Medicaid Planning Protects Your Home

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Multigenerational family has breakfast in yard on a sunny day behind modern home.Your most valuable property may be your home, which is true for many people. You likely want your children to inherit that value when you pass away.

However, you may also have concerns about planning for the future, especially if your health declines and you need expensive long-term care. You may be aware that Medicaid can pay for these services. However, Medicaid rules say you can own no more than around $2,000 in assets to be eligible – now what?

Medicaid Planning Using an Irrevocable Trust

One solution is to take your home out of your name while reserving your right to live in it. This is possible with a carefully drafted irrevocable trust.

Putting the house in the ownership of a trust could prevent Medicaid penalties and ensure reimbursement of health expenses. (Note that each state’s rules can vary.) It all depends on whether your health continues to keep you out of long-term care for the next five consecutive years.

An irrevocable trust has numerous other advantages, one of which is to avoid probate proceedings. Trusts are private agreements that usually require no court supervision. So, signing away valuable property can feel like a major step, but it keeps your living situation unchanged and can pay off in the long run.

Avoiding Capital Gains Taxes

But suppose you later decide to sell the house and move into a smaller place. That could pose a capital-gains tax problem. If the trust hasn’t been carefully drafted, and it (not you) sells the home, the personal residence exemption would be lost. Capital gains tax could be prohibitive if the house has appreciated in value since the date of purchase.

A similar problem arises when it comes time for your children to inherit. If the trust is not carefully drafted to cover this eventuality, your heirs will lose the basis-adjustment tax break, which could cost them dearly. The basis adjustment allows the inherited value of the home, for capital-gains purposes, to be calculated not from the date you originally purchased the home but from the date your heirs inherit the property.

For example, imagine you paid $100,000 for your house in 1980, and you kept it in good condition; when you pass away, the house is worth $300,000. Now suppose the home is titled in the trust name, but the trust wasn’t written carefully to preserve the basis adjustment that would otherwise be allowed for inherited property. If the children sell the home for $350,000 in those circumstances, they would have made a taxable profit of around $250,000.

With the basis adjustment, however, profit would be calculated from the $300,000 mark as of the date of inheritance. This would leave your children with a tax bill on the $50,000 profit, not $250,000. This tax advantage comes from “stepping up” the taxable basis to the market price at the time of inheritance. As a result, your family receives more value by having to pay less taxes.

Protecting Your Assets for Heirs with an Irrevocable Trust

First, the irrevocable trust takes the home out of your name and, instead, titles it to the trust. Medicaid rules view the owner of the property as the trust, not you, and that’s why you want to reduce your assets and qualify for Medicaid assistance.

Next, to preserve the personal residence capital-gains exemption, an irrevocable trust creates what’s known as grantor trust tax rules. Current tax rules allow property owned by this kind of trust to remain part of your estate for tax purposes and exempt from capital gains up to specified value limits, depending on your state and whether you file single or jointly as a married couple.

Even though the trust has ownership, you are still allowed to take the personal residence exemption. For capital gains, the IRS disregards the trust. However, as of 2023, assets transferred to an irrevocable trust before your death that are not subject to estate tax will not receive a step-up in basis.

To minimize your heirs’ exposure to capital gains tax in the future, the trust also provides a limited testamentary power of appointment. The appointment power permits you to designate someone with the authority to disburse your assets to chosen beneficiaries, provided those beneficiaries are limited to family or charities.

The limited power of appointment may allow your assets to pass down to beneficiaries while preserving eligibility for both the tax basis adjustment and Medicaid. (There is never any guarantee of this tax treatment, and you should always consult with your tax advisor for tax advice — your elder law attorney can point you to a CPA if you don’t already have one.)

The right estate planning strategies neatly solve Medicaid planning and tax issues by:

  • Transferring the house title to the irrevocable trust while retaining your right to live in it, avoiding Medicaid penalties or reimbursement problems after five years
  • Creating grantor trust status to preserve the residence exemption, avoiding capital gains tax on the sale during your lifetime
  • On your death, the adjusted-basis tax break is preserved by designating a person or entity to administer the assets in the trust

Trusts are carefully drafted to comply with current rules regarding ownership and taxes to prepare for Medicaid eligibility and protect your assets for your family.

Consult With Your Estate Planning Attorney

You may have a will, but it will not be able to protect your assets unless it becomes part of an estate plan that includes an irrevocable trust.

You may already have a will or estate plan in place but want to have a professional review it. Your estate planning attorney may find that your will or estate plan isn’t Medicaid-qualified, or that it lacks provisions for a grantor trust or the necessary powers of attorney. However, this is not a reason to worry, as an irrevocable trust can be changed.

Trusts that fail to account for various contingencies can happen if you don’t know where to find a trusted and reputable estate planning attorney. Many states have passed legislation permitting the alteration of trusts for tax reasons, even if the trusts are nominally irrevocable. All parties must consent, or court proceedings would be required, but an expert estate planning or Medicaid planning attorney knows how to correct these problems efficiently.

