Our country may be facing a simultaneous growth and recession… unfortunately, according to journalist John Leland, the two seem to be at odds. What we are referring to is the growth of the elderly population and the recession of funds available to help this aging community pay for the care they need.

The economic downturn of the past few years has hit the elderly with a double-whammy. Many of them lost close to all of their savings when the stock market bottomed out, and now budget cuts to state-funded home-care services threaten to force many of them out of their homes and into hospitals or nursing facilities.

“’I’m not getting a cost-of-living adjustment, and now I’m not getting food,’ said Joyce Plennert, 83, who is on a waiting list for Meals on Wheels in Palatine, Ill. ‘Now I’m worried my home services will be cut. Without that, I’d be in a nursing home, if I could find one with room.’”

According to the above-mentioned NY Times article, a number of states have already made cuts to home-care services, including Alabama, Arizona, California, Colorado, Florida, Kansas, Mississippi, Missouri, Nevada, New Jersey, New York and Texas. “The situation is grim, and it’s safe to say that present trends are expected to continue,”

These budget cuts impact more than just senior citizens—they affect the professional caregivers and home aides who lose their jobs when state programs are cancelled, as well as the families of the elderly. When these seniors lose their ability to live at home it’s their families who will have to pick up the slack either by contributing to the costs of care or more often by become the caregiver themselves.

If you or a loved one is facing a loss of benefits due to budget cuts don’t be afraid to explore your options. Geriatric care managers can help families through confusing times, and other advisors such as elder lawyers, estate planners, financial planners and others can offer invaluable advice when creating your plan for the future.

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If you are among the wave of Baby Boomers about to begin enrolling in Medicare you may be in for some tough times. Recent stories in Financial-Planning.com and USA Today report that the number of doctors refusing new Medicare patients is reaching a record high—and it’s not expected to improve anytime soon, especially since last month “Congress failed to stop an automatic 21% cut in payments that doctors already regard as too low.” Doctors simply feel they cannot afford to treat Medicare patients anymore.

Here are some of the distressing details you’ll find in the USA Today article:

• The American Academy of Family Physicians says 13% of respondents didn’t participate in Medicare last year, up from 8% in 2008 and 6% in 2004.
• The American Osteopathic Association says 15% of its members don’t participate in Medicare and 19% don’t accept new Medicare patients. If the cut is not reversed, it says, the numbers will double.
• The American Medical Association says 17% of more than 9,000 doctors surveyed restrict the number of Medicare patients in their practice. Among primary care physicians, the rate is 31%.

What this means for seniors is that although you may be able to qualify for Medicare you may not necessarily be able to count on it. But you can take action to ensure that a crisis for Medicare doesn’t mean a crisis for you. Your financial advisor or estate planner can help you determine what options you have regarding long-term care, asset protection, and even using alternate strategies in conjunction with Medicare.

The days of being able to count on the government to take care of you in your old age may be coming to an end. It’s time to make your own luck and plan for your own future. Our office can help.

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Part of creating an estate plan is talking to your spouse, your family—and yes, your attorney—about your end-of-life wishes. A living will or healthcare directive is an essential part of any estate plan. This is the document in which you nominate the person or people who will make healthcare decisions for you when you are unable. It is also in this document that you specify what treatment you would (or would not) like to have at the end of your life. It is in this document that many people specify their do not resuscitate (DNR) orders; and once they’ve created and signed this document they think they’re all done.

Not quite.

Studies have shown that even with perfectly executed healthcare directives many patients receive treatment they specifically did not want; this is because their wishes are unclear or have not been communicated to medical providers. Some states have found a way to prevent this miscommunication… with a program called Physician Orders for Life-Sustaining Treatment, or POLST. “The program involves an innovative medical form that is signed by a doctor, allowing patients to specify what kind of care they want at the end of life, such as feeding tubes and other medical interventions.”

The key here is that the medical form is signed by the patient’s doctor. This requires patients to include their primary care physician in their decisions regarding end-of-life care—or at the very least notify their physician of these wishes—with excellent results. A study published in the Journal of the American Geriatrics Society found that “patients with the Physician Orders for Life-Sustaining Treatment forms had much less unwanted hospitalization and medical interventions.”

