Medicaid CCC Plus Rolls Out in Northern Virginia on December 1, 2017

Q. My mom, who you recently did asset protection for and got qualified for Medicaid, recently received a letter in the mail from the Virginia Department of Medical Services that welcomed her to Commonwealth Coordinated Care Plus (CCC Plus), Virginia Medicaid’s new, required managed care program.

The letter mentions that her mandatory enrollment in the CCC Plus Medicaid Health Plan will give her all her Medicaid health care, long-term services and supports, and prescription drug benefits, and that she will have a care team that works with her and her providers for primary care, mental health, hospital, nursing facility, and specialty care; and that she will have the added benefit of a care coordinator.
 
Can you explain more clearly what this is all about and what these changes mean for my dad? My dad will likely need long-term care in the not-so-distant future, and also wants to know how this will affect him if he qualifies for Medicaid through your office, and wants to know if there are other alternatives to CCC Plus. Thanks for your help!

A. Commonwealth Coordinated Care Plus (CCC Plus) is a new Medicaid program that provides medical, behavioral, substance use disorder, and long-term services and supports all under one program. CCC Plus is being phased in by region across Virginia, as follows:

Tidewater – August 1, 2017
Central – September 1, 2017
Charlottesville/Western – October 1, 2017
Roanoke/Alleghany – November 1, 2017
Southwest – November 1, 2017
Northern/Winchester; December 1, 2017

The letter your mom received was from the Commonwealth of Virginia Department of Medical Assistance Services. It welcomed her to CCC and should have included the following information:

Your CCC Plus Medicaid health plan is SAMPLE MEDICAID HEALTH PLAN. Your coverage will begin October 1, 2017.
Your Medicaid ID # is 00999999999

If this is the letter that your mom received, below is some information about the CCC program, her next steps, and other options:

Who is Covered? 

Medicaid individuals who meet CCC Plus participation criteria are required to participate. You are eligible for CCC Plus when you have full Medicaid benefits, and meet one of the following categories:

· You are age 65 and older
· You are an adult or child with a disability
· You reside in a nursing facility (NF)
· You receive services through the CCC Plus home and community based services waiver — formerly called the Elderly or Disabled with Consumer Direction (EDCD) Waivers and the Technology Assisted Waiver.
· You receive services through any of the three waivers serving people with developmental disabilities (Building Independence, Family & Individual Supports, and Community Living Waivers), also known as the DD Waivers.

Health Plan Choice

Your mom’s CCC Plus health plan will give her all of her Medicaid health care, long-term services and supports, and prescription drug benefits. She should have a care team that works with her and her providers for primary care, mental health, hospital, nursing facility, and specialty care.

In the initial letter that your mom received, she was presented with the ability to choose a different health plan or keep the assigned health plan. A health plan comparison chart should have been included in the mailing to help her decide. If she opts to choose a different health plan, she must do so within 90 days of her enrollment date (which is included in the letter) by calling the CCC Plus Help Line at 1-844-374-9159, or going online at www.cccplusva.com and requesting the change. She may also call the help line to find out if her doctor and other health care providers are in the network of her new health plan. If she wants to keep the Medicaid health plan that was chosen for her, she does not need to do anything. She will receive a health plan ID card. She should keep her Medicaid card, and show both cards when she gets care.

The Care Coordinator

As a CCC Plus member, your mom will be assigned a Care Coordinator through her health plan. The Care Coordinator is supposed to work with her and her providers to make sure she is receiving the services she needs. If she is enrolled in Medicare, her Care Coordinator can assist her with coordinating her Medicare and Medicaid benefits.

Your mom’s Care Coordinator can help her understand and access her plan benefits.

Another Alternative to the CCC Plus Program

As mentioned previously, enrollment of all CCC Plus eligible Medicaid members into the CCC Plus program is required. If you meet certain eligibility criteria, however, the Program of All-Inclusive Care for the Elderly (PACE) may be another option. This program helps people with their health care needs in the community instead of a nursing home or other facility.

The PACE program uses an adult day-care model to deliver the entire continuum of care and services to those with chronic care needs, while maintaining their independence at home for as long as possible. PACE was created as a way to provide family, caregivers, and professional health care providers the flexibility to meet health care needs and to help those who wish to continue living in their own homes.

If your mom or your dad are age 55 or older, they may qualify for PACE. For those in the Fairfax area, InovaCares for Seniors Fairfax is the sole PACE provider, and they can be reached at 703-239-5888, or by email at pace@inova.org. To learn more about PACE, go to: www.PACE4you.org. The website also has a “PACE Finder” to will help you find out if there is a PACE site in your area. If you qualify for and enroll in PACE, you will be “disenrolled” (dropped) from your CCC Plus health plan.

