Caring for Aging Parents - Finances

7 ways to help aging parents handle finances

By Robert Powell

Make no mistake about it, there’s a large generational role reversal taking place in this country. Adult children are increasingly providing advice and counsel to their aging parents about a wide variety of financial and nonfinancial issues. And, they are being asked to answer questions about everything from Medicare to how to reinvest a maturing CD.

Knowing full well that you might be called upon to become a subject matter expert, if you haven’t already, we asked experts for some help.

“Children of aging and/or disabled parents need to help their parents face up to the decisions they need to make now,” said Chris Cooper, the owner and founder of ElderCare Advocates.

Below is what experts said adult children and aging parents ought to consider, now.

Financial matters

All of us are going to lose our ability to make more complex financial decision when we reach advanced ages, said Michael Finke, an associate professor at Texas Tech University. “The problem is that we often don’t recognize the decline,” he said.
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This is very similar to what happens to older drivers, he said. “Since the decline is so gradual and consistent (we measure the decline in financial decision making at about 2% per year), we often don’t recognize when we become vulnerable to making mistakes,” said Finke.

So, his advice to aging parents and their adult children is this: “Part of a retirement plan needs to be accounting for the decline in our ability to make these decisions,” said Finke. “That means sitting down with a trusted relative or financial adviser and putting a plan in place to delegate some decisions in advanced age,” he said.

Selecting investments that require less active management, such as annuities or a managed payout mutual fund can also help. “We need to not only protect our portfolio against market risk, we also need to protect it against the risk of cognitive decline,” said Finke.

And for adult children, Finke’s recommended the following: “Create a plan with an older parent that includes establishing a power of attorney and allowing an adviser to contact a trusted child if they become aware that the parent is making financial mistakes.”

What’s more, Finke advised doing this sooner rather than later. “Putting the plan in place early in retirement before cognitive decline begins may be easier than convincing a parent who is exhibiting signs of dementia that they need to relinquish control of their finances,” he said.

Jack Tatar, author of “Safe 4 Retirement: The 4 Keys to a Safe Retirement,” agrees. “We all end up having the conversation, but usually too late, when mental capacities are diminished and certain expectations may be set, such as one sibling’s belief that they will get this or that.”

Having these conversations, said Tatar, provide peace of mind for everyone. “Allowing the retiring/retired parents to be more comfortable living out their retirement dream and providing the adult child with a major task done,” he said. “These conversations should result in documented plans, which should be updated regularly.”
Get those documents in order

Speaking of documents, Tatar said, one major way adult children can help their aging parents is make sure all their affairs are in order. “Adult children need to be sure that their parents have things documented such as wills, assets, end-of-life considerations, even their medications and health records,” said Tatar, whose new book, “Having ‘The Talk” with Your Parents About Retirement,” will be published in January 2013.

In some cases, an adviser could be the central point of contact or the adult child, or both.

Read more HERE


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The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in wills and trusts, estate planning, guardianship, probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for family law issues such as divorce, child custody and visitation, support, and military family law.

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

Live Up to Your Commitment to the Nursing Home, or Beware

A recent Connecticut case highlights the risk to family members of nursing home residents who don't live up to their financial commitments to such facilities.

When her mother was admitted to the Cook Willow Health Center, Judy Andrien signed an admission agreement on behalf of her mother as "responsible relative," agreeing to take steps to ensure that the nursing home would be paid from her mother's assets or by Medicaid.

The facility sued Ms. Andrien, claiming that she did not live up to this commitment. Ms. Andrien asked the court to dismiss the case, arguing that she cannot be held liable because she did not agree to use her own funds to pay for her mother's care.

The Superior Court of Connecticut has ruled in the facility's favor, stating that the claim is not that Ms. Andrien personally guaranteed payment, but that she is in breach of contract for not using her mother's funds to pay the nursing home or taking steps to get her mother Medicaid coverage. The court's ruling means that the case will continue to trial on the nursing home's claim, which it still must prove.

The moral of this case is that even when family members do not commit their own funds to pay for the care of family members, they can be personally liable if they do not satisfy commitments they make to the facility.

