What Matters to Me Workbook

March 2, 2021

My favorite topic!

If you have been reading these newsletters, then you know that the subject that I return to over and over again (and again and again) is the health care proxy and the importance of advance care planning.  If you are ever in a situation where you are unable to make your own health care decisions, then your trusted decision makers will be able to speak for you only if you give them the authority to do so (that’s the health care proxy you signed).  But also, they will need to know what matters most to you, which turns on you knowing and conveying what matters most.

Well, you are in luck, because the good folks at Ariadne labs (that’s Atul Gawande’s lab – if you haven’t read Being Mortal, pick it up and start reading it now!) and the Conversation Project (remember Ellen Goodman from the Globe?  She’s been busy since “retirement) are here to help.  They have done the field research and reviewed the data, and they used these to develop a fabulous new workbook that helps you both think through what matters most to you and also to convey your thoughts to the people who matter most.

The new workbook is called “What Matters to Me.”  You can download it here, or contact our office and we will print one out and mail it to you.

Please take the time to complete the workbook, and then pat yourself on the back for a job well done.

– Alexis

Useful Info During COVID (v. 5)

August 15, 2020

Hello Friends!

I hope you have been enjoying / avoiding / surviving this heat, depending on your predisposition to such weather.  We live in a proper New England house with not enough storage and no A/C (just window units), so I have definitely been missing the luxurious central air conditioning in my office lately!  But we have been getting to the beach a bit, especially in the evening (the best time of day).  I hope you have too.  Don’t you just love living on the South Shore?

Let’s start at the top:

#1 If you have a loved one in a nursing home, then you know there are a lot of changes going on lately when it comes to procedures and protocols.   Here are a few places where you can go to keep up: Consumer Voice, MANR, Center for Medicare Advocacy, and mass.gov.  If you have an issue with a nursing home and you don’t feel like you are making headway, call your Ombudsman.  These are volunteers who genuinely love the role and usually want to help develop a solution that is win-win.

#2 Great news on qualifying for MassHealth home care!  As you may know, MassHealth has some programs that will pay to send home health aides into you home.  To qualify, you must (1) medically need a certain level of care, (2) be below an asset limit, and (3) be below an income limit of $2349/month.

Ironically, this last piece, the income requirement, has put home care out of reach for many over the years, needlessly forcing people into the nursing home, which MassHealth will pay for with no income cutoff.  For far too long, if an elder meets the other requirements for home care, but is $1 over the income limit, she must spend down, every single month, on medical care, every dollar over $542.  That means that she could use the excess over $542 to pay for health insurance, private aides, and the like, but then she is somehow supposed to pay for groceries, heat, home repairs, sundries, and all the rest on just $542 per month!  Impossible to do.  Most elders in that situation have no choice but to move to a nursing home (which can cost the state much more than a home care package!!).

But – great news.  On a temporary basis, during the state of emergency, MassHealth is CHANGING the rules for anyone over-income for home care.  Instead of spending down to $542, an elder can simply spend down to the actual home care income limit of $2349.  It will be very interesting to see the data as the months go by, to see how many more seniors were able to stay at home with this simple change.  But what about after the state of emergency, you may ask?  Well, there is a health care bill currently in conference at the state legislature.  Please call your state representative and your state senator, and ask them both to talk to their caucus representatives about making this change permanent.

#3 Last week I had my first telehealth appointment!  What a pleasure to not have to drive, navigate through a building, and then sit in a waiting room forever.  An added bonus was getting a glimpse into the doctor’s life and personality, as he was sitting in his studio at home, surrounded by musical instruments.  That added a new dimension to the relationship.  Congress is talking about making telehealth a more prominent part of our medical landscape post-pandemic – yes, please.

#4 This is your periodic reminder to keep your health care proxy and emergency contact information with you at all times!  If you are out and about, that could mean keeping copies in the glove compartment of your car or making up a card to keep in your wallet.  We enroll all of our clients in DocuBank, and they send you a wallet card that connects emergency responders to your key health information.  I keep my DocuBank card in my wallet, and if I am going off adventuring without my bag, I put the card in my pocket.  Like when I go rowing with the fabulous crew out of the Hull Lifesaving Museum.

