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Distributing Tangible Personal Property Can Cause Conflict

By Hyman G. Darling, Esq.

 

Very often in preparing an estate plan, issues arise over the tangible personal property, also known as ‘the stuff.’ This may include cars, collectibles, the dining-room furniture, Waterford china, and basically any other item in a house that is not attached to the walls. These tangible personal property items are often dealt with separately from other assets, such as stocks, bonds, real estate, cash, etc.

Unfortunately, when the client has not provided enough detail in listing the distribution of assets, the tangible property becomes a major issue. Arguments may ensue, and often, the family brings the case to litigation to argue about all these items. In some cases, the family has significant assets to be distributed, but these tangible items become contentious and cause the estate to be litigated and prolonged.

Hyman G. Darling

Hyman G. Darling

“Arguments may ensue, and often, the family brings the case to litigation to argue about all these items.”

There are several ways in which this matter may be resolved, but the clients need to take the time to prepare properly for the distribution. The first way would be to have a complete listing of the items that may have either sentimental value or material value. The client can either list these items in the will, in which case they may have to be probated, or in other cases, the client can sign a memorandum.

The memorandum is fairly new in Massachusetts, as determined in the Uniform Probate Code, which was enacted in 2013. A client may now make a listing of assets and the individuals to receive the assets, which may be memorialized in writing and signed by the client, and then merely referred to in the will. In this manner, if the client desires to change the memorandum, they may merely write up a new memorandum and have it signed and dated and placed with the will, as opposed to having the entire will rewritten.

It is very important in this memorandum to be clear about what items are listed. For example, a mention of a ring or a watch may not be clear enough; perhaps the ring should be listed as the engagement ring with two small diamonds, and the watch could be listed as the Timex watch with rhinestones.

If there are items that are to be identified more clearly, they also should be listed, so that a painting or picture should state the setting or picture, as well as where it may have been hanging in the house, such as in the den above the piano.

Some clients have made lists and put stickers on the back of items or underneath them with identifying colors such as a yellow sticker for daughter Susie, a white sticker for son John, and green stickers for all the grandchildren. This is acceptable so long as the stickers are still on the items at the time of the client’s death and if someone doesn’t get to the items and move the stickers to different items.

In cases where the client was not clear, there are several alternatives to litigation. The first would be to have all parties make a list of the items that are important to them and then allocate an item to each person from their lists, taking turns between the beneficiaries. In some cases, clients have had to draw straws in determining who makes the first selection. Once they are finished choosing all of the items, they can then do their own ‘horse trading’ between themselves, but at least some of the beneficiaries will receive some of the items they want.

If this does not work, it may be necessary to gather the lists of the desired items by the family and engage the services of a mediator to attempt to resolve the differences. The problem then becomes whether the items are more valuable in terms of material value or sentimental value. If the sentimental value isn’t as great as the material value, then a client might decide to choose a larger, more valuable item and hope to trade it later for the more sentimental item.

If the resolution is not able to be made voluntarily, then an inventory of all items will have to be filed with the court, and perhaps an appraiser or two will have to be hired by the estate to value all the items. Some items without much value may be included in a ‘lot,’ which will be valued as a commingling of these items and valued as such.

Once these are all valued and listed on the inventory, one party might have to petition the probate court to determine the proposed distribution of these items, which is unfortunate, as they will be utilizing valuable court time merely to divide the tangible items. The court has the discretion to appoint a master, who will be an experienced lawyer, to hold the hearing at the expense of the estate, and then each party will also be paying their own lawyer to argue over who will receive what items.

In many cases, when this matter is over and resolved, none of the parties are pleased with the result, which means it was probably a fair and equitable decision.

Very often, clients are convinced that the children will have no problem distributing the assets and dividing the items; the client will merely state that nobody will want anything, as they have their own items. This is not always the situation; when a person passes away, not only do the children have a say in what will be distributed, but their spouses may wish to intervene and strongly suggest what their spouse should take. It is usually helpful to keep these in-laws (often called out-laws) out of the decision-making process, as this only causes more people to be involved and greater dissent between the parties.

When completing your own estate plan, consider the potential use of the memorandum with specific detail for the items you wish to distributed. Be careful in considering and discussing these issues with the children since, if you ask them all what they want and they all state that they want the same items, you will then be faced with the decision of having to tell some of them they will not be getting certain items. This can easily cause conflict, and family dinners and holiday occasions may prove to be less than pleasant.

 

Hyman G. Darling is a shareholder and the head of the probate/estates team at Bacon Wilson; (413) 781-0560; [email protected]

Senior Planning

Ten Tips on How to Approach a Difficult Topic

 

By the AARP Foundation

 

The reality is that some conversations are just plain difficult — even with the people to whom you feel the closest. When preparing to discuss a difficult topic like senior care needs, it helps to follow the ground rules below to ensure that everyone’s feelings are respected and viewpoints are heard. To help make the conversation as productive and positive as possible:

 

1. Try not to approach the conversation with preconceived ideas about what your loved ones might say or how they might react. “Dad, I just wanted to have a talk about what you want. Let’s just start with what is important to you.”

 

2. Approach the conversation with an attitude of listening, not telling. “Dad, have you thought about what you want to do if you needed more help?” — as opposed to “we really need to talk about a plan if you get sick.”

 

3. Make references to yourself and your own thoughts about what you want for the future. Let them know they are not alone, that everyone will have to make these decisions. “Look, I know this isn’t fun to think about or talk about, but I really want to know what’s important to you. I’m going to do the same thing for myself.”

 

4. Be very straightforward with the facts. Do not hide negative information, but also be sure to acknowledge and build on family strengths. “As time goes on, it might be difficult to stay in this house because of all the stairs, but you have other options. Let’s talk about what those might be.”

 

 

5. Phrase your concerns as questions, letting your loved ones draw conclusions and make the choices. “Mom, do you think you might want a hand with some of the housekeeping or shopping?”

 

6. Give your loved ones room to get angry or upset, but address these feelings calmly. “I understand all this is really hard to talk about. It is upsetting for me, too. But it’s important for all of us to discuss.”

 

7. Leave the conversation open. It’s OK to continue the conversation at another time. “Dad, it’s OK if we talk about this more later. I just wanted you to start thinking about how you would handle some of these things.”

 

 

8. Make sure everyone is heard — especially those family members who might be afraid to tell you what they think. “Susan, I know this is really hard for you. What do you think about what we are suggesting?”

 

9. End the conversation on a positive note. “This is a hard conversation for both of us, but I really appreciate you having it.”

 

10. Plan something relaxing or fun after the conversation to remind everyone why you enjoy being a family. Go out to dinner, attend services together, or watch a favorite TV program.

These are just a few suggestions of things you, your loved ones, and other family members can do to unwind after a difficult conversation.

Senior Planning Special Coverage Special Publications

Inside This Year’s Planner

When BusinessWest and the Healthcare News first started publishing an annual Senior Planning Guide, the idea wasn’t to create a roadmap to the end of life, though it could, in some sense, be described as such.

The goal is to make sure you get your plans in order — from where you or your loved ones will live to how finances will be distributed — so you don’t have to worry so much, and instead enjoy the senior years to the fullest, or to help your aging parents enjoy them.

After all, the retirement years should be an enjoyable time, highlighted by special moments with family and friends, the freedom to engage in a range of activities, maybe even a chance to develop new interests and hobbies.

But to make the most of that time, proper planning — estate planning, financial planning, plans for care — is critically important. According to the U.S. Census Bureau, the number of Americans age 65 and older — which was 35 million in 2000, just 12% of the population — will reach 73 million by 2030, or 21% of U.S. residents. That’s a lot of people. And a lot of planning. And a lot of living left to enjoy.

Achieving your goals — and your desires for your loved ones — requires careful thought, and that’s where our annual Senior Planning Guide, presented by UMassFive Financial & Investment Services, comes in. So let’s sort through some of the confusion and get those conversations — and the rest of your life — started.

View this  year’s digital Senior Planning Guide HERE

Wellness for Life

Sharing a Life

Journaling Is a Therapeutic Exercise — for All Those Involved

Savvy Seniors Freeze It

Nutrition-minded Older Adults Should Heed These Tips

The Emotional Bank Account

How Seniors Can Maintain Mental Wellness

A Whole Year of Fun

Older Adults Have Plenty of Ways to Stay Physically Active

Estate & Financial Planning

Estate Planning: An Introduction

Goals, Strategies Can Vary with Each Stage of Life

Creating an Estate Plan

The Process Begins by Understanding the Key Documents

Decisions, Decisions

How to Choose a Medicare Plan

Preparing a Will

It Can Be a Dreaded Task, but It’s an Important One

A Task Better Left to a Professional

Being in Charge of an Estate Can Be Unsettling for All Involved

Roadblocks to Equality

LGBTQ+ Elders Face Unique Planning Challenges

Let’s Not Fight over This Stuff

Distributing Tangible Personal Property Can Cause Conflict

Caregivers & Adult Children

A Gentle Reminder

Don’t Lose Yourself in Caring for Others

Reading the Signs

Six Indications It Might Be Time for Memory Care

Having the Talk

Ten Tips on How to Approach a Difficult Topic

Four Steps to Emotional Wellness

Caregivers Must Understand the Importance of Self-care

It’s Not About Dying

How Hospice Care Supports the End-of life Journey

Senior Resources

Senior Planning

Journaling Is a Therapeutic Exercise for All Involved

Liz Berezin, who recently completed a journal for John Scalia

Liz Berezin, who recently completed a journal for John Scalia, described the experience as one that was rewarding on many levels.

Lisa Berezin acknowledged she was moving out of her comfort zone.

“Completely out of my comfort zone,” actually.

Indeed, she had never done anything remotely like the assignment she agreed to take on. But when her good friend, Susan Jaye Kaplan, asks for help with something, it is her policy to say ‘yes.’

In this case, she was agreeing to a request to create a journal chronicling the life and times of one of the residents at Ruth’s House, an assisted-living facility in Longmeadow. For Berezin, who earned a degree in elementary education before segueing into business, and someone who had volunteered mostly with young people, this was a going to be an exercise in learning while doing, but she was willing and able.

So was John Scalia, a 64-year-old resident whose life has been dominated by four passions — his family, his friends, his love of music (especially doo-wop), and an obsession with the New York Yankees. Family comes first; after that, it’s a toss-up between the other three.

The journal makes that clear.

While Berezin fashioned a cloth cover for Scalia’s journal, one dominated by Yankees logos and pennants, his large family is arguably the focal point of this document. It is dedicated to his mother, Lucy; father, Joseph Sr.; brother, Joseph; and sister-in-law, Michelle with a note expressing that he wouldn’t be where he is today without them.

“The process itself works different parts of the brain — the memory part and the creative part can be very healing if you have any conflicts or things you need to resolve as you’re speaking them out, working them out … it can be very healing in that way.”

Capturing passions and letting others know all the many moments and memories that go into a life is just one of the broad goals behind journaling and this particular project, said Kaplan, known to many in this region as the founder of the nonprofits Go FIT and Link to Libraries.

Others include a desire to have the subjects of these documents open up to people, exercise their memory, and simply talk about what is important to them.

Berezin agreed.

“The process itself works different parts of the brain — the memory part and the creative part can be very healing if you have any conflicts or things you need to resolve as you’re speaking them out, working them out … it can be very healing in that way,” she said. “John was very excited to share his memories, and I think he was so happy to be part of this project and have someone who really and truly cared and listened, and asked questions back. And what made John happy was so contagious for me; John’s like a happy pill for me.”

As for John, he said this was a fun experience, one in which Berezin’s questions, and prompting, brought back many great memories and made him even more appreciative of all that he’s been able to experience. “She asked all the right questions, and I tried to answer as best I could,” he said, noting that he moved to Ruth’s House with his mother several years ago and helped take of her until she died shortly after they arrived there.

Kaplan’s husband, Steve, is a resident of Ruth’s House, now four years into a courageous battle against brain cancer. And it was while creating a journal for Steve — an eye-opening experience on many levels, she said — that she decided that more people should be sharing in the process of creating these living documents — and enjoying the final product.

Susan Jaye Kaplan, left, and Delia Jones

Susan Jaye Kaplan, left, and Delia Jones say the journaling project at Ruth’s House has been a learning experience for all those involved.

So she put out a call for volunteers on Facebook, and eventually saw more than a half-dozen area residents, including Berezin, sign up to be part of this initiative.

Most of the journals are still works in progress, she said, adding that the work to compile them is as important as the final document.

It is here where the resident and the volunteer meet several times over the course of a few months to talk, learn about each other, and, most importantly, forge a friendship, said Delila Jones, Life Enrichment director at Ruth’s House, adding that, in a word, journaling is therapeutic for all those involved.

“Journaling is about voicing yourself — your identity, your mind, your heart — and just giving it a voice,” she explained. “Journaling is bringing it out of your mind and putting it down on paper.”

Berezin agreed, noting that, because of the journaling project, she has made a friend in John, and has also become committed to Ruth’s House and its patients. Indeed, she now volunteers for Wednesday trivia and other programs, and volunteered her husband, Mark, a pianist, to play on Fridays at the facility. And he, in turn, volunteered Lisa to lead a sing-along.

That’s one example of how journaling has not only enabled someone to become involved in telling a life’s story, but become more involved in the lives of others in general.

And that’s a big part of what this project is all about.

 

Pride in the Yankees

As she put her journal of Scalia’s life together, Berezin used words, pictures, and even some numbers, such as $12.6 million.

That’s the amount a 1952 Mickey Mantle baseball card fetched at an auction several years ago, making the card the most valuable sports collectible in the world.

Mantle has always been one of Scalia’s favorite Yankee players, as is the case with many who grew up when he did. Others include Reggie Jackson, Thurman Munson, Don Mattingly, and, more recently, Aaron Judge.

These insights are a few of the many references to the Yankees in this journal. Others include everything from Scalia’s bobblehead collection to his recollections of five-time Yankee manager Billy Martin, to memories of visits to both the old and new Yankee Stadiums.

“He’s the biggest Yankees fan you’ll ever meet,” Berezin told BusinessWest. “He can tell you what positions people played, what years, who their managers were … and on and on.”

These many and different references to the Bronx Bombers help explain how the journaling exercise yields what could be called the ‘essence’ of a person, said Berezin, adding that what came through with Scalia were both general themes — family, the Yankees, and doo-wop — and small bits of information that, together, tell a story.

In Scalia’s case, these small but significant bits include the fact that he worked at Stop & Shop in Enfield for 40 years — and wasn’t particularly thrilled with the company when it didn’t recognize his four decades of service. And the fact that he met Whitey Ford at the store one day — the Yankee legend pulled up in a limo — and got his autograph.

They also include his fondness for Mel’s Diner in Naples, Fla. and its barbecue ribs, as well as the long list of TV shows he has enjoyed over the decades, from Leave It to Beaver to the original Charlie’s Angels (yes, he had that iconic Farrah Fawcett poster on the wall in his bedroom when he was young), to a slew of cop shows including Columbo, Kojak, and Police Woman.

They also include memories of his grandmother, who would pick grapes off the vine and grind them up to make wine, and his mother, who would discipline him by saying simply, “wait ’til your father gets home.”

Summoning such memories — and Scalia has many of them, not just of his mother and grandmother, but also his Uncle Tony, a restaurant owner, and his Aunt Louise and Aunt Ann — is why journaling is such good therapy for those taking part in this exercise, Jones said.

“It’s important for the senior to participate in this because it’s giving them a voice — the opportunity to share who they are, their situation, what they grew up with … sharing their life,” she said. “For the person who facilitates this … they’re giving us access to another world, another perspective, another vision. It’s like reading a book; it’s like listening to another life and gaining a perspective that’s not yours, and that’s a privilege, because humans need to see beyond themselves, and this provides that opportunity.”

Kaplan agreed. She said she created a journal for a Ruth’s House resident more than 20 years ago, an experience that opened her eyes to the importance, and value, of such an experience.

“I didn’t know the resident very well; I just knew the family,” she recalled. “The family was on vacation. I brought a notebook with me and started asking some simple questions, and it opened a flood of memories, everything from where she grew up as a child to who her siblings were and what she remembered about growing up with them.

“I was amazed; she had beautiful stories to share — some happy, some not so happy,” Kaplan went on. “And she was willing to open up to me, a virtual stranger. She was so delighted to share a little about herself, and I found it was a win-win for me as well because I gained a wealth of knowledge about so many things and learned about this remarkable woman.”

Rob Whitten, president of JGS Lifecare, said this journaling project has yielded learning experiences on many levels.

“This is a program that opens people up and allows them to make connections that they otherwise might not have made,” he told BusinessWest. “JGS Lifecare has always had a strong track record for volunteer engagement, and this is just another example of this; it’s a wonderful program that is really by volunteers and family members … and it connects people together.”

 

The Last Word

Berezin said she received a wonderful and very sincere thank-you note from Scalia’s family after she presented him — and them — with the journal.

She was touched by the gesture, quickly adding that, in many ways, she should be sending one to them as well. That’s because, while this experience, this document, is beneficial for him and his family, it has been beneficial to her as well. It has given her insight into not just one life, but many, and a new appreciation for all the things that make a life special.

As she said, the best part is that she made a good friend in the process.

That’s what journaling is all about.

Senior Planning

Nutrition-minded Older Adults Should Heed These Tips

By Kimberly DaSilva with Carrie Taylor and Andrea Luttrell

 

Your nutritional needs change throughout your lifetime. Some physical changes may impact appetite, senses, and fluctuations in your digestive system. These changes may be due to aging, decreased physical activity, or in conjunction with prescriptive medication suppressing your appetite.

Having a decreased appetite may impact your intake of calories, essential vitamins, minerals, and proteins needed to maintain muscle mass and prevent unintentional weight loss. When it comes to appetite, decreased senses of smell and taste can also affect the enjoyment of your food’s flavor and aroma. For digestion, your gastrointestinal tract could become less mobile and more rigid — leading to issues including constipation, stomach pain, and nausea.

“Produce that freezes well includes tomatoes, corn, carrots, peppers, zucchini, and berries. High-water-content foods such as melons, cucumbers, lettuce, and eggplant should stay clear of the freezer.”

To overcome any decrease in taste and smell, get creative. Cook with spices; herbs; aromatic vegetables like celery, onion, garlic, and shallots; and savory sauces to engage your taste buds. Select higher-quality food; cook seasonal fruits and vegetables so they have a softer mouth feel in recipes like soups, stews, and casseroles; drink plenty of water; and reduce stomach irritants, such as alcohol, to overcome physical changes as well.

