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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

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

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.