Contact estate planning attorney Addison Goff today. You may visit GoffandGoffAttorneys.com or call 318-255-1760 to set up an office visit. 

A Senior’s Guide to Estate Planning

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Happy senior couple meets with an estate planning attorney.Most older adults acknowledge that estate planning is essential. Yet, nearly half of Americans age 55 or older do not have a will, and even fewer have designated powers of attorney, a living will, or health care directives.

These legal documents help guide your representatives to provide the end-of-life wishes you seek. Estate planning also reduces the burden your loved ones face and lessens the potential for conflict among your family members after you are gone.

Whether you own a little or a great deal, every senior should have an estate plan. Your estate comprises your home, real estate, vehicles, businesses, bank accounts, life insurance, personal possessions, and any debt you may owe. The goals of your estate plan include:

  • Establishing who will receive your assets upon your death
  • Setting up a durable power of attorney
  • Selecting a trusted representative to make health care decisions on your behalf if you become unable to manage your own affairs due to illness or injury
  • Creating a will and trust
  • Minimizing estate taxes
  • Appointing your estate executor or representative
  • Providing peace of mind to you and your loved ones

Four basic elements of an estate plan can help you achieve these goals.

Creating Your Will

This legal document, called a testamentary will, transfers your estate, after you die, to the individuals or charities you name. Naming your executor  is another function of your will. This individual will ensure your wishes are carried out. Many older adults choose their most responsible adult child for this role.

Advise the person you choose to manage their expectations and advise your family of what to expect in your will. This way, you can address questions they may have and stave off family confrontations after you are gone.

Your will needs to include the following:

  • your named executor,
  • a list of individuals or charities you wish to receive your assets, and
  • a list of significant assets to leave to heirs

Be aware that if you have substantial assets in probate court in a succession, the process can be costly and time consuming.  (Succession (sometimes called a probate proceeding in states outside Louisiana) is the legal proceeding where the court oversees the distribution of your assets.) This can add stress to your executor’s role, as well as increase the time it takes for your family members to receive their inheritance.

You may wish to establish a trust; you can do so by working with an elder law attorney or estate planning attorney. Creating a trust can minimize taxes, restrict asset distribution, and also bypass probate / succession proceedings. These trusts are usually a revocable or irrevocable living trust, or special needs trusts. Your attorney can identify the trust type that best meets your needs.

Your Living Will and Durable Health Care Power of Attorney

A living will (or Advanced Medical Directive) outlines your choices regarding end-of-life treatments and will come into play while you are still alive but unable to communicate health care decisions. Similarly, a health care power of attorney gives authority to another person to make medical decisions for you. The person you name in your  medical power of attorney is typically a caregiver or family member who inspires the utmost trust.

Here are some general issues to consider when creating a living will:

  • Medications you are willing or unwilling to have administered to you
  • Permission for a feeding tube if you are unable to eat
  • Permission to be on life support and, if so, for how long
  • Willingness to accept palliative care at the end of life
  • Having a do-not-resuscitate order or DNR
  • Your decision about being an organ donor

If you have both documents, a living will usually trumps your health care power of attorney. Many older adults prefer to forgo a living will. They instead opt to rely on their health care proxy to make medical decisions on their behalf in the event that they become unable to communicate their wishes for treatment and life-saving measures. Whatever you choose, it is important to inform your loved ones of your health care preferences.

Durable Financial Power of Attorney

Much like a health care power of attorney, a financial power of attorney becomes active when you can no longer make financial decisions. The person you designate will manage your finances on your behalf. To alleviate excessive burden, consider appointing a different individual than your health care power of attorney. However, note that it is legally permissible to name the same person.

Your financial power of attorney should be highly trustworthy and financially stable. When selecting an individual in your life to fulfill this role, you may consider someone who not only lives near you, but is also willing and capable of serving. The individual must be financially responsible, trustworthy, and able to act in your best interests. Finally, this person should be proactive and assertive in protecting your finances.

While these documents represent the basics of an estate plan, your situation may require far more detail and nuanced expertise that an elder law attorney can provide if they do not also offer estate planning. Begin with a checklist including:

  • A list of your assets and debts
  • Assemble important supporting documents
  • Choose candidates for the executor (personal representative) and powers of attorney
  • Draft an outline of estate planning documents as listed above
  • Talk with your family about your goals and wishes

Connect With an Estate Planning Attorney

When you accomplish these tasks, an experienced estate planning attorney or elder law attorney can review your efforts and put your plan into legal action. You will save time and money by being organized and having a basic understanding the estate planning process before meeting with an attorney.

Once all of your estate planning documents are complete, you’ll have a sense of peace knowing you have a solid plan that best protects you and your loved ones. To get your estate plan going, contact Estate Planning and Elder Law Attorney Add Goff today at 318-255-1760 or info@GoffandGoffAttorneys.com. 