Planning for Long-Term Care for Your Father

You mentioned that your father is interested in applying for Medicaid soon, to help pay for the catastrophic costs of long-term care ($10,000 – $14,000 a month in the Metro DC area). As you know, Life Care Planning and Medicaid Asset Protection is the process of protecting your assets from having to be spent down in connection with entry into a nursing home, while also helping ensure that you or your loved one get the best possible care and maintain the highest possible quality of life, whether at home, in an assisted living facility, or in a nursing home. Your father should call us as soon as possible to make an appointment for his own planning:

Fairfax Elder Law: 703-691-1888
Fredericksburg Elder Law: 540-479-1435
Rockville Elder Law: 301- 519-8041
DC Elder Law: 202-587-2797

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Critter Corner: The CCC Program When You’re Already in a Nursing Home

Dear Angel,

My mother received a letter in the mail about the mandatory Commonwealth Coordinated Care Plus (CCC Plus) Medicaid Managed Care Program. However, she is in a nursing home. Can she remain living at her current nursing facility, and what if anything will change?

Al Reddy-Thayer


Dear Al,

Commonwealth Coordinated Care Plus (CCC Plus) is a new Medicaid program that provides medical, behavioral, substance use disorder, and long-term services and supports all under one program. Medicaid individuals who meet CCC Plus participation criteria are required to participate.

If your mother resides in a nursing facility at the time of her CCC Plus enrollment, she may remain in her nursing facility for as long as she continues to meet the Medicaid level of care requirements for nursing home care. Even if her nursing facility does not contract with her health plan, she can remain in her nursing facility. In fact, efforts will be made to assign her to a health plan that contracts with the nursing facility where she lives.

If Medicaid determines that she continues to need nursing home level of care, she also has the option of choosing a different nursing facility or returning to the community with some services in place to help her. Her Care Coordinator should work together with the staff members of the nursing facility to develop her plan of care, monitor the care she receives, and help with discharge planning, if applicable.

If you or your mother would like help from a CCC Plus Advocate in making a decision about CCC Plus options or in resolving problems about plan benefits, she or you can call the Department of Aging and Rehabilitative Services, Office of the State Long-Term Care Ombudsman, at 1-800-552-5019.

Hope this is helpful!

Purrs and hugs,
Angel

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Come Hear Evan Speak This Weekend at The Positive Aging Fair!

This Sunday, Evan Farr will be speaking at The Northern Virginia Positive Aging and Wellness Fair. The fair will be held at the Inova Center for Personalized Health Conference Center at 3225 Gallows Road (across from the Inova Fairfax Hospital and formerly the Exxon Mobil campus) in Fairfax, VA from 8:45 am to 4 pm. Evan’s session will be held at 11:30am-12:30pm, and the description is as follows:

Medicaid Planning: Protect Your Assets
by Evan Farr, Certified Elder Law Attorney

Long-term care is catastrophically expensive, averaging $12,000– $14,000 a month for a nursing home in the Metro DC area. With proper Medicaid asset protection planning, almost everyone can eventually qualify for Medicaid when needed, without having to be broke or to first spend down your life savings. This workshop will explore how to protect your assets and obtain valuable Medicaid benefits to pay for long-term care.

The fair includes more than 30 interactive and informative workshops promoting active aging through healthy lifestyles that may help you live longer, more independently, and more positively. Bob Levey, former columnist for The Washington Post, is the keynote speaker. There will also be a trade show featuring more than 35 exhibitors — including The Farr Law Firm, the non-profit Reiki Outreach Services for Elders (ROSE) founded by Evan Farr, along with numerous other nonprofits, and government agencies offering one-on-one assistance and resources. The fair is geared for adults 50+. Visit positiveagingfair.com for more details and to register!

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Critter Corner: Does Medicare Really Not Care About Long-Term Care?

Dear Bebe,

I read in a couple of Mr. Farr’s blogs that Medicare doesn’t cover long-term care. I thought that it did cover some long-term care services. Can you clarify? Thanks!

Metta Caire
—-

Dear Metta,

Medicare pays for health care for people age 65 years and older, people under age 65 with certain disabilities, and people of all ages with end-stage renal disease. Medicare only covers medically necessary care and focuses on acute care, such as doctor visits, drugs, and hospital stays. Medicare also covers short-term care and rehabilitation, such as physical therapy to help you regain your function, after injuries such as a fall or a stroke.

Medicare does not pay one penny, ever, for long-term care (often called custodial care) —which involves help with activities of daily living such bathing, dressing, and using the bathroom; nor does Medicare pay for supervision needed by those suffering from dementia.

