Family Caregiving is NOT Cheaper Than Professional Care. Here’s Why!

Five years ago, Karen got her PhD to teach at the college level. Upon graduating, she began her dream job, but she only was able to teach for about a year, when her mother’s Alzheimer’s began getting worse. Karen quit her job and put her dream on hold, and has been caring for her mother full-time ever since. For Karen, caring for her mother is a labor of love. Although she has to pay back student loans and put her teaching career on the back burner, her mother did so much for her throughout her life, that she really wanted to give back. Another reason Karen helps out is because she feels that it will be cheaper in the long run, considering the cost of assisted living and nursing home care. Unfortunately, the true cost to Karen may turn out to be much more than anticipated.

Family caregivers lovingly offer their help free of charge, contributing their time, energy, and often their own well-being, and what they do and the sacrifices that they make truly make them heroes. Currently, nearly 10 million people over the age of 50 are caring for their aging parents, according to a study conducted by the MetLife Mature Market Institute, in conjunction with the National Alliance for Caregiving and the New York Medical College. The number of caregivers has more than tripled over the past 15 years.

We know that what caregivers do is of incalculable emotional value and of enormous social worth. At the same time, the unpaid care they provide is estimated to be worth $3 trillion, according to MetLife.

Similar to Karen, many families assume that since assisted living communities and nursing homes are so expensive, it must be cheaper to do it yourself. But this is often a miscalculation. There are several hidden costs to family caregiving that should be taken into consideration. Being aware of these costs can also help non-caregivers appreciate the sacrifice caregivers make, and the profound importance of their role.

Here are the some of the hidden costs of caregiving:

1. Lost Wages
The MetLife study mentioned above said that for the typical woman, the total individual amount of lost wages due to leaving the labor force early because of unpaid family caregiving responsibilities equals $142,693. The estimated impact of unpaid family caregiving on lost Social Security benefits is $131,351. A very conservative estimated impact on pensions is approximately $50,000. Thus, in total, the cost impact of unpaid family caregiving on the individual female caregiver in terms of lost wages and Social Security benefits equals $324,044.
For unpaid family caregivers who are men, the total impact maybe greater or lesser depending upon the man’s career prior to becoming a family caregiver.

2. Not Planning for Your Own Retirement
Family caregivers are themselves aging, yet are providing care at a time when they also need to plan and save for their own retirement. The people who drop out of the workforce “can jeopardize their future financial security,” the MetLife study concluded. In addition, in a study by the National Alliance for Caregiving and Evercare found that a stunning 47% of working caregivers reported having used up all or most of their savings for retirement. In addition, leaving the workforce can also reduce your Social Security benefit, a key element in almost everyone’s retirement plan.

3. Decreased Employability
Caregivers who leave the workforce for months or years often find that it’s difficult to get another job when their time as a caregiver ends, due to lower wages after returning to the workforce with rusty skills and a big chunk of time on their resumes being unemployed.

4. Underestimating the Amount of Time You Will Be Providing Care
Some people think that the “job” of watching over loved ones will not last all that long. But sometimes it lasts a lot longer than you might think. Some people with Alzheimer’s can live 20+ years after a diagnosis. We might imagine ourselves providing care a few hours per week for a couple of months, but end up providing full-time care for many years. Leaving the workforce for two months may be tolerable, but leaving the workforce for years can be financially decimating.

5. Increased Health Care Costs
Caregiving is physically and mentally taxing. Gallup researchers found that caregivers have both worse physical and emotional health than non-caregivers. What’s more, a study by the Center on Aging found that more than 1 in 10 caregivers say that the role has caused their own health to decline. This translates into increased healthcare costs for family caregivers, particularly those who have lost their own health insurance because they left their job to become caregivers.

Addressing the Problem

According to AARP, family caregivers have reported dipping into savings, cutting back on personal spending, saving less for retirement, or taking out loans to make ends meet.

While a tax credit would certainly be nice, much more help is needed ― including caregiver relief, medical training for the tasks family members now must do, and Social Security credits to make up for the loss of benefits resulting from when caregivers must drop out of the workplace.

AARP strongly supports H.R.2505 – Credit for Caring Act of 2017, which would provide financial relief in the form of tax credit to caregivers. According to AARP Executive Vice President and Chief Advocacy and Engagement Officer Nancy LeaMond, “As a nation, we need to do more to support America’s greatest support system. Passing the bipartisan Credit for Caring Act, which provides a federal tax credit of up to $3,000, would give some sorely needed financial relief to eligible family caregivers. Whether helping to pay for services or make home modifications, the costs can be enormous and may put their own economic and retirement security at risk.”
Currently, the Credit for Caring Act is still listed as “in Progress,” and seems to be on hold. No status updates have been made since May of this year.

Financial Planning for Caregivers

Caregivers are often so focused on managing their parent’s health and financial needs that they don’t even think about their own future needs. Although your focus is on providing care for your loved one, it’s important to think about and prepare for your own future financial and caregiving needs. If you haven’t done so already, now is the time to start planning for own your retirement.

Whether you are a senior or a caregiver, if you should ever want expert guidance with your financial planning process, remember that qualified assistance is available right here at the Farr Law Firm. Our team looks forward to helping you – no matter where you’re at in your financial journey! Call us to make an appointment.

Medicaid Planning for Seniors

How has caregiving impacted your own family? Were their costs that you did not anticipate? Are you now considering nursing home care? If you or your loved one is over 65 or suffering from any sort of serious health condition, the best time to do Medicaid Asset Protection planning is now. Whether you or your loved one is years away from needing nursing home care, is already in a nursing facility, or is somewhere in between, the time to plan is now, not when you are about to run out of money. Please don’t hesitate to call us at any time to make an appointment for a no-cost initial consultation:

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

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When Caregiving Makes You Crazy

Q. My mother passed away six months ago, and my father is living alone in our family home, about a mile away from me. He is in the early stages of dementia, and has gotten quite forgetful lately. I have been a caregiver for him since mom died, but it’s hard with a full-time job, a family of my own, and a struggle with insomnia.

