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Senior Planning

Senior Planning

What Options Are Available?

Many seniors are not aware of the options available for affordable housing and care as they age. In Massachusetts, there are a few financial-assistance programs that can assist low- to moderate-income seniors pay for both housing and care options. Residential care homes in Massachusetts offer seniors and disabled adults affordable housing options that include services such as homemade meals, snacks, scheduled activities, housekeeping, laundry, and clinical oversight with medication management.

“Many homes, like the Lathrop Home, offer private rooms, with shared common areas and daily activities to enrich the lives of the residents we serve,” said Crystal Cote-Stosz, executive director of the Northampton facility. “For many individuals, the offerings of a residential care home can bridge the care gap by providing assistance that is customized and affordable. Finances are a major consideration with life’s transitions, and for those of us needing support services such as meals, medication management, and assistance with personal care, making these choices can be difficult. Luckily for Massachusetts residents, subsidized care options are available in many residential care homes and assisted-living facilities.”

Paying for care is a significant stressor for families, especially for those who have not planned ahead or saved enough. According to a TD Bank study, one in five Millennials helps to financially support their aging parents, to the tune of $18,250 per year on average, and nearly three-quarters of the financial aid goes towards general living expenses like food and housing.

Both the state and federal government offer subsidy programs for residential care facilities, like the Lathrop Home, Cote-Stosz noted. The federal subsidy that assists individuals pay for residential care is through the Supplemental Security Income (SSI) program combined with the state Supplemental Security Program. Both programs work together to supplement an individual’s income to pay for the care provided by a residential care home.

The state program that assists residents in Massachusetts pay for residential care is called EAEDC (Emergency Aid to Elderly and Disabled Children). Residential care facilities like the Lathrop Home can have residents with monthly incomes up to $3,450 qualify for assistance paying for care. Many Massachusetts residential care facilities offer nursing on staff to triage residents’ clinical care needs, which allows individuals to remain independent from long-term care.

Residential care facilities provide application assistance for the financial-assistance programs available to those residents that spend down or require a subsidy application from point of admission. Individuals interested in residential care should visit the Massachusetts Assoc. of Residential Care Homes website at maresidentialcarehomes.org.

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: 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

20 University Road, 7th Floor, Cambridge, MA 02138

(617) 301-4868; www.theconversationproject.org

Administrator: Kate DeBartolo

Services: Helps people talk about their wishes for end-of-life care; its team includes five seasoned law, journalism, and media professionals working pro bono alongside professional staff from the Institute 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: Information and referral, care management, respite care, homemaker and home health assistance, healthy-aging programs, and MassHealth nursing home pre-screening; also offers housing options, adult family care, group adult foster care, long-term-care ombudsman, and money management, and oversees 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: 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: 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: Private, nonprofit corporation that develops, provides, and coordinates a range of services to support the independent living of elders and people with disabilities; 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.

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 services like senior centers, councils on aging, nutrition programs such as Meals on Wheels, exercise, health coaching, and more; supports frail adults through programs and quality-improvement initiatives in nursing homes and assisted-living facilities; caregiver support programs.

MASSACHUSETTS SENIOR LEGAL HELPLINE

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

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

Administrator: Joanne 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: 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: John Collins

Services: Provides primary, specialty, and mental-health care, including psychiatric, substance-abuse, and PTSD services, to a veteran population in Central and Western Mass. 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.

Senior Planning

When It’s Time to Leave Home: Making the Change

By the National Institute on Aging

The decision about whether your parents should move is often tricky and emotional. Each family will have its own reasons for wanting (or not wanting) to take such a step. One family may decide a move is right because the parents can no longer manage the home. For another family, the need for hands-on care in a long-term care facility motivates a change.

In the case of long-distance caregivers, the notion of moving can seem like a solution to the problem of not being close enough to help. For some caregivers, moving a sick or aging parent to their own home or community can be a viable alternative. Some families decide to have an adult child move back to the parent’s home to become the primary caregiver.

