Planning for Senior Care

Planning for retirement and senior care is very important. The activities of daily living for a senior person include eating, dressing, bathing and walking or moving. At some point, every senior is likely to need assistance in one of these areas.

An important consideration will be the cost of providing that care. By retirement, it is helpful for you to own your home, be debt free and have retirement income and savings. Retirement income will frequently include Social Security, your IRA or 401(k), a pension plan and investment earnings.

Typically, there are four different levels of care utilized by seniors. The first level includes “in-home care” which includes moderate assistance with certain living functions, such as meal delivery. In-home care often eventually progresses to “home healthcare,” defined as assistance with the activities of daily living by a home healthcare aide or nurse. The next level is a more formal assisted living or independent living facility. In an assisted living facility, there are more staff and a higher level of assistance. Finally, the fourth level is skilled nursing care. This is 24-hour nursing care in a facility that is designed to provide a higher level of medical assistance.

Independent Home Care

Independent home care is popular for several reasons. First, it is the least expensive of the four levels of care. Independent home care, or “home care” typically provides a senior with assistance for one or more life functions that do not include healthcare.

With home care, seniors are able to live independently in their home. Seniors with home care might, for example, benefit from a program that delivers a daily meal to their home. If they are not able to maintain their driver’s license, they might also participate in a ride-sharing program once or twice per week so they can go to the store to buy certain essentials.

There are a number of local charities that provide services to assist with home care and outreach services. In addition, friends and family can create a schedule to provide assistance to their senior loved one.

Finally, home care often includes a home monitoring system that allows seniors to contact the monitoring service if they are injured. This service might also require seniors to check in at the same time every morning when an alert sounds so that the monitoring service can contact a relative who lives nearby if the senior does not respond.

Home Healthcare

Home healthcare involves a greater degree of assistance to seniors and includes healthcare services that are provided in the senior’s home. Home healthcare costs vary significantly depending on the level of services provided. However, it frequently will cost from $10,000 to $30,000 per year.

Many seniors prefer home healthcare rather than assisted living or nursing home care because the person receiving care will be able to maintain his or her independence. While the cost is generally reasonable, there are many organizations and providers who can give you good quality care. A key decision for home healthcare is the person who will be the caregiver. Family is often the first option. If you have a child or other relative who is willing to provide assistance, you may be able to live quite comfortably in a family home or perhaps in an attached apartment.

The next care level is frequently a service provider such as a home healthcare aide. The aides usually visit on a regular basis and provide assistance. Many individuals are able to manage well by themselves as long as they have a home healthcare aide who makes regular visits.

A third level of home healthcare may involve visits by a practical nurse or registered nurse. The nurse may assist you with various types of care and check to see that you are using your medications or other types of therapy in a beneficial manner.

There are safeguards that should be carefully considered for home healthcare. The organizations that provide home healthcare are generally licensed by each state. You can check their certification and also their reputation. It is helpful to have a family member who is in regular contact with the senior person who is receiving home healthcare.

As you age and become more senior, it may be appropriate for you to stop driving and to depend on others for transportation. In addition, the family protector can watch to see that you do not make inappropriate expenditures or become vulnerable to any type of abuse.

Independent or Assisted Living

The next level of care is independent or assisted living, which typically has a cost of $40,000 to $65,000 per year.

Many facilities provide both independent and assisted living. Independent living permits the individual to live in a residential facility, but to have a reasonably high level of control of his or her life. With independent living, the person will live in his or her own apartment or small residence and frequently retains a vehicle and the ability to drive. Independent living often offers a meals plan so that the resident can choose to enjoy meals and community in a common dining area.

Assisted living occurs in a more structured residence with a higher level of staff services. The assisted living facility will involve staff who may assist residents with the activities of daily living.

Long-term Care

Long-term care includes several levels of care. The two most common levels are skilled nursing and intermediate care. Skilled nursing provides around-the-clock care from a licensed practical nurse or registered nurse. The cost of skilled nursing care may be $90,000 to $110,000 per year.

Intermediate care facilities also are intended to care for residents who have chronic illnesses or impairments of health. These facilities offer 24-hour staff care. However, they will not always have a registered nurse and may use vocational or practical nurse staff.

It is extremely important with long-term care to examine the facility. Is the facility owned and managed by a for-profit or a nonprofit? What is the affiliation of the organization?

A person may be in a skilled nursing home for several years. Because the costs are significant, the financial strength of the organization is quite important. If the organization at some point in the future has a financial shortfall, it may find it necessary to reduce services. This could have great impact on the care of a senior person.