I’ll be honest with you. Sometimes, I find myself getting frustrated with my situation and I take it out on my father. Recently, a neighbor confided in my sister that she thought I yelled a lot and that I lose patience too easily. The neighbor told my sister that she thinks I treat dad like a child. I don’t think I am acting this way, but maybe I am. The situation is new to me, and with so much on my plate, I am getting very stressed out.

I want my father to have a good quality of life, and I want to be the best caregiver I can be, but I am overwhelmed. How can I treat my dad better, get the help I need, and prepare for other options for his care in the future?


A. I am sorry to hear about the loss of your mother, and your stressful situation.

Bearing the responsibility for an aging loved one can become a demanding job—especially when you have so many other things going on in your life. Caregivers themselves can sustain emotional, mental, and physical blows that may go unattended in the name of duty to their loved one. Sleep is lost; stress mounts steadily; and something just might give.

In the case of caring for someone with dementia, says research just published in the British Medical Journal, sometimes that lapse comes in the form of psychological—or even physical—abuse. Sadly, more than half of family caregivers surveyed in the study reported some abusive behavior toward the person they cared for.

In the study, the definition of abuse includes using a harsh tone, screaming or yelling, threatening to stop caring for the person, handling the person roughly, and fearing being on the verge of hitting or hurting the person. The most common forms of abuse reported were verbal, and more than a third of family caregivers said abusive behaviors occurred “at least sometimes” in the previous three months.

As you well know, the burden felt by caregivers is real and can manifest itself in a variety of ways. How can you ease your stress and help yourself to become a better caregiver? Here are some things you can do:

  • Acknowledge what’s going on. In cases of early dementia, when someone’s mental faculties may at times seem normal, and at other times wane, being a caregiver can be especially stressful. In these situations, sometimes the person doesn’t realize they’re being [verbally] abusive. Adjusting to and mourning the decline of someone you love can be very sad and emotionally taxing. So if you find yourself feeling as if you want to yell the person you’re caring for and are overcome with stress, take it as a sign to get some assistance. You, of course, have already acknowledged the issue and havve taken the first step in trying to correct it by reaching out for guidance.
  • Do the work, but reap the reward. Plenty of family caregivers acknowledge the challenges, stress, and exhaustion of caring for a loved one. In fact, more than a fifth of caregivers report exhaustion at day’s end, while more than a quarter report that taking care of their family member is hard on them emotionally, according to stats on the Family Caregiver Alliance website. But caregivers also report an immense gain from having the chance to nurture that person in a time of need. Most people feel it’s well worth their while to do the work, to rediscover the relationship, to give up hard feelings, and find a new approach to their parent or spouse. Tap into some of that joy.
  • Understand you don’t need to be a martyr. Allow yourself to call on help. As you seem to be experiencing, doing it all out of duty, or feeling you have to do everything yourself, can breed resentment, feeling overwhelmed, and sometimes becoming physically ill from stress.
  • Put together an elder care team. To look out for the everyday and long-term needs of your father, it is beneficial to have an elder care team on board—from physicians and home care professionals to elder law attorneys and financial planners. This care team can advise your father and family members on possible medical treatments and allow him to make personal preferences on care, while he can still make decisions for himself. Family members on this team can also help out and provide you with assistance and much needed respite.
  • Call in professional reinforcements, for the sake of your health and sanity. The Family Caregiver Alliance notes that those who experience chronic stress could be at increased risk of loss in cognition, including loss of short-term memory, attention, and verbal IQ. Help does exist, though it can take effort to find it. Outside of getting family, friends, or neighbors to assist, your local Area Agency on Aging is one place to look for relief. The Eldercare Locator provides a database of resources by ZIP code, and our trusted referrals are also quite helpful. If a nursing home becomes a consideration, using Medicare’s online Nursing Home Compare tool is a great starting point.
  • Take care of yourself. Caregiving can be both emotionally and mentally taxing, and can easily lead to “caregiver burnout.” Please be sure to take advantage of services that offer respite and support. Read more about alleviating caregiver stress in our blog post on the topic.

Hire an Experienced Elder Law Attorney to Help Plan for Your Father

An experienced elder law attorney, such as myself, can guide your family through advanced healthcare directives, Medicare and Medicaid issues, estate planning, family caregiver agreements, and other documents that safeguard the current and future care of your father.

To make an appointment for a no cost initial consultation, please contact us:

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: Virtual Caregiver Support Groups

Dear Magic,

I am a new caregiver for my mother who has Alzheimer’s. I would love to chat with some people who are going through the same thing as me. I am interested in finding a virtual support group. Since you’re in the know about tech stuff, can you recommend any good ones? I use Facebook a lot, so if there are any Facebook groups that would be great!

Faye Spue-Grupe

Dear Faye,

When you’re caring for a loved one with Alzheimer’s, a great way to reduce stress and not feel so alone is to join a caregiver support group.

On Facebook, there are many private groups dedicated to caregivers such as yourself. They’re completely free and allow you to get support, vent, or ask questions anytime – day or night. If you use a smartphone, you can participate anywhere!

Below are 11 caregiver support groups that are “Closed Groups,” which means they’re all private, and you can request to join if you’re interested, and unjoin if you’re not.

First, to sign up for a private group:

1. Sign in to your Facebook account. If you don’t already have an account, it’s easy to set one up. Here are tips on signing up.
2. Go to the Facebook group you’d like to join (links included below).
3. Click the “Join Group” button to send a request to the group administrators.
4. Wait to be admitted into the group – check the page later if you don’t get a message or notification.
5. Check the “Description” section of the group page to find out what it’s focused on. Some groups include special instructions to join or community guidelines in this section.