#5 Along the same lines… your health care agent can do a better job for you if you have shared your care wishes.  There are some great tools out there to help you think through your priorities and wishes for yourself, and then share them with your health care agent.  One free option online is the Conversation Project.  We give our clients the Your Way Workbook.  If we gave you one and you have not completed it – go pull out your black folder with all of your estate planning documents, find the Your Way workbook in there, and fill it out!

As always, reach out with any questions related to elder law, veterans benefits, long-term care, estate planning, and special needs planning.  Get outside, and wash those hands!

– Alexis

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.

 

 

 

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.

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.

Elder Care Workshop Series at Norwell Public Library

March 13, 2017

Filed under: Alzheimer's,Caregiver Issues — Alexis @ 2:02 PM

Getting older? Taking care of someone who is? Come to this series to learn some helpful tips from local Elder Services professionals.

 

Wednesday, March 15:

“Learn to Speak Alzheimereze”

Discover tips to work with a person who is changing before your eyes and to learn to speak ‘Alzheimereze.’

Presented by Alzheimer’s coach Beverly Moore.

Wednesday, March 29: 

“Hospital to Home”

Understand how to make a successful transition from hospital to home.

Presented by Kim Bennett, LSW, of Visiting Angels, Inc.

“Do I Need Palliative or Hospice Care?”

Learn about the difference in important care choices.

Presented by Catherine Harrington, BA, RN, of Norwell VNA and Hospice.

***Workshops will be held at the Norwell Public Library from 6:00 – 7:30 p.m. Registration is requested, but not required via email at Doreen@alexislevitt.com or calling 781.740.7269.

This series is sponsored by the Law Office of Alexis B. Levitt, the Norwell Council on Aging, and the Norwell Public Library.

Elder Care Workshop Series at Norwell Public Library

March 7, 2017

 

Getting older? Taking care of someone who is? Come to this three-part series to learn some helpful tips from local Elder Services professionals.

Wednesday, March 8:

“Who Can Help Me?”

Find out how to access elder services in your community.

Presented by Susan Curtin, Director at Norwell Council on Aging.

 

“Elder Law 101”

Get to know the basics of preparing for your future.

Presented by Attorney Alexis B. Levitt.

 

Wednesday, March 15:

“Learn to Speak Alzheimereze”

Discover tips to work with a person who is changing before your eyes and to learn to speak ‘Alzheimereze.’

Presented by Alzheimer’s coach Beverly Moore.

 

Wednesday, March 29: 

“Hospital to Home”

Understand how to make a successful transition from hospital to home.

Presented by Kim Bennett, LSW, of Visiting Angels, Inc.

 

“Do I Need Palliative or Hospice Care?”

Learn about the difference in important care choices.

Presented by Catherine Harrington, BA, RN, of Norwell VNA and Hospice.

 

***Workshops will be held at the Norwell Public Library from 6:00 – 7:30 p.m. Registration is requested, but not required via email at Doreen@alexislevitt.com or calling 781.740.7269.

 

This series is sponsored by the Law Office of Alexis B. Levitt, the Norwell Council on Aging, and the Norwell Public Library.

 

 

 

Cohasset Alzheimer’s Association Presentation on Dementia-Related Behaviors

February 2, 2017

Filed under: Alzheimer's,Caregiver Issues — Alexis @ 9:44 AM

This looks like a good presentation coming up soon in Cohasset. Presented by the Alzheimer’s Association, participants will learn how to “decode” what an Alzheimer’s patient is trying to express through their behavior. For example, someone lashing out verbally might be doing so because they are frustrated that they are cold but can’t find the words to say so. Come learn how to understand what a behavior is really saying and how to respond.

Event will take place on Wednesday, February 8 at the Cohasset Senior Center from 10:00 – 11:30 a.m. For more information and to register, click here.

Are You Caring for Someone Who Wanders?

December 22, 2016

CMS (the agency that manages Medicare and Medicaid) recently put out this interesting FAQ piece on wandering. The piece is aimed at managers of day programs and assisted livings, but there are a lot of useful nuggets in here for people who are caring for loved ones still at home who tend to wander.

Have You Been Appointed Representative Payee?

December 21, 2016

If you are caring for a loved one who receives Social Security and who cannot manage the Social Security benefits on her own, then you can ask the Social Security Administration to name you (or someone else) as your loved one’s “representative payee.”

This is not a difficult job, but there are some things you need to know. The Social Security Administration has developed a series of videos to help you understand your new job. You can find the videos here.

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