What causes many people confusion is that Medicare will help pay for a short-term stay in a skilled nursing facility, for hospice care, or for home health care, but if you meet the following conditions:

• You have had a recent prior hospital stay of at least three days (3 midnights);
• You are admitted to a Medicare-certified nursing facility within 30 days of your prior hospital stay;
• You need skilled care, such as skilled nursing services, physical therapy, or other types of therapy.

If you meet all these conditions, Medicare will pay for some of your costs for up to 100 days (i.e., short-term care). For the first 20 days, Medicare pays 100% of your costs. For days 21 through 100, you pay your own expenses up to $140.00 per day, and Medicare pays any balance. Anything after 100 days is considered long-term care, and you pay 100% of costs for each day you stay in a skilled nursing facility after day 100.

In addition to skilled nursing facility services, Medicare pays for the following services for a limited time when your doctor says they are medically necessary to treat an illness or injury:

• Part-time or intermittent skilled nursing care: Physical therapy, occupational therapy, and speech-language pathology that your doctor orders , for a limited number of days;
Medical social services to help cope with the social, psychological, cultural, and medical issues that result from an illness. This may include help accessing services and follow-up care, explaining how to use health care and other resources, and help understanding your disease;
Medical supplies and durable medical equipment such as wheelchairs, hospital beds, oxygen, and walkers. For durable medical equipment, you pay 20% of the Medicare approved amount.
There is no limit on how long you can receive any of these services as long as they remain medically necessary and your doctor reorders them every 60 days.

Hospice care

Medicare covers hospice care if you have a terminal illness and are not expected to live more than six months, but you must first switch your Medicare into “hospice mode,” which means that Medicare will then not cover existing medications and procedures that are designed to improve your condition. You may receive hospice care in your home, in a nursing home (if that is where you live), or in a hospice care facility. Medicare also pays for some short-term hospital stays and inpatient care for caregiver respite.

You can learn more at Medicare.gov. Hope this is helpful!

Purrs and hugs,

Bebe

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Has In-home Care Gotten a Lot More Expensive this Year?


Q. I’ve been a full-time caregiver for my mother for the past few years. Last year, when I noticed that my role was becoming more than I could handle myself, I started looking into in-home care. At the time, I decided against it because it was too expensive. This year has been particularly hard on me, and I could really use the assistance with mom. I decided it was time to spend the money and get my mother the help that she needs to continue to stay in her own home for as long as possible.

I called several home health care agencies in our area for quotes, and couldn’t believe what I was hearing. The cost went up so much since last year! Is this just happening locally, since everything is expensive here, or is it a national trend? I am beginning to get worried. Has assisted living and nursing home care also increased in cost, and most importantly, how can I afford the care that my mother needs now and will likely need in the future?

A. The increase you noticed in the cost of in-home care is not just local. It is happening across the country! Home-based services are increasingly getting more expensive thanks in part to ongoing labor woes of home health care workers, according to the latest Cost of Care Survey from insurer Genworth Financial.

From 2016 to 2017, the national median cost of home health aide services shot up 6.17% to $21.50 per hour — the most pronounced increase among the various care settings according to the survey.

Why the Cost Increase?

According to the New York Times, by current standards, an “in-home health care worker is likely to be a middle-aged immigrant woman, with maybe a high school education and little if any training, making $20,000 a year.”
Despite their critical importance to the well-being of tens of millions of aging Americans, a quarter of these aides live in poverty. The jobs are so unappealing that it is hard to keep workers in them. In fact, 4 out of every 10 leave the occupation entirely within a year, and there is a shortage of these workers in the entire field because of it. Many prefer the fast-food business.

“Home care is absolutely the bottom rung on the ladder, but home-care workers are the people that spend the most time with the client,” said Adria Powell, who runs Cooperative Home Care Associates, a worker-owned long-term-care agency in New York. Sadly, Paul Osterman of the Massachusetts Institute of Technology’s Sloan School of Management calculates that if nothing is done to draw more workers into the field, there will be a shortage of at least 350,000 paid care providers by the year 2040.

The increasing demand for long-term care services as our population ages coupled with a shortage of workers and rising labor costs, is why the cost of in-home care keeps increasing.