As you age, your nutrition may be affected by your social and financial situation versus physical. For example, your social circle may become smaller due to the loss of a spouse, family members, and friends. Living alone and cooking for one while eating on a fixed income can present challenges for some as well.

Not all is lost! Below are some tips when cooking for one on a budget.

Six Nutritional Tips for Older Adults

Older adults have unique nutritional needs.

Simple adjustments can go a long way toward building a healthier eating pattern. Follow these tips from the National Institute on Aging to get the most out of foods and beverages while meeting your nutrient needs and reducing the risk of disease.

• Enjoy a variety of foods from each food group to help reduce the risk of developing diseases such as high blood pressure, diabetes, and heart disease. Choose foods with little to no added sugar, saturated fats, and sodium.

• To get enough protein throughout the day and maintain muscle, try adding seafood, dairy, or fortified soy products, along with beans, peas, and lentils, to your meals.

• Add sliced or chopped fruits and vegetables to meals and snacks. Look for pre-cut varieties if slicing and chopping are a challenge for you.

• Try foods fortified with vitamin B12, such as some cereals, or talk to your doctor about taking a B12 supplement.

• Reduce sodium intake by seasoning foods with herbs and citrus such as lemon juice.

• Drink plenty of water throughout the day to help stay hydrated and aid in the digestion of food and absorption of nutrients. Avoid sugary drinks.

Tip 1: Be a savvy shopper. Get the most out of your food budget and purchase meats and shelf-stable foods when they are on sale. And stock up on fruits and vegetables when they are in season.

Tip 2: Be an organized shopper. Plan meals in advance and create a shopping list from your menu. Buy store brands for the same quality items at a lower cost.

Tip 3: Freeze your meals. When cooking for one, a great option is to cook and freeze meals. To do this, make multiple servings versus just one. Divide quantities into individually sized portions and freeze for future ready-made meals. Planning portions also prevents waste and can save you money.

 

Freezing Inspiration

With cooler weather around the corner, plan for hearty soups, stocks, and quick casseroles. For example, take advantage of less-expensive seasonal fruits and vegetables and preserve their fresh-picked flavor by freezing them.

Why freeze? Freezing temperatures stop the growth of microorganisms while slowing the chemical reactions that break down food and reduce its quality. This makes freezing food perfect for enjoying the taste of summer for seasons to come!

Produce that freezes well includes tomatoes, corn, carrots, peppers, zucchini, and berries. High-water-content foods such as melons, cucumbers, lettuce, and eggplant should stay clear of the freezer. Avoid discoloration of fruits such as peaches, apples, pears, and apricots by tossing with lemon juice prior to freezing.

For the best flavor and texture, use ripe, non-bruised produce free of nicks. Most raw fruit freeze just fine without blanching.

 

Tips for Freezing

• Rinse and cut produce into the desired size.

• Blanch vegetables before freezing. Drop vegetables in boiling water for one to two minutes, then immediately transfer to an ice bath and chill completely to help stop the cooking process. Drain and pat dry.

• Place fruit or vegetables in a single layer on a sheet pan lined with wax or parchment paper. Place in the freezer until the produce is frozen solid.

• Once frozen, pack into whichever freezer-safe container you prefer — a freezer-safe food-storage bag, a plastic container with an airtight lid, plastic wrap, or aluminum foil. Avoid glass, as it can shatter and cause your food to become unsafe to eat.

• Leave only a half-inch to one-inch space at the top of containers. Reducing food’s contact with air will prevent ‘off’ flavors or freezer burn.

• Store sauces and soups in freezer-safe food-storage bags and lay flat on shelves to save space.

 

Tips for Storage

• Practice food safety when cooling leftovers. Cool to room temperature for no more than two hours, or one hour for hot summer conditions above 90 degrees Fahrenheit, to avoid the risk of a foodborne illness. Putting hot food directly into the freezer creates condensation on the food, which can lead to freezer burn while possibly raising the temperature of the refrigerator. Although freezer-burned food may have off flavors, it will not cause you harm.

• Label foods with prepared, frozen, and use-by dates. Soups and stews with meat can be frozen for up to two to three months. Leftover meals can be frozen for two to six months, and fruits and vegetables can be frozen for up to one year.

 

Tips for Thawing

• Determine the quality of food after thawing. First, check odor, as some foods will develop a rancid or off odor when frozen too long. Discard such items. (Note: although some items may not look picture-perfect when frozen, they work exceptionally well in soups, stews, casseroles, and sauces.)

• Never defrost foods at room temperature. Use these three safe ways to defrost food: in a refrigerator running at 40 degrees Fahrenheit or lower, in the microwave, or under cold running water. (Note: for foods thawed in the microwave or by running cold water, cook immediately after thawing.)

 

Tips for Use

• Enjoy frozen fruit as is, without cooking, for smoothies, flavoring plain yogurt, adding to sautés, and baking recipes.

• Vegetables can be cooked while still frozen and/or after thawing.

• Raw meat and casseroles can be cooked, or reheated, from the frozen state.

• Always reheat and/or cook foods to their recommended internal temperature, as verified with an instant-read food thermometer.

As you can see, any challenges that impact nutrition as you age can be minimized by incorporating a few new practices into your normal routine. Preserving nutrients and flavor of seasonal produce and your favorite recipes by freezing is a great way to control your food budget as well. Happy freezing!

 

Kimberly DaSilva is dietetic intern with Be Well Solutions. Carrie Taylor, RDN, LDN, RYT and Andrea Luttrell, RDN, LDN are registered dietitians with Big Y.

Senior Planning

How Seniors Can Maintain Mental Wellness

By Behavioral Health Network

 

How can people continue to support their mental health and find ways to engage in life as they age? Leona LaFleur, a behavioral-health clinician and mental-health consultant for elder services at Behavioral Health Network, has been finding those answers through the people she works with.

Their wealth of life experience is key, she says. “I am constantly learning from my clients. They have a good degree of resilience, and so I try to help them identify what their strengths are.”

Leona LaFleur

Leona LaFleur

“A lot of people have this idea that we have to make huge changes in order to feel some success, and that’s not really necessary. We can experience success from small changes.”

According to LaFleur, there are four pillars of mental wellness for seniors: sleep, nutrition, exercise, and social connection. The latter of these is of the utmost importance, as recently referenced in an advisory by the U.S. surgeon general.

As we get older and our bodies age, maintaining a sense of control can be difficult, and choosing the people you allow to be in your life and influence you helps maintain that sense of control. Not only that, but the COVID-19 pandemic and forced isolation was tough on many people’s connections, and many are still reeling from those impacts today.

LaFleur advises seniors and their loved ones to assess how well these pillars are being addressed and where they might need to make a change. It is important to normalize what they are going through, recognize where they may be stuck, and then identify what small things can be done to make progress.

“A lot of people have this idea that we have to make huge changes in order to feel some success, and that’s not really necessary,” she said. “We can experience success from small changes.”

For example, if there is a need for more physical activity, she might recommend connecting with a friend who does yoga. Sometimes the change is as simple as getting out of bed, which can be difficult for some seniors due to their physical limitations. It is important to note that, in many cases, the elderly are not disconnected in life because they are depressed, necessarily, but because it is physically difficult for them to actively engage in their life.

Breaking things down into small components helps with anxiety and decision fatigue as well. Because of the abundance of information in the world today, people can be easily overwhelmed. Simplifying things is important to identify where the challenges are and where improvement can happen. LaFleur notes that “I try to break things down and recognize the individual, and try to get them to identify what they need.”

She also recommends considering mental healthcare like an ‘emotional bank account.’ Determine what actions can you take — whether relaxing, socializing, or otherwise — to put ‘money’ in the bank and increase your reserves for managing stress. With more reserves in your emotional bank account, you are better able to manage difficult situations that you encounter.

Deposits are different for each person and situation. For example, social actions are not always a deposit; time spent with family can come with difficult history and thus can increase stress. It is important to give yourself credit for the things you do, especially the little things, because they all contribute to your self-worth and overall well-being.

Senior Planning

Older Adults Have Plenty of Ways to Stay Physically Active

By the National Institute on Aging

There are lots of fun and simple ways to build exercise into your daily routine. It’s easy to come up with ideas for activities to do with your family and ways to stay active in all four seasons.

 

Spending Time with the Family

Being physically active with your family is a great way to stay healthy and make exercise fun. Whether you play team sports with the entire family or take brisk walks with your spouse, child, or grandchild, you’ll be rewarded with improved health and time spent together. Here are a few activity ideas for you to do with your grandchildren:

Infants and toddlers:

• Take them for walks in the stroller and rides on your bike. Don’t forget your helmets.

• Play games that get your bodies moving, like wheels on the bus, pretend we’re animals, and hide and seek.

• Sign up for baby yoga or exercise classes.

• Try baby-friendly swimming classes.

School-aged children:

• Walk to the park and push their swing.

• Jump rope together.

• Build a fort — indoors or out.

• Play catch, kickball, basketball, or soccer.

• Go swimming or biking together.

• Play a video fitness game together and see who wins.

Teens and young adults:

• Participate in activities that interest them. Try hiking, skating, or tennis.

• Go golfing or swimming. Invite them to join you in physical activities that require two people, such as tennis or ping pong.

• Ask them to help you in the garden or with heavy-duty household chores.

 

Be Physically Active Without Spending a Dime

You don’t need to spend a fortune to be physically active. In fact, you can be active in many ways without spending any money. You don’t need special exercise equipment other than comfortable walking shoes. Here are a few ideas to help get you moving for free:

• Make your own weights from household items such as soup cans or bottles of water.

• Try out free demonstration exercises classes at your local senior center or fitness center.

• Go for a hike in a park.

• Participate in community-sponsored fun runs or walks.

• Yard work such as raking, digging, and planting can keep you active.

• Make sure to drink water or juice after exercise.

 

Find Ways to Stay Active in All Four Seasons

Being creative about your physical activity plans and trying new forms of exercise can keep you motivated by preventing boredom. A change in seasons is an excellent time to be creative about your exercise routine and try something new. There are many ways to be active throughout the year.

 

Winter:

• When your grandchildren visit, head outside to build a snowman together or go ice skating.

• Cold outdoor temperatures are an excellent reason to join a mall-walking group.

• Start the new year by trying out a fitness center — many offer New Year’s resolution specials.

• Give your heart a Valentine’s Day gift with dance lessons, such as salsa, tango, or belly dancing.

 

Spring:

• As the temperatures start to get warm, get your garden ready for spring and summer. The lifting and bending you do when gardening are great for strength and flexibility.

• A bike ride is a great way to enjoy the warmer temperatures.

• Anything can be fun with upbeat music, including spring cleaning.

• Build your endurance and strength with a bike ride during National Bike Month (May). Remember your helmet.

 

Summer:

• Swim laps or take a water-aerobics class. These are both refreshing once the weather gets steamy.

• Walking in the mall is a cool way to beat the heat.

• Now that the grandchildren are out of school for the summer, ask them to teach you their favorite sport or physical activity.

• Celebrate National Bowling Week the first week in August. Get friends and family together and challenge each other to a friendly tournament.

 

Fall:

• If you’ve heard about the benefits of yoga but haven’t tried it yet, National Yoga Awareness Month (September) is a great time to find special events and trial classes for beginners.

• As the weather begins to cool, join an indoor sports league, such as basketball, handball, or bowling.

• Fall provides great opportunities for physical activity. You can take long walks to see the beautiful fall colors. Once the leaves have fallen, raking is good exercise.

• If you have holiday shopping to do, walk the entire mall each time you’re there.

Senior Planning

Goals, Strategies Can Vary with Each Stage of Life

By UMassFive Financial & Investment Services

 

By definition, estate planning is a process designed to help you manage and preserve your assets while you are alive, and to conserve and control their distribution after your death, according to your goals and objectives. But what estate planning means to you specifically depends on who you are. Your age, health, wealth, lifestyle, life stage, goals, and many other factors determine your particular estate-planning needs.

“Your age, health, wealth, lifestyle, life stage, goals, and many other factors determine your particular estate-planning needs.”

For example, you may have a small estate and may be concerned only that certain people receive particular things. A simple will is probably all you’ll need. Or you may have a large estate, and minimizing any potential estate-tax impact is your foremost goal. Here, you’ll need to use more sophisticated techniques in your estate plan, such as a trust.

To help you understand what estate planning means to you, the following sections address some estate-planning needs that are common among some very broad groups of individuals. Think of these suggestions as simply a point in the right direction, and then seek professional advice to implement the right plan for you.

 

Over 18

Since incapacity can strike anyone at any time, all adults over 18 should consider having:

• A durable power of attorney: This document lets you name someone to manage your property for you in case you become incapacitated and cannot do so; and

• An advance medical directive: The three main types of advance medical directives are a living will, a durable power of attorney for healthcare (also known as a healthcare proxy), and a do-not-resuscitate order. Be aware that not all states allow each kind of medical directive, so make sure you execute one that will be effective for you.

 

Young and Single

If you’re young and single, you may not need much estate planning. But if you have some material possessions, you should at least write a will. If you don’t, the wealth you leave behind if you die will likely go to your parents, and that might not be what you want. A will lets you leave your possessions to anyone you choose (e.g., your significant other, siblings, other relatives, or favorite charity).

 

Unmarried Couples

You’ve committed to a life partner but aren’t legally married. For you, a will is essential if you want your property to pass to your partner at your death. Without a will, state law directs that only your closest relatives will inherit your property, and your partner may get nothing. If you share certain property, such as a house or car, you may consider owning the property as joint tenants with rights of survivorship. That way, when one of you dies, the jointly held property will pass to the surviving partner automatically.

 

Married Couples

For many years, married couples had to do careful estate planning, such as the creation of a credit shelter trust, in order to take advantage of their combined federal estate-tax exclusions. For decedents dying in 2011 and later years, the executor of a deceased spouse’s estate can transfer any unused estate-tax exclusion amount to the surviving spouse without such planning.

You may be inclined to rely on these portability rules for estate-tax avoidance, using outright bequests to your spouse instead of traditional trust planning. However, portability should not be relied upon solely for utilization of the first to die’s estate-tax exclusion, and a credit-shelter trust created at the first spouse’s death may still be advantageous for several reasons:

• Portability may be lost if the surviving spouse remarries and is later widowed again;

• The trust can protect any appreciation of assets from estate tax at the second spouse’s death;

• The trust can provide protection of assets from the reach of the surviving spouse’s creditors; and

• Portability does not apply to the generation-skipping transfer (GST) tax, so the trust may be needed to fully leverage the GST exemptions of both spouses.

Married couples where one spouse is not a U.S. citizen have special planning concerns. The marital deduction is not allowed if the recipient spouse is a non-citizen spouse (but a $164,000 annual exclusion for 2022 is allowed). If certain requirements are met, however, a transfer to a qualified domestic trust will qualify for the marital deduction.

 

Married with Children

If you’re married and have children, you and your spouse should each have your own will. For you, wills are vital because you can name a guardian for your minor children in case both of you die simultaneously. If you fail to name a guardian in your will, a court may appoint someone you might not have chosen. Furthermore, without a will, some states dictate that, at your death, some of your property goes to your children and not to your spouse. If minor children inherit directly, the surviving parent will need court permission to manage the money for them.

You may also want to consult an attorney about establishing a trust to manage your children’s assets in the event that both you and your spouse die at the same time.

You may also need life insurance. Your surviving spouse may not be able to support the family on his or her own and may need to replace your earnings to maintain the family.

 

Comfortable and Looking Forward to Retirement

If you’re in your 30s, you may be feeling comfortable. You’ve accumulated some wealth, and you’re thinking about retirement. Here’s where estate planning overlaps with retirement planning. It’s just as important to plan to care for yourself during your retirement as it is to plan to provide for your beneficiaries after your death.

You should keep in mind that, even though Social Security may be around when you retire, those benefits alone may not provide enough income for your retirement years. Consider saving some of your accumulated wealth using other retirement and deferred vehicles, such as an individual retirement account.

 

Wealthy and Worried

Depending on the size of your estate, you may need to be concerned about estate taxes. For 2022, $12,060,000 is effectively excluded from the federal gift and estate tax. Estates over that amount may be subject to the tax at a top rate of 40%.

Similarly, there is another tax, called the generation-skipping transfer (GST) tax, that is imposed on transfers of wealth made to grandchildren (and lower generations). For 2022, the GST tax exemption is also $12,060,000, and the top tax rate is 40%.

The Tax Cuts and Jobs Act, signed into law in December 2017, doubled the gift- and estate-tax basic exclusion amount and the GST tax exemption to $11,180,000 in 2018. After 2025, they are scheduled to revert to their pre-2018 levels and cut by about one-half.

Whether your estate will be subject to state death taxes depends on the size of your estate and the tax laws in effect in the state in which you are domiciled.

 

Elderly or Ill

If you’re elderly or ill, you’ll want to write a will or update your existing one, consider a revocable living trust, and make sure you have a durable power of attorney and a healthcare directive. Talk with your family about your wishes, and make sure they have copies of your important papers or know where to locate them.

 

Help with Estate Planning

Looking for guidance for getting started with estate planning, or maybe you just need a second opinion? The CFS fnancial advisors at UMassFive Federal Credit Union are well-versed in this type of planning and can work in conjunction with your estate-planning attorney. Visit [email protected] for more information.

Non-deposit investment products and services are offered through CUSO Financial Services, LP (CFS), a registered broker-dealer (member FINRA/SIPC) and SEC registered investment advisor. Products offered through CFS are not NCUA/NCUSIF or otherwise federally insured, are not guarantees or obligations of the credit union, and may involve investment risk, including possible loss of principal. Investment representatives are registered through CFS. UMassFive has contracted with CFS to make non-deposit investment products and services available to credit-union members. CFS does not provide tax or legal advice. For such guidance, consult your tax or legal professional.

Senior Planning

The Process Begins by Understanding the Key Documents

By Stephen Sobey, Esq.

 

In the back of your mind is a list that, particularly in quiet moments, likes to assert itself. It’s the list of the things you know you should do but haven’t. Items may include scheduling an oil change, finding a primary care physician, cleaning out your refrigerator…and creating an estate plan.

Stephen Sobey

Stephen Sobey

“You need to consider who you trust and, among those individuals, who has the right skill set and disposition to serve as personal representative of your estate or as the guardian of your children.”

