Paul O. Dillon, Attorney at Law

Can You Protect Property and Qualify for Long-Term Care with Medicaid?

Long-term care costs keep many seniors and their adult children up at night, with good reason. However, with the right long-term care and asset protection plan, you can protect your home and other assets so you can pay for any supplemental needs and protect a well spouse. A recent article from The National Law Review, “Protecting and Preserving Property When Paying for Long-Term Care” provides details.

Your primary residence remains an exempt asset if you plan to return home. An exempt asset is the term used to describe any asset not countable by Medicaid when considering your eligibility. The property is also exempt if your spouse, minor child, or disabled child lives in the home.

If you have a child who has lived at home with you for at least two years and has provided care that allowed you to remain home, as opposed to being in a nursing home, the property may be transferred to the child, who is then considered a “caregiver child.”

Another permitted transfer of the primary home is to a disabled child. This transfer is allowed by Medicaid and doesn’t lead to any penalty period for Medicaid. Check with your estate planning attorney to ensure that this asset's transfer doesn’t conflict with any Special Needs planning or make the child ineligible for any means-tested government benefits.

Medicaid has a five-year look-back period, when any transfers of any property, as noted above, are not allowed and result in your being ineligible for Medicaid benefits. Many people think Medicaid won’t find out about moving assets, including retitling homes or accounts. However, this is not a good idea in this age of data connectivity.

A Medicaid Asset Protection Trust is commonly used if created five years before applying for Medicaid benefits. The family home, investment accounts and other assets are retitled to be transferred into the trust. The assets within the trust are protected and exempt from Medicaid. This allows the well spouse to continue to live in their home and enjoy using the assets saved for retirement or plan for these assets to be passed to the next generation.

Suppose the need for Medicaid benefits arises and no planning has been done. In that case, some home sale proceeds can be protected by using Medicaid Compliant Annuities and creating supplemental needs trusts. An estate planning attorney will review your situation and determine the best options for each situation.

Reference: The National Law Review (June 20, 2024) “Protecting and Preserving Property When Paying for Long-Term Care”

Caregiving and Estate Planning Provides Peace of Mind for All Generations

If your goal is to keep the farm, ranch, or small business in the family, planning, including estate planning and caregiving, is the number one strategy to making it happen. Families may dissolve the farm or business without advance planning to pay for long-term care expenses. A recent article from AgWeek, “Caregiving plans can provide peace of mind for farming and ranching families,” explains what needs to be done.

Part of the issue is that most ranchers and business owners won’t qualify for Medicaid because they own a significant asset. Having to sell off something they’ve worked their entire lives to build is often a result of no planning.

If you have a long-term care insurance policy, it needs to be carefully reviewed to determine what conditions need to be met for benefits to be paid. For example, most policies have a “waiting period,” so you’ll need to plan how to pay for caregiving during the months before the policy kicks in.

There’s also confusion about the difference between Medicare and Medicaid. Medicare is health insurance for medical expenses, while Medicaid is usually used for long-term care and caregiving needs. However, Medicaid is a needs-based program. An estate planning attorney can help the family determine what needs to happen in advance, whether the goal is to protect the farm, ranch, or small business while helping the aging parent become eligible for Medicaid.

Estate planning includes planning for incapacity, which can occur at any time but is more likely as we age. Suppose the individual hasn’t completed a power of attorney, healthcare power of attorney, and other medical directives. In that case, the family will need to go to court to obtain conservatorship or guardianship to take over the person’s financial matters and make healthcare decisions on their behalf. An estate planning attorney can help the family prepare the documents and create a plan.

Having an estate plan in place is also another means of protecting the family’s assets from elder abuse. Everything needs to be documented, and records need to be well-organized so every family member knows where documents are, where assets are and the plan for the inevitable events of aging.

Meeting with an estate planning attorney to create the last will and testament, power of attorney and all other planning documents can minimize the stress and costs involved. Without planning, everything becomes far more complicated, costly and stressful for all concerned.

Reference: AgWeek (May 14, 2024) “Caregiving plans can provide peace of mind for farming and ranching families”

What Is the Purpose of a Pet Trust?

You don’t have to be a billionaire to want to protect your pets. However, you do need to plan for their well-being, if something happens to you. Since pets are considered property, they can’t inherit money to be used for their care. Instead, as explained in a recent article from Barron’s Penta “Future Returns: Why Fido Needs a Trust” titled owners can create pet trusts to protect them, if something happens to their humans. With close to 70% of American households having pets, pet trusts have now become mainstream.