Other Notable Findings

In-home care services weren’t the only area where costs increased. Overall, the annual median cost of all long-term care services climbed an average of 4.5% from 2016 to 2017, marking the second-highest year-over-year increase for nursing homes and home care since the study began in 2004. These were some additional findings from the survey:

  • The national median cost for a one-bedroom unit in a private-pay assisted living community reached $3,750 per month, or $45,000 a year, according to the survey. That’s an increase of 3.36% from 2016 to 2017.
  • National median rates for semi-private room nursing home care increased 4.44% and hit $7,148 per month, and private room nursing home care reached $8,121 per month, a 5.50% increase.
  • For nursing homes, higher labor expenses and tightening Medicare rules have resulted in shorter hospital stays and sicker patients being sent to nursing homes for shorter rehab stays, driving up costs.
  • Room and board for assisted living communities has gone up to accommodate residents who are sick, but not sick enough to require nursing home care.
  • Luxurious amenities commonly found in private pay communities also increased costs of care.
  • About two-thirds of respondents in a companion survey to this year’s Cost of Care report said they “expect government programs to cover all or part of their long-term care costs.” The primary government benefit that pays for long-term care is Medicaid, which is why it is so important for people to do Medicaid asset protection planning after age 65, or earlier if there is any sort of disability in the family.

Paying for Long-term Care

With long-term care services being so expensive, how can anyone afford them without going broke or depleting their assets?  Are government programs enough to help pay the costs? Medicare will pay for skilled home health, but most home care and homemaker services are paid out of pocket. Medicare will also pay for limited skilled nursing care following a three-day hospital inpatient stay. But, Medicare does not pay one penny for long-term care!

Medicaid, on the other hand, has different income and functionality requirements. Medicaid is the single largest payor of long-term care costs because so many people can’t afford to cover the costs themselves, but what many people often don’t realize is, it is extremely difficult to qualify and the help of an experienced elder law attorney, such as myself, is absolutely essential.

Genworth includes the following extremely truthful quote in their survey findings: “It usually takes personal experience caring for a parent or other family member for people to realize the enormous costs associated with long term care and wake up to the fact that they themselves need to do a better job of planning ahead for how they will cover these costs.”

Planning for Long-term Care

Medicaid planning can be started while your mother is still able to make legal and financial decisions, or can be initiated by an adult child acting as agent under a properly-drafted Power of Attorney, even if your mother is already in a nursing home or receiving other long-term care.  In fact, the majority of our Lifecare Planning and Medicaid Asset Protection Planning clients come to us when nursing home care is already in place or is imminent.

Generally, the earlier someone plans for long-term care needs, the better.  But it is never too late to begin your planning.
To afford the catastrophic costs of long-term care without depleting all of her hard-earned assets, your mother should begin her Long-Term Care Planning as soon as possible. You both should also do Incapacity Planning and Estate Planning, if you haven’t done so already. Please call us to make an appointment for a no-cost initial consultation:

Fairfax Elder Law: 703-691-1888
Fredericksburg Elder Law: 540-479-1435
Rockville Elder Law: 301-519-8041
DC Elder Law: 202-587-2797

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Local College Students Invent New Gadget to Diagnose Alzheimer’s

University of Maryland Student Invention- EEG to diagnose Alzheimer’s (photo: NIH)

Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks. It is the most common cause of dementia in older adults.

Currently, doctors can’t definitively diagnose Alzheimer’s, so they typically inform patients of “possible Alzheimer’s dementia,” “probable Alzheimer’s dementia,” or some other problem causing memory complaints. The only definitive diagnosis that exists for Alzheimer’s comes from an autopsy. However, a team of sophomores at the University of Maryland, College Park, may have invented a gadget that could help change that! In fact, they just won first prize in a National Institutes of Health (NIH) competition for their prototype portable EEG device designed to diagnose Alzheimer’s, in a convenient, inexpensive manner.

“The solution is really smart and has the potential to really work,” said Zeynep Erim, program director at NIH’s National Institute of Biomedical Imaging and Bioengineering and a judge in the contest. She was impressed by the students’ entry in the Design by Biomedical Undergraduate Teams (DEBUT) Challenge.

From Concussions to Alzheimer’s

When the students were working on their entry for the competition, they were initially focusing on concussions, since there has been a lot of discussion of concussions in professional football players. The students were thinking of how they could use an electroencephalogram (EEG), a test that records the electrical activity of the brain, to diagnose brain waves for concussion.
When their initial idea didn’t work out, they shifted their focus to whether an EEG could be used to diagnose Alzheimer’s. They discovered a lot of literature on the topic, but nothing was ever brought to market. Both of the student team leaders had relatives who had died of Alzheimer’s, so the students thought this could be a way their research could help other individuals and families afflicted by the disease.

How the Invention Works

The EEG used in a research lab typically has as many as 256 electrodes, is the size of a desk, and costs hundreds of thousands of dollars. The team felt that it was much more than it needed for its purposes, as it only takes eight or 16 electrodes to record brain waves.

