I Just Got a Rate Increase on My Long Term Care Insurance Policy

By Fredrick P. Niemann, Esq. of Hanlon Niemann Wright, a Freehold, NJ Estate Planning Attorney

Clients with long term care policies are calling more frequently about rate increases.  They receive a letter from their long term care insurance company that they are increasing premiums by a whopping 60%.  If that’s not bad enough, the letter warns that the individual should expect further increases in future years.

Take hypothetical Jim who is 71 years old and healthy.  While he doesn’t have a crystal ball to look into the future, he is currently healthy and has no idea if or when he’ll need long term care.  How many rate increases could he face – and will he be able to afford them – before he ever starts to receive benefits under the policy?

The letter Jim received gives him options.  One of course is to pay the 60% rate increase and keep his benefits the way they are.  A second option is to reduce his daily benefit – the amount paid per day for care – or to reduce or eliminate the inflation protection that raises the daily benefit each year to keep pace with the rising cost of care.  A third option is to keep a more limited benefit for long term care.  In that case Jim does not have to make any more premium payments.

Jim is unsure of what to do.  He’s not even sure he understands each option to be able to make an informed decision.  In my next post I’ll explain the options and give you the pros and cons of each.

To discuss your NJ estate planning 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.



I Just Got a Rate Increase on My Long Term Care Insurance Policy (Part 2)

By Fredrick P. Niemann, Esq. of Hanlon Niemann Wright, a Freehold, NJ Estate Planning Attorney

In my last post I was telling you about calls I receive with increasing frequency.  Remember my client, Jim who received a letter notifying him of a rate increase of 60% on his long term care insurance premium.  He wanted to know what he should do.

The letter explained that the increase is not based on a change in Jim’s age, health, claims history or really anything specifically about Jim.  The reason for the increase is that the insurance company underestimated the number of claims and the amount paid out on those claims when it set the premium at the time Jim purchased the policy.  In other words, it must raise the premium to be sure it will have enough money to cover future claims.

The insurance company can’t do this unilaterally.  It must get approval first from the New Jersey’s Department of Insurance.  Often times, the State will approve a smaller increase or will grant the desired increase but spread over a period of several years.  The State also requires the insurance companies to offer their policyholders options rather than simply raising the premiums.

Let’s go back to Jim’s letter.  He currently has a policy that provides a benefit of $300 per day for up to 4 years to cover his care at home, in an assisted living facility or in a nursing home.  His policy has an inflation rider of 5% simple, meaning that every year the daily benefit increases by $10 (5% of $200, the original daily benefit he purchased).  His current premium is $2400 per year.  To keep the same coverages he must now pay $3840 per year.  Jim has been offered several options.

Option 1A is to reduce his inflation protection to 1% simple.  That means that every year his daily benefit will increase by $2 instead of $10.  Over time that will erode his coverage because long term care costs are increasing at a much higher rate, by some calculations as much as 5% to 7% per year.  Nevertheless, taking this option means that Jim will avoid the premium increase.

The insurance company has also offered Jim an Option 1B which enables him to avoid half the increase if he reduces the inflation rider to 3%.  That means his premium will jump 30% but his daily benefit will increase by $6 each year.

Option B allows Jim to essentially redesign his policy to reduce the premiums he will pay.  He can call the insurance company to discuss options that may be available to reduce his daily benefit, the inflation rider, the elimination period (waiting period before benefits start), or the type of care covered.  In this way he may be able to reduce his premium to an amount close to what he has been paying.

Option C is a limited benefit that does not require Jim to make any more premium payments.  It is a paid up policy that provides total coverage under the existing limits of Jim’s policy up to the amount of premiums he paid.  If Jim has paid $2400 per year in premiums for 10 years, under this option he has $24,000 of long term coverage payable at $300 per day.  In other words, if he decides the increased premiums make the policy un-affordable and he drops it, the insurance company must at least give back his premiums in the form of long term care coverage.

