Gainesville Florida Estate Planning & Elder Law Blog

In order for Medicare beneficiaries to receive access to Medicare’s skilled nursing benefit, the hospital must classify them as an inpatient. Unfortunately, more and more patients are either classified as outpatients receiving observation services instead of inpatients.

Studies have found that hospitals are classifying patients as outpatients more frequently. Researchers have suggested that hospitals are using outpatient observation status as a substitute for inpatient status – meaning more and more patients aren’t qualified for their Medicare benefits.

Hospitals are hesitant to classify patients as inpatients because they are concerned about the Recovery Audit Contractor (RAC) program, which can deny hospitals reimbursement if they conclude that a patient was incorrectly classified as an inpatient. Additionally, the hospital could face other penalties – causing the decrease in patients labeled inpatient.

Currently, Congress is working to solve the problem and ensure that Medicare beneficiaries who qualify for Medicare’s skilled nursing benefit receive adequate treatment. Multiple congresspersons are working on bills that improve access to necessary Medicare benefits. 

It should always be a priority for homeowners to protect their property from creditors.  Of course, if you own a homestead in full, that property is yours and protected from creditors; but things get tricky when you sell a homestead and/or buy another. 

Usually, homesteads are protected from creditors under the Florida Constitution.  In the case JBK Associates v. Sill Bros Inc., the extent of protection under the Constitution becomes muddled.  JBK obtained a $740,487.22 judgment against Patrick Sills in 2010.  In October of 2013, Sills sold his homestead pursuant to a divorce decree – the proceeds were placed in an account, which was later divided into one cash account and two security accounts.  Therefore, Patrick claimed, the accounts were homestead funds and should be protected. JBK appealed by arguing that Patrick lost his right to the homestead protection when he purchased securities with the homestead proceeds.

In Orange Brevard Plumbing & Heating Co. v. La Croix, The Supreme Court of Florida essentially ruled that in order for a homestead to be protected once an owner sells it, the owner must purchase a new homestead within a “reasonable amount of time.”

Each case is different; it would be wise to consult an expert to ensure that your homestead and assets are protected from creditors.  Since the circumstances change with all kinds of variables, protect your homestead by purchasing a new homestead within a reasonable amount of time after selling one. 

Sometimes, the world can be a scary place.  Everyone is at risk for being taken advantage of in some way or another, but some of the most vulnerable people are the elderly.  But don’t worry – there’s a few rules of thumb to follow that could help you avoid any potential scams.

• Do your research.

  Make sure you can trust the people who are asking you for any personal information.  It can be impossible to know who is on the other line of the telephone or who is sending you emails.  They may not be who they say they are – so confirm exactly whom you are communicating with before you reveal anything.

• Take your time.

  Don’t let anyone you don’t know rush you into giving them your personal information.  They may use tactics to try to persuade you that they need money or information immediately, but if you can’t confirm exactly who they are and where your information is going, don’t fall for it.

• Consult someone you trust.

Make sure you ask about any questionable emails or phone calls you might receive.  Your friends and family might have heard warnings by word of mouth or on the news about your exact circumstance; it could save you a lot of trouble (and not to mention money). If you see a scam or suspicious activity, report it. You can call 1-877-382-4357 or visit ftc.gov/complaint to file a report.  

Today, one out of three adults in the U.S. is clinically obese. Every day, more and more overweight and obese adults head into their senior years with more health risks than ever before.

According to an article from Kaiser Health News, research shows that obese and overweight adults face an increased risk of other health problems and disabilities as they age. The article also states that obese adults face a higher risk of dementia, Alzheimer’s disease and certain cancers as they grow older. Excess weight is also linked to cardiovascular issues and high blood pressure, high cholesterol and diabetes.

Nursing homes and hospitals will treat unprecedented numbers of obese, elderly citizens with complicated health problems that stem from carrying excess weight. More seniors are facing bigger hospital and nursing home charges at a younger age because of their weight.

As a senior citizen, your health is already at risk. Make sure that you are proactively watching your weight.  It could save you time, money, and your life.

Read more about the effects of obesity on the elderly here: http://kaiserhealthnews.org/news/the-extra-cost-of-extra-weight-for-older-adults/

The results of a new study reveal the presence of the brain plaque buildup related to Alzheimer’s disease in the brains of individuals as young as 20. And that means it’s never too early to plan for the future.

The study’s co-author, Changiz Geula, explained that he and his colleagues analyzed the brain tissue of 48 deceased people, ranging in age from 20 to 99. The buildup in victims of Alzheimer’s is referred to as plaque and involves an abnormal protein that surrounds specialized neurons in the individual’s brain tissue.

While experts still aren’t sure of the exact mechanism by which the plaque causes damage or even if the buildup is the sole cause of Alzheimer’s, the discovery of the plaque in brain tissue so young is groundbreaking.

Ultimately, the information from the study has demonstrated that doctors and experts might have to intervene to prevent Alzheimer’s much earlier than they would have imagined.  Since researchers now realize that the proteins involved in the buildup linked to Alzheimer’s can be present in some brains as early as age 20, researchers now realize that treatment for the disease will have to be much more preventative than originally thought.