Facebook Groups for Caregivers

  1. Memory People
    Memory People is an Alzheimer’s, dementia, and memory impairment support and awareness group, consisting of patients, caregivers, advocates, family members and professionals.
  2. Dementia Caregivers Support Group
    For caregivers of loved ones afflicted with dementia and Alzheimer’s, this group is designed to stimulate conversation and ensure all members a safe haven in posting personal feelings.
  3. Alzheimers and Dementia Caregivers Support
    This is an Alzheimers and dementia caregivers support group designed so caregivers can support one another through trying times.
  4. Caregivers Connect
    This is a community that brings a voice to family caregivers, and related care-industry professionals who are caring for a parent, spouse, or other loved one. Members share personal experiences, advice, and stories with one another in order to provide support along each of our journeys.
  5. Caring for Elderly Parents
    As caregivers learn to cope, they share info, vent frustrations, and share support.
  6. The Caregiver Space Community
    This is a supportive community of spousal caregivers.
  7. Working Daughter
    This is a space for women who are balancing caring for an aging parent with their career and the rest of their life.
  8. Sandwich Generation
    This is a group where sandwich generation caregivers can vent, and give ideas on how to handle taking care of senior parents and children.

Hop this is helpful!

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Oscar the Cat and Other Incredible Therapy Animals

Oscar is a cat who was adopted as a kitten from an animal hospital. Sounds pretty typical, huh? Well, when it comes to cats, Oscar is anything BUT typical.

What makes Oscar so extraordinary is that he is a cat with a supernatural ability to feel when people are about to die. In over 50 documented cases, Oscar, who lives in a nursing home, has curled up beside patients in their final hours, seeing them through to the ‘other side’.

Ever since he was adopted, Oscar was raised as a therapy cat at the Steere House Nursing and Rehabilitation Center in Providence, Rhode Island. The Center cares for people with severe dementia and in the final stages of various illnesses. When Oscar was about six months old, the staff noticed that he would curl up to sleep with patients who were about to die. Oscar, was portrayed as a furry grim reaper or four-legged angel of death.

Oscar’s unique story was revealed by Dr. David Dosa, a geriatrician and assistant professor at Brown University, who claims Oscar’s predictions have rarely been wrong in the past six years. Dr. Dosa broke the news of Oscar’s abilities in a paper in the New England Journal of Medicine in 2007. He also wrote the book, “Making Rounds with Oscar: The Extraordinary Gift of an Ordinary Cat,” to help people whose loved ones are terminally ill.
The book describes Oscar’s daily routine, how he spends his time pacing from room to room at the nursing home, rarely spending time with patients who have still got a fighting chance of survival. Instead, he picks out certain patients and cuddles up next to them. These are often the ones who will pass away in a short time. If kept outside the room of a dying patient, he will scratch at the door, trying to get in.

How Does This Happen?

Oscar has accurately sensed numerous deaths, convincing Dr. Dosa and staff at the nursing home that it wasn’t just a series of coincidences. In fact, during one instance, the staff was convinced of the imminent death of one patient but Oscar refused to sit with that person, choosing instead to be on the bed of another patient down the hallway. Oscar proved to be right. The person he sat with died first, taking staff on the ward by surprise.
Dr. Dosa doesn’t think Oscar is that extraordinary; however, he believes he is in a unique environment. This is how he explains Oscar’s unique abilities:

• Dr. Dosa said there is no scientific evidence to explain Oscar’s abilities, but he thinks the cat might be responding to a pheromone or smell that humans simply don’t recognize.
• And according to animal behaviorist Dr. Daniel Estep, Oscar may only be recognizing the patients’ lack of movement and interpreting it as illness, as cats can often sense when their owners are sick.

To this day, Oscar remains unchanged by the attention, spending most of his days staring out of a window, although he has become a bit friendlier.

Other Amazing Animals

There is no question that Oscar is amazing! Dr. Dosa believes that animals are remarkable in their ability to see things we don’t, be it the dog that sniffs out cancer or the fish that predicts earthquakes. Here are some other amazing therapy animals that help seniors, veterans, and those with special needs.

Nala the Poodle, Nursing Home Therapy Dog

Nala may be little, but this once-rejected dog has proven that her heart is huge. The tiny 5-year-old toy poodle comes to work at a St. Paul, Minnesota nursing home every day with her human, Doug Dawson. He’s a medications assistant at a senior housing facility. But as soon as they arrive in the morning, the little dog heads off on her own. While Dawson does his work, Nala does hers – going room to room in the care center, visiting residents and hopping up on beds and into laps to offer kisses. Nala even knows how to ride the elevators all by herself.

In Dawson’s care, Nala has thrived. And she’s become a popular fixture at the nursing home, often seeking out the sickest residents to offer them comfort. “She’s here for a purpose, I believe,” said Dawson.
Similar to Oscar, Nala even sits with residents on their deathbeds – the comfort she offers is its own kind of medicine. “She’s an angel,” said one of the residents at the nursing home, “I love her and she loves me.”

Lexy the German Shepherd Therapy Dog

With the rank of “lieutenant colonel,” Lexy is Fort Bragg’s only therapy dog. She calms soldiers that suffer post-traumatic stress disorder, and helps to further the cause of pet-supported therapy for soldiers dealing with post-war stress and other trauma. She also often enables soldiers to overcome any stigma about seeking treatment.

Buttercup the Therapy Pig

Buttercup, an adorable, 70-pound miniature Vietnamese pot-bellied pig, has a talent for working with special-needs kids. Her partner is speech pathologist, Lois Brady, and they spend their time visiting San Francisco schools. Buttercup is super calm and her easy-going manner makes her a huge hit with kids who might otherwise be afraid. She helps autistic children improve their social skills, and one severely autistic boy even spoke to his classmates for the first time after stroking Buttercup!

Elsa the Pit Bull Therapy Pup

Elsa’s young life was marked by abuse and neglect, and at one-year-old, she suffered an embolism that left her back legs barely functional. Eventually, she came into the care of Kelly Dann, who got her into physical therapy and registered her for a pet visitation program. Now, Elsa visits long-term care patients as well as those suffering from spinal cord injuries. She can move a bit on her own, but most of the time, she’s fitted with a special cart.