Retirees: Deduct Your Long-Term Care Insurance Premium

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Even if you have a long-term care insurance policy, you may likely be hoping that you won’t ever have reason to use it. Regardless of what the future holds, there’s one silver lining of which you may not be aware. That is, premiums on many long-term care insurance policies are in fact tax-deductible.

What Is Long-Term Care Insurance?

Long-term care insurance, or LTCI, can help you prepare for covering the cost of care in a nursing home facility or other setting when and if you need it. Unfortunately, the likelihood that you’ll need long-term care services at some point is high. In fact, about 70 percent of older adults find themselves having to rely on at least some long-term care in their later years.

When individuals require long-term care, it means that they need assistance when completing activities of daily living (ADLs). These basic daily tasks include dressing oneself, showering, or moving safely from one place to another in one’s household, such as from the bed to the bathroom, or in and out of one’s chair. In most cases, your LTCI policy will begin covering long-term care services if you cannot perform at least two ADLs on your own.

The cost of LTCI policy premiums can be out of reach for many people, and some insurers have been raising premiums over the course of time. According to one 2022 survey by HCG Secure, a mere one in 10 of Americans older than 65 have a long-term care insurance policy. However, if you have purchased a tax-qualified plan, you may be able to deduct the insurance premium as a medical expense.

Is My Long-Term Care Insurance Policy Tax-Deductible?

You can deduct numerous types of medical and dental expenses from your taxes. In addition to qualified long-term care insurance premiums, other deductible health expenses include the following:

  • prescription medications and insulin
  • substance use disorder inpatient treatment or smoking-cessation programs
  • prescription or reading eyeglasses
  • contact lenses
  • hearing aids
  • X-rays
  • artificial teeth
  • acupuncture treatments
  • the cost of caring for a guide dog for a person with a vision or hearing disability

When filing your 2023 federal income taxes, check with your insurance broker or state insurance commission to determine whether your LTCI policy qualifies.

Only certain long-term care insurance policies meet the criteria for a tax deduction. The National Association of Insurance Commissioners sets these rules. Typically, many hybrid long-term care policies do not qualify for a premium deduction. (For more information on what defines a qualified LTCI contract, consult the IRS’ Publication 502 for the current tax year.)

If your policy does qualify, you can deduct your LTCI policy premium up to a specified limit. Keep in mind that you will only be eligible for a tax deduction if all of your eligible medical expenses totaled more than 7.5 percent of your adjusted gross income for the year.

Select states also offer LTCI tax incentives, so be sure to check with your tax advisor. Note, too, that if you are self-employed, the rules regarding these deductions can differ.

How Much Can I Deduct in 2024?

If your annual LTCI policy premium is higher than the limit provided in the table below, it will count as a medical expense. The older you are, the higher your deductible limit. For example, if you are a 75-year-old individual at the end of 2023, you may be able to deduct up to $5,880 in LTCI premiums as qualified medical expenses.

Table 1. 2024 LTCI Tax Deductible Limits.

Attained Age Before the Close of 2023 Maximum Deduction in 2024
Age 40 or younger $470
Age 41 to 50 $880
Age 51 to 60 $1,760
Age 61 to 70 $4,710
Age 71 and older $5,880

These are lower deduction limits than in previous years. The Internal Revenue Service adjusts these limits each year.

The cost of long-term care services can in large part depend on where you live. Check out this online tool to get an estimate based on your ZIP code.

The ins and outs of LTCI products can prove to be complicated. Consult with Explder Law Attorney Add Goff to learn more about how LTCi can help your estate plan. An elder law attorney can provide guidance on purchasing an LTCI policy and also assist you in planning for the possibility that you will need long-term care in the future.  Goff and Goff cannot give tax advice. For tax questions, please consult with your tax professional.

Medicare Benefits 2024: 5 Positive Changes for Seniors

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Three senior women clap and celebrate together around a table.More than 65 million seniors across the country benefit from Medicare, a government health insurance program.

When Does Medicare Start?

At age 65, you become eligible for Medicare if you are a U.S. citizen. You do not have to wait until you retire to apply for the program.

You can enroll in Medicare beginning three months prior to your 65th birthday. You can also do so during the month of your 65th birthday or during the three months that follow. (If it’s your first time enrolling in Medicare, learn more about rules that are making it easier to sign up.)

Can I Get Medicare at Age 62?

Certain individuals may be able to secure Medicare coverage earlier than age 65. For instance, if you have end-stage renal disease, ALS, or a disability, it’s possible you could qualify.

What Are the Different Parts of Medicare?

Medicare’s four main parts cover different aspects of health care:

  • Part A covers institutional care in hospitals and skilled nursing facilities. Part B pays for doctor visits and preventative care. This includes routine lab tests and certain outpatient treatments. Parts A and B serve as the so-called “traditional” parts of Medicare.
  • You can choose to enroll in the alternative to traditional Medicare, Medicare Part C, or Medicare Advantage. Part C plans bundle Parts A and B (and sometimes Part D) with other benefits, such as dental or vision care.
  • Medicare Part D coverage, which is often optional, covers many of your prescription medications.

