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General Legal

Monday, June 26, 2017

The Four Most Important Legal Documents You Will Need to Manage Your Aging Parent's Affairs

To help your parents get their affairs in order, you should first make sure that you or someone trustworthy has the legal ability to manage your parent’s affairs.  This article is a guide to the four fundamental legal documents you and your parent may need in order to get financial affairs in order.



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Thursday, June 1, 2017

Important Things You Should Know Before Deciding to Seek Guardianship or Conservatorship of an Adult


What exactly is a guardian, what is a conservator and when should you become the guardian or conservator of an adult?

Aunt Mary is 86 years old and has always been a little eccentric, but lately she’s been giving money to John, a much younger man that she calls her special friend.  Aunt Mary says that she knows her family doesn’t approve of her giving him money and gifts, but she has plenty of money, John has been her friend for many years, he has always helped her with her home and yard, and she doesn’t have anyone else she would rather spend her money on.  Does she need a guardian or conservator?

What is a guardian and conservator?

A guardian is a person who is legally responsible for someone who is not able to manage his or her own affairs. Guardians and conservators are appointed by the judge of the probate court in the county in which the person in need of a guardian/conservator, called a ward, resides or can be found.

In Georgia, a guardian is the term that is used for the person responsible for managing affairs related to the health and safety of the ward, while a conservator is responsible for the financial affairs of the ward.


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Thursday, August 6, 2015

Five Questions to Ask Loved Ones About End of Life Treatment

How do we decide how we want to be treated at the end of life?

What would a good day look like if you were suffering from a terminal illness?

This is one of the questions Dr. Atul Gawande asks in Being Mortal, Medicine and What Matters in the End, New York: Metropolitan Books, Henry Holt and Company, 2014, his book exploring medical treatment at the end of life.

Dr. Gawande looks at how this one question, along with a series of questions most physicians are not asking their patients, might shape the course of medical treatment and care of those who are terminally ill, as well as those frail elderly who are in need of long term care.

In the book, one patient says that he is willing to have medical treatment for his terminal illness so long as the treatment will allow him to eat ice cream and watch football on television.  However, if at the end of the treatment he can’t have that ice cream and television, he does not want the treatment.

Another patient says a great day for her would be to take her grandchildren to Disneyworld.  Unfortunately, by the time she tells her doctor this she has undergone months of aggressive treatment that leaves her tired and weak and no longer able to go to Disneyworld.  The question then might be, if your idea of one good day is to go to Disneyworld, should physicians forgo treatment that will not cure you in order for you to have at least that one good day at Disneyworld with those people you love?

In our office, we spend lots of time helping clients fill out their Advance Directives for Healthcare, a document that allows a person to nominate an agent to make healthcare decisions for them if they are not able to make or communicate those decisions.  We talk about whether the client wants extraordinary medical treatment if they have a terminal illness that will likely end in death and they are not aware of their surroundings.  Most people say that they don’t want aggressive treatment under those circumstances.  However, we don’t have a good way for clients to really communicate their wishes to their loved ones when the question may be quality of life versus quantity of life.  What decisions should a healthcare agent make if treatment will prolong life but may leave that life not worth living for the person for whom the agent is deciding?

Dr. Gawande suggests a series of questions that should be asked while a person is still able to give answers. These questions would also be appropriate to ask someone who is aging and becoming frail :

  1. What is your understanding of where you are and your illness?
  2. What are your fears and worries for the future?
  3. What are your goals and priorities?
  4. What outcomes are unacceptable to you?  What are you willing to sacrifice and not willing to sacrifice?
  5. What does a good day look like for you?

Here is a link to an article about the author, along with a video discussing the five questions:

http://www.nextavenue.org/atul-gawandes-5-questions-ask-lifes-end/

Of course, the answers to these questions will change over time and as diseases progress.  For instance, a young mother facing terminal cancer will have very different goals, fears and worries from the frail 90-year old great-grandmother facing admission to a nursing home.

How would the answers to these questions help if you were the person who has to make or communicate these decisions for someone else?  If you knew a good day for your father was for him to be able to sit and eat ice cream while watching football on T.V., would you make decisions for his care that would allow him to do that?

