Friday, April 24, 2015

Long-term care issue hits close to home for Sen. Warner

Five years after U.S. Sen. Mark Warner's mother died of Alzheimer's, he is still haunted by what he might have done differently for her — if only he had known her wishes.

When the disease first took hold of Marjorie Warner in about 2000, her son was already a wealthy, self-made businessman, on his way to being elected Virginia's governor the following year. He prided himself on being a take-charge executive who could solve tough problems.

But after his mother was stricken, none of his money or experience really mattered.

It wasn't that Alzheimer's, which slowly destroys a person's memories and cognitive abilities, was incurable. It wasn't that private nursing care is pricey - his family had access to the best health care available.

What gnawed at the senator then — and still does today — is that he, his parents and his sister never had what he calls "the conversation" before his mother became too ill in the waning years of her life.

The warning signs were there. Her own parents had died from the disease.

Still, despite nagging worries about what was to come, they never had that difficult but necessary conversation about how she wanted to approach the last years of her life. How aggressive should her doctors be in trying to extend her life? Would she want to be put on a feeding tube? Nothing that would have helped guide them when decisions had to be made about her advanced care.

"I think she was always afraid of getting Alzheimer's. But there was never a question of 'When do you let go?' 'How many extraordinary additional actions do you take?' " Warner said. "She came up from that generation of having that fear of being put in a nursing home. I think a lot of people did."
His lingering frustration is fueling an effort to pass legislation that would launch a national campaign to encourage people to set up advanced-care plans. His bill also would establish a new Medicare benefit to cover the cost of professional counseling with health care professionals about long-term care planning.

Two years ago, Warner and Sen. Johnny Isakson, a Georgia Republican, introduced similar legislation that went nowhere. In the coming weeks, he and Isakson will try again, introducing a new care-planning bill.

Warner seldom talks at length about his family. But he has spoken in more detail about his mother's disease, hoping that his family's experience will help others see the importance of his legislation.
"Everybody has got a personal story," Warner said in a recent interview. "My story is my mom. For 11 years she had Alzheimer's, and nine of those years, she couldn't speak."

The Warners, who lived in the Connecticut city of Vernon, northeast of Hartford, were a close-knit family, The senator describes his mom as a 1960s housewife, who in a later era would have had a professional career. His father, now retired, worked in the insurance industry.

His mother's influence on him was immense.

He credits her with sparking his love of reading, and his sense of organization. He was the first in his family to graduate from college, and he later earned a law degree from Harvard University.

Watching the disease "chip away at her" was particularly hard, Warner said, because — like him — she was an energetic, social person. "She loved people."

After her diagnosis, Warner's father, Robert, and sister, Lisa, stepped in to take care of her at home.
"My dad," Warner said, pausing. "I think the hardest thing I can imagine is what he and my sister did for more than a decade. Taking care of her 24-7, with some additional help."

"Since we hadn't ever had the full conversation, near the end — particularly for my dad and my sister — it was harder to let go," he said. "There were times we were choosing things in intensive care near the end that I just personally felt she would have preferred..." Warner said, not completing his thought.

Marjorie Warner died Jan. 23, 2010, in her Connecticut home. She was 81.

The Warner family's experience is all too common, said Eric Sokol, a vice president of the Alzheimer's Foundation of America.

"Not everyone has an opportunity to set up their wishes," Sokol said. "It's an uncomfortable discussion. It's a topic not a lot of people want to deal with."

A key element of Warner's legislation would compensate doctors, nurses and other professionals to work as a team in discussing with a patient his or her long-term desires, explain how a disease would progress, and assist the patient in drafting a care plan. The advanced directive, which makes clear what the patient wanted, would be transferable to whatever state the patient might move to.

Warner said such planning also would involve clergy, should the patient want them included.

"This is something that would have been harder to talk about 10 or 15 years ago," he said.

Heeding his own advice, Warner, 60, and his wife, Lisa, have discussed care options for themselves, and the senator has prepared his own advanced directive.

He's not certain how his bill will fare this session. Past efforts have run into opposition because of the costs associated with providing the services. His new bill has not yet been reviewed by the Congressional Budget Office, so the cost estimates haven't been determined. Some also worry about negative associations that come with frank discussions about end-of-life care.