Therefore, they used a portable EEG with an open source headset, the Ultracortex by OpenBCI, which costs less than $2,000, and connected it to a laptop computer. Using this, the team would look at the brain signals and finds patterns in healthy patients and those with Alzheimer’s. They then extracted features from brain signals and asked the computer what kinds of patterns it saw.

The small-scale trial the students did was with existing data from other studies. The machine, using data from the portable EEG and mathematical algorithms created by the students, was able to predict Alzheimer’s in those patients with 83% accuracy. “It’s definitely not diagnostic yet, but I think it gives it some value,” said Christopher Look, one of the student researchers.

NIH calls the device “a noninvasive and relatively inexpensive tool with the potential to detect Alzheimer’s disease with a high level of accuracy.” The agency says the device “could make dementia diagnosis more quantitative, systematic and less costly — allowing doctors to use it at regular checkups.”

Next Steps for the Students

Currently, the student researchers are figuring out if they want to pursue research for early diagnosis or for diagnosis of current patients. Either would be an improvement from what is used today. The most widely used diagnostic tools now are a questionnaire, the Mini-Mental State Exam (MMSE), and an MRI and PET scan, which are expensive and disruptive. “If this [test] can tell you there’s something wrong or you just need further testing, it [the device] could still be valuable to a patient,” Look said.

Another possible way to test for Alzheimer’s

An experimental blood test is another test that is being developed to possibly diagnose Alzheimer’s disease, according to a study published in the journal, Proceedings of the National Academy of Sciences. Though still in development, the test may someday be used to diagnose other degenerative brain disorders and even mild cognitive impairment resulting from head injuries.

The researchers say that using the test, they were able to identify Alzheimer’s patients with up to 86% sensitivity and specificity. The test also differentiated Alzheimer’s from dementia with Lewy bodies, a related condition, with 90% sensitivity and specificity.

The test is currently beyond pilot studies, and in the validation phase. It could take 5-10 more years, however, before it’s fully released. Researchers are still concerned that at this time, the accuracy isn’t high enough, and could lead to misdiagnoses. Read more about this blood test on CNN’s website. 

Benefits of Early Diagnosis

Hopefully, the EEG developed by the students and the blood test become viable ways to accurately test for Alzheimer’s in the future. Once people with Alzheimer’s find out that they  have the disease, they can take advantage of the benefits to early diagnosis, even though no treatment or cure currently exists. For instance, those who learn that they are likely to have Alzheimer’s could enroll in clinical trials testing possible treatments. Another potential benefit could be that it will help those with Alzheimer’s work with their family, caregivers, and an experienced elder law attorney, such as myself, to plan for their future and their loved ones.

Medicaid Planning for Alzheimer’s and Other Types of Dementia

Alzheimer’s is the biggest health and social care challenge of our generation, and a diagnosis of the disease is life-changing.  When it comes to planning for long-term care needs, generally, the earlier someone with dementia plans, the better. But it is never too late to begin the process of Long-term Care Planning, also called Lifecare Planning and Medicaid Asset Protection Planning.

Medicaid planning can be initiated by an adult child acting as agent under a properly-drafted Power of Attorney, even if your loved one is already in a nursing home or receiving other long-term care.

Medicaid Asset Protection

Do you have a loved one who is suffering from Alzheimer’s or any other type of dementia? Persons with dementia and their families face special legal and financial needs. Here at the Farr Law Firm, we are dedicated to easing the financial and emotional burden on those suffering from dementia and their loved ones. We help protect the family’s hard-earned assets while maintaining your loved one’s comfort, dignity, and quality of life by ensuring eligibility for critical government benefits such as Medicaid and Veterans Aid and Attendance. As always, please feel free to call us for a no-cost initial consultation:

Fairfax Alzheimer’s Planning: 703-691-1888
Fredericksburg Alzheimer’s Planning: 540-479-1435
Rockville Alzheimer’s Planning: 301-519-8041
DC Alzheimer’s Planning: 202-587-2797

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What’s in Your Estate Plan, Mom and Dad?

Q. Our daughter, Melanie, recently came to visit us. She told us that she and her husband will be meeting with your firm to do their estate planning and incapacity planning. Then, she inquired about what we put in our estate plan. We were taken aback by the question, and luckily, the time wasn’t ideal to have a conversation with our grandchildren jumping on our laps.

I know it will come up again. My wife and I discussed it and first and foremost, we want to consider the relationships between our daughter and her sisters. So, although we were hesitant at first, we decided it’s a good idea to have this conversation all of them. What we don’t know is how we should tell them. Should we meet with each daughter separately to focus on just one important and unique person at a time? Or is it better to gather them all in one place so everybody hears the exact same message in the same words? What things should we make sure they are aware of? Thanks for your help!