Many retirees are ready for the freedom and stress-less lifestyle that retirement brings, but there are other aspects  that could be unexpected. Most retirees have substantial health concerns, financial woes and free-time is only fun if you can make good use of it. Here are 10 ways that retirement might just surprise you.

• It can be difficult to spend down your savings. After years of collecting enough money to comfortably retire it can be inherently challenging  to spend down that money and watch the nest egg that you acquired get smaller and smaller each year.  “They are going to feel like they spent a lifetime accumulating this pile, and the idea of spending this down is just repulsive to them,” says Alicia Munnel, director of the Center for Retirement Research at Boston College. “For anyone who is retiring, I would give them permission to spend their money,” she advises.
• You still need investment growth. Accumulating just enough money to retire is not your final goal. You must also lay out a plan to make that money last as long as you do. “You need to understand how you can minimize risk in the portfolio, but you also need a component of that strategy that gives you growth,”  says Laura Mattia, a certified Financial planner and wealth management principal for Baron Financial Group. This fundamental growth factor in your investing strategy will help you stay ahead of both inflation and taxes.
• It's common to rely on Social Security. Social Security is a momentous source of income for many retirees. Approximately 86% receive income from Social Security and Social Security payments make up at least half of the retirement income of 65% of retirees, and comprise 90% of retirement income for over 36% of retirees. The monthly average retirement benefit was around $1,300 as of December 2014.
• Medicare does not cover everything. Steep health care costs don't go away once you qualify for Medicare. While Medicare will cover a large amount of your medical bills, there are still a few prevalent services that it doesn't. For example, Medicare won't cover any visits to the optometrist or the dentist, along with the costs of hearing aids.  Medicare will also only cover up to 100 days in a nursing home. Retirees who require any additional long term care will have to pay for it out of pocket. And while most preventative care services are covered by Medicare with no cost-sharing requirements, if something of concern is found, then additional tests and procedures will mean that copays and coinsurance will apply.
• You may spend a lot of time alone. Without a job to spend your nine to five at, you may find that you spend much of your time alone. Approximately 44% of Americans ages 65 and older now live alone, according to the U.S. Census Bureau. Unless you begin volunteering or make a point to socialize often, you are at a high risk to become bored and lonely.
• Many retirees are dating. If you end up divorcing or outliving your spouse, you will once again find yourself single. While just over 50% of Americans ages 65 and over are currently married, the rest are either divorced, separated, widowed, or even never married according to census data. Some of these single seniors have begun meeting and dating new people, again. There are even a large variety of online dating services that specifically serve the senior population.
• Moving is difficult. While making the move to the sunbelt is an attractive prospect, most retirees don't relocate for their retirement. On average 5.7% of Americans age 65 and older actually moved between 2009 and 2013, and those who did often relocated to the same state, or even county, found the Census Bureau. Only 1% of retirees actually retired to a new state. Moving far away usually means leaving behind all of your family and loved ones, making it difficult to reconstruct your life in a new place.
• You will need help from others. While aging is an expected part of retirement, one losing their independence is not usually a welcomed change. There may come a day when you can no longer drive, climb a ladder to clean your gutters, change a light bulb, or shovel the driveway. You may also eventually need help preparing meals and bathing. Although the start of your retirement is full of new adventures, it is also a smart time to make plans for later, when you may no longer be able to take care of yourself.
• Retirees watch a lot of TV. Most retirees spend over half of their down time watching television. Seniors ages 65 to 75 tune in for about 4 hours on weekdays, while those 75 and over watch TV for an average of 4.2 hours every day, according to the 2013 American Time Use Survey by the Bureau of Labor Statistics.
• There is no need to hurry. Compared with the rest of the population, retirees between the ages of 65 and 75 spend much extra time lingering over meals, working on their home or garden, and shopping, found the American Time Use Survey. Retirees also tend to spend more of their time relaxing, reading or volunteering than their younger counterparts. 

As you begin planning for your retirement and the exciting new phase of life that comes with it, it would be wise to check your expectations. The reality may not be what it seems. Those in the Baby Boomer generation, currently in their 50s and 60s, have begun to show a trend in viewing retirement very differently than those who came before them. Many Boomers consider retirement as their chance to begin a new hobby, passion or even career, which is good. But unfortunately these soon-to-be retirees may not be seeing the whole picture.

