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Understanding Palliative Care

Monday, December 30th, 2013

Palliative care is a branch of medicine devoted to improving quality of life for people diagnosed with serious illnesses. Receiving such care can make a huge difference in patients’ lives, but many people do not know that it exists, or confuse it with hospice care. One of the hurdles to overcome in making this relatively new specialty more widely available is helping people understand when it is appropriate and why it is so important.

Palliative care focuses on providing relief from the pain, stress and other symptoms of serious illnesses. Hospice care is a type of palliative care that focuses on people who are dying. However, palliative care is also appropriate for patients who are continuing treatment for their illnesses and are expected to live much longer or even recover.

In hospitals and other settings where palliative care is provided, it is delivered by a team of doctors, nurses and specialists to provide additional support beyond that provided by the patient’s primary treatment team. A palliative care team may assist patients with cancer, cardiac or pulmonary disease, Alzheimer’s Parkinson’s, ALS or other illnesses. The team concentrates on addressing symptoms such as pain, fatigue, nausea and depression, improving patients’ ability to endure necessary medical treatments and bettering their quality of life.

Pain relief is often a major focus of palliative care. Patients who have serious illnesses or are recovering from major surgery may suffer from debilitating pain, and both doctor and patient may be wary of opioid use because of the danger of dependence. However, pain relief is an important part of treatment, and a palliative care team can help a patient find the best way to relieve suffering.

Relief from pain is not the only aspect of palliative care. It also includes more general help with quality of life issues such as accessing community services, living comfortably at home and obtaining medical and personal care services that a person with a serious illness may need.

The use of palliative care results in fewer emergency room trips and lower medical costs, in addition to making life more enjoyable for patients and improving prospects for recovery. Advocates for palliative care want the services to become universally available in hospitals, nursing homes and assisted living facilities, but there is much road to travel before that goal is reached. This type of treatment was first defined as a medical specialty in 2007, and many doctors are unfamiliar with it. Doctors who are untrained in palliative care may – like much of the public – equate it with hospice care, and therefore not request it for some patients who may need it.

Palliative care is available at most large hospitals in the United States, but patients may have to request it. Depending on the patient’s reason for seeing a doctor, palliative care may be covered by private insurance, Medicare and Medicaid. Patients who would benefit from palliative care, and their families, should advocate for the patient and request the services they need.

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Increased Payouts Coming to Social Security Beneficiaries in 2014

Friday, December 27th, 2013

The amount of monthly Social Security benefit checks will increase by 1.5 percent in 2014. The annual cost-of-living adjustment is expected to add $19 to the average Social Security check for retired workers, for an average monthly benefit of $1,294. The benefit for couples who both receive benefits is expected to climb by an average of $31, yielding an average monthly benefit of $2,111.

The cost-of-living adjustment happens every year and is based on the Consumer Price Index, the government’s measure of inflation. This increase is one of the lowest since automatic cost-of-living changes started in 1975. The basis for the small increase is the fact that consumer prices did not rise much overall in the past year. For example, the price of gasoline actually dropped. However, many essential goods and services, such as the cost of housing and medical costs, rose by more than 1.5 percent.

The cap for Social Security taxes will also increase in 2014. Most workers will pay 6.2 percent of their income into the system, until their earnings reach $117,000, up from $113,700 in 2013. The change will affect about 6 percent of workers.

Also in 2014, retirees below age 66 may earn up to $15,480 before some or all of their Social Security benefits are temporarily withheld, up $360 from 2013. Beneficiaries who earn more than that will have $1 withheld for every $2 they earn over the limit. People who will turn 66 in 2014 may earn up to $41,400, after which $1 is withheld for every $3 they earn. At age 66 or older, there is no earnings limit.

Finally, the maximum possible benefit a retiree can claim increases to $2,642 in 2014, up from $2,533 in 2013.

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Different Types of Assisted Living Facilities Meet Different Needs

Tuesday, December 17th, 2013

Assisted living facilities are residences for senior citizens where help is provided with daily living activities, as needed. This can include making doctor’s appointments and taking medication, as well as bathing, dressing and grooming. Meals and housekeeping are also provided at such facilities. In the state of New York, all types of assisted living residences are licensed as adult care facilities by the Department of Health. However, there are different types of adult care facilities, which may also be called enriched housing programs or adult homes.

