Guiding elders, special needs persons, and families by offering the experience and care clients need for thoughtful planning and peace of mind.

 

Useful Info During COVID v.4

May 12, 2020

Dear Friends,

This is our fourth newsletter during these interesting COVID times.  It’s funny – my writing bug tends to come in waves and then go away for a while.  Apparently it’s been sticking around lately.  I’m sure you can relate when it comes to your writing, art, or hobbies.  This week I want to focus on what our office can do for you, right now.  You can revisit our prior newsletters here.

Get Your House in Order a/k/a Get Your Ducks in a Row

If you have time on your hands right now, maybe it’s a good moment to spend a few hours working out the what / who / how of your estate plan.  I can help you make sure that those who matter most know what matters most to you in terms of your health care.  We can think through and plan for how to make sure that you get the hands-on care you might need over the years.  We can figure out what the best vehicle is for you to create an inheritance process for your heirs.  We can talk through who the best people are to be your health care proxy, power of attorney, executor, and trustee.  We can wrestle with and work through the various components of getting your house in order (or, if you are sick of being at home – we can call it getting your ducks in a row).

Billing & Discharge Issues from the Hospital, Rehab, or Nursing Home

For anyone on Medicare (plus a supplement, or, on a Medicare Advantage Plan), you need to know that Medicare has strict billing requirements.  If the hospital, rehab, or nursing home bills incorrectly to Medicare and the supplemental insurance, the provider will be in trouble.  Not only will they not be paid for the particular service that they incorrectly billed for, but they may even owe a penalty.  If you are having billing problems with a provider, you need to understand this.  And, it gets tougher – during this state of emergency, CMS (the federal agency housing Medicare) has changed MANY of their billing and service requirements.  It is very understandable that some medical billing offices could be confused, receiving conflicting guidance, etc.  If you are having billing problems, first, be patient with the person on the other end of the phone, and second, feel free to call me for help.

MassHealth Applications

If you find out that your loved one needs to stay in a nursing home and you are worried about how to pay for that, please reach out and we can analyze whether it may be appropriate to apply for MassHealth.  If it is, then Doreen and I can handle the application for you.  Or, if the situation is sufficiently straightforward, I can give you some advice and then you can handle the application on your own.

Guardianship & Conservatorship

If your loved one has lost cognitive capacity and does not have an acceptable health care proxy or durable power of attorney, then you might need the probate court to appoint a guardian (to make health care decisions) and/or a conservator (to handle finances and real estate).  If you need this, you have two options: If a hospital or nursing home is telling you that you need a guardianship and/or conservatorship, they may have their attorney handle it, for free.  If that’s the case, just make sure that the attorney is naming someone that the family agrees would be a good choice.  If the free work is not an option for you, then call me and I can handle the guardianship and/or conservatorship for you.  (Pro tip: Don’t ever put your family in this position – instead get your ducks in a row now and sign a health care proxy and power of attorney!)

Stimulus Checks to the Deceased

Some of you have received stimulus checks made out to persons no longer living.  Turns out, you need to send those back.  If you still have the check, you can mail it to the IRS.  If you cashed it or received it by direct deposit, you will need to write out a check to mail to the IRS.  Here are the (very clear) directions from the IRS on how and where to mail it (see Q41).

Pick the Lawyer’s Brain

Go bold or go home.  Oh wait, I’m already working from home.  In any event, I’m trying something new: a Zoom call to ask me anything related to elder law, special needs planning, veterans benefits, or estate planning.  Let’s try this and see how it goes!  Thursday, May 14 from 2:00 – 2:30.  Limited to 15 people.  Reply to this newsletter, or email Doreen (doreen@alexislevitt.com), and we will send you the login information.

Also I am converting a playhouse into a chicken coop, so I am happy to receive any and all chicken coop construction advice!

Be good to yourself and each other, and get outside to enjoy this glorious spring.

– Alexis & Doreen

Useful Info During COVID v.3

May 11, 2020

Dear Friends,

This is our third newsletter during these interesting COVID times.  This one shares useful info, plus something beautiful.  You can revisit our prior newsletters here.

