Paul O. Dillon, Attorney at Law

How Important Is a Health Care Power of Attorney?

Health care decisions are often the most personal and private decisions a person can make. Information about your health can be very sensitive and if revealed to the wrong person, cause embarrassment, job loss and harm to your reputation. The HIPAA law (Health Insurance Portability and Accountability Act of 1996) was created to provide restrictive protection of medical care. A recent article from The Sentinel titled “Elder Care: The power of an informed healthcare agent” explains how this law makes it more important than ever to have a Healthcare Power of Attorney (POA) in place.

If you think you’re too young or healthy to need a health care POA, think again. If a sharp decline in health occurs, your dignity and care may fare far better with a POA than without, for several reasons. For one, if done in advance, you are the one who chooses who your health care advocate will be.

You may not think an estate planning lawyer’s office is the place to go to deal with important health care decisions. However, this is an important part of your estate plan. Planning for incapacity is as much a part of estate planning as is planning for asset distribution postmortem.

What would happen if you were still alive but not able to understand what is happening around you or unable to speak for yourself? Who would you want making critical medical decisions on your part? Your estate plan includes a Health Care Power of Attorney, which authorizes a person of your choice to be your advocate and authorize or refuse medical treatment, based on the wishes you express in this important document.

Giving someone you trust the power to make health care decisions for you has to be done while you still have capacity. Once you are incapacitated by a medical emergency, even if you have some limited ability to express your wishes, you are not legally permitted to sign this document.

A Health Care Power of Attorney is valuable even without a sudden decline in health or a serious diagnosis. Even in routine medical situations, there are benefits to naming a health care agent. Let’s say you go in for a routine colonoscopy, which is a common procedure for anyone over age 50. Several polyps are discovered and someone has to authorize the doctor’s taking them out. If you have a Health Care Power of Attorney and your agent is waiting nearby, they can authorize the removal. If not, and if the doctor has not asked for prior consent to remove the polyps, then you’d have to wait for a post-procedure meeting with the doctor and then undergo the entire procedure all over again.

Ideally, more than one person should be named as your health care agent. If the primary person is not reachable and an emergency occurs, someone else will be able to step up and help as needed.

Your estate planning attorney should also prepare a Living Will to provide guidance on end-of-life medical decisions. This includes whether you want to be resuscitated, how much medical treatment you would want in case of severe and irreversible brain damage and what life-extending procedures you’d want if you are dying from an end-stage medical condition.

Your estate planning attorney will help guide you through these decisions, since they are ultimately yours to make. However, the idea of having them in place before they are needed puts you in charge of what will happen when you can’t speak for yourself. It’s not easy to consider, but better done than left undone.

Reference: The Sentinel (Sep. 23, 2022) “Elder Care: The power of an informed healthcare agent”

Planning for Long-Term Care Before It’s Too Late

Starting to plan for elder care should happen when you are in your 50s or 60s. By the time you are 70, it may be too late. With the national median annual cost of a private room in a nursing facility coming in at more than $100,000, not having a plan can become one of the most expensive mistakes of your financial life. The article “Four steps you can take to safeguard your retirement savings from this risk” from CNBC says that even if care is provided in your own home, the annual median national cost of in-home skilled nursing is $87.50 per visit.

There are fewer and fewer insurance companies that offer long-term care insurance policies, and even with a policy, there are many out-of-pocket costs that also have to be paid. People often fail to prepare for the indirect cost of caregiving, which primarily impacts women who are taking care of older, infirm male spouses and aging parents.

More than 34 million Americans provided unpaid care to older adults in 2015, with an economic value of $522 billion per year.

That’s not including the stress of caring for loved ones, watching them decline and needing increasingly more help from other sources.

The best time to start planning for the later years is around age 60. That’s when most people have experienced their parent’s aging and understand that planning and conversations with loved ones need to take place.