Therapy Animals Support Those in Need

Scientists believe it’s possible that the comfort of a therapy animal, such as those described, may actually help some patients to heal, and animals have been known to support people struggling with illnesses from cancer to addiction. All kinds of animals have been known to sense when their humans and others need some support, and are there to assist!

Don’t Forget about the Pet

Do you have a pet who is a member of your family? Many of us who think of our pets as family members want to ensure that they are cared for after we become incapable of doing so. One way to fulfill this responsibility is to set up a pet trust, or a legally sanctioned arrangement that provides for the care and maintenance of your pet(s) in the event of your disability or death. For more details, read the Pet Trust FAQ on our website.

Please call us to make an appointment for a no-cost consultation. If you come to the Fairfax office, be sure to visit with all of the therapy animals who live here, including Angel and Bebe (our cats), Ribbit (our African Dwarf Frog), and Magic (our bunny). And be sure to follow our Critter Corner column that appears most Fridays in our weekly Ask the Expert newsletter.

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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What Happens When a Long-Term Care Insurer Goes Belly Up?

Q. My husband and I are seriously considering long-term care insurance. I read recently, however, that Penn Treaty is facing liquidation, and health insurers across the country are on the hook for hundreds of millions of dollars because of this. If the liquidation of one long-term care insurance company has such an effect on health insurance carriers, does it also affect other long-term care insurers and life insurance carriers, as well?  Do you typically recommend long-term care insurance, and if so, or if not, what recommendations do you have?

A. Recently, as you mentioned, a good-size American long-term care insurance company, Penn Treaty, was ordered to liquidate and wind down its affairs. Its demise will orphan tens of thousands of policyholders — people who bought long-term-care insurance to protect their assets from catastrophic nursing home costs.

“Liquidation is rare, but it does happen in bunches sometimes,” said Robert Hunter, director of insurance for the Consumer Federation of America. The organization has been warning about problems with long-term-care insurance since the early 1990s.

How can this happen? In many cases, companies underestimate the true cost of coverage and are struggling now to make good on all their promises. “There is definitely talk in the street that it’s still a high-risk situation for quite a few companies,” Hunter said. “It’s not a healthy situation.”

In most cases, however, an insurer in a similar situation will quietly find a buyer, and policyholders may not know what happened, or care, as long as their claims are paid.

Policies Will Pay Some Amount, Even if An Insurer Liquidates

Each state has a guarantee fund to rescue policyholders in insurance failures. The funds pay people’s claims, up to a predetermined limit that varies by state.

A few states cap guarantee-fund relief at $100,000. Others, such as California and Connecticut, guarantee up to $500,000 and more. New Jersey is said to have no limit at all, but some analysts question that promise, especially if another big long-term-care insurer fails.

How does it work? In liquidation, the policies will be canceled, and the guarantee fund will take care of a certain dollar amount worth of claims. For some though, it will not be enough, and they will suffer a loss, and may not be able to buy coverage to replace what they lost.
Liquidation Makes LTC Insurance and Health Insurance Premiums Go Up, But Not Life Insurance Premiums

Traditional long-term care insurance is a type of health insurance, so in situations such as this where a long-term care company liquidates, both long-term care insurers and health insurers are liable for the guaranteed payments. This will almost certainly result in increased future premiums.  Life insurance companies, which also offer long-term care benefits, are not affected.

When it comes to Penn Treaty, industry analysts estimate the parent company has long-term claims liabilities approaching $4 billion, but only about $700 million in assets. Therefore, Penn Treaty’s liquidation will pose a “potential shock to the health marketplace.” Companies will try to pass it on in some way to policyholders, by imposing premium surcharges on customers, or they can shift the burden to taxpayers by paying less in state premium taxes.

Anthem Inc., the nation’s second-largest health insurer, estimates it will pay $253.8 million to cover its portion of Penn Treaty claims. Anthem said last month, “(p)ayment of the assessments will be largely recovered through premium billing surcharges and premium tax credits over future years.” Aetna, the industry’s third-largest insurer, expects to pay $231 million. And Blue Shield of California has booked a loss of nearly $41 million. Those numbers may rise as Penn Treaty’s policyholders collect on their benefits.

Some health insurers may impose surcharges of up to 2% annually over several years to cover Penn Treaty assessments — one more unwelcome charge tacked onto the country’s growing health tab.

Asset-Based Long-Term-Care Hybrid Coverage is Recommended

Traditional long-term-care insurance is particularly expensive and frequently its purchase comes at a time when people are facing retirement and looking for ways to cut back. One way to avoid spending a lot of money directly on a long-term-care policy while still getting its benefits is to buy a hybrid insurance policy.

As you may know, I offer specialized elder-focused financial planning services through Lifecare Financial Services, a company I started over 10 years ago. Among our offerings are hybrid products such as annuities and life insurance policies that provide a long-term care benefit which is much less risky than the traditional long-term care insurance described above. The appeal of these hybrid products is that you are guaranteed to receive the benefits you pay for, and these products are typically much easier to qualify for than traditional long-term care insurance.

These hybrid products can:

  • pay for some or all your long-term care costs should you need care •provide you with income or provide your estate with a tax-free life insurance benefit should you not need care •offer you a 100% money-back guarantee should you change your mind

Who should consider hybrid policies?

A hybrid life insurance policy with long-term care benefit may be worthwhile for you to consider if you have liquid assets, especially tax-qualified assets such as IRA funds, that you probably will not need for retirement income.

For example, you may have already set aside $500,000 in your savings, should you need long term care. Let’s presume you are a 60-year-old female. As an alternative to self-funding your needs, you could choose to move $250,000 of the $500,000 in your savings into a linked-benefit policy. In doing so, you could possibly receive benefits such as:

  • a $507,000 tax-free life insurance benefit to your beneficiaries should you not need long-term care; or • up to $10,140 per month tax–free for 50 months (or if less money is needed, you can take it out over longer period of time up to the maximum of $507,000) to pay for Home Health Care, Assisted Living, or Nursing Home Care; or •your entire premium of $250,000 returned to you should you change your mind. •Plus, for a small additional annual premium, you might be able to qualify for an unlimited long-term rider that will pay you up to $10,140 per month tax–free for the rest of your life.

