Law Offices of Laurie E. Ohall

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“There are only four kinds of people in this world. Those who have been caregivers, those who are caregivers, those who will be caregivers, and those who will need caregivers.” Rosalynn Carter, Former First Lady

The U.S. Department of Labor estimates that in the year 2010, 54% of workforce employees will provide eldercare for a parent or parents and that nearly two-thirds of caregivers will experience conflict between demands at home and demands from employers.

Today’s employed Baby Boomers are the caregiver generation for their parents. They are finding themselves juggling care responsibilities around their employment obligations. Sometimes employees find they have no option but to take leave from work or use sick time to meet their caregiving demands.

Employers also feel the toll it is taking on their employees. A report by the AARP describes the cost to employers:

“Companies are also seeing the emotional and physical toll that caregiving takes on their workers. In one study, 75% of employees caring for adults reported negative health consequences, including depression, stress, panic attacks, headaches, loss of energy and sleep, weight loss, and physical pain. Businesses suffer, too, by having to pay high health insurance costs and in lost productivity. That doesn’t count the promotions or assignments workers turn down that require travel or relocation away from aging relatives.”

Businesses that don’t offer benefits or address eldercare wind up paying for them. A recent study by the MetLife Market Mature Institute and the National Alliance for Caregiving states that U.S. companies pay between $17.1 billion and $33.6 billion annually, depending on the level of caregiving involved, on lost productivity. That equals $2,110 for every full-time worker who cares for an adult.

Eldercare cost businesses:

• $6.6 billion to replace employees (9% left work either to take early retirement or quit)
• Nearly $7 billion in workday interruptions (coming in late, leaving early, taking time off during the day, or spending work time on eldercare matters)
• $4.3 billion in absenteeism” AARP

Typically, human resource departments work with employees on many issues that may affect their work productivity.  There are programs for drug and alcohol abuse, domestic violence, illness, absenteeism and child care; but, help with eldercare issues is not normally provided.

The AARP report follows several companies who are providing help with eldercare issues and what they are doing for their employees.

• “Freddie Mac has a free eldercare consultant and access to subsidized aides for a relative up to 20 days.
• Verizon Wireless offers seminars on eldercare issues and allows full-time workers 80 hours a year in back-up care, 40 hours for part-time, and $4/hour for in-home help.
• At the Atlanta law firm Alston & Bird LLP, workers can donate vacation time to colleagues who have used up theirs to care for family members. “ AARP

A growing number of companies nationwide are directing their HR departments to provide resources, education and group help for caregiving issues by:

• Providing materials from community resources such as phone numbers to their local Senior Centers or Area Agencies on Aging.
• Making available brochures and booklets on specific programs and services by eldercare experts
• Providing speakers to educate employees on caregiving options
• Allowing options to use paid sick leave, employee job sharingand flexible hours
• Allowing employee caregivers to use business computers for caregiving research
• Contracting with companies who provide eldercare services to help employees

Eldercare service providers are also reaching out to help employee caregivers by providing informational presentations at the work place during lunch time or other times set up by employers. One such presentation provided information on reverse mortgages. Jason, who had been trying to help his parents pay for home care, learned at a work site presentation that a reverse mortgage was one way to cover caregiver expenses.

The HR Department of a local business in Utah, invited the Salt Lake Eldercare Planning Council to present a “Brown bag, Lunch and Learn” during their employees’ lunch hour. In 30 minutes time, those who attended learned how the services of a Care Manger, Home Care Provider, Elder Attorney, Medicaid Planner and Financial Consultant can help with caregiving decisions. Problems were discussed, questions answered and employees left armed with information and the names of professional people they knew could help them.

“This was the most productive lunch I have ever attended”, related Mary, one of the attendees.

“I had been very hesitant to contact an attorney to discuss my parents’ estate, because of the cost involved.  The attorney at our ‘lunch and learn’ answered my few basic questions which will allow me to prepare what I need before I meet with him to finalize my parents’ estate planning.”