Owners need to designate a reliable caregiver, just as they would designate a guardian for minor children. If you don’t have family members or friends who love animals, contact a local animal rescue group to learn if they have a life-long care program for animals. Many do, with programs incorporating Charitable Remainder Trusts to cover the cost of the pet’s care.

If you want a friend or relative to care for your pet, make sure they are willing and able to do so.  You should have another person as a back-up, in case something happens to them. Circumstances change, and someone who wants to take care of your pet now may not be able to in future years. How long you need to plan for depends upon the lifespan of your pet.

An experienced estate planning attorney can create a pet trust. Because state law enforces conditional distributions from the trust, the care of your pet can be enforced in court, if necessary. The pet owner names a beneficiary, the caregiver and funds the trust with enough assets to care for the pet.

The pet owner also names a trustee. They are a responsible person who will be in charge of distributing funds and making sure they are used for the pet’s well-being. The trustee also makes sure that the pet is healthy and being properly cared for, following the directions of the trust.

Your estate planning attorney will know what your state’s laws are regarding pet trusts, which varies from state to state. For instance, Pennsylvania requires a pet trust to end when the last pet in the trust dies, while other states may limit the trust’s length to 21 years. For dogs and cats, 21 years is a reasonable period of time. However, for other pets, like birds who can live to 100 years, this won’t be long enough.

You’ll need to fund the trust, making sure that there’s enough money to cover the pet’s needs throughout their lifetime. You may also consider the caregiver’s needs, depending on circumstances. How much is reasonable will depend upon the type of pet and the lifestyle of the caretaker. An apartment dweller caring for an elderly cat will need a different level of resources than a person tasked to care for a young horse.

Some states limit the amount of money in a pet trust and will penalize overfunding. Making sure your pet trust is appropriately funded may limit the likelihood of its being challenged.

Reference: Barron’s Penta (April 18, 2022) “Future Returns: Why Fido Needs a Trust”

Special Needs Planning

When a family includes a disabled individual, sometimes referred to as a “person with special needs,” estate planning needs to address the complexities, as described in a recent article titled “Customize estate plan to account for disabled beneficiaries” from The News-Enterprise. Failing to do so can have life-long repercussions for the individual.

This often occurs because the testator, the person creating the estate plan, does not know the implications of failing to take the disabled person’s situation into consideration, or when there is no will.

The most common error is leaving the disabled beneficiary receiving an outright inheritance. With a simple will, or no will, the beneficiary receives the inheritance and becomes ineligible for public benefits they may be receiving. The disruption can impact their medical care, housing, work and social programs. It may also lead to the loss of their inheritance.

If the disabled beneficiary does not currently receive benefits, it does not mean they will never need them. After the death of a parent, for instance, they may become completely reliant on public benefits. An inheritance will put them in jeopardy.

A second common error is naming the caregiver as the beneficiary, rather than the disabled individual. This causes numerous problems. The caregiver has the right to do whatever they want with the assets. If they no longer wish to care for the beneficiary, they are under no legal obligation to do so.

If the caregiver has any liabilities of their own, or when the caregiver becomes incapacitated or dies, the assets intended for the disabled individual will be subject to any estate taxes or creditors of the caregiver. If the caregiver has any children of their own, they will inherit the assets and not the disabled person.

The caregiver does not enjoy any kind of estate tax protection, so the estate may end up paying taxes on assets intended for the beneficiary.

The third major planning mistake is using a will instead of a trust as the primary planning method. A Special Needs Trust is designed to benefit a disabled individual to protect the assets and protect the individual’s public benefits. The trust assets can be used for continuity of care, while maintaining privacy for the individual and the family.

Planning for individuals with special needs requires great care, specifically for the testator and their beneficiaries. Families who appear to be similar on the outside may have very different needs, making a personalized estate plan vital to ensure that beneficiaries have the protection they deserve and need.

Reference: The News-Enterprise (March 15, 2022) “Customize estate plan to account for disabled beneficiaries”

What Happens to a Pet when Owner Dies?

Pet trusts are a legally binding arrangement in which the donor (the person creating the trust) formally outlines their wishes for how they want their pet to be cared for.

A few more people are involved in a pet trust, according to the article “’Paws-ing’ to plan: How you can ensure your pet’s future well-being with pet trust planning” from The Gilmer Mirror. A trustee oversees the way trust funds are dispensed, a caretaker, who is in charge of the pet’s care and an enforcer, who makes sure the donor’s wishes are followed. Donors may appoint a caretaker of their choice, or work with an agent to find someone suitable for their pet.