The above is just an example, and not financial advice.  Actual premiums for any specific individual are based on age and health and other factors.

The pros of hybrid policies are as follows:

  • The underwriting is usually less stringent than for a conventional long-term care policy. Genworth, for example, asks applicants whether they have or have had some serious illnesses like cancer, but the company often doesn’t require a physical, and less serious ailments don’t affect insurability at all. People as old as 80 may be able to buy these policies, even with as little as a $50,000 initial investment.
  • Most policies have few restrictions on how you use the money. Once you meet the qualifications, usually the inability to manage two of the six activities of daily living (eating, bathing, dressing, toileting, transferring and maintaining continence) or a serious cognitive impairment, how you spend your money is up to you. You can pay a neighbor or a family member to help out or use the tax-free payments to augment other money that you have available.
  • If you are in a high tax bracket even post retirement, getting the money tax-free could make a big difference in the amount you have to spend.
  • The annuity and your long-term-care insurance are fully funded. Once the plan is in place, you don’t have to pay anymore (unless you qualify for and elect a lifetime rider).

Talk to Us First

If you have done your research and decide that long-term care financial planning may be a good fit for you and your family, you should first meet with an experienced Elder Law Attorney, such as myself, who also does elder-focused financial planning, in order to understand all of your options. Hybrid financial products provide numerous options, but there are also dozens of other long-term care asset protection strategies, including the Living Trust Plus™ Medicaid Asset Protection Trust, Veteran’s Aid and Attendance Benefits (for eligible Veterans and their spouses), and Medicaid Planning.

To discuss the strategies listed above further, or if you have not done long-term care planning, estate planning, or incapacity planning (or had your planning documents reviewed in the past several years), please call us to make an appointment for a no-cost consultation:

Fairfax Medicaid Planning: 703-691-1888

Fredericksburg Medicaid Planning: 540-479-1435

Rockville Medicaid Planning: 301-519-8041

DC Medicaid Planning: 202-587-2797

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Critter Corner:  FAQs About Hybrid Insurance Policies

Dear Ribbit,

I am considering a hybrid insurance policy, but I have several questions. If I send them to you, can you help me answer them to clarify some things to help me make a decision. Thanks very much!

Hy Bridd

Dear Hy,

I’d be happy to help. Below are your questions in the form of an FAQ. I suggest you make an appointment with Mr. Farr if you are interested in learning more about hybrid policies!

Q. Why are so many people moving from traditional long-term care insurance to hybrid policies?
A. Since people are living longer, many insurance companies have found traditional long-term care insurance (LTCI) policies are not profitable enough.

Several years ago, MetLife and Prudential stopped selling traditional LTCI policies, and they were joined recently by John Hancock. These were three of the biggest insurance companies selling LTCI. Pretty much every LTCI company has also increased the premiums for existing policies. Genworth, One of the other biggest LTCI providers, for now still offers new policies, but it was recently purchased by a Chinese company and has increased the premiums for existing and new policies. Other companies are still selling traditional LTCI policies, but premiums are generally guaranteed for one year only, and can be increased if the insurance company gets your state insurance commissioner’s approval.

Q. How is a hybrid policy different from a traditional policy?
A. With hybrid policies, consumers have policy options that provide both life insurance (or an annuity) and long-term care coverage.

Q. What is a single premium policy option, and what are the advantages?
A. Hybrid policies are typically considered to be asset-based long-term care coverage, because the purchaser pays a single up-front premium for a policy that provides both traditional life insurance coverage and a rider that provides LTC coverage.

An advantage of the single-premium option is that generally it is easier to obtain coverage even if an individual has a pre-existing health problem.

With the single-premium policy, the insurance company specifies a specific lump-sum that is available for LTC-related expenses, such as home health care, adult health care, assisted living expenses, or full-time nursing home care. After a specified surrender period, such as five years, the policyholder can typically elect to receive a full refund of premium if for some reason they decided they no longer need the insurance coverage.

The lump-sum option is viable one for individuals who have some assets set aside, such as an IRA or a CD, that are not required for day-to-day living expenses.

Q. What are the benefits of hybrid policies?
A. One of the potential benefits of the hybrid policies is that your heirs will receive a death benefit if you do not use all of the LTC benefits. Another benefit of asset-based long-term-care coverage is that once you have paid your premium, your policy is fully paid for, and you will never have to pay an additional premium. Almost everyone who has purchased traditional LTCI policies have found that premiums have increased dramatically, and there is no reason to believe this trend will discontinue. Another advantage of a hybrid policy is that you may be able to purchase an “extension” or “benefit rider” which would allow you to receive monthly benefits after the base amount has been exhausted. This could double the time frame for receiving LTC benefits, or even provide you with lifetime benefits for a fraction of the cost of traditional long-term care insurance.

Of course, hybrid asset-based long-term-care insurance is not right for everyone, and there are many other asset protection strategies to protect your assets from the potentially devastating costs of long-term care. Be sure to make an appointment with Mr. Farr to learn more.

Hop this helps,


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Seniors Get SMARTER as They Get Older – How to Retain Your Smarts and Your Memory

Forty year-old Rachel is quite forgetful. She always forgets at least one item when she goes to the supermarket, forgets names (but typically remembers faces), and can’t always tell you what she had for breakfast that day. Eighty year-old Roberta, on the other hand, never forgets a grocery item, a name, a face, or a trivia fact, and is typically as sharp as a tack. Do people actually get smarter as they get older? And, why do some people’s brains stay sharp as they age, while others (some of whom are younger) do not?

People DO Get Smarter as They Age

As we get older, for some of us like Rachel in our example, our memory may occasionally short out. However, researchers have made some surprising discoveries about how we actually get smarter as we age, as follows, and there are also things you can do in your life to preserve the smarts that you have, as I will explain later.