Other areas to consider are the facility and the services. What is the location of the facility? You should review the cleanliness of the rooms and the public areas and try to determine the general feelings of current residents toward the facility. Many care facilities offer a number of different types of services. Some of these are social or recreational while others are therapeutic and health related.

Finally, how are the levels of staffing and the food service for the facility? A good facility will have a caring and adequate staff and food service team for the number of residents.

Alzheimer's and Memory Care

Alzheimer's is a challenging disease because it leads progressively to very high care requirements. Because of the staff and facility requirements, Alzheimer's care can cost $100,000 or more per year.

There are three general levels of Alzheimer's. Early-stage Alzheimer's involves some short-term memory loss, difficulties with routine tasks and mood swings. Middle-stage Alzheimer's patients may start to show confusion about time and place, loss of memory and wandering. With late-stage Alzheimer's, there is a loss of cognitive function and eventual physical deterioration.

Home care is possible for early-stage Alzheimer's. A family member can provide the level of care needed. It is important that the caregiver understands the risks and takes protective actions to minimize the potential for the senior person to wander off and become lost.

The next level of care is an organized senior residence with a measure of independence. This will provide available 24-hour care, but still enables an early or middle-stage Alzheimer's patient to have some level of control of his or her activities.

Finally, for advanced stages of Alzheimer's, the senior person will need 24-hour residential care. Family members should examine the rooms, consider the staffing levels and review the policies regarding medication for those Alzheimer's patients.

Health Insurance Options for Early Retirees

I plan on retiring in a few months and need health insurance until I can enroll in Medicare. What are my options?

There are several places early retirees can find health insurance coverage before Medicare kicks in, but your options will depend on your income level, your health care needs and the length of time you need coverage.

Affordable Care Act: For most early retirees who are not yet eligible for Medicare, the Affordable Care Act (ACA) health insurance marketplace, also known as Obamacare, is the best option for getting comprehensive health coverage. Coverage will not be denied or cost more for preexisting health conditions.

If your income falls between 400% to 100% of the poverty level (or to 138% in states with expanded Medicaid coverage) after you retire, you will also be eligible for a subsidy that will reduce your monthly premiums. In 2024, 400% of poverty level is $60,240 for one individual or $81,760 for a married couple. Those with incomes below 100% of poverty level (or 138% in Medicaid expansion states), will qualify for Medicaid. For those with household incomes above 400% of poverty level, the ACA also provides subsidies to ensure premiums do not exceed more than 8.5% of their income for a benchmark policy.

To see how much subsidy you are eligible for, use the subsidy calculator at https://www.healthcare.gov/lower-costs/. To shop for ACA plans in your state, visit HealthCare.gov or call 800-318-2596. For extra help, contact a certified agent or broker at HealthCare.gov/find-assistance.

COBRA: Another temporary health insurance option you may be eligible for is the Consolidated Omnibus Budget Reconciliation Act (COBRA). Under this federal law, if you work for a company that has 20 or more employees, you can remain on your employer’s group health plan for at least 18 months – but could last up to 36 months. It is important to note that with COBRA, you will pay the full monthly premium yourself, plus a 2% administrative fee.

For more information, talk to your employer’s benefits administrator or contact the Employee Benefits Security Administration at Askebsa.dol.gov or call them at 866-444-3272.

If the company you work for has fewer than 20 employees, you may still be able to get continued coverage through your company if your state has “mini-COBRA.” Contact your state insurance department to see if this is available where you live.

Short-Term Health Insurance: If you cannot find an affordable ACA plan and COBRA is too expensive, another possible option is short-term health insurance. These plans, which are not available in every state, are more affordable, basic health plans that provide coverage for up to three months with a one-month extension available. Please note that short-term plans do not need to comply with the ACA so they can deny coverage, exclude preexisting conditions and may not cover prescription drugs.

Healthcare sharing ministries: If the previously listed options do not work for you, another temporary solution could be healthcare sharing ministries (HCSM). These are cost-sharing health plans in which members – who typically share a religious belief – make monthly payments to cover expenses of other members, including themselves.

HCSMs are less expensive than paying full out-of-pocket costs for traditional health insurance but be aware that HCSMs are not health insurance. They do not have to comply with the consumer protections of the ACA, and they can also reject or limit coverage for having pre-existing health issues and limit how much you will be reimbursed for your medical costs. Preventive care is also typically not covered either.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living” book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization’s official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.

 

Published September 13, 2024

Are you ready for a natural disaster?