Nursing facilities cannot require a personal financial guarantee as a condition of admitting a family member, and relatives of patients being admitted should sign nursing home admission agreements only as representatives of their parents (or other family members), not for themselves.  (When the case does go to trial, Ms. Andrien might argue that since the facility cannot make a family member's commitment a condition of admission, there was no consideration provided by the facility and that portion of the admission contract may not be enforced.)

To read the full text of the court’s decision in the case, Cook Willow Health Center v. Andrien, go to: http://caselaw.findlaw.com/ct-superior-court/1577974.html

Consult with your attorney before signing any agreement with a nursing home or other long-term care facility. For more on signing nursing home admission agreements, and the original location of this article, click HERE.


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The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in wills and trusts, estate planning, guardianship, probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for family law issues such as divorce, child custody and visitation, support, and military family law.

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

Medicare Suit Settled

The following article was taken from Robin G. Smith Consulting

Medicare settles suit - this could be huge

There are several confusing, and ultimately, for patients, expensive Medicare policies concerning what Medicare will and will not cover in nursing homes. Last month, Medicare settled a lawsuit challenging the current policy that a patient in a SNF had to be “improving” to be eligible for the full 100 days of Medicare payment. Now, if the person would decline without SNF care, Medicare will pay. This still leaves the dreaded ”inpatient vs observation”  rule, which hospitals are abusing, and for which patients are paying dearly. There is a class action suit pending on that, too.

The “Direct Primary Care” model has started to rate news articles, as large employers, as well as states, pay primary care clinics directly to care for their employees. United Air­lines teamed with Walgreens to build a clinic at O’Hare air­port in Chicago. Montana has built a primary care clinic for state employees, which has been very well received. Wal­mart has negotiated bundled payments for expensive surger­ies for its employees. Sears and Darden restaurants are offer­ing a voucher to their employees to shop for healthcare. And estimates are that 7% or more of doctors are going to a “Concierge” care model. (By the way, I offer a prepaid pri­mary care plan that is very strong in RI, and the Boston area.
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The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in wills and trusts, estate planning, guardianship, probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for family law issues such as divorce, child custody and visitation, support, and military family law.

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.



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The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in RI for wills and trusts, estate planning, guardianship, probate, and Veterans Aid and Attendance Benefits. They practice Pension and Retirement law as well with a focus on Qualified Domestic Relations Orders (QDRO), Military Pension Orders, Civil Service Orders, as well as Consultation on Pension issues. They also are Newport RI Divorce lawyers, attorneys, mediators, and arbitrators providing services for family law issues such as divorce, child custody and visitation, support, and Military family law.

They offer Elderlaw Mediation for disputes and intergenerational issues as well as probate court resolution. They also do Superior Court Mediation and Arbitration as well as Pension Mediation. Mediation and Arbitration is also offered by the firm for divorce mediation, separation, and all family law issues pre and post divorce.

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

How Gifts Can Affect Medicaid Eligibility

Gifts Can Affect Medicaid Eligibility

We’ve all heard that it’s better to give than to receive, but if you think you might someday want to apply for Medicaid long-term care benefits, you need to be careful because giving away money or property can interfere with your eligibility.

Under federal Medicaid law, if you transfer certain assets within five years before applying for Medicaid, you will be ineligible for a period of time (called a transfer penalty), depending on how much money you transferred. Even small transfers can affect eligibility. While federal law allows individuals to gift up to $13,000 a year without having to pay a gift tax, Medicaid law still treats that gift as a transfer.

Any transfer that you make, however innocent, will come under scrutiny. For example, Medicaid does not have an exception for gifts to charities. If you give money to a charity, it could affect your Medicaid eligibility down the road. Similarly, gifts for holidays, weddings, birthdays, and graduations can all cause a transfer penalty. If you buy something for a friend or relative, this could also result in a transfer penalty.

Spending a lot of cash all at once or over time could prompt the state to request documentation showing how the money was spent. If you don't have documentation showing that you received fair market value in return for a transferred asset, you could be subject to a transfer penalty.

