Monday, October 22, 2012

ESTATE PLANNING FOR ALZHEIMER'S - My Alzheimer's Archive of ...

To the reader. This is not a normal post following the sequence I have been presenting. At the same time it fits in. It is a repeat of two posts I have made one in October of this year and the second in August of 2009. I am posting it for Perpectives News Letter:

Perspectives is published by

Shiley-Marcos Alzheimer's Disease Research Center?

University of California, San Diego?

9500 Gilman Drive- 0948

La Jolla, California ?92093

Phone: 858-622-5800 ? ? ? Fax: 858-622-1012

Email: lsnyder@ucsd.edu

Editor:

Lisa Snyder, MSW, LCSW, Clinical Social Worker

In their News Letter for Summer of 2012 Vol 17 No 4 an excellent article appeared talking about the need for estate planning. He talks about getting a lawyer and how to find one. This offering is a sequel?telling?you what to do when you find one and why it is so important.

I am sending this to perspectives for publication as a sequel in the event they do not have one from another writer cursed with the same calamity as I was. I am posting this for their ease in using it.?


?The scariest thing to me about having Dementia, Alzheimer?s disease (AD) or whatever else it may be is contained in the foregoing title! In this blog in the past I have discussed the cost of the out of pocket medical and care expenses to the degree that it qualifies as one of my major issues. I do because in my view: 1.??? Their cost this high cost has the potential of breaking my wife and me as my care needs go any length of time.? a.???? ?As federal and state laws now are I will be ok because Medicaid will pick up such gaps that I cannot financially cover. b.??? It is my wife who will suffer. Her gaps will not be covered. If we have spent down to the poverty level that qualifies me for Medicaid that means we are jointly without sufficient funds for her to live on for any amount of time. There are no programs for her. ?She is effectively out in the street! c.???? Always keep this in mind. Whichever spouse will incur the cost of care, the estate that must be paid down to qualify that spouse is the joint and several obligation of both spouses. (Joint and several is the lawyer?s long way of saying the obligation of both spouses!) 2.??? Medicaid is under attack in Congress and is subject to state administration where the State has the ability to set policy for who qualifies and what those qualifying get. I live in a state, Minnesota, where the administration of Medicaid is far more sensitive to needs than too many other states. Between the federal government and too many states Medicaid cannot be trusted to continue to provide an alternative. (Medicare and Medicaid are two different programs. I believe people can get very confused by this and make mistakes, particularly those of us with Dementia and our harried caretakers. Why is this? I suspect for some nefarious reason!) 3.??? The cost of care is very high, in many cases confiscatory.?? a.???? Those families having more assets than the poverty level set by government must pay all care cost, all medical costs not paid by Medicare and its supplemental coverage if carried by the family.???? b.??? Between Nursing Home expense, Assisted Living expense and Home Care cost this can easily eat up the financial and retirement holdings of a family that would be otherwise secure. Home Care or Nursing Home care has a real average of approximately $100,000 a year. c.???? How many couples, who have the joint obligation for these expenses has $500,000 put away for retirement? I could continue on this topic for pages, and have in other essays. I refer you to: both of these titles are essays I have written on this blog in the past. Note they titles are in hypertext, click on then to go there. A roundup of a many of this issues can be found at: Much of it was based on the analysis I did in: The estate planning essay was written in 2007 initially and posted a number of times, the last time being in 2009 and can be accessed by clicking on its hypertext?d title that appears immediately above this. The? rude truth about the financial problems that exist with any disease needing care, particularly true of all the Dementia?s is set out in this essay. I prepared it after seeing an elderly law specialist after diagnosis in 2006. I spent 43 years as a practicing lawyer and did many wills, probate many estates and did Estate Planning. In my circumstances I did not trust myself to do it. I went to my old partner and asked him to find the best Estate Planning Lawyer and Elder Law Specialist in the Twin Cities and the two of them set my wife Diane and I up to face our catastrophe. I have posted an essay that appeared in the ?New Old Age? column of the New York Times this past week. (Oct 11, 2012) It validates all I have said about the cost and the extreme risk it puts us at. I strongly recommend its reading. It says it all in a different, clearer and far more succinct way than I do.