This is wonderful news if you’re in a state like California or Oregon, which already has the POLST program in place. But it doesn’t mean you’re out of luck if you happen to reside in a non-POLST state. Even without the official POLST program, the key to having your end-of-life wishes respected is communication; communication with your doctor, with your family, and with the nursing or caregiving staff most likely to be attending you in an emergency situation.

If you are concerned about having your wishes followed, don’t hesitate to talk to your doctor and/or nursing staff about your living will or healthcare directive. Even have them read and sign off on it if necessary. After all, a healthcare directive is a wonderful tool, but it doesn’t do much good gathering dust in your filing cabinet. Make sure your family and medical staff are aware of your end-of-life wishes.

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The American Association for Long-Term Care Insurance recently released a report on the costs of long-term care insurance, and the results were surprising. Most people mistakenly believe that long-term care insurance is going to be expensive and difficult; but in fact, according to the report, “over one-fourth [of buyers under the age of 61] paid less than $999-per-year.” And in fact, “fewer than one in 10 (9.3%) pay $3,500 or more.”

This is great news! This means that long-term care insurance could cost you less than $100 per month! The trick is that you have to think about it early. “Age at the time of application plays an important role in determining the cost for long-term care insurance the Association study reports. While 41.5 percent of buyers under age 61 pay between $500 and $1,499-per-year, only 20.8 percent of buyers who are ages 61-to-75 pay within this range.”

This is not to imply that if you’re over the age of 75 you’re out of luck. You’re not likely to get the same great rates as someone in their 50’s, but you still may not have to pay an arm and a leg for long-term care insurance. According to the report, of applicants aged 76 and older only 28.2% end up paying an annual premium of $4,000 a year or higher. Actually, almost half of applicants in this age range still end up paying less than $2,500 a year. This may not be the attractive $500/year you could have gotten in your 50’s, but it also isn’t the thousands of dollars a month most people seem to be afraid long-term care insurance is going to cost them. In fact, it’s only a little over $200/month.

If you’ve been thinking about long-term care insurance, don’t wait any longer. This is one situation where time is not on your side; the quicker you act the better it will be.

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From a recent announcement on PR Newswire:

“Many Americans seem confused and immobilized by a key part of the recent Health Reform legislation, the CLASS Act, which will offer a form of long term care insurance for working people and others who may become disabled. ‘CLASS’ stands for Community Living Assistance Services and Supports, and the program, a legacy of the late Senator Edward Kennedy, is intended to offer new choice and security for millions now at risk. But, ‘we find that the public doesn’t know how to react,’ says Denise Gott, Chairman of the Board of LTC Financial Partners LLC (LTCFP), one of the nation’s most experienced long term care insurance agencies.”

The new Health Care Reform will almost surely affect your long term care plan, but is it too soon to know exactly how? You don’t want to be caught without coverage, but you also don’t want to make any decisions without having all the facts.

To help you discover how health care reform may affect your long term care plans, the link above provides access to a newly released 2010 Long Term Care Guide complete with healthcare reform update. Don’t let your family be caught off-guard.

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What will you be doing when you’re 73? If you think you will have earned the right to have someone take care of you, think again; you may end up serving as a caregiver for someone else. A recent article in the New York Times describes a new trend in caregiving: the elderly are being cared for increasingly by the elderly. According to the article, “Professional caregivers — almost all of them women — are one of the fastest-growing segments of the American work force, and also one of the grayest.”

As odd as it may sound, the arrangement of 55-75 year olds caring for 85-100 year olds often works out beautifully. Older caregivers may not be able to do much heavy lifting, but what they are able to do is connect with their charges. Many older caregivers have already spent months or years caring for their parents or spouse, so they have an understanding of the fear, frustration and stress the families are going through. In addition, because older caregivers often share similar culture and experiences, the relationship can end up turning into a friendship, as with the case of Grace Jackson and Mary-Lou O’Neill:

“Grace Jackson, who is 101, said she never wanted a helper at home and resented Mary-Lou O’Neill, 73, when she arrived four years ago at Ms. Jackson’s daughters’ insistence. But as their relationship has grown, ‘It’s developed into a friendship,’ Ms. Jackson said, adding that friends who had younger aides were often offended by their manners or language.”

