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Methods to Finance In-Home Care

In-home care is the preferred living arrangement for many aging seniors. However, many medical conditions and personal care needs as adults age can cause this to become more difficult due to cost. The cost of in-home care varies from place to place, but generally follows the cost of living. Places where the cost of living is lower usually have lower costs for in-home care and the opposite is also true. In areas with a higher cost of living, in-home care is generally more expensive. Another challenge of paying for in-home care is the strict limitations on using Medicare and Medicaid to pay for in-home care. However, it is possible to pay for in-home care. Let’s look at some of the options.

Medicare and Medicaid

Although these two options are more limited in the in-home care covered, there are occasions where they can be used to pay for in-home care. Medicare generally pays for in-home care services for a period of time and most often occurs for a time after a patient is discharged from a hospital or rehabilitation facility. Treatment generally would not be covered for a chronic condition. Medicaid rules vary from state to state but are often similar to Medicare. All programs cover short-term in-home care when the patient has an acute condition. Medicaid offers long-term coverage in some areas, but this is often limited to patients who are ill enough to qualify for nursing home coverage. This care must be provided by a Medicaid-certified care agency. With Medicaid, each state runs its program differently and coverage will vary from state to state. In Louisiana, for example, Medicaid would not generally cover in-home long-term care.

Reverse Mortgage

A reverse mortgage is an option for paying for in-home care. If the senior, age 62 or older, owns a home outright or owes little on the home, they can apply for a reverse mortgage. A reverse mortgage gives seniors the option of using the value of the equity in their home to get cash. The bank enforces strict rules about taxes, maintenance, homeowner’s insurance, and mortgage insurance. Therefore, it is important to do research on reverse mortgages and find a reputable bank, to lower the risk of defaulting on the reverse mortgage. Another important consideration is the length of time that care may be needed, as compared to the value of the equity. If a senior decides the reverse mortgage is a good choice for them, the cash can be used to cover the cost of in-home care.

Veteran’s Aid and Attendance Benefits

Aid and Attendance is an often-overlooked benefit available to veterans who are paying out of pocket for care. Veterans who served on active duty for 90 days, with one day during wartime, and who were honorably discharged, may be eligible for aid and attendance benefits. However, the qualification process is not easy and many veterans become frustrated when trying to do so.  As a result, the majority of veterans who may be eligible for the benefits never receive them.

Once qualified, a veteran can receive a monthly cash benefit, tax-free, to use for care. For veterans and their spouses, these benefits can be a major help in paying for in-home care. Surviving spouses of wartime veterans can also qualify for a monthly cash payment through the aid and attendance benefit.

Life Insurance

Life insurance is another possible way to pay for in-home care. If the life insurance policy is no longer needed to care for someone after death, it can be an option for paying for in-home care. A life insurance policy can be sold back to the company for a percentage of the value – usually 50 – 75%. This money can then be used to pay for in-home care. Many policies have flexibility, but some require the senior adult to be terminally ill. A policy with an Accelerated Death Benefit rider allows the policyholder to take a cash advance on the policy that is subtracted from the amount beneficiaries would receive. In this instance, the premiums are still paid and the policy still belongs to the policyholder.

Although in-home care is costly, the good news is that there are options available to help seniors pay for this care. The above are just a few options that may help seniors who wish to continue to live at home even when extra assistance is needed.

We help seniors and their loved ones find and pay for good long-term care using many of the options discussed above. We also create legal plans to protect the home and savings to make sure our clients never run out of money or options for good care. If you would like to learn more, please feel free to contact us. Please contact our Ruston, LA office by calling us at (318) 255-1760 or schedule an appointment to discuss how we can help with your long-term care needs.

Opportunities for Wartime Veterans

In the past, the Department of Veterans Affairs (VA) released eligibility rules for the VA pension program. VA pension, a tax-free monthly cash benefit, is available to wartime Veterans who served at least 90 days of active duty service with 1 day during a declared period of war. Surviving spouses of wartime Veterans may also qualify for a monthly cash payment. Veterans or surviving spouses who need care on a regular basis are eligible for a higher payment (often referred to as “Aid and Attendance,” payments of which can be over $2,000 per month, depending on marital status and care needs.

