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PART I: INTRODUCTION TO PLANNING FOR THE ELDERLY
CHAPTER 1
Advising the Elderly Client
Chapter Contents
ñ 1.01 An Example of an Initial Appointment
ñ 1.02 A Multi-Disciplinary Approach
ñ 1.03 A State-Specific Practice With a Federal Overlay
ñ 1.04 Needs and Concerns of the Elderly Client
[1] Retirement
[2] Health Care
[3] Being Remembered
ñ 1.05 Tailoring Advice to the Specific Client
CHAPTER 2
Assessment of the Elder's Needs
Chapter Contents
ñ 2.01 Articulating the Concerns of the Elderly
ñ 2.02 Gathering the Necessary Background Information
ñ 2.03 Ethical Dilemmas when the Background Information is Provided by Someone Other than the Client
ñ 2.04 Geriatric Assessment
ñ 2.05 Form: Master Intake
CHAPTER 3
Ethical Concerns
Chapter Contents
ñ 3.01 Identifying the Client
[1] Checklist of Factors in Identifying the Client
[2] Identifying the Client: Hypothetical Case Studies
[a] Children Contact Attorney Regarding Draft of Will for Father ("Hypothetical A")
[b] Children Contact Attorney Regarding Medicaid Planning for Mother ("Hypothetical B")
ñ 3.02 Conflicts of Interest
[1] Intergenerational Conflicts
[2] Interspousal Conflicts
ñ 3.03 Confidentiality
ñ 3.04 Dealing with Diminished Capacity
[1] Capacity Assessment Algorithm for Lawyers
[2] Assessing the Client for Diminished Capacity: Hypothetical Case Studies
[a] Client with Questionable Capacity
[b] Subject Whose Capacity is Unknown
Part II: TOOLS AND TECHNIQUES OF PLANNING FOR INCAPACITY
CHAPTER 4
Informal Methods
Chapter Contents
ñ 4.01 Joint Ownership
ñ 4.02 Financial Institution's Form Power of Attorney
ñ 4.03 Representative Payee
CHAPTER 5
Revocable Living Trusts
Chapter Contents
ñ 5.01 Creation and Basic Requirements
ñ 5.02 Use as an Incapacity Planning Device: Discussion of Form
[1] Selection of Successor
[2] Defining and Determining Incapacity
[3] Powers of Trustee When Settlor Is Incapacitated
[4] Form: Revocable Living Trust Language to Address Incapacity Issues
ñ 5.03 Coordination with Durable Power of Attorney
ñ 5.04 Tax Consequences
CHAPTER 6
Durable Powers of Attorney
Chapter Contents
ñ 6.01 Introduction and Background
ñ 6.02 Differences Among General Durable Powers of Attorney and Other Methods of Incapacity Planning
[1] Comparison With Informal Planning Mechanisms
[2] Comparison With Revocable Living Trusts
[3] Comparison With Guardianships
ñ 6.03 Elements of a Durable Power of Attorney
[1] Principal
[a] Capacity of the Principal
[b] Execution by the Principal
[c] Death of the Principal
[2] Agent
[a] Choice of Agent
[b] Powers and Duties of the Agent
[i] Agent as a Fiduciary
[ii] No Duty to Act
[c] Compensating the Agent
[3] Enumerated Powers
[a] General Legal, Financial and Personal Powers
[b] Powers That May Be Non-Delegable
[i] Marriage
[ii] Divorce or Separation
[iii] Voting
[iv] Representing the Principal in Court
[v] Filing for Bankruptcy
[vi] Executing, Amending or Revoking Wills and Trusts
[vii] Election Against Will
[viii] Change of Domicile
[c] Rule of Strict Construction
[d] Self-Dealing or Expanding Powers of Agent
[e] Powers Over Principal's Personal Affairs
[f] Health Care Powers
[4] Effect of Incapacity of Principal
[a] "Immediately Effective" or "Surviving" Durable Powers of Attorney
[b] "Springing" or "Conditional" Durable Powers of Attorney
ñ 6.04 Third Party Acceptance of Durable Powers of Attorney
ñ 6.05 Revocation and Termination
[1] By Death of the Principal
[2] Revocation by Other Means
ñ 6.06 Durable Power of Attorney Drafting