One day, hopefully soon, you resolve to check off this last, very important item. What do you need to know? Although an estate-planning attorney can guide you through this process, it is to your benefit to have a basic understanding of the core documents that make up an estate plan and have already considered certain key questions.

The documents generally considered to form the core of any estate plan are the last will and testament, durable power of attorney, and healthcare proxy. Depending on your circumstances (e.g., minor children, taxable estate, etc.) or preferences, a fourth document, the revocable trust, may also be part of this core group. A discussion of trusts would require more space than is available in this article, but the questions posed here will still be useful if you and your attorney decide trust planning is appropriate.

 

Last Will and Testament

A will’s primary functions are to direct the distribution of probate property, nominate the personal representative (previously known as the ‘executor’) of your estate, and nominate the guardians and conservators of any minor children who survive you.

First, who do you want to get your probate property when you die? Although seemingly straightforward, this question contains within it a multitude of sub-questions. Do you want to make sure someone gets a particular item? Do you want to leave someone a specific dollar amount, and, if so, how much? Is there someone you want to make absolutely sure gets nothing from your estate? And what happens if everyone you have named in your will predeceases you?

As you consider these questions, keep in mind two critical points: the will ultimately controls only the distribution of probate property, which is not necessarily all the property you may own. Probate property consists only of the assets you owned in your name alone at your death. Assets with beneficiary designations, such as life-insurance policies and IRAs; jointly owned assets, such as some bank accounts; and assets in trust are all examples of non-probate property. In creating an estate plan, then, just as important as the question of what you own is the question of how you own it.

Finally, you need to consider who you trust and, among those individuals, who has the right skill set and disposition to serve as personal representative of your estate or as the guardian of your children. The best way to think about these roles, and about any of the other roles discussed here, is as jobs with their own particular job descriptions. In this way, deciding on the right person should be more than a matter of simply naming, for example, your eldest child; rather, give some thought to each person’s proverbial resumé.

 

Durable Power of Attorney

The purpose of the durable power of attorney is to designate someone to manage your financial affairs during your life. The person you appoint is variously referred to as your ‘agent’ or ‘attorney-in-fact.’

When your agent may act for you will depend on how the document is drafted. In some durable powers of attorney, the agent’s authority is immediate. In so-called ‘springing’ durable powers of attorney, the agent’s authority commences only upon the determination of a physician that you lack the capacity to manage your own affairs. Each of these approaches has its own pluses and minuses, which your attorney can explain.

 

Healthcare Proxy

In a healthcare proxy, you designate an individual to serve as your ‘healthcare agent.’ Their role is to make medical decisions on your behalf in the event you are unable to communicate your wishes. However, the healthcare agent’s authority is effective only upon a physician’s determination that you are incapacitated.

Healthcare proxies are often conflated with what are commonly known as living wills. A living will is a document in which you set your preferences regarding, among other things, end-of-life care. Living wills, unlike healthcare proxies, are not legally binding in Massachusetts; however, this document can provide a helpful framework for your healthcare agent in making medical decisions on your behalf.

This is a general overview of what is ultimately an intensely detail-oriented subject. But, armed with this little bit of knowledge, you have the beginnings of what you need to create your estate plan. The next step, naturally, is to contact an attorney.

 

Stephen Sobey is an associate with Shatz, Schwartz and Fentin.

Senior Planning

How to Choose a Medicare or Medicare Advantage Plan

By Sarah Fernandes

 

In Massachusetts, more than 1.4 million people who are 65 or older will be making decisions about their 2024 Medicare and Medicare Advantage coverage during the Medicare Annual Enrollment Period (open enrollment) from Oct. 15 to Dec. 7. Before choosing their plans, Medicare beneficiaries should consider a few things.

Sarah Fernandes

Sarah Fernandes

“By focusing on prevention, any potential health issues can be identified early, and you can work to maintain optimal health and prioritize your well-being.”

Is All Medicare Coverage the Same?

While Original Medicare (Parts A and B), the plan provided by the federal government, covers hospitalizations and most doctors’ services, coverage for other services like outpatient care, medical supplies, and preventive health care (Parts C and D) can vary widely. Part C, otherwise known as Medicare Advantage, and Part D (prescription drug coverage) are offered through private insurers, such as Health New England and others.

 

What is Medicare Advantage (Part C)?

Medicare Advantage (Part C) plans cover everything Original Medicare (Parts A and B) would cover, but offer additional benefits and services beyond Original Medicare. These added benefits can include prescription-drug coverage, vision care, dental services, hearing aids, wellness programs, and more. Medicare Advantage plans provide greater opportunities for beneficiaries to engage in preventive services, such as regular checkups, screenings, vaccinations, and health education.

By focusing on prevention, any potential health issues can be identified early, and you can work to maintain optimal health and prioritize your well-being. If you do have a chronic condition, a coordinated approach from your Medicare Advantage plan and your providers ensures that you receive the necessary support, education, and interventions to manage your condition effectively, leading to improved quality of life and health outcomes.

 

How Do I Decide?

To decide what plan is right for you, be sure to review the features of the plan. For instance:

• Make a list of your preferred healthcare providers and see if they are considered in-network or out-of-network for each plan you are considering. Some plans do not cover out-of-network services at all, while some cover them partially.

• Similarly, make a list of your medications and see if they will be covered and how much, if anything, you will need to pay out-of-pocket (your co-pay).

• If you travel or spend time in other areas of the country, check if the plan allows you to use any Medicare-accepting doctor anywhere in the U.S.

• See if the plan covers dental, vision care, hearing services, and prescription drugs.

• Ask if the plan offers additional healthy benefits such as gym memberships, coverage for acupuncture, activity trackers, and weight-management programs.

How Do I Learn More?

Health New England’s Medicare Advantage plans are a popular option for people aged 65 and older who are looking to tailor their healthcare coverage to their personal needs. As part of Baystate Health, Health New England has many high-quality providers in our network across Western Mass., and we have plans that cover you anywhere you travel in the U.S.

To learn more about choosing the right Medicare or Medicare Advantage plan, you can attend Health New England’s live information sessions, which you can find and register for at healthnewengland.org/medicare/sessions.

For more information about Health New England, visit healthnewengland.org/medicare or call (877) 443-3314 (TTY: 711). SHINE, Massachusetts’ free Medicare advice service, is available online at mass.gov/health-insurance-counseling or by calling (800) 243-4636. For more information about Medicare, visit medicare.gov.

 

Sarah Fernandes is the Medicare sales manager at Health New England and been with Health New England for more than 23 years. She and her team educate Medicare beneficiaries in Western Mass. on their Medicare options.

 

Senior Planning

It Can Be a Dreaded Task, but It’s an Important One

By Mary Paier Powers, Esq.

 

Completing a will is often a dreaded task to undertake — partly because we don’t want to face our own mortality, and partly because we don’t know where to begin.

A will is an important document that ensures property you own in your own name passes to the beneficiaries of your own choosing, and it can be changed as necessary. Your will gets filed at probate court when you pass away owning assets in your own name. Assets that have a beneficiary listed or assets that you own jointly are not controlled by your will.

Mary Paier Powers

Mary Paier Powers

“A will is an important document that ensures property you own in your own name passes to the beneficiaries of your own choosing, and it can be changed as necessary.”

As you are about to embark on this process, here are some thoughts to consider.

• Who are your beneficiaries? Family, children, friends, charities, or a combination of all? You can construct your will to leave your estate to the beneficiaries of your choosing.

• How old is a beneficiary, and does that beneficiary have the ability to manage the money or inheritance? Can they be in control if they receive a lump sum of money?

• Will you need a trust as part of your will? A trust provides for the management and distribution of assets for a beneficiary in a manner that is best for the beneficiary.

• What if a beneficiary passes away before you? Does that beneficiary’s share pass to their children? Or does it go only to your surviving beneficiaries?

• Some people plan for the future when they prepare their wills and try to accommodate various situations. It is OK and often recommended to update your will as your family and beneficiaries change. There is always uncertainty with what the future holds.

• If you do want to make minor changes later, you can do that with a codicil. This is an amendment to your will that changes the specific paragraphs that need to be adjusted, or, if there are a lot of changes, you would redo your entire will.

• If you opt to leave money to a charity, I encourage you to look at the organization’s website. You can opt to leave your money to a general fund and allow the charity to use the funds as the charity chooses, or you can specify your preferences for the use of your bequest.

• Another consideration is whom you should name as your personal representative, formerly known as an executor. This is an important responsibility since this person will gather your assets and distribute them as you direct. The personal representative will be responsible for making sure that the estate-tax return and income-tax return are completed if required, as well as making sure final personal income-tax returns are done.

• You should think of a second person to serve as a backup if the first named person/party cannot carry out these responsibilities.

• If you have minor children, you will want to think about who their guardian and/or conservator will be. Generally, the spouse or the child’s surviving parent will be listed, but you can also name alternate agents to serve in this capacity.

• You can also prepare a memorandum that will list various personal property items. Your personal representative will follow this list as a guideline. A memorandum can be completed by you individually, but you need to keep it with your will so the personal representative has access to it. This memorandum is a great mechanism to distribute personal items as well as sentimental items to beneficiaries of your choice — and if you change your mind, you can write a new memorandum.

This list is meant to be a starting point, and everyone’s situation is different. The most important step is to prepare a will; otherwise, the Commonwealth will dictate who will receive your assets at your death.

 

Mary Paier Powers is a partner at Powers Law Group in Springfield and West Springfield, where her practices focus primarily on estate settlement, estate planning, and elder law.

Senior Planning

Being in Charge of an Estate Can Be Unsettling

By Janice Ward, Esq., CFP

 

It is a fact: estate administration is complicated and time-consuming. Money can, and often does, complicate relationships. Money can make people do things they wouldn’t ordinarily do. Money can breed distrust — and worse.

These are just some of many reasons why those with estates, especially large estates or those with complex assets, should think carefully about who they choose to be their personal representative (formerly known as an executor or executrix) to administer their estate after they pass. Because settling an estate can be an unsettling experience and can potentially damage and destroy personal family relationships, you might consider an alternative to a family member.

Janice Ward

Janice Ward

“Overall, the person you choose as your personal representative will be responsible for a daunting list of tasks.”

Overall, the person you choose as your personal representative will be responsible for a daunting list of tasks. For a grieving family member, this could represent an unintended burden that requires a wide range of expertise and significant time commitment during this very difficult life transition. And if this isn’t enough, they may have to contend with pressure from — and disputes with — beneficiaries who are usually other family members. The resulting tug of war can lead to lengthy delays, sometimes lasting years, and often resulting in strained relationships and sometimes irreconcilable, heartbreaking splits among surviving family members.

An increasingly popular alternative is to choose a third-party professional, such as the Estate Settlement team within Greenfield Savings Bank Wealth Management and Trust Services. Such professionals can take away the burden and worries of estate settlement and ensure that one’s estate is managed efficiently and according to their wishes, without overburdening one specific family member. Alternatively, a professional personal representative can serve jointly alongside a family member. Such professionals can handle a wide array of responsibilities, including:

• Entering the will into probate and handling other legal requirements;

• Gathering all personal property and arranging for support of the family;

• Clearing out the decedent’s home and preparing for distribution or sale;

• Obtaining appraisals of required property for tax purposes;

• Reviewing real-estate records to assure timely payment of taxes and collection of rents;

• Evaluating contracts and leases, giving necessary notices, and complying with all requirements;

• Investigating all claims against the estate and handling them accordingly;

• Collecting all life insurance, rents, and other amounts due;

• Preparing and filing your final personal income-tax return, as well as any estate/inheritance tax returns that may be required either on a state or federal level;

• Paying related estate and inheritance taxes;

• Preparing a final accounting of the estate for the remainder beneficiaries; and

• Distributing the estate as directed by the will.

This partial list of responsibilities reveals just how complicated and time-consuming the settling of an estate can be. Individuals should keep this in mind when they are choosing a personal representative.

While choosing a family member may seem like a logical step, and some family members may actually volunteer for the assignment, most individuals are not fully qualified to handle such duties, and even if they are, they would often be placed in a difficult situation where relationships can become strained and matters can be delayed. There is often a perception of unfairness if one family member is making all the decisions that affect the personal finances and tax consequences of each beneficiary. For example, is this individual liquidating all the assets — which might cause significant capital gains to family members who pay high tax rates — and are those decisions equally fair and appropriate for all affected parties?

A professional personal representative will not only know the requirements of estate administration from a tax perspective, but will also understand the consequences of every decision they make as they assemble and then distribute each important piece of the puzzle. Choosing such a professional shouldn’t be considered disrespectful to family members. It should be looked upon as a common-sense alternative, one that can alleviate potential problems and eliminate the stress on familial relationships that often arises when money is at stake and an estate needs to be settled.

 

Janice Ward is an attorney, certified financial planner, and first vice president and trust officer at Greenfield Savings Bank.

Senior Planning

LGBTQ+ Elders Face Unique Planning Challenges

 

By Julie A. Dialessi-Lafley, Esq.

 

You have heard it and read it over and over again: everyone, regardless of their level of wealth, should have an estate plan. However, for LGBTQ+ elders, it may be even more critical to have an estate plan in place due to the challenges faced by many in the community.

Despite the fact that same-sex marriages are legally recognized in all 50 states, only 54% of same-sex couples are married. Not only are there still challenges for married same-sex couples, the high percentage of non-married couples also necessitates planning. While the government can create a law recognizing these marriages, there are organizations, businesses, and people who do not acknowledge these couples. The result is challenges for couples who simply want equality, as well as to provide and plan for their loved ones and chosen family.

Julie A. Dialessi-Lafley

Julie A. Dialessi-Lafley

“Making sure planning is in place to provide for the needs of the surviving spouse, partner, and other family and friends is crucial, as the laws in the absence of planning may not provide for those loved ones as you would want.”

Planning for retirement is both a financial goal as well as a lifestyle decision for LGBTQ+ elders. Making sure planning is in place to provide for the needs of the surviving spouse, partner, and other family and friends is crucial, as the laws in the absence of planning may not provide for those loved ones as you would want.

Additionally, social isolation can really creep up and become a serious problem to overcome. The question of where to retire has become overwhelming, as relocation brings with it a need to find an area that provides for the social inclusion for these elders as well as financial stability, reasonable cost of living, and lifestyle needs.

Within the U.S., about 80% of long-term care for older people is provided by family members, such as spouses, children, and other relatives. LGBTQ+ elders are only half as likely as their heterosexual counterparts to have close family to lean on or children to help. Simply put, folks who are part of the LGBTQ+ community are less likely to be married, they may have children where only one partner is the biological parent, and there is a high incidence of alienation from non-accepting family members.

Planning how long-term-care medical needs will be paid and who will act as the healthcare proxy/advocate for the LGBTQ+ elder is crucial, as many LGBTQ+ elders need to make sure they have an appropriate person to assist in making decisions about their care, as well as being concerned about harassment and hostility in facilities that serve the aging population. These folks often do not access aging services out of fear of hostile and harassing treatment. Few facilities are prepared to address insensitivity or discrimination aimed at LGBTQ+ elders by staff or other older people. Proper planning and memorializing those wishes in an estate plan can allow the elder person to age with the dignity and respect they deserve.

For non-married partners, planning is extremely important because, under the law, a partner is not going to have the standard rights to healthcare information and the ability to make healthcare decisions on behalf of their partner. A partner will not be able to access bank accounts if they are not in joint names and they are not able to make any and all decisions on behalf of their partner. Unmarried partners are not entitled to any inheritance in the absence of a will, trust, or proper planning.

Regardless of marital status, end-of-life decisions, the question of cremation versus burial, and any memorial arrangements should be documented to make sure your wishes are carried out as, again, both non-married and married partners may face significant challenges in carrying out your wishes in the absence of documentation.

In LGBTQ+ couples with children, only one parent might be the biological parent, or neither might be. They might have used an egg or sperm donor to conceive, or a surrogate to carry the child. There are varying rules across states about parental rights, but from a legal perspective, the biological parent is the one with the legal rights, barring any other court documentation. Even a birth certificate with both parents’ names on it may not be enough.

A last will and testament lays out who your assets should go to after you die. It also allows you to name a guardian for your minor children. It can help your family avoid disputes that might arise if there is not a plan in place or if it is not clearly stated. Additionally, trusts can be used to plan where assets go after you die and also avoid probate of your estate. This can be a cost-effective way to reduce conflict in the future and avoid claims against the elder’s estate from family who have been intentionally omitted from the planning.

As a result of what the community describes as continued discrimination and lack of inclusion, elders need to ensure that they have in place, at minimum, the appropriate documents, such as durable power of attorney, healthcare proxy; will, trusts (if warranted), and end-of-life directives in order to ensure their wishes can be carried out and their needs will be met in the event of an illness or death.

Estate planning can help to navigate through an increasingly complex legal system, and proper planning can protect your loved ones when they will need it most.

 

Julie Dialessi-Lafley is a shareholder with Bacon Wilson whose practice areas include estate planning and elder law, domestic relations and family law, and business and corporate law; (413) 781-0560; [email protected]

Senior Planning

Don’t Lose Yourself in Caring for Others

By Mary-Anne Schelb

 

Seasons.

And I don’t mean winter, spring, summer, or fall. I am referring to the seasons of life. Seasons of friendship, seasons of career, seasons of family. You get it.

We all know the saying: friends come into and out of our lives for a reason, a season, or a lifetime. Really, the same thing happens in all we do. Getting married, you become someone’s wife or husband or partner. You have children, and you are mom or dad. You get a career, and you are someone’s employee or boss. Even C-suite employees report to someone. If you are a business owner, you may have a board of directors you are in step with — or you are answering to your customers or clients. Some of these will be for a reason, for a season, or maybe a lifetime.

Mary-Anne Schelb

Mary-Anne Schelb

“If you give too much of yourself away, there will be nothing left for you, and that is why, when you step into your final season — retirement — it’s easy to feel sad or lost.”

When you are all of these things to everyone, all the time — wife, mom, employee, business owner — are you losing the core of who you are? Are you getting lost in the hustle and bustle? We all know that, as the years pass, the hustle and bustle gets more hustley and bustley.

Don’t get lost. Don’t lose your identity of who you are at your core. Remember what you need — to feel whole, to feel alive. If you give too much of yourself away, there will be nothing left for you, and that is why, when you step into your final season — retirement — it’s easy to feel sad or lost.

