Emergency Rooms and the Elderly Patient

April 17th, 2014

Emergency rooms are designed for fast treatment of serious or life-threatening conditions.  Elderly patients suffering from chronic illnesses may not always be able to convey important medical information to treating professionals.  This is particularly true of those suffering from Alzheimer’s disease or dementia. Additionally, elderly patients may not be able to properly communicate information about their prescribed medications. These factors mean that quick treatment is not always the most effective treatment.

hospitalPatients coming to hospital emergency rooms receive treatment and are sent home with detailed instructions about arranging their own follow-up care. This approach is grounded in the efficient use of limited resources. For many elderly patients, this approach may not be ideal because more thorough evaluation is necessary.

Specialists in geriatric medicine and emergency room care have taken steps to address the problem. Recently, the Society for Academic Emergency Medicine (SAEM) published a set of guidelines to help emergency departments provide better care for elderly patients.

The purpose is to “provide a standardized set of guidelines that can effectively improve the care of the geriatric population and which is feasible to implement in the ED. These guidelines create a template for staffing, equipment, education, policies and procedures, follow-up care, and performance improvement measures.”  (Society for Academic Emergency Medicine, 2014)

Elderly-Man-With Doctor

The guidelines include better training for hospital staff to recognize certain factors that play a role in providing care to the elderly. For instance, older patients may need more assistance getting prescriptions filled, and may need for transportation to be arranged for follow-up medical visits. The guidelines also recommend sound-absorbing materials and non-slip flooring in emergency rooms to reduce noise and prevent accidents.

Recommended changes also include printing discharge instructions in a large font size, and making sure that emergency rooms communicate important information to the patient’s family and any outpatient caregivers, including nursing homes. Emergency departments should also develop relationships with providers of resources that patients can use for follow-up care regarding mobility, safety assessments, prescription assistance and education, and home health care assistance. The guidelines stress that much depends on educating hospital staff about the needs of elderly patients.

Similar changes have been made in regard to pediatric and cardiac emergency care, but changes to help the elderly have not come as quickly. Nevertheless, progress is being made. Today over 50 medical centers have made such improvements, as opposed to ten years ago, when there were no such features.

 

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Society for Academic Emergency Medicine. (2014). Geriatric Emergency Department Guidelines. Retrieved from saem.org: http://www.saem.org/education/geriatric-ed-guidelines

 

Glossary of New York Estate Administration Terms

April 8th, 2014

If you are preparing your will, or if you have been named as executor in a will, you may be encountering some unfamiliar terminology. It is important to know the meaning of the terms used in the administration of estates, so that you can begin to understand how wills are probated and what the responsibilities of a fiduciary are. This glossary defines some of the terms that are used in the administration of estates in New York State. More information can be found at the website of the Public Administrator of New York County.

 

  • Administrator: A fiduciary appointed to administer the estate of a decedent who died without a will.
  • Decedent: A person who has died.
  • Distributee: A person entitled to take some or all of the property of a decedent who died intestate. Also called an heir.
  • Domicile: The permanent place where a decedent lived. If a decedent lived in more than one place, then the domicile is where the person intended to return.
  • Estate: The total property of a decedent.
  • Executor: A fiduciary who is named in a will to administer the estate of a decedent.
  • Fiduciary: Also called a personal representative, a person appointed by the Surrogate’s Court to administer or manage the estate of a decedent. A fiduciary may be an executor if named to that position in a will, or an administrator if appointed to administer the estate of a decedent who died intestate.
  • Intestate: Describes a person who died without a will.
  • Personal Representative: Another term for a fiduciary.
  • Probate: The process by which the Surrogate’s Court recognizes the validity of a will. When a will is recognized as valid, it is admitted to probate, and the executor is usually appointed to administer the estate.
  • Public Administrator: The Office of the Public Administrator administers estates in each New York county, and is the default fiduciary, administering estates when no one else is available, such as when a decedent dies intestate and there are no distributees, or the distributees are ineligible to serve as administrator.
  • Surrogate’s Court: The New York county courts that oversee the estates of decedents. In other states, these may be called probate courts.