It is entitled:?The High Cost of Out-of-Pocket Expenses

In hypertext, click on title to go to my Archive to read it. It is worth reading in every way. I cannot keep quiet about this. I see our nation, the pure stupidity of the politics relating to aging, the duplicity of so many from Wall Street to?Money Changers related investment programs and companies as well as Fund Raisers skimming enormous profits off the top leaving little or no funds to help. They build the complexes pay all the fees and do not have enough pay the help to care for the patients. All of this cries to heaven for vengeance. I hope they hear there because we do not hear here https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZjekgXOq6wYRm3mf7DNN98MLcVNC9t_AnPt1nvcM6drJtXULS_nnDYyJ8M1czZuOe4Ph20tX_kZwXKtrSPx_H_6EG6ynjuEM8Jbpc4UtNbEnyKvYEW6mKgR5pOfk_y6D9BaxIvgws0wzV/s400/Blank.jpg
A COMPENDIUM ON ESATED PLANNING FOR ALZHEIMER?S DISEASE The Diagnosis of Alzheimer?s Disease (AD) produces a Paradigm Shift in your life that compares to little that has preceded it in its breadth and abruptness!

When AD hits it affects everyone around you. You have it; your spouse must to deal with it; your loved one?s need to accept it. These are but the tip of what is a never ending list of a new and different permanence in your life.

One of the most difficult issues of many that need attention is the financial affairs of you and your spouse. Your life is going to be decidedly different; the roles between you and your spouse are going to change significantly.

As it concerns your financial affairs, how you own and what you own may have to be changed to protect it from being unnecessarily drained because of the care needs of your illness. This requires planning; it is called Estate Planning.

Your Estate comprises whatever property you and your spouse own or to which you have the absolute power to direct (like a trust fund). This includes everything from your bank accounts, insurance policies, homestead, personal property around your home, car, anything having value.

It is important to review this with your attorney and a financial planner should you have one. The purpose of it is to make sure you qualify for all financial support for which you may be entitled before incurring the Cost of Care. The Cost of Care for AD is enormous and can literally confiscate all of your funds leaving your spouse with little or nothing to live on.

What follows is an outline of points I learned in 1977 when I consulted with my attorney who brought in a specialist in Elder Law to work with him. In turn they worked with my financial planner and my tax accountant.

I was a practicing lawyer for 43 years. I did not trust myself even though I had sufficient training and expertise in it. I needed someone. A lawyer who represents himself has a fool for a client. A person not a lawyer who does the same has a pair of fools serving her/him.

What follows are the circumstances as I recall them and noted them at the time. This is dated, things may be different. What they were then was appalling, what they may be now will probably be worse if changed at all.

You need to protect your estate. What was accumulated was from your own efforts at saving for retirement. It needs to be preserved as much as possible to care for you and your spouse for the rest of your life expectancy. That is only fair when you have undertaken this effort and accumulated protection by your own efforts.

Like so many my spouse and I saved for our own retirement and funded a reasonable life for the rest of our days. In the planning for retirement we did not include funding the occurrence of the catastrophe of one of us becoming afflicted by AD.

The special circumstances of having AD as it regards your finances are these. If you look at AD occurring in three stages, Early, Mid, and Late Stage, you know this. In Early Stage you can get along well on your own in most instances. You will normally start to need help as you reach the Mid and Late Stage. It starts with the need of intermittent home care to help you and to relieve your caregiver spouse.

Companion care will run $20 to $25 an hour. A qualified health care person runs $30 to $35 an hour. (Minneapolis MN approximate) This is not bad once and awhile. A regular use adds up quickly, such as: 8hrs a day @ 20 = $160.00. Monthly is $4,866.66, annually is $58,400. If 24 hour care is required simply multiply those numbers by three and get daily $480, monthly $14,595.88 annually $175,200.

This simple calculation takes Cost of Care out of the ballpark and directs you towards Assisted Living or Nursing Home Care.

The savings there are substantial. Assisted Living Costs amount to an average in Minneapolis of $6,000 a month $72,000 a year. Nursing Home Costs amount to an average in Minneapolis of $7,000 a month $84,000 a year.

Is it unreasonable to estimate the Cost of Care will equal $75.000 to $100.00 a year?

If not supplemented by outside help how long can the normal retirement savings withstand such a drain of cash resource before it runs out leaving the surviving spouse in poverty and the afflicted spouse on Medicaid?

This is the issue you needed to address as does every one of the middle class.

Who of you in the middle class who have industriously saved enough to cover retirement have not saved enough to cover catastrophe?

The subject of this paper is to point out the significant reality in our community of those who are afflicted by AD.