I know how difficult conversations about end of life can be, but perhaps asking these five questions can at least open up a dialogue that will ultimately lead to better decisions about end of life care.

 

 

 

 

 

 

 

 

 

 

 

 


Thursday, July 23, 2015

Four Ways to Pay for Long-Term Care

Concerned about how your parents will pay for their long-term care?  Here are the four basic ways to pay for care.


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Thursday, July 16, 2015

The Zen of a Family Meeting: The Five Things You Must Cover When Planning for Your Aging Parents’ Care

 

 

July is Sandwich Generation Awareness Month.  The Sandwich Generation refers to those people, mostly in their mid-40’s to late 50’s, who are caring for aging parents as well as caring for young children or dependent young adult children.  If you are the meat or peanut butter in that sandwich, you might be looking for help from your siblings or other family members.  One of the best ways to plan the care for an aging or disabled family member is by holding a family meeting.  The meeting is designed to do many things:  get information from the aging or disabled person about their needs, figure out what kind of care is needed and brainstorm about ways to find that care, gauge the financial resources available for care, and assign duties to various family members so that one caregiver does not get burned out.

Who should attend the meeting?  I recommend that all of the parents and siblings attend a meeting, preferably where they can meet face to face to talk about the issues facing the aging parent now, and those issues that may come up in the future.  If grandchildren, aunts and uncles or friends will be responsible for some of the care, invite them along.    The parent or person with a disability should be in attendance so long as they are physically able to be there. 

It is usually best to hold the meeting in a neutral place, such as a meeting room in a hotel or community center.  I also recommend there be a fairly impartial facilitator to keep the meeting on track, if possible.  And, there should be plenty of snacks and drinks so people won’t want to leave before you’ve discussed all the important points.

With so many families spread out over the world, it can be difficult to get everyone together.  If the family has a regular family reunion, perhaps the reunion time can be extended to allow the family to get together for this meeting.  If there is no regularly scheduled reunion, you can use scheduling programs such as www.doodle.com to find out when the most attendees will be available. If some family members absolutely cannot meet in person, you can use tools such as Skype www.skype.com or Google Hangouts www.google.com/hangouts‎ to bring those other family members in by video.

Once you have set the time and place, have everyone agree to an agenda.  Appoint someone to come up with a proposed agenda in advance of the meeting, and then circulate that proposed agenda for comments, additions and changes.

Here are the five basic items that should be covered in the meeting:

 

  1. The Health and Safety of the aging parent or person with a disability

     

    How do they feel about their own healthcare and safety and what are they concerned about?

    Are there any disease or illness diagnoses?

    Are they paying attention to personal hygiene?

    Have there been any instances where the safety of the parent has been compromised, such as falling, leaving the stove on, wandering, etc.?

    Who are their physicians, dentists, therapists, professional and volunteer caregivers?

    What medications are they taking and are they remembering to take them regularly? 

     

    What health insurance do they have?  If they are on Medicare, is there supplemental insurance or prescription medication coverage?

    How are the premiums paid and is there someone who will be informed if the premiums are not paid?

     

    How are their finances? 

    What financial resources do they have? 

    What are their regular bills and how do those bills get paid?  How will you know if they forget to pay the bills?

     

  2. The current living and care arrangements, whether those arrangements are working, and a plan for future living arrangements

 

 If the parent’s condition is changing, what living and care arrangements will be necessary in the future?

How will you find appropriate housing and care?

 

  1. The legal documents do they have and the legal documents they need

     

    Who is their lawyer and when was the last time they saw a lawyer?  Where are the legal documents stored?

    Who is named as Agent, Personal Representative, etc. in those documents?

    Who are their beneficiaries on their IRA’s, 401(k)’s, life insurance policies and annuities?

     

  2. A plan to pay for long-term care

    Is there long-term insurance available?  If so, what are the terms?  Where is the policy and how are the premiums paid for? 

    If there is no long-term care insurance, can the parent or person with disability afford to pay for care by him or herself?  Are there any government programs, such as Veterans benefits or Medicaid, that can help pay for long-term care?

