The Cost of Long-Term Care: Are You Prepared?

10 Signs that Families Need Help

Attorney Kevin Pillion has received Accreditation by the Department of Veterans Affairs (“VA”) that enables him to give advice to and file benefit claims for all Veterans. Accreditation refers to “The authority granted by the VA to those attorneys who meet the established standards.” The Department of Veterans Affairs stated purpose in requiring attorney accreditation is to ensure that claimants for VA benefits receive “…qualified assistance in preparing and presenting their claims.” With this certification, Attorney Kevin Pillion has the distinction of being one of only a few attorneys in Southwest Florida with a VA Accreditation. To receive Accreditation, Federal law requires an attorney to complete an application and continuing legal education requirements. An attorney must also establish that he is of good character and reputation. The privilege of accreditation carries with it the responsibility to maintain specified standards of conduct and comply with the laws that govern VA representations, as set forth in the United States Code and the Code of Federal Regulations. The VA accreditation system is designed to ensure that lawyers who represent VA claimants have a thorough understanding of the VA health and benefit systems, so that they may provide quality assistance in the preparation, presentation and prosecution of those claims.

1. Relying solely on a will or a living trust A Will takes effect only upon your death, and a Living Trust, although preferable in some cases, will not protect your assets from Medicaid Recovery and Nursing Homes. 2. Relying on Medicare or health insurance Neither Medicare nor health insurance pays for the cost of long-term care in a nursing home. With the average cost exceeding $7,000 a month, without a Plan most families will quickly run through their life savings. 3. Transferring all assets to children or other relatives This almost always results in lengthy, unnecessary periods of ineligibility when Medicaid or other public assistance is applied for. And the tax consequences can be devastating. Often, it’s wiser to do nothing. 4. Placing all assets into joint ownership with another family member This is often regarded the same as a transfer and can result in lengthy disqualification periods. Or it may not shelter assets at all. It can also create unfortunate legal problems for families. 5. Selling the family home to pay for nursing home care This is almost never required. Yet many still believe that a person must sell his home to pay the nursing home. 6. Not taking Medicaid estate recovery seriously Medicaid can and does sell your home after your death to recoup benefits paid out on your behalf. 7. Applying for a guardianship This court-supervised method of dealing with a person’s incapacity is time-consuming, costly, burdensome, and restrictive. With proper planning, you avoid the need to go to Court. 8. Relying on family members to “do the right thing” when critical health care and financial decisions need to be made In the absence of a Plan to protect assets and other planning documents, this is an awful burden to place on the members of your family. 9. Not seeking the advice of a specialist in elder law and asset protection planning Medicaid and other government benefits programs are a highly complex area of the law; the law varies from state to state and even within a particular state. Very few attorneys and advisors know and understand the laws and rules that apply. 10. Doing nothing Unless you have no assets to protect or you are unconcerned about how decisions will be made in the event of your disability or incapacity, you should take steps now to protect yourself.

Have you just signed a Durable Power of Attorney? Maybe you’ve had one for awhile, or maybe someone has named you his or her “Attorney-in-Fact.” If you have, to help you understand this important legal document, this page is organized in 6 parts: About the Power of Attorney Powers and Duties of an Attorney-in-Fact Using the Power of Attorney Financial Management and Liability of an Attorney-in-Fact Relationship of the Power of Attorney to other Legal Devices Health Care and the Power of Attorney (NOTE: Not all of this information may apply to you personally. Please ask your own attorney for advice on your own situation.) 1. About the Power of Attorney A Durable Power of Attorney may be the most important of all legal documents. This legal document gives another person the right to do certain things for the maker of the Durable Power of Attorney. What those things are depends upon what the Durable Power of Attorney says. A person giving a Durable Power of Attorney can make it very broad or can limit the Durable Power of Attorney to certain acts. From this point forward, we’re going to refer to the maker of the Durable Power of Attorney as the “Principal.” And we’re going to refer to the person who has been given the power of attorney as the “AIF” or “Attorney-in-Fact.” What can a Power of Attorney be used for? A Power of Attorney can be used to give another person the right to sell a car, home, or other property in the place of the Principal. A Power of Attorney might be used to allow another person to sign a contract for the Principal. It can be used to give another person the authority to make health care decisions, do financial transactions, or sign legal documents that the Principal cannot do for one reason or another. With few exceptions, a Power of Attorney can give others the right to do any legal acts that the Principal could do himself or herself. What is a “General” Power of Attorney? A “General” Power of Attorney gives the Attorney-in-Fact very broad powers to do almost every legal act that the Principal can do. When an Elder Law Attorney drafts a General Power of Attorney, the document still lists the types of things the Attorney-in-Fact can do, but