Share Your Care Wishes with the People Who Matter Most:

None of us knows when our health will take a turn.  The best gift you can give yourself and to the people who matter most is to think through and then share what matters most to you.  Your health care proxy can do the best possible job only if she or he knows what kind of care you want and don’t want.  An EXCELLENT springboard for thinking through, documenting, and sharing what matters most with the people who matter most comes from the Conversation Project.  Visit their site for an excellent worksheet.  While you are there, check out all the other resources on their website.

Excellent Community Resources

The Alzheimer’s Association 24/7 Helpline is open.  If you are feeling at the end of your rope, or even if you are well before that point, call them.  They can help.

Remember that your local Council on Aging is a bastion of information and resources!  If you need anything, call them and they will either solve your problem or refer you to someone who can.  Yes, your local senior is open for phone calls!  (But not walk-ins.)

Technical Stuff:

If you have medical billing issues related to Medicare, check out this amazing guide from the Center for Medicare Advocacy.  It’s technical, but readable.  There have been a LOT of changes to Medicare billing and requirements in light of COVID-19.  This guide provides excellent summaries of many of them.

A Reminder (Third Time – We are Serious about This Point!):

Keep your Health Care Proxy, HIPAA Statement, and medication list at your fingertips. 

(a) If you are a client of ours, then we enrolled you in DocuBank.  Take five minutes now to update your medication list.  (Really.  Five minutes.  I updated mine recently, it was very easy.)

(b) Keep copies on your phone.  You can save the documents to your Google Drive, you can simply keep them attached to an email, whatever you like, so long as they are accessible to you on your phone.  If you would like us to email PDFs of your signed documents to you, or to someone important to you, please call us or email us (doreen@alexislevitt.com).

(c) Keep copies on the back of your front door or on your refrigerator.  Many first responders will look in these places for emergency medical papers.

(d) If you do not have a health care proxy, download one today from Honoring ChoicesYou will need to witnesses – perhaps your neighbors can watch you sign through your glass door or window.

Something Beautiful:

Have you seen the Stephen Sondheim 90th birthday party?  It is so beautiful.  (Pro tip: It’s easy to skip around if you don’t like a particular song.)  Be sure to watch the closing remarks and final song – you just may cry from the beauty in this world.

And Remember:

Our office is open.  We are working from home, but if you need anything at all, just call or email, and we will get right back to you.

We had our first outdoor signing last week, and it was actually a bit of a party, since the Xfinity truck yard next door was playing some loud music!  We can also do video signings now, thanks to a bill that the governor signed this week.  We did our first one today.  It’s certainly been a period of firsts for a lot of things.

Hang in there, and get outside for plenty of fresh air and sunshine.  And wash your hands!!

– Alexis & Doreen

Our first outdoor signing!  That’s Doreen, Rich (Alexis’ spouse, pinch-hitting as a witness), and Alexis.  Photo used with clients’ permission.


E-Newsletter: Useful Info During COVID

April 2, 2020

Following is the text of our recent e-newsletter. If you would like us to add you to our e-newsletter mailing list, please visit our homepage.

———–

Dear Friends,

This is our second newsletter during these interesting COVID times. The first newsletter offered legal information. This one shares useful info, plus something beautiful. You can revisit our first newsletter here.

We begin with a reminder:

Keep your Health Care Proxy, HIPAA Statement, and medication list at your fingertips.

(a) If you are a client of ours, then we enrolled you in DocuBank. Take five minutes now to update your medication list. (Really. Five minutes. I updated mine recently, it was very easy.)

(b) Keep copies on your phone. You can save the documents to your Google Drive, you can simply keep them attached to an email, whatever you like, so long as they are accessible to you on your phone. If you would like us to email PDFs of your signed documents to you, or to someone important to you, please call us or email us (doreen@alexislevitt.com).

(c) Keep copies on the back of your front door or on your refrigerator. Many first responders will look in these places for emergency medical papers.

(d) If you do not have a health care proxy, download one today from Honoring Choices. You will need to witnesses – perhaps your neighbors can watch you sign through your glass door or window.

We move on to community offerings:

The Wonder Duo of Two Sisters Senior Living Advisors, Michelle and Alyson, are bringing you free, professional chair yoga every Tuesday and Thursday morning! More info here (scroll down the page). Mark your calendars!