Keep in mind that leaving a home, community, and familiar medical care can be very disruptive and difficult for the older parent, especially if they are not enthusiastic about the change. You might first want to explore what services are available in your parents’ community to help them in their home — including home health care, housekeeping, personal care, and transportation services.

Myriad options exist when it comes to deciding where to live, but these choices can be limited by factors such as illness, ability to perform activities of daily living (for example, eating, bathing, using the toilet, dressing, walking, and moving from bed to chair), financial resources, and personal preferences.

Tips for the Transition

• Keep in mind that leaving a home, community, and familiar medical care can be very disruptive and difficult for the older parent. First explore what services are available in their community to help them in their home.

• Some families find a conference call is a good way to talk together about the pros and cons of each option. The goal of this call is to come up with a plan that works for everyone, especially your parent.

• Many older adults want to ‘age in place’ — to stay in their own homes as they get older — but may have concerns about safety, getting around, or other daily activities. A few changes could help the resident continue to live independently.

• Whatever your decision, try not to let your parent or loved one feel threatened or forced.

Older adults, or those with serious illness, can choose to stay in their own home or move to a smaller one, move to an assisted-living facility, move to a long-term care facility, or move in with a family member. Making a decision that is best for your parent — and making that decision with your parent — can be difficult. Try to learn as much as you can about possible housing options.

Some families find a conference call is a good way to talk together about the pros and cons of each option. The goal of this call is to come up with a plan that works for everyone, especially your parent. If the decision involves a move for your mom or dad, you could, even from a distance, offer to arrange tours of some places for their consideration.

Experts advise families to think carefully before moving an aging adult into an adult child’s home. There are a lot of questions to consider. For example, is there space in your home? Is someone around to help the older person during the whole day? What are your parents able to do for themselves? What personal care are you willing and able to provide — moving your parent from a chair to a bed or toilet, changing adult diapers, or using a feeding tube, for example? What kinds of home-care services are available in your community? What kind of specialized medical care is available nearby?

Many older adults want to ‘age in place’ — to stay in their own homes as they get older — but may have concerns about safety, getting around, or other daily activities. A few changes could make the home easier and safer to live in and help the resident continue to live independently.

For example, don’t use area rugs, and check that all carpets are fixed firmly to the floor. Replace handles on doors or faucets with ones that are comfortable for you to use. Install grab bars near toilets and in the tub or shower. Reduce fall hazards by placing no-slip strips or non-skid mats on tile and wood floors or surfaces that may get wet. Place light switches at the top and bottom of stairs and remember to turn on nightlights. Install a ramp with handrails to the front door.

Whatever your decision, try not to let your parent or loved one feel threatened or forced. Help them understand you have their best interest at heart, and want to find a solution that works for everyone.

Senior Planning

The Four Key Documents of an Estate Plan

By Gina Barry

Consider this — tomorrow, you take a terrible fall.

You are injured to the point that you cannot communicate, or worse yet, you pass away. No one expected this to happen. Your loved ones are reeling. They are in shock and not thinking clearly.

Gina Barry

By Gina M. Barry, Esq.

They are now immediately called upon to act on your behalf. Do you know who will handle your affairs? Have you given that person the legal authority they would need to do so without added cost, time, and administrative difficulties? If your estate plan is in place and up to date, your affairs can be handled efficiently and effectively, leaving your loved ones to grieve the tragedy without all the added stress of navigating your affairs blindly and without authority.

Thus, every adult should have an estate plan in place. Fortunately, a basic estate plan is quite simple to establish. It requires four documents:

Last Will and Testament

The will is the document most people think of when contemplating an estate plan. Your will directs how your probate assets will be distributed after you pass away.

When you die, your probate assets are those assets held in your name alone that do not have a designated beneficiary. If you pass away without a will, your estate will be distributed in accordance with the Commonwealth’s intestacy laws, which may not be as you would have wanted.

A common misconception is that a will is not needed unless you have a lot of assets; however, a will can do much more than simply distribute assets. A will is necessary for you to name a personal representative (formerly known as executor), who will carry out your estate. Your personal representative will gather your probate assets, pay valid debts, and distribute the balance as set forth in your will.