Besides workplace help for employers and employees dealing with caregiving, the internet is also a great research tool.  The National Care Planning Council website at www.longtermcarelink.net is a comprehensive resource for eldercare, senior care and long term care planning.  It contains hundreds of articles on all aspects of eldercare.  Professional providers list their services on the NCPC website.  Each of their listings provides unique information on specific eldercare services and how to obtain help.

Employers, employees and eldercare service providers working together can make parent or senior caregiving a workable solution for all.
For more information, visit www.ohalllaw.com.

PreNeed (Pre-Paid) Funeral and Burial Plans

Advantages and Disadvantages of Prepaid Plans
One way to plan in advance for the end of one’s life is to sign a formal contract called a “preneed funeral plan.” With this plan, money to pay for a funeral and/or burial is held in a trust, in an escrow account or paid through an insurance policy on the life of the person desiring the plan. Parts of or all of the funeral service and burial are designed in advance and pre-funded in advance and the family has little to do but show up.

This type of planning has become very popular in recent years. A survey conducted by the AARP in 1999, found that two out of five people over age 50 had been approached to pre-purchase funerals and burial goods and services. An AARP survey in 1998 indicates that 32% of all Americans over age 50, roughly 21 million people, have prepaid some or all of their funeral and or burial expenses (but not necessarily through a formal preneed plan). Breaking that down; about 25% of the over age 50 population have prepaid for their burials (cemetery plot, mausoleum or niche), 18% have prepaid for headstones, urns, caskets , grave liners or vaults, opening and closing of graves and so on and 13% have prepaid for goods or services from a funeral home or funeral director. The same survey indicates that over $25 billion is being held in preneed trust funds. Roughly another $25 billion is waiting to be paid out in life insurance benefits. Prepaid or preneed funerals and burials are big business.

Funerals and burials funded privately by the family, or paid from an individual life insurance policy and arranged informally through a funeral home or funeral director are generally not subject to state regulation. Any formal arrangement through a second party or involving a contract is subject to regulation in all states. Each state has adopted different rules as to who can sell these plans, what the plans can provide, what contract provisions must be, how the plan is to be funded and what recourse purchasers might have in the event of fraud or default. All states call these regulated plans “preneed” funeral and burial arrangements.

Here are some advantages as to why one would want to buy a preneed plan for funeral and burial services and goods.

• It provides peace of mind knowing these arrangements have been made in advance.
• It avoids the burden on family members to make decisions when they are most vulnerable to manipulation.
• It allows one to virtually control from the grave by determining in advance the funeral products, funeral services, burial products and burial services that one would prefer having for final arrangements.
• It helps the family to avoid taking loans, arranging finance plans, raiding savings or selling assets to pay for a funeral and burial.
• It guarantees (for many contracts) that if products and services currently purchased are not available in the future, equivalent substitutes will be provided at no additional cost.
• It locks in guaranteed prices (available with some contracts) forever.
• It allows for inflation in future costs (for those contracts that do not guarantee prices) by investing money in an interest-bearing account or buying life insurance that increases in value over time.
• Depending on the contract, it may allow for transfer to another funeral home or for partial or full refund.

Unfortunately, there are also problems with prepaid, preplanned final arrangements.

• With some trust fund and insurance funding options there may be no refund if someone wants to cancel the plan in the future.
• If a purchaser moves to another state there may be no transfer options or there may be different rules governing the funding option.
• In some contracts, interest earnings on investments resulting in excess money not needed for the plan may be retained by the funeral home or funeral director.
• On installment plans interest may be charged but not credited to the account.
• In certain insurance funded contracts, the ownership or death benefit may be irrevocably assigned to the contract holder (funeral home), preventing the purchaser from enjoying ownership rights in the policy.
• In certain insurance funded contracts, a growth in the death benefit over time that exceeds the cost of the preneed plan services and goods may be pocketed by the contract holder (funeral home) instead of being refunded.
• If the contract provider goes out of business or fails to secure 100% of the funds for future payment, there may be no recourse to get all of the money back that was put in.
• If certain services or goods that were purchased initially are not available in the future, but more expensive versions might be, the family may be forced to pay extra for those items.
• In certain insurance funded plans, if the insured dies too soon, there may have been a waiting period in which few or no benefits are paid at death, thus forcing the family to pay out of pocket for the funeral.
• Certain unscrupulous providers may have failed to provide an itemized list of services and goods or failed to identify properly, specific services and goods, thus allowing the provider in the future to substitute less expensive items or to leave out services and goods that were originally anticipated in the agreement.