The Alzheimer’s Association 24/7 Helpline is open. If you are feeling at the end of your rope, or even if you are well before that point, call them. They can help.

The Alzheimer’s Association is also hosting a slew of webinars online. They have even found a way to continue with their support groups. Check it out. There is no need to go this alone.

Remember that your local Council on Aging is a bastion of information and resources! If you need anything, call them and they will either solve your problem or refer you to someone who can. Yes, your local senior is open for phone calls! (But not walk-ins.)

Now for Community Requests:

South Shore Hospital is requesting the following:
Financial donations
Homemade masks (attention people who love to sew!)
Supplies so that the hospital can make their own masks
Gift cards for employees in need
N95 masks, gowns, goggles, other PPE

Norwell VNA & Hospice is requesting N95 masks, gowns, goggles, and other PPE.

And, Something Beautiful:

There is a national movement to plaster our neighborhoods with hearts, in support of our health care workers who are on the front lines. In our neighborhood, teacher Kathleen Malone and her kids took the lead, and now we all have lovely homemade hearts on our doors. The ones with the Red Cross symbols were given to the nurses in our neighborhood, and they have told us that this makes them feel supported and loved. Pull out some art supplies and bring the same to your street!

   

And Remember:

Our office is open. We are working from home, but if you need anything at all, just call or email, and we will get right back to you.

Hang in there, and get outside for plenty of fresh air and sunshine. And wash your hands!!

– Alexis & Doreen

E-Newsletter: If You Are Hospitalized During the State of Emergency

March 30, 2020

Following is the text of our recent e-newsletter.  If you would like us to add you to our e-newsletter mailing list, please visit our homepage.

———–

Dear Friends,

I hope you are all staying home (unless you are an essential worker).  I want to share some important points to keep in mind if you are hospitalized during the state of emergency.  These apply whether you are hospitalized for COVID-19 specifically, or for any other reason.

1. Keep your Health Care Proxy, HIPAA Statement, and medication list at your fingertips. 

(a) If you are a client of ours, then we enrolled you in DocuBank.  Take five minutes now to update your medication list.  (Really.  Five minutes.  I updated mine recently, it was very easy.)

(b) Keep copies on your phone.  You can save the documents to your Google Drive, you can simply keep them attached to an email, whatever you like, so long as they are accessible to you on your phone.  If you would like us to email PDFs of your signed documents to you, or to someone important to you, please call us or email us (doreen@alexislevitt.com).

(c) Keep copies on the back of your front door or on your refrigerator.  Many first responders will look in these places for emergency medical papers.

2. Advocate to be coded as “inpatient” rather than “under observation.”  If you are in the hospital and then transferred to a rehab, how you were coded at the hospital will make a big difference in payment source for the rehab stay.

3. If you are transferred to rehab and told that you will be paying privately, call us.  Under the State of Emergency, some of the usual coverage triggers for payment for rehab have changed.  Nursing home billing offices could be – quite understandably – overwhelmed and perhaps not updated on the temporary changes.  We can help.

4. Call us if you need a guardianship or conservatorship.  For anyone who has not signed a health care proxy or a power of attorney, the hospital (or rehab) may tell you that you need a guardian or conservator.  This is a court proceeding handled by an attorney.

(a) It’s possible that the hospital or rehab attorney will handle the guardianship and/or conservatorship for you, for free.  If that is the case, be sure to check in with them as to who they are naming to act as the guardian or conservator, and, if you are not happy with their choice, advocate for naming someone you prefer.

(b) If the hospital or rehab tells you that you need to find your own attorney (or if you are not comfortable using their attorney), then please call our office.  This is something that we can handle for you.

5. Our office is open.  We are working from home, but if you need anything at all, just call or email, and we will get right back to you.

Hang in there, and get outside for plenty of fresh air and sunshine.

– Alexis & Doreen

My Loved One Died.  Do I Need to Probate a Will?

January 15, 2019

Filed under: Estate Planning,Probate — Alexis @ 2:37 PM

When someone dies and has a will, the obvious question is, “What do I do now?”

