El Cuidado de Atención de Largo Plazo: Información Importante para Ud. y sus familiares

Hace unos meses, dí una breve presentación sobre el cuidado a largo plazo para los ancianos y discapacitados. Al contemplar mi propia mortalidad, la de mis padres y la de mis clientes, quise escribir un post sobre este tema. Es un poco largo, pero te prometo que aprenderás algo valioso.

Los estadounidenses tienden a pensar: “Tengo seguro médico, así que estoy cubierto.” Y mientras esto puede ser cierto para la atención médica de rutina, visitas al médico, recetas medicas, hospitalización y algunos tipos de rehabilitación, no se extiende a cuidado a largo plazo.

¿Qué es el cuidado de atención de largo plazo ? Yo podría definirlo, pero el Instituto Nacional de Salud (NIH) hace un mejor trabajo al explicarlo aquí. Cuando escuchamos “cuidado a largo plazo ” a menudo visualizamos una persona mayor, pero eso no es siempre el caso.  Cualquier persona puede enfermarse en cualquier momento y requiere de cuidados a largo plazo en una institución . Como estadounidenses estamos viviendo más tiempo debido a una mejor atención médica, los avances en la ciencia, los factores ambientales y, si tienes suerte, buenos genes. Inevitablemente, sin importar sus genes, todos nos vamos a enfermar. Simplemente no sabemos como ni cuándo.

La mayoría de nosotros no estamos preparados para financiar nuestras estancias a largo plazo en un hogar de ancianos. Y es costoso, más costoso que pagar por un año de universidad ( pública o privada ), una boda y, en algunos estados, el valor de los pagos de la hipoteca por un año . Durante mi presentación me referi a esta infografía y hace el costo económico realidad. Afortunadamente, hay maneras de planificar la financiación de cuidado de atención de largo plazo. Cuanto antes lo haga, más opciones tiene disponible. Ninguna de las opciones son baratas, pero las opciones posteriores son mucho más costosos – y no me refiero sólo al dinero.

a)       Pago privado . Esto es exactamente lo que significa. Usted o un ser querido paga de su bolsillo por largo plaza la atención en un centro . La mayoría de nosotros ahora sobrevivir a nuestros ahorros , especialmente a la luz del costo financiero muy alto asociado con el envejecimiento. Pero , si usted es uno de los relativamente pocos que se encuentran en el tramo impositivo exclusiva de “extremadamente ricos ” – felicitaciones. Ahora , para el resto de nosotros.

b)       Un seguro de atención de largo plazo ( LTC en ingles) . Yo se lo podría explicar pero creo que el Instituto Nacional de Salud ( NIH ) hace un mejor trabajo al definirlo aqui. El LTC es un seguro que usted paga para que pueda cuidar de usted en caso de necesitarlo en la incapacidad o vejez. Porque soy un gran fan de las infografías, aquí comparto otro del ano 2013 , que ilustra las tasas de aceptación y rechazo de seguros LTC en base a la edad, y también el costo de mantenerla.

De nuevo, lo mejor es planear lo mas pronto posible, porque una vez que se enferme, este tipo de seguro ya no está disponible para usted. Una advertencia: El seguro LTC probablemente no cubrirá toda su atención a largo plazo las necesidades para el tiempo que lo requieran. Este último es suponiendo que viva mas allá  del periodo de cubrimiento de la póliza; es decir, el dinero se acaba antes de Ud. morir. El seguro LTC seguro está destinado a ser un cojín de clases, para retrasar o prevenir el gasto de su bolsillo, separarse de sus activos , o la solicitud de Medicaid. Aplicando para Medicaid es el siguiente paso para muchos, pero no deja de tener problemas .

c )     Medicaid. Es un programa de seguro medico para personas con bajos ingresos. Para las personas   mayores calificar, deben de cumplir con ciertos límites de ingresos y recursos. Y esos límites son bajos y, en la opinión de algunas personas, casi cerca de indigencia . Aproximadamente 2/3 de los residentes de hogares de ancianos dependen de Medicaid para su cobertura médica y la mayoría de esas personas han trabajado con un abogado con el fin de calificar porque tenían “demasiado” en bienes. Y usted se sorprendería al conocer lo que consideran “demasiado.”