September is designated as National Preparedness Month. All individuals should use this time, before the natural disaster season, to protect important tax and financial information. The IRS offers several helpful tips to protect personal, financial and tax information. Additional information is also available on IRS.gov or FEMA.gov.

  1. Protect Important Documents —Original documents may include tax returns, Social Security cards, marriage certificates, birth certificates and deeds to property. These should be secured in a waterproof container in a safe location. You should also make copies of important documents and keep them in a safe deposit box or send them to a trusted person in a different location.
  2. Record of Valuables — With the ease of taking pictures on your cellphone, you should maintain photos of your high-value items. These photos or videos will be important if you lose the items in a natural disaster. These photos can help support your claims for tax benefits or insurance claims. The IRS also offers Publication 584, Casualty, Disaster, and Theft Loss Workbook. This will be very helpful to you if you have a loss due to a natural disaster.
  3. Rebuild Your Records — After any natural disaster, you may have a challenge in reconstructing or rebuilding your records. These records could be essential for receiving a federal grant or an insurance company payment. If you can accurately estimate your loss through records, the insurance adjuster will be able to justify the payments. The IRS has a Reconstructing Records webpage on IRS.gov that may be helpful.
  4. Employer Fiduciary Bond — If you are an employer, you may have difficulties if your payroll service provider experiences a natural disaster. Your payroll service provider is obligated to make timely federal tax payments. There should be a fiduciary bond that protects you as an employer if your payroll service provider is in a natural disaster and defaults.
  5. IRS Tax Relief — If FEMA declares your area a federal disaster zone, the IRS frequently postpones tax filing and payment deadlines. If you are within the disaster area, you will not need to contact the IRS. The IRS automatically identifies taxpayers with a business or personal address in the covered disaster area. If you reside outside the covered disaster area but have been impacted by the disaster, you may call 866-562-5227 to determine whether you qualify for relief.

Tips for Choosing a Walker

Can you give me some tips on choosing an appropriate walker for my parent? My parent has some balance issues as well as arthritis and could use a little more help than what a cane provides.

When it comes to choosing a walker, there are several styles and options to consider, but finding the best fit for your parent will depend on their abilities and where they will be using it. Here are some tips that can help you choose.

Types of Walkers

There are three basic types of walkers on the market today. To help your parent choose, consider how much support they will need. You should also visit a medical equipment store or pharmacy that sells walkers to test the different types. To locate a nearby equipment supplier, search Medicare’s directory available at Medicare.gov/medical-equipment-suppliers.

Here are the different types of walkers to choose from:

Standard walker: Considered the most basic style, this walker has four legs with rubber-based feet (no wheels), is very lightweight, about 5 to 6 pounds, and typically costs between $30 and $100. This type of walker must be picked up and moved forward as you walk, so it is best suited for individuals who need significant weight-bearing support or who are walking very short distances.

Two-wheel walker: This type has the same four-leg style as the standard walker except it has wheels on the two front legs that allow you to easily push the walker forward without lifting, while the back legs glide across the floor providing support while you step forward. These are ideal for people with balance issues and are priced between $50 to $250.

Rollator: A rolling walker has wheels on all (three or four) legs. Four-wheel rollators typically come with a built-in seat, basket and hand-breaks. This style is best suited for people who need assistance with balance or endurance inside or outside the home. Some rollators even come with pushdown brakes that engage with downward pressure and lock if you sit on the seat. If your parent needs to navigate tight spaces at home, three-wheel rollators provide good maneuverability, but without a seat. Rollators typically run between $55 and $650.

Other Tips

After deciding on the type of walker, there are additional factors to consider to ensure that the walker meets your parent’s needs. The walker’s height must be adjusted appropriately. To find the correct height, your parent should stand with their arms relaxed at their sides and adjust the walker so that the handgrips line up with the crease on the inside of their wrist.

You should also verify that the walker’s weight capacity will support your parent, and if they choose a four-wheel rollator, that their body fits comfortably between the handgrips when sitting. Heavy duty (bariatric) rollators with higher weight capacities, bigger wheels and wider seats are also an option.

Your parent should also test the handgrips to make sure they are comfortable and that the walker folds up for easier storage and transport. Depending on where your parent plans to use the walker, there are accessories that can be added for convenience such as food tray attachments, tote bags for carrying personal items, oxygen tank holders and tennis ball walker glides that go over the feet of a standard walker to help it slide more easily across the floor.