Living Transitions. Do you want to remain at home as long as is practicable, or would you rather move to a continuing care retirement community? If you are planning on aging in place in your home, what changes will need to be made to your home to ensure that you can live there safely? How will you protect yourself from loneliness, if you plan on staying at home?

Driving Transitions. Knowing when to turn in your car keys is a big issue for seniors. How will you get around, if and when you are no longer able to drive safely? What transportation alternatives are there in your community?

Financial Caretaking. Cognitive decline can start as early as age 53, leading people to make mistakes that cost them dearly. Forgetting to pay bills, paying some bills twice, or forgetting accounts, are signs that you may need some help with your financial affairs. Simplify things by having one checking, one savings account and three credit cards: one for public use, one for automatic bill-paying and a third for online purchases.

Healthcare Transitions. If you don’t already have an advance directive, you need to have one created, as part of your overall estate plan. This provides an opportunity for you to state how you want to receive care, if you are not able to communicate your wishes. Not having this document may mean that you are kept alive on a respirator, when your preference is to be allowed to die naturally. You’ll also need a Health Care Power of Attorney, a person you name to make medical decisions on your behalf when you cannot do so. This person does not have to be a spouse or an adult child—sometimes it’s best to have a trusted friend who you will be sure will follow your directions. Make sure this person is willing to serve, even when your documented wishes may be challenged.

Reference: CNBC (Jan. 31, 2020) “Four steps you can take to safeguard your retirement savings from this risk”

Life Insurance Is a Good Estate Planning Tool but Needs to Be Done Carefully

With proper planning and the help of a seasoned estate planning or probate attorney, insurance money can pay expenses, like estate tax and avoid the need to liquidate other assets, says FEDweek’s recent article entitled “Errors to Avoid in Using Life Insurance for Estate Planning.”

As an example, let’s say that Reggie passes away and leaves a large estate to his daughter Veronica. There’s a big estate tax that’s due. However, the majority of Reggie’s assets are tied up in real estate and an IRA. In light of this, Veronica might not want to proceed directly into a forced sale of the real estate. However, if she taps the inherited IRA to raise cash, she’ll be required to pay income tax on the withdrawal and forfeit a very worthwhile opportunity for extended tax deferral.

If Reggie plans ahead, he could purchase insurance on his own life. The proceeds could be used to pay the estate tax bill. As a result, Veronica can retain the real estate, while taking only minimum required distributions (RMDs) from the inherited IRA.

If the insurance policy is owned by Veronica or by a trust, the proceeds probably won’t be included in Reggie’s estate and won’t increase her estate taxes.

Along these same lines, here are some common life insurance errors to avoid:

Designating your estate as beneficiary. When you make this move, it puts the insurance policy proceeds into your estate, exposing it to estate tax and your creditors. Your executor will also have to deal with more paperwork, if your estate is the beneficiary. Instead, name the appropriate people or charities.

Designating just a single beneficiary. You should name at least two “backup” beneficiaries. This will decrease any confusion, if the primary beneficiary predeceases you.

Throwing the copy of your life insurance policy in the “file and forget” drawer. You should review your policies at least once every few years. If the beneficiary is an ex-spouse or someone who’s passed away, make the appropriate changes and get a confirmation from the insurance company in writing.

Failing to carry adequate insurance. If you have a youngster, it undoubtedly requires hundreds of thousands of dollars to pay all her expenses, such as college bills, in the event of your untimely death.

Talk to a qualified and experienced estate planning attorney about the particulars of your situation.

Reference: FEDweek (Dec. 12, 2019) “Errors to Avoid in Using Life Insurance for Estate Planning”

How Do I Tell If Dad Needs Caregiving Support?

When you're visiting older family members, you have a chance to judge how they're doing in terms of health, safety, and quality of life. AARP’s recent article, “5 Signs Your Loved One May Need Caregiving Support,” advises us that any of the following five red flags may indicate that your parent needs help.