Medicare Updates for 2024

Although 2024 Medicare premiums are seeing an increase, there are nevertheless a few bright spots.

Starting on January 1, 2024, Medicare enrollees may be pleased to hear about several positive changes taking place. These include the following five updates:

1. Medicare’s mental health coverage is expanding.

  • If you need a licensed mental health provider, you will be more likely to able to find a professional near you who accepts Medicare. About 400,000 more of these providers added nationwide by Medicare will include marriage and family therapists as well as mental health counselors.
  • Medicare can now help if you require treatment for alcohol abuse or substance use disorder. Older Americans are currently suffering from a substance abuse epidemic. In 2022, roughly 4 million seniors aged 65 and older were living with an addiction. Covered treatments will now include such services as psychotherapy, prescription drugs, and screenings.
  • Medicare will now cover up to 19 hours per week for intensive outpatient mental health care for qualifying patients. This includes enrollees who are struggling with serious mental health illnesses or substance abuse.

2. Up to 3 million more people could qualify for extra help paying their Medicare Part D premiums.

As of the start of 2024, the Medicare Extra Help Program will strive to boost its number of enrollees through various outreach efforts. Extra Help assists low-income seniors and people with disabilities. However, many who are eligible do not currently participate in the program, sometimes because they remain unaware of its existence.

In addition, another 300,000 individuals who already are part of the program will see their benefits expand further. They’ll see their out-of-pocket costs for their prescription medications drop by an average of $300 a year. These enrollees also will not have to pay a premium or deductible.

3. If your specialty medications are particularly pricey, you will see considerable savings in 2024.

Many people rely on certain expensive medications to treat such serious health conditions as cancer. Even with Medicare Part D, they may have no choice but to pay tens of thousands of dollars out of pocket each year for them.

If your prescription drugs covered by Medicare cost you more than $8,000 out of pocket, you will not be responsible for any other co-pays or coinsurance for the remainder of the calendar year. This is because Medicare Part D enrollees, as of 2024, will no longer have to pay a 5 percent co-pay for catastrophic coverage.

Note that if you rely solely on brand-name prescription medications, you will end up spending roughly $3,300 out of pocket to avoid the 5 percent co-pay. (Even better, come 2025, Part D enrollees will not pay more than $2,000 out of pocket for their prescription drugs in any given year.)

4. You’ll pay no more than $35 a month for insulin supplies covered by Medicare Part D.

As part of the Inflation Reduction Act, price cuts on insulin became effective on January 1, 2024. Medicare Part D plans therefore cannot charge enrollees more than $35 per month for insulin included in their plan. Part D deductibles for insulin supplies will no longer apply, either.

The cost of this medication has tripled over the past decade or so. Even for people who require insulin daily, many are still unable to afford it. In 2022, more than a million individuals with diabetes chose to ration their insulin supply because of the cost, according to one report.

5. If you suffer from chronic pain, Medicare will now cover your monthly services.

For the first time, people receiving Medicare who have persistent or recurring pain lasting longer than three months now can have such services has medication management and pain assessment covered by their plan. (You will still need to pay for your Medicare Part B deductible and coinsurance.)

Work With a Professional

If you need assistance navigating Medicare, reach out to Elder Law Attorney Add Goff in Ruston, La. at 318-255-1760 or info@GoffandGoffAttorneys.com. 

Do Caregiver Duties Help Older Women Live Longer?

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Older woman cares for her senior husband at home who uses a wheelchair.Despite the considerable level of stress that can come with serving as a unpaid caregiver, a new study now suggests that taking care of a loved one may in fact lead to increased longevity among older women.

The findings, published in The Journal of the American Geriatrics Society, revealed that women who said they were taking care of a loved one on a regular basis had a mortality rate 9 percent lower than that of non-caregivers over the course of the study.

While the study did not find a direct connection between caregiving and reducing risk of death, its authors describe the association as robust. As they point out, the existing literature about the health impacts of caregiving has been contradictory. Research in this area will therefore need to continue exploring the potential connection between reduced death rates among women who choose to take on caregiving responsibilities – as well as the reasons why this may be the case.

Women and Caregiver Responsibilities

Today, more than 35 percent of caregivers in the U.S. are age 65 or older, with caregiving services mostly undertaken by older women.

This study followed nearly 160,000 women aged 55 to 79 over roughly 20 years. The participants took part in two assessments 10 years apart.

The data was collected as part of several clinical trials focused on prevention of major chronic conditions in older women. However, the assessments included questions on caregiving. Participants were asked about whether they were actively providing caregiving aid to a loved one and, if so, how many hours they dedicated to the service weekly. About 41 percent of them reported serving in a caregiver role anywhere from less than once to more than five times a week.

The women also provided information on a number of other factors, including depressive symptoms, race, living status, smoking, and history of cancer, diabetes, cardiovascular disease, and hypertension.

Results

The women who reported being a caregiver over the two assessments showed not only a 9 percent lower death rate from any cause than those who were not caregivers, but also a lower risk of death from cancer or cardiovascular disease. This proved to be the case no matter how frequently they reported performing caregiver duties. Other factors, including how old the women caregivers were or whether they lived alone, likewise did not appear to affect this result.

