Nugen Law; specializing in estate planning and elder care law, emphasizing independence and quality of life.

Serving Indiana, Ohio, Michigan, and Florida.

More information at NugenLaw.com.

good evening.

>> Welcome to for Wayne.

>> I'm Eddie Thompson the host of this show which is called Like the Head if you're a regular viewer you know that our intent is to try to provide you with some information and some education on different topics that might apply to you or very likely will apply to most of you at some point in your life and hopefully what we can share with you we'll give you some points of reference if you will, to make some good choices in your LIFE Ahead.

>> Brian Nugent is with me tonight.

He's been a regular for us here on PBS for Waking LIFE Ahead.

>> Welcome back.

Thank you, Sandy .

Good to be here.

I always thank you.

>> Thank you.

And Brian, by the way, I'll tell you now always gets a lot of phone calls.

So if something strikes you and you want to ask a question, get on the phone.

We do have a phone operator in the control room that will answer that and answer your call and if you're comfortable talking to live on the air, Brian likes that because if he has a question back to you, you're right there on the phone.

If not, the operator will take your question.

Type it up and send it out here in the studio to us on the teleprompter that works as perfect.

>> OK, Sandy .

All right.

We're going to talk about some statistics and some things that happen as you age Brian is you know, when you've been with us monthly for for quite some time and a lot of times we talk about estate planning and that sort of thing as people move into some senior years.

>> But you often sprinkle your information with I would say alarming statistics and that's always such a surprise.

Baby boomers is a big topic because there are so many people in baby boomer range now.

>> Right.

What does that mean to planning so baby boomers in the United States ten thousand people a day hit age 65 that's one in ten thousand people a day turned 60 the fastest growing portion of our population.

>> We have not hit our peak yet and we will continue growing that that age group will continue growing up until like maybe twenty fifty.

So it's a very long time where that that age group people are turning sixty five and maturing and figuring out what to do of course with their estate planning and elder law that that whole bubble of our population quite frequently those are clients that are speaking with elder law attorneys, estate planning attorneys and one of the topics that comes up typically is gosh as I'm aging are there costs related to that that I might be able to plan for ?

Are there things of which I should be aware and some of the costs I think are relevant and for in-home care and for let's say an assisted living facility or a care at a nursing home care unit those topics are very relevant and I would think members of our audience would would have some of those same concerns not only for themselves but possibly children as they have parents that are aging.

They may also be curious to know gosh, what are those costs of care that I may be facing for either myself or for my parents?

>> You know, Brian, in lieu of other things we talked about in this arena in past shows you've shared that as people are getting older baby boomers now especially in that category they prefer to stay at home if possible because no home care or home health care rather than going to a facility.

>> Do you see that change?

I don't see it changing at all.

In fact I I think that a common conversation between an estate planning elder law attorney and their client would be how do we keep you at home realistically so long that makes sense and how do we pay for that care if you are remaining at home?

So I I would say for myself when I'm speaking with my client's other attorney speaking with our clients, we really are focusing on how do I set you up now so that you will be able to get that in-home care that you need and that you want we want the most restrictive least restrictive environment for for ourselves and for our clients as they age.

>> So oftentimes folks will be exploring how is it that I'm going to pay for that care they may be thinking about they'll come in asking questions about Medicare.

Does Medicare pay for my in-home care do you think Medicare does not pay for one's in-home care?

That's a common misconception that people will think oh I've got Medicare, I've got great insurance.

They cover everything as I age.

>> I'm going to be able to use Medicare to pay for care in the home.

Medicare does not pay for in-home care as I recall and I very likely might be wrong.

>> It doesn't Medicare pay a certain period of time if you've had surgery and have to have rehabilitation so Medicare will pay for rehabilitation rehab inside hospital.

So Medicare is so long as you're improving there's something called advantage Medicare and then there's also traditional Medicare.

So Advantage Medicare will pay up to twenty days of rehab after you've had a procedure, a hip replacement knee replacement you took a tumble or something like that.

>> You're going to have to go straight from the hospital to you do?

Yeah.

So you're in the hospital first you have your stay your procedure.

You're then discharged to rehab.

What's confusing about Medicare and we're kind of talking about two different things here but Medicare paying for you is that people are used to seeing Medicare pay for one's rehab at a nursing home but actually it's the rehab portion of the nursing home that they're paying for .

So under the same roof you may have rehabilitation and you may have longer term skilled care.

So Medicare will pay for a portion of that.

But your long term stay at the nursing home they'll not pay for Medicare will pay for home health to come to your home but home health is different than personal care.