As the years go by, you see many college graduations with children becoming adults and going out on their own. Empty-nest syndrome is a real thing, and it is OK to feel sad, but (you knew there would be a but) do not lose yourself in this sadness. Try to replace the sadness with excitement that your kids are going forth into the world with all you have taught them, all you have shown them. Our job is to guide them and encourage them to become successful and contributing members of society. Let them live. Let them experience. And I dare you to do the same.

What were things in your world you used to love to do that got pushed to the side or put on a back burner while you cared for your children, or while you worked countless hours at a job you may or may not have even liked. Hobbies you used to love? Friends you used to see? Live your life. Become the person you have always wanted to become — or reignite the passion for yourself you used to have. I always share with clients: it is never too late.

Whether you are still mom and dad — or now maybe caring for your own mom and dad — or you are finding you are identifying too much with a job, take a deep breath, close your eyes, and picture the perfect you. Connect with your higher self (that perfect version of yourself) and move toward that. One small step at a time still moves you forward.

Don’t get lost in someone else’s dream; make sure you are living your own. And if you are? Kudos to you! We are very few and far between. So I ask this of you: reach out to a friend who may be in need. Give them a hug, spend some time, lend an ear. Talk to them about the wonderful person you know they are, and remind them not to get lost.

We are all in this together.

 

Mary-Anne Schelb is director of Business Development at JGS Lifecare.

Senior Planning

Six Indications It Might Be Time for Memory Care

By Arbors Assisted Living

 

Memory care is a special kind of long-term care designed to meet the specific needs of people with Alzheimer’s and other forms of dementia or types of memory problems. Often housed within an assisted-living community, a memory-care program offers a more structured environment that comes with set schedules and routines to create a stress-free lifestyle, safety features to ensure the health of the residents, and programs designed to cultivate cognitive skills.

Five Symptoms of Dementia to Look Out For

1. Memory loss that disrupts daily life.

One of the most common signs of dementia involves trouble with short-term memory. From forgetting recently learned information to asking for the same information over and over, your aging loved one may be able to remember events that took place years ago, but not what they had for breakfast.

2. Difficulty handling complex tasks.

You might notice a subtle shift in your loved one’s ability to complete normal tasks, such as driving to a familiar location, managing a budget at work, or remembering the rules of a favorite game — or when they start having difficulty handling more complex tasks, such as balancing a checkbook.

3. New problems with words in speaking or writing.

Maybe your mom has always been a stellar conversationalist, and you notice that now she may have trouble following or joining a conversation. Or perhaps your dad struggles to find the right word or calls things by the wrong name.

4. Apathy and withdrawal or depression.

Changes in mood can be an indication that your loved one has dementia. Perhaps they avoid being social because of the changes in their brain. They may also have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby, so they may start to withdraw from things they previously enjoyed.

5. Increasing confusion and disorientation.

Someone in the early stages of dementia may often lose track of dates, seasons, and the passage of time. Confusion may arise as they can no longer remember faces, find the right words, or interact with people normally.

When to see a doctor:

If your aging loved one exhibits several of these signs, consult a doctor. A general practitioner will typically refer you to a neurologist who can examine your loved one’s physical and mental health to determine whether the symptoms result from dementia or another cognitive problem.

One of the goals of a memory-care community is to keep seniors with dementia engaged and active in a safe, home-like environment and to promote the highest quality of life by adapting the staff, environment, and daily routine to the needs of each individual.

Because of this, there is no downside to placing a loved one in a memory-care community too soon. However, there are many drawbacks to waiting too long.

So, how do you know when it’s the right time to consider moving your loved one to a specialized memory care community? The following questions may be helpful when determining if a move to memory care is a good option.

 

1. Is My Loved One Becoming Unsafe in Their Current Home?

As dementia progresses, your loved one will have a harder time functioning independently. Maybe you used to be able to help your mom by writing out a daily to-do list and a schedule of when she should take her medications. But now, she needs reminders to shower and help choosing appropriate clothes for the season.

Bathing, toileting, dressing, and other activities of daily living all come with risks. Safety should always be considered, and if there are any tasks that your loved one cannot perform safely on their own, assistance should be provided.

How often each day you worry about her, check on her, or make a call regarding her safety or whereabouts? If your loved one has fallen, had a driving accident, or suffered an unexplained injury, these are safety signs it’s time to consider moving your loved one to a memory-care community.

 

2. Is the Health of My Loved One or My Health as a Caregiver at Risk?

Dementia will affect your loved one’s ability to remember to take prescribed medications at the right time or the right dosage, which can lead to serious health problems. For example, chronic health conditions such as COPD and heart disease may worsen rapidly if dementia interferes with your loved one’s ability to manage their treatment. You might also notice that your loved one starts to look different. Maybe your dad is losing weight because he forgets to eat or gaining weight because he forgets he’s eaten and eats again.

When you look in a mirror, you might notice that you are starting to look different, too. Caring for someone with dementia is mentally draining and physically exhausting. If the stress of caregiving is left unchecked, it can have an impact on your health, relationships, and state of mind, eventually leading to burnout.

Is dementia preventing your loved one from taking care of their health? Are you and your other family members exhausted? It’s important to be honest with yourself about your emotional and physical limits while caregiving. Sometimes placement in a memory-care community is best for both the caregiver and the loved one’s overall health and well-being.

 

3. Are My Loved One’s Care Needs Beyond My Physical Capabilities?

In the later stages of dementia, your loved one may require assistance getting in and out of bed and moving from the bed to a chair. Additionally, dementia physically damages the brain, which can affect your loved one’s personality and behavior.

Wandering, agitation, repetitive speech or actions, paranoia, and sleeplessness may pose many challenges for families and caregivers. However, it’s important to remember that these behaviors are often coping tactics for a person with deteriorating brain function.

Is your petite, 70-year-old mom trying to get your 180-pound dad to the bathroom two or three times each night? Is your dad’s aggression triggered by something — physical discomfort, being in an unfamiliar situation, poor communication — on a regular basis? If continuing to care for your loved one at home puts both of you in danger, that’s a telltale sign that it’s time for memory care.

 

4. Am I Becoming a Stressed, Irritable, and Impatient Caregiver?

Stress arousal is the first sign that you’re not getting the physical and emotional support you need as a caregiver. Maybe you’re frustrated or disappointed over your loved one’s deteriorating condition or lack of progress. It can be hard to accept that the quality of your care and effort have nothing to do with the actual health-related decline or mood of the care recipient. This frustration can lead to caregiver stress.

If you are so overwhelmed by taking care of someone else that you have neglected your own physical, mental, and emotional well-being, it will not be long before you are experiencing caregiver burnout. When you are burned out, it is tough to do anything, let alone look after someone else.

 

5. Am I Neglecting Work Responsibilities, My Family, and Myself?

You might be struggling to maintain a sense of purpose in working so hard to provide care, which leads to neglecting responsibilities, withdrawing socially from friends and family, and having much less energy than you once had.

Family caregivers often have to take time off, either paid or unpaid, while some have to reduce their work hours. Others leave the workforce entirely in order to provide full-time care for a loved one. Additionally, caregivers don’t have as much time to take care of themselves, and they can often feel cut off from the outside world. Social isolation leads to higher levels of both caregiver stress and depression.

“There is no downside to placing a loved one in a memory-care community too soon. However, there are many drawbacks to waiting too long.”

Are you feeling irritable or hopeless, struggling with emotional and physical exhaustion, or getting sick more often? Do you have heightened anxiety or trouble making care decisions? If your loved one’s need for care is wearing you out, it may be time to start considering your memory-care options.

 

6. Would the Structure and Social Interaction at a Memory-care Community Benefit My Loved One?

Somewhere in the middle and late stages of dementia, your loved one will no longer be able to drive, and communication with others will become increasingly difficult. Your loved one may lose track of their thoughts, be unable to follow conversations, and/or have trouble understanding what others are trying to communicate.

Maybe it’s become too challenging to take your mom out to eat, shop, or exercise because her behavior is unpredictable. Or perhaps your dad can no longer drive, so he rarely goes out and is restless and lonely.

Is dementia shrinking your loved one’s world? Memory-care programs are equipped to provide activities and stimulation — including trips and outings — that can keep your loved one engaged and active in a safe, homelike environment.

If you answered yes to any of these questions or if you have reached a point where you feel like you cannot fully meet the needs of a loved one struggling with memory impairment, it is time to start visiting memory-care communities, which offer specialized environments where your loved one can not only live, but even thrive. Plus, knowing that your loved one has trained, 24-hour care can help relieve the caregiving burden and give your family peace of mind.

Senior Planning

Caregivers Must Understand the Importance of Self-care

By A Place for Mom

Being a caregiver for a parent or senior loved one can be a full-time job, leaving little opportunity for anything else, including your own self-care. However, self-care is essential, benefitings not only you, but the loved one you are caring for as well.

Many people who find themselves in the role of caregiver experience feelings of guilt for wanting (and needing) time for themselves; however, the necessity for self-care is sometimes compared with that of applying your own oxygen mask on an airplane before assisting anyone else. Only when we first help ourselves can we effectively help others.

Self-care is an essential and necessary part of the process of providing care that benefits not only you but the person you are caring for as well. After all, you cannot pour from an empty cup.

While providing care can be very rewarding and satisfying, it can also be exhausting, with many caregivers reporting personal health issues including depression; excessive use of alcohol, tobacco, and other drugs; failure to exercise; failure to stay in bed when ill; poor eating habits; postponement of (or failure to make) medical appointments; and sleep deprivation.

“Self-care is an essential and necessary part of the process of providing care that benefits not only you but the person you are caring for as well. After all, you cannot pour from an empty cup.”

To combat these possible issues and live your best life possible while providing care for a loved one, consider adopting the following restorative practices for a healthy body, mind, and soul:

 

Eat a Healthy Diet

A healthy diet is important, not just for your physical health, but your emotional health as well. In the short term, enjoying a diet of nutritious and well-balanced meals can help to increase energy and reduce sluggishness, while in the long-term, eating well can reduce the risk of cancer and heart disease.

 

Get Enough Sleep

Sleep deprivation can wreak havoc on your mental health and cause a ripple effect of negative emotions and thoughts. Your body needs seven to eight hours of restorative sleep each night for optimal health. Try implementing a predictable and regular bedtime routine to coax your body into a relaxing slumber, including limiting mobile devices or tablets two hours before bed; sleeping in a cool, dark room; and wearing comfortable pajamas.

 

Get Regular Exercise

Exercise promotes better sleep, reduces depression and tension, and increases alertness and energy. Although finding the motivation and time to exercise, especially in the beginning, may be a struggle, small steps will add up. Try walking for 20 minutes a day, three days a week to experience the full benefits of exercise.

 

Make Time for Hobbies

Taking a break from caregiving to reinvest in activities and hobbies you enjoy will help to reinvigorate you and remind you of who you are, outside of being a caregiver. Accepting help from family, friends, and professionals to reinvest in yourself may be difficult, but the reward of getting reacquainted with yourself and rediscovering what brings you happiness and peace will allow you to be the best caregiver you can be.

Senior Planning

How Hospice Care Supports the End-of life Journey

 

By Maria Rivera

 

Hospice care focuses on the quality of one’s life as they embark on the end-of-life journey. It is not about dying. Instead, hospice affirms life, neither hastening nor postponing death.

The goal of hospice care is to provide patients with comfort and symptom management to help them find peace and meaning in the final months or weeks of their lives. At Hospice of the Fisher Home, we focus on quality of life, and this guides everything we do to support patients and their families.

Managing terminal illness can feel overwhelming. A hospice care team provides support to patients and their families through a delicate and challenging time using a comprehensive care model.

Maria Rivera

Maria Rivera

“Hospice helps people to live the best life they possibly can up until their very last day.”

The hospice team forms a safety net for the patient and the family. The medical director, nurses, and CNAs are experts in comfort care. They manage pain and symptoms so that patients can live as fully and comfortably as possible.

Spiritual and bereavement counselors meet with patients and their loved ones to guide them through the emotional and social challenges that often arise at the end of life. Social workers assist with social and emotional issues. Volunteers offer support in various ways, including massage, harp, and other live music, as well as therapy dogs, Reiki, acupuncture, meditation, reading books, and sitting vigil. Each member of the team has specialized hospice training and a deep dedication to helping patients and their families experience peace, comfort, and happiness.

Hospice helps people to live the best life they possibly can up until their very last day. For some people, that may mean feeling good enough to float in the pool at the local YMCA, spend a few hours fishing with a friend, or have their favorite dish for dinner and a big helping of dessert.

Educating people about the benefits of early hospice admission is important. Because hospice care focuses on the well-being of the whole patient — physical, mental, emotional, and spiritual — earlier admission to hospice means the patient can experience more quality time with loved ones. There is also a greater opportunity to contemplate what matters most in life when the patient is comfortable and experiences less stress and anxiety during their final months.

When caregivers and providers are aware of the benefits of hospice, they can facilitate early admission. It’s important to plan for these difficult decisions, put preferences in writing, and have conversations about the care you want for the end of life.

 

Maria Rivera, BSN, RN, is executive director of Hospice of the Fisher Home in Amherst, the only independent, nonprofit hospice in Western Mass., providing end-of-life care at a nine-bed residence in Amherst and visiting private residences, assisted-living facilities, and retirement communities throughout Hampshire, Franklin, and Hampden counties. It also provides hospice care to veterans at the Veterans’ Home in Holyoke.

Senior Planning

These regional and statewide nonprofits can help families make decisions and access resources related to elder-care planning.

 

AARP Massachusetts

1 Beacon St., #2301, Boston, MA 02108

(866) 448-3621; www.states.aarp.org/region/massachusetts

Administrator: Mike Festa

Services: AARP is a nonprofit, nonpartisan, social-welfare organization with a membership of nearly 38 million that advocates for the issues that matter to families, such as healthcare, employment and income security, and protection from financial abuse

 

The Conversation Project and the Institute for Healthcare Improvement

53 State St., 19th Floor, Boston, MA 02109

(617) 301-4800;
www.theconversationproject.org

Administrator: Kate DeBartolo

Services: The Conversation Project is dedicated to helping people talk about their wishes for end-of-life care; its team includes five seasoned law, journalism, and media professionals who are working pro bono alongside professional staff from the Instititute for Healthcare Improvement

 

Elder Services of Berkshire County Inc.

877 South St., Suite 4E, Pittsfield, MA 01201

(413) 499-0524; www.esbci.org

Administrator: Christopher McLaughlin

Services: Identifies and addresses priority needs of Berkshire County seniors; services include information and referral, care management, respite care, homemaker and home health assistance, healthy-aging programs, and MassHealth nursing home pre-screening; agency also offers housing options, adult family care, group adult foster care, long-term-care ombudsman, and money management, and oversees the Senior Community Service Aide Employment Program

 

Estate Planning Council of Hampden County

www.estateplan-hc.org

Administrator: Susan McCoy

Services: Provides a forum for current, accurate, and authoritative information with regard to estate and financial planning; council members are life-insurance professionals, bankers, fiduciaries, lawyers, accountants, planned-giving professionals, and other financial-service providers engaged in the planning, settlement, and management of estates

 

Greater Springfield Senior Services Inc.

66 Industry Ave., Suite 9, Springfield, MA 01104

(413) 781-8800; www.gsssi.org

Administrator: Jill Keough

Services: Private, nonprofit organization dedicated to maintaining quality of life for older adults, caregivers, and people with disabilities, through programs and services that foster independence, dignity, safety, and peace of mind; services include case management, home care, home-delivered meals, senior community dining, money management, congregate housing, and adult day care

 

Highland Valley Elder Services

320 Riverside Dr., Florence, MA 01062

(413) 586-2000; www.highlandvalley.org

Administrator: Allan Ouimet

Services: Services include care management, information/referral services, family caregiver program, personal emergency-response service, protective services, home-health services, chore services, nursing-home ombudsman services, adult day programs, elder-care advice, bill-payer services, options counseling, respite services, representative payee services, local dining centers, personal-care and homemaker services, and home-delivered meals

 

LifePath

101 Munson St., Suite 201,
Greenfield, MA 01301

(413) 773-5555; www.lifepathma.org

Administrator: Barbara Bodzin

Services: LifePath, formerly Franklin County Home Care Corp., an area agency on aging, is a private, nonprofit corporation that develops, provides, and coordinates a range of services to support the independent living of elders and people with disabilities with a goal of independence; it also supports caregivers, including grandparents raising grandchildren

 

Massachusetts Executive Office of Elder Affairs

1 Ashburton Place, Unit 517, Boston, MA 02108

(617) 727-7750; www.mass.gov/elders

Administrator: Elizabeth Chen

Services: Connects seniors and families with a range of services, including senior centers, councils on aging, nutrition programs such as Meals on Wheels, exercise, health coaching, and more; supports older adults who may be somewhat frail through programs in nursing homes, such as the ombudsman program, volunteers who visit residents, and quality-improvement initiatives in nursing homes and assisted-living facilities; caregiver programs offer support to people with mild Alzheimer’s disease or those caring for someone with more advanced Alzheimer’s

 

Massachusetts Senior Legal Helpline

99 Chauncy St., Unit 400, Boston, MA 02111

(800) 342-5297; www.vlpnet.org

Administrator: Joanna Allison

Services: The Helpline is a project of the Volunteer Lawyers Project of Boston that provides free legal information and referral services to Massachusetts residents age 60 and older; the Helpline is open Monday through Friday, 9 a.m. to noon

 

MassOptions

(844) 422-6277; www.massoptions.org

Administrator: Marylou Sudders

Services: A service of the Massachusetts Executive Office of Health and Human Services, MassOptions connects elders, individuals with disabilities, and their caregivers with agencies and organizations that can best meet their needs; staff can also assist with determining eligibility for and applying to MassHealth

 

VA Central and Western Massachusetts Healthcare System

421 North Main St., Leeds, MA 01053

(413) 584-4040;
www.centralwesternmass.va.gov

Administrator: Suzanne Krafft

Services: Provides primary, specialty, and mental-health care, including psychiatric, substance-abuse, and PTSD services, to a veteran population in Central and Western Massachusetts of more than 120,000 men and women

 

WestMass ElderCare Inc.