Need for Further Research Regarding Caregiving and Decreased Death Rates

Caregiving remains a critical need and will continue as Americans grow older and live longer. Currently, 10,000 people in the U.S. are turning 65 years old each day, according to AARP.

The Centers for Disease Control and Prevention (CDC) has identified caregiving – whether paid or unpaid – as a major public health issue. Because caregiving is such an expensive service, many older people rely on family members to stand in the gap and provide their care. The resulting burden on family caregivers can include burnout, lost wages, and a lack of support.

“The burden of caregiving demands and their influence on health will be substantial in coming years,” co-author Michael J. LaMonte of the University of Buffalo-SUNY said in a news release. “[It] is an increasingly important focus in epidemiologic research,” he adds.

Fewer Exams Needed When Seeking Veteran Disability Benefits

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Military veteran who uses wheelchair hugs his kids outside.Service members transitioning out of active-duty service and who have a disability claim may be able to take advantage of a more streamlined application process for disability benefits.

Previously, when service members began their transition back to civilian life and filed a disability claim, they had to have two medical exams performed, one by the Department of Defense and another by the Department of Veterans Affairs. As of Spring 2023, these offices now require veterans to submit just one common health assessment form with their application.

What Is the Separation Health Assessment Form?

The Separation Health Assessment form currently in place reduces the number of required medical exams. Now, the Department of Veterans Affairs and the Department of Defense will both accept a single medical examination.

The Separation Health Assessment form discourages redundant medical examinations and ensures accurate results from exams. This ultimately makes the process of getting a decision regarding your disability benefits more quickly.

Questionnaire + Clinical Assessment

The Separation Health Assessment includes two main parts for the veteran. Each part collects the information a service member must provide in their disability application.

Part A requires a service member to complete a medical history questionnaire. Service members must complete this questionnaire before attending a clinical assessment.

Part B of the Separation Health Assessment requires a service member to submit to a clinical assessment. During the assessment, a medical provider will review the service member’s treatment records. They also will give an opinion regarding the service member’s disability status.

How Does the Separation Health Assessment Expedite My Disability Claim?

Using the new Separation Health Assessment process can potentially speed up the disability claim process. The Separation Health Assessment form expedites the disability claim process by providing the following benefits:

  • Avoids duplicate examination results for medical examinations.
  • Avoids wasted time waiting for medical examination results that are likely to be duplicated.
  • Helps service members and medical providers get early illness and disease detection and connect ailments to occupational hazards due to exposure to dangerous conditions.
  • Assesses a service member’s current medical and health care history.        
  • Discovers and names all medical concerns the service member had during their military career.

How Do I File a Disability Claim?

Service members put their lives on the line when they join the military. Unfortunately, many veterans suffer permanent disability after their service ends. If you have a disability claim, consider taking the following steps:

  • Visit a local Veterans Affairs office and file a disability claim in person with a Veterans Affairs representative.
  • Complete your application online on the Veterans Affairs website.
  • Connect with a Veterans Service Officer, whose support is available at no cost. Visit the VA website to access additional resources and to learn more.

The implementation of the Separation Health Assessment form is intended to make it easier for U.S. service members to get access to disability benefits so they can settle back into civilian life.

VA Disability Compensation Rates

Note that the amount of disability benefits payments you will receive each month depend on several factors, namely:

  • the severity of your disability
  • whether you have dependents

Check out the 2023 VA disability compensation rates online.

Is Bipolar Disorder a Disability According to the SSA?

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Woman sits on couch looking depressed while someone talks to her.According to the National Institute of Mental Health (NIMH), approximately 4.4 percent of adults experience bipolar disorder during their lives.

Individuals with certain disabilities may be able to secure disability benefits through the Social Security Administration (SSA). If you or a loved one have bipolar disorder, you may wonder whether the SSA considers bipolar disorder a disability.

Depending on the severity of the illness, the SSA may consider mental health illnesses such as bipolar disorder a qualifying disability. The law firm Atticus reports that , in 2020,13 percent of people receiving disability benefits qualified based on mental health issues. Five percent of these individuals had bipolar disorder or a similar condition.

What Is Bipolar Disorder?

Formerly known as manic depressive disorder, bipolar disorder involves extreme mood swings. Highs can entail various levels of mania, and lows can bring depressive episodes.

When someone experiences mania, they may feel euphoric, creative, and talkative. Highly energetic, they may have trouble sleeping and may also show poor decision-making ability.

During the lows of the disorder, individuals may feel sad or hopeless, lose interest in things they typically enjoy, and have trouble concentrating and completing tasks.