1. Falls and safety. Look for things like unsafe indoor or outdoor stairs, especially without railings or poor lighting, along with loose rugs, clutter, or a laundry room that makes your mom or dad carry laundry baskets up and down stairs. You should evaluate fall hazards with a certified aging in place specialist (CAPS), an aging life care specialist, or a physical or occupational therapist. They can help evaluate your parent's needs, abilities and the home environment. Consider installing safety measures, such as ramps, handrails on both sides of stairs, grab bars in the bathroom, or a walk-in shower.
2. Unfinished business. If you see a lot of unopened mail and unpaid bills, or key financial, home or legal documents that haven't been addressed, your mom may be cognitively, physically, or emotionally unable to handle them. You may want to help your parent simplify her affairs or engage a financial manager. You can also volunteer to assist with the more complicated matters, while she continues handling day-to-day household and personal finances. You should also be sure your parent has advanced directives and other legal documents in place, so you are able to help manage her affairs in an emergency.
3. Auto accidents and moving violations. When you see multiple accidents—even minor fender benders—or several warnings or citations, scrapes, or dents on the car, it's time to discuss driving. You can ride along and observe any health issues causing problems like vision, hearing or cognitive changes. You can suggest that he refresh his driving skills by taking a driver safety course, or if it's time to stop driving, give him other viable transportation options.
4. Isolation. Does your mom appear to be disconnected from friends, family and community? If her support system seems to be deteriorating, her physical and mental well-being are at risk. Discover with whom she regularly interacts. Ask if she feels lonely. Look for some activities she’d enjoy and help make arrangements for ongoing participation and transportation. Regular phone calls can help her connect, as well as using technology, including video chat, online communities and social media.
5. A change in appearance. If you notice a change in your mom’s appearance, like a big gain or loss of weight, wearing the same clothes every day, or lack of personal hygiene, or if she appears sad, anxious, and distressed or has sleep issues—something is not right. Propose a complete medical and psychological evaluation to determine what’s normal for her, because there may be several reasons for these changes. Depression or anxiety may call for treatment.

Review her medications with a pharmacist and set up a pill organizer for her. Find out how she’s making or receiving meals. If appropriate, arrange for home-delivered meals, housekeeping, medication management and laundry assistance.

Tackle these conversations with love, concern, and a supportive attitude. Your objective is to help her remain as independent as possible, for as long as possible.

Reference: AARP (December 12, 2019) “5 Signs Your Loved One May Need Caregiving Support”

What are the Major Changes to Social Security in 2020?

Social Security supports millions of Americans, giving them vital benefits in retirement or if they are disabled. For many of those recipients, Social Security contributes most or all of their income.

Motley Fool’s recent article, “4 Must-Know Facts About Social Security for 2020,” says that to get as much as you can from Social Security, you need to understand how each year's changes will impact you. With benefit checks, retirement age, maximum benefit calculations and Social Security payroll taxes, there's quite a bit for people to monitor with Social Security in 2020. Let’s look at few big changes:

1. Next year’s cost-of-living adjustment. Every year, Social Security gives those receiving benefits a cost-of-living increase in their monthly checks. The amount varies from year to year, based on inflation figures. The SSA recently announced that it would increase benefit checks by 1.6% at the start of 2020. This bump will impact seniors in different ways. The typical retired worker will see monthly benefits rise from $1,479 to $1,503. For couples receiving two benefit checks, the typical total will rise by $40 to $2,531 per month. If you're receiving Social Security benefits based on a family member's work history, you'll also see increases. Widowed parents with two children will see $46 more per month ($2,934). Surviving spouses without eligible children will receive a $22 per month increase to $1,422, while the typical disabled worker will see checks go up $20 to $1,258 per month.
2. Early retirees in 2020 will see a higher full retirement age. The SSA figures your benefits using a formula that anticipates that you'll claim Social Security when you reach full retirement age. If you claim earlier, then you'll receive less than if you had waited. However, for those turning 62 in 2020, full retirement age will be slightly higher than it was for those turning 62 in 2019. Those born in 1958 will have a full retirement age of 66 and eight months—two months older than it was for people who were born in 1957 and reached 62 in 2019. Thus, 2020's 62-year-olds will take a 28.33% reduction in their monthly payment, compared to what they'd get at full retirement age. That's a little more than the 27.5% reduction that applied to 2019's 62-year-olds.
3. High earners can anticipate a larger maximum Social Security benefit. If you retire in 2020 and qualify for the maximum benefit, you'll see a bigger check than those who retired this year. If you work to full retirement age before collecting benefits, your maximum amount for Social Security benefits will be $3,011. That’s an increase of $150 from 2019.