With any pension claim, there are financial and medical requirements. The medical requirements are straightforward – a Veteran or surviving spouse must be 65 or older or permanently disabled to receive the lowest pension amount. If the Veteran or surviving spouse is blind or nearly so, a patient in a nursing home, or requires assistance with activities of daily living on a regular basis as prescribed by a physician then it is possible to qualify for the highest amount – pension with an aid and attendance allowance. The money paid by the VA goes straight to the Veteran or surviving spouse to help pay for care. The VA doesn’t choose who provides the care – the Veteran or surviving spouse does. And often times, it’s a family member who can be paid.

The financial requirements are a little more complex. Prior to October 18, 2018, there was no clear rule about how much a wartime Veteran or surviving spouse could have before qualifying for VA pension. That is no longer the case! Now, a wartime Veteran or a surviving spouse can have about $130,000 (increased annually), a home, car, and other personal effects and still qualify for a monthly cash payment.  Even if you have more than that there are legal ways to reduce total assets in order to qualify. However, if you give money away after October 18, 2018, you may have to wait months or years to qualify, so make sure you have solid legal advice before doing so.

There are also income limitations, however income can be reduced by recurring out-of-pocket medical expenses. There are certain requirements that must be met before a medical expense can be deducted from income, but most expenses directly related to care will qualify.

The VA pension program can be a huge financial benefit to wartime Veterans or surviving spouses of wartime Veterans. We help families determine whether a claim is possible, and advise how a veteran can qualify. Give us a call today so we can start helping you or a loved one. Please contact our Ruston, LA office by calling us at (318) 255-1760 or schedule an appointment to discuss how we can help with your long-term care needs.

 

VA Benefits for Aging Louisiana Veterans

The US Census Bureau reports that more than 18.2 million veterans live in the United States, and 38 percent of them are 65 and older. Additionally, the Census Bureau reports that more than 9 million veterans receive services from the Department of Veteran’s Affairs (VA) annually. If you are a veteran or have a loved one who is, it is important to understand all the VA benefits and aid that is available. Beyond education programs, home loans, and job search and training resources, the VA also provides a host of other resources to assist you as you transition to your retirement years.

Wartime Veterans Supplemental Income (Veterans Pension)

Supplemental income is available for wartime veterans through the VA pension benefit. If you served at least 90 days of active duty before September 7, 1980, or 24 months after that date, or served the full period for which you were summoned or ordered to active duty with at least one day of wartime, you may qualify.  You must have also been discharged under conditions other than dishonorable. There are strict income and asset requirements attached to this benefit as well as the survivors’ pension and the housebound or aid and attendance allowance discussed below.

Survivors pension

If your late parent or spouse served during wartime, you might qualify for the survivor’s pension. This tax-free program provides relief for unmarried children or a widow or widower who has low income. The deceased military veteran must have served a minimum of 90 days active service with a minimum of one day served during a period of wartime before September 7, 1980, and been dishonorably discharged. After that September date, the deceased veteran must have served a minimum of 24 months or the full period summoned or ordered to serve active duty. Pensions are based on annual family income and under a designated amount set by Congress. More details regarding military pension eligibility are found on the VA website.

Housebound Allowance and Aid & Attendance VA Benefits

If you are eligible for or are already receiving a veterans’ pension, you may qualify for additional monetary benefits. If you are permanently disabled and must remain in your current home, the Housebound Allowance will increase your monthly pension. Aid & Attendance (A&A) will compensate a veteran who is either residing in a nursing home, bedridden, requires assistance for activities in their day to day life, or whose eyesight problems meet specific thresholds of degradation. More details for Housebound Allowance and A&A eligibility can be found on the VA website.