None of these options, however, allows Jim to keep what he thought he had bought and locked into10 years ago.  So what should he do?  The tendency for many who find themselves in Jim’s shoes is to focus on the premium and take option 1A.  However, Jim chose his original coverage amount because he determined that this was what he needed to protect himself.  Simply focusing on keeping the cost down leaves him unprotected.

There is another greater danger to consider and I’ll share that with you next week.

To discuss your NJ estate planning 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.


I Just Got a Rate Increase on My Long Term Care Insurance Policy (Part 3)

By Fredrick P. Niemann, Esq. of Hanlon Niemann Wright, a Freehold, NJ Estate Planning Attorney

In my last post I was reviewing with you Jim’s dilemma.  He received a notice of a rate increase from his long term care insurance company.

I went through with you the options outlined in that letter.  For some people in Jim’s situation Option B may be the way to go, redesigning their policy.  For example, if you have a policy that, with the inflation rider, covers $300 a day for lifetime you probably have more coverage than you need.  A simple solution would be to reduce the daily benefit and switch from lifetime coverage (which most companies don’t offer anymore) to a lifetime cap of 4 or 5 years.  In many cases that could dramatically reduce or entirely eliminate the rate increase you face.

There is, however, another concern to be aware of.  There are far fewer insurance companies offering the type of traditional long term care insurance that Jim has than there were 10 or 20 years ago.  As rate increases for these policies become more commonplace healthier policyholders are more likely to look to switch to other ways to pay for long term care.

As I have talked about in previous posts on this blog, there are some asset based long term care products that may be more attractive.   Some of those products permit you to lock into premiums with no future increases.  Not everyone, however, will be a good fit for these options.  Getting through the underwriting process could be a problem for some because they may no longer be healthy enough.

How does this impact someone like Jim?  Over time, if healthy policyholders choose Option C, effectively dropping their policies because they have decided to go elsewhere for their long term care coverage, that will leave only the sicker policyholders who will have no choice but to stay.  That could cause steeper and more frequent premium increases as the insurance company pays more in claims than it is receiving in premiums from fewer and fewer healthy policyholders.  It becomes a cyclical thing.

Food for thought for many who find themselves in the same shoes as Jim and one more reason that planning for long term care is so challenging but ever more important as the American population continues to age.

To discuss your NJ estate planning 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.


Is it Dementia or Adult ADHD?

Ginny is a 58-year-old widow who struggles each day with where she puts her keys, her cell phone, her purse, and even sometimes her coffee cup after she fills it with coffee. She often has trouble following conversations, and after about 15 minutes, she doesn’t remember much of what was said at all.

After observing his mother’s bouts of forgetfulness, Ginny’s son Trevor became very concerned and insisted that she make an appointment with a neurologist immediately. Trevor was diagnosed with attention deficit hyperactivity disorder (ADHD) as a child, but since his mother was already in her late 50’s, his internet research pointed him to concerns that she could be in the beginning stages of dementia and, of course, he became alarmed.

During the examination, the doctor asked Ginny about her school days as a teenager. She recalled that she had trouble paying attention to the teacher, did poorly on tests because she couldn’t sit still, and was always forgetful when it came to her keys, remembering people’s names, and knowing where her car was parked. After interviewing her extensively, and noting the presence of patterns of impairment that spanned throughout her lifetime and her son’s diagnosis of ADHD, the doctor did not think Ginny had dementia. He diagnosed her with ADHD! She was surprised that she didn’t realize this about herself until now, and relieved that he didn’t think she had dementia.

Adult ADHD vs. Dementia

Once seen as a disorder affecting mainly children and young adults, it has been found that ADHD can last throughout one’s lifetime (with 30% to 70% of children with ADHD continuing to have symptoms when they grow up.) In addition, people who were never diagnosed as kids may begin to develop more obvious symptoms in adulthood. Many adults, such as Ginny in our example, don’t realize they have ADHD, leaving them mystified about why they are so forgetful all of a sudden.