[1] Discussion of Form
[2] Form: Durable Power of Attorney
CHAPTER 7
Health Care Directives
Chapter Contents
ñ 7.01 Self-Determination in Medical Treatment
ñ 7.02 Constructing Advance Directives
[1] Three Types of Forms
[a] Health Care Proxy
[b] Living Will
[c] Health Care Power of Attorney
[2] The Legal Basis for Advance Health Care Directives
[a] Common Law
[b] State Statutes
[c] Federal Statutes
[i] Patient Self-Determination Act
[ii] Health Insurance Portability and Accountability Act of 1996 (HIPAA)
[3] The Advantages and Limitations of Advance Directives
[4] Drafting Issues for the Advance Directive
[a] Selection of Agents
[b] Scope of Agent's Authority
[i] Detailed Instructions vs. Broad Discretionary Authority
[ii] Specifically Enumerated Powers
[c] Mechanics of Execution and Post-Execution Logistics
[d] Form: Comprehensive Health Care Power of Attorney
[e] Form: Valid Stand-Alone HIPAA Authorization
[5] Do-Not-Resuscitate Orders (DNRs)
ñ 7.03 Surrogacy Statutes: When There Are No Medical Instructions
ñ 7.04 The Countervailing Interests of the State and Other Parties
[1] The State
[a] Preserving Human Life
[b] Preventing Suicide
[c] Protecting Innocent Third Parties
[d] Maintaining the Ethical Integrity of the Medical Profession
[e] Encouraging the Charitable and Humane Care of Disabled Persons
[2] Medical Providers
CHAPTER 8
Guardianship and Conservatorship
by Sally Hurme
Chapter Contents
ñ 8.01 Overview
[1] Creature of State Law
[2] Variations in Language and Procedures
[3] Advantages and Disadvantages of Guardianship
ñ 8.02 Elements of a Guardianship
[1] Incapacitated Person
[2] Evidence of Incapacity
[a] Medical and Other Types of Evidence
[b] Diminished Capacity: Tailoring the Guardianship
[i] Guardianship of Property
[ii] Guardianship of the Person
[3] Due Process
[a] Notice
[b] Presence
[c] Counsel
[4] Guardian
[a] Family Member
[b] Private Professionals or Agencies
[c] Public Guardian
[5] Representation of the Parties
[a] Attorney for Petitioner
[b] Attorney for Alleged Incapacitated Person
[c] Guardian ad Litem
[d] Attorney for Guardian
ñ 8.03 Appointment Process
[1] Preparing and Filing the Petition
[2] Types of Petitions
[a] Plenary Guardianship
[b] Limited Guardianship
[c] Temporary/Emergency Guardianship
[3] Contested Petitions
[a] Mediation
[b] Burden of Payment of Costs
ñ 8.04 Supervision of Guardian
[1] Guardianship Plan
[2] Personal Status Report
[3] Inventory
[4] Accounting
[5] Sanctions
ñ 8.05 Rights of the Ward
[1] Retained Rights
[2] Removed Rights
[3] Delegated Rights
ñ 8.06 Interstate Jurisdiction Problems
[1] Initial Jurisdiction
[2] Interstate Recognition
[3] Transfer
CHAPTER 9
A Failure of Incapacity Planning:
Abuse, Neglect, and Financial Exploitation of the Elderly
Chapter Contents
ñ 9.01 Introduction
ñ 9.02 Important Factors in Analyzing State Statutes
[1] Organizational Schemes
[2] Statutory Remedies
[3] Defining the Protected Class
[4] Coverage in Domestic and Institutional Settings
[5] Reporting Elder Abuse and Ethical Issues
ñ 9.03 Relevant Federal Statutes
ñ 9.04 Risk Factors and Indicators of Elder Abuse
ñ 9.05 Financial Exploitation and Consumer Fraud Distinguished
ñ 9.06 Types of Financial Exploitation
[1] Traditional Theft Offenses
[a] State Law
[b] Federal Law
[2] Fiduciary Abuses
[a] Durable Powers of Attorney
[b] Guardianships
[3] Undue Influence
PART III: FINANCIAL PLANNING FOR THE RETIREE
CHAPTER 10
Fundamental Issues in Retirement
CHAPTER CONTENTS
ñ 10.01 Emerging New Perspectives on Retirement