What Services and Goods Can Be Prepaid?
All states allow for prepaid plans for funeral services and merchandise. This would include such things as picking up the body, embalming and restoration, rooms or chapel for viewing and funeral services, casket, vault or grave liner, transportation, permits, death certificates, obituaries and so forth. Almost all states allow for prepaid burial services and merchandise as well. Only about six states do not allow it. Burial services and merchandise might include opening and closing the grave, grave markers, vaults or grave liners, mausoleums or niches. Cemetery plots are excluded from prepaid plans in all states.

The AARP has excellent information for consumers on planning for funerals. Quoting from the AARP:

“Most states have a licensing board that regulates the funeral industry. You may contact the board in your state for information or help. If you want additional information about making funeral arrangements and the options available, you may want to contact interested business, professional and consumer groups.”

For elder law and estate planning, contact Laurie Ohall at www.ohalllaw.com.

By Steve Vernon | Aug 23, 2010
Original Article Found Here

This post continues my ongoing series on the threat of big bills for long-term care, starting with my first post Should You Buy Long-Term Care Insurance? Last Monday I provided tips for buying long-term care insurance, and I made the point that some people may not find it necessary to cover most or all of their long-term care risks with insurance. Here I’ll explore this concept further.

A long-term care insurance policy with the most comprehensive features — short waiting period, lifetime benefit payment period, high daily benefit, and inflation protection on the daily benefit — also has the highest premiums. Some people may get scared off and just pass altogether on insurance, which might not be the best solution.

Here’s one compromise strategy to consider: Buy “catastrophic” long-term care insurance and self-insure for the remaining costs through one or more of the alternative strategies that I’ve written about previously. These include building a dedicated savings account and/or keeping home equity in reserve in case you ever need it to pay for long-term care expenses.

A “catastrophic” long-term care policy would substantially reduce the premiums you pay compared to a comprehensive policy, yet still would protect you against the most ruinous situation — a multi-year stay at an expensive facility. Such a policy would have a long waiting period — up to a year — but would then pay benefits for your lifetime. I talked with one long-term care expert who estimated that a policy with a one year waiting period might have premiums that are 25 percent lower than a policy with a 90 day waiting period, and 40 percent lower than a policy with a 30 day waiting period.

Another alternative for married couples is to consider purchasing coverage for just the wife. Often, the husband is the first to need long-term care, since husbands are typically older than their wives. In this case, the wife usually becomes the primary caregiver. Eventually the husband passes away, leaving his wife exhausted — both physically and financially — with the distinct possibility that nobody is left to care for her, should she need long-term care. For these reasons, most residents of nursing homes or assisted living facilities are women. According to one website, 70 percent of nursing home residents are women; my own observations of the proportion of women at assisted living facilities is higher — roughly nine out of 10. Buying insurance for the wife can protect them against becoming vulnerable widows.

If you buy insurance just for the wife, however, you need to understand and accept the potential burden this can place on the wife, and have strategies in place in case the husband needs long-term care. Also, there’s the risk that the wife passes away first, leaving the husband vulnerable. Another way to address this issue is to buy a joint insurance policy that provides a pool of benefits that can be paid either for the husband or the wife, or both. Such a policy has the potential to pay benefits when the need is greatest.

The above ideas have one potential downfall that is vitally important: If you haven’t planned for the long-term care expenses that aren’t covered by insurance, you might have difficulty paying out-of-pocket for expenses that can be significant. Don’t forget to combine the above ideas regarding insurance with the other strategies — dedicated savings accounts or home equity. And make sure those resources are adequate to fill in for costs that aren’t covered by insurance.