Types of Bipolar Disorder

There are four different types of bipolar, Healthline reports:

  • Bipolar 1 – Mania is more intense with Bipolar 1, while depression is less severe. Some patients may not experience depression.
  • Bipolar 2 – Individuals with Bipolar 2 experience a less severe form of mania and episodes of depression.
  • Cyclothymic disorder – The ups and downs of this form of bipolar disorder are less intense than in Bipolar 1 or 2.
  • Other specified and unspecified bipolar disorders – Individuals with these disorders may still experience highs and lows in mood.

Popular culture often depicts those with bipolar disorder as highly creative artists. Yet this type of mental illness can nonetheless be devastating.

According to the NIMH, those with bipolar disorder experience the highest levels of severe impairment among people with mood disorders. Having bipolar disorder can make it difficult for someone to regulate their mood. Fluctuating moods can complicate relationships, making keeping long-term relationships difficult. Changes in productivity and interest in working can also make maintaining employment challenging.

The National Alliance on Mental Health states that the average age of onset for bipolar disorder is 25. This illness can also occur in adolescents and even children as well.

Treatment of Bipolar Disorder

Treatment options may consist of a combination of medication and cognitive behavioral therapy. Health care providers often also recommend learning strategies for self-managing bipolar disorder. These could include keeping to a stable routine and learning how to recognize one’s triggers. Maintaining a strong network of loved ones for support and living healthfully can also prove helpful.

The Substance Abuse and Mental Health Services Administration offers a free hotline available 24-7 for those coping with mental health disorders such as bipolar disorder. Call 1-800-662-HELP to obtain referrals to treatment centers and support groups near you. This national service is confidential and available as in English as well as Spanish.

Is Bipolar a Disability Under the SSA’s Definition?

As having bipolar disorder can cause day-to-day challenges, individuals with this illness may qualify for disability benefits.

Eligible individuals who meet the SSA’s definition of disability may receive one, or both, of the following types of public benefits:

  • Social Security Disability Insurance (SSDI). SSDI provides monetary assistance to workers who can no longer participate in the workforce because of a disability. They must have a work history and had to have paid into Social Security to qualify for these benefits. (Individuals who became disabled before age 22 may be able to qualify for SSDI based on a parent’s work record.)
  • Supplemental Security Income (SSI). SSI gives financial support to those with very limited income and resources, including children and adults with disabilities.

The SSA administers both programs, and the medical requirements are the same. However, these programs do differ in three important ways. They do not have the same financial requirements, offer access to the same health benefits, or provide the same monthly payments.

Disability Definition

To receive SSI or SSDI for a disability, you first have to meet the SSA’s definition of disability. You must have a medically determinable physical or mental impairment that prevents you from engaging in any substantial gainful activity. (The SSA considers “substantial” activity any type of work that requires significant physical or mental activity, or both. “Gainful” activity is work generally performed for pay.)

Your disability must also:

  • be terminal,
  • have lasted for at least a year, or
  • be likely to last at least a year.

Since the illness must be severe enough to prevent you from working, not all with bipolar disorder can obtain benefits.

Applying for Disability Benefits

To receive benefits, you must prove that your bipolar disorder qualifies as a disability. This entails the following:

  • Submitting information about health care providers, doctors, hospitals, and clinics
  • Providing your job history

For your application to succeed, it should establish that your bipolar disorder severely limits your mental functioning and ability to work. It must also show that your illness is long-term. Even though the Americans With Disabilities Act recognizes bipolar disorder as a disability, the SSA may not.

Contact our Ruston, LA office by calling us at (318) 255-1760 today and schedule an appointment to discuss how we can help you with your planning.

Take a Moment Before Signing a Nursing Home Contract

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In the scenario where your parent is no longer capable of making decisions, dressing, or eating independently and requires nursing home care. You are stressed and anxious. The nursing home puts a twenty-page contract in front of you. You wish you could flip straight to the last page and sign just to get it over with.

Don’t do it. You could be agreeing to pay thousands of dollars out of your own pocket for your loved one’s care.

Try to get your parent admitted, and before you sign the contract, bring it to an elder law attorney for review and guidance. Once your loved one has moved in, they can’t be evicted just because you want to negotiate the contract. Elder law attorneys look for wording that may not be compliant with state laws or is misleading in some way. Nursing homes want to get paid and may be deliberately vague about financial responsibility.

If you don’t have an elder law attorney, sit down and take a few deep breaths. Read the contract carefully and make a list of questions for a facility representative to answer. Ideally, that person would go through the document with you. Don’t sign until you understand.

Things to Watch Out for in a Nursing Home Contract

A nursing home should not ask you to use your own money to pay for a loved one’s care

Do not sign the contract if it requires you to pay with your own money. Carefully scrutinize any language referring to you as the responsible party, resident representative, or agent.

More language to look out for includes:

  • Co-signor
  • Guarantor
  • Personally guarantee
  • Personally liable
  • Private-pay guarantor
  • Surety
  • Individual capacity

Words like these obligate you, personally, to pay if your loved one doesn’t have the money. Don’t sign if you see something like this: “If the resident does not or cannot pay, I will pay the amount owed for residency charges, services, equipment, supplies, medication, and other charges.” The nursing home can ask you to agree – and you can refuse.

