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Using a Hybrid Approach to Long Term Care

In many areas in and around Baltimore, nursing-homecare ranges between $9,000 and $13,000 per month. This can drain a life savingsvery quickly causing many seniors to attempt to “age in place” as long aspossible, meaning they attempt to stay in their home with health care aides.

Long-term care insurance (LTCI) and the Medicaid AssetProtection Trust (MAPT) are ways to address these soaring long-term care costs.Often viewed as either/or options, using a hybrid approach may be a better alternative.

Long-term care insurance protects both income and assets fromthe costs of long-term care. It is a form of self-insuring and is typicallypurchased when one is younger and healthier in anticipation of getting olderand needing long-term care. When needed, the insurance will pay for healthaides in the home.

Depending on the benefits of the policy, long term careinsurance may also pay for assisted living and nursing-home costs. The downsideis that long term care insurance is expensive and requires passing certainhealth assessments to qualify.

Another option for planning for long term care needs is aMedicaid Asset Protection Trust (MAPT) that protects assets from going tonursing-home costs after the assets are in the trust for five years.  Once the time limit passes, you may then applyfor Medicaid to pay for nursing-home costs.

However, unlike long term care insurance, the trust does notprotect your income. Medicaid income rules determine how much income you keep.

Now for the hybrid approach:  buy some long-term care insurance and also create a Medicaid Asset Protection Trust. Factors that help make the decision regarding the hybrid approach include the daily benefit of the LTCI, the maximum lifetime payout, if there is an inflation rider, and other assets and income that could supplement the insurance. For more information on this strategy and how to best apply it to your situation, contact the experienced Elder Law attorneys with Stouffer Legal at 443-470-3599.

November 8, 2019
Should Your Will Contain an In Terrorem Clause?

An in terrorem clause,also called a no-contest clause, may be added into certain legal documents,such as a Last Will and Testament. The clause is designed to threaten someone,i.e. invoke terror, hence the name, if they do not act or refrain from acting a certain way. The threat is typically in the form of either litigation or criminal prosecution.

Maybe you have considered including a “no-contest” or “in terrorem” provision in your will or trust, in the hopes that it will help maintain family harmony. The clauses specifically in the case of wills and trusts are intended to terrorize anyone who would otherwise inherit from filing any contests. They typically read:  "If any person shall commence proceedings to have this Will set aside or declared invalid or to contest any part or all of the provisions included in this Will they shall forfeit any interest in my estate."

Does this approach actually work? Sometimes, but seldom does it work the way it was intended. Why is that?

For starters, most wills do not need one because testators tend to leave everything to the beneficiaries in equal shares. The beneficiaries in this situation typically feel like the will is fair and are not as likely to want to contest anything. Another example when these clauses may not work as intended is when someone is disinherited altogether (i.e. they receive nothing at all). Again, the in terrorem clause is not going to prevent the child from contesting because he or she did not stand to inherit in the first place. Nothing to lose. Stating that they will be disinherited if they contest the will is not a deterrent in this situation because they were not inheriting to begin with.

Let’s try to make the ‘in terrorem’ clause work. If you leave the child you intended to disinherit something (a little bit of money,some specific bequest of artwork or personal items) and include the in terrorem clause in your will. Now the child has to consider his options. Contest it and try to inherit more or not contest it and accept what was given.

If conflict avoidance is important to you, there are many alternatives to in terrorem clauses that may better accomplish your goals of family harmony. To discuss your situation and learn more options, schedule a consultation with Stouffer Legal at 443-470-3599 in the Greater Baltimore area.

November 7, 2019
Psychiatric Advance Directives

Maryland law allows anyone 16 years of age and older to be involved in decisions about their mental health treatment. A psychiatric or mental health advance directive (PAD) is a legal document that allows a person with mental illness to state their preferences for treatment in advance of a crisis. This may help protect a person’s autonomy and ability to ensure the right care and procedures are followed during a mental health crisis. PADs are similar to living wills and other medical advance planning documents used in palliative care, but specifically address psychiatric concerns.

Both advance medical directives and psychiatric advance directives (PADs) consist of two parts: a “living will” and a “health care proxy” or “medical power of attorney.” A living will is a document in which a patient provides direction regarding medical treatments that the patient wishes to accept or refuse under various circumstances. A health care proxy is a document designating an agent to act on the patient’s behalf with respect to medical decisions. 

The first part of a PAD gives patient instructions regarding future mental healthcare treatment, while the second part of a PAD designates a proxy decision-maker for mental health care. A person who wishes to develop aPAD can use one or both parts.