"There will always be opposition," Warner said. "This is about saying 'Do you really want to have a fourth time of resuscitation?' "

Warner has particular disdain for former Republican vice presidential candidate Sarah Palin, who falsely claimed that the 2009 Affordable Care Act included "death panels" that would decide patients' fate.

Warner said Palin's irresponsible comments scared people and set back serious consideration about the importance of long-term care planning.

"It was just awful," he said. "We're talking about expanding choices and not limiting anyone access to health care…. It's about having a conversation."

Source: NewsLeader

Friday, April 17, 2015

Money Mistakes 30-Something-Year-Olds Make

Hands holding piggy bank and jar of pennies

As I venture into my early 30s, I think I’ve become pretty careful about our finances. I certainly know not to continue on with the mistakes I made in my 20s like buying more car than I can afford or not paying myself first. But something happened last week that made me go, “Uh-oh.”

Now that spring is here, I went shopping to look for new clothes for my daughter. After a while, my husband looked at all the stuff and asked me, “Don’t you think you’re going a little overboard here? Why so much stuff?”

I started to justify why we needed each item. And after a bit, I realized I was actually repeating myself: “Well, this looks pretty. And this is very pretty.” I could see the look on my husband’s face. I just stopped. I had to admit that she only needed half of what I was going to purchase. She is a baby after all; she doesn’t care about being pretty, only about being comfortable. Uh-oh, I am making new money mistakes!

When we reach our 30s, many of us have our careers on a steady path; most of us are married or are getting married; some of us have started traveling more, purchased a house and might even have a baby or two. But it’s not a time to become complacent with our finances. If we aren’t careful, we can make new money mistakes.

I guess that is true for every stage in our lives — we keep making new mistakes. But we can also keep learning from each other and avoid as many mistakes as we possibly can. Isn’t that why we read this blog in the first place?

So here I am, compiling a list of potential money mistakes my 30-something peers and I should avoid. On the eve of my 40th birthday, I don’t want to be thinking “I wish someone had told me this 10 years ago.” I will start with the one that served as my wake-up call and got this thought process going for me in the first place:

Buying too much for your child. I think every parent makes this mistake. In fact, compared to what I see other moms in my local mommy groups purchasing, I seem to buy very little. And what I buy is more than plenty. So I can only imagine how much money people are spending on cute clothes, shoes, blinking and screaming toys, even educational apps. I (and other parents) should just save that money and start a college fund.

Getting married without talking about finances. Maybe money is a touchy subject for people; but by the time you have reached your 30s, you should be more capable of negotiating difficult discussions. It is extremely important to be on the same page with your spouse when it comes to money. Otherwise, it can become a major source of conflict in your married life and potentially the reason it ends in divorce. Talk about finances with the person who will share your life and develop your monetary goals together.

Still having consumer debt. I have heard of excuses like “If only I were single, I would have paid off all this debt” or “I was paying off my debt, but we had a kid.” There will always be some new event in life; some exciting, some unfortunate. But if we choose to ignore our debt, it can become an obstacle that prevents us from pursuing opportunities that might better our lives. Take charge of your debt! Budget aggressively, earn as much as you can, and pay it off.

Buying more house or car than you need. A lot of people move when they have children, thinking they need more room with a kid than they did before. They take the same approach with cars, trading in their sedan for a big SUV. Why? We don’t need giant homes or huge cars to raise kids!

Keeping up with the Joneses. Speaking of giant homes and huge cars, people of all ages seem to be afflicted with the desire to keep up with the Joneses — but unfortunately, it seems especially common among 30-somethings. Maybe it’s the subconscious messaging of television advertising or the desire to be accepted in our social groups; but no matter what the reason, it is important to keep our spending within our means, forego lifestyle inflation, and chart our own financial course.

Ignoring a will. If you have a significant other or any children, please make out a will or set up a living trust. It may be unpleasant to think about death in your 30s; but you don’t want your loved ones to go through the hassle of fighting the State to get what is theirs. While you’re at it, get a durable power of attorney and healthcare power of attorney too!

Not having enough life insurance. Again, no one wants to think about death; but if you have anyone that depends on your income or your time, you need life insurance. And you have to get enough life insurance to cover the needs of your dependents, not just the minimum offered by your employer.