Unlike an informal promise to care for a pet made by a well-meaning friend or family member, the pet trust is legally enforceable, giving it more "teeth” than a verbal promise. There is nothing to stop the person you leave your pet with from doing whatever they wish with the pet, from leaving the pet at a shelter to selling the pet. With a trust, all parties are bound to use the money for its intended purposes and to follow pet care instructions.

What can you ask your pet’s caretaker to do? Anything you feel is necessary. It can be as basic or as detailed as you wish. The pet could be cared for as they were by you, with the same kind of food, attention and affection. They can also continue to be seen by the same veterinarian, if one is named in the trust.

Pet planning has become increasingly popular, as more people see their pets as members of the family. However, pet trusts are not just for house cats or dogs. Work animals, show animals, specially trained service and companion animals and animals used for breeding are also protected by pet trusts.

A pet trust could ensure the future of a highly trained show jumper, or to ensure a working dog ends up at a farm where she continues to herd sheep.

Pet trusts are especially important for people with service animals. A blind person who has bonded with a seeing-eye dog may only wish another blind person to inherit a seeing-eye dog. The trust could ensure that animals who have been trained to provide emotional support, or to detect health conditions like seizures, should go to individuals with these same challenges.

Individuals who live with highly trained service animals should consult an experienced estate planning attorney along with the organization that trained the animal to ensure a pet trust is created within the scope and requirements of the organization, as well as the wishes of the owner. The organization may be better able to place the animal, while adhering to the pet trust’s requirements.

A pet trust helps protect our beloved animal companions and provides peace of mind for their humans. It should be part of your overall estate plan and should be updated regularly.

Reference: The Gilmer Mirror (March 23, 2022) “’Paws-ing’ to plan: How you can ensure your pet’s future well-being with pet trust planning”

How Does the Caregiver Tax Credit Work?

Family caregivers who support loved ones are eligible for several tax credits and deductions. It’s not just for taking care of parents; other relatives may be covered as well, notes a recent article “If you are a caregiver of elderly parent, you may be eligible for tax breaks” from The Oklahoman. The IRS has different options and certain requirements must be met.

When a dependent mother lives with an adult child who pays for more than half of her living expenses—food, housing, utilities, health care, repairs, clothing, travel, and similar necessities—and if the mother’s gross income is under $4,300—the child can claim the mother as a dependent. The tax credit, which is nonrefundable, can be as much as $500.

When siblings are cooperative and everyone contributes to mom’s expenses, only one can claim the mother as a dependent. It has to be the adult child who pays for at least 10% of support costs. The IRS calls this a “multiple support agreement.” There’s information on the IRS website to help you figure out if you qualify for a “Credit for Other Dependents.”

Medical deductions are another credit. If an adult child claims a parent as a dependent and also pays medical, dental, and/or long-term expenses that are not reimbursed by insurance, the expenses in excess of more than 7.5% of the adult child’s Adjusted Gross Income (AGI) can be deducted.

For example, if the adult child’s AGI is $80,000, anything after the first $6,000 of the parent’s medical bills—7.5% of the AGI—could be deductible. If the parent’s medical bills were $8,000, $2,000 would be deductible. When calculating the total, include medical expenses for you and your spouse.

AGI thresholds vary by state, so if your state has a lower AGI, you might get a break on state income taxes, even if you do not qualify on federal income taxes.

What about in-home care or adult day care costs? They might also be covered, under the Dependent Care Tax Credit, and could be worth as much as $4,000. To qualify, the dependent parent must have been physically or mentally incapable of taking care of themselves and have lived with you for more than six months.

There is also the possibility of using funds from a Health Savings Account (HSA) or a Flexible Savings Account (FSA) from your employer to pay for a loved one’s medical expenses, as long as she is a qualified dependent. One caveat: if you use the funds from an HSA or FSA to pay for a dependent’s medical costs, you cannot take a tax deduction on the expenses.

Reference: The Oklahoman (Jan. 25, 2022) “If you are a caregiver of elderly parent, you may be eligible for tax breaks”

Should Inherited Money Be Equally Split Between Family Members

Leaving an equal amount to adult children works for many families, but equal is not always equitable. In those cases, leaving different amounts to heirs can lead to irreparable breaks within the family. A recent article titled “The Unequal Inheritance: It Can Work, or It Can ‘Destroy Relationships’” from The New York Times examines the problem and some of the solutions. There are times, however, when even the fairest of decisions doesn’t heal the “Mom always liked you best” hurt, imagined or otherwise.