ñ 10.02 The Financial Risks of Retirement
[1] Inflation
[2] Longevity
[3] Health Care Costs
[4] Financial Investment Risk
[5] Client Psychology
ñ 10.03 Planning for Lifetime Income: A Checklist for Retirement Planning
[1] Visualizing Retirement
[2] Estimating Expenses
[3] Taking Inventory of Income and Net Worth
[4] Comparing Essential Expenses with Income
[5] Taking Appropriate Action
[6] Performing Regular Check-Ups
ñ 10.04 Forms
[1] Attitudes and Expectations About Retirement
[2] Cash Flow Statement (Budget)
[3] Statement of Financial Condition (Net Worth)
CHAPTER 11
Managing the Retirement Portfolio
Chapter Contents
ñ 11.01 Goal of Portfolio Management
ñ 11.02 Determining a Reasonable Withdrawal Target
ñ 11.03 Balancing Expected Portfolio Return Against Risk of Loss
[1] The Risk/Return Trade-Off
[2] The Benefits of Diversification
ñ 11.04 Types of Investments to Diversify a Portfolio
[1] Stocks
[a] Public Utilities
[b] Mortgage Companies
[c] Real Estate Investment Trusts (REITs)
[d] Oil and Gas Royalty Trusts
[e] Canadian Income Trusts
[f] Master Limited Partnerships
[g] Preferred Stock
[h] Income Deposit Securities
[2] Bonds
[a] High-Yield Bond Mutual Funds
[b] Bond "Ladders": Diversifying a Bond Portfolio
[c] United States Savings Bonds
[3] Cash
[4] Aggregate Investments: Mutual Funds and Their Alternatives
[5] Options: Writing Covered Calls
ñ 11.05 Summary and Conclusion
CHAPTER 12
The Role of Annuities in Retirement Planning
Chapter Contents
ñ 12.01 Annuity Basics
[1] Straight Life vs. Term Certain Payment
[2] Fixed vs. Variable Annuity Earnings
[3] Immediate vs. Deferred Payment
[a] Immediate Annuities: Basic Annuity Income Taxation
[b] Deferred Annuities: Adding Complexity to the Basic Annuity Taxation Rules
[4] Qualified vs. Non-Qualified Annuities
[5] Special Types of Annuities
[a] Charitable Gift Annuities
[b] Structured Settlement Annuities
ñ 12.02 Annuitization Strategies Regarding Immediate Annuities
ñ 12.03 Addressing an Unsuitable Deferred Annuity Situation
[1] Financial Initiatives
[2] Legal Advocacy
CHAPTER 13
Social Security and Other Pensions
Chapter Contents
ñ 13.01 History, Law, and Administration of Government Retirement Programs
[1] Social Security Retirement
[2] Railroad Retirement
[3] Federal Civil Service Retirement
[4] Other Public Sector Retirement
[a] Government Pension Offset
[b] Windfall Elimination Provision
ñ 13.02 Social Security Retirement Benefits
[1] Retirement Benefits for Workers
[2] Spouse's, Dependents,' and Survivors' Eligibility for the Worker's Retirement Benefits
[a] Spouses
[b] Divorced Spouses
[c] Widowed Spouses
[d] Children and Surviving Children
[e] Surviving Parents
ñ 13.03 Strategies for Maximizing Social Security Retirement Benefits
[1] Evaluating Taking Retirement Benefits Early
[2] Evaluating Taking Delayed Retirement Benefits
[3] Spousal Cases
ñ 13.04 Maximizing the Benefits of Defined Benefit Pensions
[1] The Law Governing Defined Benefit Plans
[2] The Choice of Annuity vs. Lump Sum
[3] The Choice of Straight Life vs. Survivor Annuities
CHAPTER 14
The Home as a Retirement Resource
Chapter Contents
ñ 14.01 Home Equity Lending
ñ 14.02 Intra-Family Transactions
[1] Sale and Leaseback
[2] Sale of a Remainder Interest (with Retained Life Estate)
ñ 14.03 Reverse Mortgages
[1] The Basic Concept
[2] Types of Federally Insured Reverse Mortgage Programs
[a] Home Equity Conversion Mortgage
[b] Home Keeper Mortgage
[3] Prudent Uses of Reverse Mortgages
[4] Effect on Public Benefits
CHAPTER 15
Management and Taxation of Qualified Retirement Plans