Lastly, if a walker is medically necessary, consult with your parent’s doctor or a physical therapist. If a walker is prescribed, Medicare will cover 80% of the rental or purchase price.

Living Wills and Advance Directives

As you approach end-of-life decisions, there are several steps that should be taken to make sure you receive the right type and level of care. To assist you in these decisions, most states now permit either an advance directive or a living will. Some seriously-ill persons also have a doctor sign a Physician Order for Life-Sustaining Treatment (POLST). These documents are designed to assist your family and doctors in making the decisions according to your preferences.

Senior Medical Planning

There are three important background areas that you should learn about before entering into senior medical care. These are the medical oath and principles of your care providers, the rules created by Congress to ensure your medical information is protected and the decisions by your state on the specific document that you use to convey your wishes.

Doctors will frequently follow a set of principles that were originally called the Hippocratic Oath. The first oath was written by Hippocrates, a Greek doctor who is considered the father of modern medicine.

A modern version of the Hippocratic Oath typically states, "To practice and prescribe to the best of my ability for the good of my patients." Following this principle, your doctor will attempt to restore you to good health.

Because of modern improvements in medicine, it is possible to prolong your life through the use of ventilators, intravenous feeding and other devices. While you certainly want your doctors and nurses to provide very good care, you may also need to offer some guidance on how extensively your family and doctors should use modern technology to prolong your life.

A second major area for you to understand is called HIPAA. The Health Insurance Portability and Accountability Act (HIPAA) was passed by Congress in 1996. It is designed to provide protection for you and to keep your health information private.

Under the HIPAA rules, you have the right to see your health records, but you must give written permission before your records are released to other individuals. The information provided by doctors or nurses about your care, medications or other personal information is protected. However, you will want to be certain that your designated healthcare proxy (the person who will assist in making healthcare decisions) has the right to review these records. You should sign a HIPAA release form in order to enable your advisors to give proper recommendations to your doctors and nurses.

Finally, you must understand the specific documents of your state. Some states use an advance directive in which you choose a combination of a durable power of attorney for healthcare and a living will. Other states have separate documents. It is very important that you use the appropriate document tailored for the laws of your state.

The Advance Directive

Your first key advisor is the person who will make your medical decisions if you are incapacitated. This individual is frequently called the healthcare proxy. He or she is your agent and holds your durable power of attorney for healthcare. Normally, you will select primary and secondary persons as your healthcare proxy agent.

You will want to list the persons, their addresses and phone numbers so they can be easily contacted. Your secondary healthcare proxy will assume the primary role if the first person is unable or unwilling to serve.

Part of your advance directive will also explain the level of authority that you have given. Your healthcare proxy usually does not have the authority to make decisions unless, in the view of your doctor, you are no longer able to make decisions yourself. However, many forms allow you to sign and empower that person immediately. The authority of your healthcare proxy may also extend after you pass away so that he or she can make appropriate decisions at that time.

Your healthcare proxy may be called upon to make significant decisions for your care. For example, it may be necessary to decide whether or not to use morphine or other types of pain medication. If the decision is to make use of morphine, then a second decision will be made on the use of a low dose or a high dose. With a lower dose of morphine or other types of pain medication, you may have greater clarity of mind but may be less comfortable. If you receive higher doses of medication, you may not be as clear-headed, even though you are at a higher comfort level. These decisions can only be made based on your condition at a given time, but they do directly impact the quality of your life in that circumstance.

A healthcare proxy may also be called upon to make very significant decisions about the hospital, nursing home or other care facility and the level of treatment. For example, some seniors have suffered broken hips or limbs at a time when their demise was near. A healthcare proxy will need to make decisions about the appropriate level of care or treatment under those circumstances.

A second section of an advance directive allows you to give counsel on the level of measures and technology that will be used to prolong your life. If you have an incurable or irreversible condition that will result in your death within a relatively short time, there are medical devices that can significantly prolong your life.

These are sometimes referred to as "heroic measures." If you desire all reasonable measures to be taken, you can generally request that care. If you do so, your life may be extended to the greatest extent possible under "generally accepted healthcare standards."

Your healthcare guidelines expressed in your advance directive will discuss your preferred level of nutrition and hydration. If you prefer to receive nutrition and hydration through intravenous methods, you may specifically request those options.

It is helpful for medical providers to have some level of direction for your pain management. If you prefer a higher level of pain management even though that gives you less clarity of thought, you may so indicate.

A third, fairly typical section of the advance directive covers donation of organs and designation of your primary doctor. If you would like to donate specific organs or designate specific purposes for the use of your body, you may identify the particular organs or discuss purposes. Common purposes include transplantation, therapy, research and education.

