New website for health care decision-making

I was recently introduced to the website www.prepareforyourcare.org and find it to be a very informative and useful tool to use in the initial planning stages of your health care directives. The website offers an easy to use navigational format, and through videos and presentation slides, the site will guide you to information in the following areas:

1)      Choosing a Medical Decision Maker

2)      Deciding What Matters Most In Life

3)      Choosing Flexibility for Your Decision Maker

4)      Telling Others About Your Wishes

5)      Asking Doctors the Right Questions

After completing the presentation, the site will construct an action plan for you, which you can print out, and use to begin preparing for your future medical needs. 

Planning for end-of-life and other health care needs is becoming crucially important as medical technology advances. There is evidence that patients who lack advance directives may be subjected to more burdensome care than patients who have thought about and communicated their preferences ahead of time. For those who have trouble thinking about these subjects, this website is a great place to start. 

Commentary: The Problem With Government

As we enter a new year, and brace ourselves for the upcoming presidential election campaign, it appears that the enemy of many politicians and citizens alike on all sides of the political spectrum is, simply, government itself. Obviously this is not a new phenomenon--it has been building ever since the beginning of the financial crisis in 2008. From the Tea Party movement to the Occupy Wall Street protests, more and more people are speaking out against a government that increasingly does not seem to be protecting their interests.

I have never been someone who believes in the simplistic slogan that government itself is the problem. I believe that, when properly utilized, democratic government can be an amazing tool to create greater liberty, equality and prosperity for all.

But I do believe people are right about one thing--government often does not do a very good job of providing basic services to the people. For many of us, interacting with the government can be a frustrating, unsatisfying, and even degrading experience.

As an attorney who deals frequently with a variety of local, state and federal government agencies, I see this on a regular basis. It's the little things--waiting on hold for 20 minutes to speak to someone about a benefit application that was filed 9 months ago, then being told the paperwork you mailed in has been lost and must be resubmitted; fighting with local offices over fees they cannot legally charge; voice messages to government workers that are never returned; being spoken to rudely by a government telephone operator. Don't get me started on the TSA and how they treat people. I'm sure most of you reading this have encountered problems like these when dealing with the government.

The length of time it sometimes takes to access government services and benefits is ridiculous--over 12 months for veteran's benefits; over 2 years for Social Security disability benefits; over 6 months to get a decision on a Medicaid appeal.

The government agencies often say in response to such criticisms that lack of resources is to blame--lack of funds to hire more workers, lack of time to properly train workers, lack of funds to upgrade technology. It becomes a vicious cycle--the more we dislike government, the less we invest in it, which causes us to like it even less, and invest in it even less. It just goes on and on. Morale among government workers gets worse, turnover gets higher, and those who keep their jobs care about doing them well less and less.

Some people say we need to get rid of the bureaucrats and bring in people from business, people who know how to manage large organizations effectively. But if you have ever had to deal with customer service at most large banks, telephone companies, health insurance companies, etc., you know they are not very effective at managing their customer operations either.

I don't know what the solution is, but until government can take on a more helpful, customer-service-oriented attitude and provide basic services to the people more effectively, the massive protests and anti-government political feeling will continue.

Medicaid Planning: An Overview

Planning for the eventual costs of long term care can be extremely complicated. Most people do not have the resources to self-pay nursing home expenses, which can be as much as $6,000 a month, at least not for very long. Likewise, long term care insurance, while very advantageous, is out of reach for many due to high premiums and lack of insurability.

Most families faced with placing a loved one in a long term care facility have no choice but to apply for Medicaid, the only public health benefit that pays for nursing home care. (Contrary to popular belief, Medicare will only pay for a very limited amount of time in a nursing home, and private health insurance usually does not cover anything.) In order to qualify for Medicaid, however, an individual may be forced to drastically spend down his or her assets, often to only $1,500.

Avoiding this spend down while enabling an individual to qualify for Medicaid is the goal of much long term care planning. Other goals may include increasing cash flow, providing for the safe management of assets for an incapacitated individual, avoiding probate and mitigating the possibility of a Medicaid estate claim after the individual's death. Care must be taken to work around various pitfalls in the Medicaid rules, which have gotten stricter in recent years as Congress attempts to discourage aggressive asset-protection planning.

As with any other type of financial planning, time is of the essence. The earlier a person starts, the more options he or she will have. In the world of Medicaid, this is especially true of making gifts. Currently, there is a harsh penalty for making gifts within the five year "look-back" period. This means that an individual should not start Medicaid planning when he or she is already in poor health and possibly even in a nursing facility. The most effective planning must be done well in advance of any need for long term care. Obviously, we do not live in a perfect world and many people will still fail to plan until a health care crisis rears its head. Fortunately, there are still opportunities to plan and avoid the worst of a Medicaid spend-down even in these situations.