these powers are very broad, as opposed to being a “Limited” Power of Attorney. People often do General Powers of Attorney to plan ahead for the day when they may not be able to take care of things themselves. By doing the General Power of Attorney, they designate someone who can do these things for them. What is a “Durable” Power of Attorney? Normal Powers of Attorney terminate if and when the Principal becomes unable to act — due, for example, to Alzheimer’s disease. If a power of attorney terminates in such circumstances, powers of attorney would not be very useful to help people plan to have someone act for them if they are unable to act for themselves. It is precisely when persons can no longer do for themselves that a power of attorney is most valuable.To remedy this inconsistency, the law created a “Durable Power of Attorney” that remains effective (“durable”) even if a person becomes incapacitated. The only thing that distinguishes a Durable Power of Attorney from a regular Power of Attorney is special wording that states that the power survives the Principal’s incapacity. Even a Durable Power of Attorney, however, may be terminated under certain circumstances if court proceedings are filed. Most Powers of Attorney done today are durable. On this Web page, when we refer to a “Power of Attorney,” we mean that the power is “durable.” Must a person be competent to sign a Power of Attorney? Yes. At the time the Durable Power of Attorney is signed, the Principal must have mental capacity. Although a Durable Power of Attorney is still valid if and when a person becomes incapacitated, the Principal must understand what he or she is signing at the moment of execution. That means a person can be suffering from dementia or Alzheimer’s disease or be otherwise of limited mental capacity sometimes but so long as they have a lucid moment and know what they are doing at the moment they sign the Power of Attorney, it is valid, even if later they don’t remember signing it. At the time it is signed, the Principal must know what the Power of Attorney does, whom they are giving the Power of Attorney to, and what property may be affected by the Power of Attorney. Who may serve as an Attorney-in-Fact? Any competent person 18 years of age and older can serve as an Attorney-in-Fact. Certain financial institutions can also serve. There is no course of education that attorneys-in-fact must complete or any test that attorneys-in-fact must pass. Because a Power of Attorney is such a potentially powerful document, attorneys-in-fact should be chosen for reliability and trustworthiness. In the wrong hands, a Power of Attorney can be a license to steal. It can be a big responsibility to serve as an Attorney-in-Fact. 2. Powers and Duties of an Attorney-in-Fact What can I do as an Attorney-in-Fact? Powers of Attorney can be used for most everything but an Attorney-in-Fact can only do those acts that the Powers of Attorney specifies. Powers of Attorney should be written clearly so that the Attorney-in-Fact and third parties know what the Attorney-in-Fact can and cannot do. If you, as Attorney-in-Fact, are unsure whether or not you are authorized to do a particular act, you should consult the attorney who prepared the document. What can’t I do as an Attorney-in-Fact? There are a few things that an Attorney-in-Fact is forbidden to do even if the Power of Attorney says otherwise. An Attorney-in-Fact may not sign a document stating that the Principal has knowledge of certain facts. For example, if the Principal was a witness to a car accident, the Attorney-in-Fact may not give a statement for the Principal stating that the light was green. An Attorney-in-Fact may not vote in a public election for the Principal, or create or revoke a will or codicil to a will. Nor may the Attorney-in-Fact perform personal services for the Principal under a contract (such as paint a picture or write a book). Likewise, if the Principal were appointed by a court to be a guardian or conservator for someone else, the Attorney-in-Fact cannot take over those responsibilities under the authority of the Power of Attorney. Is there a certain “Code of Conduct” for Attorneys-in-fact? Yes. Attorneys-in-fact must meet a certain standard of care when performing their duties. An Attorney-in-Fact is looked upon as a “fiduciary” under the law. A fiduciary relationship is one of trust. If the Attorney-in-Fact violates this trust, the law may punish the Attorney-in-Fact both civilly (by ordering the payments of restitution and punishment money) and criminally (probation or jail). The standard of care that applies to attorneys-in-fact is discussed below in the discussion on liability. No matter what, however, if the Power of Attorney legally authorizes a particular act, the Attorney-in-Fact cannot be held personally liable for doing that act. 3. Using the Power of Attorney When is a Power of Attorney effective? The Power of Attorney is effective as soon as the Principal signs it, unless the Principal states that it is only to be effective upon the happening of some future event. These are called “springing” powers, because they spring into action upon a certain occurrence. The most common occurrence states that the Power of Attorney will become effective only if and when the Principal becomes disabled, incapacitated, or incompetent. Okay. I’m ready to do something as an Attorney-in-Fact. What do I do? After being certain that the Power of Attorney gives you the authority to do what you want to do, take the Power of Attorney (or a copy) to the third party. Explain to the third party that you are acting under the authority of the Power of Attorney and are authorized to do this particular act. Some third parties may ask you to sign a form stating that you are acting properly. So long as the form is substantially the same as that appearing here at the end of this pamphlet, you may want to sign it. If it states