4 Valley Mill Road, Holyoke, MA 01040

(413) 538-9020; www.wmeldercare.org

Administrator: Roseann Martoccia

Services: Provides an array of in-home and community services to support independent living; interdisciplinary team approach to person-centered care; information, referrals, and options counseling as well as volunteer opportunities available; primary service area includes Holyoke, Chicopee, Granby, South Hadley, Belchertown, Ludlow, and Ware, as well as other surrounding communities

 

Daily News Elder Care HCN News & Notes Health Care Healthcare Heroes News Retirement Planning Senior Planning Summer Safety

SPRINGFIELD — In the spring of 2017, Healthcare News and its sister publication, BusinessWest, created a new and exciting recognition program called Healthcare Heroes.

It was launched with the theory that there are heroes working all across this region’s wide, deep, and all-important healthcare sector, and that there was no shortage of fascinating stories to tell and individuals and groups to honor. That theory has certainly been validated.

But there are hundreds, perhaps thousands of heroes whose stories we still need to tell, especially in these times, when the COVID-19 pandemic has brought many types of heroes to the forefront. And that’s where you come in.

Nominations for the class of 2022 are due July 29, and we encourage you to get involved and help recognize someone you consider to be a hero in the community we call Western Mass. in one (or more) of these seven categories:

• Patient/Resident/Client Care Provider;

•  Health/Wellness Administrator/Administration;

• Emerging Leader;

• Community Health;

• Innovation in Health/Wellness;

•  Collaboration in Health/Wellness; and

• Lifetime Achievement.

Nominations can be submitted at

https://businesswest.com/healthcare-heroes/nominations/

For more information call Melissa Hallock, Marketing and Events Director, at (413) 781-8600, ext. 100, or email to [email protected]

Senior Planning

Follow These Five Steps When It’s Time to Talk About Care

Whether your loved one needs full-time care or you’re just beginning to anticipate a need, here’s a series of steps you’ll need to take, with some thoughts on each from leading voices in the field. Just take it one step at a time.

1. Start the Conversation

“Talking with your parents about their future will not be a one‐time conversation, but an ongoing process,” says Catherine Hodder, author of Estate Planning for the Sandwich Generation: How to Help Your Parents and Protect Your Kids. “You must be patient and willing to wait until your parents feel comfortable. They will need to be ready to talk with you or to make certain decisions about their future. The hardest part will be for them to admit they need help and that you will be taking on more responsibility for them. Understand they still see you as their child who they should be helping, not the other way around. Try to feel out the right times to talk about healthcare concerns and when to talk about finances. Depending on your parents’ personalities, one may be an easier conversation than the other.”

2. Consider How Much You Can Take On

“For many, our responsibilities extend beyond the needs of our aging parents and carry over to our own families,” says Amy Osmond Cook, author of Things to Discuss with Aging Parents Before Becoming Their Caregiver. “Those obligations don’t end when a parent needs extra care. By discussing a schedule with your loved one, you can establish a balance between his needs and the needs of your family. For example, you may have a nurse stay in the home on certain days with an understanding you will take your aging parent to all of the doctor’s appointments. A routine can provide comfort to your loved one because he will know when to expect you or other helpers when care is needed.”

3. Build a Team and Make a Plan

“Family meetings are a way for siblings, parents, and other concerned relatives or friends to try to clarify the situation, work out conflicts, and set up a care plan that, ideally, all can agree upon,” says  Bonnie Lawrence, author of A Sibling’s Guide to Caring for Aging Parents. “If the meeting is likely to be contentious, or if you want an experienced, objective voice to guide it, involve a facilitator such as a social worker, counselor, geriatric care manager, or trusted outside party who will ensure that all participants have a chance to be heard. You may need more than one meeting.”

4. Discuss How You Will Pay for Care

“What is the truth about your parent’s situation — finances, health, and what they want for care?” asks Catherine Flax, author of Aging Parents and Money: Difficult Conversations That Need to Be Had. “The reality is that, when it comes to finances, most people (parents and their children) are largely in the dark. What are the rules around Social Security? How much do they currently spend on healthcare, and how do Medicare and insurance supplements work? What is the optimal, tax-efficient draw-down schedule for their retirement assets — and how far will these assets take them? Do they have other assets that they could manage to their advantage (like a home that could be downsized) to give them a higher quality of life, and would they want that?”

5. Make the Transition — and Follow Up

“Once your mother selects a place and settles in, visit frequently — by whatever means possible,” says Kerry Patterson, author of Preparing for a Crucial Conversation with an Aging Parent. “Check to see what is working and what isn’t. Where possible, make further changes to match her needs to the facility. Finally, live up to the promise you made to yourself. You meant it when you decided that you wanted what’s best for your mom/dad or loved one. Whether this turns out to be true depends a great deal on how often you make contact with him/her once she’s/he’s found a new place to live.”

Senior Planning

Start the Conversation

From the AARP FOUNDATION

The reality is that some conversations are just plain difficult — even with the people to whom you feel the closest. When preparing to discuss a difficult topic like senior care needs, it helps to follow the ground rules below to ensure that everyone’s feelings are respected and viewpoints are heard. To help make the conversation as productive and positive as possible:

1. Try not to approach the conversation with preconceived ideas about what your loved ones might say or how they might react. “Dad, I just wanted to have a talk about what you want. Let’s just start with what is important to you.”

2. Approach the conversation with an attitude of listening, not telling. “Dad, have you thought about what you want to do if you needed more help?” — as opposed to “we really need to talk about a plan if you get sick.”

3. Make references to yourself and your own thoughts about what you want for the future. Let them know they are not alone, that everyone will have to make these decisions. “Look, I know this isn’t fun to think about or talk about, but I really want to know what’s important to you. I’m going to do the same thing for myself.”

4. Be very straightforward with the facts. Do not hide negative information, but also be sure to acknowledge and build on family strengths. “As time goes on, it might be difficult to stay in this house because of all the stairs, but you have other options. Let’s talk about what those might be.”

5. Phrase your concerns as questions, letting your loved ones draw conclusions and make the choices. “Mom, do you think you might want a hand with some of the housekeeping or shopping?”

6. Give your loved ones room to get angry or upset, but address these feelings calmly. “I understand all this is really hard to talk about. It is upsetting for me, too. But it’s important for all of us to discuss.”

7. Leave the conversation open. It’s okay to continue the conversation at another time. “Dad, it’s OK if we talk about this more later. I just wanted you to start thinking about how you would handle some of these things.”

8. Make sure everyone is heard — especially those family members who might be afraid to tell you what they think. “Susan, I know this is really hard for you. What do you think about what we are suggesting?”

9. End the conversation on a positive note. “This is a hard conversation for both of us, but I really appreciate you having it.”

10. Plan something relaxing or fun after the conversation to remind everyone why you enjoy being a family. Go out to dinner, attend services together, or watch a favorite TV program.

These are just a few suggestions of things you, your loved ones, and other family members can do to unwind after a difficult conversation.

Senior Planning

Having the Talk

From VISITING ANGELS

Here are sample conversation starters and strategies to introduce home-care services to your loved one. Each scenario is a catalyst to take action and start talking. Prior to talking, prepare and arrange with a reliable friend or your spouse to take part in the plan.

SCENARIO: Your loved one mentions plans to drive to the grocery store. He’s shown signs of unsafe driving (getting lost or confused or unexplained dents on the car). Coordinate with a trusted neighbor, friend, or spouse to serve as a driver for one trip. 

SAY: “I see you’re planning to go to the grocery store.  I think it would be a great idea to ride with [the neighbor/friend/spouse] next time or even hire a professional who can take you where you need to go. You could tell her exactly where you want to go, and she’ll get you there. You’d be in control.”

SCENARIO: You noticed your mom or dad isn’t eating.  

SAY: “I don’t have the time to stay and cook tonight, but [neighbor/friend/spouse] loves to cook, and said she would love to cook with you tomorrow night, and she won’t have to leave early. Then you won’t have to worry about making dinner, and the family will feel good knowing someone’s with you to help you out in the kitchen. You can tell them what you’d like to eat, and you’ll be in total control. Let’s at least try it and talk about it afterward to see if it’s an arrangement you’d like.”

SCENARIO: Your loved one forgets to take her medicine repeatedly. (Alert the doctor first.)

SAY: “I’m worried that you forgot to take your medicine again. I spoke with your doctor, and he’s especially concerned about missing doses. He suggested we find a way prevent it from happening. I thought a professional caregiver would be really helpful. Let’s at least give it a try and see how you like it. Then we can talk about it and see if it’s something you want going forward.”

SCENARIO: Your elderly loved one is struggling to get dressed, whether it’s a fall or a misbuttoned shirt. You’ve realized they need help in the bedroom to get dressed.

SAY: “I’ve noticed you’re wearing the same clothes again. What if we got you a helper for the mornings — someone who can stop by and help get you ready for the day? She could even do a load of laundry or two; that’s completely on your terms. Think of how nice it’ll be knowing there’s one less thing you have to do. Mind if we give this a try?”

SCENARIO: You notice a high pile of dishes in the kitchen sink. 

SAY: “I know you care about keeping your place clean and tidy. But your dishes have piled up again, and the kitchen’s getting dirty. I’ll help you get those done, but what if we explored getting someone in here to keep the dishes done and the place clean? We’d love to take that off your plate, and then everyone can feel good knowing your house is clean and the way you like it. Let’s at least give it a try and go from there.”

Senior Planning

Understand the Difference, and Seek Help If It’s Needed

By Beth Cardillo

As Baby Boomers are getting older and representing the largest age group, the questions concerning dementia, as opposed to normal aging, continue to crop up in medical offices.

In the Greater Springfield area, 16.9% of residents over age 65 are living with a diagnosis of Alzheimer’s disease or other related dementia. The national average is 13.6%.

Someone develops Alzheimer’s disease every 68 seconds, with 5 million Americans affected, and the number expected to increase to 20 million by 2050.

Given these numbers, it’s understandable when loved ones become concerned when they notice a family member having memory issues. It’s also understandable when people start to wonder themselves if they a problem. So how does one know if it’s dementia or simply normal aging?

“Someone develops Alzheimer’s disease every 68 seconds, with 5 million Americans affected, and the number expected to increase to 20 million by 2050.”

Let’s discuss normal aging first, so you can have a sigh of relief. We all have occasional word-finding difficulties, but you can come up with the word given a bit of time. Not remembering someone’s name if you don’t see them often, or see them out of context, is normal. That is something we all do. Misplacing an item, but having the ability to retrace your steps and locate the item, is also normal. How many times do we all walk into a room and not remember why, then walk out and immediately remember, ‘oh yeah, I was getting the book I left on the couch’?

Rest assured, these are all normal signs of aging. Have any of you purchased ‘the tile’ so you can keep track of your keys, work keys, iPad, and whatever else you need? It can even help you find where you parked your car, which is extremely helpful in New York City, where there’s alternate parking every day.

What isn’t normal is having new problems finding words when speaking or writing (more than being on the tip of your tongue) and you just can’t bring them up. Or forgetting things more often, such as appointments, events, and your way around familiar places. Perhaps you can’t remember or keep up with conversations, books, movies, or newspapers. Are you stopping in the middle of the conversation because you can’t remember what was just said, or the thread of the conversation?

Also, are decisions harder to make? Is your judgment a bit skewed? Are friends and families asking if you are OK? Are you showing up to people’s homes or appointments on the wrong date? Is your mood and behavior a bit unstable or unpredictable? Are you withdrawing from social activities because you don’t want people to notice that you are having difficulty, but instead they notice you aren’t showing up?

These are symptoms of mild cognitive impairment, a precursor to a full dementia diagnosis.

There are more than 100 types of dementia. People are very reluctant to use the ‘A’ word. They quickly point out it’s not Alzheimer’s or they have just “a little bit of dementia.” The reality is that Alzheimer’s disease accounts for approximately 75% of all dementias. It could be vascular dementia, frontotemporal lobe dementia, Parkinson’s disease, or the 97 other types, and often they are concurrent. If you feel like this could be you, contact a neurologist, or a neuropsychologist, or the Alzheimer’s Assoc. at (413) 787-1113.

Today, there is no cure, but there are medications that can slow down the progression of the disease. Diet, exercise, genetics, and co-morbidities all play a part in the diagnosis, and it is said that those physiological changes could be forming in the brain 10 to 20 years before the actual symptoms start to show. There is no shame in asking for help if you feel you may have increased symptoms or you suspect them in a loved one.

On a side note, worth mentioning is that COVID-19 has wreaked havoc with the senior population, and the virus could be a new type of dementia. It has many side effects consistent with dementia if the virus has traveled to the brain. People are experiencing physiological and neurological changes within the brain, causing confusion, seizures, emotional dysregulation, and strokes that are having long-term effects.

Beth Cardillo, M.Ed., LSW, CDP is a licensed social worker, certified dementia practitioner, and executive director of Armbrook Village, and has worked in the dementia field for more than 20 years. Previous to working with dementia, she opened the nation’s first state-funded traumatic brain injury program in Westfield. She was named Western New England Social Worker of the Year in 2016, and was the 2019 Friends of the Alzheimer’s Assoc. Honoree of the Year; [email protected]; www.armbrookvillage.com

Senior Planning

How Will You Know If Your Older Parents Need Help?

By Brenda Labbe

Many experience aging as a joyful time in their life, filled with retirement, travel, and spending more time with family. But for some, aging represents a series of losses — loss of employment, health and energy, friends, mobility, and independence.

As such, it is not uncommon for older adults to resist reaching out for help. To help start the conversation, we have listed some common signs that might indicate your loved one may need some extra support.

“Stacks of unopened mail, late-payment notices, unfilled prescriptions, and the lack of general upkeep of the house can all be signs that your loved one may need someone to assist with bill paying or homemaking.”

1. Neglecting household responsibilities. Stacks of unopened mail, late-payment notices, unfilled prescriptions, and the lack of general upkeep of the house can all be signs that your loved one may need someone to assist with bill paying or homemaking. Lack of interest in eating or preparing nutritious food and/or lack of food in the home can be a sign that they may need help with grocery shopping or meal prep.

2. Frequent falls. If your loved one experiences frequent falls or you have observed new bruises on their face or body, chances are they should be evaluated by their physician for illness, dehydration, or infections, or X-rayed for fractures. Other items that can increase the risk for falls include the lack of proper medication management and the lack of proper safety equipment in the home. You may want to consider having a safety evaluation of the home to look for any other factors that may be contributing to their falls.

3. Unsafe driving. As our bodies slow down in the aging process, so too will our reflexes, which can make driving even more difficult. Observe your loved one’s car for new scrapes, scratches, dings, or missing mirrors. Avoiding driving or not being able to tolerate any changes in directions may indicate some cognitive changes which signal that now might be the time to consider transportation assistance.

4. Listen for clues in conversation. Many seniors will state they do not want to burden their busy adult children with requests for help. They describe feeling foolish for not being able to keep up with cleaning, medications, or repairs. However, if you listen closely, you may hear repeated areas of concern. Your loved one’s close friends or neighbors may also have input to offer, if asked in confidence.

Finally, consider the old adage “it is all in how you wrap the gift.” In this case, the gift is the offer of help and support. Try asking the question in a manner that is non-threatening and neutral. For example: “gosh, I would be so overwhelmed if I got all this mail — how about I help you go through it?”

Unfortunately, many people will experience a traumatic event before realizing that they need assistance. One way to help better prepare for any emergencies is to monitor your loved one’s physical and mental abilities and start researching care options before you need them. Greater Springfield Senior Services is your local resource to find help, support, and care for your loved one.

Call our office Monday through Friday, 8 a.m. to 5 p.m., and ask to speak with one of our highly trained information and referral specialists to find out more. Knowledge is power, and we are here to help.

Brenda Labbe is the caregiver specialist at Greater Springfield Senior Services and specializes in assisting caregivers in accessing respite and support services for their loved ones.

Senior Planning

It’s Important to Understand Your Alternatives

By Eric Aasheim

Moving from home to a senior-living community is one of the most consequential decisions elder loved ones may be faced with in their lifetimes.

The move is usually permanent; is unfortunately often made in crisis mode or under duress, and involves a host of emotional and psychological implications around declining physical capabilities, perceived loss of independence, and financial worry.

“Moving from home to a senior-living community is one of the most consequential decisions elder loved ones may be faced with in their lifetimes.”

Knowing the answers to these commonly asked questions will help seniors and their adult children plan ahead and ultimately put themselves in a position to make thoughtful and informed decisions about the most appropriate living and care options for their needs.

What is the difference between independent living, assisted living, memory care, and skilled nursing?

Independent living (IL) is intended for seniors who do not need assistance or supervision with independent activities of daily living (IADLs) like showering, dressing, toileting, eating, or transferring (mobility, bed to standing, sitting to standing, etc.).

Most IL communities provide apartments with full kitchens, and the monthly fee includes one main meal per day in the dining room. Independent living in Western Mass. ranges from $2,000 to $5,000 per month.

Assisted living (AL) communities are appropriate for seniors who require some level of assistance with two or more IADLs and help with medication management; apartments are typically equipped with a kitchenette only because the monthly fee includes three restaurant-style meals per day. Assisted living in Western Mass. ranges from $4,000 to $9,000 per month.

Memory care (MC) is intended for individuals who have dementia, Alzheimer’s, or other neurogenerative diseases and require an intensive or specialized program of care and supervision. Memory-care communities are secure settings with passcode entrances and enclosed outdoor spaces to keep residents on site, and can be stand-alone facilities or a separate wing or ‘neighborhood’ within a traditional assisted-living community. Memory-care communities most often provide private studio or shared companion suites for their residents. Memory care in Western Mass. ranges from $3,500 (companion suites) to $11,000 per month.

Skilled-nursing facilities (SNFs) are licensed healthcare residences for individuals who require a higher level of medical care than can be provided in an AL setting. Skilled-nursing staffs consisting of RNs, LPNs and CNAs (certified nursing assistants) provide 24-hour medical attention for their long-term and short-term rehabilitation residents. While private rooms are available in many SNFs, shared living arrangements with two or three residents to a hospital-style room are much more common. Skilled-nursing facilities in Western Mass. range from $250 to more than $500 per day.

Can I receive care at home rather than moving to a senior-living community?

Absolutely. There are any number of quality home-care companies that can provide a wide range of custodial and healthcare services in the comfort of your own home. Home care is often referred to as non-skilled care (grooming, dressing, bathing, cleaning, and other everyday tasks) and home health care as skilled care (skilled nursing and therapy).

Seniors who are largely independent but can benefit from limited home care or home-healthcare services may choose to continue living in their homes as long as these services help them do so safely. Unless you hire a full-time live-in, skilled and non-skilled care are typically provided for only a few hours per day a few days per week, meaning family members often are called upon to supplement the home-care schedule on their own.