While most transfers are penalized, certain transfers are exempt from this penalty. Even after entering a nursing home, you may transfer any asset to the following individuals without having to wait out a period of Medicaid ineligibility:

•     your spouse
•     your child who is blind or permanently disabled
•     a trust for the sole benefit of anyone under age 65 who  is permanently  disabled

In addition, you may transfer your home to the following individuals (as well as to those listed above):

•     your child who is under age 21
•     your child who has lived in your home for at least two years prior to your moving to a nursing home and who provided you with care that allowed you to stay at home during that time
• a sibling who already has an equity interest in the house and who lived there for at least a year before you moved to a nursing home

Before giving away assets or property, check with your elder law attorney to ensure that it won't affect your Medicaid eligibility.
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 The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in wills and trusts, estate planning, guardianship, probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for family law issues such as divorce, child custody and visitation, support, and military family law.   

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

Home Care Agencies Hiring Unqualified Caregivers, Study Finds

Unqualified Caregivers

A new survey has shed light on the hiring practices of private home care agencies, and the news is not good.  In many cases, agencies are sending to the homes of vulnerable elderly patients workers with little or no experience or knowledge, no training, and inadequate background checks.

The study, which was carried out by researchers at Northwestern University, surveyed 180 private home care agencies in Illinois, California, Florida, Colorado, Arizona, Wisconsin, and Indiana.  (The study did not include agencies that are certified by Medicare and are subject to federal regulations.)

The researchers posed as people calling the agency to obtain assistance for a family member, and they queried the agencies about their hiring and oversight of their caregivers.  The results may surprise families who assume that agencies follow strict hiring guidelines.

For instance, none of the agencies assessed their caregivers' ability to understand medical terminology, and only 15 percent provided their caregivers with any training prior to sending them out to clients.  Although slightly more than half (55.8 percent) of the agencies surveyed ran criminal background checks on their caregivers, none conducted checks outside of their own states, meaning that caregivers with criminal records in other states could still be employed.  According to a summary of the study in the Senior Journal, more than one agency told the researchers that they used screening tests that don't exist, such as the “National Scantron Test for Inappropriate Behavior” and the “Assessment of Christian Morality Test.”

"People have a false sense of security when they hire a caregiver from an agency," the study’s lead author Lee Lindquist, M.D., said in a statement. "There are good agencies out there, but there are plenty of bad ones and consumers need to be aware that they may not be getting the safe, qualified caregiver they expect. It's dangerous for the elderly patient who may be cognitively impaired."
"Some of the paid caregivers are so unqualified it's scary and really puts the senior at risk" for elder abuse, Lindquist said.

Only a third drug-tested their workers.  "Considering that seniors often take pain medications, including narcotics, this is risky," Lindquist said. "Some of the paid caregivers may be illicit drug users and could easily use or steal the seniors' drugs to support their own habits."

Read more HERE
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 The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in wills and trusts, estate planning, guardianship, probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for family law issues such as divorce, child custody and visitation, support, and military family law.   

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

“Part 2. When your loved one changes...coping with Alzheimer's Disease”

Coping With Alzheimer's Disease

It's important to remember that the disease, not the person with Alzheimer's Disease, causes these changes.

Part. 2 Changes in personality and behavior

Because Alzheilmer's Disease causes brain cells to die, the brain works less well over time. This changes how a person acts. You will notice that he or she will have good days and bad days.

Here are some common personality changes you may see:

• Getting upset, worried, and angry more easily
• Acting depressed or not interested in things
• Hiding things or believing other people are hiding things
• Imagining things that aren't there
• Wandering away from home
• Pacing a lot of the time
• Showing unusual sexual behavior
• Hitting you or other people
• Misunderstanding what he or she sees or hears

Also, you may notice that the person stops caring about how he or she looks, stops bathing, and wants to wear the same clothes every day.