something substantially different from that shown here, you may wish to consult your attorney prior to signing it. The third party should accept the Power of Attorney and allow you to act for the Principal. When acting as an Attorney-in-Fact, always make that clear when signing any document. How should I sign when acting as an Attorney-in-Fact? You always want it to be clear from your signature that you are not signing for yourself but are, instead, signing for the Principal. If you just sign your own name, you may be held personally accountable for anything you sign. As long as your signature clearly conveys that you are signing in a representative capacity and are not signing personally, you are okay. Though lengthy, it is therefore best to sign as follows: Rachel Wilson, by Howard Carver as her Attorney-in-Fact In this example, Howard Carver is the Attorney-in-Fact and Rachel Wilson is the Principal. The exact wording is not important. Just make sure you indicate that you are signing for your Principal, not for yourself. The third party will not accept the Power of Attorney. What now? For a number of reasons, third parties are sometimes hesitant to honor Powers of Attorney. Still, so long as the Power of Attorney was lawfully executed and so long as it has not been revoked, third parties must honor the Power of Attorney. Under some circumstances, if the third party’s refusal to honor the Power of Attorney causes damage, the third party may be liable for those damages and even attorney’s fees and court costs. Even mere delay may cause damage and this too may subject the third party to a lawsuit for damages. It is reasonable, however, for a third party to have the time to consult with legal counsel about the Power of Attorney. Banks will often FAX the Power of Attorney to their legal department for approval. There comes a time, of course, when delay becomes unreasonable. Upon refusal or an unreasonable delay, call your lawyer. Why do third parties sometimes refuse to honor Powers of Attorney? To third parties, the Power of Attorney you have shown them is nothing more than a piece of paper with writing on it. They do not know if it is valid or forged. They do not know if it has been revoked. They do not know if the Principal was competent at the time the Power of Attorney was signed. They do not know whether the Principal has died. Third parties do not want the liability if anything goes wrong. Some third parties refuse to honor Powers of Attorney because they believe they are protecting the Principal from possible unscrupulous conduct. Refusal is more common with older (“stale”) Powers of Attorney, although in fact age should not matter. If your Power of Attorney is refused, talk to your lawyer. What is an Affidavit and do I have to sign it? An affidavit is a sworn written statement. A third party may require you, as the Attorney-in-Fact, to sign an affidavit stating that you are validly exercising your duties under the Power of Attorney. If you want to use the Power of Attorney, you do need to sign the affidavit if so requested by the third party. The purpose of the affidavit is to relieve the third party of liability for accepting an invalid Power of Attorney. What happens to the third party if they unreasonably refuse to accept the Power of Attorney? The law provides that that third party may be liable for any losses caused by the refusal as well as attorney’s fees and court costs. The problem, however, can usually be resolved with a call from your attorney to the third party. In most cases, once the law is explained to the third party, the Power of Attorney is accepted. 4. Financial Management and the Liability of an Attorney-in-Fact What is “Fiduciary Responsibility”? As an Attorney-in-Fact, you are fiduciary to your Principal. A “fiduciary” is a person who has the responsibility for managing the affairs of another, even if only a part of that person’s affairs are being managed. A fiduciary has the responsibility to deal fairly with the Principal and to be prudent in managing the Principal’s affairs. You, as an Attorney-in-Fact, are liable to third parties only if you act imprudently or do not use reasonable care in performing your duties. If ever you are acting as an Attorney-in-Fact and are unsure as to whether you are doing the right thing, seek out professional advice not only to protect yourself but to protect the Principal. Can I have other people do things for me as Attorney-in-Fact? You may hire accountants, lawyers, brokers, or other professionals to help you with your duties, but you can never delegate another person to act for you as Attorney-in-Fact. The Power of Attorney was given to you by the Principal and you do not have the right to give that power to anyone else. 5. Relationship of Power of Attorney to Other Legal Devices What is the difference between an “Attorney-in-Fact” and an “Executor” ? An Executor, sometimes referred to as a “personal representative,” is the person who takes care of another’s estate after that person dies. An Attorney-in-Fact can only take care of a person’s affairs while they are alive. An executor is named in a person’s will and can only be appointed after a court proceeding called “probate.” What is the difference between a Living Trust and a Power of Attorney? A Power of Attorney empowers an Attorney-in-Fact to do certain specified things for the Principal during the Principal’s lifetime. A Living Trust also allows a person, called a “trustee,” to do certain things for the maker of the trust during that person’s lifetime but these powers also extend beyond death. A Living Trust is like a Power of Attorney in that it allows a person to manage another’s assets. Like an Attorney-in-Fact, the Trustee can do banking transactions, investments, and many other tasks related to the management of the person’s assets. Unlike a Power of Attorney, however, the Trustee has control only over those assets that