The down side to this “graying trend” in caregiving is that most of these elderly women—in spite of how they excel and make the best of their situation—become caregivers because they have to, they can’t afford to retire completely, even at the age of 70 or 75. The time to think about your own future is now. Talk to your advisors about planning for your own retirement; because although you may have everything it takes to be a wonderful caregiver in your senior years, the fact is that you may not want to.

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Health Care and Education Reconciliation Act

On March 25, 2010 the House of Representatives in a 220-207 vote passed the Health Care and Education Reconciliation Act. This new law will make major changes in Health Care and Education over the next ten years. The changes include new consumer protection provisions, coverage of millions of uninsured Americans, tax savings for businesses, new taxes on individuals and businesses who don’t buy health insurance, and attempts to control rising costs. Here is a year-by-year review of what the new law should look like:

2010
Adults who can’t get coverage because of a pre-existing medical condition can join a high-risk insurance pool (this is an interim step pending the launch in 2014 of the health insurance marketplace).

Children with pre-existing conditions will be covered immediately and dependent children will be covered until they turn 26.

Insurance policies cannot be revoked due to illness. For new policies, there will no longer be lifetime limits on coverage and annual limits will be restricted.

Certain preventive services will be fully covered, with no co-pays or deductibles.

People in the Medicare prescription drug program will receive a $250 rebate this year to help pay for expenses in the coverage gap, or “doughnut hole,” of Medicare Part D. The doughnut hole will be phased out entirely by 2020.

Certain small businesses will start getting tax credits to offset up to 35 percent of the cost of insuring their employees. That will rise to 50 percent in 2014.

Effective July 1, 2010, private lenders will no longer grant student loans. The loans will come directly from the U. S. Department of Education. The money saved will be put back into the Pell grant program. Prior to the new legislation, the Pell grant program had run out of money. Now, for the fall 2010 school year, the Pell grant program will remain in tact, and eligible students will see the maximum Pell grant rise from $5,550 this year to $5,975 in 2017.

The first tax increase kicks in: A 10 percent tax on indoor tanning services.

2011
Medicare changes will include free annual wellness visits and a major reduction in cost sharing for preventive care; Preventive care includes immunizations and cancer screenings.

Some bonuses will be paid to primary care doctors and general surgeons; there will be discounts on certain prescriptions for those on Medicare who are in the “doughnut hole”.

2012
Primary care physicians will receive additional funding. There will also be incentives to encourage doctors to join together in “accountable care organizations (ACO) .” An ACO would be a combination of one or more hospitals, primary care physicians and possibly specialists that would be accountable for total Medicare spending and quality of care for the Medicare patients served. Bonuses and penalties could be tied to overall Medicare spending and quality measures.

2013
This is the year that there will be tax increases for high earning taxpayers. For married taxpayers who file jointly the tax will increase for couples with income above $250,000. For individuals there will be an increase for taxpayers with income above $200,000. The new tax will be in the form of a Medicare payroll tax. The tax on earnings above those amounts will rise from 1.45 percent to 2.35 percent. Unearned income above those amounts, such as dividends, will now be subject to a 3.8 percent tax.

In addition, maximum contributions to pre-tax Flexible Savings Account contributions will be limited to $2,500 a year (down from the current $3,050 for individuals).

Medical devices will pay a new 2.9 percent excise tax.

2014
This is the year that additional consumer protection rules will kick in. Annual limits on coverage will be banned. Insurance companies will not be able to deny policies to anyone based on pre-existing conditions. Insurance companies will have limited ability to increase premiums on individuals as a result of age, family size or tobacco use.

Each state will open a health insurance exchange, or marketplace, for individuals and small businesses without coverage. People will be able to comparison shop for standardized health packages. There will be a multistate private plan available nationwide, supervised by the U.S. Office of Personnel Management.

Tax credits will be available to make insurance and care affordable for people who make too much to qualify for Medicaid, but have incomes below 400 percent of the poverty level.

Most people will be required to buy insurance coverage or pay penalties that start at $95 in 2014 and rise to $695 or 2.5 percent of income in 2016. Employers with 50 or more workers who do not offer coverage will have to pay annual fees.