A diferencia de el seguro de atención de largo plazo, Medicaid continuará cubriendo su atención médica –mientras que cumpla con los requisitos del programa. Es posible que Medicaid pueda cubrir su cuidado de largo plazo hasta su muerte. Algo muy importante, Medicaid es el único seguro de salud que cubre el cuidado de largo plazo. Este enlace proporciona proporciona información sobre el program de Medicaid en mi estado natal, Nueva York.

d)    Hipoteca Inversa. Esta es una opción para las personas que tengan al menos 62 años de edad y han pagado su hipoteca por completo o que tienen más equidad en su casa que el balance de la hipoteca .  El importe de la hipoteca inversa debe ser suficiente para pagar su hipoteca (si es necesario), vivir en la casa y mantenerla, pagar facturas o deudas de algún tipo, fondos de renovaciones en su casa o tener ahorros para lo inesperado. Usted puede obtener una hipoteca inversa y nunca tocar un centavo de ella. Tengo poca experiencia con las hipotecas inversas, así que voy a dejar que La Comisión Federal de Comercio de los Estados Unidos proporcione más información aquí.

Por último, y como un bono por leer este post hasta el final, es una infografía de la financiación de envejecimiento en los Estados Unidos- y sin duda cuenta una historia. Hágase un favor grande, a planear y a planear temprano … y a compartir este post con los demás!

Mi próximo post será sobre la protección legal en lo que se refiere a cuidado de atención de largo plazo, principalmente en la formación de un fideicomiso y otros mecanismos legales. Haciendo esto puede salvaguardar sus bienes y anticipar su futuro cuidado de atención de largo plazo. Para planificar adecuadamente, necesitará un abogado apoyándolo.

Para aprender más sobre mí, visita mi sitio web aquí y conéctate conmigo en Twitter, Facebook y Google +

Your government will not take care of you…so you have to: a post on paying for long-term care

A few months ago, I gave a brief presentation on long term care for the elderly and disabled. As I contemplate my own mortality, that of my parents and the people I come into contact daily– I thought I’d write a post about it. It’s a little long, but I promise you’ll learn something valuable.

Americans tend to think, “I have medical insurance so I’m covered.” And while this may be true for routine medical care, doctor’s visits, prescriptions and in-patient hospitalization and some types of rehabilitation, it does not extend to long-term care.

What is long-term care? I could define it, but the National Institutes of Health does a better job explaining it.

When we hear “long-term care” we often visualize an older person, but that is not always the case. Anyone can become ill at any time and require long term care in a facility.  As Americans we are living longer due to better medical care, advances in science, environmental factors and, if you’re lucky, good genes. Inevitably, no matter your genes, you will become ill. We just do not know from what-or when.

Most of us are not prepared to finance our long term stays in a nursing home. And it’s expensive, more expensive than paying for one year of university (private or public), a wedding and in some states, a year’s worth of mortgage payments. During my presentation I referenced this infographic and the dollars and cents really do make it real. It is worth a look.

Thankfully, there are ways to plan the financing of long term care. The earlier you do it, the more options you have. While none of the options are cheap, the later options are much more costly – and I am not just referring to money.

a) Private pay. This is exactly what it means. You or a loved one pays out of pocket for your long-term in care in a facility. Most of us will far outlive our savings, especially in light of the very high financial cost associated with aging.

But, if you are one of the relatively few who find themselves in the exclusive tax bracket of “exceedingly wealthy”- congratulations. Now, for the rest of us.

b) Long-term care insurance (LTC). I could tell you what it is, but the National Institutes of Health (NIH) does a better job of defining it here. It is insurance that you pay for so that it can take care of you should you need it.  Since I am a huge infographic fan here is another one, from 2013, that illustrates rates of  LTC insurance acceptance and rejection based on age, as well as the cost to maintain it

Again, the earlier you plan the better off you are. Because once you become ill, this type of insurance is no longer available to you.

One caveat: LTC insurance will likely not cover your entire long term care needs for the time you will require it. The latter is assuming you live past the period for which it will cover your needs i.e. the money runs out before you die. LTC insurance is meant to be a cushion of sorts, to delay or prevent spending out of pocket, parting with your assets, or applying for Medicaid. Applying for Medicaid is the next step for many, but it is not without challenges.

c) Medicaid. It is a needs based insurance program. In simplest terms, you must meet certain income and resource limits in order to qualify. And those limits are low- and in some people’s opinions- almost near indigency.