Chapter Contents
ñ 15.01 Types of Qualified Retirement Plans
[1] Employer Defined Contribution Plans
[a] Money Purchase Plans
[b] Profit Sharing Plans
[c] Stock Bonus Plans and Employee Stock Ownership Plans (ESOPs)
[d] 401(k) Plans
[e] 403(b) Plans
[f] 457 Plans
[g] Simplified Employee Pension (SEP) Plans
[h] Savings Investment Match Plan for Employees (SIMPLE)
[i] Keogh Plans
[2] Individual Plans
[a] Individual Retirement Accounts (IRAs)
[i] Traditional IRAs
[ii] Roth IRAs
[iii] Coverdell Education Savings Accounts (CESA)
[b] Section 529 College Savings Plans
[c] Health Savings Accounts (HSAs)
ñ 15.02 Distribution and Taxation of Qualified Plan Benefits
[1] Payment of Benefits
[2] Income Taxation of Benefits
[3] Rollovers of Benefits
[4] Required Minimum Distributions
ñ 15.03 Strategies to Minimize Tax and Maximize Returns
[1] Rollovers of Qualified Retirement Plans to Traditional IRAs
[2] Traditional IRAs vs. Roth IRAs
[3] The Decision to Convert to a Roth IRA
[4] Tax-Efficient Allocation of Retirement Assets
[5] Tax-Efficient Withdrawal Strategies
CHAPTER 16
Income Tax Issues
Chapter Contents
ñ 16.01 Income Tax on Savings and Investment Income
[1] Capital Gaines and Losses
[a] Wash Sale Rule
[b] Charitable Donations of Appreciated Assets
[2] Qualified Dividend Income
[3] Municipal Bonds and United States Government Securities
[4] Taxation of Social Security Benefits
[5] Life Insurance
[6] Part B Medicare Premium Surcharges
ñ 16.02 Income Tax and Health Care Issues
[1] Medical Expense Deductions
[a] Long-Term Care and Long-Term Care Insurance
[b] Medically Deductible Home Improvements
[2] Taxation of Compensation for Personal Illness and Injuries
ñ 16.03 Tax Benefits for Family Caregivers
[1] Dependency Exemption
[2] Head of Household Filing Status
[3] Paying the Elder's Medical Expenses
[4] Dependent Care Credit
ñ 16.04 The Home as a Tax Shelter
ñ 16.05 Final Tax Returns of Decedents
PART IV: PLANNING FOR LONG-TERM CARE
CHAPTER 17
Three Paths to Financing Long-Term Care: Which One to Choose?
Chapter Contents
ñ 17.01 Introduction
[1] What is Long-Term Care?
[2] The Costs and Risks of Long-Term Care
[a] Out of Pocket Expenditures
[b] Likelihood of a Need for Long-Term Care
[c] Odds of a Prolonged Stay in Long-Term Care
ñ 17.02 Self-Financing Care
ñ 17.03 Insurance
ñ 17.04 Government Programs
ñ 17.05 Roadmap to Financing Long-Term Care
CHAPTER 18
Strategies for Self-Financing Long-Term Care
Chapter Contents
ñ 18.01 Introduction
ñ 18.02 Hypothetical Case Studies
[1] One Member of a Married Couple Requires Nursing Home Care
[2] Self-Financing Combined with Long-Term Care Insurance
[3] Paying for Care at Home
ñ 18.03 Investment Techniques to Make Self-Financing Work
CHAPTER 19
Long-Term Care Insurance Strategies
Chapter Contents
ñ 19.01 Types of Long-Term Care Insurance Policies
[1] Individual, Stand-Alone Coverage
[2] Individual, Combination Products
[3] Group Coverage
ñ 19.02 Choosing a Carrier
ñ 19.03 Methods of Benefit Payment
ñ 19.04 Long-Term Care Insurance Coverage
[1] Nursing Home Coverage
[2] Assisted Living Facility (ALF) Coverage
[3] Home Care Coverage
ñ 19.05 Benefits and Benefit Triggers
[1] Activities of Daily Living (ADLs)
[2] Variations in the Payment of the Daily Benefit
[3] Duration of Benefits
[4] The Waiting (Elimination) Period
[5] Inflation Protection
[a] 5% Compound COLA
[b] 5% Simple COLA
[c] 5% Compound COLA and Two Times the Lifetime Maximum
[d] 5% / 3% Compound COLA
[e] Guaranteed Purchase Option
[6] Shared Benefits
