ONLINE INFORMATION AND DOCUMENTS
Aging with Dignity offers a document called Five Wishes, “The most popular and easy to understand. . .advance directive in America.” https://agingwithdignity.org/docs/default-source/default-document-library/product-samples/fwsample.pdf?sfvrsn=2
PERSONAL ADVICE FROM LBDRC ADVISORY BOARD MEMBER, ROBIN FELSHER
Parts of the following information were taken from: Caregivers Library
Our revenue stream and living costs play an intrinsic role in the quality of our daily lives and our well being. For most of the population, the strain of rising costs for the basic things we need in life—food, shelter, clothing, medical care, transportation—and fixed or limited income growth or savings, make the management of our finances a challenge.
It is even more daunting a challenge when it involves a loved one who can no longer manage for himself/herself.
This was my experience when my father lost his second wife, who managed their finances, and when he developed the life altering disease, Lewy Body Dementia. The responsibility of managing my father’s finances and caregiving fell to me. I really did not want the responsibility. There was no one else that I trusted to do it. This is an excerpt of what I learned…
Information and trusted advisors are critical.
Most people fear their loss or a loved one’s loss of control of their world. While the conversation is changing, most people still do not talk about this possibility or how they will manage.
Finances can often be a taboo subject especially between parents and children and the barriers between or among loved ones, especially on the topic of money, prevent the acquisition of the very knowledge that they need to manage their lives. As shared in other published articles, it is important to open up the conversation with a loved one about what he/she may want as they age, which includes their finances, before they can no longer effectively manage their lives.
Try to do the following:
Develop a list of assets including contact names and telephone numbers for their savings and checking accounts, investment accounts, automobile, condo, co-op, home, property, etc. and their estimated value. Take photographs of assets where possible.
Develop a list of daily, weekly, monthly, annual, quarterly and semi-annual expenses.
Include costs for food (groceries and dining); loans including automobile leasing costs, home mortgage, home equity loans; housing costs including maintenance, rental, time share; insurance premiums including auto, home, life, long term health, medical Insurance, personal liability; medical costs including Medicare/Medigap, Medicaid; physicians, dentists, therapists, medical supplies, prescription drugs.; transportation costs including buses, subways, taxis, car service; utility costs including cable, cell phone, gas, electric, internet, telephone, and water.
Determine the Method of Bill Payment being used for expenses including Auto Pay, Credit Card, Debit Card, Check, Online Payment
Develop a list of all your loved one’s creditors including account numbers, contact names, contact numbers, billing cycle, user IDs, passwords, and website addresses.
Locate and safeguard records including checkbook, bank statements, tax records including tax filings, insurance policies, investment statements, Medicaid policy, Medicare/Medigap policies.
Locate and safeguard legal documents including a Birth Certificate, a Baptismal Certificate, Death Certificate (Spouse), Department of Motor Vehicle License, Divorce Decree, Durable Power of Attorney, a Green Card Health Insurance Card, Marriage Certificate, Medicare/Medicaid Card, Military Service Record, Naturalization Certificate, Passport, Pay Stubs, Photo ID, Pension Award Letter and pension payment stub, Separation Agreement, Voter Registration Card, Social Security Card including award letter of benefits, the most recent Last Will and Testament, Power of Attorney, Assignment of Guardianship, Trusts, and Partnerships.
Work with a trusted advisor(s): an Accountant, Attorney, Daily Money Manager,
Financial Planner, Personal Banker, Professional Geriatric Care Manager, Investment Firm who can help you sort through the complicated network of taking control
Develop a list of all income sources and funding amounts and schedule of income including Investments, Social Security, Pension, Catastrophic Medical Insurance Reimbursement, Health Insurance reimbursement, Medicaid reimbursement, Medicare reimbursement, Medigap reimbursement, and Long Term Health Insurance reimbursement.
Determine the method and nature of income including Cash, Checks, Direct Deposit.
Create a tracking system by using a diary, spreadsheet or custom software into which you can enter your transactions or actions taken on your loved one’s behalf.
Trust between the individual whose finances you are managing, and you, is central to facilitating all of this. Of course, your own personal integrity while you manage someone else’s finances is very important.
If you can be made a joint account holder on your loved one’s accounts, then the process is slightly easier. Even if you hold a Durable Power of Attorney with the appropriate rights, you have more legal standing, but you may encounter issues with the banks, and other financial organizations.
There is no blueprint for how to manage your own finances or someone else’s for that matter.
ADDITIONAL HELP FROM LBDRC’S DIRECTOR OF COMMUNITY OUTREACH, SUSAN VISCONTI:
Legal Matters, Asset Protection
When one of our senior family members becomes ill, very often a family is in such great distress/crisis as they begin the process to navigate the medical diagnosis, proper treatment, and the exhausting tasks of doctor visits and ongoing medical tests, that they are not able to focus on the more practical legal matters that will greatly impact their ability to provide their loved one with the best care–in the best environment–as LBD progresses.