Other factors that may affect how people with Alzheimer's Disease behave

In addition to changes in the brain, the following things may affect how people with Alzheilmer's Disease behave.
How they feel:

• Sadness, fear, or a feeling of being overwhelmed
• Stress caused by something or someone
• Confusion after a change in routine, including travel
• Anxiety about going to a certain place

Health-related problems:

• Illness or pain
• New medications
• Lack of sleep
• Infections, constipation, hunger, or thirst
• Poor eyesight or hearing
• Alcohol abuse
• Too much caffeine

Problems in their surroundings:

• Being in a place he or she doesn't know well.
• Too much noise, such as TV, radio, or many people talking at once. Noise can cause confusion or frustration.
• Stepping from one type of flooring to another. The change in texture or the way the floor looks may make the person think he or she needs to take a step down.
• Misunderstanding signs.
• Some signs may cause confusion. For example, one person with Alzheimer's Disease thought a sign reading "wet floor" meant he should urinate on the floor.
• Mirrors.
• Someone with Alzheilmer's Disease may think that a mirror image is another person in the room.

How to cope with personality and behavior changes

Read more HERE


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 The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in wills and trusts, estate planning, guardianship, probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for family law issues such as divorce, child custody and visitation, support, and military family law. 

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

WHAT IS ELDER AND ADULT FAMILY MEDIATION?

Elder and Adult Family Mediation

Most of what we term mediation involves a process wherein litigants or contestants (or a group of people) with a problem participate in a process with a neutral mediator in order to find common ground by defining issues, exploring options and finding a solution. The participants make the decisions. The mediator(s) act as guides but do not judge or impose a solution.

In the case of "ELDER AND ADULT FAMILY MEDIATION" the process is utilized by elders, families with an elder involved, and families with no elder involved. The term has been coined to distinguish these mediations from "Family Law or Divorce" mediations. What type of problems fall into this category? In the "Elder" type are: Guardianships; Inter-generational issues; Advance Directives and Powers of Attorney; Estate Planning and all other family issues involving either an elder or elders and others. The "Adult Family" type might involve sibling disputes or rivalries, post-death problems or any other family problems that do not necessarily involve an elder.

The Rhode Island Mediator's Association is hosting a seminar regarding this type of mediation on April 18, 2012. Crystal Thorpe, a mediator and co-founder of Elder Decisions, in MA will describe the landscape of Elder and Adult Family Mediation and how it differs from other types of mediation. She will share her insights on why families come to mediation, who should be at the table, and the model her firm employs to serve clients. Jeremy Howe and Nancy Johnson-Gallagher (co-mediators at Partners In Mediation in RI) will also share their individual and joint perspective(s) on elder mediation in the Ocean State. Jeremy is an Elder Law Attorney and Nancy has extensive experience working with elders. This program will include a discussion of cases and it will highlight some of the challenges and benefits of this new area of mediation. If you are interested in attending please visit http://www.rimediators.org

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The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in wills and trusts, estate planning, guardianship, probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for family law issues such as divorce, child custody and visitation, support, and military family law. 

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

Recognizing the Need for Outside Help in Caregiving

Article: Recognizing the Need for Outside Help in Caregiving

Caregivers often don’t recognize when they are in over their heads, and often get to a breaking point. After a prolonged period of time, caregiving can become too difficult to endure any longer. Short-term, the caregiver can handle it. Long-term, support is needed. Outside help at this point is often necessary.

A typical pattern with an overloaded caregiver may unfold as follows:

· 1 to 18 months--the caregiver is confident, has everything under control and is coping well. Other friends and family are lending support.

· 20 to 36 months--the caregiver may be taking medication to sleep and control mood swings. Outside help dwindles away and except for trips to the store or doctor, the caregiver has severed most social contacts. The caregiver feels alone and helpless.

· 38 to 50 months--Besides needing tranquilizers or antidepressants, the caregiver's physical health is beginning to deteriorate. Lack of focus and sheer fatigue cloud judgment and the caregiver is often unable to make rational decisions or ask for help.

It is often at this stage that family or friends intercede and find other solutions for care. This may include respite care, hiring home health aides or putting the disabled loved one in a facility. Without intervention, the caregiver may become a candidate for long term care as well...

Please read the entire article and previous articles: Either click on the link http://www.planforcare.org or copy and paste the following into your browser: http://www.planforcare.org.

Please note: This article is provided for informational purposes only, and the resources provided when you follow the applicable "link" may or may not be recommended by our office. .