To explore further, let’s look at the symptoms of adult ADHD versus the symptoms of dementia, to see how they are different.

Symptoms of Adult ADHD

  • Running Late: Adults may be chronically late for work or important events.
  • Risky Driving: One of the hallmarks of ADHD is difficulty keeping your mind on the task at hand. Studies show that people with ADHD are more likely to speed, have accidents, and lose their drivers’ licenses.
  • Distraction: Adults with ADHD may have trouble prioritizing, starting, and finishing tasks. They tend to be disorganized, restless, and easily distracted. Some people with ADHD have trouble concentrating while reading.
  • Outbursts: Adults with ADHD may have problems with self-control. This can lead to difficulty controlling anger, impulsive behaviors, and blurting out rude or insulting thoughts.
  • Hyper Focus: Some adults with ADHD can focus intently on things they enjoy or find interesting. But they struggle to pay attention to tasks that bore them. The trouble is that many tasks necessary for success in everyday life are dull, from making a grocery list to filing documents at work. People with ADHD tend to put off boring tasks in favor of more enjoyable activities.

Symptoms of Dementia

You will see from the list below that dementia is very different, and far more severe than ADHD. According to the Alzheimer’s Association, while symptoms of dementia can vary greatly, at least two of the following core mental functions must be significantly impaired to be considered dementia:

  • Memory: In the earlier stages of dementia, memory loss and confusion may be mild, while in the later stages, memory loss becomes far more severe.
  • Communication and language:  In the early stages of dementia, the person’s communication may not seem very different or he or she might repeat stories or not be able to find a word. As the disease progresses, it can get a lot worse with easily losing train of thought, having difficulty organizing words logically, and more.
  • Ability to focus and pay attention: Although functionally separate from memory, problems with attention can also impact on a person with dementia’s ability to learn or recall information.
  • Reasoning and judgment: The ability to exercise judgment, weigh facts, and organize and sequence information is progressively affected.
  • Visual perception: As there are many different stages involved in the seeing process, various types and combinations of mistakes can occur including illusions (distortion of reality), misperceptions (distorted information), and misidentifications (distinguishing between a son, husband, or brother may become difficult.)For more details on dementia and Alzheimer’s symptoms, please visit the Alzheimer’s Association Website

ADHD May be Overlooked in Seniors

According to Dr. Thomas Brown, associate director of the Yale Clinic for Attention and Related Disorders at the Yale School of Medicine, “Most doctors are not thinking of ADHD as a characteristic of somebody who is 60 or over.” Hence, the condition may be overlooked in the 80-year-old who has trouble staying engaged at the senior center, despite a lifelong history of inattention. “They figure it’s just cognitive decline from aging” or diagnose depression or anxiety in such patients, which may or may not be the case, he said.

Can ADHD Cause Dementia?

Adults with symptoms of ADHD are more than three times as likely as other adults to develop Lewy Body Dementia (LBD) later in life, according to new research from Argentina. LBD symptoms include cognitive impairment, in addition to visual hallucinations, fluctuation in cognition, and motor abnormalities similar to those in Parkinson’s disease patients.

To conduct the study, researchers evaluated 360 patients with dementia — 109 had LBD and 251 had a non-LBD type of dementia — comparing them with 149 healthy people matched by sex, education, and age. They looked at how often ADHD symptoms had been reported earlier in the person’s life. In patients who were too impaired to answer, they got information from an informant who had known the patient for at least 10 years and had information from a close relative who knew the patient in childhood.

They found:

  • A whopping 47.8% of those with LBD had previous ADHD symptoms.
  • Only 15.2% of those with other types of dementia had previous ADHD symptoms.