Understand that the facility can legally require you to pay nursing home bills for your loved one if you hold financial power of attorney or are a guardian. However, you are required to spend their money on their care.

When Your Loved One Runs Out of Money to Pay for Care

If your loved one lacks the money, the next step is to apply for Medicaid assistance, not dig into your own pocket. Reach out to an elder law attorney for assistance, as the eligibility requirements and application process can be a bit complex. It will be worth it to have the benefits processed quickly so they can begin sooner.

Everyone in need has the right to apply for Medicaid

The nursing home contract must not require your parent to waive their right to seek government assistance like Medicare or Medicaid, nor can it ask either of you to sign any statement that your loved one is ineligible for benefits.

If your loved one has no money to pay for care, a Medicaid application will be required. The contract may seek your permission to apply for Medicaid for you. You have the right to decline that option and seek an elder law attorney you trust to help you apply instead. Some facilities mishandle Medicaid applications, resulting in an incorrect denial of benefits and lengthy appeal process.

The Medicaid application process begins with providing all financial and medical records necessary for your loved one’s application.

Once eligible for Medicaid, Medicaid pays

If your loved one qualifies for Medicaid, the nursing home must not require an additional payment over and above the Medicaid amount determined by your state.

The nursing home must not demand that your loved one receive additional services not covered by Medicaid and evict your loved one if they decline those services. The facility should ask, in advance, whether those services are desired at a specified additional cost.

Other Considerations in a Nursing Home Contract

  • The nursing home must not require additional donations to a charity as a condition of admittance.
  • Do not agree to arbitration. If you agree, you will be giving up your right to a jury trial if a dispute arises.
  • Understand the nursing home is obligated to protect your parent’s property during their stay. However, use good judgment to safeguard valuable property by keeping it elsewhere.
  • Cross out provisions in the contract that you decline, and put your initials by the strike-outs. Also, be sure to sign the contract only as your parent’s agent. Your signature should read: “[Parent name], by [your name], power of attorney, guardian, or agent.”

To be fair to nursing homes, they are entitled to be paid, and they often have difficulty collecting legitimate debts. Facilities are forbidden from suing to take a resident’s Social Security or pension income. They must comply with strict federal consumer protection restrictions. Despite these payment hurdles, they must still protect frail and vulnerable people from all manner of harm. They also suffer public hostility, thanks to the misconduct of some bad actors.

Our elder law firm always urges cooperation with nursing home personnel if possible because their job is a difficult one. However, you and your family have the right to be protected from bad actors and confusing contract language. No matter how reputable the facility is, consulting our elder law attorneys before you sign an admission contract makes sense and avoids difficulty later.

Contact our Ruston, LA office by calling us at (318) 255-1760 today and schedule an appointment to discuss how we can help you with your planning.

Reevaluating Your Retirement Investments: 5 Compelling Reasons

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To ensure a comfortable retirement, it’s essential to reconsider your financial retirement portfolio. While you might have accumulated a substantial nest egg in a 401(k) plan, withdrawing money from it comes with significant tax planning considerations. In the early stages of a 401(k), employers match your contribution to the plan. Contributions come out of your paycheck before calculating taxes and compound every year. When you retire, however, the tax impact of a 401(k), 403(b), or traditional IRA can become significant.

Retiring at a Higher Tax Bracket

You have probably been told you’ll be in a lower tax bracket at retirement. However, many people experience the opposite. Your tax rate is expected to increase if you maintain the same standard of living, requiring the same amount of income and tax rate. With your children grown and the house paid off, substantial tax deductions are gone, which may push you into a higher tax bracket. You will pay taxes on withdrawals from your contribution plan(s) annually, whether the money comes from dividends, capital gains, or your contributions. That money will be taxed at your income tax rate at the time of withdrawal. Currently, the top marginal income tax rate is 37 percent, and considering the US deficit, that tax rate could increase in time.

Double Taxation

Unless you have a Roth IRA, distributions from your retirement plans count against you when calculating what percentage of your Social Security is subject to tax. The result is paying more taxes on your retirement plan distributions and Social Security income. You also pay more taxes from capital gains, dividends, and interest from your investments.

Required Minimum Distributions (RMDs)

It can be frustrating and expensive if you neglect to make your minimum required distributions. You must withdraw funds from your retirement fund accounts when the IRS deems it necessary. Even if you want to leave the money in the account, as of 2023, the IRS will schedule your withdrawals when you reach age 73. There are stiff penalties for not taking out the required minimum distribution. You may pay an additional 25 percent tax. If you correct the shortfall during a two-year window, it could reduce to 10 percent.

Leaving a 401(k) or IRA to a Spouse

If you’re married, a 401(k) or IRA is the worst account to leave to your surviving spouse. No one wants to die without leaving their spouse financially secure, but these two financial vehicles are fully taxable accounts. Upon your passing, your spouse changes their tax filing status from married filing jointly to single. That takes their tax obligation from the lowest to the highest bracket — probably not exactly what you had in mind.