The advance instruction can detail preferences for treatment, give consent for admission and provide consent for who may be contacted in advance. It can designate preferred medications and treatments.

A PAD goes into effect when aperson is deemed unable to make sound decisions in his or her best interest. A treating physician or psychologist makes the decision about capacity based on how the person presents at the time of examination. Some examples of periods when a person may lack capacity include acute psychosis, mania, catatonia,delirium, or unconsciousness. At this point the PAD goes into effect and treating medical professionals can use the PAD to get a  better understanding of the person’s treatment preferences and family/friends to contact. If there is a health care power of attorney in place, the designated health care agent can make decisions on the patient’s behalf.

PADs are only used temporarily. Once the person regains capacity to make sound decisions, they can resume participating directly in decisions about care. Any adult of sound mind can create a PAD. For more information on creating Advance Medical Directives or Psychiatric Advance Directives, please contact Stouffer Legal at 443-470-3599 in the Greater Baltimore area.

November 6, 2019
Upcoming Workshops!

Our workshops are designed to be educational, interactive, informative and generate relevant discussion for attendees. Modern Estate Planning is more than just preparing a will and putting it in a safe. Find out how a comprehensive Estate Plan will protect your assets and your family. Our experienced attorney, Wilson McManus, will be sharing stories on how Estate Planning is beneficial and sometimes crucial. In an Estate Plan, you need to know the Rules: Who's "Rule-book" controls your Estate Plan? Yours? The Governments? Someone else? You need to know your Predators: Who's a Threat to Your Stuff? The Government?Long-term Care Costs? Your Family? You need to know your Options: What Plans are out there? Does a Will work? What about a Trust? Which kind of Trust?

Please join us for one of our Upcoming Workshops:

November 14th or November 19th at 6pm

All workshops are held at the Stouffer Legal Estate Planning Center located at 658 Kenilworth Drive, Suite 203, Towson, Maryland 21204.

Our workshops fill up fast, so please call (443) 470-3599 today to RSVP.

November 5, 2019
Two Documents You Need When Your Child Turns 18

When your child reaches the age of eighteen, he or she is now entitled to privacy and you no longer have the same level of access to or authority over financial, educational and medical information.

At a minimum, you should take these three steps to ensure you can still protect your adult child:

  1. HIPPA RELEASE. Have your child sign a HIPPA Release form that ensures you can gain access to critical health care information should your child be hospitalized or under medical care. A health care proxy with a HIPAA release would enable your child to designate you or another trusted person to make medical decisions in the event your child is unable to convey his or her wishes.
  • DURABLE POWER OF ATTORNEY. Like medical information, your 18-year-old child’s finances are also private. Having a durable power of attorney in place does not change the access to private financial records unless it is triggered by incapacity. This is a tool that allows you take over if your child is no longer of sound mind. Without it, you will not have access.

For information on some basic estate planning for your child turning 18, contact Stouffer Legal at 443-470-3599 in the Greater Baltimore area. We can help you obtain the documents you need that will provide you access to the right information should that become necessary.

November 1, 2019
Top 4 Tips for Recognizing Elder Financial Abuse

Unfortunately, there are predators out there looking for ways tofinancially exploit seniors. Be on the lookout for these four things:

  1. Changes to BankAccounts. Check statements monthly and pay attention to any largewithdrawals. Review the cancelled checks to make sure they were not made out tocash. Make sure no changes are made to the status of the account (new signatureauthorizations, payable on death beneficiaries added, etc.)
  2. Valuables. Regularlycheck on all personal valuables such as jewelry collections, antiques, artwork,etc. Take inventory frequently. Know who is allowed entry into the elder’s homeand keep track of when individuals come and go.
  3. Isolation. If any newperson in the elder’s life attempts to cut him or her off from friends and familyview it as a serious warning. Make sure you are not prevented from checking onfinancials and taking property inventories.
  4. Fear. If your lovedone expresses any type of fear towards other family members, neighbors orcaregivers keep a close eye on the individual. Sometimes elders fear theabusers but are not able to articulate what is happening. Watch thoseindividuals closely. Consider using a “nanny” cam or some other type ofsurveillance.

If you suspect financial elder abuse, consult with anexperienced elder law attorney in the Greater Baltimore area.

October 31, 2019
Controlling from the Grave: Incentive Trusts

When you accumulate a significant amount of wealth, you may worry that your descendants may not know how to deal with such a sizable inheritance. If the amount is large enough that your heirs do not have to earn a living, you may worry that they will waste away their lives in a consistent vacation mode. You may also want the money to be preserved for future generations rather than spent lavishly.