These ideas have been tested — unintentionally — by older relatives of mine who had bought long-term care insurance policies and still incurred substantial out-of-pocket expenses. While this outcome wasn’t planned and it wasn’t ideal, they patched together the insurance benefits with their other resources, and they made it work. Actually, I should say that their children made it work — which illustrates the point that most people reach a point in their lives where they need a younger advocate to look out for them.

While writing this series, I’ve received valuable comments from insurance agents and other experts on long-term care. I’m sure the ideas in this post will generate more comments or additional creative ideas to consider. Given the complexity and importance of addressing the threat of potentially ruinous long-term care expenses, all ideas are welcome!

Experts say that over a million people in the United States have chronic obstructive pulmonary disease (COPD). It is a chronic lung condition that includes bronchitis, emphysema or both.

COPD affects the airways and air sacs within the lungs, which makes breathing difficult and can result in a person becoming less active over time. An elderly person who has COPD will easily become depressed, when dealing not only with breathing difficulties but other age related problems.

One example of COPD related depression is Martin, age 72. Martin had lived a busy lifestyle, playing golf, volunteering at the community center and working in his garden. Diagnosed with COPD six months previous, and uncertain how to mange his breathing difficulty and new medications, Martin stopped all his activities. Giving up the things he loved to do and sitting more at home along with improper diet, he became a victim to depression.

Martin’s son Anthony realized that his father could not handle his new situation and depression alone. A trip together to Martin’s physician began the steps to dissipating the depression and enabling Martin to return to his social life.

Anthony received instructions about his father’s medications from the doctor and how they were to be used and consequently could help his father with medication reminders.

The most common types of daily COPD medicines are:

• Inhaler for daily maintenance – Bronchodilators help relax the muscles around the lungs’ breathing tubes. This reduces shortness of breath and makes breathing easier.
• Steroids – Corticosteroids, taken in pill form or inhaler reduce swelling in breathing tubes to quickly make breathing easier. Not commonly for prolong use.
• Oxygen Treatment – Severe COPD will reduce your lungs’ ability to put oxygen into your blood to be carried throughout your body. Martin’s oxygen level was measured to determine if he would need prescribed oxygen therapy. Oxygen is usually prescribed if the oxygen in the blood is low during sleep, exercise, or while not active. A respiratory therapist from an oxygen supply company or home health service can help with learning how to use oxygen.

An important factor in Martin’s depression and COPD management was his diet.

“A healthy diet can play an important role in the management and treatment of COPD.
Finding the right diet can be tricky for people with chronic obstructive pulmonary disease (COPD), since they need to eat a healthy diet and maintain their optimal weight to keep COPD symptoms in check.” )Krisha McCoy, MS, Lindsey Marcellin, MD, MPH)

Maintaining the right nutrition and taking vitamins not only keeps the body healthy but heals the mind, providing emotional well being. Fad diets or extreme dieting are not appropriate for COPD patients. Extreme weight loss can be as much a hazard as being overweight. A home care nutritionist can help establish a healthy menu and diet plan.

With medication and diet under control the final steps to overcoming Martin’s depression were to return to his daily activities. With COPD, an elderly person is more hesitant to leave home, especially if that person’s breathing capacity is not as it used to be. There is a lot of available mobility support for the elderly with small portable oxygen units, walkers, electric scooters and other supportive equipment to help these disabled people move about in the community.

With the help of mobile services and his son at his side to start with, Martin returned to the golf course and community activities. His new diet and return to previous activity helped Martin overcome his symptoms of depression.

Studies show that the intervention of family and friends in helping and supporting elderly people with COPD results in a decrease of depression and a healthier outcome for the patient.