About 2/3 of nursing home residents rely on Medicaid for their medical coverage and a majority of those people worked with an attorney in order to qualify because they had “too much” in assets. And you’d be surprised to learn what “too much” is.

Unlike long term care insurance, Medicaid does not “run out” and will continue to cover your medical care —as long as you meet income and resource eligibility. It can quite possibly cover your long term care needs until your death. Very important, Medicaid is the only health insurance that covers long term care; Medicare has never and will never do so.

This link provides a succinct overview of the income and resource limits required in my home state, New York.

d) Reverse Mortgage. This is an option for individuals who are at least 62 years old and have either paid off their mortgage completely or have way more equity in their home than a mortgage balance. The amount of the reverse mortgage should be sufficient to pay off their mortgage (if necessary), live in the home and maintain it, pay off bills or debts of any kind, fund home renovations or to have a “nest egg” for the unexpected.

You can obtain a reverse mortgage and never touch a penny of it.  I have little experience with reverse mortgages, so I will let US. Department of Housing and Urban Development (HUD) provide further information here.

Lastly, and as a bonus for reading this post to the end, is one last infographic painting a literal picture of financing aging in the U.S.  Pictures definitely tell a story.

Do yourself a big favor, plan and plan early…and share this post with others!

My forthcoming post will be about how legal protection, in the form of a trust document (and other legal mechanisms), can safeguard your assets as you anticipate long term care needs in your future. To properly plan, you will need a lawyer in your corner.

To learn more about me, visit my law practice website here and connect with me on Twitter, Facebook and Google + 

It can never be too early, but it can always be too late

As a solo practitioner, I now find myself doing a lot of networking. In recent months the phrase, “It can never be too early, but it can always be too late” has become a part of my lawyer lexicon. I think it is a phrase that is applicable to certain parts of our lives, but it definitely applies when speaking about what I do– mainly the practice of elder law and trusts and estates.

I generally deal with an older population- people who have lived life,  gained insight and experience (or maybe not) and, at the very least,  have a life to reflect on. But I also meet with younger people: single, married, with or without children, whose own  experiences have influenced their life outlook.  There is never a right age to plan for the future- it really depends on the person and their circumstances.  Some people need to feel “ready” to do so. News flash–you’ll never be 100% ready for anything.

People procrastinate when it comes to estate planning. My own parents did it, so it does not surprise me. I think estate planning, in general, really forces us to confront  our own mortality and to literally take stock of our lives– and our life’s work.

We will all die one day. You do not know when or how, but you know it will happen. This a scary thought for many of us. Who wants to think about drafting a will where you decide who gets what when you die…before you actually do? Morbid? No. I just call it smart.

I  hope to be a very old lady who dies peacefully in her sleep. I want to age and die with dignity, like everyone should. But I do not call the shots when it comes to my aging and dying– that is genetics and the luck of the draw.  Who wants to think about what happens if you can no longer take care of yourself or live independently? Who wants to think about who will make medical decisions for you if you can  no longer make those decisions competently? Scary stuff. Scarier still? Leaving those decisions to someone you would not have chosen to make them for you- just because you did not make that election when you had the opportunity.

I was taught from a young age that we have to confront the things that scare us in order to move forward.  I have learned that when I have confronted frightening situations: 1) I am stronger than I thought, 2) What I thought was scary really was not, and 3) That everything in life comes and passes. As quickly as it came, it can also go away.  In sum, we overcome.  Survival is what human beings do best.

Do not be afraid. Confront your mortality head on. Plan ahead.  Believe me, you will fee a lot of better if you do. Who does not like being in the driver’s seat?

How exactly did SHE become a foster parent?

Imagine my anger when I am surfing the internet and come upon this article in the New York Daily News,”Brooklyn tot covered in bruises fights for his life after suffering horrific abuse, mom eyed.”  The toddler, who had been removed from the custody of his biological mother and placed in foster care, is currently clinging to life and suffering from various internal injuries to major organs- as well as evidence of past injuries to his body. According to the article, the seriousness of his injuries were clearly visible to anyone looking at his battered little body.