1. You use both sides of your brain, rather than just one: While young people often use only one side of their brain for a specific task, middle-aged and older adults are more likely to activate both hemispheres at once. By involving both sides, older people use the full spectrum of the brain’s power, allowing them to make more fruitful connections among the parts of a problem or situation.
2. Your brain is still growing: We not only hang on to our neurons as we get older—we grow new ones, too. Throughout a person’s lifetime, the brain is continually reshaping itself in response to what it learns. For instance, in an experiment, Swiss neuroscientist Lutz Jäncke studied people who were learning to play a musical instrument. After they had been practicing for five months, Jäncke noted significant changes in the regions of the brain that control hearing, memory, and hand movements, even in participants who were 65 or older.
3. Your reasoning and problem-solving skills get sharper: According to a study prepared for the Brookings Institute by Sumit Agarwal, an economist at the Federal Reserve Bank of Chicago, middle-aged and older adults make smarter money decisions than their younger counterparts. In particular, they are better at financial transactions such as managing their credit card balance and avoiding excess interest rates and fees—with the best performance notched by those in their early 50s.
4. Your people skills are constantly improving: As we get older, our social intelligence keeps expanding. We get better at sizing up people, at understanding how relationships work—and are typically not getting into arguments unless we mean to.
5. You’re always adding to your knowledge and abilities: There are some kinds of information we learn and never forget, such as vocabulary: Studies show that we keep adding new words to our repertoire as we age, giving us more ways to express ourselves. Job-related knowledge also continues to accumulate, meaning we keep getting better and better at what we do.
6. You gain control of your emotions: Older adults (between ages 61 and 81) have more clarity about their feelings, make better use of strategies to regulate their emotions, and have a higher degree of control over their emotional impulses.

Retaining These New Skills and Keeping Your Mind Sharp

Susan Bookheimer, Professor of Cognitive Neuroscience at UCLA, is currently researching the factors that predict who is going to stay sharp and why. Her research is part of a new study to answer how some people are able to retain their memory better than others as they age.

Over the next two years, researchers at UCLA will scan the brains of 300 healthy people ranging in age from 35 to over 100, to collect cognitive data and measurements such as blood pressure, hormone levels, and body mass index. Two years later, they’ll re-scan everyone, allowing them to document changes.

This project, launched this past spring by UCLA with funding provided by NIH, is called the Lifespan Human Connectome Project-Aging (HCP-A) “Connectome” refers to the mapping of connections, or wiring, between brain regions. It will be interesting to see what the study finds, and we will certainly keep you up-to-date. In the mean-time, there are some things that we know to be true now, and things you can do to better preserve the mental sharpness that you have.

What You Can Do to Stay Sharp

Since we are getting smarter every day (see examples above), how do we preserve the new skills we are acquiring and stay sharp? Here are some suggestions:

· Simple physical exercise does the brain as much good as it does the body. To keep your brain sharp, physical exercise is the best-proven prescription so far, scientists agree. For instance, when 72-year-olds started a walking program three days a week, sophisticated scans showed their brains’ activity patterns started resembling those of younger people.
· Use it or Lost it: People with higher education, more challenging occupations, and enriched social lives build more cognitive reserve than couch potatoes. But how can we maintain them? Everything from doing crossword puzzles to various computer-based brain-training programs has been touted, but nothing is yet proven to work. Johns Hopkins University has a major government-funded study under way called the “Experience Corps,” where older adults volunteer to tutor school students 15 hours a week, to see if such long-term stimulation maintains the elders’ brains.
· Control high blood pressure. High blood pressure can increase your risk for heart disease and stroke, which are thought to contribute to memory loss and the development of certain types of memory impairment.
· Don’t smoke and don’t drink excessively. Because these are both seen as putting you at increased risk for memory loss or dementia, kick the habit if you smoke and, if you drink, do so only in moderation.
· Eat a healthy diet. People who consume plenty of vegetables and fatty fish and keep away from saturated fats are thought to have a lower risk for cognitive decline.

Promising research shows that you can reduce your risk of dementia through a combination of healthy habits, including eating right, exercising, staying mentally and socially active, and keeping stress to a minimum. By leading a brain-healthy lifestyle, you may be able to prevent the symptoms of Alzheimer’s disease and slow down, or even reverse, the process of deterioration.

Medicaid Asset Protection

Do you have a loved one who is suffering from dementia? Persons with dementia and their families face special legal and financial needs. 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. Please call us as soon as possible 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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Supreme Court Rules that the Bare Minimum Isn’t Enough/Planning for an Uncertain Future

Q. My daughter, Hailey, has high-functioning Autism Spectrum Disorder (ASD), is severely learning disabled, and has a difficult time paying attention in school. We have attended Individualized Education Plan (IEP) meetings, and are aware that she is just not grasping remedial mathematics, reading, science, or social studies, and has failed most of her Standard of Learning (SOL) tests. Although she isn’t learning much and failing, she keeps passing to the next grade.

Based on how little she actually knows, we’re concerned for her future. If she graduates from high school, I honestly think that her social and learning deficiencies may make it difficult for her to leave our home and be independent, and work a job where she could afford to live on her own. What we are most concerned about is, if something happens to us, what will happen to her? What kind of planning can we do to ensure our daughter is taken care of in the future?

A. Sometimes, despite our best efforts to advocate for our children, children with mental or physical disabilities are not learning enough to succeed in school, and slipping through the cracks. And that doesn’t bode well for them being independent and earning living wages in the future.

As far as your daughter’s situation in school, luckily, the United States Supreme Court recently made it easier for parents of special needs children to ensure that their children receive an appropriate education. In fact, in Endrew F. v. Douglas County School District, a unanimous Supreme Court made it very clear to educators that they are required to educate a disabled child more than just enough to help them “get by.”

Endrew is a young boy with autism who filed suit through his parents against his Douglas County, Colorado school district, under the Individuals with Disabilities Education Act (IDEA). Similar to your daughter’s situation as you described it, the public school Endrew was attending was doing just the minimum to get him from grade to grade and he wasn’t really learning anything.