     

  3. The family caregivers – who will do what and when

Sometimes family members volunteer to perform the tasks for which they have talent.  The brother who is a nurse may be the natural fit for the person to oversee the parent’s healthcare and the sister who is the CPA will take over the finances.  What if it isn’t so clear or if no one wants to take on the tasks?  Can people be hired to perform some of the tasks such as paying the bills? 

Can the family agree that it may not be fair to one of the children to take on all of the responsibility for care?

If one family member is taking on the bulk of the care, can the others agree to take a turn to provide relief to the primary caregiver? 

 

The topics may vary from family to family, and for those families who may find it especially hard to discuss these items you might consider having a professional or a mediator to assist in these discussions.

 

 

 

 


Monday, June 30, 2014

Adaptive Housing for Veterans with Disabilities

Steve, a veteran who receives service-connected compensation for ALS, amyotrophic lateral sclerosis, often known as Lou Gehrig’s disease, has trouble walking up the stairs and it is getting increasingly difficult for him to get in to the bathtub.  His wife, Jane, can no longer lift him into the tub.

Steve may be eligible for a grant from the VA to adapt his house to accommodate his disability.  The VA provides grants to Service members and Veterans who have total service-connected disabilities to help modify a home, purchase an already adapted home, build an adapted home on land already acquired, or pay down the unpaid principal on the mortgage of an adapted home the Service member or Veterans has already acquired. 

There are two types of grants, with unfortunately similar acronyms:  the Specially Adapted Housing (SAH) Grant, which provides up to $67,555 or the Special Housing Adaptation (SHA) Grant, which provides a maximum of $13,511 in 2014.

The SAH Grant is available to Service members and Veterans who have certain permanent and total service-connected disabilities, such as the loss of or loss of use of both legs.   The medical requirements for the SAH are presumed for those with ALS with a service-connected rating of 100%.  In addition to the medical requirements, the disability must require that the Veteran or Service member have the regular and constant use of a wheelchair, brace, crutches or canes as the regular mode of locomotion. 

 The SHA Grant is available to Veterans and Service members who have service-connected disabilities which include: blindness in both eyes with 5/200 visual acuity or less; the anatomical loss or loss of use of both hands; certain severe burn injuries; or certain severe respiratory injuries.

Steve will need to file an application on VA Form 26-4555, Veteran’s Application in Acquiring Specially Adapted Housing or Special Housing Adaptation Grant. Those Service members or Veterans whose disability is not one presumed to meet the medical requirements for the grants will need to make sure that the VA Loan Guaranty office at their Veterans Regional Office gets a report of examination or hospitalization and VA Form 10-4555b, Certificate of Medical Feasibility.

 

 

 

 

 


Friday, November 29, 2013

How to Talk to Your Parents, Friends, In-laws, etc. about VA Benefits

How to talk to your parents,

Siblings, Friends and Neighbors about Veterans Benefits

Most of us know someone who served in the military at some point in time.  We’ve seen pictures of them in uniform posted on their walls, or we’ve heard them talk about when they were in Korea, or Viet Nam, or Fort Benning. 

Today, there is a lot of anxiety about healthcare costs, education costs, and long-term care costs.  Have you ever asked someone who served in the military whether they are receiving any benefits or have thought about receiving benefits?  Often veterans or their families will say, “When my dad came back from the war, he never wanted to talk about the war and the VA just reminded him of a really bad time in his life. “  Or, my dad visited a VA hospital and it was too confusing and overwhelming for him.  He was told he didn’t qualify for anything because he had too much money, or didn’t serve at the right time or had never been injured in service, so he just gave up.

To be frank, the VA often does a really bad job of informing veterans about what benefits they might qualify for.  The VA is especially bad in giving advice over the telephone.  Of course, as most of us know, in any business the advice you get depends on who happens to answer the telephone when you call.  What I’ve learned as an attorney is that the caller has to be responsible for asking enough questions and asking them in as many different ways as possible to get to the right answer.  Step one is often to learn the language of the institution you are calling.  When you call your doctor’s office, you try to convey your symptoms in a way that will let the office know enough about your illness or injury to let you know whether you need to rush to the emergency room, or whether your symptoms are nothing to worry about.  You know the doctor will want to know whether you have a fever, whether you are bleeding, when was the onset of the fever.  In order to get the best advice, you are responsible for using language that the doctor’s office will understand.