However, not every increase will be that large, because receiving the maximum depends significantly on exactly when you elect to retire and take benefits. For those claiming Social Security at 62, the maximum monthly benefit will go up $56 to $2,265. Those retiring at 65 will see a $100 increase to $2,857 per month. However, for those retiring at age 70, the increase will be minimal, increasing only $20 to $3,790 per month. Even if you end up short of the absolute maximum, those earning higher incomes can generally expect to see a boost to what they'll receive.

4. High-income workers can plan on paying more in Social Security taxes. Payroll taxes are the main source of revenue for Social Security, and the maximum Social Security payroll tax is going up. In 2020, $4,800 more in earnings will be subject to payroll tax, maxing out at $137,700. Between the 6.2% employee portion and the matching 6.2% employers have to pay, a total of 12.4% of your earnings will be taken by federal government.

Those earning in excess of $137,700, will have their withholding increase by $297.60. Self-employed workers will see their maximum taxes rise by $595.20. However, most workers won't see any change at all, because typical Americans earn far less than $137,700, and the same 6.2% rate will continue to apply on total earnings below that amount.

Reference: Motley Fool (October 27, 2019) “4 Must-Know Facts About Social Security for 2020”

Does Your Retirement Plan Include Long Term Care Insurance?

Roughly 60% of those turning 65 can anticipate using some form of long-term care in their lives, according to the U.S. Health and Human Services Department. It may be a nursing home, assisted living, or in-home care.

CNBC’s recent article, “Not having long-term care insurance can be ‘the single biggest devastator’ of your financial plan,” reports that over 8 million Americans have long-term care insurance. However, the cost of that insurance is rising. This increase is because of several factors, including the fact that companies underpriced their policies for years and misjudged how many would drop coverage.

Because of those rising premiums, some individuals may choose self-insurance. That means saving a pool of money to earmark for long-term care. Coverage is also available through Medicaid, which has eligibility requirements.

Even with these increases, you should purchase some form of coverage. This is because not being insured can be the biggest devastator of a financial plan.

The rule of thumb has been to buy LTC coverage at age 55. However, it really depends on your situation. The big unknown is health, and the odds of being able to qualify for coverage at age 60, compared to age 30 or 40 is vastly different.

A traditional LTC policy will cover the costs of care for a certain period of time, generally up to six years. The amount of coverage is based on the average cost of care for your location. Most insurers offer it in the form of a monthly benefit, and possibly with some inflation protection.

There’s also a hybrid policy that covers long-term care costs but becomes life insurance paid to heirs, if it’s not used. Of the 350,000 Americans who purchased long-term care protection in 2018, 85% chose the hybrid coverage. It’s also called combo or linked-benefit. The big difference is price: you’ll pay more for the hybrid policy.

Medicaid is another option, particularly if you don’t have a way to save. To be eligible, you must deplete your assets. You can also work with an attorney to find out how you can shield your assets, before you need care. Medicaid also looks back five years into your finances, so if you have given away any money during that period of time, it will be subject to penalty.

Reference: CNBC (October 14, 2019) “Not having long-term care insurance can be ‘the single biggest devastator’ of your financial plan”

Should I Add My Elderly Dad as a Co-owner of My Checking Account?