Seniors who are at risk for (or have experienced) frequent falls or who require consistent overnight supervision or assistance may find that moving to an assisted-living community provides them with a more secure living environment.

The choice between home care and senior living is highly personal and almost always comes down to a question of safety, location, the desire and need for socialization, and finances.

What is a continuing-care retirement community (CCRC), and what are the benefits compared to other senior-living communities?

Continuing-care retirement communities (CCRCs) are senior-living communities that offer a complete continuum of care (IL, AL, MC, and SNF), usually on a single campus. The primary benefit of a CCRC is that you can stay in the same community and never have to move, even as your care requirements change as you age. CCRCs (also referred to as life-plan communities) do typically require a substantial up-front community fee that can range from $10,000 to $300,000 or more depending on the community, the structure of the life-care plan, and the size and type of apartment.

Many CCRCs offer declining, refundable options that can return 70% to 90% of the up-front community fee to the resident when he or she moves, or to her estate when the resident passes away. CCRCs do still charge monthly fees, but they are often lower and increase less from one level of care to the next than traditional senior-living communities. CCRCs also offer a potential tax-deduction benefit that many non-CCRCs do not provide.

Will my health insurance cover the cost of assisted living or memory care? What if I am eligible for Medicaid?

Medicare and private insurance plans do not cover the cost of assisted living or memory care. Medicare will cover short-term and intermittent home care or rehabilitation stays in a SNF following hospitalization, but will not pay for either long-term. Seniors generally must pay for assisted living, memory care, and home care privately unless they have long-term-care insurance with benefits specifically designed to cover these services.

Qualifying veterans and their spouses may be eligible for the aid and attendance benefit from the VA to help pay for the cost of assisted living, memory care, home care, and skilled-nursing facilities.

Some, but not most, assisted-living and memory-care communities do participate in programs administered by Medicare and Medicaid that are designed for low-income seniors who could otherwise not afford senior-living communities.

Medicaid does cover the cost of long-term care in Medicaid-certified skilled-nursing facilities and home healthcare services for recipients who would qualify for nursing-home care.

What other senior-living and care options are there?

• Residential care facilities (also called rest homes) provide meals, housing, supervision, and care for seniors who need assistance with activities of daily living but don’t yet require skilled nursing care.

• Congregate housing is a shared-living environment that combines housing, meals, and other services for seniors but does not provide 24-hour care or supervision. Public congregate housing is administered by municipal housing authorities and is partially subsidized by the state and federal government.

• Adult foster care is an alternative to residential care and matches seniors who can no longer live on their own with individuals or families who provide room, board, and personal care in their homes.

• Respite care is short-term care and supervision provided for seniors at home or in assisted-living or skilled-nursing facilities to provide family members who need some time off from their caregiver duties.

• Adult day health programs (also called adult day care) provide a wide array of community-based services for seniors during the day (skilled nursing, supervision, direct care, nutrition and dietary services, and therapeutic, social, and recreational activities) so that family members can work or attend to other responsibilities.

• Hospice care is available for individuals with life-threatening illnesses or a life expectancy of six months or less and can be provided in the home, in assisted-living or skilled-nursing facilities, in the hospital, or in specialized hospice facilities. When curative treatment is no longer an option, hospice professionals work to make a patient’s life as dignified and comfortable as possible and provide critical emotional and spiritual support services to the patient and family members.

How have senior-living and care options been impacted by COVID-19?

In short, the impact has been profound, and the ‘new normal’ is taking shape as we speak. Most home-care providers and senior-living communities have resumed services to current and new clients at some level. However, the provision of these services is governed by strict protocols to protect the health and safety of residents, staff, and family members.

For instance, many assisted-living communities are not currently offering in-person tours and assessments and instead facilitating these interactions virtually. Since most senior-living communities are observing social-distancing guidelines, new residents must quarantine for 14 days after move-in, and residents are dining in their apartments rather than in the community dining room. Social activities and outings have largely been modified or canceled, and visits from family members have been curtailed for the time being.

Eric Aasheim is a certified senior advisor and owner of Oasis Senior Living of Western Massachusetts. He assists seniors and family members through the entire process of transitioning from home to senior-living communities in Hampden, Hampshire, and Berkshire counties and surrounding areas.

Senior Planning

Some Questions and Answers About Home-care Services

By Tania Spear

What is home care?

Home-care services are delivered to clients wherever they call home. There is a wide variety of assistance available, including everything from occasional help with housekeeping, meal preparation, companionship, and errands to skilled services such as nursing, physical therapy, occupational therapy, speech therapy, and hospice care. The goal is to support clients who prefer to remain at home, but need care that cannot easily or effectively be provided by family or friends.

Who provides home care?

Home-care services can be provided by an agency or an individual. Support can be provided from one hour to up to 24 hours a day, 365 days per year. There are many reputable agencies in the area. Your physician, area Council on Aging, hospital-discharge planner, or geriatric-care manager will be able to refer you to a home-care provider most appropriate to assist you.

“The goal is to support clients who prefer to remain at home, but need care that cannot easily or effectively be provided by family or friends.”

How do I pay for home-care services?

Government and private insurance may pay for services under specific circumstances such as after a recent hospitalization when skilled nursing or therapy services are needed. Ongoing assistance with activities of daily living (bathing, dressing, feeding, etc.) and housekeeping are generally not covered by insurance and are often private pay. It would be best to contact your provider for more information.

Are there benefits to using an agency?

While you may pay more using an agency caregiver, there are some advantages. An agency will offer pre-screening of workers, liability protection, workers’ compensation, and backup care in the event a particular caregiver isn’t available. An agency handles scheduling, payroll, and taxes, resulting in less paperwork.

How do I evaluate a home-care agency?

You will want to know if the agency works with you to develop a written plan of care and/or service contract and, if so, how often it is updated. How does the agency screen and evaluate employees? Are caregivers and supervisors available 24/7/365? How does the agency resolve concerns or complaints? Can the agency provide a list of local references?

What about COVID-19?

While accepting help at home from an agency may cause some fear during the pandemic, there are some things to consider that may help make you feel more confident in your decision to refuse or accept care as well as minimize risks. First, you want to assess the need for care. For many, care is essential, and refusing assistance in not an option. If you’ve determined help is necessary, check with the agency to determine what infection-control protocols are in place and if the agency has enough personal protective equipment (PPE) available. In addition to following CDC guidelines, you may want significant details related to how the agency is protecting staff and clients.

Are there any other things I should consider before receiving home care?

If a client or family hasn’t ever had help at home in the past, it can create some distress. The loss of independence and privacy can be factors. Oftentimes, if a competent caregiver with the right skills is placed, even the most seemingly resistant client may begin to look forward to the caregiver visits. Establishing expectations based on an appropriate plan of care and a goal for each visit is important for both the client and caregiver. With the right blend of care and compassion, a bit of support can make a world of difference in allowing someone who wishes to remain home to stay safe and healthy.

Tania Spear, MSN, MBA, RN is the owner and administrator of Silver Linings Home Care, LLC. She is a registered nurse and an Elms College graduate with a master of science degree in nursing and health services management and an MBA in healthcare leadership; (413) 363-2575; [email protected]

Senior Planning

Eight Tips for Medication Management for Seniors

By Kara James

In general, as we age, our need for a variety of medications increases. This includes everything from prescriptions to over-the-counter medications, as well as vitamins and supplements.

Unfortunately, as the number of remedies we take increases, so too does the difficulty in managing them, which can lead to problems such as potential interactions and missed doses. Here are eight tips to help properly manage medications.

1. Check for interactions. Talk to your pharmacist and let them know about all the medications you are taking, including natural remedies and over-the-counter products. Your pharmacist can let you know in advance about any potential for interactions that could have serious health consequences.

“As the number of remedies we take increases, so too does the difficulty in managing them, which can lead to problems such as potential interactions and missed doses.”

2. Make a written schedule. It’s important to take medications as prescribed so they work effectively. Write down which medications you need to take, and at what time of day (morning, noon, evening, or bedtime). Be sure to include any important reminders, such as if you are supposed to take a medication with food or on an empty stomach. Keep this schedule in a visible place. Use an alarm to set reminders, if necessary, to stay on schedule.

3. Pre-sort medications weekly. A pill organizer makes it easy for you to see what medications you need to take and when, and also lets you easily see if you already took a dose so you don’t accidentally take it twice. Our MediBubble medication-management system does this for you with monthly pill-pack organizers.

4. Create a comprehensive list. Make a list of all your medications and supplements and keep it on your phone or in your wallet for easy reference. Include the medication name, dosage, frequency, and purpose.

5. Store medications appropriately. Many people store their medications in the bathroom; heat and humidity can cause medications to degrade. They should be kept in a cool, dark place, out of the reach of children.

6. Ensure accessibility. Some seniors struggle with opening child-proof bottles, so make sure you can actually access the medications you need to take. If you must put them in another container, make sure the container is labeled with the medication name, dosage, and other instructions.

7. Understand side effects. Make sure you understand the potential side effects of medications you take, and be sure to let your provider know if you experience any that are serious. They can often provide advice or change the medication or dosage to minimize issues. You can also talk to your pharmacist with questions and concerns about side effects.

8. Plan ahead for refills. Make sure you order refills well in advance to avoid missed doses. Some pharmacies now offer medication-management programs allowing for routine refilling of your prescriptions, and will notify you when your refill is ready. n

Kara James, Ph.D. is pharmacy manager and co-owner of Louis & Clark Pharmacy in Springfield.

Senior Planning

Many Options Are Available for Seniors and Their Families

From the NATIONAL INSTITUTE ON AGING

Many older adults and caregivers worry about the cost of medical care. These expenses can use up a significant part of monthly income, even for families who thought they had saved enough.

How people pay for long-term care — whether delivered at home or in a hospital, assisted-living facility, or skilled-nursing facility — depends on their financial situation and the kinds of services they use. Often, they rely on a variety of payment sources, including personal funds, government programs, and private financing options.

Out of Pocket

At first, many older adults pay for care in part with their own money. They may use personal savings, a pension or other retirement fund, income from stocks and bonds, or proceeds from the sale of a home.

“How people pay for long-term care — whether delivered at home or in a hospital, assisted-living facility, or skilled-nursing facility — depends on their financial situation and the kinds of services they use.”

Professional care given in assisted-living facilities and continuing-care retirement communities is almost always paid for out of pocket, though Medicaid may pay some costs for people who meet financial and health requirements.

Medicare

Medicare is a federal government health-insurance program that pays some medical costs for people age 65 and older, and for all people with late-stage kidney failure. It also pays some medical costs for those who have gotten Social Security Disability Income (discussed later) for 24 months. It does not cover ongoing personal care at home, assisted living, or long-term care.

Medicaid

Some people may qualify for Medicaid, a combined federal and state program for low-income people and families. This program covers the costs of medical care and some types of long-term care for people who have limited income and meet other eligibility requirements.

Program of All-Inclusive Care for the Elderly (PACE)

PACE is a Medicare program that provides care and services to people who otherwise would need care in a nursing home. PACE covers medical, social-service, and long-term-care costs for frail people. It may pay for some or all of the long-term-care needs of a person with Alzheimer’s disease. PACE permits most people who qualify to continue living at home instead of moving to a long-term care facility. There may be a monthly charge.

State Health Insurance Assistance Program (SHIP)

SHIP, the State Health Insurance Assistance Program, is a national program offered in each state that provides counseling and assistance to people and their families on Medicare, Medicaid, and Medicare supplemental insurance (Medigap) matters.

Department of Veterans Affairs

The U.S. Department of Veterans Affairs (VA) may provide long-term care or at-home care for some veterans. If your family member or relative is eligible for veterans’ benefits, check with the VA or get in touch with the VA medical center nearest you. There could be a waiting list for VA nursing homes.

Social Security Disability Income (SSDI)

This type of Social Security is for people younger than age 65 who are disabled according to the Social Security Administration’s definition. For a person to qualify for Social Security Disability Income, he or she must be able to show that the person is unable to work, the condition will last at least a year, and the condition is expected to result in death. Social Security has ‘compassionate allowances’ to help people with Alzheimer’s disease, other dementias, and certain other serious medical conditions get disability benefits more quickly.

Private Financing Options for Long-term Care

In addition to personal and government funds, there are several private payment options, including long-term-care insurance (see story on this page), reverse mortgages, certain life-insurance policies, annuities, and trusts. Which option is best for a person depends on many factors, including the person’s age, health status, personal finances, and risk of needing care.

Reverse Mortgages for Seniors

A reverse mortgage is a special type of home loan that lets a homeowner convert part of the ownership value in his or her home into cash. Unlike a traditional home loan, no repayment is required until the borrower sells the home, no longer uses it as a main residence, or dies.

There are no income or medical requirements to get a reverse mortgage, but you must be age 62 or older. The loan amount is tax-free and can be used for any expense, including long-term care. However, if you have an existing mortgage or other debt against your home, you must use the funds to pay off those debts first.

Trusts

A trust is a legal entity that allows a person to transfer assets to another person, called the trustee. Once the trust is established, the trustee manages and controls the assets for the person or another beneficiary. You may choose to use a trust to provide flexible control of assets for an older adult or a person with a disability, which could include yourself or your spouse. Two types of trusts can help pay for long-term-care services: charitable remainder trusts and Medicaid disability trusts.

Life-Insurance Policies for Long-term Care

Some life insurance policies can help pay for long-term care. Some policies offer a combination product of both life insurance and long-term-care insurance.

Policies with an ‘accelerated death benefit’ provide tax-free cash advances while you are still alive. The advance is subtracted from the amount your beneficiaries will receive when you die.

You can get an accelerated death benefit if you live permanently in a nursing home, need long-term care for an extended time, are terminally ill, or have a life-threatening diagnosis such as AIDS. Check your life-insurance policy to see exactly what it covers.

You may be able to raise cash by selling your life-insurance policy for its current value. This option, known as a ‘life settlement,’ is usually available only to people age 70 and older. The proceeds are taxable and can be used for any reason, including paying for long-term care.

A similar arrangement, called a ‘viatical settlement,’ allows a terminally ill person to sell his or her life-insurance policy to an insurance company for a percentage of the death benefit on the policy. This option is typically used by people who are expected to live two years or less. A viatical settlement provides immediate cash, but it can be hard to get.

Using Annuities to Pay for Long-term Care

You may choose to enter into an annuity contract with an insurance company to help pay for long-term-care services. In exchange for a single payment or a series of payments, the insurance company will send you an annuity, which is a series of regular payments over a specified period of time. There are two types of annuities: immediate annuities and deferred long-term-care annuities.

Senior Planning

Five Things to Know About Long-term-care Insurance

By ELLEN STARK for the AARP BULLETIN

By the time you reach 65, chances are about 50/50 that you’ll require paid long-term care (LTC) someday. If you pay out of pocket, you’ll spend $140,000 on average. Yet you probably haven’t planned for that financial risk. Only 7.2 million or so Americans have LTC insurance, which covers many of the costs of a nursing home, assisted living, or in-home care — expenses that aren’t covered by Medicare.

“Long-term care is the unsolved problem for so many people,” said Christine Benz, director of Personal Finance at Morningstar, an investment research firm in Chicago. Here’s what you need to know about long-term-care insurance today.

1. Traditional policies have fewer fans. For years, long-term-care insurance entailed paying an annual premium in return for financial assistance if you ever needed help with day-to-day activities such as bathing, dressing, and eating meals. Typical terms today include a daily benefit for nursing-home coverage, a waiting period of about three months before insurance kicks in, and a maximum of three years’ worth of coverage.

“This is a classic story of market failure. No one wants to buy insurance, and no one wants to sell it.”

But these stand-alone LTC policies have had a troubled history of premium spikes and insurer losses, thanks in part to faulty forecasts by insurers of the amount of care they’d be on the hook for. Sales have fallen sharply. While more than 100 insurers sold policies in the 1990s, now fewer than 15 do. “This is a classic story of market failure,” said Howard Gleckman, a senior fellow at the Urban Institute, a nonpartisan think tank in Washington, and the author of Caring for Our Parents. “No one wants to buy insurance, and no one wants to sell it.”

2. You might not need insurance  …  but you need a plan. Premiums for LTC policies average $2,700 a year, according to the industry research firm LifePlans. That puts the coverage out of reach for many Americans. (One bright spot for spouses: discounts for couples are common —  typically 30% off the price of policies bought separately.)

If your assets are few, you may eventually be able to cover LTC costs via Medicaid, available only if you’re impoverished; if you have lots of money saved, you likely can pay for future care out of pocket. But weigh factors other than cash: do you have home equity you could tap? Nearby children who can be counted on to pitch in? Or do you have a family history of dementia that puts you at higher risk of needing care?

3. There’s a new insurance in town. As traditional LTC insurance sputters, another policy is taking off: whole life insurance that you can draw from for long-term care. Unlike the older variety of LTC insurance, these ‘hybrid’ policies will return money to your heirs even if you don’t end up needing long-term care. You don’t run traditional policies’ risk of a rate hike because you lock in your premium up front. If you’re older or have health problems, you may be more likely to qualify.

4. But old-school policies are cheaper. If all you want is cost-effective coverage — even if that means nothing back if you never need help — traditional LTC insurance has the edge. “Hybrid policies are usually two to three times more expensive than traditional insurance for the same long-term care benefits,” said Scott Olson, an insurance agent and co-owner of LTCShop.com in Camano Island, Wash. With hybrids, you’re paying extra just for the guarantee of getting money back.

A hybrid policy may make the most sense if your alternative is to use your savings, or if you have another whole-life policy with a large cash value.

5. Speed and smart shopping pay off. If you want insurance, start looking in your 50s or early 60s, before premiums rise sharply or worsening health rules out robust coverage. “Every year you delay, it will be more expensive,” Olson said. Initial premiums at age 65, for example, are 8% to 10% higher than those for new customers who are 64.

As for where to shop, seek out an independent agent who sells policies from multiple companies rather than a single insurer. For extra expertise and a wider choice of policies, Olson suggests looking for agents able to sell what are known as long-term-care partnership policies — part of a national program that has continuing-education requirements for insurance professionals.

Ellen Stark, a former deputy editor of Money, has written about personal finance for more than 20 years.

Senior Planning

Consider These Important Estate-planning Documents

By KEN COUGHLIN

Making sure you have the right estate-planning documents is one of the simplest ways to have a positive impact on your family’s future. Proper planning ensures that your wishes will be followed and that your family will have less to worry about after you are gone.