A. For those of us who have completed our estate planning and incapacity planning, the most stressful part of the process is often the prospect of telling family members what you plan to do with your assets, and what your wishes are. In many instances, parents shy away from discussing these things with their grown children, because they are afraid that children will strongly disagree with choices that are made, be angry or disappointed, will build too much on their expectations for an inheritance, or will be resentful of other heirs. As difficult as it seems, you are making a good choice to have this conversation with your adult children.

So, what’s the best way to tell your grown children about your plans, without creating family drama? That depends on your situation. For instance, do any of your daughters have special circumstances, such as difficulty handling money or a physical, mental, or emotional challenge? If so, the conversation will look different than if all your daughters will inherit equally. In most situations, however, a balanced approach to sharing information about family wealth is the best option.

Setting Up the Family Estate Planning Meeting

The purpose of your meeting will be to tell your adult children what they can expect and what roles they may play in the future managing the estate.

Before the talk, determine the goals and objectives you want to achieve and draft an outline or an agenda, with a few talking points. Choose a quiet place for the meeting that will make everyone feel comfortable and secure.

During the meeting, speak in a calming tone and use words such as “safety,” “security” and “protection.”

If the environment gets toxic, don’t lash out or shut down out of fear, anger, embarrassment, defensiveness or any other unpleasant feeling. Make sure everyone has an opportunity to speak. Should thorny issues arise, try to come up with solutions. It can be helpful to have a trusted adviser at this family meeting, to help ensure an atmosphere of tolerance, patience and impartiality.

Things to tell your children

The following is information that you should share with your children at this meeting, so they know that your estate is in order and can ensure that your plans will be carried out accordingly:

1. Who’s on your team: If you work with financial and legal professionals, compile a list of their names, addresses and phone numbers (or let them know where to find that list if they need it). Include names and numbers of your doctors, in case medical decisions need to be made.
2. Who the executor will be and where the documents are: Tell them how recently your documents were written, who will be the executor, and where they are. If your documents are more than five years old, be sure to review them with us to make sure your current wishes are represented.
3. What are the details and who will be the agent(s) for the Advance Medical Directive and Financial Power of Attorney: Disclose your feelings about life support and other end-of-life issues, and disclose who will manage your financial affairs if you no longer can.
4. Who your beneficiaries are: Tell them who the beneficiaries on insurance policies, pensions, and investments are and how to locate the paperwork. Make sure your designations are up-to-date to reflect your current wishes.
5. What financial accounts you have — and where: Put together a list of your bank, brokerage, and mutual fund accounts and your account numbers. If you have any user names and passwords on the accounts, include those also. Put the list in a safe place, such as a safety deposit box, and make sure they know how to access it when it is needed.
6. What insurance you have and where the policies are: If you or your wife become incapacitated, your children will need to know about your health insurance — private or Medicare. Also, provide info about your life insurance, auto, homeowners, disability and long-term-care policies, so they know your coverage and whom to contact to cancel.
7. Where your financial paperwork is: You’ll want to tell them where to find the title to your house and car, your property deed, and all loan documents.
8. Where your tax files are: Let them know where they can find your previous years’ returns.
9. How you envision your memorial service: This information is in your estate planning documents, but it doesn’t hurt to discuss what kind of funeral you have in mind, assuming you want one, and where you want to be buried or cremated. Tell them about any burial plots you have that they might not know about.
10. Whether you’re an organ donor: This is also in your incapacity planning documents (part of your estate planning), but again it is good to tell them your preferences in advance and let them know where you keep your organ-donor designation (on a driver’s license or if there’s an organ donor card.)
11. Where your safe-deposit box and key are located: The executor of your estate may be able to get into the box without a key, but it’ll probably involve a drill and a substantial fee. Save them the headache and let them know in advance where they can find the key!
12. Where other important passwords are located: Set up Keepass or Lastpass and keep all your passwords in one place. Share how they can access this file, when needed.

I hope your family meeting goes smoothly. If your family is experiencing conflict regarding your estate planning wishes, please read our article, “How to Minimize Family Conflict Over Your Estate Planning Wishes,” for tips on how to handle it.

Planning in Advance is Important!

