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.


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.

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.

 

 

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.

The Globe Made It Sound Like All of Our Seniors are Living Like the 1% and That Ticked Me Off

June 13, 2016

Filed under: Financial,Living at Home — Alexis @ 2:08 PM

The Boston Globe Magazine wrote in its 1/31/16 issue of a Massachusetts building boom of senior care communities targeted essentially at the “1%.” You can see that article here.

I was ticked off at the tone of the article, to say the least. The author talks about the high-end senior living communities that developers are building in Eastern Massachusetts, because, well, some seniors through a combination of work and luck have accumulated that kind of wealth. The fact is, most Massachusetts seniors are patching together a network of care and services and doing their best to stay at home. The Globe Magazine published my comment, which you can read here.

The country needs a more comprehensive network of services for seniors, and Massachusetts needs to lead the way.

National Grid Warns Customers to Guard Themselves & Sensitive Account Information

January 12, 2015

Filed under: Elder Abuse,Financial — Alexis @ 10:13 AM

Apparently scammers are getting better at their craft – received this from my local police department:

During this holiday season National Grid and local police departments received an increasing number of calls from customers being targeted by billing scam artists and impersonators trying to gain access to account information and entry to National Grid customers’ homes. The bill scams mirror reports received by utility companies throughout the country where the scammers are demanding immediate payment for electricity and natural gas bill balances and threatening immediate service shutoff if payments are not received within an hour or two. If the customer has made a payment, the caller will say that the payment has not been received and an immediate payment must be made. For the most part the scammers are demanding that the customer secure a pre-paid debit card and provide the account number to the scammer who then redeems the card.
National Grid does contact customers with past due balances by phone to offer payment options. Direct payment is an option but direct payment is never demanded as a prerequisite for continued service. If customers wish, they can arrange for a payment by check, credit card or debit card if they speak directly to a customer service representative. Payment can also be made by credit card or debit card without a representative’s assistance. National Grid does not accept pre-paid debit cards for payment and would never ask a customer to acquire one of these cards to make a bill payment.
The callers have shown to be adept at extracting account information from unsuspecting customers and they use sophisticated telephone technology to convince customers they are actually calling from National Grid.
Ask Questions/Demand Proper ID
In addition to the on-going fraudulent bill collection calls, there have been recurring reports of individuals going door-to-door, identifying themselves as employees of National Grid and demanding to see the customer’s electricity or natural gas bills. In other instances, people claiming to be a utility company employee have been able to gain entry to a home by telling the customer they must inspect their meter, which is usually located in the customer’s basement. When the customer accompanies the impersonator into the basement, an accomplice enters the home and removes items of value without the customer knowing it.

Life Estate Deeds – An Antique Technique Providing Modern Convenience

October 16, 2014

Filed under: Estate Planning,Financial,Uncategorized — Tags: , — Alexis @ 9:30 AM

When we pass away, our assets are divided into two groups – probate and non-probate. Non-probate assets are things like bank accounts and life insurance policies that you have named joint owners or TODs on – they transfer to the named beneficiaries upon your death without any court involvement. Probate assets are held only in your name. The court looks to your will, or the intestacy statute, if there isn’t a will, to determine who receives these assets. This can be a lengthy, and potentially costly, process.

 

One way to make your home a non-probate asset is to create a life estate. This concept was borrowed from old English property law. You, as the owner of the home, deed the home to yourself for life (making you the “life tenant”) and then to another person(s) known as the “remainderman” (most often your children). Upon your passing, the remaindermen immediately become the owners of the home (they just need to file a copy of your death certificate with the Registry of Deeds).

 

Creating a life estate has many benefits. First, upon your passing, your home transfers seamlessly to the remaindermen without any court involvement. Second, you are guaranteed the right to remain in your home for the rest of your lifetime – you cannot be compelled to sell or move out. Next, after your passing, the remaindermen receive a step-up basis for capital gains purposes, minimizing the capital gains tax due should they decide to sell the property after your death. Fourth, because the remaindermen have no ownership interest in the home until after your death, their creditors (in the event of a bankruptcy or divorce, for example) cannot access the equity in the home during your lifetime. Lastly, the entire value of the home can be protected from your nursing home costs so long as the life estate is created at least five years before you ask MassHealth for assistance in paying for nursing home care (more on this below).

 

Creating a life estate, however, has its potential pitfalls. First, the remaindermen must all sign off if you decide you want to mortgage, reverse mortgage or sell the property. The thought of giving up so much control can be frightening for many homeowners. (It’s worthwhile to note that your remaindermen should have their own powers of attorney in place, in the event you need their approval and they are out of the country, in the hospital, or otherwise incapacitated.)

 

Also, if you need to ask the state for assistance in paying for nursing home care in the five years following the creation of a life estate, you could be disqualified for a period of time. MassHealth uses a formula to calculate the “value” of your life estate based on your life expectancy and the value of the home. The disqualification can also be cured if the remaindermen agree to deed the property back to the life tenant outright, destroying the life estate. If it’s likely that you’ll be asking MassHealth to help pay for your nursing home care in the next five years, then you should meet with an elder law attorney to explore other options to protect the value of your home to the greatest extent possible.

 

A life estate deed can be a valuable addition to your estate plan. If you’re interested in learning more about life estates and whether this might be the right solution for you, call our office to schedule a planning session.

The Importance of Caregiver Contracts

October 2, 2014

Filed under: Caregiver Issues,Financial — Tags: , , — Alexis @ 12:40 PM

A goal that my clients bring up in meetings time after time is that they wish to stay in their own homes for as long as possible. Many people, however, find the cost of bringing help into their homes to be daunting. Elders are increasingly turning to their adult children for in-home care. As thanks, to reimburse the child for their time and expenses, or a combination of both, elders often wish to “pay” the child. But should the elder need nursing home care in the future, MassHealth will view informal payments as gifts, which could prevent the elder from receiving public assistance. So the question is, what is a family to do?

 

One solution is a “caregiver contract.” This is a written agreement between the elder(s) and their adult children, laying out tasks the child will perform and a rate of pay. Set up along with worker’s compensation and the usual payroll deductions, this provides an income stream to the caregiver while giving the parent what most elders want – being cared for by his or her own family.

 

Caregiver contracts benefit both parties. The caretaker child gets the benefit of worker’s compensation, in addition to reportable, reliable income for state and federal income tax purposes. (You may not think that’s a benefit – but paying taxes can be much better than the consequences of being discovered as delinquent!) The elder gets to remain in his or her home with a familiar caretaker, often at a rate much less expensive than those charged by home health agencies. Should the elder require MassHealth to pay for nursing home care, he or she can prove that the payments were just that – payments – and not gifts.

 

Only an elder law attorney familiar with the ever-changing MassHealth rules should draft a caregiver contract, so that it will protect the elder in the event he or she needs nursing home care in the future. If you believe a caregiver contract would be helpful to you, please do not hesitate to contact my office.

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