Over time his parents grew increasingly frustrated and eventually removed him from public school and enrolled him in a private school, where he made great strides. After years of litigation over Endrew’s claim, the Supreme Court ruled in favor and held that in order to comply with the Individuals with Disabilities Education Act (IDEA), a school must give a child an IEP that has a chance of actually working. In Endrew’s case, the district ended up reimbursing his private school expenses.

IDEA is the Foundation of Special Education

Based on the outcome of the Supreme Court case that resulted from Endrew F. v. Douglas County:

•Educators will now be on notice of what their education obligations truly are, and parents will be able to negotiate these education plans from a position of strength.
•The Supreme Court unanimously rejected a “bare minimum standard.” Instead, the Court said that schools must provide an IEP that is “reasonably calculated to enable a child to make progress (in his/her education) appropriate in light of the child’s circumstances.”
•A school has to do more than the bare minimum when creating an IEP. The school is required to work out an IEP that actually has a chance of educating a special needs child, and if it doesn’t work, change the IEP so it actually has a chance of working. For Endrew and children like him, this can even mean a public school system paying for a private school education.

For most children, the standard system works. But for those children that face challenges, schools are now going to have to work harder to help them.

What Happens After Graduation? – When a Special Needs Adult Child Cannot Support Him or Herself

You are not alone in your concerns about your special needs child living with you after she completes school. In fact, according to a study cited in Disability Scoop, since leaving high school, the vast majority of young adults with autism — nearly 9 in 10 — have spent at least some time living with a parent or guardian. And most have never tried another living situation.

“As the prevalence of ASDs continues to rise, so too does the number of young adults transitioning into adulthood,” wrote Kristy Anderson of the University of Wisconsin-Madison and her colleagues in their findings. “The evidence presented in this study suggests that the vast majority of this population will be residing in the parental or guardian home during the period of emerging adulthood.”

For the study, researchers looked at the experiences of 620 individuals with autism from across the country. Young adults on the ASD spectrum had “the highest rate of supervised living arrangements and the lowest rate of independent living since leaving high school,” the study found.

Planning for a Loved One with Special Needs

If your daughter with special needs will likely live with you for the long term, what would happen to her if something happened to you? In your situation, it is wise to consider creating a special needs trust. Also known as “a supplemental needs trust,” this type of trust preserves eligibility for federal and state benefits by keeping assets out of the disabled person’s name. Special Needs Trusts fall generally into these categories:

Third-Party SNTs that one person creates and funds for the benefit of someone else.

First-Party SNTs (also called d4a trusts) that are created for the person with special needs using that person’s own money. Now, people with disabilities can create their own first-party special needs trusts without having to rely on others.

Pooled third-party trusts are an alternative to setting up your own special needs trust if you can’t come up with a good choice for trustee or if you are only putting a small amount of money into the trust, but are not for every family.

Microboards are usually small, non-profit corporations, established by the family of a disabled child or adult, that are established to provide for the ongoing special needs of a disabled person.

Learn more about Special Needs Trusts here.

Ready to Start Your Special Needs Planning?

When it comes to special needs planning, we can guide you through this process. Please contact us to make an appointment for a no-cost consultation:

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

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Critter Corner: An ABLE Account for a Loved One with a Disability

Dear Angel,

I have an intellectually disabled daughter, and I’ve seen a lot of information this month from the ABLE National Resource Center through their #ABLEtoSave campaign. I understand that it’s state run, and that Virginia was among the first states to participate. Can you tell me more about the ABLE Act in Virginia and how we can get started?


Abe Bell

Dear Abe,

ABLE accounts are savings accounts that enable a person with a disability that began before age 26 to put aside more than the $2,000 allowed to continue receiving SSI benefits. The accounts let a person who is working, at some capacity, to put aside funds.

ABLE accounts can be another savings option and a good complement, are sometimes an alternative, to a first-party special needs trust, but it should never be used as a substitute for a third-party special needs trust because it requires pay back to the state for Medicaid expenses.

Here are seven things you should know about ABLE accounts.

1. What it covers. Qualified expenses include education, housing, transportation, assistive technology, employment training and support, financial management and health care expenses.
2. Eligibility. A beneficiary is eligible for an ABLE account if he or she is already receiving benefits under Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). If the potential beneficiary is not already receiving those benefits, his or her disability must be certified with a written diagnosis by a licensed physician. Under all circumstances, the onset of the disability must have begun prior to age 26.
3. Bypassing asset limitations. An ABLE account is disregarded when determining certain federal benefit eligibility with the following two exceptions for individuals receiving Supplemental Security Income (SSI): For the purposes of determining eligibility for SSI, money in an ABLE account in excess of $100,000 is considered an asset to the individual with a disability and may cause SSI benefits to be reduced or suspended. An account balance up to and including $100,000 is disregarded.

There is no impact on Medicaid benefits, regardless of how much money is in the ABLE account.

4. Contribution limits. The cumulative ABLE account value limit is currently $500,000. Contributions to an ABLE account may technically be made by any person (the account beneficiary, family and friends);however, family and friends should never make contributions to an able account because of the Medicaid payback requirement. Instead, if family and friends want to contribute money to benefit a special-needs beneficiary, a family member should establish a third-party special needs trust, which does not require Medicaid payback.

5. Taxes and fees. Earnings in an ABLE account grow tax-deferred, and withdrawals are tax-free when used for qualified disability-related expenses. In addition, states may offer state tax incentives. For example, in Virginia, earnings grow free from federal and state taxes. Virginia also offers an annual state income tax deduction of up to $2,000 per contributor for contributions to an ABLE account.

6.Timeline. Money in an ABLE account can be used over the lifetime of the beneficiary so long as funds are used for qualified expenses.
Today, you can open an ABLE account using any state’s plan following the 2015 removal of a residency requirement for beneficiaries.