Both your 401(k) and IRA plans are subject to tax law changes. Every time Congress convenes a session, there is the possibility that increases in taxes on your retirement plans can occur. It’s highly unlikely that your taxes won’t increase. The US debt continues to grow at an alarming rate, and tax increases are used to gain some level of financial control.

Get together with a tax planner to identify ways to move your retirement funds into better financial retirement vehicles. Sometimes conversion can cost a bit of money upfront, but in the long run, you’ll be far better off with regard to your retirement tax obligations.

Contact an Estate Planning or Elder Law Attorney

Connect your tax planner with your estate planning attorney. Retirement and tax planning are heavily tied to money and property being managed, preserved, and eventually distributed to your heirs. Our estate planning and elder law attorneys look at changing tax laws and retirement goals to maximize your family legacy. We also discuss preparing for potential long-term care expenses and how they could affect your retirement income. Costs for health care services continue to rise, and you don’t want to lose significant income to medical emergencies.

Contact our Ruston, LA office by calling us at (318) 255-1760 today and schedule an appointment to discuss how we can help you with your planning.

A Changing Landscape for Memory Care

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There are many opportunities for specialized facilities offering memory care. The number of adults with cognitive impairments is increasing, but the number of caregivers is decreasing, which requires more innovative solutions. While some facilities are stand-alone solutions for memory care patients, others offer care integrated into existing assisted living or nursing home facilities.

Innovative Changes

Recent changes to memory care needs include inventive settings that are vastly different than existing dementia support floors and secure units. New care settings use the latest research and understanding of cognitive impairment to provide the best possible environment and services. There will be many more options to choose from in the near future. The small house model has become increasingly popular. It’s an intimate setting within existing nursing communities consisting of 10 enclosed, secure units designed for couples facing memory challenges. A small-scale affordable housing model, partially funded by the Department of Housing and Urban Development (HUD), is typically available to low-income seniors. Design elements include:

  • High visibility of features so patients can see the toilet from the bed, the kitchen from the living room, the activity space from the dining room, etc.
  • Discreet security measures like disguised doors to prevent exit-seeking behavior and decorative fencing to provide a secure environment.
  • Separate bedroom suites furnished with the patient’s own belongings.
  • Time-appropriate bright lighting during awake hours and dimmer lighting in the evening.
  • Accessible outdoor space to enjoy nature and walk and wander safely.

Those seniors who can afford private pay for their memory care can live in an assisted living facility designed like a neighborhood from an earlier time. Often, dementia patients readily recall memories from long ago, and these centers look like a community replete with porches, rocking chairs, carpet that mimics grass, and fiber optic ceilings that allows transitional lighting, creating a sense of the day and night sky. Other elements, like aromatherapy, calm residents or stimulate their appetite depending on the selection of oils integrated into the therapy. All these elements help reduce anger, anxiety, and depression, which are hallmarks of seniors who suffer from dementia illnesses.

Full Continuum Care with Geriatric Psychiatry

Memory care is improving to meet the increasing number of residents. Many facilities are tapping into the expertise of geriatric psychiatry. Geropsychiatry, psychogeriatrics, or psychiatry for older adults is a subspecialty of psychiatry dealing with the study, prevention, and treatment of mental disorders in seniors. This field of study can enhance a memory care facility and improve the problems of anger, depression, and anxiety with medical components that address dementia. The techniques use a person-centered approach that fosters autonomy, develops empathy with residents, and even focuses on humor to help alleviate stress and increase quality of life.

Certified Memory Care Professionals

Professional caregivers offer specialized care to patients with dementia. Formal memory care education will become a more commonplace accreditation as the number of patients increases. Rather than a certified nursing assistant (CNA), dementia patients will be tended to more frequently by certified dementia care nursing assistants (CDNAs). This change in credentialing is driven by rising consumer expectations and tighter regulations that govern memory care.

Slowing the Progression of Dementia

Dementia is more prevalent than ever before, and so is the understanding that the disease has a long preclinical phase. Intervention and healthy lifestyle modification can delay the clinical dementia phase. Physical activity, social engagement, and brain fitness through smart devices and computer applications are excellent cognitive compensation strategies that protect executive brain function, particularly in the preclinical phase of the disease. Cutting-edge technology can also help seniors compensate for memory loss, allowing them to remain at home longer. It also enables senior facility operators to refine their services with fewer staff.

Wearable cameras with artificial intelligence (AI) facial recognition capabilities can provide a patient with the name of the person approaching them. AI can also help a senior’s cognitive load, helping them stay informed regarding daily decisions. New software applications are making it easier for memory care patients to use video, audio, and sensory technologies that provide predictive analytics to caregivers to detect depression and receive alerts indicating a patient is having a bad day or at an increased risk of falling due to a change in gait.

Do you or your loved one have a plan in place in the event you become a memory care patient? Are you aware of the changing options available for living arrangements? Contact our Ruston, LA office by calling us at (318) 255-1760 today and schedule an appointment to discuss how we can help you with your planning.