Veterans Life Insurance Options

There is a wide variety of life insurance offerings through the Veterans Administration. Servicemembers’ Group Life Insurance (SGLI, VA form SGLV8286) is a group term life insurance that is low cost and is automatic for most active-duty service members. It is also available for those veterans who serve at least 12 periods of inactive training per year with the Ready Reserve or the National Guard. Other automatic qualifiers include belonging to the Commissioned Corps of the National Oceanic and Atmospheric Administration or the Public Health Service, and for midshipmen and cadets of the US military academies and ROTC members. You can extend the coverage up to two years if you are fully disabled at separation. Veterans’ Group Life Insurance (VGLI, VA form SGLV 8286A) allows you to convert your SGLI to a civilian program of lifetime renewable term coverage after leaving military service.

Family Servicemembers’ Group Life Insurance

If you qualify for SGLI, your spouse and children are qualified for Family Servicemembers’ Group Life Insurance (FSGLI, VA form SGLV 8286A). This insurance covers your dependent children free of charge, although the coverage for your spouse cannot surpass your amount of coverage.

Servicemembers’ Group Life Insurance Traumatic Injury Protection

If you sustain a traumatic injury during your service that leads to amputation, blindness, or paraplegia, you qualify for benefit payments made through Servicemembers’ Group Life Insurance Traumatic Injury Protection (TSGLI, VA form SGLV8600).

Service-Disabled Veterans’ Life Insurance

The Service-Disabled Veterans’ Life Insurance (S-DVI, VA Form 29-4364) coverage is provided to veterans who have been given a VA rating for what is called a new service-connected disability within the past two years. Coverage is free for eligible veterans who are fully disabled, and you can purchase additional life insurance.

Veterans’ Mortgage Life Insurance

As a veteran, if you are disabled and approved for a VA Specially Adapted Housing (SAH) grant, you may receive mortgage life insurance coverage through the Veterans’ Mortgage Life Insurance (VMLI, VA Form 29-8636).

This link takes you to an overview of these VA insurance benefits. You can click on the insurance program by name and be automatically redirected to the appropriate VA web page for that benefit.

Disability Compensation

Tax-free Dependency and Indemnity Compensation (DIC, VA Form 21-534EZ) is available to veterans who sustain or aggravate an injury or disease during their active service. The disability may include physical and mental health issues and secondary or related items diagnosed after your discharge. Your child may be eligible for DIC if they are not included in the spouse’s DIC, and there is an income-based DIC for parents. A disability can also qualify you for a higher, tax-free Special Monthly Compensation if you are housebound and need special assistance or have trouble performing daily living activities. Additionally, housing and insurance benefits through the VA, like Veterans’ Mortgage Life Insurance, Service-Disabled Veterans’ Insurance, and Adapted Housing Grants may be available.

Geriatrics and Extended Care Services

The Geriatrics and Extended Care Services (GEC) provides help to veterans with life-limiting illnesses, multiple chronic conditions, or disabilities associated with aging, injury, or chronic disease. The GEC will assist a veteran living at home or in a nursing home, assisted living, or other residential community care facilities. GEC services include home health aide care, daily care, telehealthcare, palliative care, respite care, hospice care, and even veteran-directed care.

Military Burial

Veteran, burial benefits include a gravesite in a national veteran’s cemetery, a government marker or headstone, the opening and closing of that grave and its perpetual care, and a Presidential Memorial Certificate. The marker, headstone, burial flag, and certificate are provided at no cost to the veteran. Additionally, dependents and spouses buried in a national veteran’s cemetery may also qualify for some benefits such as burial with the veteran, inscription on their headstone, and perpetual care. For a complete description of your veteran benefits, check this VA website link.

Percentages of veterans receiving benefits:

  • 25-34 years 24.7 percent
  • 36-44 years 21.5 percent
  • 45-54 years 25.8 percent
  • 55-64 years 19.8 percent
  • 65-74 years 5.0 percent
  • 75+ years 1.3 percent

If you are a veteran or have a loved one who is, it is crucial to understand that veteran resources go far beyond career and end-of-life issues. Many veterans are not taking full advantage of VA offerings. Many VA age-related programs can benefit a veteran’s life beyond simply planning their future care. Become acquainted with the many options available and determine which programs you qualify for and best serve your interests. With so many benefits available through the VA, you can improve your living situation during your retirement.