Estate planning does not need to be difficult; a few documents can make a big difference. Here are the five legal documents, in order of priority, that everyone should have in place:

1. Durable Power of Attorney. This appoints one or more people to act for you on financial and legal matters in the event of your incapacity. Without it, if you become disabled or even unable to manage your affairs for a period of time, your finances could become disordered and your bills not paid, and this would create a greater burden on your family. They might have to go to court to seek the appointment of a conservator, which takes time and money, all of which can be avoided through a simple document.

“Estate planning does not need to be difficult; a few documents can make a big difference.”

2. Healthcare Proxy and Medical Directive. Similar to a durable power of attorney, a healthcare proxy appoints an agent to make healthcare decisions for you when you can’t do so for yourself, whether permanently or temporarily. Again, without this document in place, your family members might be forced to go to court to be appointed guardian. Include a medical directive to guide your agent in making decisions that best match your wishes.

3. HIPAA Release. While the healthcare proxy authorizes your agent to act for you on health care matters, you may appoint only one person at a time. It may be important for all of your family members to be able to communicate with healthcare providers. A broad HIPAA release — named for the Health Insurance Portability and Accountability Act of 1996 — will permit medical personnel to share information with anyone and everyone you name, not limiting this function to your healthcare agent.

4. Will. Your will says who will get your property after your death. However, it’s increasingly irrelevant for this purpose, as most property passes outside of probate through joint ownership, beneficiary designations, and trusts. Yet, your will is still important for two other reasons. First, if you have minor children, it permits you to name their guardians in the event you are not there to continue your parental role. Second, it allows you to pick your personal representative (also called an executor or executrix) to take care of everything having to do with your estate, including distributing your possessions, paying your final bills, filing your final tax return, and closing out your accounts. It’s best that you choose who serves in this role.

5. Revocable Trust. A revocable trust is icing on the cake and becomes more important the older you get. It permits the person or people you name to manage your financial affairs for you as well as avoid probate. You can name one or more people to serve as co-trustee with you so that you can work together on your finances. This allows them to seamlessly take over in the event of your incapacity. Revocable trusts are not as simple as the prior four documents because there are many options for how they can be structured and what happens with your property after your death. Drafting a trust is more complicated, but also more nuanced, giving you more say about what happens to your assets.

Unless your situation is complicated, these documents are straightforward, and the process to create them is not difficult. By drafting an estate plan, you can save your family a great deal of strife, difficulty, and cost at an already-tough time.

Ken Coughlin is editorial director of ElderLawAnswers.

Senior Planning

These regional and statewide nonprofits can help families make decisions and access resources related to elder-care planning.

AARP Massachusetts
1 Beacon St., #2301, Boston, MA 02108
(866) 448-3621
states.aarp.org/region/massachusetts
Administrator: Mike Festa
Services: AARP is a nonprofit, nonpartisan, social-welfare organization with a membership of nearly 38 million that advocates for the issues that matter to families, such as healthcare, employment and income security, and protection from financial abuse

The Conversation Project and the Institute for Healthcare Improvement
53 State St., 19th Floor
Boston, MA 02109
(617) 301-4800
www.theconversationproject.org
Administrator: Kate DeBartolo
Services: The Conversation Project is dedicated to helping people talk about their wishes for end-of-life care; its team includes five seasoned law, journalism, and media professionals who are working pro bono alongside professional staff from the Instititute for Healthcare Improvement

Elder Services of Berkshire County Inc.
877 South St., Suite 4E, Pittsfield, MA 01201
(413) 499-0524
www.esbci.org
Administrator: Christopher McLaughlin
Services: Identifies and addresses priority needs of Berkshire County seniors; services include information and referral, care management, respite care, homemaker and home health assistance, healthy-aging programs, and MassHealth nursing home pre-screening; agency also offers housing options, adult family care, group adult foster care, long-term-care ombudsman, and money management, and oversees the Senior Community Service Aide Employment Program

Greater Springfield Senior Services Inc.
66 Industry Ave., Suite 9
Springfield, MA 01104
(413) 781-8800
www.gsssi.org
Administrator: Jill Keough
Services: Private, nonprofit organization dedicated to maintaining quality of life for older adults, caregivers, and people with disabilities, through programs and services that foster independence, dignity, safety, and peace of mind; services include case management, home care, home-delivered meals, senior community dining, money management, congregate housing, and adult day care

Highland Valley Elder Services
320 Riverside Dr., Florence, MA 01062
(413) 586-2000
www.highlandvalley.org
Administrator: Allan Ouimet
Services: Services include care management, information/referral services, family caregiver program, personal emergency-response service, protective services, home-health services, chore services, nursing-home ombudsman services, adult day programs, elder-care advice, bill-payer services, options counseling, respite services, representative payee services, local dining centers, personal-care and homemaker services, and home-delivered meals

LifePath
101 Munson St., Suite 201
Greenfield, MA 01301
(413) 773-5555
www.lifepathma.org
Administrator: Barbara Bodzin
Services: LifePath, formerly Franklin County Home Care Corp., an area agency on aging, is a private, nonprofit corporation that develops, provides, and coordinates a range of services to support the independent living of elders and people with disabilities with a goal of independence; it also supports caregivers, including grandparents raising grandchildren

Massachusetts Assoc. of Older Americans
19 Temple Place, Boston, MA 02111
(617) 426-0804
www.maoamass.org
Administrator: Chet Jakubiak
Services: Aims to improve the economic security of older Massachusetts residents through research and advocacy on policies that may reduce risk and hardship; fights against the dual stigma of being old and mentally ill, to preserve Medicare and Social Security, to ensure access to community-based long-term care, and to obtain mental healthcare for elders suffering from depression and other brain disorders; organizes regular conferences on important issues throughout the state and collaborates with councils on aging to hold training sessions for senior advocates

Massachusetts Executive Office of Elder Affairs
1 Ashburton Place, Unit 517
Boston, MA 02108
(617) 727-7750
www.mass.gov/elders
Administrator: Elizabeth Chen
Services: Connects seniors and families with a range of services, including senior centers, councils on aging, nutrition programs such as Meals on Wheels, exercise, health coaching, and more; supports older adults who may be somewhat frail through programs in nursing homes, such as the ombudsman program, volunteers who visit residents, and quality-improvement initiatives in nursing homes and assisted-living facilities; caregiver programs offer support to people with mild Alzheimer’s disease or those caring for someone with more advanced Alzheimer’s

Massachusetts Senior Legal Helpline
99 Chauncy St., Unit 400, Boston, MA 02111
(800) 342-5297
www.vlpnet.org
Administrator: Joanna Allison
Services: The Helpline is a project of the Volunteer Lawyers Project of Boston that provides free legal information and referral services to Massachusetts residents age 60 and older; the Helpline is open Monday through Friday, 9 a.m. to noon

MassOptions
(844) 422-6277
www.massoptions.org
Administrator: Marylou Sudders
Services: A service of the Massachusetts Executive Office of Health and Human Services, MassOptions connects elders, individuals with disabilities, and their caregivers with agencies and organizations that can best meet their needs; staff can also assist with determining eligibility for and applying to MassHealth

VA Central and Western Massachusetts Healthcare System
421 North Main St., Leeds, MA 01053
(413) 584-4040
www.centralwesternmass.va.gov.
Administrator: Andrew McMahon (interim)
Services: Provides primary, specialty, and mental-health care, including psychiatric, substance-abuse, and PTSD services, to a veteran population in Central and Western Massachusetts of more than 120,000 men and women

WestMass ElderCare Inc.
4 Valley Mill Road, Holyoke, MA 01040
(413) 538-9020
www.wmeldercare.org
Administrator: Roseann Martoccia
Services: Provides an array of in-home and community services to support independent living; interdisciplinary team approach to person-centered care; information, referrals, and options counseling as well as volunteer opportunities available; primary service area includes Holyoke, Chicopee, Granby, South Hadley, Belchertown, Ludlow, and Ware, as well as other surrounding communities

Senior Planning

Five Steps to Take When Your Parents Need Assisted Living

By MERRITT WHITLEY

Many families look to assisted-living facilities to provide essential care and peace of mind when it comes to their aging parents. Finding the best senior-living community means matching your parents’ needs, lifestyle, and budget with communities in their desired area. The process is easiest and most successful when you ask the right questions, prepare, and have open conversations with your family.

If you’ve noticed signs your parents need help, it may be time to look for assisted-living options. Follow these six steps to find the right senior-living facility for your parents.

Determine Cost and Payment Options

Decide what your family can afford on a monthly basis, and look for assisted-living communities that fit your budget. Some people have savings or long-term-care insurance to help fund senior living, while tthers need to be creative. You may consider options such as Social Security, VA benefits, cashing out a life-insurance policy, selling a home, or reverse mortgage to help pay for care.

Have a Conversation with Your Aging Parents

You can do much of the legwork for your parents, but have regular discussions with them about their desires and preferences. When you have a list of options ready, talk to them about communities you think are a good fit and why you like them. The more your parents know and are involved, the smoother their transition to senior living will be.

Visit or Virtually Tour a Community

No amount of time spent viewing brochures, floor plans, photos, or reviews can substitute for an in-person visit to or virtual tour of an assisted-living community. Visit at least three communities for comparison. Schedule visits for you and your parent, and try to tour during mealtimes. This allows you to interact with staff and residents, and sample the food. Overall, you’ll get a good feel for the environment and culture of the community.

Consult a Variety of Sources

You can always bounce ideas off of a senior-living advisor during the decision-making process. When making a decision, talk to those in the know to learn as much as you can. Read reviews of senior communities on senioradvisor.com to help you make an informed and confident decision. Check the background of an assisted-living community you’re considering with the state licensing agency tasked with monitoring facilities.

Prepare for the Transition

Do not delay the move — it’s risky to procrastinate, especially when a parent needs care. Delays can lead to avoidable accidents and medical problems. When preparing for a move, it’s important to:

• Consolidate possessions. Is your loved one downsizing? Can you help them sell or donate any items?

• Plan and coordinate the move. Are you hiring a company or helping on your own? Set up a schedule and plan to ensure the move goes smoothly to alleviate stress.

• Gather and manage legal documents. Locate medical documents, tax returns, or any important information your parents may need. Make sure they’re in a safe place so they don’t get lost or misplaced during the move.

Bottom Line

Whether your parents are choosing the community themselves, or you’re helping decide for a parent, the above steps should help ensure everyone in your family feels good about the assisted-living facility selection. When possible, have conversations with your parents, discuss the pros and cons of each option, and try to come to a consensus together.

Merritt Whitely is an editor at A Place for Mom.

Senior Planning

It’s Not About Giving Up, but About Quality of Life

From the AMERICAN ACADEMY OF HOSPICE AND PALLIATIVE MEDICINE

There may come a time when efforts to cure or slow an illness are not working and may be more harmful than helpful. If that time comes, you should know there’s a type of palliative care — called hospice — that can help ensure your final months of life are as good and fulfilling as they can be for you and your loved ones.

Hospice is not about giving up. It’s about giving you comfort, control, dignity, and quality of life.

Insurers, Medicare, and Medicaid will generally provide coverage for hospice care if your doctors determine you likely have six months (a year in some cases) or less to live if your illness follows its normal course.

“Requesting hospice care is a personal decision, but it’s important to understand that, at a certain point, doing ‘everything possible’ may no longer be helping you. Sometimes the burdens of a treatment outweigh the benefits.”

So, how do you know when it’s time for hospice care? Requesting hospice care is a personal decision, but it’s important to understand that, at a certain point, doing ‘everything possible’ may no longer be helping you. Sometimes the burdens of a treatment outweigh the benefits. For instance, treatment might give you another month of life but make you feel too ill to enjoy that time. Palliative doctors can help you assess the advantages and disadvantages of specific treatments.

Unfortunately, most people don’t receive hospice care until the final weeks or even days of life, possibly missing out on months of quality time. This may be out of fear that choosing hospice means losing out on a chance for a cure. Sometimes doctors fear their patients will feel abandoned if they suggest hospice.

Hospice care can help you continue treatments that are maintaining or improving your quality of life. If your illness improves, you can leave hospice care at any time and return if and when you choose to.

The following are some signs that you may experience better quality of life with hospice care:

• You’ve made several trips to the emergency room, and your condition has been stabilized, but your illness continues to progress.

• You’ve been admitted to the hospital several times within the last year with the same symptoms.

• You wish to remain at home, rather than spend time in the hospital.

• You are no longer receiving treatments to cure your disease.

Hospice care can free you up to ensure a time of personal growth and that you get the most you can out of your time left, allowing you to reflect on your life; heal emotional wounds and reconnect with a loved one with whom you have been estranged; visit favorite places or those with special meaning, such as a school, house, or location with a beautiful view you’ve always loved; put your financial affairs in order; create a legacy, such as a journal, artwork, or a videotaped message; or simply be with the people you love and who love you.

There are other benefits of hospice care, too:

• Hospice care allows you to remain and receive medical care in your own home, if desired and possible.

• It prevents or reduces trips to the emergency room for aggressive care that you might not want. Although you still might go to the hospital for tests or treatments, hospice allows you and your loved ones to remain in control of your care.

• Members of the hospice team can clean, cook, or do other chores, giving your loved ones a chance to run errands, go out to dinner, take a walk, or nap.

• Hospice programs offer bereavement counseling for your loved ones, often for up to a year.

Hospice care may not be appropriate if you are seeking treatments intended to cure your illness. Whether receiving hospice or palliative care, you should make a plan to live well so that your wishes for care and living are known.

Senior Planning

It’s Important to Act Based on Facts, Not What You Think You Know

By Gina M. Barry

In the realm of estate planning, the following myths are rampant. You may have heard them, or even believe them, yourself.

As it is not possible to make proper decisions with incorrect information, it is important to dispel these myths.

Myth 1: “If I need to go into a nursing home, Medicare will pay for my care.”

This myth may very well be perpetuated by the fact that ‘Medicare’ sounds very much like ‘Medicaid,’ which does pay benefits for nursing-home care for qualified applicants. Medicare Part A will pay for medically necessary inpatient care in a skilled-nursing facility, but only following a three-day hospital admission.

Gina M. Barry

Gina M. Barry

“The best estate-planning legal advice comes from a qualified estate-planning attorney, who will explain the options that best suit your unique situation and help you choose the best option for you based on correct information.”

In this case, Medicare will pay for up to 100 days of skilled-nursing care or rehabilitation services. The actual length of benefits could be much shorter than 100 days if those services are no longer required.

When Medicare benefits are available due to a qualifying hospital admission, Medicare pays 100% of the cost for the first 20 days, but only 80% of the cost for the next 80 days. Most Medicare recipients also have Medigap insurance, which will pay the balance not covered by Medicare. When Medicare benefits are exhausted, an alternative payment source is needed to pay for ongoing nursing-home care.

This alternative source could be long-term-care insurance benefits, private payment from income and assets, and/or Medicaid. For qualifying individuals, benefits from the Veterans Administration may also be available.

Myth 2: “I can give away assets and then obtain Medicaid benefits to pay for my nursing-home care.”

When faced with a nursing-home bill of approximately $13,000 per month, many people seek Medicaid benefits to pay for this care. In order to obtain Medicaid benefits, an asset limit must be met; therefore, assets valued above this amount must be reduced to the asset limit before benefits will be paid.

To reach this asset limit, most hope to give away excess assets, usually to their children. The Medicaid program imposes a penalty when any assets are given away within five years of the application for benefits, except in very specific circumstances. This penalty results in the applicant being unable to obtain Medicaid benefits for at least five years after such a gift is made.

There are planning options available at the time of a nursing-home admission, but in most cases, gifting will not be one of those options. Gifting options can exist if undertaken five years prior to nursing-home admission or earlier.

Myth 3: “I can give away $10,000 to as many people as I want each year, but if I give more, then I have to pay gift tax.”

This myth emanates from the federal gift-tax system. There is currently no gift tax in Massachusetts. In 2020, you may give up to $15,000 to as many people as you want without having to file a federal gift-tax return. The amount that can be gifted is stated incorrectly in the myth, as most people remain unaware of the ongoing increases in the allowable gift amount, which is known as the annual gift-tax exclusion. Also, in 2020, even if a gift-tax return must be filed because more than $15,000 is given to one person in one year, the giver of the gift will not pay any gift tax until they have gifted more than $11.58 million during their lifetime.

All gifts made that exceed the annual gift-tax exclusion will reduce the estate-tax exclusion available at the death of the giver of the gift. Thus, if you have $115,000, and you give all of it away in one year to one person, then you will need to file a federal gift-tax return. You will not owe any gift tax because the gift itself does not exceed the lifetime threshold, but when you die, the amount of assets you would have been allowed to pass without paying estate tax will be reduced by $100,000 (the amount of the gift that exceeded the annual exclusion amount).

Myth 4: “When I die, if I have a valid will, my estate does not have to go through probate.”

The assets in your probate estate are those that, when you pass away, are held in your name alone and do not have a designated beneficiary. Whether probate is needed is not based upon whether you have a will; rather, it is based upon how your assets are owned when you die. If you leave probate assets, then in order for your will to ‘speak,’ a probate estate must be opened. To avoid probate, you would need to have all assets held jointly or in a trust or with a designated beneficiary.

Although the above myths remain popular, they are not accurate. The best estate-planning legal advice comes from a qualified estate-planning attorney, who will explain the options that best suit your unique situation and help you choose the best option for you based on correct information.

Gina M. Barry is a partner with the regional law firm Bacon Wilson, P.C. She is a member of the National Assoc. of Elder Law Attorneys, the Estate Planning Council, and the Western Massachusetts Elder Care Professionals Assoc. She concentrates her practice in the areas of estate and asset protection planning, probate administration and litigation, guardianships, conservatorships, and residential real estate; (413) 781-0560; [email protected]

Senior Planning

It’s Helpful … Like Driving with Google Maps

By Liz Sillin

It is a product of the COVID-19 era, but we have found that many people are thinking about wills and other estate-planning issues this year. The truth is that people of all ages should be thinking about a will, and not just during a pandemic.

What is a will, and why would you want one?

A ‘last will and testament’ is a document that spells out who it is that you would like to receive certain assets of yours — your ‘probate assets’ — at your death. In it, you name a ‘personal representative’ (formerly known as an executor/executrix) who oversees the directives in your will.