Medicaid eligibility will increase to 133 percent of the poverty level ($14,404 for individuals) for everyone under 65 (when they qualify for Medicare).

2015
A new Independent Payment Advisory Board will be formed to come up with ways to lower Medicare costs and promote better care. The recommendations will go to Congress and private insurers.

2018
This is when the most controversial new tax begins, a 40 percent excise tax on insurance companies and plan administrators for any family plan that costs more than $27,500. The tax applies to the cost above that threshold. There are higher thresholds for retirees over 55 and plans that cover workers in high-risk jobs.

2019
The new system will have reduced the number of uninsured people by 32 million, according to the nonpartisan Congressional Budget Office. That will leave an estimated 23 million uninsured, one-third of them illegal immigrants. Coverage of legal residents too young for Medicare (under age 65) will be 94 percent, up from 83 percent now.

Sources: Jill Lawrence, Columnist for Politics Daily March 26, 2010; Patricia Murphy, Columnist for Politics Daily March 23, 2010; House Energy and Commerce Committee, speaker.house.gov, White House.gov, Kaiser Health News, Congressional Budget Office.

Are you ready for the financial implications that come with growing older? As the average American lifespan grows longer the cost of aging becomes more and more prohibitive.

A recent segment on NBC’s The Today Show is takes a close look at long-term care and the price individuals and couples are required to pay as age related illnesses make it more and more difficult for senior citizens to live at home without care.

The show tells the story of “Roberta” and her husband, a couple married for 44 years, who felt there was no choice but to divorce after Roberta’s husband was diagnosed with dementia and the subsequent nursing home bills quickly depleted their assets. After paying no less than $75,000 in care costs, Roberta was advised by her attorney that one of the only ways to conserve her remaining assets for her own support would be to divorce her husband, allowing him to qualify for Medicaid coverage.

With growing numbers of senior citizens being diagnosed with debilitating elderly illnesses, and the cost of nursing care on the rise, more and more couples are finding that without some kind of long term care insurance they simply can’t afford the cost of aging. Medicaid can help, but as the story of Roberta and her husband shows, Medicaid doesn’t come without its own price.

Plan ahead for your own old age by talking to your advisors about Medicaid and your options for long-term care insurance.

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Do you have a health care directive? If not, the Los Angeles Times has just given you one more reason to create one: Advance directives for end-of-life care result in preferred treatment.

That’s right, according to the recent article; those people who have recorded their wishes for end-of-life treatment have their wishes followed by agents and doctors over 80% of the time. According to a health and retirement study done between the years of 2000 and 2006, “researchers found that of the 398 incapacitated people who had used a living will to request limited care at the end of life, almost 83% received it…” and “…Of the 417 incapacitated people who had requested comfort care in a living will, 97% received it.”

Those are huge percentages, especially when you consider how easy it is to create a health care directive or living will.

There is no down side to recording your wishes and nominating a trusted agent to help ensure those wishes are followed—it brings you peace mind, it brings comfort to your family members, and our office can help you execute one quickly and easily. Knowing all this, as well as the fact that studies now show how truly effective they are in getting you the treatment you desire… there’s really no reason to delay any longer. Call our office for more information.

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Everybody knows the latest big news: President Obama’s healthcare reform bill was finally approved by the senate—for better or worse—and although politicians may still be arguing the benefits and evils of the bill across party lines, most Americans are asking one simple question: What does this legislation mean for me?

CNN Health attempts to answer that question and more in a recent article entitled (appropriately) “Answers to your questions on healthcare law.” At a time when everyone either loves or hates the bill, it’s not always easy to get a straight and non-partisan answer to a question that really has nothing to do with politics; but this CNN article does a good job of providing straightforward answers to many of the frequently asked questions, and explaining exactly how this bill is likely to affect you and your family now and in the years to come.

We know that many of our clients will have questions about this bill that go beyond those answered in this article, and we invite you to contact our office with any concerns you may have; especially about how this may affect your decision-making rights, legal healthcare documents, or Medicaid qualification. Whether you are a parent of young children worried about your health insurance, or a retiree facing the need to tighten your purse strings in your “golden years,” this legislation may have an impact on you; contact our office to find out how.

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