There are several issues to consider when you add an elderly parent as a co-owner of your checking account, says nj.com in its recent article, “Is having a joint bank account with my father going to cause any problems?”

The father is still a named joint holder of the account, so he can withdraw some or all of the funds in the checking account at any time. As a result, the transfer is neither a completed gift nor a payment from the father to the adult son, until the son withdraws funds.

If the elderly father predeceases the adult son, the checking account would be included in his taxable estate. There may be taxes due on the estate, depending on the size of the estate and the state in which he lives, since some states have their own estate taxes at much lower levels than the federal thresholds. In New Jersey, there is a procedure where a tax waiver would need to be obtained to release the funds to the son in this case.

If the adult son dies before his father, the checking account funds would automatically pass to the father by operation of law, and not pursuant to the terms of the son’s will, nor to his children or spouse.

In light of the fact that the father can withdraw the funds during his lifetime as a joint holder of the account, those funds in the checking account are subject to him being a victim to scams.

To safeguard these funds, the adult son should take the time to properly title the checking account. If the transfer of funds was a gift to the son in excess of $15,000, the father would also need to file a Form 709, U.S. Gift and Generation-Skipping Transfer Tax Return, even if no tax is due because the federal gift and estate tax exemption is at $11.4 million per person.

If the transfer was made by the father to qualify for Medicaid, it is important to understand that the Medicaid five-year look-back period and penalty could be an issue. The look back is from the time of the application. Any gifts or transfers made within this period, are subject to a penalty, that is equal to a period for which Medicaid benefits are denied. Since the transfer isn’t complete until the son removes his father’s name from the account, for purposes of Medicaid qualification, it would be best to remove the father’s name ASAP.

A joint account may also be subject to legal judgments, collections and other debt collection efforts.

Reference: nj.com (September 25, 2019) “Is having a joint bank account with my father going to cause any problems?”

How Will New Legislation Update Social Security?

People with disabilities who receive Supplemental Security Income would be allowed to keep a few more assets and wouldn’t be penalized for marrying under a new proposal, according to Disability Scoop’s recent article, “Lawmakers Look To Update SSI Program.”

Right now, in order to retain benefits, SSI recipients generally can have no more than $2,000 to their name at any given time. However, Congress is looking to significantly increase that ceiling, with a bill introduced this month that would increase SSI’s asset limit to $10,000 for an individual and $20,000 for couples.

The Supplemental Security Income Restoration Act would also increase the amount of disregarded income that beneficiaries can collect monthly.

The bill would also repeal penalties for marrying or receiving financial, food, and housing assistance from family members.

Supporters of the Act say it’s time to update Social Security’s SSI program, which has remained largely static since 1972.

“This issue is one I have heard about directly from autism advocates and families in our district, particularly parents preparing for children with disabilities to transition into adulthood,” said Rep. Elissa Slotkin, D-Mich., who introduced the measure along with Rep. Raúl Grijalva, D-Ariz.

“This bill brings the Supplemental Security Income (SSI) program’s outdated limits up to speed with inflation—a common-sense adjustment that will make a huge difference for individuals and families caring for someone with disabilities.”

Reference: Disability Scoop (September 23, 2019) “Lawmakers Look To Update SSI Program”

What is Florida Doing to Protect Seniors from Exploitative or Neglectful Guardians?

Orlando Sentinel’s recent article, “DeSantis, Florida lawmakers consider changes in troubled guardianship program,” reports that legislative leaders and officials of Governor Ron DeSantis’ administration met with judges, guardianship trade groups, state attorneys and people from the Elder Law section of the Florida Bar to talk about ways to protect seniors from exploitative or neglectful guardians.