 

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National Financial Literacy Month: Six Steps Toward Successful Estate Planning

April 1st, 2014

In support of National Financial Literacy Month (April) and National Estate Planning Awareness Week (3rd week in October), the following estate planning article contains a very important message:

Estate planning is a financial process that can protect you and your family and is a very important component of your overall financial planning. Now is the perfect time to put your estate planning house in order. If you don’t have an up-to-date estate plan and you happen to get hurt or sick and cannot manage your financial affairs, the courts will have to appoint someone to manage them for you. The person they appoint might not be the one you would want to perform those tasks.

Without an estate plan, when you pass away, your affairs will be settled by default through a complex legal system called “probate.” The handling of your financial affairs can turn into a costly and frustrating ordeal for your family and heirs.

The crafting of a good estate plan starts with planning, followed by the proper drafting and signing of appropriate legal documents such as wills, trusts, buy-sell agreements, durable powers of attorney for asset management, and an advanced health-care directive or health-care power of attorney. Having these documents in place saves you and your family a lot of money and time at a very difficult and emotional time.

Your estate planning should also address the coordination of the way you hold title to your various assets, your beneficiary selections, and the possible transfer of certain assets while you are alive.

Regardless of the extent of your net worth, estate planning is important for everyone. Complex strategies may be used by wealthy people to reduce death taxes and costs. Others may only require a simple will and/or trust to pass on property to their heirs and provide for minor children.

Even if a simple will is all you require, an estate plan is an essential part of your financial planning. Everybody will need it someday. The time to address or update your estate plan is now. See the checklist provided below to help update your estate plan:

CHECKLIST — SIX STEPS TOWARD SUCCESSFUL ESTATE PLANNING

1. DEFINE YOUR GOALS: What do you want to happen to your assets in the event of your death or disability? If your beneficiaries predecease you, who are your alternate selections? How will your assets be distributed, and when will these distributions take place?

  • Decisions on distribution of your estate assets should take into account the size of the estate, the ages and abilities of your children, and your personal desires. For example, a distribution to children over time might consist of 10 percent of the estate at age 18, 25 percent at age 21, 50 percent at age 24 or upon completion of college, and the balance at age 30.
  • Choose your appointees for important roles: Who will be your executor and, if applicable, trustee and/or guardians? It is advisable to list at least a first and second alternate for each appointment in case your first choice is unwilling or unable to serve.
  • If you have children who are minors, the appointment of a guardian is probably the most important decision you’ll make. With the court’s approval, this person, or persons, will raise your children. Consider appointing a family member and spouse, or another close couple who’ll care for your children the way you would want.
  • You may want to consider listing multiple executors, trustees and guardians to serve together in handling the details of your estate. This can provide a check-and-balance system for the appointees and help them avoid oversights or misappropriations. Consider appointing family members, friends, professionals, advisers and/or trust companies for this position.
  • There is some risk here: If these people disagree and have problems, they can each be represented in court by counsel paid for by your estate, so be very careful in making your selections.
  • Living trusts have become popular because less administration is required in comparison with a will. Be aware that having a living trust does not eliminate the need for a will and administration at either the first or second spouse’s death.
  • To get the benefits of the trust, certain details must be attended to, and this is the job of your appointees. For example, leaving a trust for the surviving spouse requires that the trust be funded properly and in a timely manner at the first death, or major tax benefits can be lost.
  • Is estate privacy an issue for you? Do you want your estate to be public record upon your death? Do you have any special gifts you want made to charity? Do you want an elderly parent or friend to be financially cared for? All of these circumstances should be noted in your plan.
  • GATHER & ORGANIZE YOUR DATA: There are three basic tasks to be accomplished:
  • Review and update your financial position.
  • Review how you hold title to your assets. Is it consistent with your estate plan?
  • Review your beneficiary selections. Are they aligned with your estate plans?
  • Did you know that how you hold title to assets has a higher legal priority than your will? For example, if you and your best friend held title to an investment club account as joint tenants and you died, the property would revert to your friend even though you had willed your interest to your spouse.

3. ANALYZE YOUR SITUATION: Start by determining your current net worth, assuming your death occurred today. This can be done by totaling your current assets and liabilities, and adding the value of any life insurance.