The rich will probably have enough to weather the financial storm. The poor have Medicaid available to them to cover this cost. The middle class have nothing but what they have on their own.

Before they can get any help the middle class need to reduce their estate to the threshold level to qualify for Government Aid. In 2007 the conditions and circumstances were as follows:

I.?? Funding the Cost of Care:
  1. When a family requires health care service for an Alzheimer?s patient the cost is not insured unless the patient has long term health care coverage, then it is covered to the amount and the time the insurance company agrees to pay in the policy.
  2. Without the coverage the cost is the families?, no other.
  3. If the family cannot pay, they can apply to the state for payment of the cost.
  4. To do this there are qualifications set by the government. They are called eligibility requirements.
  5. Among those at least as they apply to me are the following:
    1. I must first deplete (pay out entirely) all of the property that I have excepting:
??????????????????????????????????????????????????? i.???? $3,000.00 ????????????????????????????????????????????????? ii.???? My Homestead ??????????????????????????????????????????????? iii.???? My household goods and personal goods
    1. I can?t have an income greater than $79.00 per month.
    2. This includes everything that is in my name. The income from my deferred (IRA and like kind) retirement accounts are included in that.
  1. My wife is financially responsible for my medical needs and all other expenses of living I have including nursing home, assisted living and home care before the government can be made responsible.? If she has funds of her own other than mine those funds need to be depleted before I am eligible. The rules for the spouse in my case I am told are these:
    1. My wife?s separate estate must be no more than $102,000.00 (2007).
    2. Her income must be less than $1,650 in some cases less than $2,489 in other cases per month.
  2. We can keep our home, that is exempt at least to a value of $500,000 or in some cases $1,000,000.00 should my wife live in it while I am receiving services.
8.???? Should I require health care service, whether it is home care to help my wife, some form of day care or assisted living, nursing home or otherwise, we pay this until our funds between us do not exceed $105,000.00 plus our homestead. This requires we pay out all our retirement investment funds, cash values of all of our insurance policies, anything and everything unless we have annuities that pay income only without any beneficiary for the balance of principal if any at the end. (There are certain exceptions, but the foregoing is the net effect.) 1.???? Shelter the Estate so the Government does not eat up the spouse?s share of the Estate needed by her/him to survive me.

The history of the ?Spending Down Your Estate? as it is often called is this:?

Years ago the older farm couple would go in to see the lawyer and have him transfer the farm to the kids. Their reason: ?You don?t want the to go to the county when you go into the nursing home.?

In the insular culture of the family farm community this was done consistently, although often counseled against by the family lawyer. It did have its margin of safety because the kids would be shamed and shunned by the community if they did not honor their parents. In this way the county paid the bill and the farm passed on to yet another generation.

Initially the County placed an Old Age Assistance Lien on the real estate owned by the applicant once the State started paying for assistance. The lien was collected when the applicant died. The reason farm couples started to stop by the lawyer?s office before they went to the nursing home was to make sure they didn?t own anything the County could put a lien on.

As this practice expanded the State placed a time limit before which the transfer had to be made or they could enforce a lien against the property even though it was transferred to a child. They called these ?Look Back Rules.? Each couple of years more limitations were introduced and ?Look Back? time extended on the practice which was called: ?Spending Down Your Estate.?

To consider sheltering your estate you must be aware of the ?Look Backs? and the other limitations in force against sheltering.

Most estates are not sufficient to cover the Catastrophic Cost of Care that will come with AD. How quickly can an estate pay an extra 75 to 100,000 a year addition to the budget to cover this Cost of Care?

There are two alternatives other than sheltering that are too often too complicated or unacceptable to moral values. One is Divorce the other is Doctor assisted suicide allowed in a few states. I will discuss each of these in a later paper as they do not bear discussion on the money nuts and bolts discussed in this paper

SHELTER OR ROLL THE DICE DOING NOTHING!?