Coming from a child welfare law background I know that foster care agencies usually scrutinize potential foster parents very closely- even those who are biologically related to the children they intend to care for. If you  had past involvement with child welfare authorities, either in or out of Court, and have “indicated” or substantiated cases of abuse or neglect  in the State Central Register for Child Abuse and Maltreatment (SCR) then you cannot become a foster parent nor are you in a position to adopt a child.

What is also lesser known, is that foster care agencies also conduct criminal background checks of potential foster parents, and  individuals over the age of 18 who reside in the same home or who could come into regular contact with the child. In addition, once a child is placed in foster care regular visits by a caseworker are required to ensure the health and safety of the child.  So it really blows my mind how this woman could have fallen through the cracks–and how no one- NO ONE noticed the multiple beatings this child took.  Body checks are part of caseworker visits, particularly for babies and small children. Fact.

Out of curiosity, I googled  “requirements to become a foster parent” and was taken directly to New York State’s Office of Children and Family Services (OCFs) website and read this. What struck me was this paragraph:

“Character: Each applicant for certification or approval must be required to provide the agency with the names of three persons who may be contacted for references. The agency must seek signed statements from these individuals attesting to the applicant’s moral character, mature judgment (emphasis added), ability to manage financial resources, and capacity for developing a meaningful relationship with children, or interview the individuals in person.”

AND THIS ONE:

Criminal History Record Check

The agency must (emphasis added) send the fingerprints to the New York State Office of Children and Family Services (OCFS) where they are then sent to DCJS to conduct a search of its database and for DCJS to send the fingerprints to the FBI for a search of its database (emphasis added). The fingerprints are kept on file at DCJS and the certifying/approving agency would be notified should there be an arrest or conviction reported in the future to DCJS. The fingerprints are not maintained by the FBI.”

So, with all of these regulations I would really like to know how this 32 year old woman got through the cracks- because she certainly lacks in “moral character and mature judgment,”  especially if one believes that her 19 year old boyfriend is responsible for these atrocities. Did she forgot that she was responsible for this child, and I am not talking about her kid boyfriend? Did someone forget to send the proper documentation to the correct office? Did someone decide that her criminal record didn’t really mean anything? Did someone forget to make their required home visits, to inquire who was around the baby or to do body checks? What about physicals? Doctors? Oh, that neighbor who heard the child being massacred next door, stood by and did nothing?

Indifference. This is what this story reeks off. Indifference for the life of a child. Indifference towards the responsibility of being a foster parent, doing one’s job, and protecting those who can’t speak for themselves.  It’s disgusting.  Oh, to the 19 year old boyfriend, you can run and hide, but you’ll be found. Coward. To the foster mother, may God have mercy on your soul- because I sure don’t.

Mi blog– en espanol?

I am flirting with this idea…so don’t be surprised if you see posts popping up in my first language-Spanish. My law practice website is bilingual, like me, so why shouldn’t my blog be the same?  My posts will not be translations of my English language postings, rather they will be specifically geared towards a Spanish speaking public.  The more I write about it, the more excited I become.

Buena idea, no?

Children and the Elderly- getting the short end of the stick?

I usually write about the law and its relevancy to my practice areas. However, I just started to think about how so much of my work (and my clients) are impacted by external forces that are beyond our control. These forces affect how effectively I can  do my job and how my clients will live. We are living in very difficult economic times, that some people refer to as the worst economic depression the United States- and the world– has seen in years (second only to the Great Depression).

All of us,  to different extents, have had to practice “austerity”- i.e. the tightening of the purse strings,  doing more with less, putting ourselves on a spending “diet,” and using less plastic and more green –or in many instances, counting our pennies and putting them away.

We have also felt the repercussions of our fragile economic state in the programs that support the most vulnerable in our population- children and the elderly. In my 30 something years on this Earth, I have learned that when times get tough, programs benefiting children and the elderly are always the first to get a good trimming or axed altogether. I admit that these programs are very expensive to administer, however I refuse to look at everything as dollars and cents all the time. I think it is important to look at the dividends these programs yield- that have absolutely no monetary value.