Not having long-term disability insurance. In your 30s, the chances of becoming disabled and not being able to work are higher than death. Most people have long-term disability insurance from their employer; but you should calculate how much you need and then purchase supplemental insurance. When it comes to insurance, life or long-term disability, it is better to get your own policy and not depend on your employer (unless getting your own policy is prohibitively expensive for some reason). If you change your job, you will lose that insurance and then replacing it will be that much more expensive. This type of insurance is less expensive in your 30s than it is later in life.

Not re-evaluating your retirement goals. In your 30s, you have a new lifestyle; hopefully your income is different now than it was 10 years before when you started saving for retirement. If your income has increased since you formulated your retirement goals, have you done the calculation on how much you need in retirement with your new income and lifestyle? If not, now is the time.

Not paying attention to how your investments perform. You might have started your 401(k) with a very basic money market fund with the intention of learning about investing and doing a better job. Have you done that? Have you studied how your investments are performing and adjusted them based on your current goals and tolerance for risk? If you need help, now would be a great time to find a fee-only financial planner and see if you are on the right track.

Neglecting your children’s education. If you have a child and intend to pay for at least part of their education, you need to start putting money away for college now. At the very least, start saving money in an online savings account until you fully research college savings plans.

Putting too much importance on your children’s education. You should save for your children’s college tuition but not at the expense of your own retirement. Make a budget, fund your retirement, and then find ways to save more money to fund college.

Going back to graduate school for the wrong reason. I am all for getting a graduate degree if it propels your career to new heights. But if you are going to graduate school after a job loss to avoid job-hunting or if you are going to grad school because you can’t find a job with your undergraduate degree — particularly if you have not researched job prospects after a graduate degree — then you are making a huge mistake.

Not diversifying your income. It used to be that you stayed loyal to your employer and in return they took care of you. For example, each of my parents had one job throughout their working years. When they retired from their jobs, they each had a pension. But since that isn’t the case today, we need to find ways to maximize and diversify our income. If you have a hobby that can make some money, pursue that. Try to generate income from sources other than your job. After all, job loss is no longer an uncommon occurrence and the only person who cares about your future is you.
Those are the mistakes of which I am aware. Some of these are things I notice myself doing and others I see happening with my friends. But unlike the mistakes we are likely to make in our 20s, these are born more from complacency, not necessarily naivete. The good news is that we 30-somethings can wake up, take charge of our finances and still hope to achieve our financial goals.


Tuesday, April 14, 2015

Parents should know the ABCs of special needs trusts

We all want to provide for our children, and perhaps even leave a little something behind to help lighten their load after we're gone. But when you're the parent of a disabled child who may outlive you, the importance—and complexity—of putting financial safeguards in place takes on new meaning. 

Indeed, the manner in which you distribute assets to a special needs beneficiary after you die not only impacts his or her eligibility for government benefits but also their quality of life going forward.
Parent child holding hands
"Being well-intentioned is not enough," said Michael Duckworth, a Merrill Lynch financial advisor who specializes in estate planning for clients with a disabled loved one. "There are a lot of stories of grandparents who accidentally knocked their grandchild out of a needs-based program by leaving money to him or her outright."

How so?

Children and adults with significant disabilities, either physical or mental, are eligible for essential long-term nursing care under Medicaid, along with cash assistance under Supplemental Social Income—but only if they own no more than $2,000 in countable assets or $3,000 for a married applicant—and a number of state programs, including special education classes and vocational training. 

"You may have a situation whereby Grandma writes a check out in her disabled grandson's name and he gets kicked out of the program that was giving him a better life experience," Duckworth said. To get back in, the beneficiary would have to spend down his assets and reapply for the program, which causes a lapse in service and disrupts continuity of care.

Unbeknownst to many, said Duckworth, many of the best state programs—including vocational training and those designed to service individuals with specific diagnoses, such as autism—are available only through Medicaid.

Supplement their needs

"No matter how much wealth you may have, there isn't a system whereby you can write a check and get in," he said. 

Enter the special needs trust. 

Such trusts, also called supplemental needs trusts, are designed to enable third-party individuals, generally family members, to leave an inheritance to disabled heirs without those assets counting against them for the purpose of securing public benefits.

Because assets are titled to the trust, they are not considered part of the estate.

There is no limit to how much you may contribute. 