  • Try sketching a picture or flow chart of your existing estate plan. Review your appointees:
  • Executor
  • Guardian of the Person/of the Property
  • Trustee
  • Power of Attorney – Property Management
  • Advance Health-Care Directive or Health-Care Power of Attorney

4. DEVELOP YOUR STRATEGIES: With the assistance of your estate planning advisor(s), identify the legal documents that need drafting or make any necessary adjustments to existing documents. Determine any other actions that must be taken for your wishes to be carried out.

5. IMPLEMENT YOUR PLAN: Do what needs to be done — i.e., create new wills, trusts and powers of attorney, adjust title to your properties, change alternate beneficiaries of retirement plans and life insurance policies to trusts.

6. TRACK & MONITOR YOUR PROGRESS: Check your estate plan annually or any time there are changes in your family situation or net worth. Use your financial planning calendar to schedule your next review.

 

Learn more about National Financial Literacy Month by clicking here. For more information on estate and financial planning content contact v.sabuco@TheFinancialAwarenessFoundation.org.

 

 

 

Age-Related Financial and Planning Milestones that People Will Encounter in their Sixties

March 28th, 2014

As one nears retirement age, a number of important financial planning milestones begin to approach. It can be difficult to keep them all straight. Here is a timeline of what happens when:

  • At age 59 1/2, people can begin to make withdrawals from 401(k)s, traditional IRAs and similar retirement savings accounts, without an additional tax penalty of 10 percent. (Withdrawals are still taxed as income in any case.) Of course, just because one can begin to make withdrawals at this age does not mean one necessarily should.
  • At age 60, if one’s spouse has died, then one can begin to collect a Social Security survivor benefit. This is also true if an ex-spouse has died, if the marriage lasted at least 10 years and the survivor did not remarry.
  • Upon reaching age 62, people can take the option of early Social Security retirement benefits. Keep in mind that starting one’s benefits early results in lower payments, and it is usually better to wait a few years to receive a larger benefit. If one is eligible for a pension, these benefits also often kick in at this age.
  • At age 65, one becomes eligible for Medicare. There is a seven-month window around one’s 65th birthday to sign up for Medicare benefits and avoid a surcharge.
  •  Age 66, for most baby boomers, is full retirement age for the purposes of Social Security retirement benefits. Additionally, at this age, someone who chose early benefits can now suspend benefits in order to build up delayed retirement credits.
  •  Upon reaching age 70, there is no further advantage to delaying taking Social Security retirement benefits. People who wait until this age to begin receiving benefits maximize their monthly payments.
  • At age 70 1/2, required minimum distributions begin for 401(k)s and IRAs. A certain amount must be withdrawn from these accounts each year, based on the total value of all such accounts.

By paying close attention to these milestones, one can complete a more precise budget, an important part of retirement planning.

 

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Further Thoughts on Long-Term Care Insurance

March 17th, 2014

Our recent post (see below) entitled, “Is Long-Term Care Insurance Worth the Cost?” has generated a lot of discussion.

We’d like to clarify a few points:

  • Long Term Care (LTC) insurance pays for expenses associated with chronic illnesses, such as home care, assisted living and nursing homes. On a long-term basis, these expenses are not covered by Medicare, which covers mainly short term rehabilitation.
  • In many cases, long-term care insurance enables policy holders to protect their financial assets.
  • Premiums for LTC insurance are based on a variety of factors, including the person’s age, health, medical history and policy benefits.  The earlier you buy, the less expensive the policy will be.

Whether and when a particular individual should purchase a LTC policy is a complex issue and the answer to the question posed in the original post can differ by individual, age, family situation, income and assets.  There really is no bright line test. LTC insurance should be considered by all as part of the estate planning process.

Before purchasing a LTC  policy:

  • Familiarize yourself with the benefits as well as the limitations
  • Have a thorough understanding of your financial situation and goals

Work with a reputable agent who specializes in LTC insurance.  In addition, speak to an elder law attorney and discuss the terms of the policy, the costs, the associated benefits as well as the financial strength of the insurer.

 

Is Long-Term Care Insurance Worth the Cost?

As the cost of a nursing home stay has increased, so has the cost of long-term care insurance, causing many seniors to reassess the value of such insurance.

Many people’s financial planning for retirement includes a combination of Social Security retirement benefits, other sources of income such as a pension, and savings and investments. On the expenses side, many costs are stable and predictable, with one serious risk being the need for nursing care for a long period of time. Since the annual cost of care in an Alzheimer’s unit can reach $100,000 or more, it is no wonder that many consider long-term care insurance. However, it is important to think about whether such protection is right for you.