Some of these programs give children a “head start” in life –literally, or provide their parents the opportunity to work and better their lives while the children are being cared for in government subsidized day cares, or allow them to feed their family when they can’t afford groceries.  Others, allow otherwise home bound seniors to receive a nice hot meal, once– or sometimes twice– per day.  Or they run the risk of eating poorly,  not eating at all or burning down the house. I could go on– and on- about the  issues, but I realize this is a blog post not a chapter in a book . And I COULD write a book about my thoughts (just ask any of my close friends, if you know them)

My point is this, if you offer children better opportunities as they begin life you are leveling the playing field and giving them a better chance at having a brighter future.  If you cut off their opportunities early in life, you are basically telling them they aren’t worth the effort– not as much as more affluent children.   If you offer the elderly basic human services as they enter the twilight of their years, you are bestowing upon them the dignity and respect they deserve after contributing to our society during their most productive years.  They are old; not disposable.

Whenever I see someone going through rough times, I say to myself, “There but for the grace of God, go I.”  And it’s true. Anything that is given can also be taken away. Never think it  can’t be you– or someone you know and love. I just wish our legislature saw it that way too…my next post will be about the proposed cuts to existing programs- like Medicaid and home care– for the elderly…which has me scared for my elderly clients. Coming soon.

Having “The Talk” with your Parents

Yeah, I know it can be uncomfortable to talk about these kinds of things with your parents. They come from a different time (and sometimes a different country)where these topics are  taboo,  but it has to be done.  I’ve done it repeatedly and it wasn’t as bad as I thought.  Come to think of it, it was cathartic and I know my parents felt good about it too.

No, I am not talking about the “birds and the bees.” What I am talking about is health, death and money.

We’d all like to think that our parents will live to a ripe old age, without infirmities and  pass away snug in their beds.   I know I want that for myself- and for my parents- but the reality is that all of us will die of something. Health and Death are not topics to shy away from.  On the contrary, you need to have these discussions with your parents while they are still alive and have the capacity to meaningfully talk about these issues with you. You also need to have this discussion with yourself about your own health and wishes.

The below is a succinct and general post that provides an overview of  the legal documents that serve to protect your parents’ wishes regarding their health, money and death.

Health: Does your parent (or parents) want to be kept alive by artificial means if they were to suffer from a catastrophic injury or illness that would severely impact their quality of life?  Whether the answer is yes or no, your parent needs a Living Will. While the latter is not legally enforceable in New York State, it is a document that is recognized and respected by medical personnel.  Click here to download a copy to read.  It expressly states a person’s wishes regarding medical treatment, artificial respiration and the appointment of a health care agent to carry out those wishes.  In addition, a Health Care Proxy, which is legally recognized,  is also strongly recommended. Like a Living Will, it memorializes a person’s wishes regarding end of life issues but it is a general power regarding medical care and treatment should the principal become disabled. Click here to download a copy to read.

They have religiously conscious health care proxies too, like a Halachic Health Care Proxy that aligns with Jewish law.  Click here to download a copy to read.  In addition, there are reading materials on the internet for Catholic and Orthodox Christians, as well as other denominations, regarding the use of health care proxies.

Money: Does your parent (or parents) have a Last Will and Testament? They should, no matter how big or small their “estate” is. If your parent dies without a will it means they died ” intestate,” which means a headache to obtain and/or dispose of their assets-plus Uncle Sam will take a nice chunk out of it before it ever gets to the beneficiaries.  For some assets, a  Trust is an even better testamentary document for the disposition of assets.  There are different types of trusts and each has a specific function and objective.  And last but not least, the never to be forgotten Power of Attorney.  Necessary.  End of story.

Death: The “Last Will and Testament” can express the testator’s wishes regarding burial or disposition of remains, as well as who or what will pay for it.  In my opinion, there is an even more important document that everyone should have in their legal arsenal,  the  “Appointment of Agent to Control Disposition of Remains. Click here to download your own copy. It can designate how  remains are to be disposed (i.e. burial, cremation, spreading of ashes, being buried in your favorite dress, etc.) as well as whether  there will be a wake for the deceased, an open or closed casket,  a religious ceremony (a service or Mass), a graveside prayer, or no prayer at all.

These topics may not be easy to talk about, but once you do and they put their wishes in writing, you will feel as if a big weight has been lifted. I would even venture to say, it’s a good feeling.

So go and have “the talk” with mom and dad, or anyone else you care about.