The overview is just a summary of what may be available to a wartime veteran or a veteran who is disabled as a result of their prior service. If you or a loved one would like to explore whether you are eligible for benefits, please don’t hesitate to reach out. Please contact our Ruston, LA office by calling us at (318) 255-1760 and schedule an appointment to discuss how we can help.

Now More Than Ever Veterans Benefits Planning is Essential

The COVID-19 virus is not going away as many had hoped. And studies have shown it is deadlier for those over the age of 65. Individuals living in senior living communities, such as independent living, assisted living, memory care, and nursing homes have the highest risk of becoming infected and possibly dying from the virus or secondary illness, such as pneumonia, after being weakened from the virus. For many families, providing long term care for a loved one in the home has become an even bigger priority than normal. In-home care can be costly, which makes the Aid and Attendance Benefit provided by the Department of Veteran’s Affairs of critical importance to help pay for such care.

Veteran Aid and Attendance Benefit

The Aid and Attendance Benefit, technically called the Improved Pension Benefit, is a cash benefit paid to wartime veterans that are over the age of 65 and require another person to assist them with activities of daily living, such as bathing, dressing, feeding, and assistance with incontinence, or requires a protective environment due to mental decline. The Aid and Attendance Benefit is also available to similarly disabled spouses of deceased wartime veterans that are over the age of 65. It is this need for assistance with care or a protective environment that has the family looking into long term care facilities for their loved one.

The Aid and Attendance eligibility rules also require the person receiving the benefit of having limited income. Simply put, all income of the applicant and the applicant’s spouse must be offset by the medical expenses of the applicant and the applicant’s spouse. Any income not offset by medical expenses reduces the amount of the benefit. Under the Aid and Attendance rules, when the wartime veteran or surviving spouse requires assistance with activities of daily living or a protective environment, paying an in-home caregiver to provide that care is a medical expense. It does not matter whether the caregiver is a child or hired through an agency.

Current Veteran Benefits

For 2020, the maximum benefit paid to a married wartime veteran is $2,266 per month. The maximum benefit paid to a single wartime veteran is $1,911. The maximum benefit paid to a surviving spouse of a wartime veteran is $1,228. Working carefully through the math, if a married wartime veteran needs long term care and has a household income of $4,000 per month, he or she will need to spend $4,000 per month on medical expenses to receive $2,266 per month. That veteran likely already has medical expenses in the form of two Medicare and two Medicare supplement premiums, as well as possibly two Medicare prescription supplements. The remaining income needs to be spent on additional medical expenses, specifically an in-home caregiver.

The family must now decide the best way to navigate paying the in-home caregiver. If the couple has children, perhaps the remainder of the household income can be paid to a child, or split among the children, as payment for caregiver services. In many cases, using a child or children as a caregiver allows for flexibility in the amount a caregiver is paid. The income calculation can be manipulated to net out at exactly zero, instead of going into the negative. This allows the veteran to use the $2,266 per month benefit to pay for the couple’s non-medical living expenses.

Other Veteran Benefits for Caregiving

The other option is to hire a caregiver from an agency. This option is more expensive than using a child as a caregiver, but it comes with the added benefit of ensuring taxes are withheld and workers’ compensation insurance is provided in case of an accident. If the family wants the income calculation to net out at exactly zero, the veteran typically will not get as many hours of service from the caregiver hired through an agency compared to hiring a child since an agency typically charges a higher per hour rate. This would work well for a veteran that does not need a lot of care, or that has a wife and/or children that can cover the additional hours of care for free. Otherwise, the agency will need to be paid to provide the additional hours of service, which means the $2,266 benefit paid by the Department of Veterans Affairs will also be used to pay for the care and the couple will have to use assets to pay for the couple’s non-medical living expenses.

The Aid and Attendance Benefit also has an asset limit the applicant must meet, along with a penalty for giving assets away and a 3-year period to look back at the applicant’s assets to see if any gifts were made. These rules should not dissuade a wartime veteran or surviving spouse from seeking this benefit. The need for long-term care will only increase. The cost of care will only increase. And now the COVID-19 virus makes it critical that everything possible is done to protect this vulnerable community.