are titled in the name of the Living Trust. For example, if a bank account is titled in the name of the person alone, the Trustee has no power over that asset. In order to give the Trustee control over an asset, the maker of the Trust must arrange for the account or property to be owned by the Trust. Also unlike an Attorney-in-Fact, upon death the Trustee can then distribute the person’s assets in accordance with the person’s written instructions. There are some transactions that a Power of Attorney is better suited for than a Trust and vise versa. As Attorney-in-Fact, what can I do to assist the Principal with his or her estate plan? Estate planning involves making sure that a person’s possessions and property will pass to whom they want after their death and may also involve saving money on taxes. As Attorney-in-Fact, you cannot make a will for the Principal nor can you make a codicil to change an existing will. Likewise, you cannot revoke a Principal’s wills or codicils. If the Power of Attorney specifically says so, however, you, as Attorney-in-Fact, can transfer assets to a Trust that the Principal had already created and may even be able to execute a new trust for the Principal. As discussed earlier, a Trust only has powers over those assets that are titled in the name of the Trust. If the Power of Attorney specifically says so, you may change the names on accounts or property to add things to the Trust. If the Power of Attorney specifically says you can, you may also do certain transactions that will, ultimately, benefit persons after the Principal’s death. For example, if specifically mentioned in the Power of Attorney, you could do a document called a “Life Estate Deed” that allows the Principal to own a piece of real estate for the rest of his or her life but that, immediately upon the Principal’s death, will pass title to the person or persons named in the deed. What is a Durable Power of Attorney for Health Care? A Durable Power of Attorney for Health Care is a document whereby a person designates another to be able to make health care decisions if he or she is unable to make those decisions for him- or herself. A Power of Attorney can be drafted to give these same powers so there is not much difference. However, a Durable Power of Attorney for Health Care is totally dedicated to health care whereas the Power of Attorney can be much more comprehensive. Because the statutes creating the Durable Power of Attorney for Health Care are usually more detailed about health care than the Power of Attorney statutes, it is best that the Durable Power of Attorney for Health Care be used. Specificity is important so that the medical profession feels comfortable in honoring the health care Attorney-in-Fact’s decisions. If you foresee making health care decisions for the Principal of your Power of Attorney, you should consult your attorney. What is the relationship between a Living Will and a Power of Attorney? A Living Will reflects a person’s own wishes as to the termination of medical procedures when they are diagnosed as terminally ill or in an irreversible coma. A living will and a health care power of attorney are termed “advance health care directives” because we make them in advance of incapacity. If a person becomes unable to understand or unable to communicate with his or her doctors, the person’s Living Will is a legally enforceable method making sure his or her wishes are still honored. Whether or not a person has a Living Will, the person’s Attorney-in-Fact may make health care decisions if the Power of Attorney specifically gives this right and some very exact requirements relating to the manner of execution of the Power of Attorney are followed. For this and other reasons, the Principal should execute a separate advance directive called a “Durable Power of Attorney for Health Care.” 6. Conservators and Powers of Attorney What is a Guardian? Guardians are appointed by the Courts for people who are no longer able to act in their own best interests. A person who has a guardian appointed by the Courts may not be able to lawfully execute a Power of Attorney. If you find out that a guardian had been appointed prior to the date the Principal signed the Power of Attorney, you should inform your lawyer. The law requires that whoever starts the guardianship proceeding should give the Attorney-in-Fact notice. If a guardian is appointed after the Power of Attorney was given to you, the Court will probably allow those powers to continue unless good cause is shown why you should not continue as Attorney-in-Fact or the Court determines that the Principal was not competent to sign the Power of Attorney. If you find out about a guardianship proceeding being brought against your Principal, you should consult with your attorney. Court proceedings were filed to appoint a guardian for the Principal or to determine whether the Principal is competent. How does this affect the Power of Attorney? If a guardianship court proceeding is begun after the Power of Attorney was signed by the Principal, the Power of Attorney may be suspended until the Courts decide whether the Power of Attorney should remain in force. It is up to the Court to decide whether you can continue to exercise your powers under the Power of Attorney. The Courts encourage people to execute Powers of Attorney to avoid guardianship proceedings, so it is likely that you will be able to continue to exercise those powers unless the court believes that it would be in the best interests of the Principal that someone else be appointed. The Court may appoint a guardian and permit you to remain as Attorney-in-Fact. If you have the right to make health care decisions for the Principal, the Court may not appoint someone to make those decisions in place of you unless you have abused those powers or the Principal was not competent when he or she executed the Durable Power of Attorney for Health Care. 

