needing eldercare.
• Assigning a care coordinator and determining the role of other family members, friends or advisers involved in caregiving.
• Holding a planning meeting and drawing up a written agreement for involvement between all those who are willing to participate in future caregiving for you or a loved one.

There are four crucial steps necessary in this process for long term care planning. The four steps are based on the following concepts:

1. Knowledge and preparation are the keys to success.
2. Having funds to pay for care greatly expands the choices for care settings and providers.
3. Using professional help relieves stress, reduces conflict, and saves time and money.
4. Success is assured through a written plan accepted by all parties involved.

In Part II we will discuss these steps in greater depth.

The Importance of Planning for Eldercare

According to some sources, 60% of us will need long term care sometime during our lives. It is important for all of us to prepare for that day when we will need to help loved ones with care or we will need long term care for ourselves.

We may prepare financially for unexpected disasters by covering our homes, automobiles and health with insurance policies. But no other life event can be as devastating to an elderly person’s lifestyle, finances and security as needing long term care. It drastically alters or completely eliminates the three 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 and not outliving assets and income

Sadly, the majority of the American public does not plan for the devastating crisis of needing eldercare. This lack of planning also has an adverse effect on the family, with sacrifices made in time, money, family lifestyles and even affecting the family’s or caregiver’s medical and emotional health.

Because of changing demographics and potential changes in government funding, the current generation, more than any before them, needs to plan for long term care before the elder years are upon them.

What Is Long Term Care?

The need for long term care arises when an individual requires, from someone else, assistance with medical care, daily living activities, comfort, supervision or advice. This need for care may be caused by an accident, disease process, or frailty. Such conditions may require help with the ability to move about, dress, bathe, eat, use a toilet, medicate, and avoid incontinence.

Also care may be needed to help the disabled person with household cleaning, preparing meals, transportation, shopping, paying bills, visiting the doctor and answering the phone. Oftentimes, long term care in the form of supervision or confinement is needed due to cognitive impairment from stroke, mental retardation, depression, dementia, Alzheimer’s, Parkinson’s Disease and so on. Most long term care is provided at home by family members.

What Is Long Term Care or Eldercare Planning?

For seniors, the terms “long term care” and “eldercare” are synonymous. For younger people, “long term care” is the more appropriate phrase.

For the uninformed family member, eldercare or long term care might appear to be a very straightforward and easy-to-understand process. Unfortunately, the reality is that long term care is very complicated and finding care systems and providers is a frustrating and time-consuming process. There is no one single source to help caregivers find services or solve problems with a simple phone call or a single community contact. For this reason, planning for care requires a great deal of prior knowledge in order to avoid operating in a crisis mode trying to find help when the need for care suddenly arises.

However, knowledge of long term care systems is not enough. Because it can happen suddenly, at any time, you must take action now to prepare for the day when you will need to deal with eldercare for your loved ones or for yourself. This action involves

• Determining the care settings and services you or a loved one most likely would want.
• Providing funding for paying the cost of care, especially when government support programs are lacking or require sacrifice of assets.
• Completing a survey to determine necessary financial and legal arrangements to be made.
• Completing a written long term care planning document to provide instructions to caregivers and to your care coordinator in advance of needing eldercare.
• Assigning a care coordinator and determining the role of other family members, friends or advisers involved in caregiving.
• Holding a planning meeting and drawing up a written agreement for involvement between all those who are willing to participate in future caregiving for you or a loved one.

There are four crucial steps necessary in this process for long term care planning. The four steps are based on the following concepts:

1. Knowledge and preparation are the keys to success.
2. Having funds to pay for care greatly expands the choices for care settings and providers.
3. Using professional help relieves stress, reduces conflict, and saves time and money.
4. Success is assured through a written plan accepted by all parties involved.

In Part II we will discuss these steps in greater depth.