If you have questions or would like to discuss whether you or a loved one may qualify for Veterans Benefits, please don’t hesitate to reach out. Please contact our office by calling us at (318) 255-1760 and schedule an appointment to discuss how we can help you with your VA planning needs.

Did you Know? Wartime veterans can qualify for a VA Pension without being disabled.

Many wartime veterans receive a disability pension due to injury. It is a challenge to keep up with US Military benefits as they are always changing, and many veterans miss out on what can be life-changing aid. But did you know that wartime veterans age 65 or more may qualify for a VA Pension without being disabled? The Veteran’s Administration qualifications for this type of VA Pension include:

  • Your military service discharge is deemed anything other than dishonorable conditions,
  • Your service was 90 or more active duty days with at minimum one day of service during a period of wartime.
  • You are age 65 years or older,
  • Your countable family income is below a threshold set every year by law.

2020 Family Income Limits (Effective December 1, 2019)

If you are a… Your yearly income must be less than…*
Veteran with no dependents $13,752*
Veteran with a spouse or a child $18,008**
Housebound veteran with no dependents $16,805
Housebound veteran with one dependent $21,063
Veteran who needs aid and attendance and has no dependents $22,939
Veteran who needs aid and attendance (A/A) and has one dependent $27,195
Two veterans married to each other $18,008
Add for each additional child to any category above $2,351

 

*Some income is not counted toward the yearly limit (for example, welfare benefits, some wages earned by dependent children, and Supplemental Security Income. It is also important to note that your medical-related expenses are considered when determining your yearly family income. *To be deducted, medical expenses must exceed $687 ** To be deducted, medical expenses must exceed $900

 

The financial information chart above, published by military.com, is commensurate with the numbers posted on the Veteran’s Administration website.  Be aware; there is a look-back period that will determine if you have transferred assets in the three years previous to filing your claim. There would be a penalty period rate of $2,266 if you did move assets for less than fair market value during this period.

The VA will pay a qualified veteran the difference between personal countable family income and the yearly income limit category into which they fall. Payments are made in 12 equal installments per month and rounded down to the nearest dollar. As an example, a single veteran with a $5,000 annual income qualifies for an annual limit of $13,752. Subtracting that veteran’s income from the income limit yields an annual pension rate of $8,752, which translates into a VA monthly pension check of $729.33 or $729.00 rounded down to the nearest dollar value.

The VA website recognizes the following wartime periods that determine if your service was during an eligible wartime period:

  • World War II (December 7, 1941, to December 31, 1946)
  • Korean conflict (June 27, 1950, to January 31, 1955)
  • Vietnam War era (February 28, 1961, to May 7, 1975, for Veterans who served in the Republic of Vietnam during that period. August 5, 1964, to May 7, 1975, for Veterans who served outside the Republic of Vietnam.)
  • Gulf War (August 2, 1990, through a future date to be set by law or presidential proclamation)

In addition to VA pension, wartime Veterans may also qualify for an additional allowance called Aid and Attendance. To qualify medically for VA Aid and Attendance, one of the following must be true:

  • Another person is required for you to perform daily activities such as bathing, dressing, and feeding, or
  • You spend a large portion, or all of your day in bed due to illness, or
  • Due to a loss of mental or physical abilities related to a disability you are a patient in a nursing home, or
  • Your eyesight is severely limited (wearing glasses or contacts your eyesight is 5/200 or less in both eyes or your concentric contraction visual field is 5 degrees or less)

There are similar benefits available to surviving spouses of wartime Veterans. If you are a wartime veteran or the surviving spouse of a wartime Veteran, we can help you determine whether you could qualify for pension benefits.

While eligible veterans or surviving spouses can apply for benefits on their own through the www.va.gov  website, it is advisable to seek the advice of counsel before applying. There may be planning options available to avoid a penalty period and speed up the qualification process. If you would like to explore whether you might qualify for VA pension benefits. Please contact our office by calling us at (318) 255-1760 and schedule an appointment to discuss how we can help you with your VA planning needs.