First, keep in mind that many nursing home stays are not covered by such policies. Most long-term care policies do not cover the first 90 days, and two-thirds of nursing home stays are for less than 90 days, so insurance will not help at all in these cases. In the case of an extended stay, many policies will cover only a certain dollar amount and only for the period of time covered, often three years.

For many seniors entering a nursing home for an indefinite stay, Medicare will provide for the cost, with assets being used to offset the cost until they are exhausted, when Medicaid will kick in. Therefore, for a single person with no heirs, long-term care insurance may not be necessary. For a married couple, if one spouse requires an extended stay in a nursing home, the healthy spouse may keep the house, one vehicle, and assets of about $116,000 (the amount varies by state), and still qualify for Medicaid for the nursing home expenses.

One view is that long-term care insurance may be unnecessary either if a couple’s assets are less than $116,000 exclusive of the home and one vehicle, such that they will be eligible for Medicaid, or if assets are above about $700,000, in which case the couple can probably self-fund a nursing home stay. Within that window between roughly $116,000 and $700,000, long-term care insurance may be useful.

 

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Social Security Announces New Disability Process for Veterans

March 17th, 2014

Social Security Announces New Disability Process for Veterans

The process of applying for Social Security disability benefits will be expedited for some veterans.

Under a new initiative, veterans who have a 100 percent Permanent and Total disability compensation rating from the Department of Veterans Affairs (VA) will be able to apply for Social Security disability benefits on an expedited basis. Social Security will handle these claims on a high priority basis, similar to the way claims from service members wounded in combat are processed.

Carolyn Colvin, the Acting Commissioner of the Social Security Administration (SSA), said that the agency worked with the VA to identify veterans with disabilities who were most likely to also meet Social Security’s definition of disability.

Veterans who wish to take advantage of the expedited processing of their claim must submit their VA Notification Letter showing their 100 percent Permanent and Total disability compensation rating to Social Security. The new initiative begins March 17 and only expedites processing; it does not guarantee that a veteran’s application for disability benefits will be approved. Both the VA and SSA pay disability benefits, but they use different criteria to determine disability, and they have different processes and programs.

In general terms, the SSA considers an individual to be disabled if the person has a severe disability that has lasted or is expected to last for a year or more, and the person is not able to perform previous work and is not able to adjust to other work, due to the disability.

The SSA estimates that tens of thousands of veterans could be eligible for the expedited service over time. In 2012, about 360,000 veterans receiving VA disability benefits were classified as fully disabled. However, many of those veterans may already be receiving Social Security benefits.

Almost 11 million people receive Social Security disability benefits. The initial processing of a claim takes about three months, and many claimants wait over a year for an appeal to be heard.

Under the expedited processing system, the SSA would still need to interview the claimant and obtain medical records, but the process is expected to be much shorter. Rep. John Sarbanes of Maryland, who pushed for the change, said that expedited decisions could be made in a matter of days, rather than months.

 

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How Divorce and Remarriage Affect Social Security Retirement Benefits

March 11th, 2014

People considering divorce as their 10-year wedding anniversary approaches should know that delaying the split until after the decade mark can result in higher Social Security retirement benefits for a spouse with a lower earning record.

Taking the example of a divorced couple where the ex-husband had a higher earnings record, if the couple was married for 10 years or more, then the ex-wife can receive higher benefits based on his record, provided she is age 62 or older and has not remarried.

Even if the ex-husband has not applied for retirement benefits, the ex-wife may receive benefits based on his record, provided they have been divorced for more than two years. If the woman remarries, then she would no longer be able to collect the benefits unless the later marriage ends.lawyer-or-notary-with-cl

Recent years have seen a rise in both marriages and divorces later in life, and statistics suggest that divorcing couples may take retirement benefits into account, as there is a measurable increase in divorce after the 10-year mark. As might be expected, the effect is most pronounced for couples nearing retirement age. A recent study found that for people 55 and older, there is an 11.7 percent increase in the likelihood of divorce at about the decade mark. For couples age 35 to 55, that drops to a 6 percent increase in likelihood of divorce at 10 years, and for people under age 35, there is almost no effect.