Unequal inheritances can trigger sibling fighting after a parent dies, some of which end up in court, especially if one child thinks that a parent was being overly influenced by the sibling who ended up with the bigger inheritance.

Parents need to explain their decision to each child, individually and as a group, or even seek mediation. Many estate planning attorneys encourage a family meeting, where everyone is in a neutral location, to discuss the parent’s wishes and estate plan. In some cases, the children understand when one of the siblings is disabled or has a lower earning potential.

Another reason for unequal inheritances is to balance things out when one child received significant support that others did not need. Equalization of gifts can be documented in an estate plan, as heirs may need to be reminded of the parent’s generosity at an earlier date. If this isn’t addressed, the siblings who received less help during the parent’s lifetime may resent their decision to give equally.

What about the caregiving child? Some parents decide to give extra to the adult child who became their primary caregiver. That usually takes the shape of the family home, a larger cash distribution or life insurance proceeds. However, siblings don’t always agree on how this is handled. Some will see the child’s decision to care for their parents as manipulative.

Blended families with stepchildren run into complications often. The growth in stepfamilies is a big part of why Americans 50 and older left their children unequal bequests, which more than doubled from 16 percent in 1995 to 35 percent in 2010, as reported in a study from the National Bureau of Economic Research.

At the same time, the study also found that the longer the relationship, the more likely the parent would leave stepchildren inheritances equal to that of a biological or adopted child.

Even when parents intend to split the estate equally, failing to plan for taxes can leave children with different inheritances. This happens when parents leave different types of assets to different heirs.

If a parent left a $500,000 IRA to one child and a $500,000 taxable brokerage account to another, the child who received the IRA will pay federal income taxes up to 37 percent on every withdrawal, which now must be done within ten years of the death of the parent. The child with the brokerage account would have to pay a long-term capital gains tax of up to 20 percent, when an appreciated asset was sold.

Generally speaking, IRA and other tax deferred accounts should have all children as equal beneficiaries. These accounts are usually outside of the probate estate. A house may be left in a trust or the will, with directions for the house to be sold and all assets divided equally.

There is no way around it—inheritances are seen as a proxy for love, and any unequal distribution will be felt as such, even by the most rational of people. Speak with your estate planning attorney to learn how to avoid these scenarios and consider holding a family meeting to make sure your intentions and the reasons behind your intentions are made clear to all concerned.

Reference: The New York Times (Feb. 19, 2021) “The Unequal Inheritance: It Can Work, or It Can ‘Destroy Relationships’”

Preparing for the Impact of Alzheimer’s Disease

The impact of these diseases will not just be on the individuals, but on their spouses and families. Surveying 1,000 mass affluent and high net worth families currently caring for relatives with cognitive decline, the study found that the lifetime direct and indirect costs can be more than $750,000. A recent article from Think Advisor, “4 Things Advisors Should Know About Cognitive Disorder Caregiving,” explains how families can prepare for this challenge.

Expect expenses to grow over time. Most people with cognitive decline problems live for five to fifteen years, with an average cost of $750 per month early on. However, as the disease progresses, those expenses increase, to as much as $1,200 per month. Families need to work with an experienced estate planning attorney to apply for Medicaid as soon as the individual is diagnosed, or as soon as possible. Failing to plan may mean spending down all assets to qualify.

Cognitively impaired adults mismanage finances. This is often the first symptom that something is wrong. The study found that 80% of people with dementia experience financial mismanagement. Bills go unpaid, spending patterns change dramatically and they are often victims of financial elder abuse. If multiple calls concerning the same question are made to a family member, that should be treated as a warning signal that something is wrong.

Women continue to carry most of the caregiving responsibilities. Women make up about 66% of family caregivers. The impact on their ability to earn wages, from leaving the workplace for a time period, retiring early or leaving the workforce permanently, takes a huge toll on their income and savings. This also hurts future income, with losses to 401(k) plans, pensions and Social Security benefits.

Estate planning attorneys, CPAs and financial advisors are important resources for caregivers. The financial and emotional stress on caregivers, loss of income and pressure to avoid their own problems means that caregivers need support from family, friends and professionals. Planning for the legal and financial impacts of caregiving needs to happen proactively. Professionals are also in a position to help through their networks of colleagues, like geriatric social workers, nursing homes, etc.

