Could the Draconian New Medicaid Rules for Long-Term Care in Illinois (effective Jan. 1, 2012) Really Be A Cloud With A Silver Lining?

February 1, 2012

- Alzheimer's Care, Elder Law Articles, Medicaid and Paying for Nursing Home Care

New Rules As you may have read in recent columns, Illinois has adopted new rules for Medicaid coverage for long-term care for our citizens and the state of Illinois (“DRA”). These new rules took effect January 1, 2012. The new rules are going to require that our clients engage in what we call “Five-Year Planning.” This “Five-Year Planning” has become necessary because of the fact that there will be a new five-year lookback for all Medicaid applicants when there are asset transfers that take place after January 1, 2012. The Silver Lining What may come as a surprise to many of our clients is that the unintended consequences of these rules may be that long-term care planning for our clients may actually be enhanced in some ways. The silver lining in all of this is that while the lookback period and the need to plan further in advance is one of the negative aspects of the new law, the need to use trusts of a very specialized type in order to comply with the five-year look back may actually provide some very positive consequences. How to take advantage of the New Rule Following is an example of how the new rules could work in your favor. Instead of leaving assets for their children outright, parents can now consider leaving assets in trust for their children. Leaving assets in trust for children carries with it the following benefits:

the ability to protect the assets inherited by a child from the creditors and predators of the child, such as divorcing spouses, business creditors, tort creditors, etc.;
the ability to allow the management of the assets to continue under the supervision of the parents’ financial advisor who may have assisted the parents over the years in accumulating a critical mass of assets that can provide for many years of security for the children;
the ability to meet the five-year lookback requirement of the new Medicaid laws;
and, finally, the ability to prevent the children from squandering or losing the assets that the parents carefully accumulated during their lifetime.

We are currently experiencing the greatest intergenerational transfer of wealth in the history of the world. However, there are often problems with transfers of wealth. Quite often, the parents pass away and the baby boomer generation will take funds in what used to be a well-managed and profitable brokerage account, and the money is randomly moved or, worse yet, squandered shortly after it is received. So I often ask both our clients and their financial advisors if they would be interested in establishing a systematic relationship for the management of assets so that a client’s family can continue to retain the benefit from financial management even after parents pass away? The recent adoption by the state of Illinois of the DRA will provide an entrée and solution to this problem for all. In the past, this was sometimes difficult to do. The opportunity to avoid the unintended squandering and loss of assets at the death of the parents now exists with the increased usage and importance of so called Five- Year Planning as part of our “senior” estate planning process. This planning always existed, but is now more critical than ever, with the passage of DRA in Illinois and the required “5 year or 60 month lookback period.” My preference is to work with clients and their advisors who appreciate the wisdom of keeping client assets protected from creditors and under management of the financial advisor. Call To Action If this interests you, then please call my office so that we can schedule a time to meet and I can discuss this new law with you. I think you’ll be amazed at the opportunities that the law presents to the older generation, as well as to the younger generation. You have our best wishes for the new year! I hope to speak with you soon.

Why am I so angry that my mother has been diagnosed with Alzheimer’s disease?

By Anthony Ferraro on

February 1, 2012

- Alzheimer's Care, Blog, Elder Law Articles, Uncategorized

You are going through a grieving process when you are in a situation like this. A normal, regular stage of grief is anger. The key is to not let it overtake you or cause declines in your own physical or mental health. Grieving has several stages. Just like individuals experience Alzheimer’s in different ways, at different speeds, the same is true with grief. Some stages might be quicker than others, and some might not materialize at all. Be patient with the grieving process. Allow yourself to feel, allow grieving to run its course. When Alzheimer’s is involved, the 10 normal stages of grief are as follows: (REMEMBER: You might or might not experience all of these, and even then, to varying degrees.) Shock: Disbelief that Alzheimer’s has been diagnosed. Denial: It’s not really Alzheimer’s. It’s just a stage that will pass. Depression: Feelings of loneliness and isolation take over. Physical symptoms of distress: Sickness and tiredness consume you or your thoughts. Anxiety: What will the future hold? What might happen to me? And other worries. Anger: Everyone’s fair game: Anger at the disease, the doctor, your loved one, even at God for “allowing” this to happen. Guilt: Blaming ourselves — often for things we have/had no control over, or for doing things we think we shouldn’t have done, such as yelling. Hesitancy to keep up normal activities: Worries about how others will view or treat you and/or your loved one. Healing of memories: Realize that painful memories are actually part of the healing process. Acceptance: Coming to grips with the fact that your loved one has Alzheimer’s, it is here to stay and you simply have to make the best of it. Alzheimer’s is tough on the psyche. Because your loved one can go through several stages of the disease, you might experience stages of grief (as described above) with each one. Realize that this is normal. Allow grieving to take place. Let yourself be angry. Keep a journal with your feelings and thoughts. This is often a healthy way to express yourself. It allows you to vent, without hurting your loved one or anyone else around you. If you can deal with your feelings in this manner, you will be in better shape to help your loved one — and conduct your life as you need to. If you become dispirited and internalize your distress, it can damage you not only mentally or emotionally, but physically as well. That is not going to help you be there for your loved one’s needs. Here is something that will help you deal with your feelings: “The Indispensable Alzheimer’s Resource Kit.” These FREE books will help you deal with your feelings, as well as with dozens of other subtopics.

Do I tell my loved one she has Alzheimer’s disease — and how do I prepare the rest of the family for what is then in store?

By Anthony Ferraro on

February 1, 2012

- Alzheimer's Care, Blog, Elder Law Articles, Estate Planning

This is one of those topics that has been debated by experts for years. Some feel that anyone diagnosed with Alzheimer’s should be told, while others think they should be spared the knowledge. What it comes down to is this: What do you think will be best for your loved one? Some people will go into a tailspin and become severely depressed. Others might take it more in stride. Would your loved one want to know, to help her cope? Keep in mind, if you don’t speak up, someone else is liable to slip and that would be devastating. If there is a good doctor-patient relationship, it is best to let the doctor relay the information in a somewhat matter-of-fact way. A family member, however, should be with your loved one when the physician talks with her. Then, after the doctor broaches the subject, you have an opening to call other family members and let them know. A family meeting is a good idea. Having the diagnosis out in the open is usually liberating and helpful for everyone involved. At this family meeting, you can begin brainstorming about what you want to do next. Getting an Alzheimer’s patient’s financial and legal affairs is a very important step early on. One very helpful resource is this free pamphlet on estate planning “Don’t Lose Your Wallet! The Indispensable Guide to Estate Planning.” Sometimes tension arises among family members when these topics are discussed. Whatever you do, keep in mind that extra pressure is not a good thing for your loved one. You should arrange a time when you can meet without him or her present so you can talk openly with family members without upsetting him or her. If it comes to needing a mediator, then get one. This is the time to act like responsible adults and do what is right for your loved one, nothing else. Allow the individual — and yourself and family members — to grieve. Alzheimer’s can be devastating to not only the patient but also family members and other loved ones. It’s important for everyone to take care of each other and offer support. No one should be hesitant about joining a support group. It helps to be with others in a like situation. There should be one or more support groups nearby for early-stage Alzheimer’s patients. Have your loved one get involved with one of them. It’s important for Alzheimer’s patients to have a forum to express themselves to others in similar situations. (This is true for many emotional conditions and situations.) If anybody is still having a lot of difficulty coping after trying out a support group, have them consult a professional counselor. It’s vital that you support one another. Teamwork will take you farther than working alone. Let go of circumstances you can’t control. Choose your battles wisely. And, as odd as it might sound, always try to keep a good sense of humor.