Other researchers are skeptical that many people take retirement benefits into account in their divorce decisions, pointing to studies that show that only 13 percent of people are very knowledgeable about how Social Security benefits are calculated.

Whether divorcing couples currently consider retirement benefits in timing their divorce, many advisers agree that they should. Divorcing just short of the 10-year mark could result in thousands of dollars in lost benefits, so it may be worthwhile for some to delay the process.

Financial considerations are often part of making decisions about divorce, so it is important to be aware of how Social Security benefits can be affected.

 

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Students Loans Affecting Retirees

February 24th, 2014

Unmanageable student loan debt is a common problem, with nearly one in 10 borrowers defaulting within two years, according to the U.S. Department of Education. Now student loan debt is increasingly interfering with the retirement plans of older adults as well.

According to the New York Times, people age 60 and older now comprise the fastest growing age group for student loan debt. More older adults are borrowing, and a larger percentage of the borrowers are defaulting.

Some older Americans took out loans to pay for their children’s college expenses, and some are in debt from their own education costs. The ratio is unknown because there is no government system to track that information.

A particular concern for retirees is that the federal government will take up to 15 percent of Social Security payments and apply it to unpaid loans, although this does not affect recipients who collect less than $750 per month.

The total outstanding student loan debt in the United States has reached a remarkable $1 trillion, and with unemployment still high, many people of all ages have been unable to pay back their loans. Even people who are able to pay back loans may find that their retirement is affected, because high payments make it more difficult to save for retirement.

One legislative reform that has been proposed is to allow private student loans (but not government-sponsored loans) to be dischargeable in bankruptcy.

 

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NY Connects: Long Term Care

February 12th, 2014

Choosing the right long term care services and supports can be difficult. If you are looking for long term care in New York State, you should be aware of NY Connects: Choices for Long Term Care. This is a free, state-funded service that can provide you with personalized information over the telephone about options such as assisted living residences, nursing homes, senior centers, adult day care, home care, hospice care, transportation, paying for medicine, and many other similar concerns.

Speaking with a NY Connects counselor can be very helpful if you know you need assistance but are not sure what kind of help is available or which long term care option is best for your situation.

The service is available whether you are eligible for a government program, using insurance, or paying for services yourself. Calls are confidential and are answered by trained specialists. Help is available in several different language, and TTY is available for the hearing impaired.

In Westchester County, NY Connects Can be reached at 914-813-6300. More information is available at www.nyconnects.ny.gov.

 

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Retirement Benefits: How Social Security, Medicare and Retirement Accounts Change in 2014

January 30th, 2014

Medicare, Social Security retirement benefits, and individual retirement accounts all change in small but important ways in 2014, and people too young for Medicare will have new health insurance options. Here is what is changing.

First, thanks to the Affordable Care Act, people retiring before age 65 can now purchase health insurance on the new state health insurance exchanges. People can no longer be denied health insurance because of a pre-existing condition, and subsidies may be available for low and middle income earners.

For people on Medicare, the Part D prescription coverage gap has lessened in effect. Once a Medicare beneficiary has spent $2,850 on medication, then there is a gap until catastrophic coverage kicks in after $4,550 in costs for medication. In that gap, beneficiaries were required to pay 79 percent of drug costs, but that decreases to 72 percent in 2014.

Social Security benefits go up by 1.5 percent in 2014, due to the annual cost-of-living increase. The average increase will be $19 per month for individuals and $31 per month for couples who are both receiving benefits.

Social Security taxes increase for some in 2014. Workers usually pay 6.2 percent of their income into the system until they reach the $113,700 tax cap for the year. For 2014, that cap rises to $117,000.

Finally, the income limits for those eligible to contribute to individual retirement accounts (IRAs) and 401(k)s have increased. Investors who have workplace 401(k)s and also want an IRA can claim a tax deduction for IRA contributions until their adjusted gross income (AGI) reaches between $60,000 and $70,000, an increase of $1,000 over last year. For married couples, the income limits are now between $96,000 and $116,000. The income phaseout range for investors whose spouses have a 401(k) is up $3,000 from last year, to between $181,000 and $191,000. For Roth IRAs, the income phaseout range increased by $2,000, to between $114,000 and $129,000, or for married couples between $181,000 and $191,000.

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