In order to get the best advice possible from the VA, and in order to help your family and friends get the benefits they deserve, you can learn how to talk to them about VA benefits.

First, you can ask about their service.   When I was a kid, we had a green gas mask stored in our basement storage closet.  My dad would take it out occasionally – usually when entertaining the male teachers he supervised – and tell them the story of how he was part of a unit that used chemicals to experiment on monkeys.  My father was stationed at the Aberdeen Proving Grounds during the Korean War where they experimented with chemical weapons.  I know that my father was stationed there and that my sister was born while he was stationed there in 1953.  I also know that shortly after my sister was born, my dad must have been discharged since they moved back to South Dakota where my dad was a teacher for the next 40 years.

But, how can I prove that my dad was in the service?  First, I can ask him if he has his discharge paper.  The discharge paper is often referred to as the DD-214, for the Department of Defense form number that is used now for most discharges.  However, in WWII and the Korean War it may have been referred to as a separation paper, a Certificate of Discharge, an Enlisted Report and Record of Separation, or some similar title.

There is a lot of information on the discharge paper, and the veteran will need it or a copy to get benefits.  One question you can ask is whether the veteran has that paper or if he or she recorded the paper with the county in which he or she was living at some point after discharge.  If the veteran does not have that paper, he or she will need to get one.  You can help get the discharge paper, but you will need to know the following information:  Branch of Service, Dates of Service (approximate is okay, although the more accurate the information the better chance you’ll have of getting the document) and Social Security number.  You’ll need to know the veterans full name – make sure it is the name he or she used while in the service.  I’ve known veterans who never used the name on their birth certificate, but their military records are all under the name as on the birth certificate.  Be sure you know the spelling used on the birth certificate, too.

If you don’t have the paper, you can order it from the archives.  Here is the website:  www.archives.gov/veterans/.

There was a fire in the storage facility in St. Louis in the 1970’s where many military records were stored.  Thus, some records were destroyed.  Most can be reconstructed, but it may take a little longer to get the records if they were part of that group destroyed in the 1970’s.   You will need to have some patience.

If your parent is reluctant to find out what services are available through the VA or at the VA, ask what experiences they’ve had in the past – if any- and ask whether they would like to hear some of the benefits that are available.  If you know someone in a similar situation who is receiving benefits, you can discuss what benefits that person is receiving and maybe something about their experience with the VA.

I often talk to veterans who feel that the VA has been a lifesaver for them -especially for unemployed or self-employed veterans who may not have cheap affordable healthcare available to them in their area.   My friend swears by the care given to him at the VA.  He is a middle-aged, self-employed, Viet Nam Veteran, who needed care for a heart condition that he could not afford without health insurance.  He found that he was entitled to care at the VA, and since then he has been treated regularly at the VA.

Another client, a successful man in his 60’s, discovered that he had a form of cancer.  Since he was “in country” in Viet Nam, he is now receiving a service-connected disability payment for the cancer.  In addition, the VA is evaluating his claim for PTSD.

Many of my veteran clients now receive hearing aids and other help for hearing loss through the VA.  When they were young, they didn’t notice that their experience around noisy combat affected their hearing, but in older age, the hearing loss is apparent and the treatment for that hearing loss is their right.

I encourage my clients to enroll in the VA healthcare system by filing a form 10-10-EZ, Application for Health Benefits.  You can find that online at www.1010ez.med.va.gov/sec/fha/1010ez/.


Wednesday, November 27, 2013

Nursing Home Care for Veterans

Nursing Home Care for Veterans

The VA provides “Community Living Centers”, or what used to be called Nursing Homes.  These are operated by the VA, and are usually in a Veterans Administration Hospital.  These Community Living Centers (CLC’s) provide rehabilitation for veterans recovering from injury and illness in the short-term, but also provide long-term skilled nursing care for veterans who need care for long periods of time for a service-connected injury.