Advance directives and living wills may, under state law, be witnessed in a manner similar to the witnessing of your will. Some states require two witnesses or a notary to witness your advance directive. Check with your state law to make certain that you have complied with those requirements. A helpful website with state law requirements is www.caringinfo.org. It is maintained by the National Hospice and Palliative Care Organization and seeks to improve care at the end of life.

Physician Orders for Life-Sustaining Treatment (POLST)

A Physician Order for Life-Sustaining Treatment (POLST) is a medical order signed by your doctor or a medical staff person as authorized under your state law. While the name and provisions may be different in some states, the POLST option is generally available nationwide. If you have a serious illness or may pass away within one year, you may want to ask your doctor to sign this medical order.

The POLST typically covers cardiopulmonary resuscitation (CPR), medical interventions and nutrition. You may choose to have CPR or select “Do Not Resuscitate (DNR).” Your medical interventions may include full treatment to prolong your life, selective treatment that avoids burdensome procedures or comfort-focused treatment. Nutrition can be maintained long-term with feeding tubes, for a trial period or you may select no artificial means of nutrition.

All of these decisions should be made in consultation with your doctor. Both your doctor and you or your healthcare proxy must sign the POLST. Your POLST may reflect your values, religious beliefs and goals for care.

Even if you have a POLST signed by your healthcare provider, you still need an advance directive. The advance directive appoints your healthcare proxy (primary and secondary) and covers many medical circumstances not covered by the POLST. Everyone should sign an advance directive, while those who are seriously ill may benefit from a POLST.

Action Steps

After completing your living will or advance directive, you will sign and typically have witnesses for your original document. Prepare several copies of your advance directive. You will want to give a copy to your healthcare agent, your family, clergy, your doctors and other advisors who may be involved in assisting with your medical decisions.

At any time you may revoke the living will or advance directive. It generally is best to revoke the entire document and complete a new document. If you attempt to amend different parts of the advance directive, there is a risk that you may sign provisions that conflict or are inconsistent. If you are in need of urgent care or treatment, you do not want any conflicting provisions in your living will or advance directive.

Your living will or advance directive is a very important part of your personal planning. It is designed to help you receive the best possible care at the end of your life and still comply to the greatest extent with your personal healthcare preferences.

Does Medicare Cover Cataract Surgery?

Does Medicare cover cataract surgery? My eye doctor recently told me I have developed cataracts and should consider making plans for surgery in the next year.

Developing cataracts is an inevitable part of the aging process. Eventually, more than half of our population will be afflicted with cataracts, typically starting around age 60. This condition causes cloudy or blurry vision. The only way to correct this is through surgery.

Fortunately, Medicare provides coverage for cataract surgery deemed medically necessary. Cataract surgery encompasses removing the cataract and inserting a standard intraocular lens (IOL). An IOL is a small, lightweight, clear disk that replaces the focusing power of the eye’s natural crystalline lens to restore clear vision. This procedure is performed using traditional surgical techniques or lasers. Medicare coverage can provide substantial savings, since cataract surgery often costs between $3,000 to $5,000 per eye.

Cataract surgery is usually an outpatient procedure, covered under Medicare Part B. After paying the annual Part B deductible of $240 in 2024, you will be responsible for the Part B coinsurance. This coinsurance amounts to 20% of the cost for covered services. If you have a Medicare supplemental policy, or Medigap, you will have full or partial coverage for the 20% Part B coinsurance.

If you are enrolled in a private Medicare Advantage Plan, you also have coverage for cataract surgery. Under these plans, you may have to pay different deductibles or copayments and use an in-network provider. You should call your plan to find out its coverage details before you schedule surgery.

What Is Not Covered

Keep in mind that Medicare only covers cataract surgery with standard (monofocal) intraocular lenses, which improves vision at just one distance so you may still need glasses for close-up vision. Medicare will not cover premium (multifocal) intraocular lenses that can correct vision at multiple distances allowing you to no longer require glasses after surgery.

Premium interocular lenses are expensive, costing approximately $1,500 to $4,000 per eye, which you would be responsible for if you choose to upgrade. Speak with your doctor about your options and costs before you schedule your surgery.

Are Eyeglasses Covered?

While Medicare typically does not provide coverage for eyeglasses or contact lenses, it will reimburse 80% of the cost for a single pair of corrective glasses or contacts after cataract surgery. Medicare, however, limits its coverage to standard eyeglass frames and lenses. If you want deluxe frames, progressive or tinted lenses or scratch-resistant coating for glasses, you will need to pay those costs yourself. Medicare also requires that you purchase the glasses or contacts from a Medicare-approved supplier.