If any of the members of your family have not done their estate planning or incapacity planning, or not had it reviewed and updated in the last five years, please contact us as soon as possible to make an appointment for a no-cost consultation:

Fairfax Estate Planning: 703-691-1888
Fredericksburg Estate Planning: 540-479-1435
Rockville Estate Planning: 301-519-8041
DC Estate Planning: 202-587-2797

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Critter Corner: Keeping Emotions Out of the Estate Planning Conversation


Dear Ribbit,

I understand that discussing estate planning with adult children can be an emotionally charged conversation. However, I know it’s a critical topic to address with family members. In my situation, my daughter is very sensitive and has always thought my wife and I favor her brother. It’s not true. We honestly don’t favor one child over the other. We do, however, want to leave him certain things, such as my classic car, because he is a car enthusiast. To be fair, my wife will be leaving her diamond jewelry to our daughter. How can we make what will likely be a difficult conversation less emotional?

Thanks!

Les Emoshuns

—-

Dear Les,

Mr. Farr suggests that people “talk early and talk often” about their estate plans.

Inevitably, emotion will be part of the conversation, but if you let it get out of control it can quickly derail the conversation, especially in a time of crisis where emotions are charged. This is why you should discuss your estate planning when you are healthy and when the family is already together, like during birthdays and holidays. When you normalize the conversation you’ll find that this emotional topic is much more manageable.

Also, plan for several meetings, not just one. Expecting to start the conversation and have a resolution all in one meeting is not realistic. Instead, plan to have a few conversations at different times, until you get the details sorted out. The goal is to talk early and often, and when you do you’ll find emotions are less likely to derail these important conversations.

Hop this is helpful!

Ribbit

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Her Parents Were Kidnapped by a Professional Guardian

Rudy North was an avid reader, who had a sharp mind and liked to write down quotes from his favorite books. Rennie, his wife of fifty-seven years, was recovering from lymphoma and suffered from neuropathy so severe that her legs felt lifeless. Yet, she spent her mornings prettying herself up for her husband, who referred to her as his “amour.” She was still of sound mind, and enjoyed the conversations she had with her husband and her nurse.

Rennie was happy living in her home on the outskirts of Las Vegas with her husband Rudy, a retired consultant for broadcasters. Rennie had the help she needed, with a nurse that visited five times a week to help her bathe and dress.

Retirement was going well for the Norths, until one summer day in August of 2013, when April Parks, a so-called “professional guardian” allegedly kidnapped Rudy and Rennie. They had no idea what was happening. Their only daughter, Julie Lynn Belshe, knew nothing about this. Julie says she was in daily contact with her parents and visited often, along with her husband and children. Julie says she was never contact by lawyers or by the court; never went to court; did not receive any phone calls from any lawyers or the court; and there were no letters or court documents sent to their home.

April Parks, who allegedly identified herself as an officer of the court, showed up at the North’s home with an entourage of other people. According to Julie’s parents, Ms. Parks and the others told them, “We have an emergency order to remove you from your home. You have three choices; we can call the police and you will go to jail; you can come to Lakeview Terrace (assisted living facility) in Boulder City and stay there; or you can be placed in a psychiatric ward.” Rennie started crying and told them to leave her home; Rudy, who was very worried about his wife, said they would go to Lakeview. April Parks told Rennie, “Don’t worry, you are only going there to rest for three weeks.” They were then put in a car and taken away.

The house they were living in was emptied of all of their personal belongings, allegedly stolen by the guardian. Many items were also discarded, which their daughter found in trash bins. The money in their bank accounts was allegedly stolen by April Parks, along with their identity; licenses, credit cards, and social security cards. Court hearings were held and, according to Julie, “all court documents were fabricated with a host of lies, including the story that she was an addict.” Julie spoke up in court but said that the judge ignored everything she said. According to information given to Julie by other sources, the judge and guardian already had a large number of complaints filed against them.

Parks continued to control every aspect of Rudy and Rennie’s lives — where they would live, how their money was spent, what items they could keep –and sometimes, who they could see. She charged their estate exorbitant amounts for simple tasks, such as opening mail.

In 2015, the North’s nightmare was over. The court found that Parks failed to protect the Norths and, especially, their estate. When referring to April Parks, Guardianship Commissioner Jon Norheim said, “She’s supposed to block the money. She’s supposed to come to court for release. That didn’t happen. It got spent. Things got sold. None of that was supposed to happen!”

Norheim took private, for-profit guardian April Parks off the case of Rudy and Rennie North. Guardianship was given instead to their daughter, Julie Belshe, who’s been fighting to get her parents out of the system for nearly two years. This disturbing situation hopefully paved the way for others in a similar situation to escape, since sadly, the Norths were not the only ones affected by this nightmare.

The example at the core of this story is very disturbing but also, thankfully, very unusual. It would appear that Nevada may have very unusual guardianship laws. And it is important to note that different laws govern different jurisdictions, and that there are many where the laws are humane and direct the guardian to give the ward maximum self-determination and provide counsel or a court-appointed independent investigator for the proposed ward, impose court supervision over the guardian as well a criminal background checks, among many other protections for wards and potential wards.