One has but the two foregoing options, Shelter or Roll the Dice. To roll the dice can be euphemistically called Self Insuring.:

Shelter

The following are the rules the financial and legal advisors said were applicable in 2007 when I evaluated sheltering our estate:
  1. Our estate needs to be spent down in some way for my eventual eligibility.
  2. This needs to be done five years before I make an application for Medical Assistance.
  3. This means spending down to $3000 for me 102,000 for my wife etc. etc.
  4. Specifically they said:
The time limit for spend down is now five years. Any transfers made less than 5 years before the application for medical assistance for any health care costs such as home health care, assisted living or nursing home will be included in tallying the overall estate to determine the total assets of the individual needing the aid and the eligibility of the family to qualify for aid.? In other words spend down must be completed more than 5 years before application for benefits if your estate exceeds the $105,000 referred the in section I above. There are methods available each with their respective pitfalls. The only reason for us to consider any of them was to protect such funds as needed for my wife so she can live out her years in a minimal state of financial comfort. The methods of spend down we could consider were:??
  1. We could transfer our estate to our kids and trust them to take care of us and take care of my wife after I have passed on. (Transfer the Farm)
    1. To do that each or our children?s families could have a stake in how the funds entrusted are used. This is money which they will eventually inherit if not spent for our care. Our children and their families have their own personal needs. Do we place them in a personally compromising situation?
    2. We could pick but one of them to gift to. Would the others have a gripe? It would be hard not too much as I would like to think they wouldn?t.
We could put it all into an irrevocable trust (irrevocable means we give up all incidents of both ownership and control of the funds in the trust). The only control we could exercise is the language used in the trust. Any language we use however cannot control the free exercise of discretion by the trustee. (There are nuances through which we can have some direction but it is rudimentary and not really enforceable.)
    1. Should we do this we could name one or more of our children trustee(s). This has complications.
??????????????????????????????????????????????????? i.???? First of these is who do we choose at the expense of the others? ????????????????????????????????????????????????? ii.???? If we choose them all does it become unworkable? ???????????????????????????????????????????????? iii.???? Where each of them has a beneficial interest (right to ultimately inherit anything left) what consequences does this create, particularly in the gift & estate tax arena? ???????????????????????????????????????????????? iv.???? There are tax and control consequence if we transfer directly to a trust and spell out our beneficial interest. (This means if we spell out in the trust document what the trustee must pay us in the course of the trust.)
    1. We could use our children or someone whom we absolutely trust and transfer our funds outright to that person trusting such person to then set up a trust for our benefit.? This could be an individual whom we know we can trust, or a trust department at a bank which would give us a level of objectivity and a minimum of bias.
??????????????????????????????????????????????????? i.???? This involves two transfers. The first is to the person, relative, friend, bank outright! Then we trust that person to create the trust that we want. Then the second transfer is made by that recipient to the trust ????????????????????????????????????????????????? ii.???? We relinquish control and rely on trust. This in itself has its risks. ???????????????????????????????????????????????? iii.???? We pay a gift tax on the transfer from us, subject to exemptions, and a second gift tax consequence on the second transfer into trust. Once the exemptions are used they can?t be used again. ???????????????????????????????????????????????? iv.???? We can do a number of transfers to children, grandchildren, to reduce the amount transferred and benefit from any rate or exemption advantage on individual transfers to family under gift tax rules. ????????????????????????????????????????????????? v.???? Whether into one or more trusts with one or more trusted person as trustee or a bank or trust company there is still substantial risk. That risk is whether or not that person or entity receiving the ?gift? then setting up the trust with the funds we give them will do so as we ask them to do. Will that person in creating the trust (acting as Settlor) secure the funds for us, provide for the two of us as our need arises, show no bias for either Mom or Dad, and provide the funds go to our requested beneficiaries on our deaths?? ???????????????????????????????????????????????? vi.???? This places a big order on any person. A third party not family offers one set of risks family members altogether different but as many risks. ?????????????????????????????????????????????? vii.???? A transfer to a bank or trust company has its own set of risks, starting with one bias built in. That is to keep the sums in trust as much and as long as possible. The fee of the trustee is measured more or less by the amount entrusted and resulting responsibility along with the time the trustee serves. The reasons against this kind of a transfer are these: If we do it more than five years before application Medical Assistance cannot ?Look Back? and de-exempt it. It is not part of our estate any longer and enough time has passed prohibiting Medical Assistance questioning it. But, there is nothing to assure the government will at some point in the future decide such transfers are not allowed and make that disallowance retroactive to the time we might have set up such an intricate set of transfers. At that time it is too late and our claim to use of the money is long gone! Certainly, looking at the direction regulation has taken in the changes it is made this is a reasonable expectation. Investment of more money in Homestead