Statistics show that well over 50 percent of Americans will need long-term care at some point in their lives. Many people do not give a thought to how they will pay for such care, or assume that someone else will take care of it for them if the time ever comes. Those who are willing to invest the time and money in proactive planning, however, are usually much happier with their outcomes than those who wait until the last minute.

Need Help With Veterans Benefits?

I recently became a VA accredited attorney and am now able to assist Indiana veterans with their VA benefits applications. Maneuvering through the VA claims process can be a daunting task, but with the right advice and pre-planning, the journey can be smoother. If you or a loved one need help obtaining VA benefits, please contact me for further information.

Spotlight On: Transfer On Death Deeds

The Indiana legislature did a huge favor to all Hoosiers last year when it expanded the state's transfer-on-death (TOD) laws. It has been possible for a long time to designate beneficiaries for assets like bank accounts and investments, but this new law goes even further. Now it's possible to designate a TOD beneficiary for almost any asset, including real estate.

The process for designating a TOD beneficiary for a home or land is quite simple. A person simply signs a Transfer on Death Deed describing the property and naming the beneficiary. If desired, contingent beneficiaries can also be named in case the primary beneficiary dies prior to the owner. The deed must be recorded at the county recorder's office in order for the beneficiary designation to take effect.

The owner can revoke the TOD deed at any time prior to death. Also, because the deed does not convey title to the beneficiary, the owner is free to sell, mortgage, lease or otherwise deal with the property as though the beneficiary designation had never been made. Unless revoked, the TOD designation will override any gift of the property in the owner's will and the property will pass automatically to the beneficiary upon the owner's death.

TOD deeds should be considered by anyone owning real estate. They are a simple, inexpensive way to leave real estate to a loved one without incurring the legal costs of probate. It is also an alternative to the standard living trust arrangement for probate avoidance at death.

The Importance of Leaving a Will

Here is a great reminder of how important it is for everyone to make out a will, based on an actual case I've seen recently. A brother and sister came to see me today about their father's estate. The conversation went something like this--dad didn't leave a will, but always said that he wanted his property to go to us. They went on to explain to me that dad also had another child--who is disabled and on Medicaid and SSI. I had the job of explaining to them that, regrettably, the disabled daughter is also an heir of the estate under Indiana law and, what's worse, her inheriting the property could jeopardize her benefits. Also, because dad named his son as joint owner of a large bank account (with the intention that the son split it with one of the sisters) the son could be subject to Indiana inheritance tax, a problem that could have been avoided if dad had simply named both children as TOD beneficiaries.

Obviously, none of this was dad's intention. There may be solutions to some of these problems, but getting there is going to be much more expensive and complicated than if dad had simply sat down with an attorney and had his will drawn up. The amount of money his kids are going to spend now on legal fees will probably be 10 times more expensive (at least) than the cost of a simple will!

The bottom line is this: the law will not honor your wishes regarding the disposition of your estate unless you make out a will or have appropriate beneficiary designations for your assets.

Welcome to 2010!

Happy New Year! It's January once again, and if you're like me, you've already started the new diet and are wondering how long it's going to be until it finally starts to warm up. Hopefully, you are also starting to think about another important matter--getting your affairs in order, and by this, I mean updating your estate plan (or starting one, for that matter!)

If you are one of those folks I see all the time who has a 20 year old will sitting in a drawer at home, made dutifully when the children were little and life seemed a little less complicated, now is the perfect time to pull out that old document and replace it with something more up to date. If your will is up to snuff, it's still important to make sure you've covered all the bases, like having a power of attorney and living will too.

Here are some other things to do now to make sure your family is protected if a death or disability occurs--

• Check beneficiary designations. It is crucial to have appropriate beneficiary designations for assets like IRAs, life insurance policies and annuities. Otherwise, your estate can potentially owe lots of money in extra taxes. Make sure that you have up-to-date primary and contingent beneficiaries named for these types of assets.
• Organize financial records. Take it from me, trying to probate a disorderly estate is a real pain in the neck! You can help out your future executor immensely by organizing your financial records. Keep a file listing all assets and major liabilities, including account numbers and contact information for all financial advisors. Dispose of old records that no longer need to be maintained (no, you don't still need to keep that light bill from 1978--for an idea of how long to keep important records, look here.) Make sure your future executor knows how to access your records and other key documents, including any kept on your computer.
• Consider long term care insurance. This is a big topic, but if you are between ages 55-65, now is an excellent time to consider buying a long term care insurance policy. This coverage tends to be expensive, but for those who can afford it, it can be highly worthwhile in the event long term care is needed. Also, with the Indiana Partners Program, individuals who buy long term care insurance can exclude up to 100% of assets if they exhaust their benefits and have to go on Medicaid.

Having a basic estate plan doesn't need to be expensive or complicated, but it does need to be done. Resolve to make it part of your action plan for 2010!