Here are five of the most common fallacies surrounding retirement:

1. Retirement is like an extended vacation. Living a life of leisure will be great, right? Unfortunately not. Having too much spare time leaves many retirees feelings depressed, or without purpose. Scientific studies show that those who continue working after the age of 65 actually tend to be happier, whether or not they do so by choice. But above all, voluntary part-time workers were the happiest with their life. While money is the main motivation to work through retirement, having day-to-day duties and satisfaction are just as important.
2. Money is the most important piece to your happiness in retirement. The biggest key to a happy retirement is good health, so just having financial security is not enough. But money only relates to happiness to a certain level, you can still enjoy your life as a retiree even if you are not a millionaire.
3. Spending is consistent during retirement. People tend to spend less money in retirement, but this does not always hold true. Many find themselves traveling and enjoying vacations for the first few years, but as the years go on the number of trips generally decreases, while the cost of medical care and family expenses increase. A couple should expect to put aside $220,000 to cover their health-care throughout their retirement. While medical expenses are usually a large concern for retirees, very few spend time planning for that.
4. Retirement is for couples. As a married couple there is a large adjustment to be faced upon entering retirement. One in three couples don't agree on their ideal type of lifestyle they wish to have in retirement. You should also be aware that you and your partner will require time to themselves, for their own hobbies and passions.
5. Your financial planning stops at retirement. You will still have many problems that you will deal with during your retirement. This means you will have to continue the planning of your investments to make sure that your money will last as long as you do.

Retirement is not the lifestyle that you leave, but the one that you begin. Just because you reach a specific age does not mean you are required to stop working, and if you do, it is important to remember that to stop working does not mean you stop planning. To enjoy life without worry, you must plan. 

It is safe to assume that an individual is capable of making their own medical decisions, until they are determined unfit to do so. If a person is incapable to make their own decisions or speak for themselves on the matter of personal healthcare, their attending physician will give an opinion that the patient lacks the capacity to give informed consent. Before becoming incapacitated, a person can sign a document that names someone as their surrogate, or proxy, to make his or her medical decisions. This form is signed by the patient with two adult witnesses present, one of whom must not be a spouse or blood relative, and can designate both a proxy and an alternate in the case that the original is unwilling or unable to perform their duties.

A healthcare surrogate has the jurisdiction to make any and all medical decisions for the patient during their time of mental incapacity. One may also appoint a separate surrogate to consent to mental health treatment in the event that he or she is determined by a court to be mentally incompetent.

The surrogate is charged with making any and all healthcare decisions in congruence with the prior instructions given by the patient for whom they are serving. These decisions include consenting, refusing to consent or withdrawing consent to any and all medical treatment, as well as life-prolonging procedures. If there is no expression of what the patient would have chosen, the surrogate must consider their best interest in deciding what treatments are to be administered or withheld. The proxy's duties also include applying for private, government, or veterans' benefits to help bear the costs of healthcare. The surrogate also has the right to access all of the patient’s medical records to assist them in making decisions involving medical care and to apply for benefits.

With the commencement of the surrogate’s authority, the patient's spouse or adult children must be made aware that such an appointment has been made and that the proxy now has the authority to make the decisions. The proxy's authority to make healthcare decisions remains effective until there is a determination that the person who was labeled as incapacitated regains their ability to make medical decisions.

If the surrogate is unable or unwilling to make medical decisions in accordance to the patient’s expressed wishes and no alternate is named, the healthcare facility caring for the patient may seek the appointment of a healthcare proxy. 

Starting with a session in Tampa on Feb. 19, the White House is holding a series of regional forums to engage older Americans, their families, advocates, experts and leaders in the community on the imperative issues affecting the elderly.  These forums are designed to help provide ideas and input for the upcoming 2015 White House Conference of Aging.

These regional forums will be taking place all over the United States. Following the Tampa forum others are scheduled in Phoenix on March 31, Seattle on April 9, Cleveland on April 27 and Boston on May 28.

Each of these will give the White House the chance to hear directly from the general public on the issues of retirement, healthy aging, providing long term services and the protection of the elderly from financial abuse, exploitation or neglect. The White House will also be reaching out to older Americans, along with their caregivers and families where they live for further input.

The AARP has co-sponsored each of the regional forums and are currently coordinating their efforts with the Leadership Council of Aging Organization. While participation is by invitation only, you can watch all of the events over a live webcast by going to www.whitehouseconferenceonaging.gov.

Candidates (or candidates and their partners) are not eligible for V.A. Aid and Attendance benefits if they have a net worth exceeding $80,000. Currently, there is no look-back period for asset relocation, like there is for Medicaid benefits, which have a five-year look-back period.

Previously, it has seemed that a V.A. look-back period might have been looming, but after the Senate failed to pass SB 1982, which would establish a three-year look-back period, it did not seem that this would come anytime soon. However, on January 23^rd, the Federal Register included a proposal by the V.A. to establish, among other regulations, a three-year look-back period for transfers and corresponding penalty periods during which V.A. pensions would be unavailable, despite whether or not the veteran qualified in all other aspects.

Follow link to read more on this:  https://www.federalregister.gov/articles/2015/01/23/2015-00297/net-worth-asset-transfers-and-income-exclusions-for-needs-based-benefits

In the latest issue of the Caregiver Chronicle there is another great article, this one by  Dr. Joel Rich, one of the physicians at the Senior Health Center at Crown Pointe. Dr. Rich is often the last Doctor many of his patients will see. He works with patients and families to help make extremely challenging decisions about care, especially as they near end-of-life issues. In this article Dr. Rich explains how he attempts to eliminate the fear of the unknown, and lay out a plan for those he works with.

 Please follow the link to read the full article:

http://www.caregiverchronicle.com/2015/01/preparing-for-end-of-life-decisions/