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The Law Offices of Jeremy W. Howe, LTD. are Elder Law Attorneys in Newport, Rhode Island who specialize in Wills and Trusts, Estate Planning, Guardianship, Probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for Family Law issues such as divorce, child custody and visitation, support, and Military Family Law.

Call them today at 401-841-5700 or visit them on the web at http://www.counselfirst.com

Estate Planning Issues to Consider

Estate Planning

In May, 2011, I was asked to speak at the United States Coast Guard’s Senior Executive Leadership Conference on the key issues facing our generation as they relate to elder law and elder care. Many in our generation are taking care of themselves and their children, as well as elderly parents, so I focused on advance care and estate planning.

Just recently I met with the Coast Guard officer who had invited me to the conference. He told me that the “reviews” of my talk were very positive and he asked if I would be willing to come to the next conference since so many of the attendees found the subject matter of personal interest. Of course I was flattered by the invitation, but more importantly, I was reminded how “timely” the subject of estate planning is and how critical it is that people learn now what they should have in place for the future.

Simply put we need to start asking the following:

• What type of medical care do I want towards the end of my life?
• Where do I want to be cared for?
• How can I ensure that my desires will be honored if I am not able to speak or act for myself?
• What financial arrangements should I make now to ensure that I can receive the care I want?
• What resources are available for my care?
• What will happen if I outlive my assets?
• What do I want to happen after my death?

The practice of elder law attempts to assist people in formulating the answers to these questions by articulating goals for care while you are alive and plans for taking care of your estate upon your death. At the very least your planning should include the drafting of Durable Powers of Attorney for Medical Care and Finances and executing a Will or Trust. Our office can help by initiating the discussion that leads to plans that will meet your individual needs.

- Hilary



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The Law Offices of Jeremy W. Howe, LTD. are Elder Law Attorneys in Newport, Rhode Island who specialize in Wills and Trusts, Estate Planning, Guardianship, Probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for Family Law issues such as divorce, child custody and visitation, support, and Military Family Law.

Call them today at 401-841-5700 or visit them on the web at http://www.counselfirst.com

Law Office of Jeremy Howe, LTD Mediation Seminars

In our ongoing efforts to maintain the highest levels of education, information, and involvement in the Elder Law and Family Law fields, we continuously update our skills and legal education through attendance and involvement in seminars and speaking engagements in New England.

Below are some of our undertakings from March and October of 2010.


March 15 and March 19, 2010
Mediation training under the supervision of Bruce Kogan, Roger Williams School of Law
guest lecturer on “Mediating pension issues”
observer and commentator on the final student mock mediation

March 25, 2010
Mediation presentation for the National Association of Social Workers “From BFF to YBS” (From “Best Friends Forever” to “You’ll Be Sorry”, HOW MEDIATION CAN HELP.
Jeremy Howe presented with Frank & Michelle Geremia and Bryna Bettigole from the Rhode Island Mediators Association

October 27, 2010
Rhode Island Association of Mediators- mediation training
Mediation of Advanced Financial Cases, “Organizing the Data
And Balancing the Power”,
Jeremy Howe presented with co-mediator Nancy Johnson Gallagher, LICSW

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The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in Wills and Trusts, Estate Planning, Guardianship, Probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for Family Law issues such as Divorce, Child Custody and Visitation, Support, and Military Family Law. 

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.

Estate Planning in RI Elder Law House Calls

A new (grieving) widow wrote to Jeremy:

“Thank you so much for handling the Deed to my home, my Will and all other matters. I appreciate your kindness in coming to the house for my convenience. It is difficult for me to get to your office. …I’ve always felt relaxed in your presence and confident that you would advise me what to do which would be most beneficial to me. …I really do consider you a dear friend.”

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The Law Offices of Jeremy W. Howe, LTD. are ElderLaw attorneys in Rhode Island who specialize in Wills and Trusts, Estate Planning, Guardianship, Probate, and Veterans Aid and Attendance Benefits.

They also are Newport Rhode Island Divorce Lawyers, Attorneys, Mediators, and Arbitrators providing services for Family Law issues such as Divorce, Child Custody and Visitation, Support, and Military Family Law. 

Call them today at 401-841-5700 or visit them on the web at http://www.CounselFirst.com.