A U.S.-based expert cautions that although the study found an association between ADHD symptoms and Lewy Body Dementia, that it is not necessarily a cause and effect. “It may be that both of these disorders are linked to some other risk factor that is common for both,” says James B. Leverenz, MD. Other experts believe that these studies are inherently flawed, as people must recall their histories or those of loved ones, and that the next step is replication of the findings by other researchers.

Adult ADHD or Something Else?

If you are often restless and have trouble concentrating, don’t jump to the conclusion that you have ADHD. These symptoms are also common in other conditions. Poor concentration is a classic sign of depression. Restlessness or anxiety could indicate an overactive thyroid or anxiety disorder. And, as you can see from the distinctions listed above, forgetfulness could be a sign of dementia. Your health care provider can investigate whether these conditions could be causing your symptoms instead of — or in addition to – ADHD. So if you are concerned, be sure to check with your doctor.
If you or a loved one has ADHD.

Common conditions that can coexist with ADHD include learning disabilities, Oppositional Defiant Disorder, Conduct Disorder, Anxiety and Depression, and Bipolar Disorder. The term “special needs” is used to collectively define those persons that require assistance due to physical, mental, behavioral, or medical disabilities or delays, including those mentioned. If your loved one has special needs that impact his or her independence, find out more about Special Needs Trusts, a vehicle that provides assets from which a disabled person can maintain his or her quality of life, while still remaining eligible for needs-based programs, such as Medicaid, that will cover basic health and living expenses.

If you or a loved one has dementia

Persons with dementia and their families face special legal and financial needs. At The Law Firm of Evan H. Farr, P.C., we are dedicated to easing the financial and emotional burden on those suffering from dementia and their loved ones.  We help protect your family’s assets while maintaining your loved one’s comfort, dignity, and quality of life by maintaining eligibility for vital government benefits such as Medicaid and Veterans Aid and Attendance.

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

Premarital Agreements and Medicaid Eligibility in New Jersey

Premarital Agreements and Medicaid Eligibility in New Jersey

By Fredrick P. Niemann, Esq. of Hanlon Niemann Wright, a NJ Medicaid Attorney and Law Firm


Medicaid says it does not recognize premarital agreements signed by spouses prior to entering into a first, second or subsequent marriage.  A premarital agreement is a signed contract between two competent adults prior to marriage which addresses each other’s economic, and financial support obligations and responsibilities during the marriage and/or in the event of divorce or the death of one spouse.  These agreements are legally binding upon each signatory provided certain formalities and disclosures are made (these formalities and disclosures are outside the scope of this page).  But there are strategies which I believe preclude Medicaid from refusing to acknowledge and enforce these agreements. In my opinion, Medicaid is powerless to deny an otherwise lawful premarital (a/k/a prenuptial agreement) legality.  To be successful however requires a deliberate strategy and precise timing.

My strategy requires an immediate application to the Superior Court to obtain a judgment that declares the prenuptial agreement enforceable and enters a divorce from the prospective (or actual) institutional spouse.

There is an interesting dynamic and running conflict within New Jersey laws when this strategy is contemplated.  First there are published cases that hold each spouse to be legally responsible to the other spouse for life’s “essential necessities,” but this case law does not address the enforceability of those obligations when a premarital agreement has been legally signed by the spouse prior to marriage.  Therefore, filing for divorce and enforcing the terms of the premarital agreement is your only option to escape Medicaid’s non-negotiable position on marriage, which is if you’re married when you file for Medicaid you’re bound by the Medicaid laws.

Please read my extensive blog on this subject found under the Recent Posts/Blogs section of this page. http://bit.ly/1o6vWmd Click here


To discuss your NJ Medicaid 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.

Critter Corner: Can a $6,000 Stuffed Seal Replace Caregivers?


Dear Baxter,

I heard from my cousin, who told me that his mother recently leased a $6,000 stuffed seal to assist with stress relief, relaxation, and motivation. Supposedly when it came out, production of it was stalled at first with the fear that it would replace human caregiver. Have you heard of such a thing, and if so, can you please explain?