If you have minor children, you name a guardian and conservator for them. A will is a formal document, signed in front of two disinterested witnesses and a notary who attest to your apparent soundness of mind and that you appear to be over the age of 18 and signing willingly.

It’s a little like having Google Maps for those you leave behind — it lays out where you want your assets to go and how to get there. You can say who you want to receive specific assets, be it your mother’s wedding ring or your house, and you can direct assets to family, friends, and charities in whatever proportions you wish.

“It’s a little like having Google Maps for those you leave behind — it lays out where you want your assets to go and how to get there.”

If you die without a will, state law takes over. The state has tried to determine what most people would want in the absence of a will, but it is not nuanced. For example, if you are married and all your children are from that marriage, state law presumes that you want all your probate assets to go to your spouse — no direct gifts to your children, no charitable gifts, no gifts to friends. By contrast, if you are married and have children from a prior marriage, then state law presumes that the first $100,000 of your probate assets should go to your surviving spouse, and the rest of the probate assets are split 50/50 between the spouse and the children of the prior marriage.

State law cannot know that you have a disabled child who needs a special-needs trust or a house that you really want your surviving spouse to have. State law also sets forth who has priority to serve as your personal representative if you don’t have a will.

We should pause to talk about ‘probate assets.’ These are assets that you own in your own name — not jointly with someone else and not owned in a trust — and assets as to which you have not made a beneficiary designation or a pay-on-death payee. You own a house in your own name — it’s a probate asset. You own a house jointly with your spouse — it transfers to the spouse by operation of law at your death and is not a probate asset. If you have a retirement asset, such as a 401(k) or an IRA, or a life-insurance policy on which you have filled out a form designating a beneficiary, the asset passes to that beneficiary at your death and is not a probate asset.

If you make a will and in it you say your life insurance proceeds go to Joe, but your life-insurance beneficiary designation form says they go to Jane, the proceeds go to Jane. It is important to understand that the will only deals with your probate assets.

Why is a will helpful?

• It is easier to sell real estate from your probate estate if you have a will.

• You may not want your assets to go the way that state law directs. In Google Maps talk, state law provides directions to Boston, and you are thinking more about Alaska, with stops in Ohio and California along the way…

• You may not want the person state law prescribes as your ‘driver’ (the personal representative); perhaps you love your spouse dearly, but your sister is much more organized and would be much better at following directions.

• You want to name your neighbors to serve as guardians for your children if your spouse is unable to do so, because it is important that they stay in the neighborhood and stay in their current schools through high school.

• It provides certainty among those you leave behind that the map you have drawn is going to direct your heirs to where you want your assets to go, with the driver you have selected. It provides you, as well as your family, with certainty. And certainty, in this COVID-19 era, is a very nice thing.

Liz Sillin is an estate-planning specialist with the law firm Bulkley Richardson; (413) 272-6200.

Senior Planning

Take care to prepare

What was once a demographic ripple has become a full-blown wave — and it’s getting bigger.

According to the U.S. Census Bureau, in 2000, the number of adults age 65 and older was 35 million, or 12.4% of the total population. In 2016, the number of seniors had risen to 49.2 million or 15.2% of the population.

By 2030, the bureau estimates, more than 20% of U.S. residents will have passed their 65th birthdays, and by 2035, that demographic will outnumber children younger than 18 — an unprecedented swing.


View the PDF flipbook HERE

 

What does all this mean?

It means it’s time to prepare — the sooner, the better.

As the Baby Boom generation continues to march into their retirement years — at the rate of 10,000 per day — Americans are living longer than ever. But what that life will entail, post-65, can wildly vary depending on lifestyle preferences, health status, finances, and more.

The questions are myriad. What levels of care are available, and what do they include? How will I pay for all of this, especially if I, or my parents, live well past 80 or 90? How do I approach mom or dad with my concerns that they might not be able to live alone anymore? What’s an estate plan, and what documents do I need to worry about?

It’s a lot to think about, and no single guide can answer all those questions. But hopefully, this special section will sort through some of the confusion and get those conversations started.

Senior Planning

Don’t Neglect Any of These Five Important Steps

Whether you’re taking care of a family member full-time or just beginning to anticipate a need, the American Association of Retired Persons recommends a series of five steps to make the process easier for both you and your loved one. Just take it one step at a time.

1. Start the Conversation

Ask your loved one about their wishes, values, and preferences on things that matter, from health to finances. If you wait until a fall, accident, or serious diagnosis, your choices may be more limited, more difficult to evaluate, and made hastily under stress.

Look for an opening. Rather than bringing up a tough topic out of the blue, it can help to point to a newspaper story or a relevant comment as a conversation starter. (Example: “You mentioned your eyes are bothering you. Is this causing problems with reading or driving?”)

It can be hard for some people to admit they need help. If your first conversation doesn’t go well, gently try again. Listen to and respect your loved one’s desires. If you are repeatedly shut out, consider asking another trusted family member, friend, or doctor to approach them about your concerns.

2. Form a Team

Don’t go it alone. Trying to handle the responsibilities of caregiving yourself can lead to burnout and stress-related health problems. It’s important to form a larger network of friends, family, and community resources to help you. Remember to consider your loved one part of the team.

Then, decide who’s in charge. It’s important to have a point person to keep the process moving and make sure everyone on the team understands the plan and priorities. In most families, one person assumes the primary role because he or she lives nearby, has a close relationship, or simply is a take-charge person. That may be you.

Also, consider a mediator. It can be useful to engage an unrelated facilitator, such as a social worker or minister, to help keep everyone focused, manage potential disagreements, and communicate difficult subjects when meeting with your team.

3. Make a Plan

Now it’s time to work with your team to develop a plan. You can’t anticipate every detail or scenario, but being forward-thinking now will help you respond more quickly and effectively in an emergency. It also helps assure that everyone keeps the focus on what’s best for your loved one.

You’ll need to determine roles. Ask your caregiving team members about what tasks they can and are willing to take on. Who is free to travel to medical appointments? Who can prepare meals a few times a week? Who can be responsible for bill paying?

Finally, summarize the plan in writing. A written record will assure everyone is on the same page and help avoid misunderstandings (while remembering, of course, that the plan will likely change as time passes).

4. Care for Your Loved One

This step encompasses the others, of course, and every caregiver’s situation is different. But there are a wide range resources and tools that can make your job easier, whether you’re caring for a parent from another state, a spouse with a long-term illness, or a family member with dementia.

Advocate for yourself. Let the doctor know if you are the primary caregiver and need to be informed about your loved one’s condition and the treatments prescribed. Ask for training on procedures you’ve never done at home, such as injecting medication or changing bandages.

If the person you’re caring for has more difficulty getting around or their vision or hearing fades, implement some simple changes to make their home less hazardous. Consider installing things like handrails, grab bars, nightlights, and adjustable shower seats.

5. Care for Yourself

It’s easy to forget about your own needs, which is why caregivers are more likely to report high stress levels and suffer from depression and other health problems. Don’t neglect exercise, sleep, and healthy eating, and take time for activities you enjoy. You’ll need to keep up your energy and stay well to care for others.

Understand that your personal finances can take a hit from family caregiving — which might require time off of work, cutting back on hours, or passing up promotions, as well as paying for things like groceries and prescriptions for your loved one from your own pocket. Also, find out if your workplace will accommodate your working from home part-time or making certain adjustments to your schedule.

Finally, give yourself a break. Sometimes caregivers feel guilty about taking time to have fun. Find ways to reduce your stress and enjoy yourself.

Senior Planning

A Challenging First Step

By Joe Gilmore, Landmark Senior Living

Talking about long-term care needs with an elderly parent or other loved one can be a difficult thing. You may not know exactly how to approach it without coming off as rude or disingenuous. However, when it comes to a loved one’s health, it is important to cast aside how you feel to ensure that they can live safely and happily later in life. It is especially important to have this conversation before a problem occurs, not after.

An American Assoc. of Retired Persons survey found that two-thirds of adult children have never had this conversation. This is most likely due to the fact that a lot of adult children don’t know how to engage in this type of talk, or how to begin it. To begin, you have to decide who is going to be there during the talk and what the discussion is going to center around.

Keeping your loved one or parent safe later in their life is a priority, and talking to them about living situations, such as assisted living or even enlisting the help of a caregiver, is the first step. This is especially true if your parent or loved one has experienced a traumatic event in the recent past, such as a fall or the loss of a spouse.

Tips for the Talk

• Decide how you are going to do it and who’s going to be there. Sometimes a one-on-one talk is best; however, if you need someone to back up your points or provide another point of view, it may be a good idea to get other family members involved.

• Go over which talking points you will speak on before approaching your loved one, and set up a time and place to talk.

• Express each idea as an opinion of yours rather than a need for them. For example, choosing phrases like “I think” or “I need” rather than “you should” or “you need” are good ways to avoid conflict.

• Remind your loved one that everyone is there because they care and want to help keep them safe.

• Stay calm. Don’t raise your voice, speak over your loved one, or encourage any hostility during this discussion, as it will only make the situation worse.

• If your loved one immediately dismisses the idea of leaving their home, it may be best to drop the issue for the moment and bring it back up at another time.

The first step in beginning the talk is setting up how you are going to do it and who’s going to be there. Sometimes it is best for the talk to be a one-on-one; however, if you need someone to back up your points or provide another point of view, it may be a good idea to get other family members or loved ones involved. Every family is different, and it may be a good idea to disregard some family members when deciding who is invited to speak.

It is best to go over which talking points that you will speak on before approaching your parent or loved one. Meeting beforehand to talk about these things is recommended. Create a plan on how you wish to talk about this.

Understanding Your Loves Ones’ Goals for the Future

Your conversation about the future doesn’t have to focus only on a caregiving plan. You may also consider talking generally with your loved ones about what is important to them as they grow older. This checklist can be used as a starting point to better understand their priorities. Start by asking then to check all those that apply and then spend some time talking about each one in a little more detail:
__ To remain as independent as possible for as long as possible

__ To remain healthy and active

__ To remain in my home as long as possible

__ To focus on a hobby

__ To work for as long as possible

__ To become involved in the community

__ To remain as financially independent as possible

__ To take classes

__ To create a safety net in the event of an emergency or crisis situation

__ To start my own business

__ To buy a second home

__ To move closer to my family

__ To relocate to a smaller home

__ To retire in a different place

__ To travel

__ To be able to help my children and grandchildren

After going over the points you will make, the first thing you’ll want to do is set up a time and place to talk with your parent or loved one. This may require the use of some type of web communications like Skype or just over the phone if someone can’t be there or lives in a different area.

Depending on how you are hoping to help your parent, there are a few ways to go about this. For example, if you are just hoping to enlist the help of a caregiver, or become the caregiver yourself, it will take less convincing than, say, getting them to agree to be admitted to an assisted-living or residential care facility.

When speaking with a parent or a loved one about what you feel they should do, it is best to phrase it in a way that expresses that it is an opinion of yours rather than a need for them. For example, choosing phrases like “I think” or “I need” rather than “you should” or “you need” are good ways to avoid conflict.

Be sure to remind your parent or loved one that everyone is there because they care and want to help keep them safe. It may even be beneficial to bring up times when your parent may have had their health put at risk — maybe a fall or another incident.

This is also true for other major events like the loss of a spouse. There is evidence that the social isolation that stems from living alone and independently can lead to problems like loneliness and depression.

It is also important not to raise your voice or encourage any hostility during this discussion, as it will only make the situation worse. You should also be aware of when your parent is trying to talk. Do not try to speak over them, as it will likely lead to an argument. Keep your cool and remain calm during the discussion, even if others don’t.

Some parents will dismiss the idea of moving to an assisted-living facility immediately or adamantly. If this is the case, it may be best to drop the issue for the moment and bring it back up at another time down the road.

At the end of the meeting, make sure everyone has a clear understanding of the issues, concerns, and considerations presented.

Senior Planning

Choosing the Right Level of Care Begins with Understanding All of Them

By the Massachusetts Senior Care Assoc.

Massachusetts has a broad array of care options and a national reputation for quality. Understanding the different types of healthcare services offered by providers is the first step to determining which care option best fits your needs.

Skilled Nursing and Rehabilitation

Nursing facilities provide both short- and long-term care services for older adults and people with disabilities or chronic illnesses.

Of the more than 120,000 people Massachusetts Senior Care Assoc. members care for annually, close to two-thirds return to their community within one month after a brief, post-hospital, rehabilitative stay. With ever-shortening hospital stays, skilled-nursing facilities have become the preferred choice for discharged hospital patients who need short-term transitional care before they can return safely to their homes. Those who cannot live safely and comfortably at home receive precisely the care and community they need as long term residents of Massachusetts’ nursing and rehabilitative facilities.

Short-term care is available for individuals who have been hospitalized and need a period of medical monitoring and/or rehabilitation before returning home. Often referred to as subacute or transitional care, this kind of care can be provided in a free-standing nursing facility or a hospital-based skilled-nursing unit. Most stays are for fewer than 30 days, after which the patient usually returns home. This kind of care can be beneficial after a surgery or a prolonged hospitalization, or for rehabilitation following a stroke or other serious medical event.

Long-term care is available for people who are unable to live safely and comfortably at home, require 24-hour nursing care and support, and need help with many of the activities of daily living, such as eating, dressing, toileting and bathing. When considering long-term nursing facility care, it is important to discuss the issue thoroughly with the person involved and his or her personal physician before the situation becomes an emergency. Finding the right facility can take time, and since some facilities have waiting lists, it helps to plan ahead so space will be available when it is needed.

Among the services provided are 24-hour nursing care; rehabilitative care such as physical, occupational, speech, and respiratory therapy; and help with personal care such as eating, dressing, toileting, and bathing. In addition, a growing number of nursing facilities provide post-operative rehabilitative care, inpatient and outpatient rehabilitation, Alzheimer’s/dementia specialty care, respite care, restorative and residential care for people with multiple sclerosis and other neurological disorders, pediatric specialty care, and acquired brain-injury specialty care.

Assisted Living

Assisted-living residences are for older people who no longer feel comfortable or safe living alone, but do not need 24-hour nursing and medical care. While assisted-living residences monitor the well-being of their residents and help coordinate health services by licensed outside agencies or providers, they do not provide these services directly and are not designed for people with serious medical needs. State law prohibits assisted-living residences from admitting or retaining individuals who need skilled nursing care for more than 90 days in a 12-month period.

Assisted living residences combine apartment-like living with a variety of support services, including meals, assistance with activities of daily living such as bathing and dressing, on-site staff to respond to emergencies and help with medications, housekeeping and laundry services, social and recreational programs, and 24-hour security.

Assisted-living residences have one- or two-bedroom units with private bathrooms and entry doors that lock. Some units may also have a living or sitting room. In addition to a group dining area, assisted-living residences typically provide either a private kitchenette or access to a communal cooking area. Units are usually furnished with a resident’s personal belongings and furniture.

Continuing-care Retirement Community

Continuing-care retirement communities (CCRCs) combine independent retirement housing, assisted-living services, and nursing facility care, usually on the same campus, to allow elders to have their current and future care needs met at one location. As a senior’s needs change, he or she can choose from among the services and care settings available.

CCRCs are another option for older people who no longer want the responsibility of caring for a house and want the peace of mind of knowing that they have planned for their future long-term-care needs. Most CCRCs require incoming residents to be fully capable of independent living upon entering, or may impose conditions based on certain pre-existing conditions. However, some CCRCs allow residents to enter their assisted-living units directly from the community.

CCRCs also provide assisted-living services (either in separate assisted-living units or to individuals residing in the independent living units) and 24-hour nursing-facility care.

Most independent-living units in a CCRC consist of one or two bedrooms, a living room, a kitchen, and a full bathroom. CCRCs typically have a number of common areas, including one or more resident dining rooms, and many also have libraries, hair salons, convenience stores, exercise and game rooms, and banking facilities.

Other Care Options

• Adult day health programs, also known as adult day care centers, provide supervision, recreation, health, and personal-care services during the day to older people so that family caregivers can work or attend to other responsibilities. All adult day health programs must meet minimum standards set by the Massachusetts Medicaid program, also known as MassHealth. Adult day health programs are provided either on a private pay basis or through Medicaid.

• Adult foster-care programs match elders who are no longer able to live alone with families willing to provide room and board and personal care. Families are paid a stipend by MassHealth for elders who are Medicaid-eligible. Some adult foster-care funding is also available to pay for assisted-living services for people who are clinically and financially eligible through the state’s Group Adult Foster Care Program.

• Congregate housing facilities provide a living arrangement in which elders have a private bedroom and share common space with others. Support services are usually available to help elders maintain their independence. Most congregate housing sites are sponsored by local municipal housing authorities or nonprofit organizations. Public congregate housing is partially subsidized by the state or federal government.

• Home-based services help individuals live independently at home and are provided by home health agencies, visiting nurse associations, and state-funded home-care corporations (called aging services access points, or ASAPs). They include homemaker services to maintain household functioning, including help with home management, shopping, meal preparation, and light housekeeping; and personal care, including bathing, dressing, grooming, and toileting. They may also provide health services; home health aides provide basic healthcare services such as personal care, recording temperatures and checking pulses, changing simple bandages, and assisting with self-administered medications, while licensed nurses and therapists provide skilled nursing care and therapeutic services.

• Hospice care serves patients with a life-threatening illness and a life expectancy of six months or less. Hospice care may be provided in the home, nursing facility, or hospital, and the hospice team works cooperatively with the patient, family, physician, and other caregivers to provide specialized care that is focused on comfort, not cure. The hospice team includes the patient’s physician, hospice medical director, registered nurses, home health aides, licensed social worker, bereavement counselor, pastoral counselor, rehabilitation therapists, and volunteers.

• Resident Care Facilities (RCFs), also known as rest homes, provide housing, meals, 24-hour supervision, administration of medications, and personal care to individuals who do not routinely require nursing or medical care.

• Respite care is short-term care provided at home, in a nursing facility, or in an assisted-living residence to give families caring for elders at home some time off from their caregiving responsibilities.

• Finally, independent-living senior communities are an option if you want to live on your own, but don’t want to have all the chores that go along with having a home. It’s also a great option for people who want to live in a community with other seniors. Depending on the community you choose, you can rent an apartment either at the market rate or, if your income level applies, a lower rate. They are often specially designed with things like railings in bathrooms or power outlets higher up on the wall. They may also offer a 24-hour emergency call service if residents need help right away. Some facilities may also offer services like meals, transportation, social activities, and other programs.