Further, if you leave behind minor or disabled children, a guardian can be named in your will to take custody of these children. Likewise, a trust can be established in a will to provide ongoing protection for minor or disabled children as well as for other beneficiaries who should not receive their inheritance outright, usually due to spendthrift concerns. When there is no will in place, your power to make these designations and to direct the distribution of your property is forfeited.

Many also believe that, if every asset is jointly owned or has a designated beneficiary, a will is not necessary. For such a plan to be successful, the joint owner or beneficiary must survive you. If they do not survive you, your estate will need to be probated, which is when your will would direct the distribution of those assets.

Further, there are some instances where joint ownership cannot carry out your wishes, such as when you have more than one child, but cannot add all of their names on the same account due to the financial institution’s practices or because one or more of your children cannot be trusted to have access to your account as a joint owner during your lifetime.

Healthcare Proxy

A healthcare proxy is a document that designates a healthcare agent, who would make healthcare decisions for you if you were unable to make them for yourself.

Your healthcare agent would step into your shoes and make your decisions as you would if you were able. For example, your agent may decide whether a certain medication should be taken, a certain medical procedure should be done, or an admission or discharge from a medical facility should occur. Should you lose capacity and not have a healthcare proxy in place, your loved ones would need to petition the Probate Court to become your guardian, which is a lengthy, expensive, and public process that most would rather avoid.

‘Living-will’ language is normally included within the healthcare proxy, as it addresses your end-of-life decisions and generally sets forth that you do not want extraordinary medical procedures used to keep you alive when there is no likelihood of recovery. This can be a difficult decision to carry out; therefore, care should be taken to name someone who would be able to honor that decision.

If you have a terminal illness or are of advanced age, you also should consider establishing Medical Orders for Life-Sustaining Treatment (MOLST) in addition to your healthcare proxy. A MOLST is a form completed by you and your physician that relays instructions about your care. A MOLST would eliminate the need for living-will language in a proxy, but the best practice would be to reference the MOLST in your proxy.

Durable Power of Attorney

A durable power of attorney is a document that designates someone to make financial decisions for you. This document is usually in full force and effect when it is signed, but it is expected it will not be used unless you want help with or are unable to handle your own financial affairs.

It is also possible to grant a springing power that does not take effect until incapacity arises. Should you lose capacity and not have a durable power of attorney in place, your loved ones will have to petition the Probate Court to become your conservator, which, just like the guardianship process, is also lengthy, expensive, and public.

The durable power of attorney is a very powerful document with authority that is as broad as the powers granted within it. It gives power to the person you name to handle all your financial decisions, not just pay your bills. In most cases, the person named will be authorized to handle your real estate, life insurance, retirement accounts, other investment accounts, bank accounts, and any other matters involving money, such as tax returns and applications for public benefits.

As such, the person chosen to serve in this capacity should be someone with financial savvy who can be absolutely trusted to use your assets for only your benefit.

Homestead Declaration

For Massachusetts homeowners, a homestead declaration, once properly recorded in the Registry of Deeds, will declare your principal residence to be your homestead. The homestead declaration protects the equity in your primary residence up to $500,000 from attachment, seizure, execution on judgment, levy, or sale for the payment of debts.

In some cases, such as advanced age or disability, the equity protection can be up to $1 million. If a homestead declaration is not recorded, there is an automatic $125,000 of equity protection. It should be noted that, in addition to some other specific exceptions, a homestead declaration will not protect your real estate from nursing-home costs or tax liens.

Conclusion

While incapacity and death are not the most joyous of topics, when faced with them, most people would prefer to have a plan in place to ensure their needs and goals will be met.

You can help your loved ones avoid expensive legal hassles related to your ongoing care and your estate. Individuals with more complicated estates may require different or additional documents to fully protect their interests, but for most, an estate plan is only four documents away.

Gina Barry is a partner with the 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].