Cele Forcomfort

Dear Cele,

What your cousin is referring to is PARO, an animatronic baby harp seal with large black eyes, made by the Japanese company, AIST. The stuffed seal was first introduced to the U.S. in 2008, and classified as a medical device by the Food Drug Administration in 2009, and has been since used to provide therapy in hospitals and care centers.

You are correct in that it’s $6,000 price tag and the fear that it would replace human caregivers stalled its introduction. However, now, its creator, inventor Takanori Shibata, is offering a lease-to-own program (with maintenance support) to try to spread PARO’s presence in the United States.Dozens of facilities, including several in the DC Metro area are currently using PAROs.

According to AIST, “PARO allows the documented benefits of animal therapy to be administered to patients in environments such as hospitals and extended care facilities where live animals present treatment or logistical difficulties.” Patients have seen the following benefits:

• It has been found to reduce patient stress and caregiver stress;

• It stimulates interaction between patients and caregivers;

• It has been shown to improve patient’s relaxation and motivation;

• It improves the socialization of patients with each other and with caregivers.

PARO was recognized as the World’s Most Therapeutic Robot, as certified by Guinness World Records, according to the company.

How does PARO work?

PARO has five kinds of sensors: tactile, light, audition, temperature, and posture sensors, with which it can perceive people and its environment. With the light sensor, PARO can recognize light and dark. It feels being stroked by it’sitactile sensor, or being held by the posture sensor. PARO can also recognize the direction of voice and words such as its name, greetings, and praise with its audio sensor.

PARO can learn to behave in a way that the user prefers, and to respond to its new name. For example, if you stroke it every time you touch it, PARO will remember your previous action and try to get you to repeat that action.

By interaction with people, PARO responds as if it is alive, moving its head and legs, making sounds, and showing your preferred behavior. PARO also imitates the voice of a real baby harp seal.

I don’t think PARO will be replacing human caregivers anytime soon, but it seems like it could be an effective way to provide comfort to patients(when they don’t have a real pet like me!)

For more details on PARO, please see this article in the Wall Street Journal or visit the PARO website.

Arfs and kisses,


Now You Can Clone Grandma — April Fool’s Joke . . . or Not?


Q. I am very close with my 100-year-old grandmother, Emily. She is a remarkable, accomplished woman who went to college (which was rare in her time) and became a successful brain surgeon. She is also a very talented artist. I visit her every week and we talk for hours. Despite the fact that she is sharp-witted, creative, and absolutely brilliant, she has some severe health impairments, and I’m not sure how long she’ll be around. I read somewhere that companies are replicating dead loved ones with robot clones. Do you know if this is real, out of a sci fi movie, or an outlandish dream I had that seemed real? Thanks for your help!

A. Although it is April Fool’s Day and what you mention seems like an intriguing sci fi movie plot, I think what you read is really in the works! According to a recent article in Motherboard titled, ​“Companies Want to Replicate Your Dead Loved Ones With Robot Clones,” many struggle with grief and moving on after the death of someone well-loved, and companies are working to develop robot clones to recreate the personalities and mannerisms of those who are deceased.

According to the article, “Many grieving people feel an emotional connection to things that represent dead loved ones, such as headstones, urns, and shrines, according to grief counselors. In the future, people may take that phenomenon to stunning new heights: Artificial intelligence experts predict that humans will replace dead relatives with synthetic robot clones, complete with a digital copy of that person’s brain.”

Terasem Movement, a research foundation that aims to transfer human consciousness to computers and robots, has already created thousands of highly detailed “mind clones” to log the memories, values, and attitudes of specific people. Using the data, scientists created one of the world’s most socially advanced robots, a replica of Terasem Movement founder Martine Rothblatt’s wife, Bina Aspen, called Bina48, which sells for roughly $150,000.