If you experience post-surgery complications or problems that are deemed medically necessary, your expenses will be covered by Medicare. Any eyedrops, antibiotics or other medication prescribed after your surgery would also be covered by Medicare Part D or a Medicare Advantage Plan that includes prescription drug coverage.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living” book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization’s official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.

Teachers Return to School and Deduct $300

As teachers return to the classroom, the Internal Revenue Service (IRS) reminds educators they should consider the deduction for classroom expenses. During the next few weeks, both parents and teachers face back-to-school expenses. Many parents will spend over $500 on clothes, books, computers and other supplies. Similarly, teachers who teach kindergarten through 12th grade will be purchasing many classroom materials for their students. A survey indicated most teachers spend over $600 per year to support their students with educational supplies.

An important benefit for teachers is the above-the-line deduction for classroom expenses. The deduction for 2024 and 2023 is $300, an increase from $250 in earlier tax years.

A benefit of the deduction is that teachers are permitted to take the standard deduction and still deduct educator expenses. If a teacher is married to another qualified educator and they file jointly, they may deduct up to $600 of classroom expenses. Each educator individually, however, is limited to the $300 amount.

  1. Who Is an Educator? - The IRS defines an "eligible educator" as a teacher, instructor, counselor, principal or aide at a school with students from kindergarten through 12th grade. This could be a public school or a private school. A teacher must work at least 900 hours per year to qualify.
  2. What Expenses Are Qualified? - There are many classroom expenses that qualify. These could include books, teaching supplies, computers and software. Because there are still COVID-19 cases, the expense also may include masks, disinfectant, sanitizer and disposable gloves.
  3. What is Not a Qualified Expense? - There are some types of expenses that do not qualify. Expenses for home schooling or expenses by athletic instructors that are not related to their class are not qualified.
  4. Are Professional Development Expenses Qualified? - If the teacher is qualified and spends funds on professional development courses that are related to his or her teaching area, those expenses can be counted. However, they are still subject to the $300 limit. There may be other deductions or credits (such as the lifetime learning credit) that provide greater benefits.

Editor's Note: As millions of students return to school, it is helpful for both students and teachers that the $300 deduction is above-the-line. Most teachers take the standard deduction and still qualify for this additional tax-saving benefit.

 

Published August 23, 2024

Your Family Letter - Memorial Services

 

A family letter is a key part of a good estate plan. It is much more personal than many of your estate documents. A family letter allows you to share your heart and show appreciation and gratitude to family members. During a time when family members are grieving, it also helps them to complete many practical steps to protect your property.

The family letter may have up to ten different sections. Each section will cover an important but separate topic.

Estate Data

Your estate organizer usually has four parts. It will explain the family names and key information, identify your attorney, CPA and other financial and health advisors, cover all of your assets and financial information and outline your estate planning choices.

The estate organizer may be printed or you may use an online version. Your family letter should explain where the information is located. If you are using an online estate planner, it's important for your personal representative to know your account name and password so the information will be available.

Important Documents

Your important documents will generally be safeguarded in three different ways. First, many individuals have a safe deposit box. The safe deposit box typically holds birth certificates, death certificates, degrees and other legal agreements, marriage or divorce documents, military discharge records, property deeds, a personal property inventory, stock and bond certificates and vehicle titles.

Second, you may have a fireproof box at home. This box will frequently include your insurance policies, your living will, medical power of attorney or advance directive, trust documents and your will.

Third, there are some items that should be left with your attorney, friend, agent or another trusted person. These are items that may be needed while you are still living or will be necessary very soon after you pass away. These documents (or copies of documents) could include your financial power of attorney, a durable power of attorney for healthcare or advance directive, your living will, trusts and your will.

Accounts and Passwords

Because an increasing number of records and information are retained online in personal accounts, you will want to be certain that your personal letter lists all accounts. You may decide to include passwords with the personal letter. Alternatively, if you are entrusting all of this information to a specific person or other location, that should be identified.

With the rapid movement to online banking, online mutual funds and securities accounts, donor advised fund accounts, health savings accounts and your email accounts, you may have six to 10 accounts with various passwords. It will be important to have all of this information recorded.