Like many other people, you may be thinking about giving your home away now that you are older. There may be several reasons why you might consider doing this: You want to avoid probate You want someone else to take responsibility for the upkeep of the property You want to help a family member You fear you can no longer live alone and want someone to stay in the home with you, or You worry that you may have to enter a nursing home someday. If you are one of the people thinking about transferring your home, here are some things to think about first. You should never sign away your home ownership without first getting advice from an attorney. There are many risks in transferring a home to another. You should talk to an attorney who is certified for or knowledgeable in elder law or estate planning. Here is some general information about the risks you face if you transfer your home. What happens if you transfer your home? You will lose control over the use of your home and property. You will have no say in whether the property is sold, mortgaged, taken by creditors or used for a purpose that you don’t like. You will lose the right to live in the home or somewhere on the property. You will lose the right to rent the property or otherwise use or occupy the property. You may create problems with creditors. You may get in trouble if you have creditors that have a lien on the property or if you file bankruptcy. If you transfer a home or other property, and, as a result, a bank or other creditor is unable to collect a debt, the transfer can be canceled. In some circumstances, such a transfer is considered fraud. You may lose your Property Tax relief. If you are over age 65 or disabled, you may have the right to some relief in paying property tax under state law. If you add another person’s name as co-owner of the property, that person’s income will be counted along with yours. The increase in income may cause you to lose your eligibility for tax relief. Of course, if you are no longer the homeowner, you would no longer have to pay the taxes. The new homeowner will not have a right to relief from these taxes unless he or she can qualify. You may lose the chance to get help from Home Weatherization and Rehabilitation programs. You may lose your eligibility to participate in these programs if you add another’s name to the property deed or if you transfer the property. If You Are on Medicaid or Get an SSI Check If you have Medicaid and live in a nursing facility, or if you live in a nursing facility and plan to apply for Medicaid within the next three years, there is a Medicaid penalty for any gift or transfer “for less than fair market value.” The state checks to see if transfers of any property (including a home) occurred during the three years prior to entering the nursing home or applying for Medicaid. The time is five years for transfers involving trust property. A transfer made that is improper for Medicaid purposes may result in the denial of Medicaid for a certain amount of time (depending on the amount of the gift or transfer). Taking your name or any co-owner’s name off the deed is also considered a transfer that may be penalized under the Medicaid program. If you give away assets when you are on SSI, there is a penalty similar to the Medicaid penalty. You may lose SSI for a certain amount time depending upon the amount of the gift or transfer. If you give your home to someone who receives SSI or other government benefits, your gift may cause the other person to lose benefits, if he or she already has a home. (Owning property, other than your home, can affect eligibility for SSI, Medicaid, Families First benefits and food stamps.) There may be TAX consequences if you give your home away. You may have to pay a gift tax. The gift tax, generally, applies to the transfer of a present interest. Sometimes, the first $10,000 of a gift is exempt from taxation. There may be a $20,000 exemption if a gift is made by a married couple. The person who receives the gift may have to pay more capital gains tax if he or she sells the property at a later time. There are many factors which determine whether a capital gains tax is owed and how much the tax will be. An agreement to exchange your home for in-home care is risky and should always be reviewed by an attorney. This is especially important if you plan to give the caregiver the deed to your home or a promise that the caregiver will inherit your home. These arrangements are dangerous and may cause many problems. The agreement may also affect Medicaid eligibility and tax liability. Never make this type of agreement without the help of an attorney who is knowledgeable in this area of the law. *Prepared for the Caregivers Project, January 15, 1998, by Pam F. Wright, Certified Elder Law Attorney, West Tennessee Legal Services; Updated March 2001 by Timothy L. Takacs, Certified Elder Law Attorney