ñ 19.06 Premiums and Premium Increases
ñ 19.07 Long-Term Care Insurance Comparative Analyses
[1] LTCI vs. Self-Financing (Hypothetical Case)
[2] LTCI vs. Life Insurance
CHAPTER 20
The Medicaid Program and Medicaid Planning
Chapter Contents
ñ 20.01 Overview of the Medicaid Program
[1] Legislative Beginning and Administrative Background
[2] Covered Groups
[a] Categorically Needy
[i] The Aged
[ii] The Blind
[iii] Persons with Disabilities
[iv] Other Mandatory Groups
[b] Optionally Categorically Needy
[c] Medically Needy
[3] "Spend Down" vs. "Income Cap" States
ñ 20.02 Financial Eligibility
[1] Income Standard in Section 209(b) States
[2] Resource Standard in Section 209(b) States
[3] Income Standard in SSI States
[4] Resource Standard in SSI States
ñ 20.03 Protection from Spousal Impoverishment
[1] Treatment of Income
[a] Minimum Monthly Maintenance Needs Allowance (MMMNA)
[b] Excess Shelter Allowance
[c] Family Allowance
[2] Treatment of Resources: The Community Spouse Resource Allowance (CSRA)
[3] The "Income First" Rule
[4] Appeals of Spousal Impoverishment Determinations
[5] Spousal Refusal
ñ 20.04 Transfers of Assets
[1] History of the Transfer Penalty Rules
[a] Omnibus Budget Reconciliation Act of 1980 (OBRA '80)
[b] Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA '82)
[c] Medicare Catastrophic Coverage Act of 1988 (MCCA)
[d] Omnibus Reconciliation Act of 1989 (OBRA '89)
[e] Omnibus Budget and Reconciliation Act of 1993 (OBRA '93)
[f] Deficit Reduction Act of 2005 (DRA)
[2] Application of the Transfer Penalty Rules
[a] Look Back Date
[b] The Transfer Penalty Period
[c] Waiver of Penalty Due to Undue Hardship
[3] Exceptions to the Transfer Rules
[a] The Individual's Home
[b] Other Exceptions (Not Particular to the Home)
ñ 20.05 Medicaid Rules Regarding Trusts
[1] Testamentary Trusts
[2] "Sole Benefit"Trusts
[3] Special Needs Trusts
[4] Qualified Income ("Miller") Trusts (QITs)
[5] Pooled Trusts
[6] Irrevocable, Income-Only Trusts (IIOTs)
ñ 20.06 Treatment of Certain Assets Under the DRA
[1] The Home
[2] Annuities
[a] Prior to the DRA
[b] After the DRA
[3] Certain Life Estates
[4] Promissory Notes, Loans, and Mortgages
[5] Continuing Care Retirement Community (CCRC) Entrance Fees
ñ 20.07 Liens and Estate Recoveries
[1] History and Introduction
[2] Hardship Waivers
[3] Definition of the Recoverable Estate
ñ 20.08 Medicaid Applications and Appeals
[1] Applications
[2] Appeals
ñ 20.09 Medicaid Planning
[1] Initial Considerations
[2] Debt Payoff Strategies
[3] Strategies to Convert Countable Resources to Exempt (Excluded) Resources
[a] The Residence
[b] Tangible Personal Property
[c] Prepaid or Irrevocable Burial/Funeral Contracts
[4] Strategies to Make Assets Unavailable
[a] Acquisition of U.S. Savings Bonds
[b] Making Loans
[c] Divorce or Separation
[5] Strategies to Convert Countable Assets to Allowable Income
[a] Protecting the Community Spouse's Qualified Retirement Assets
[b] Qualified Retirement Annuities of Institutionalized Persons
[c] Annuities in Conjunction with a Penalized Transfer
[d] Generating Income from a Second Home
[6] Transfer Strategies
[a] Transfers of Assets Exempt from Transfer Penalties
[b] Transfers to Family Members in Exchange for Long- Term Care Services
[c] Transfers Subject to Penalty
[i] Transfers Usually Planned and Carried Out Early
[A] Transfer of Remainder Interest in the Home
[B] Cashing or Gifting Cash-Value Life Insurance
[C] Irrevocable Income Only Trusts (IIOTs)
[ii] Transfers Done "in Crisis"
[A] Gift and Cure