First, all adult care facilities are distinguished from nursing homes in that they are for people who do not need round-the-clock medical services or skilled nursing. People who need for medical staff to be present on a continuous basis are better served by a nursing home.

The two kinds of adult care facilities in New York, enriched housing programs and adult homes, both offer long-term care in a residential setting, including meals, laundry, housekeeping, supervision and assistance with personal care and medication. One major difference is that the law has stricter supervision requirements for adult homes, although a number of enriched housing programs may offer the same level of supervision. In addition, enriched housing programs usually provide apartment-style residences, while adult homes generally provide private rooms or two-person rooms.

The same types of service provided in enriched housing programs and adult homes may also be provided by assisted living residences and assisted living programs. In order to refer to themselves as providing “assisted living,” these facilities must meet additional requirements of providing certain disclosures and rights for residents. The goal of assisted living facilities is to provide the care necessary to allow individuals to live as independently as possible, emphasizing personal dignity and freedom of choice.

Finally, an assisted living residence that offers aging-in-place services and obtains additional certification may be designated an enhanced assisted living residence. A special needs assisted living residence is an assisted living residence that provides specialized care and meets additional certification requirements.

For more information, refer to the New York State Department of Health’s website on assisted living, available at http://www.health.ny.gov/facilities/assisted_living.

 

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New Program Enlists Doormen to Watch for Elder Abuse

Friday, December 13th, 2013

A new program in New York City is training doormen who work in apartment buildings to watch for elder abuse.

The Harry and Jeanette Weinberg Center for Elder Abuse Prevention, part of the Hebrew Home at Riverdale, developed the program, which offers free training for doormen, porters, concierges and other building staff, at the building where they work.

Joy Solomon, the director of the Weinberg Center, said that many elderly people who were being abused did not come forward on their own, so advocates realized they would have to reach out to others who might be likely to spot the signs of abuse. The center has already helped to educate people such as estate lawyers, speech therapists, and those who deliver hot meals to seniors. Now building staff are being enlisted to help as well.

Many buildings in the city have a growing population of elderly residents. An analysis of census data by Queens College found that by 2040, an estimated 21 percent of adults in New York City will be age 60 or older, an increase from 17 percent in 2010.

At a training she led recently, Ms. Solomon told of an elderly resident of an Upper East Side apartment building, who was taken advantage of by a woman. Building staff witnessed the woman removing valuables from the man’s apartment, but did not step forward, perhaps because they did not want to overstep their bounds. Solomon said that when a staff member knows that something is wrong, it is important to take action. Several older apartment building residents said they would much prefer that building staff say something about a situation that does not appear right, rather than staying quiet out of a fear of prying into someone else’s business.

For elderly residents who do not have frequent visits from friends and family, a doorman may be the first person to notice an injury, signs of confusion, or other evidence that the person needs help.

Solomon said that the training would be provided initially to buildings with large populations of older people, but would eventually be available to anyone requesting it.

 

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To Save on Taxes, Make Charitable Gifts Before Year’s End

Monday, December 9th, 2013

 

If one wishes to make charitable gifts as part of a tax-saving strategy, now is the time.

Although tax returns are not due until April 15, December is an excellent time to do a “dry run” on one’s tax return, to get an estimate of what one expects to pay in taxes, and to determine what charitable giving one may want to do before the end of the year, in order to reduce taxable income and lower one’s tax bill.

Newly retired individuals may benefit especially from such a dry run on their tax returns, as retirees are often unclear on how to manage taxes in retirement. If there are problems with withholding on pensions, Social Security or IRA withdrawals, then one may end up paying penalties and interest at tax time. IRA account owners can make use of a key strategy to deal with any underpaid taxes. It is possible for IRA owners to make a distribution and withhold the whole sum for taxes. The IRS will not consider it a late payment, but will treat it as taxes paid throughout the year.

Another IRA strategy for retirees is charitable IRA rollovers. After age 70 1/2, owners of traditional IRA accounts must begin taking required minimum distributions. However, they can make direct transfers of up to $100,000 from an IRA to qualified charities, and this counts toward the required minimum distribution, while not being counted as income.