7. If The beneficiary of an ABLE account receives Medicaid benefits during the time the ABLE account was open, then Medicaid is entitled to be paid back for all Medicaid funds expended for the benefit of the beneficiary prior to the death of the beneficiary. Before Medicaid payback, the account balance can be used by the Account Owner’s estate to repay any outstanding Qualified Disability Expenses, including funeral and burial costs.

To learn more about ABLE Accounts in Virginia, click here.

Hope this is helpful,


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Senior Care Robots are Revolutionizing Health Care in Northern Virginia

Imagine this: An 80-year-old woman named Joan lives alone at home. In the past, she has forgotten to take her medicine and she often gets lonely. Rudy, who is about the size of a typical ten-year-old, comes in and reminds her to take her pills. He even brings her the pills and a glass of water. When Joan needs companionship, Rudy provides social interaction and games to engage her. Joan’s life is much easier now because of Rudy. Rudy is a robot that was developed on the George Mason University Campus.

Robots, such as Rudy, are among us. And for seniors living alone in the DC Metro area, later this year, they very well may be helping with health care at home, in assisted living facilities, and in some skilled nursing facilities. Rudy, an assistive robot developed by Fairfax-based INF Robotics Inc., is designed to assist seniors, war veterans, and individuals with disabilities maintain their independence by acting as a health care companion and cutting down on return hospital visits, according to company founder and CEO Anthony Nunez.

Rudy offers telemedicine capabilities for doctors and caregivers to check in remotely, and will sell to both individuals and health care agencies for patient use. INF Robotics also partnered with AlertOne Services, so the Rudy assistive robot can call for help during emergencies. INF Robotics plans to sell the Rudy assistive robot for $5,000 per unit. However, the company is also seeking reimbursement through Medicare and Medicaid. It says this will make Rudy available at “little to no cost to the user.”

“We’ve designed this robot to be friendly, very easy to use, because we know seniors haven’t grown up using computers,” said Nunez, a George Mason University alum who also owns Fairfax-based Infamous Robotics LLC, which educates kids about STEM subjects.

The Status of the Rudy Robot

INF Robotics, which has been developing the now-patented product since the startup was founded in 2011, plans to start selling its first units later this year. It’s currently in its beta two testing phase, piloting Rudy at home health care agencies like SenCura in Chantilly and assisted living communities, such as Vinson Hall in McLean.

Rudy has also been tested with the Department of Veteran Affairs and about six different home care agencies, with more coming up until the end of the testing phase next month. I was recently invited to a luncheon for senior serving professionals, where Rudy is being featured.

The robots hit the market later this year in Greater Washington, with plans to expand to other parts of the Mid-Atlantic.

Why Assistive Robots, such as Rudy, Have Become Vital

The US is reaching an epidemic proportion of older adults who will need healthcare later in their lives. By 2030, that population will grow from 35 million to 72 million – close to a 20 percent increase in the US population. Adults 85-plus are now 12x as likely to reside in skilled nursing facilities, while even higher numbers of older adults are living in assisted living communities.
An impending nursing and geriatrician shortage is also predicted. In fact, in 2014, there were only 7,000 certified U.S. geriatricians; that’s one for every 2,600 patients age 75-plus, and studies estimate that by 2030, 30,000 geriatricians will be needed.

Because of these shortages, high mortality rates and re-admission likely will occur unless we get help. So, if there was ever a time for assistive robots to step in, now is the time.
In a healthcare setting or at home, assistive robots could be of great service by assisting with three basic needs: surveillance, privacy, and companionship. But how users accept and adapt to assistive robots in the US remains a question. While studies have been limited, they show the attitude of older adults is generally positive towards assistive robots. This, however, may depend on their environment and health status.

Assistive Robots Still Face a Number of Challenges

Japan has the oldest population in the world, and has been using assistive robot technology for years. From soft cuddly robotic seals named Paro, to Robear the giant lifting bear, to Pepper the humanoid robot, Japan is incorporating an assistive robotic culture to solve their healthcare needs.

Based on Japan’s experience, there have been concerns connected with adopting assistive robot technology in other countries and cultures, as follows:

1. Some experts argue that using robots as healthcare assistants creates an artificial relationship between the patient and the caregiver. Mark Meadows of Botanic believes that “we have already outsourced caregiving, saying that the sentimentality behind this thinking is something that is long gone.”
2. In many cases, cost is a factor. Many assistive robots are expensive, which makes healthcare even more expensive. Rudy is not particularly expensive, and may be covered by Medicare/Medicaid, as explained earlier.
3. How each end user will accept and adapt to this technology remains a question.
4. Robots cannot replace health care professionals. Assistive robots should complement a healthcare professional’s job, not take over. According to Carol Huston, nursing professor at California State University, “professional time is often spent on non-professional activities. This is where robotic caregivers work best – as an extender of care for nurses.”

Will Your Loved One Be Resistant to Robots and Other New Technology?

As our country ages, the needs of older adults interested in remaining independent and at home multiply. However, what happens if your loved one is resistant to adopting new technologies? Read our blog post, “Amazing Technology to Age-in-Place (But Mom is Reluctant)” for details on helping a loved one overcome resistance, and for additional assistive technologies that are available.

Aging-in-Place? When Technology is Not Enough

Most people want to stay in their home for as long as possible. However, if you or a loved one cannot live independently (even with the help of technology such as robots) and he or she is showing signs that living alone is a strain, it may be time to consider other alternatives.

Whether the outcome is in-home care, assisted living, or nursing home care in the future, it is always wise to work with an experienced Elder Law Attorney such as myself. Life Care Planning and Medicaid Asset Protection is the process of protecting assets from having to be spent down in connection with entry into assisted living or nursing home care, while also helping ensure that you and your loved ones 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. Please contact us as soon as possible to make an appointment for a no-cost consultation:

Fairfax Elder Law Attorney: 703-691-1888
Fredericksburg Elder Law Attorney: 540-479-143
Rockville Elder Law Attorney: 301-519-8041
DC Elder Law Attorney: 202-587-2797

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