For veterans rated at 70% service-connected or higher, or for those who need nursing home care for their service-connected injuries, the VA pays for their nursing home placement as part of their package of healthcare benefits.

The CLC’s are available for non-service connected veterans who are enrolled in VHA healthcare, and need short term services such as rehabilitation, hospice, respite, and for those waiting for placement in the community.

VA provides care to veterans based on a priority system.  There are currently 8 categories of veterans based on service- connection and financial need.  For example, a veteran who is 50% service-connected or higher is in category 1.  A non-service connected veteran with significant assets and income is most likely going to be enrolled in category 8.

Veterans in category 1 will be eligible for placement in a CLC, and will not have a co-pay, but those in category 8 will be placed in a CLC only if there is availability and no one in a higher category needs the bed.  The veteran in category 8 will pay a daily co-pay for services in the CLC.

In Atlanta, the CLC is located in the VA hospital on Clairmont Road, and is almost always full to capacity with a waiting list.  For those veterans for whom nursing home care is not part of the package of medical benefits, they may be able to find placement in one of the two Georgia War Veterans Homes.

The two Georgia War Veterans Homes in Georgia are not run by the national VA, but are available to veterans.  The Georgia Department of Veterans Services and the Georgia Health Sciences University operate the Georgia War Veterans Nursing Home in Augusta.   The Georgia War Veterans Home in Milledgeville is operated by United Veteran Services of Georgia, Inc., which operates the home for the Georgia Department of Veterans Services. 

In order to be eligible for admission to a Georgia War Veterans Home, the person must be domiciled in Georgia, and must have resided in Georgia for the five years immediately preceding admission.  He or she must have been a “war veteran”, defined as any veteran who served on active duty in the Armed Forces of the U.S. during wartime or during the period between January 31, 1955 and May 7, 1975.  In addition, the U.S. Department of Veterans Affairs must approve them as “eligible for care and treatment”.  Veterans accepted into the Georgia War Veterans Homes will be required to pay some expenses such as Medicare or health-care insurance deductibles and co-pays.  The forms to apply for admission to the Georgia War Veterans Homes are found at veterans.georgia.gov/gwvh-forms.


Sunday, November 24, 2013

Services Available to Blind and Low Vision Veterans

VA and Blind and Low Vision Veterans

As the veteran population ages, and as veterans come back from war with increasing numbers of traumatic brain injury (TBI), the number of veterans who are legally blind or have low vision is increasing exponentially.  Low vision and blindness can be caused by accidents, and brain injuries, but many veterans are losing their vision because of age and disease-related factors, such as macular degeneration and diabetes.

President Franklin D. Roosevelt signed an Executive Order on January 8, 1944, which declared:  “No blinded serviceman from World War II (WWII) would be returned to their homes without adequate training to meet the problems of necessity imposed upon them by their blindness.”   After the war ended, the VA accepted the responsibility of adjustment training for blinded veterans.

Legal blindness is defined as: central acuity of 20/200 or less in the better eye with ordinary corrective glasses; or, central visual acuity better than 20/200 in the better eye, and a field defect in which the peripheral field at its widest tested diameter is less than 20 degrees.  The VA estimates that there are 160,000 legally blind veterans.

In addition, there are over one million veterans with low vision, which is defined as uncorrectable visual impairment between 20/70 up to legal blindness.

The VA addresses the problems associated with veterans who are blind or have low vision in many ways.  Currently, there are 10 Blind Rehabilitation Centers (BRC), and many Visual Impairment Services Teams (VIST) throughout the country. 

The Blind Rehabilitation Centers offer daily training and counseling for veterans who are totally blind, as well as those veterans who have low vision. The programs are designed for inpatient stays, but in certain circumstances the veterans can receive the services on an outpatient basis. The programs offer classes in orientation and mobility, including training on aids for travel, such as canes.  Veterans are fitted with low vision devices and are trained in how better to use their remaining senses.  The VA also funds training for one family member who will play a significant role in the Veteran’s continued adjustment to community living.

Veterans and active duty personnel who are eligible for VA health care and meet the criteria of legal blindness or need comprehensive treatment in order for the veteran’s safety or functional independence or to be restored.