Anyone wishing to make charitable contributions before the end of the year needs to be aware of the rules for timing different types of gifts so that they count for the current year. One may also wish to make gifts to friends and family members before the end of the year without triggering a gift tax. The limit is $14,000 for individual givers and $28,000 for married couples – to as many individuals as they wish.

When donating to a charity by check, the effective date of the donation is the date the check was mailed. When giving to non-charity donees, the gift is effective when the check clears.

Giving stock to a charity by certificate form is effective on the date of transfer in the records of the issuer.

Giving stock to a charity by electronic transfer is effective on the date the issuer shows that the stock is received, which can take several days. For non-charity donees, the gift is effective when the transfer is made on the books of the corporation, which can take weeks.

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Sharing Caregiving Responsibilities Among Siblings

Thursday, November 14th, 2013

Caring for an elderly parent in declining health is a big responsibility, and one that can have a significant effect on the caregiver’s financial and emotional well-being. Having a sibling to share in that responsibility can make things easier, but it can also lead to conflict and resentment. It is important to understand the issues that may arise when two or more adult siblings are caring for an elderly parent, and the best ways to resolve problems.

One question that usually comes up at the outset is who will be the primary caregiver. If only one sibling lives close to the parent who needs care, that is often the deciding factor. When two or more siblings live close by, then the decision often depends on work schedules. If none of the siblings live close to the parent or have time available, then the question becomes how to divide the expense of hiring an in-home health aide or perhaps an assisted living facility, depending on the circumstances.

Good communication is probably the most important factor in making these decisions. Ideally, responsibilities will be divided in whatever way feels fair to everyone involved, and arriving at the best outcome depends on communication. Siblings should be encouraged to share exactly what they feel they should contribute and why. Factors such as an individual’s family income or work schedule are legitimate concerns that may play into decision-making. Feelings about this should be stated plainly so that later resentments can be avoided. Siblings should try their best not to let old sibling rivalries get in the way. Adult siblings caring for an elderly parent are taking on new roles, and they are best served by not replaying old ones.

In addition to family income and work schedules, siblings should consider each other’s particular skills. If one sibling is a more frugal money manager, it may make sense for him or her to hold the power of attorney for the parent. Someone with experience as a caregiver may do the best job handling day-to-day care. One fact that should not be forgotten is that caregiving is valuable and important work. Siblings who are not involved with day-to-day care may not be aware of just how much work is involved. The caregiving sibling should not be afraid to speak up and share with the others how much time goes into giving care for their parent. It can be easy for a sibling that is contributing more time or contributing more money to feel that his or her contribution is unfair or is going unrecognized. Full and frank discussion is the best solution.

Finally, as with most things, careful planning will save a lot of headaches. Just as mom or dad’s schedule of doctor’s appointments and daily medications needs to be kept track of, so should the finances be kept in careful order. An estate planning attorney or financial adviser can be invaluable in preparing a budget that accounts for the cost of different types of care that may be needed.

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Wives and Stepchildren Are Often in Conflict Over Caregiving

Thursday, November 7th, 2013

Being a caregiver for an older loved one can be stressful, not least because the work often seems to fall to one person, with other family members seemingly unaware of how much work goes into caregiving. When a woman is caring for her husband and needs help from his adult children from a previous marriage, conflicts can arise.

This issue was examined in a study published in The Journal of Marriage and Family. The study looked at late-life wives whose husbands had Alzheimer’s or other dementia and what sources of support they had. Many of the women in the study felt that their husband’s relatives – particularly his adult children – had a negative impact on their caregiving. The women often felt that their husband’s adult children made a minimal contribution to caregiving, or created conflict.

Researchers – and caregivers – were already aware that being a caregiver can be demanding and isolating. The new study shows that it is especially challenging for remarried caregivers.

Researchers interviewed 61 women for the study and found cases where adult children refused to believe a diagnosis of dementia or refused to participate in decision-making about caregiving. Some women had had lawsuits filed against them by their husband’s adult children, claiming money was being misspent.

For caregivers experiencing these issues, the solution is often to find positive emotional and practical support elsewhere: from friends, professionals, and their own loved ones.