Your Family History

While your estate organizer will include basic information about you and your family members, there is an excellent opportunity in your family letter to discuss your family history. This can include a few short paragraphs that give the names and background of your parents. List all of their children or other key relatives in your family. Your history may discuss marriages, divorces and any blended family relationships. Finally, the family history will show the date of death for persons who have passed away.

Family history can include discussions of your activities, interests and career. It enables all of your extended family to have a good picture of your entire life.

Care for Children, Grandchildren or Pets

If you are responsible for any children, grandchildren or pets, this is an opportunity for you to explain your plan for their care. While your estate planning documents will normally appoint guardians for your children or grandchildren who are under your care, it still may be beneficial for the guardian to receive recommendations from you on their education and other areas of development that you understand very well. If someone is to care for pets, you may have recommendations on the way in which that is done.

Memberships

You may have memberships in a number of organizations. Some memberships, such as for a country club or club that purchases sporting event tickets, are transferable to heirs. It would be helpful to your family for you to list any memberships that you have so they can handle them properly.

Care of Your Body

When you pass away, your body may be in the custody of a medical center or nursing home. If you have previously decided to make any organ donations, it is helpful to explain that decision in your family letter. The requirements for making organ donations are typically covered under state law. In many cases, decisions on organ donations are made when you sign your living will or advance medical directive.

Funeral or Memorial Services

The cost of many funerals now exceeds $10,000. If you would like to assist family members in the decisions surrounding your funeral or memorial service, the family letter is an excellent way to do so.

First, your family will need to decide whether to have a burial in a cemetery with a casket or to use cremation services and an urn. You may have personal or religious reasons for preferring one or the other.

With a casket and burial in a cemetery, your family will generally make use of a funeral home. Because there now is significant competition in the industry, funeral homes are starting to offer advance prices and package services. If you desire a specific range of services, type of casket or prefer not to be embalmed, those directions are helpful to your family.

There are funeral consumers' alliances in many locations. Your family may find assistance and guidance on www.funerals.org. This guidance may help them make good decisions during a very difficult time in the midst of grief over your loss.

If you are a veteran, your family may want to contact the Department of Veterans Affairs. You may qualify for a gravesite at no cost in one of the 130 national cemeteries for veterans and their spouses.

Obituary

In your funeral or memorial service, there will be eulogies. It is also customary to have a printed description of your lifetime. This will frequently include your basic history, awards, achievements, military service and lifetime employment. If you have specific requests for information to be included in the obituary, it is helpful to your family to give them guidance. You may have certain principles or values that are important to you that you would like to share through the obituary. This is an opportunity for you to communicate your values to the public.

Final Words and Blessings for Family

Your family letter may conclude with a word of blessing. It is a tradition in many cultures for the elders to provide a blessing for the next generation. This is frequently done when the elder is still living, but certainly your family letter provides a similar way to bless your children, grandchildren, nephews, nieces and other family members.

Your final words of wisdom and blessing for family members will be of great comfort as they grieve your loss. It is an appropriate and fitting way to conclude your family letter.

How to Choose a Walk-In Bathtub

Because of my back pain and mobility issues, I am interested in getting a walk-in bathtub that is safe and easy to get in and out of. What are some things to consider when choosing a walk-in bathtub?

For individuals with mobility challenges, a walk-in bathtub can be a useful option to consider as it provides easier access into and out of the tub and helps prevent falls. Here is what you should know, along with a reliable resource to help you choose one.

Accessible Tubs

Walk-in bathtubs are uniquely designed tubs that have a watertight, hinged door built into the side of the tub that provides a much lower threshold to step over (usually three to seven inches) compared to a standard tub that is around 15 inches.

Most walk-in tubs have high sidewalls, usually between three and four feet high, and are between 28 and 32 inches wide. In most cases, they will fit into the same 60-inch-long space as your standard tub without having to reconfigure the bathroom.

In addition to the low threshold, most walk-in tubs have a built-in seat, grab bars, anti-slip floors and anti-scald valves. Some tubs also come with handheld showerheads and quick drains that can empty the tub faster than standard tubs. Many higher-end models offer therapeutic spa-like features that are also great for individuals with arthritis and other ailments.

The best kind of tub for you will depend on your needs, preferences, budget and the size and layout of your bathroom. Prices range from $3,000 to $10,000 or more for the tub and installation costs.

Insurance and Aid

Because walk-in tubs are not considered durable medical equipment, they are not typically covered by Medicare or Medicare supplemental (Medigap) policies. However, some Medicare Advantage plans may offer coverage.

If you qualify for Medicaid, your state program may have a Home and Community-Based Services Waiver program that may provide some assistance. Disabled veterans may also receive assistance through the VA’s home modification grants.