[B] Including the Home in the Half a Loaf
[C] Annuity Half a Loaf Strategy
[D] Promissory Note Half a Loaf Strategy
[E] High-Payout Irrevocable Trust
[7] Interstate Medicaid Planning Opportunities
ñ 20.10 Hypothetical Case Studies
[1] Medicaid Planning for a Married Couple
[2] Medicaid Planning for an Unmarried Individual
[3] Wait-and-See Medicaid Planning
[a] For Married Couples
[b] For an Unmarried Individual
[c] The Irrevocable, Income-Only Trust: Discussion of Form
[d] Form: Irrevocable Income-Only Trust
CHAPTER 21
Supplemental Security Income
Chapter Contents
ñ 21.01 Overview of Supplemental Security Income (SSI) Program
[1] Legislative Beginning and Administrative Background
[2] Covered Groups
[a] Aged
[b] Blind
[c] Persons With Disabilities
ñ 21.02 Financial Eligibility
[1] Income Limits
[a] Earned Income
[b] Unearned Income
[c] In-Kind Income
[d] Deeming of Income
[2] Resource Limits
[a] Deeming of Resources
[b] Resource Exclusions
[c] Basic Resource Planning
ñ 21.03 Transfers of Resources
[1] History
[2] Comparison With Medicaid's Transfer Penalty Rules
[3] Planning Opportunities Using the Transfer Rules
ñ 21.04 SSI Rules Regarding Trusts
ñ 21.05 SSI Applications and Appeals
[1] Applications
[2] Appeals
CHAPTER 22
Using Trusts in Long-Term Care Planning
Chapter Contents
ñ 22.01 Introduction
ñ 22.02 The Issue of Unavailability
ñ 22.03 Third Party Trusts vs. Self-Settled Trusts
ñ 22.04 Other General Considerations
[1] Preliminary Matters
[2] Trust Ownership of Critical Assets
[a] The Beneficiary's Home
[b] A Vehicle
[3] Permissible Trust Distributions
[4] Selection of the Trustee
[a] Family Members
[b] Professional Trustees
[5] Termination Before the Beneficiary's Death
ñ 22.05 Testamentary Trusts
[1] Typical Situations When a Testamentary Disability Trust is Used
[2] Tax Considerations
[a] Income Tax
[b] Gift and Estate Taxes
[3] Form: Testamentary Disability Trust
ñ 22.06 "Sole Benefit" Trusts
[1] Typical Situations in Which a "Sole Benefit" Trust is Used
[2] Tax Considerations
[a] Income Tax
[b] Gift and Estate Taxes
[3] Form: "Sole Benefit" Disability Trust
ñ 22.07 Self-Settled Special Needs Trusts
[1] Statutory Elements of the Self-Settled Disability Trust
[a] Assets of the Individual
[b] Under Age Sixty-Five
[c] Who is Disabled (as Defined in Section 1382c(a)(3))
[d] Trust Established for the Benefit of the Individual
[e] Trust Established by a Parent, Grandparent, Legal Guardian, or a Court
[f] Payment to the State at Individual's Death of Amounts Paid for Medicaid Assistance
[2] Typical Situations in Which a Payback Trust is Used
[3] Considerations When Preserving Personal Injury or Other Tort Recoveries
[a] Structured Settlements
[b] Government Liens and Claims"
[i] Medicaid
[ii] Medicare
[4] Tax Considerations
[a] Income Tax
[b] Gift and Estate Taxes
[5] Combinations of Other Distribution Vehicles with Special Needs Trusts
[a] Special Needs Trusts and Charitable Remainder Trusts
[b] Special Needs Trusts and Inherited IRAs
[6] Form: Self-Settled Special Needs Trust
ñ 22.08 Pooled Trusts
ñ 22.09 Irrevocable Income-Only Trusts
CHAPTER 23
Veterans' Benefits
Chapter Contents
ñ 23.01 Overview of VA Long-Term Care Benefit Programs
ñ 23.02 Improved Pension
[1] Eligibility Requirements
[2] Basic Benefits
[3] Improved Pension Ratings
[a] Housebound Rating
[b] Aid and Attendance Rating
[4] Relationship of the Improved Program to Other Benefits
[5] Long-Term Care Planning Strategies Utilizing VA Pensions
[a] Case Study: Coordinating an Improved Pension with "Wait and See" Medicaid Planning