It is quite understandable that the family makes their loved one’s health and well-being the primary concern–and may even be in such a state of emotional turmoil–that they think it is cold & calculating to even think about “money issues” as they start the journey of caregiving. Unfortunately, part of being a caregiver is to deal with all matters of providing the full spectrum of good, quality care. The legal applications, if not addressed early on, may have a very negative impact on one’s ability to have the type of care that is suitable for each patient’s personal family values. The practical points listed below are not meant for one set of circumstances or values as opposed to another. These are life documents that would be most appropriate and are applicable for most of us in our lives in any medical circumstances.
Time is a critical component in getting the proper legal documents set up. Going through the trials and tribulations of early Asset Protection will definitely save great heartache later on when a family is working so hard to get through the escalation of this disease. It is really tough to emotionally deal with the news of a disease such as Lewy Body Dementia and worry about how this will impact your family member — but it is also the start of a ticking clock to put everything into place for future needs that one isn’t truly able to perceive at that moment. Trust me, as difficult as it is, it will help avoid unnecessary hardship, distress and emotional fallout down the road!
First, there are the basics of what most people generally need to have as their Legal Documents: a Will, a Living Will, Health Care Proxy, Power of Attorney and, where necessary, an Irrevocable Trust (to protect assets in case it is necessary to use the services of Medicaid and a Nursing Home).
A Will is a legal instrument to designate directives for an executor to administer after you have passed. It stipulates many things. Most importantly, it distributes your assets (money, IRAs, stocks & bonds, real estate and personal belongings — everything from clothing, to furniture, to artwork, to collectibles, to real estate, etc. It also designates who you entrust to be your executor; it can be more than one person also known as co-executors. You need to choose this person(s) carefully – whether they are family members, friends or an attorney. It should be someone who is trustworthy and in whom you have faith that they will follow your wishes as outlined in the document of the Will.
There are many issues to be aware of such as whether each of your children receive equal or partial shares of assets, whether their children or spouses are included, if one child is deceased prior to your passing does that person’s share go to the deceased child’s children/spouse or just to the living children. If a person has no direct heirs, the distribution of their assets needs to be carefully stated. An attorney who is well established in dealing with Elder Law and Advocacy is your best choice. An excellent way to obtain an Elder Law Specialist is by referral from family and friends who have been through similar situations and were happy with the process. Another Resource to check with is The National Academy of Elder Law Attorneys at 520-881-4005.
If you have financial assets in the form of stocks & bonds, IRAs, bank accounts, real estate, those assets ALL must be up to date in legally designating who the Beneficiaries of those Assets will be. In the case of stocks & bonds, the company managing this asset must provide you with documents for you to assign beneficiaries of said assets.
***The reason being that if you do not have this designation prior to passing then those assets will be outside the will’s ability to avoid Probation resulting in the assets being subject to lengthy court proceedings and possibly being taxed before being distributed. ***
Probate: legally proving in surrogate court that a will is valid……and to award Letters of Testamentary to the person(s) named in the will as the Executor(s). This can be a long, drawn out and expensive process which will diminish the amount of that particular asset being given directly to the heirs. (There are also the legal fees of submitting the assets to probate and then the tax implications that will follow.)
Next, there is the matter of protecting one’s assets as one’s needs for expensive care increases. An Irrevocable Trust will most likely be needed to provide protection of a person’s hard-earned assets.
An Irrevocable Trust: This is a very specific document set up through an attorney to protect all of the assets that a person has acquired and now needs to protect due to dire illness. This will avoid having assets in Probate and serve to limit or eliminate taxes on the assets poured into the Trust. (Unlike a will, the Assets in an Irrevocable Trust will not have to go through Probate when the person passes — all the distribution of assets goes directly to the persons named as beneficiaries in the Trust.)
A person who is diagnosed with an illness that will physically and mentally affect a person’s ability to properly and effectively be able to care for themselves, so that they may no longer be able to manage their property and financial matters and will need others to provide for their care, should set up an Irrevocable Trust.
An Irrevocable Trust is set up so that a designated Trustee (it could be the person who is also named as Executor in the Will) can then be given the responsibility to handle all the personal business for said person to manage the payment of medical bills, medical supplies, household expenses, caregiver expenses and ultimately manage the assets of the estate once a person has passed.
Ultimately, because of the extremely high cost factor of providing appropriate medical/living care, an Irrevocable Trust –set up properly by an attorney who is vetted and who specializes primarily in Elder Law and Trusts –will protect a person’s lifelong accumulation of assets so that he/she will not suffer financial consequences/penalty (having to reimburse Medicaid for services received due to improper Trust filing) if they age into the system of Medicaid which will provide medical services/supplies and nursing home care as their illness progresses. As of this writing, there is a 5-year look back for services provided by Medicaid at a Nursing Home & Rehabilitation Center. Any services required before the end of the 5 years will have to be paid for using the patient’s own assets.