You can read more about this case in this recent New Yorker article.

What is Guardianship and How Could This Have Happened?

Guardianship is a legal relationship in which the court authorizes one person with the power to make personal and/or financial decisions for another person. The person authorized with decision-making power is known as the guardian and the person for whom the decisions are being made is known as the ward. Guardianship over the person typically goes along with Conservatorship over property, which in some states is called Guardianship over Property.

Guardianship and Conservatorship is assigned when a person has been determined by a judge to lack the capacity to make rational and intelligent decisions in regard to his or her own medical decisions and/or finances. Usually it is a family member who applies for Guardianship and Conservatorship, but it can also be a friend, or in some cases the County or City in which the ward resides. In some cases, as was the case with the Norths, a third party may be appointed as Guardian and/or Conservator, particularly if no one close to the ward is deemed appropriate. Conservators are subject to the nightmare of “living probate,” meaning that, among other things, they must file annual accountings every year with the Probate Court or Commissioner of Accounts.

A Power of Attorney is a legal document created by one person, known as the principal, to give another person, known as the agent, legal power to act on behalf of the principal. The document can grant either broad and unlimited powers or limited powers to act in specific circumstances or over specific types of decisions. Typically a Power of Attorney is effective immediately, but is intended to be used only when necessary at some future date.

In most cases, Power of Attorney is greatly preferred to Guardianship because:

• The principal retains more control over who makes the decisions and what decisions they can make;
• Power of Attorney has significantly lower costs compared to applying for guardianship;
• No court is involved when creating or using a Power of Attorney;
• No annual accountings are required to be filed when using a Power of Attorney;
• More privacy is maintained with a Power of Attorney (probate court proceedings are public record);
• The principal may revoke the Power of Attorney at any time so long as the principal has the mental capacity to do so, whereas a Guardianship and Conservatorship can only be revoked by the court.

A Power of Attorney would have been a preferable option for the Norths, to avoid the nightmare they went through, since they were both competent and of sound mind.

Do You Have a Power of Attorney?

A properly-drafted Financial Power of Attorney is the most important legal documents that a person can have, and is an essential part of every Incapacity Plan and Estate Plan. It authorizes an agent, sometimes called “Attorney-in-Fact,” to act on your behalf and sign your name to financial and/or legal documents.

If you have not done Incapacity Planning or Estate Planning, or if you have a loved one who is nearing the need for long-term care or already receiving long-term care, the time to plan is now.

In addition, if you have not updated your planning documents in a while, don’t let too much time pass between reviews of your plan. The cost of a review is minimal; but the cost to your family if you neglect your plan could be disastrous. Be sure to ask about The Farr Law Firm’s Lifetime Protection Program, which ensures that your documents are properly reviewed and updated as needed, so that they will have the proper effect under the law.

Please contact us as soon as possible to make an appointment for a no-cost consultation:

Fairfax Power of Attorney: 703-691-1888
Fredericksburg Power of Attorney: 540-479-1435
Rockville Power of Attorney: 301-519-8041
DC Power of Attorney: 202-587-2797

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Power of Attorney Naming Multiple Parties as Agents May (WILL!) Present Problems

By Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, a Freehold, NJ Power of Attorney Lawyer

Clients often ask me to prepare a Power of Attorney. Often they have two or more children and ask if they should name both (or none) of them as attorney-in-fact. Most of the time the clients assume then children will jointly agree to make all decisions about everything together. But that’s when the clients thinking seems to stop.

A dual agent power of attorney can and generally requires each agent to agree in order to act. The easier (and I think better) approach is to allow each to act independently of the other. This approach has advantages and disadvantages. The one risk with the “either/or” approach is that one sibling acts and unintentionally (or intentionally) fails to notify the other. If a parent doesn’t quite trust one or both of the children, making them co-agents who must agree creates a checks-and-balances system that might give them peace of mind.

On the negative side, requiring them to agree might damage their relationship if they cannot see eye-to-eye. It could also be cumbersome if a quick decision is needed and one of them is not available for consultation. Another potential disadvantage: Many banks will reject a power of attorney that requires both co-agents to sign checks. With so many transactions done online and telephonically, banks find it difficult to determine if both agents are truly in agreement. You may be better off allowing each child to act independently, or name one as the primary agent and the other as the successor agent.

Seriously evaluate each child’s personality and capabilities, as well as how your plan could impact their relationship. Then discuss the issue candidly with them and with your estate planning/elder law attorney.

To discuss your NJ Power of Attorney matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com.  Please ask us about our video conferencing consultations if you are unable to come to our office.

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