[b] Case Study: A Combination of Reverse Mortgage, Long-Term Care Insurance, VA Pension, and Self-Financing Care
ñ 23.03 Service-Connected Compensation
[1] Compensation to the Veteran
[2] Dependency and Indemnity Compensation (DIC)
ñ 23.04 Health Care Benefits
ñ 23.05 VA Applications and Appeals
CHAPTER 24
Medicare
Chapter Contents
ñ 24.01 Overview of the Medicare Program
[1] Legislative Beginning and Administrative Background
[2] Covered Groups
[3] Enrollment in Medicare
[4] Medicare Savings Program
ñ 24.02 Part A
[1] The Beneficiary's Costs
[2] Coverage Related to Long-Term Care
[a] Inpatient Hospital Care
[b] Skilled Nursing Facility (SNF) Services
[c] Home Health Care
[d] Hospice Services
[3] Appeals
[a] Expedited Review
[b] Standard Process
ñ 24.03 Part B
[1] The Beneficiary's Costs
[2] Coverage Related to Long-Term Care
[a] Therapy in an SNF
[b] Durable Medical Equipment
[c] Ambulance Services
[3] Appeals
ñ 24.04 Part C (Medicare Advantage)
ñ 24.05 Part D
[1] The Financial Considerations of Enrollment
[a] The Impact of Late Enrollment
[b] Creditable Coverage
[c] Subsidies for Low-Income Beneficiaries and Medicare-Medicaid Dual Eligibles
[2] Choosing a PDP
[3] Appeals
ñ 24.06 Medicare Supplemental Insurance
CHAPTER 25
Social Security Disability Benefits
Chapter Contents
ñ 25.01 Overview of Social Security Disability (SSD)
[1] Law and Administration of the Program
[2] Relationship of SSD to Other Programs
ñ 25.02 Coverage of the Disabled Worker
[1] Disability Insured Status
[2] Definition of Disability for Social Security Purposes
[a] Substantial Gainful Activity (SGA)
[b] Medically Determinable Physical or Mental Impairment
[c] Sequential Disability Evaluation Process
[3] The Waiting Period
[4] Disability Benefits for Workers
[5] Factors That May Affect SSD Benefits
[a] Factors That May Terminate Benefits
[b] Offsets for Other Government Disability Compensation
ñ 25.03 Coverage of Other Beneficiaries
[1] Spouses and Divorced Spouses
[2] Widowed and Surviving Divorced Spouses
[3] Children and Surviving Children
[4] Surviving Parents
ñ 25.04 Applications and Appeals
PART V: HOUSING ARRANGEMENTS FOR LONG-TERM CARE
CHAPTER 26
Aging in Place and Other Independent Living Options
Chapter Contents
ñ 26.01 Introduction
ñ 26.02 Checklist of Concerns for Living Independently
ñ 26.03 Considerations When Aging in Place
[1] Physical Hazards
[2] Sources of Financial Assistance When Aging in Place
[3] If Care Is Needed While Aging in Place
[a] Home Health Care by Agencies
[b] Home Care by Family
[c] Adult Day Care
ñ 26.04 If the Client Lives in Federally Assisted Housing
[1] Historical Background of Federally Assisted Housing
[2] Eligibility for Sections 8 and 202 Programs
[3] Federally Assisted Housing and the Uses of Trusts
CHAPTER 27
Semi-Independent Living Options
Chapter Contents
ñ 27.01 Introduction
ñ 27.02 Assisted Living Facilities (ALFs)
[1] Definitions and Standards
[2] Regulation and Licensure
[3] Reliance on Contracts
[4] Other Issues Concerning Assisted Living
[a] Consumer Protection Issues
[b] Medicare and Medicaid Issues
[i] Medicare
[ii] Medicaid
[c] Quality of Care Issues
[d] Transfer and Discharge Issues
[5] Costs of Assisted Living and Their Tax Deductibility
ñ 27.03 Continuing Care Retirement Communities (CCRCs)
[1] Issues Prior to Admission
[2] Issues After Admission
[a] What Happens to Fees?
[b] What Rights Does the Resident Possess Over the Unit He or She Occupies?
[c] What Happens When the Resident's Health Deteriorates?