  1. The next shelter possibility we looked at was selling our home and buying one substantially more expensive than ours, doing it in my wife?s name and protecting a bulk of our funds in this way.
    1. If done more than 5 years before application for care, if the spouse not needing the care continues to live in the home, then the home is exempt and its value is exempt. No old age assistance lien, no other claim against it can be made. Only problem that might arise is what happens if that spouse dies before the recipient??
    2. We did not attempt to answer this question for this reason. It just did not make sense for us to put more money into a home which would by its nature incur greater living cost and its value would be dependent on the real estate market.
    3. Look at what that market is doing now! I am certainly glad we did not take this alternative though it sure seemed a viable one.
(This was written before the housing bubble burst in 2008. Cryptic?)
  1. This left us the most complicated alternative to deal with. Putting it into annuities. They are protected to the extent that they are ?income only? annuities.
    1. We were told the rules regarding them were these:
??????????????????????????????????????????????????? i.???? I can buy an annuity with funds in my name or over which I exercise control. This makes the annuity exempt from medical assistance claims. Technically this means the unpaid principal of this annuity is not an available asset for claim by medical assistance. The only claim of medical assistance is against the installments as they are paid back to me. ????????????????????????????????????????????????? ii.???? To set such an annuity up these requirements must be met: 1.???? The annuity needs to be payable in fixed installments amortized equally over my life expectancy so it is paid out completely with no remainder holding over for a beneficiary. 2.???? Should I die prematurely then my wife can be the beneficiary of what remains to have been paid out. 3.???? It does have this benefit. If I die before the annuity runs out my wife gets the remaining assets free and clear of a claim by medical assistance. 4.???? If she is not living then the State is the secondary beneficiary. There can be no provisions for family other than my wife. 5.???? The income stream paid out of it is treated as an available asset subject to pay for care. The principal is not an available asset and as such it is exempt. 6.???? To minimize risk I am told to string the payments out as long as possible, hope this will be longer than your life and shorter than your wife?s life. 7.???? I can do this at anytime before or after application and medical assistance ???????????????????????????????????????????????? iii.???? My wife can buy an annuity and that will be exempt from medical assistance claims and exempt from being figured into our total estate when calculated for eligibility should I apply for Medical Assistance. To do this these requirements must be met: 1.???? It must be purchased by my wife before I apply for Medical Assistance 2.???? The advisors told me it must be ?Amortized over life expectancy of annuitant (me), payable within time of amortization (this it the time of the life expectancy of annuitant) or earlier if Insurance Company agrees in initial annuity? 3.???? This means it is set up to be paid out completely with no remainder holding over for a beneficiary. 4.???? The company is not precluded from paying back earlier than limiting payments to the life expectancy time over which it is amortized. If they are willing they can pay early. It is optional with them and their interest is to hold as long as possible and earn on the money deposited. 5.???? The income from the annuity is exempt along with the principal invested in the annuity. 6.???? The Annuity amounts to the purchase of an income stream. The advisors went on to point out: a.????? To avoid having the transfer of funds into such an annuity treated as a transfer of assets subject to the five year look back rule, b.???? The annuity must be created and funded before the application for Medial assistance ??????????????????????????????????????????????????????????????????????????????????????????????????????????????? i.???? Recommendation is do it 60 days at least before, so application can be processed and there is time to get money out of investment and into annuity. ? ????????????????????????????????????????????????????????????????????????????????????????????????????????????? ii.???? The benefits of this is: It allows annuity planning with the ability to wait and only engage the planning if and when it is needed. ??????????????????????????????????????????????????????????????????????????????????????????????????????????? iii.???? In that way free use of the funds exist until near the last minute. ??????????????????????????????????????????????????????????????????????????????????????????????????????????? iv.???? Once the funds are paid in they belong to the company. The only right my wife has is to the installments which include return of the principle with 1 ? 3% interest paid on the unpaid principal balance in the annuity, no more! 7.???? In either case the annuity shall meet the following requirements according to the advisors: ??????????????????????????????????????????????????????????????????????????????????????????????????????????????? i.???? It be a commercial annuity, ????????????????????????????????????????????????????????????????????????????????????????????????????????????? ii.???? Begin payments as soon as possible under the contract, ??????????????????????????????????????????????????????????????????????????????????????????????????????????? iii.???? Make fixed payments on a monthly basis, ??????????????????????????????????????????????????????????????????????????????????????????????????????????? iv.???? Be projected to return all of the assets in the annuity to the annuitant over his/her life expectancy ????????????????????????????????????????????????????????????????????????????????????????????????????????????? v.???? Amortized over life expectancy of annuitant, payable within time of amortization or earlier if Insurance Company agrees in initial annuity ??????????????????????????????????????????????????????????????????????????????????????????????????????????? vi.???? Name the State of Minnesota as the secondary beneficiary following a surviving spouse.