Elizabeth Roberts, senior vice president and chief fiduciary officer at Bryn Mawr Trust, said the language in such trusts should clearly indicate that distributions are to be made exclusively for supplemental expenses, or services not covered under Medicaid, such as medical and dental expenses, recreational therapy, specialist visits, dietary supplements, transportation, travel expenses and prosthetic devices. 

"Frequently, the trust specifically states that funds are intended to supplement and not supplant," she said. 

For maximum protection, the language within should also note that distributions are to be made only after other assets and governmental programs are considered, Roberts said. 

Special needs trusts can be used to receive proceeds from litigation or a personal injury settlement on behalf of the disabled beneficiary, as well, in which case it would be structured as a "first person" or self-titled trust. 

Money held in a self-titled trust is similarly excluded from public benefit calculations during the beneficiary's lifetime, but there is a payback provision. 

Any assets remaining in the trust when the beneficiary dies would be used to pay back Medicaid for expenses incurred by the state in administering care. In the event that excess money remains after the debt is repaid, those assets would pass to a designated heir. If there's not enough in the trust to make Medicaid whole, that debt dies with the special needs beneficiary. 

Supplemental needs trusts that are set up by a third party have no such payback provision, and thus, any assets remaining in the trust after the beneficiary dies can be distributed to subsequent heirs free and clear.

Insure against claims

Special needs trusts serve another important purpose, too, according to Minerva Vazquez, an attorney with Miami law firm Frye & Vazquez, who specializes in the area of special needs estate planning.
They protect the assets held within from creditors and claims against the estate. 

"A lot of parents think it's OK to leave money to their other, non-disabled child who has agreed to care for their sibling, but they don't consider the possibility of a lawsuit or divorce settlement," Vazquez said.

If the non-disabled child gets sued, files for bankruptcy, causes a car accident or gets divorced, she said, those assets are vulnerable.

"Under a trust, that money is protected from creditors and settlements," Vazquez said.

"Everyone loves their child or grandchild, and the last thing they want is to do something that takes them out of a program they love and really benefits them."
-Michael Duckworth, financial advisor at Merrill Lynch

Indeed, mistakes are common when dealing with the unique estate-planning needs of the disabled, said Duckworth at Merrill Lynch. 

Some families, for example, create traditional life insurance trusts in the name of a disabled loved one but fail to stipulate that the proceeds should be directed to a special needs trust when it pays out. There again, the beneficiary would be bumped out of Medicaid as a result. 

"If you buy an insurance policy, you need to leave that money to the special needs trust," said Duckworth, noting that a regular trust will not suffice. "Traditional estate planning is not the approach when you have a beneficiary with a meaningful disability."

Because the consequences of estate-planning missteps are so dire for disabled beneficiaries, Duckworth suggests all immediate and extended family members (parents, siblings, aunts, uncles and grandparents) who may be inclined to generosity be advised to enlist the help of a professional experienced in special needs estate planning, be it a lawyer or financial advisor. 

"Individuals with special family members need to be present to the risks that are there," Duckworth said. "Everyone loves their child or grandchild, and the last thing they want is to do something that takes them out of a program they love and really benefits them." 

Source: CNBC

Tuesday, April 7, 2015

Medicaid Fraud and what to do if you received HRA letter

NY Top Medicaid Fraud Attorney Inna Fershteyn on RTVI with Marina Levinzon discussing Medicaid Fraud and what to do if you received HRA letter |

Languages: English, Russian speaking attorney

Areas of Practice: Estate Planning, Asset Protection, Medicaid Fraud investigations, Medicaid Planning, Wills, Trusts, Elder Law, Business Continuation Planning
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Brooklyn, NY 11235
(718) 333-2394

Tuesday, March 31, 2015

Planning for Children with disabilities attorney Inna Fershteyn answers questions on RTVI

NY Top Special needs planning Attorney Inna Fershteyn on RTVI with Marina Levinzon discusses Special Needs Trusts, Guardianships, planning for children with disabilities and Medicaid Planning. |

Languages: English, Russian speaking attorney

Areas of Practice: Estate Planning, Asset Protection, Medicaid Fraud investigations, Medicaid Planning, Wills, Trusts, Elder Law, Business Continuation Planning
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Law Office of Inna Fershteyn and Associates, P.C.
1517 Voorhies Avenue, 4 FL
Brooklyn, NY 11235
(718) 333-2394