The best thing to do is to see a lawyer who specializes in estate planning and probate.  You will bring to that meeting everything you can find about the deceased’s assets and finances: deed, mortgage papers, bank statements, brokerage statements, pension papers, etc., and, of course, the will, if the deceased had one.

At that meeting, the attorney can tell you what steps to take next.  You’ll discuss exactly what needs to be done on the home, bank accounts, life insurance policies, etc.  And you may even learn that you don’t need to file a probate with the court!

It turns out that quite often, filing a probate is not necessary.  And it also often turns out that all you need is the one meeting with the attorney and then you can handle the rest on your own.

The bottom line is that when a loved one dies, it’s a good idea to meet with an attorney.  Even if you decide to proceed on your own, you will know that you have a good roadmap.

Paying Your Caregiver Under the Table

September 20, 2018

Filed under: Caregiver Issues,Financial,Living at Home — Alexis @ 1:47 PM

Hiring a caregiver is an expense, no question about it.  Some families are lucky enough to be able to find the perfect caregiver among their circle of close family and friends.  When finding a caregiver on their own rather than through an agency, lots of families prefer to pay the caregiver under the table because it’s cheaper than using payroll.  And lots of caregivers prefer direct payments because they make more that way – wouldn’t we all prefer to make more money?

But here’s the problem with this arrangement.  Or more precisely, several problems:

  1. Both the employer and the caregiver are committing tax fraud. You really don’t want to be caught for this.
  2. The caregiver, by not using payroll to pay into her Social Security history, is setting herself up for a lower Social Security payment upon retirement. This will make things a lot harder on her in what are supposed to be her golden years.
  3. The caregiver is not covered by worker’s compensation in the event of injury. That leaves her in a lurch if she gets hurt on the job.  Or, it leaves the family in a lurch, as she can try to sue the employer to recover for her injuries.
  4. The caregiver is not covered by state unemployment benefits when the job ends.

No one wants to pay taxes, and payroll costs add to the employer’s financial commitment and reduce the caregiver’s take-home pay.  But if you run the numbers to see exactly how much the cost changes would be for both the employer and the caregiver, hopefully you will decide that the cost is not as much as you expected, and the protections will be worth it.

As the employer, once you decide to start using payroll, you have options for how to manage that.  If you are an organized person and don’t mind or maybe even enjoy “HR” type of work, you can run payroll on your own and submit the required periodic filings to the employee and the government.  You can use QuickBooks or similar programs to help.  If you don’t have the patience or stomach to do it yourself (I don’t), you can use any payroll agency that works with small employers.  Care.com caters specifically to home-based employers.  (I’ve never used them but love that they are a Massachusetts company.)

If you would like help determining the best way to manage payments to your caregiver, please call us.

 

 

 

Elder Abuse – Do You See Signs?

Filed under: Community,Elder Abuse,Financial — Alexis @ 1:45 PM

Do you have a family member or a neighbor who is elderly, or perhaps younger and intellectually disabled? These folks are prime targets for elder abuse.  Some things to keep your eyes and ears open for include:

  1. A previously uninvolved family member becomes the primary caregiver.
  2. A previously unfamiliar “friend” becomes the primary caregiver.
  3. Lots of repeat visits by the same repairmen – are they asking this person to write checks for unnecessary work?
  4. Payments in the checkbook that can’t be easily explained.
  5. Lots of ATM or bank withdrawals for cash, if that wasn’t previously this person’s habit.
  6. The caregiver won’t let others visit or call.
  7. Acting scared.
  8. Sudden bruises or injuries.
  9. Something just doesn’t seem right with the living situation. Trust your gut.

These are not all the signs of elder abuse.  If you suspect abuse of an elder or someone who is intellectually disabled, you can try any of the following: call your town senior center; call South Shore Elder Services or Old Colony Elderly Services (depending on your service area – see map here); call the police; or call the patient’s doctor.

If you see something, say something.

For help preventing yourself or a loved one from ever becoming a victim of elder abuse, please call us.