[d] Medicare and Medicaid at CCRCs
[e] Residents' Rights to Participate and Object
[3] Eviction From a CCRC
[4] Financial Planning Considerations for Residents of CCRCs
CHAPTER 28
Nursing Homes
Chapter Contents
ñ 28.01 Background of Nursing Home Regulation
ñ 28.02 Nursing Home Residents' "Bill of Rights"
ñ 28.03 Standards of Care
ñ 28.04 Issues Concerning Admission and Readmission
[1] Admission Contract Issues
[a] Contractual Responsibilities of the Resident's Representative
[b] Attempts to Avoid Reliance on Medicare and Medicaid
[c] Access to the Resident's Income
[d] Waivers
[2] Discrimination in Admission
[a] Discrimination Based on Resident's Source of Payment
[b] Discrimination Based on Disability
[3] Bedholds and Readmission
ñ 28.05 Issues Concerning Transfers and Discharges
[1] Background
[2] Legal Requirements for Transfer or Discharge
[3] Transfer or Discharge for Nonpayment
ñ 28.06 Remedies for Residents
PART VI: LEAVING A LEGACY
CHAPTER 29
Estate Planning: The Basics
Chapter Contents
ñ 29.01 Client Perceptions of Estate Planning
ñ 29.02 Titling of Assets and Transfer of Ownership
[1] Joint Tenancy with Rights of Survivorship (JTWROS)
[2] Transfer of Ownership by Contract
[a] Life Insurance
[b] Annuities
[c] Qualified Retirement Accounts
[d] Pay-on-Death (POD), Transfer-on-Death (TOD) and Totten Trust (ITF) Accounts
[3] Trust Ownership
[4] Probate Assets
ñ 29.03 Federal Estate and Gift Taxation
[1] Calculating the Estate Tax
[a] Total Value of Gross Estate
[b] Taxable Estate
[c] Addition of Adjusted Taxable Gifts
[d] Computation of the Tentative Tax
[e] Reduction for Taxes Payable on Post-1976 Gifts
[f] Estate Tax Credits
[2] Generation Skipping Transfer Tax (GSTT)
[3] The Gift Tax
ñ 29.04 Using the Federal Transfer Tax Exemptions and Exclusions
[1] The Estate Planning Threshold
[a] Maximizing the Unified Credit for Married Couples
[b] Form: Credit Shelter Trust Language
[2] The Most Efficient Transfer Tax Planning is Based on Lifetime Gifts
ñ 29.05 Economic and Actuarial Considerations of Various Transfer Tax Planning Mechanisms
[1]-The Impact of Interest Rates
[2]-The Impact of Life Expectancy
[3]-The Impact of Appreciation in the Value of the Transferred Property (Past and Future)
[4]-Selected Estate Planning Transfer Mechanisms
[a]-Grantor Retained Annuity Trusts (GRATs) and Grantor Retained Unitrusts (GRUTs)
[b]-Qualified Personal Residence Trusts (QPRTs)
[c]-Private Annuities
[d]-Self-Canceling Installment Notes (SCINs)
[e]-Split Interest Transfers to Charities
CHAPTER 30
Estate Planning in and for Special Circumstances
Chapter Contents
ñ 30.01 Multiple Marriage Situations
ñ 30.02 Naming Beneficiaries of Retirement Accounts
[1] Rules for Non-Spouse Beneficiaries
[2] Rules for Spousal Beneficiaries
[3] Trusts as Beneficiaries
[4] Multiple Beneficiaries and Separate Shares
[5] Stretching the IRA Over Multiple Generations: General Principles
ñ 30.03 Clients Who Are Charitably Inclined
[1] Charitable Remainder Trusts
[2] Charitable Gift Annuities
[3] Charitable Lead Trusts
[4] Charitable Gifts With Retained Life Estates
[5] The Wealth Replacement Trust
ñ 30.04 Estate Planning for Unmarried Partners
ñ 30.05 Planning for Pets
ñ 30.06 Transfers to Minors
[1] Uniform Transfers to Minors Act (UTMA) and Uniform Gifts to Minors Act (UGMA)
[2] Trusts for Minors
[a] Section 2503(c) Trusts
[b] Section 2503(b) Trusts
ñ 30.07 Transfer Tax Planning for Terminally Ill Persons
ñ 30.08 Transfers to Disabled Beneficiaries and Others with Special Concerns
ñ 30.09 Gathering Information for Estate Planning
ñ 30.10 Form: Estate Planning Questionnaire
Library of Congress Subject Headings for this publication:
Older people -- Legal, status, laws, etc. -- United States.
Older people -- Medical care -- Law and legislation -- United States.
Medicare -- Law and legislation.
Medicaid -- Law and legislation.
Older people -- United States -- Finance, Personal.
Estate planning -- United States.