Most people are happy to plan for college, retirement and vacations. No one likes to plan for difficult events, like disability and death. However, planning as early as possible allows the family to have more control during a difficult period of time. Allowing trusted professionals to become part of the support network can lessen some of the burden.

Reference: Think Advisor (Oct. 13, 2020) “4 Things Advisors Should Know About Cognitive Disorder Caregiving”

What Is a ‘Caregiver’ Agreement?

The idea that a family member or trusted friend may be paid to take care of an aging parent or sibling is a welcome one. However, most family members don’t understand the legal complexity involved in privately paying for care, says the recent article “Paying a family member for care” from The Times Herald. Payments made to a family caregiver or a private caregiver can lead to a world of trouble from Medicaid and the IRS.

This is why attorneys create caregiver agreements for clients. The concept is that the care and services provided by a relative or friend would otherwise be performed by an outside person at whatever the going rates are within the person’s community. The payment should be considered a fully compensated transfer for Medicaid eligibility purposes and should not result in any penalty being imposed if it is done correctly.

This is more likely to be avoided with a formal written caregiver agreement. In some states, like Pennsylvania, a caregiver agreement is required to be sure that the payments made to the caregiver are not deemed to be a gift under Medicare rules.

The caregiver agreement must outline the services that are being provided and the rate of pay, which can be in the form of weekly, monthly or a lump sum payment. This is where it gets sticky: that payment should not be higher than what an outside provider would be paid. An excessively high payment would trigger a red flag for Medicaid and could be viewed as a gift.

Medicaid has a five-year look back period, where the applicant’s finances are examined to see if there were efforts to minimize the person’s financial assets to qualify for Medicaid. If any transfers of property or assets are made that are higher than fair market value, it’s possible that it will be viewed as creating a period of ineligibility. That is why it’s so important to have a contract or written agreement in place, when a family member or other person is hired to provide those services and is paid privately.

There are also income tax consequences. The caregiver is considered a household employee by the IRS. They are not considered to be an independent contractor and should not be issued a 1099 to reflect their payment. If that is done, it could be considered to be tax evasion.

Speak with an estate planning attorney about crafting a caregiving agreement and how to handle the tax issue, when privately paying for care. They will help avoid putting Medicaid eligibility in jeopardy, as well as avoiding problems with the IRS.

Reference: The Times Herald (Aug. 13, 2020) “Paying a family member for care”

Elder Financial Abuse Risk Increasing for Seniors Isolated by Pandemic

The extended isolation and loneliness during the coronavirus pandemic is creating the perfect storm for financial exploitation of seniors, who are unable to visit with family members and friends, reports Fredericksburg Today in the article “SCC urges awareness of investment fraud among seniors due to increased pandemic isolation.” The unprecedented need to forgo socializing makes seniors who are already at risk, even more vulnerable.

In the past, scammers would deliberately strike during a health crisis or after the death of a loved one. By gathering data from obituaries and social media, even establishing relationships with support and social groups, scammers can work their way into seniors’ lives.

Social distancing and the isolation necessary to protect against the spread of the coronavirus has left many seniors vulnerable to people posing as their new friends. The perpetrators may not just be strangers: family members are often the ones who exploit the elderly. The pandemic has also led to changes in procedures in care facilities, which can lead to increased confusion and dependence for the elderly, who do not always do well with changes.

Here are a few key markers for senior financial abuse:

• A new friend or caregiver who is overly protective and has gotten the person to surrender control of various aspects of their life, including but not limited to finances.
• Fear or a sudden change in how they feel towards family members and/or friends.
• A reluctance to discuss financial matters, especially if they say the new friend told them not to talk about their money with others.
• Sudden changes in spending habits, or unexplained changes to wills, new trustees, or changes to beneficiary designations.
• Large checks made out to cash, or the disappearance of assets.
• Signatures on checks or estate planning documents that appear different than past signatures.

Not being able to visit in person makes it harder for family members to discern what is happening.  However, there are a few steps that can be taken by concerned family members. Stay in touch with the family member, by phone, video calls, texts or any means possible. Remind loved ones that scammers are always looking for an opportunity and may try to exploit them during the pandemic.

Every community has resources that can help, if elder financial abuse is a concern. An elder law estate planning attorney will be able to direct concerned family members or friends to local resources to protect their loved ones.

Reference: Fredericksburg Today (June 20, 2020) “SCC urges awareness of investment fraud among seniors due to increased pandemic isolation”