There are also grants and loans available through the U.S. Department of Agriculture that help elderly, low-income residents of rural areas make home modifications, which may be used to pay for a walk-in bathtub. Depending on where you live, there may be local programs that can help like Habitat for Humanity or Rebuilding Together. To find out if these options are available in your area, call your Area Aging Agency at 800-677-1116 or contact your nearby center for independent living (see ilru.org).

If you cannot locate any financial assistance and you cannot afford to pay upfront for a walk-in tub, most manufacturers offer financing that allows you to make monthly payments. If you are using a walk-in tub for a specific medical condition, you may also be able to deduct the costs of the tub from your taxes as a medical expense (see irs.gov/pub/irs-pdf/p502.pdf).

Choosing a Walk-In Bathtub

To help you choose a walk-in bathtub, the National Council on Aging, which is a national nonprofit organization that advocates for older Americans, put together a review team to research the different companies and tubs. See NCOA.org/adviser/walk-in-tubs/best-walk-in-tubs for their detailed reviews and product links.

To get started, you should contact a few walk-in bathtub retailers who can send a professional to your home to assess your bathroom and give you product options and estimates. Some home improvement retailers offer free evaluations and a wide range of walk-in tub options.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living" book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization's official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.

 

Published August 23, 2024

Paying for Nursing Home Care with Medicaid

If my parent needs to move into a nursing home, what are the eligibility requirements to receive Medicaid coverage?

The rules and requirements for Medicaid eligibility for nursing home care are complicated and will vary according to the state your parent lives in. With that said, here is a simplified overview of the key requirements for qualifying.

Medicaid Eligibility

Medicaid, a joint federal and state program that provides healthcare for low-income individuals, is also the largest single payer of nursing home bills in the country. Some states have different names for their Medicaid program.

Most people who enter nursing homes do not qualify for Medicaid and, instead, pay for their care through long-term care insurance or out-of-pocket. Once an individual's insurance benefits end, or their savings become exhausted, they may become eligible for Medicaid.

To qualify for Medicaid, your parent's income and assets will need to be under a certain level that is determined by your state. Most states, with the exception of California and New York, require that a single person have no more than about $2,000 in countable assets and $3,000 for married couples when both spouses apply. The assets would include cash, savings, investments or other financial resources that can be turned into cash. New York allows for $31,175, while California eliminated its asset limit starting in 2024.

Assets excluded from eligibility include your parent's home provided its equity interest is within $713,000 or up to $1,071,000 in some states. Other non-countable assets include personal possessions and household goods, one vehicle, prepaid funeral plans and a small amount of life insurance.

Be aware that an applicant's home is not considered a countable asset to determine eligibility if a non-applicant spouse lives in the home, if the applicant lives in the home, or has an intent to return to the home. If the home is not exempt, an applicant may be required to sell it to use the proceeds to reimburse the nursing home costs.

After qualifying, all sources of your parent's income such as Social Security and pension checks must be turned over to Medicaid to pay for their care, except for a Personal Needs Allowance (PNA) which varies by state but is usually between $30 and $200 per month. The PNA is intended to cover the nursing home resident's personal expenses not covered by Medicaid.

You also need to be aware that your parent cannot give away assets to qualify for Medicaid. Medicaid officials will look at their financial records going back five years (except in California which has a 30-month look-back rule) to root out asset transfers. If they find one, any Medicaid coverage will be delayed a certain length of time, according to a formula that divides the transfer amount by the average monthly cost of nursing home care in their state.

Spousal Protection

Medicaid also has the Medicaid Community Spouse Resource Allowance for married couples when one spouse enters a nursing home, and the other spouse remains at home. In these cases, the non-applicant spouse can keep one half of the couple's assets up to $154,140 (this amount varies by state), the family home, the furniture and household goods and one automobile. The non-applicant spouse is also entitled to keep a portion of the couple's monthly income - between $2,465 and $3,854. Any income above that goes toward the cost of the nursing home recipient's care.

What about Medicare?

Medicare, the federal health insurance program for individuals 65 years and older, and younger individuals with disabilities, will not pay for long-term care. It only helps pay up to 100 days of skilled nursing facility care, which must occur after a hospital stay that lasts at least three consecutive days, not counting the day of discharge.

For more information, contact your state Medicaid office. You can also get help from your State Health Insurance Assistance Program (see ShipHelp.org), which provides free counseling on Medicare and Medicaid issues.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living" book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization's official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.

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