Understanding Veterans, Home Health Care, and Technology

In the quest to provide cost-effective, quality in-home care for veterans, the Department of Veterans Affairs (VA) has been surprising trailblazers. Although the agency has long been mired in controversies surrounding its programs, particularly arbitrary caregiver dismissals, the home health services sector of the VA has long been touted as an overall success story. As Thomas Edes, director of comprehensive geriatrics and palliative care programs for the VA puts it “We’re working in this environment of challenging budget constraints, and at the same time, we’re a very mission-driven organization. Put those together and what happens? That really pushes us to innovate.”

The VA Innovations

This innovation has seen home-based primary care for veterans quadruple since 2000, and all VA medical centers throughout the US now have a palliative care program as well. The VA Medical Foster Home program care has expanded from a pilot to a national program, recognized in at least 45 states and providing veterans housing as well as in-home care. These success stories are great news for veterans and a must for the Veterans Administration in part because the median age of a veteran is now 64 and the US aging veteran population is growing even faster than the senior civilian population.

It is not just the “new-comer” seniors straining the VA health care system. Nationwide the 85 plus population is on track to increase 70% from 2000 to 2020 according to the US Department of Health and Human Services. The overall unsustainability of the US health care system has forced the hand of the VA, and there is no more cost-effective way than through subsidized, at home family and community-centered health care and technology to meet veterans’ care needs.

The Official Blog of the U.S. Department of Veterans Affairs reports that Telehealth is revolutionizing veteran care and providing high-quality treatment for them. The VA Video on Demand is delivering convenient, accessible health care particularly to those 24 plus percent of veterans who live in rural and remote access locations. Telehealth is also important for those veterans who are disabled. Although a veteran might live in a city they might be unable to get themselves to a medical center for an appointment

Technology Trends for Veterans

Assisted living technologies for veterans include assistive mobility equipment – an ever-expanding category including wheelchairs, all-terrain vehicles, exoskeletons, and in-home ceiling track mobility systems. Each of these continue to be refined and specialized to meet the individual veteran’s needs. The Veterans Administration awards grants to develop technology to assist veterans and service members in modifying their homes. Adapted computer access and electronic aids to daily living and environment control units (personal assistants) provide customized interactive abilities for veterans.

Electronic cognitive devices help veterans who struggle with activities of daily living (ADL). These devices include personal digital assistants (PDAs), smartphones, pocket personal computers (pocket PCs) and other handheld devices, global positioning systems (GPS), reminder watches, pagers with reminder features, and digital voice recorders. The use of these devices helps a veteran stay on schedule with medications as well as stay connected with family, friends, and their medical monitoring community. Those veterans with Post Traumatic Stress Disorder (PTSD) are further helped with their ADLs when robots with artificial intelligence (AI) are introduced into their environment. These AI “tech bots” are capable of reading human facial expressions and can identify when a veteran is feeling particularly stressed, isolated, angry, or depressed. The robot can upload the information to the veteran’s caregivers thus alerting them to the need for human intervention. Wearable sensors can also alert a caregiver or medical professional when vital signs are outside of a normal, healthy range.

Disabled Veteran Opportunities

The VA will provide a payment to disabled veterans toward the purchase of a car or other transportation and additionally will pay for adaptive equipment, repair, reinstallation or replacement of necessary equipment due to disability. If a veteran has lost the use of at least one foot, hand, or has a permanent impairment to their vision or severe burn injuries or immobile joints that their limit mobility, the VA will help to fund the adaptation of the vehicle to make it fully operational to the veteran.

While the latest technology brings benefits to all seniors opting to age in place, the veteran community is especially helped. Many veterans would like the luxury of aging without combat or noncombat injury so inherent to military service. Some of the aging in place obstacles they must overcome are extreme, commensurate with the injuries (psychological and physical) they have endured. Navigating the benefits that are available to a senior veteran is complicated if you are not well versed in the process. Getting enrolled in the correct program and receiving benefits can also be a lengthy process, so it is best to seek help before wasting valuable time.

If you have questions or would like to discuss your particular situation, please don’t hesitate to contact our office by calling us at (318) 255-1760 and schedule an appointment.