Example: If one sets up an Irrevocable Trust and has poured all their known assets into that Trust, by June 1st, 2015 then the end of the 5-year look back will be June 30, 2020. After June 30, 2020, applications to Medicaid to provide services and have those services paid for by Medicaid will not affect the assets that have been poured into the Irrevocable Trust before June 1st, 2015.
NOTE: Since the rules pertaining to all of this are complex and subject to change frequently throughout the years, it is critically important that the family maintain contact with the attorney who set up the Trust so that when changes occur or if they are about to occur then the Attorney & Family can plan strategies to meet those changes.
The designated Trustee & family caregivers will be responsible for maintaining contact with the attorney on a regular basis to keep up-to-date and to fine-tune things as rules change. It is not likely that one can assume the Attorney will be monitoring each of their client’s specific circumstances to such a degree that they will have the time to constantly contact each of them when rules and laws change.
The Trustee may benefit by obtaining the book: Being a Trustee for Dummies which is an excellent resource in learning how to go about the process of how to handle this to the best of their ability….to truly safeguard the assets of their loved one as laws/circumstances change.
(Note: there are so many variables that could arise after a Trust has been set up……the patient may have an increase in income due to an inheritance or sale of a substantial asset that will require an immediate consultation with the Trust Attorney to determine how that new circumstance will impact the timetable of a 5-year lookback and how to handle this in accordance with the goals of the Trust and the rules governing such things.)
Health Care Proxy: This document allows a person to appoint a person to make decisions for them if they become incapacitated.
Living Will – (also known as Advanced Directives): a document that defines what the person wants or does not want done medically during critical or end of life medical situations. The Living Will states whether a person wants all medical attempts made to keep them alive–or not. The Health Care Proxy above is directly tied to this document as a person of their choosing is given the authority to make medical decisions with the doctors using the Living Will instrument as legal proof that this is the wish of the patient.
Power-of-Attorney (POA): this designates a person to act on your behalf in all financial, medical and legal matters should you become unable to act/speak of your own accord. The POA will allow the designee to act on your behalf to sign documents, pay bills and make legal decisions while you are incapacitated. The Power of Attorney designation is only while the person is living. If the person passes, then the designated person holding the Power of Attorney no longer has any legal right to act further. The Executor then takes on that role.
DNR – Do Not Resuscitate Order
A DNR order, short for “do not resuscitate order,” alerts emergency personnel that you do not wish to receive cardiopulonary resuscitation (CPR) in the event of a medical emergency. It is a medical order that must be signed by a doctor.
DNR orders are used primarily by people who are already critically ill and feel strongly that they do not want life-prolonging treatment when close to death. If you do not have a DNR order, emergency medical personnel must use all available measures, no matter how invasive, to save your life.
Getting a DNR order in the hospital. When you are admitted to a hospital, your doctor can add a DNR order to your medical record. This may happen in a number of ways:
- You can request the DNR order yourself.
- If you are close to death and unable to communicate, and you have a living will or advance directive that makes your wishes clear, your doctor can put the DNR order in place.
- If you have appointed a health care agent and a DNR order is consistent with your known wishes, your agent can authorize the DNR order for you.
- If you have not made documents directing your health care, the person who is legally authorized to make health care decisions for you (usually your spouse or next closest relative) may be able to authorize a DNR order, if they believe it is what you would want.
Using a DNR form outside a hospital: If you are not hospitalized, you can complete a New York DNR form that alerts paramedics who respond to emergencies at home, in hospice facilities, or elsewhere. It’s important that you also get a MedicAlert or other bracelet, anklet, or necklace to make your wishes immediately apparent. Keep in mind that, to be valid, your DNR form must be signed by a doctor or other approved medical professional.
For more information about DNR orders, talk to your doctor.
The above life/legal topics are very complex and can feel very overwhelming. It may be difficult to approach your senior family member to discuss such delicate topics and have them be agreeable to go to an attorney and procure of all these documents. There are resources to help in navigating this tricky path.
One source is AARP. AARP has many articles through its monthly publications and published books on the topic of Aging, How to Manage Caregiving, etc. One book in particular, The Other Talk: A Guide to Talking to your Adult Children About the Rest of Your Life by Tim Prosch is recommended. It will help with strategies, conversation openers and the like to help families discuss a lot of important topics. AARP also has a website that will have ongoing updates and new resources posted which will be easily accessible on the computer ~ at your fingertips, just a click away.
Unfortunately, many people believe there is plenty of time ahead to deal with the Financial implications of long-term illness but it is actually as urgent as the medical side of care to have things set up before there are other situations to deal with–both physically and emotionally. I cannot stress enough that it is imperative that each of us takes the time sooner than later to consider all aspects of their life wishes and to act immediately to actively put together the resources necessary for their peace of mind and to make the carrying out of one’s wishes legally and, to a degree, for guidance and peace of mind to their loved ones who will be the ones who will need to find the ways and means to fulfill them during an emotionally fraught time. Having these documents in place will be a gift to all involved.
Have a candid Family Talk to discuss options of care as illness or infirmities due to aging require more intensive care–whether it be Community Care at Home, Assisted Living or Nursing Home care.