 

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Extending Your Retirement Savings

Tuesday, October 29th, 2013

In 1935, when the Social Security system was created, average life expectancy was 62 years. In 2013, it has increased to about 80 years. A longer life expectancy means people have a chance to enjoy their retirement years, but it is also something to keep in mind during financial planning for retirement. What if you outlive your money?

Social Security retirement benefits provide a small income for retirees, but most people want to be able to maintain a lifestyle similar to what they had when they were working, and that takes planning.Of course, one of the most important factors in successful retirement planning is to start saving early, and young people who take advantage of 401(k)s and other retirement accounts are doing their future selves a great favor. If, on the other hand, you are nearing retirement and realizing that you need to increase your savings, there are things you can do.

It is important to take advantage of Roth accounts and other retirement accounts as much as possible. Roth accounts are particularly helpful for retirement because of the tax break on withdrawals. High-income earners would be well-advised to make the maximum contributions and convert traditional accounts to Roth accounts during high earning years, when the income tax will be less of a burden.

Another useful strategy to consider is investing in tax-deferred annuities or life insurance policies such as whole life, which have a cash value component that grows tax-deferred. These investments also have death benefits that can help provide an income to survivors.

 

 

 

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How Will Your Finances Be Impacted by Caring for an Aging Relative?

Friday, October 18th, 2013

When an older loved one needs care, family members often step in to provide some of the care themselves, partly to save money. However, it is important to be aware that providing care oneself has its own costs, both to the health of the caregiver and in economic terms.

Studies show that caregivers are more likely to report poor health themselves, at least in part because so much energy goes into caring for another. The financial effect can also be significant. Someone caring for an older family member often chooses to leave the workforce at least temporarily. There is an obvious short-term cost associated with the loss of wages, but the caregiver also may be shortchanging his or her own retirement, as less time working results in less money paid into the Social Security system, and Social Security retirement benefits can be a crucial part of a retirement plan.

A 2011 study showed that a female caregiver who takes leave from work to provide care for a family member loses, on average, more than $324,000 in lifetime wages and retirement benefits.

These are costs that need to be kept in mind whenever someone is considering leaving the workforce to care for a loved one, even temporarily. Although many jobs are protected by the Family and Medical Leave Act, the law only provides for unpaid leave, and only for 12 work-weeks per year. Many people have found that what was intended as a short-term, temporary leave turned into a long-term responsibility. The best course of action is to be realistic from the start about how much care is needed and the best way to provide it. Realistic planning can protect your own health and your financial well-being.

 

Please join us in celebrating, supporting and participating in the 5th anniversary of National Estate Planning Awareness Week, October 21-27, 2013. To learn more, visit The Financial Awareness Foundation. For more information about our estate planning services, visit www.littmankrooks.com. 

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Estate Planning & Elder Law: What You Should Be Aware of If You Live in New York and Florida

Thursday, October 10th, 2013

Many New Yorkers retire in Florida, and many others choose to spend the winter months there while maintaining a residence in New York. As part-time New Yorkers and part-time Floridians, retirees have the best of both worlds. But living in two different states can present certain complications when it comes to estate planning and elder law.

One important consideration is where your legal residence will be, which can be important for purposes of estate taxes. Where you spend the most time may not be as important as where you are registered to vote, what state issued your driver’s license, and what address you list on tax documents.

Your will and any trusts should be tied to the state where you are a legal resident. However, if you own real estate in another state, you should have your estate planning attorney make sure that you do not need additional documents to transfer the property when you die or to manage it if you become incapacitated.

It is also important to make sure that documents such as a living will and health care power of attorney are valid in both states. If you happen to be traveling through another state and are hospitalized, out-of-state documents will probably not cause a problem. But if you spend a significant amount of time in another state, it is advisable to be sure that such documents comply with the laws of both states. If you spend a good deal of time in a state far away from close family members, then you may also want to consider naming a local family member or trusted friend in health documents, so that someone can get to a hospital quickly in the event of an emergency.

Littman Krooks is well-positioned to help you with these matters. Because so many of our clients live both in New York and Florida, we have partnered with Solkoff Legal, P.A. a leading Florida elder law firm, to offer superior estate planning and elder law services to residents of both states. Contact us for more information. Click here to read more about our alliance with Solkoff Legal.

 

For more information about our legal services, visit www.elderlawnewyork.com.

 

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