For low vision veterans, there is an outpatient program similar to the BRC called VISOR, or visual impairment services outpatient rehabilitation.  VISOR is a nine-day outpatient program, which teaches skills similar to those taught in the BRC’s.  The difference is that for those veterans enrolled in VISOR, they must be able to take care of all of their own activities of daily living.  VISOR does provide safe accommodations where participants can stay during the nine-day outpatient treatment.

Here is a link for more information about the blind and low vision services available to veterans:  http://www.aao.org/veterans/news/low-vision.cfm.


Saturday, November 23, 2013

Vocational Rehabilitation Services for Veterans

Vocational Rehabilitation 

What are vocational rehabilitation benefits?

The Department of Veterans Affairs provides services for qualified veterans with service-connected disabilities who need assistance to become suitably employed or to maintain employment or who need assistance or training in order to become independent in daily living.

The services provided may include counseling, as well as education and specialized training. 

Which veterans are qualified?

In order to qualify for the program, the veteran must either have, or will receive, an honorable or other than dishonorable discharge, have more than a 10% service-connected disability rating, and must apply for vocational rehabilitation services.

Generally, the veteran must apply for the vocational rehabilitation within 12 years from the separation from active duty, or from the date the veteran was first notified of a service-connected disability rating.

Once the veteran applies, a VA Vocational Rehabilitation Counselor provides a Comprehensive Evaluation, which assesses the veteran’s interests, aptitudes and abilities to determine whether the veteran is entitled to the vocational rehabilitation services and whether the service-connected disability impairs the veterans ability to find or hold a job with the skills the veteran already has.

What services are available?

Some of the services the veteran may be eligible for include post-secondary education benefits, on the job training, assistance with finding a job, medical referrals, and independent living services for veterans unable to work because their disabilities are so severe.

Are there any services available for children or spouses of veterans who need education or rehabilitation?

Vocational rehabilitation services may be available for children with spina bifida, who have one or both parents who served in the Republic of Vietnam during the Vietnam War, or in certain military units in the demilitarized zone of Korea between September 1, 1967, and August 31, 1971.  


Friday, November 22, 2013

Service Connection: What is it?

Service-Connection:  What is it?

The Department of Veterans Affairs administers many benefits to veterans and their spouses and families, but some benefits are available only to those who are classified as “Service-Connected” veterans.

Service-connected means that the veteran was injured or developed or contracted a disease or aggravated a pre-existing injury or disease while he or she was on active duty with one of the branches of service – the Navy, the Army, the Marines, the Air Force or the Coast Guard, or their Reserve Components- and that the injury or disease caused a present disability.   Some disabilities or diseases are presumed to have been caused by the veteran’s service if he or she develops the disease or becomes disabled after leaving the service.  We will discuss presumed service connection in a later post.

Some benefits available to service-connected veterans are financial, and the VA pays the veteran a certain amount of money each month based on the level of disability.  Think of that as “worker’s compensation” – the VA is paying the veteran for the loss to his or her earning abilities.  The VA prescribes a percentage based on a complicated ratings system, and a disability can be rated at 0% - meaning no compensation will be paid because, although the veteran may have some form of disability that can be traced to his or her time in the service, the veterans earnings potential is not impaired by the disability.  If the disability later impairs earnings, though, the rating can be increased.  The ratings increase in increments of 10%.   Once a disability is rated at 10%, the veteran will receive a monthly check from the VA.

Service-connected veterans receive other non-monetary benefits from the VA, including healthcare benefits and vocational rehabilitation services.   The Veterans Health Administration (VHA) provides a host of healthcare benefits, but the package of benefits available to an individual veteran, and whether he or she will have a co-pay for those benefits, depends on his or her placement in one of eight categories, known as Priority Groups. Those in Priority Group One have the most complete healthcare benefits package, while those in Priority Groups 7 and 8 must pay a co-pay for any healthcare services provided. 

The VA is only able to provide healthcare benefits based on the amount of money Congress gives them each year, so in times when the money runs low, the VA could provide benefits to those only in the higher groups.  Those veterans rated at least 10% service-connected are placed no lower than Priority Group Three. 


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