  1. The downside of annuities are the following:
    1. Principle is given up in exchange for a guaranteed income stream. My wife can be the beneficiary of mine; I can be the beneficiary of hers. If either of us is dead it goes to the State. There is no further inheritance
    2. If the annuity has a pay out for ten years the rate of return on principal is not likely to exceed than 1.5% per annum after deducting cost of administration commission etc.
    3. If for 20 years it doubles to 3% per annum.
    4. In the event of an unexpected death there are complications.
??????????????????????????????????????????????????? i.???? If my wife dies before me it can come back to me, that part I don?t use goes to the state on my death. ????????????????????????????????????????????????? ii.???? If I die first my wife?s use of the funds are limited to the installments and the balance if any goes to the state. ???????????????????????????????????????????????? iii.???? The only advantage of an income stream annuity is it written for payment for a lifetime based on life expectancy and if the beneficiary lives longer there is a gain.
    1. A difficult twist (Catch 22) occurs if the AD patient stays sufficiently lucid to not need assistance and the spouse for whom the funds have been sheltered becomes in need of Medical Assistance. Access to the principal is denied the AD patient and the installment payments goes to payment of medical assistance for the wife
    2. If Annuity is a valued way to shelter it seems it should be done by the person who is not potentially needing medical assistance. That spouse can have free use of the funds so long and until it is funded into an annuity before medical assistance application is made.
    3. The value to the spouse potentially needing medical assistance is it can be done anytime. If the payments are extended far enough into the future at the lowest possible amount, the surviving spouse is entitled to the unpaid installments should the medical assistance spouse die before the annuity fully pays out.
  1. The final issue: How to get the money into my wife?s hands so she has the freedom to use of the funds, and, to decide when to annuitize these funds.
    1. There is no application of the five year look back rule on transfers to your spouse. If however, funds are transferred to the spouse and the transferred funds are used by spouse to buy an annuity there might be some gray area invoking the 5 year look back rule. I am not sure of this nuance.
    2. Deferred Income Accounts (IRA like) are subject to income tax if transferred.
    3. Should the spouse take advantage of the Homestead Exemption and funds need to be transferred to her this should be done more than 5 years before to avoid application of the 5 year look back rule.
The purpose of the rules regarding Medical Assistance are meant to make sure the funds are available for those truly in need of assistance and avoid folks gaming the system when their estates can afford medical assistance. The fault of the rules as we review them is they overlook the limited estate of those like us who in paying for their medical assistance potentially exhaust their estate at the expense of one of the partners owning the estate. That is what we have to look at and assess. Our current conclusion is there is not much we can do. What we can do is advocate. Advocate about the overall cost to society for this epidemic soon to become. Advocate for controls of some kind on health care expense. Explore alternative care methods that can provide economy of costs. There are many of these alternatives and more that I haven?t read about or thought of. They range from in-home supportive care to group home care, privately, by co-ops, by social/charitable organizations, etc. Others are Day Care facilities, Pools of volunteer or public/private funded workers trained to help, whether giving respite, nursing service, companionship or any number of services that would be helpful are needed. There exists a great need for Government to step in with some tools to aid in everyone economizing the cost of the care that will be needed. These include tax deductions, exemptions, credits, rebates when taxable income is not sufficient to provide a return for a deduction, exemption or credit. They can be grants in aid from government, corporations, and eleemosynary (altruistic, philanthropic?) groups. Any number of public/private ways exists for us to act as a society and ease the individual predicament in dealing with this coming crisis. If nothing more eligibility requirements in light of high costs of medical assistance, insurance exclusion, and validation of separate need of both spouses needs to be reviewed. The rules as they are stop half way. They make the spouse responsible for the other spouse?s costs but offer no relief if there is not enough to go around after paying them. My purpose in doing this paper in this detail is to invoke conversation. We all need to talk about this! The foregoing has been written by me with the understanding of the technical matters of having practiced law for 43 years. This is not, however, legal advice and should not be relied on as such. I am not a lawyer; that was in a past life. I let my license expire to force myself to retire. I have not kept up in the field these more than three years I have been retired. This is not more than my understanding of what I was told, advised and counseled after my diagnosis of AD.

Source: http://ic-mike.blogspot.com/2012/10/estate-planning-for-alzheimers-he.html

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