The Oxford Journals Medicine and Ageing states

“It is also worth exploring how family and friends may be involved in supporting the patient and to encourage social interaction. Educating the spouse, family members and friends about depression may help them to understand the consequences of the disease and to develop coping strategies and in turn may reduce the likelihood of isolation. A very recent study that investigated the benefits of emotional support by family and friends and of spiritual beliefs in patients with major depression showed that those with higher perceived emotional support had better outcomes.” (Oxford Journals Medicine Age and Ageing Volume 35, Number 5)

If you are helping an elder parent with COPD related depression there are community and professional services to help you. Start with your parent’s physician. You can also find resources for oxygen therapy, homecare respiratory treatment, home nursing, home medical equipment and mobile services.

The National Care Planning Council promotes eldercare resources and lists eldercare services throughout the United States.

If we had a crystal ball and could see into the future, we would not need to prepare ahead for end of life decisions.

James was 62 years old when a stroke made it impossible for him to communicate with his family. Neither his wife nor children knew anything about his financial or medical information. James had always taken care of things himself and left no written directives in his behalf. Besides having to locate important documents, the family was left to make their own decisions about James long term care.

The National Institute on Aging gives three simple, but important steps to putting your affairs in order:

• “Put your important papers and copies of legal documents in one place. You could set up a file, put everything in a desk or dresser drawer, or just list the information and location of papers in a notebook. If your papers are in a bank safe deposit box, keep copies in a file at home. Check each year to see if there’s anything new to add.
• Tell a trusted family member or friend where you put all your important papers. You don’t need to tell this friend or family member about your personal affairs, but someone should know where you keep your papers in case of emergency. If you don’t have a relative or friend you trust, ask a lawyer to help.
• Give consent in advance for your doctor or lawyer to talk with your caregiver as needed. There may be questions about your care, a bill, or a health insurance claim. Without your consent, your caregiver may not be able to get needed information. You can give your okay in advance to Medicare, a credit card company, your bank, or your doctor. You may need to sign and return a form.” National Institute on Aging http://www.nia.nih.gov

Preparing Advance Directives or Living Will

Advance directives are legal documents that state the kind of medical care or end of life decisions you want made in your behalf. It is a way for you to communicate your wishes to family or health care professionals. Emergency response medical personnel cannot honor Advance directives or living wills. They are required to save and stabilize a person for transfer to a hospital or emergency facility. Once at the facility a physician will honor the directives.

The Living Will as part of your directives gives your consent or refusal for sustained medical treatment when you are not able to give it yourself. If this document is not in place then a family member or physician will decide such things as:

• Resuscitation if breathing or heartbeat stops
• Use of breathing machines
• Use of feeding tubes
• Medications or medical procedures

Advance Directives and Living Wills are legal throughout the United States; however, some states may not honor other states’ directive documents. Be sure to check with the state you live in for their requirements.

Review your directives periodically. They do not expire, but your wishes may change.
A new or revised Advanced Directive invalidates the old one. Be sure your family member or healthcare proxy has a current copy.

Choosing a Power of Attorney

General Power of Attorney – authorizes someone to handle your financial, banking and possibly real estate and government affairs as long as you remain competent.

Special Power of Attorney – authorizes someone you designate to handle certain things you cannot do yourself for a period of time.

Durable” Power of Attorney -The general, special and health care powers of attorney can all be made “durable” by adding certain text to the document. This means that the document will remain in effect or take effect if you become mentally incompetent.

Many people do not know the difference between a general and a durable power of attorney. A general power of attorney is a document by which you appoint a person to act as your agent.

Agents are authorized to make decisions for you, sign legal documents, etc. Many people are unaware that a General Power of Attorney is revoked when the person granting that power becomes incompetent or incapacitated.

It is the “Durable” Power of Attorney that allows for an agent to continue making decisions on your behalf no matter what happens to you. A responsible adult child of an aging parent would be given a “durable power of attorney” to act on behalf of the parent. This provides broader authority than just adding the child’s name to bank accounts and documents.

You may choose to produce notarized power of attorney documents on your own. If your estate is large and real estate or business is included it is advised to secure a reliable attorney.

National Care Planning Council http://www.longtermcarelink.net/a2cfindattorney.htm

Contact the Law Offices of Laurie Ohall for more information.