How Not to Sign Documents for Your Parents

Filed under: Caregiver Issues,Estate Planning,Uncategorized — Alexis @ 1:43 PM

Very often, adult children find themselves in the position of signing documents on behalf of their parents.  This could take the form of signing a parent into a hospital or nursing home, signing a Medicare notice, signing the lease at an assisted living, etc.

When signing documents for a parent, do not sign just your own name.  On most documents, that makes you the financially responsible party!

ALWAYS sign this way: your name, comma, your role.

For example: “Alexis Levitt, POA for Cpt. Jack Sparrow” or “Alexis Levitt, POA” or “Alexis Levitt, HCP”, etc.

Signing your own name can open you personally to unwanted liabilities.  Always remember that you are not signing as yourself, but as an assistant to your parent.

Should I Have a Trust?

Filed under: Estate Planning,Financial,Special Needs Trusts — Alexis @ 1:40 PM

I hear this question a lot when I teach seminars.  If you’ve been to a seminar, you have heard me say that “trusts come in many flavors.”  There are all sorts of trusts, and whether you should have one depends entirely on your situation.  I would say that about one-third of my clients need some type of trust.  And for the other two-thirds, the cost simply isn’t warranted.

Here are some reasons you might need one:

(1) you have a special needs child or grandchild or sibling that you want to leave money to,

(2) you want your family to avoid probate,

(3) you have a complex distribution pattern that you want followed after your death, or

(4) you have over $1 million in assets and you want to do estate tax planning.

Here are some reasons you might not need one:

(1) you don’t have a special needs child, grandchild, or sibling,

(2) you don’t have a taxable estate (or you do but don’t mind paying taxes), or

(3) your assets are fairly simple and you’ve named beneficiaries on each of them.

These two lists are by no means exhaustive, they just show you some typical scenarios.  The only way to really know whether you need a trust is to meet with an elder law attorney who can review your assets, your family tree, and your wishes, and from there determine what the best course of action will be to transfer those assets to your family after your death, with the least amount of trouble.

Please call us so that we can help you determine whether or not you need a trust, and to make the inheritance process as easy as possible for your family.

 

 

Last Week Tonight’s John Oliver Has Something to Say About Guardianships

September 10, 2018

Filed under: Caregiver Issues,Elder Abuse,Estate Planning — Alexis @ 1:14 PM

Have you seen his piece on guardianship?  It’s scary, they are extreme though not rare examples that he uses, and being John Oliver, the bit has its funny moments too.

As one of the spotlights, he tells the story of a couple who were put under guardianship, even though they perhaps were still competent (they certainly appear to be in the video), and then their guardian financially abused her power and basically ignored the couple’s everyday needs.  The couple ended up trapped in an assisted living and couldn’t get out, even though they had the mental and financial ability to leave, because a court had stripped them of the right to make their own decisions and manage their own money.  How did that happen?  He doesn’t give the back story, but in all likelihood, either they weren’t presenting well or they were difficult residents, so whomever was having a tough time with them is probably who brought the guardianship case to court, and a judge, assuming that all was in order, approved it.

Bottom line?  Don’t leave yourself in a position of ever needing a guardian!  In Massachusetts, we have two types of court-appointed fiduciaries:  a “guardian” handles your health care decisions, and a “conservator” manages your assets and finances.  (In the video, John Oliver refers to both of these as “guardians.”)  Why would a court appoint a guardian and/or conservator?  The vast majority of the time, it is because someone has become incompetent (typically due to dementia) AND never signed a durable power of attorney and health care proxy.

In a durable power of attorney, you name someone who you trust to handle your finances for you, should you reach a point where you are unable to do so.   (Technically, the POA springs to life immediately, but most agents understand not to use it until you need them to.)  In a health care proxy, you name someone who you trust to manage your health care if you reach a point where you can’t make or communicate your own health care decisions.  (The HCP springs to life only once a doctor certifies that you have reached that point.)

In both cases, the key is to name someone who you trust, and to name alternates as well.  If you don’t name alternates, and if your primary agent can’t serve when you need them to, then you are back in John Oliver’s video, where, should you become incompetent, or in some cases, if you are competent but a troublemaker, someone will go to court to have a guardian and conservator named over you.

If you would like help creating your durable power of attorney and health care proxy, please give us a call.

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