“More must be done to enhance the structure of accountability for guardians to monitor compliance with established standards of practice and ensure that guardians are acting in the best interests of their wards,” Department of Elder Affairs Secretary Richard Prudom said. “The matter is complex, and the solution extends beyond the Department of Elder Affairs; families, local communities, and public officials must also work together to prevent all forms of exploitation to provide safety and security for all.”

The recent news concerning guardian Rebecca Fierle, who investigators say was responsible for more than 400 wards and regularly signed “Do Not Resuscitate” orders for clients against their wishes, has rekindled interest among lawmakers for more control over Florida’s 550 registered guardians.

Senator Kathleen Passidomo and Representative Colleen Burton participated in the meeting and said some of the ideas being discussed include limiting the number of cases each guardian has and requiring a judge to approve a DNR order. Other ideas include increased standards for guardians and more thorough monitoring.

The lawmakers say there’s no need to increase the requirements to become a guardian. All that is required now is a 40-hour course and passing an exam. Passidomo said the issue isn’t a lack of competence, but the risk for abuse.

As a result, standards and monitoring of guardians must be increased. However, these ideas are merely being discussed, as lawmakers have yet to present a concrete plan.

Governor DeSantis will publish a budget request for the Department of Elder Affairs, which includes the Office of Public and Professional Guardians, which could include more funds for investigators to review complaints. The OPPG has only four employees. Prudom has taken control of the department since July, when he asked Carol Berkowitz, the agency’s executive director, to resign because of the Fierle case.

Reference: Orlando Sentinel (September 16, 2019) “DeSantis, Florida lawmakers consider changes in troubled guardianship program”

What is Michigan Doing to Combat Elder Abuse?

The Michigan uniform investigative and reporting form will be sent to police departments by state law enforcement associations. They will also receive a list of best practices for elder abuse investigations and videos to assist in training on those best practices, according to The Detroit News’ recent article, “Mich. task force rolls out new elder abuse reporting form.”

“People are not getting caught and this is one of the reasons,” Attorney General Dana Nessel said at a press conference announcing the initiative Tuesday. The model’s development is part of the ongoing work of the Elder Abuse Task Force established this year.

The Attorney General remarked that the form will bring some clarity to what can be, a complicated investigation. Law enforcement must look for signs of physical abuse or neglect, as well as financial evidence from banks, legal documents and purchases.

“People will know now that law enforcement is really paying attention to crimes that earlier, it wasn’t that they didn’t care about, it was that they needed assistance in identifying these crimes,” Nessel said. “Now people know that they’re watching these types of offenses.”

Michigan doesn’t have a specific elder abuse statute, so many elder abuse cases are investigated using a standard police report form that looks to establish whether the suspected crime could fall under the vulnerable adult statute, said Assistant Attorney General Scott Teter, division chief for the department’s Financial Crimes Unit.

“It’s a very complex crime,” Teter said. “There’s not a lot of teaching in the police academy on it.”

The program helps to create best practices across the state for the investigation and prosecution of elder abuse, according to Michigan State Police Director Joe Gasper. He said that it’s similar to a standardized form created in 1994 to help law enforcement investigating domestic violence cases.

“The form aids in identifying not only physical abuse but financial abuse,” Gasper said. “This will be a good foundation for all law enforcement to follow.”

The new form will prompt officers to identify items that may qualify a person as a vulnerable adult, like if they need assistance walking, cooking, bathing, driving, or taking medication. Officers will use a checklist for potential signs of physical risks, like bodily injury, dehydration, soiled conditions, bad odors or malnutrition. The form also requires officers to find out if a senior is at risk of financial harm through a “parasitic” caregiver, poor care, the person controlling the victim’s bank account, or through legal provisions that remove an individual’s decision-making capacity, such as guardianships, conservatorships or power of attorney.

Among the evidence collected in a financial harm investigation are copies of all legal documents, financial statements, vehicle titles and photographs of the senior’s living conditions.

Reference: The Detroit News (September 10, 2019) “Mich. task force rolls out new elder abuse reporting form”