An Incentive Trust is an estate planning tool where the trustee makes distributions to the beneficiaries based on pre-determined goals or conditions.Incentive trusts are structured to motivate certain types of behavior and discourage others. 

A trust can “reward” a beneficiary for obtaining a post-graduate degree, maintaining stable employment in a certain field, buying a home in specific location, or even remaining clean and sober for a specified period. Once the milestone is met, a distribution is made to the beneficiary.

Keep in mind this type of dangling a carrot may offend your family members. People tend to resist being controlled from the grave. You must also keep in mind that certain freedoms cannot be restricted. If a restriction is challenged as violating public policy, it may be overturned.

For more information on the pros and cons of using an Incentive Trust, contact Stouffer Legal at 443-470-3599 in the Greater Baltimore area.

October 30, 2019
Upcoming Workshops!

Our workshops are designed to be educational, interactive, informative and generate relevant discussion for attendees. Modern Estate Planning is more than just preparing a will and putting it in a safe. Find out how a comprehensive Estate Plan will protect your assets and your family. Our experienced attorney, Wilson McManus, will be sharing stories on how Estate Planning is beneficial and sometimes crucial. In an Estate Plan, you need to know the Rules: Who's "Rule-book"controls your Estate Plan? Yours? The Governments? Someone else? You needto know your Predators: Who's a Threat to Your Stuff? The Government?Long-term Care Costs? Your Family? You need to know your Options: What Plans are out there? Does a Will work? What about a Trust? Which kind of Trust?

Please join us for one of our Upcoming Workshops:

November 5th at 10am or November 7th at 6pm

All workshops are held at the Stouffer Legal Estate Planning Center located at 658 Kenilworth Drive, Suite 203, Towson, Maryland 21204.

Our workshops fill up fast, so please call (443) 470-3599 today to RSVP.

October 29, 2019
What Powers are Conferred by a Durable Power of Attorney?

You may authorize an agent under a Durable Power of Attorney to:

  • buy or sell property(real and/or personal) for you;
  • apply for public benefits/government assistance on your behalf;
  • manage your business;
  • collect your debts;
  • invest your money;
  • cash your checks;
  • manage your day-to-day financial matters; or
  • take legal action on your behalf.

Some powers are given only if they are specifically mentioned.Those requiring specific mention include:

  • the power to make gifts of your money or other property;
  • the power to change your community property agreement; and
  • the power to designate beneficiaries of your insurance policies.

Some powers cannot be given to an agent. Those include:

  • the power to vote inpublic elections; and
  • the power to make oralter a Will.

For more information on Estate Planning tools such as a Durable Power of Attorney, please contact Stouffer Legal at 443-470-3599 in the Greater Baltimore area.

October 18, 2019
A New Approach to Managing Dementia

Dementia,a chronic or persistentdisorder of the mental processes and marked by memory disorders, personalitychanges, and impaired reasoning affects over 44 million people worldwide. Generally, these symptoms are treatedwith drugs, and the most common medications are antipsychotic.

To find another approach, a national multidisciplinary expertpanel comprised of a dozen experts in dementia care collaborated to develop afour-step behavioral therapy approach referred to as DICE:

The four steps of the DICEstrategy include the following:

• Describe. Caregiversshould describe the symptoms and the contexts in which they occur to thedementia patient. Try to figure out cause and effect. Identify triggers tocertain behaviors.

• Investigate. Thecaregiver or medical provider should attempt to identify, or exclude, possibleunderlying causes. These can include unmet needs – lack of sleep, a need foreyeglasses or hearing aids, toiletry needs, etc.  Evaluate all possible medical andenvironmental issues that could be provoking the symptoms of dementia.

• Create. Caregivers,providers and family should collaborate to create and implement a treatmentplan. Treatments may be a combination of behavioral therapy and medication. Brainstormbehavioral and environmental approaches which could include a visiting nurse oroccupational therapist. The five domains of generalized strategies suggested inthis study are educating the caregiver; improving communication between thecaregiver and patient; creating meaningful activities for the patient;simplifying tasks and establishing structured routines; and ensuring safety andenhancing the environment.

• Evaluate. Finally,evaluate the treatment plan periodically to determine whether it is working asintended or needs modifications.  

If you have a loved one experiencing signs of dementia, contact Stouffer Legal at 443-470-3599 in the Greater Baltimore area, to meet with experienced Elder Law and Estate Planning attorneys.

October 17, 2019
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