Bina48 was created using video interview transcripts, laser scanning life mask technology, face recognition, artificial intelligence, and voice recognition technologies. She was designed to be a social robot that can interact based on information, memories, values, and beliefs collected about an actual person. Curiosity about Bina48 and other robots continues to capture the imagination and inspiration of people around the world. She has been featured in the New York Times Science Section, GQ Magazine, NPR and National Geographic Magazine since she “came to life” in 2010. Pretty incredible, huh?

You Can Create a MindFile at No Cost

Currently, at least 56,000 people have handed over information to create mindfiles, a web-based storage space for preserving “one’s unique and essential characteristics for the future,” according to Lifenaut, a branch of the Terasem Movement that gathers human personality data for free. The goal is to capture a person’s attitudes, beliefs, and memories, and create a database that one day will be uploaded to a robot or holograph, according to the Lifenaut website. Everything down to a person’s mannerisms and quirks can be recreated.
Why would one want a have a robot clone of oneself? According to the Motherboard article, there are several reasons:

  • Some people like the idea of living forever.
  • Others want to document themselves as a part of human history.
  • Some hope to pass on an artistic project or genealogical information to offspring.
  • Some will use it to “memorialize” and “communicate with” the dead.

Robot Clones Could Be Slightly More Affordable in the Future

A more advanced version of robots like Bina48 could hit the market within 10 or 20 years for roughly $25,000 to $30,000, for a variety of uses, including replicating dead loved ones, executives at the Terasem Movement predict.

Google Follows Suit

In a related effort, the search engine giant, Google, has been granted a patent for a robot they developed in cooperation with Boston Dynamics (owned by Google) that can duplicate a personality. The patent says that the robot personality could replicate the robot’s owner, ‘a deceased loved one,’ or ‘a celebrity.’ The robot could use information from a person’s mobile devices such a calendar information, emails, texts messages, call logs, internet browsing history, and even someone’s TV viewing schedule, to determine a personality to take on that would suit the user. In addition, the robot is designed to negotiate outdoor, rough terrain, and can even drive a car!

Strange and Extreme Ways to Grieve for Deceased Loved Ones

Robert Zucker, a grief counselor and author of The Journey Through Grief and Loss, suggests that there are many ways of grieving that are strange and extreme. He states that when it comes to technology such as robot clones, “as long as it doesn’t inhibit the person from moving on with his or her life in a healthy way—maybe it could work for somebody.”

Tech experts admit it will probably take decades before robot reincarnation becomes socially acceptable, and a more mainstream form of memorialization.
Zucker warns that we should embrace the things that make us human—even pain. He states that, “If people believe they can skip over grief, they’re losing an opportunity. It teaches us about life and love. And it’s part of the human condition.”

Letting Family Members Know You Want to Be Cloned

What if you created a MindFile and like the option of robot cloning in the future? Or, if when you die, you want to be cremated, have already paid for your funeral, or want your organs donated? How would your loved ones know if you haven’t indicated your wishes in your Advance Medical Directive?

Our proprietary 4-Needs Advance Medical Directive™ enables you to set forth your preferences with regard to what you want for yourself, including organ donation, funeral arrangements, and disposition of remains. The document also accomplishes several essential things. In your 4-Needs Advance Medical Directive™, you can appoint an agent and give that person the power to consent to medical and health care decisions on your behalf. This person can decide whether to withhold or withdraw a specific medical treatment or course of treatment when you are incapable of making or communicating an informed decision yourself. Our 4-Needs Advance Medical Directive™  also contains a proprietary Long-Term Care Directive™  that allows you to address numerous issues that arise if and when long-term care is needed.  You can also indicate your wishes concerning the use of artificial or extraordinary measures to prolong your life in the event of a terminal illness or injury.

If you have not done Incapacity Planning (including our 4-Needs Advance Medical Directive™  and Financial Power of Attorney), Estate Planning, or Long-Term Care Planning, or if you have a loved one who is nearing the need for long-term care or already receiving long-term care, please us to schedule your appointment for our 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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