Home health would be a nurse coming to your home once a week checking your vitals, making sure everything's OK, maybe sorting your medication, organizing for rehab in your home if we are going to getting rehab in your home.

But that doesn't it's not a situation where Medicare is going to pay for bathing and going to pay for meal preparation and pay to for you to be showered or to be dressed in the morning or to do your laundry, those types of things.

>> It's more of the health thing.

It's more medical health right .

So that in-home care that's called personal services.

So personal service Medicare does not pay for Medicaid could pay for personal services.

>> VA Veteran's Administration could pay for those personal services.

If you have long term care insurance some policies will pay for that direct one on one care in your home the most expensive care is in-home care.

So if you're speaking with an elder law estate planning attorney you'd want to make sure that you understood that even if I do go on VA to pay for that in-home care or I am receiving Medicaid benefits to pay for that in-home care, they're not going to pay for twenty four hour a day care.

So if it no longer makes sense for you to remain at home because it's too expensive for you or just it doesn't it's not appropriate for your safety to remain at home, then we might want to look at other sources to provide that care for you things like an assisted living facility perhaps we mix up the program which I've talked about earlier today.

It's a Medicaid program here in L.A. County assisted living facility.

Maybe there's adult daycare that we might be looking at.

We might also be looking at a nursing home or a memory care unit stay.

So if you don't have the esources to pay for that twenty four hour day care inside your home and we're needing to look elsewhere, that's oftentimes when folks will be speaking with an elder law attorney about how do I protect my assets, how do I secure benefits to pay for that care if I don't have that long term care insurance policy that will pay for it.

>> Are you finding with baby boomers but others as well an increase in cognitive decline dementia, Alzheimer's?

>> I don't know that there's necessarily an increase.

The reason that we're so right now just over seven million people in the United States have an Alzheimer's diagnosis and that's seven million.

>> Seven million.

Wow.

Just just a few years ago it was a little over five million to seven million.

But remember what we talked about the top of the hour or top of the program today we talked about baby boomers and we talked about ten thousand people a day hitting age sixty five.

So because of that growth in that segment of our population, you're going to see more and more of those dementia diagnoses.

It's diagnosed a little around 30 now around every 60 seconds currently and that will be going to every around every 30 seconds by the year 2050 unless we are able to find some type of a treatment to either or slow the growth of the disease or to eradicate the disease.

So it is a very big concern for folks as they're aging.

Am I going to have cognitive decline as a result of some type of a dementia?

As I mentioned before, dementia is like a giant arc and there are different types of dementia as the most widely diagnosed are most commonly diagnosed type of dementia is Alzheimer's there we also have Lewy body, we have frontal temporal, we have Parkinson's dementia.

There's something called Pick's disease.

So there are all different types of dementias that somebody could be diagnosed with.

Alzheimer's just happens to be the one that folks are diagnosed most frequently with.

So when clients are coming in and speaking to elder law attorney and they're saying gosh, my grandmother my mother suffered from dementia and they were in a facility for so many years and I'm concerned if that's going to happen to me, how am I going to pay for my care?

How is it that I'm going to preserve my house?

How am I going to save the farm?

How am I going to save my my retirement for for either myself, my children, my spouse knowing that we have that that diagnosis happening so frequently in the United States ?

>> That's an interesting observation and again we keep using that word increase, increase, increase.

>> You know, what does that do for or to you as an especially in elder law attorney are people asking for different things?

They're asking for different things typically it's interesting.

So when folks come in and they're speaking with me or I'm sure speaking with their own counsel, they're seeing programs like this.

>> They're reading articles, they're family members have been impacted.

Friends of family have been impacted and so it's prompting a question gosh, I've made it to sixty eight years of age, 70 years of age and I don't have any estate planning in place.

>> Can you believe it?

But what's prompting me to do that is a friend from high school has just passed away.

A sibling has passed away.

Somebody has been diagnosed.

So it's an eye opening experience.

Oh my gosh I'm aging.

The people around me are aging.

So I think that because of that huge bubble of our aging population there is a greater demand for elder law and for people to understand how that that can help them to seek out that advice, how it can hlp them to protect their assets, how that can help them to secure benefits and to better understand what's out there and what they're facing.

So I don't know that it's simply as a result of the diagnosis of dementia.

I think you have this larger bubble of population coming through.

They're more aware of it.

They're seeing how it's impacted their parents, friends, family, contemporaries and I think maybe again this is my theory based on the kinds of things that I've heard here on the show that people are more aware that there is help with elder law planning, with estate planning and with I like the phrase asset protection.

>> I know people don't want to panic and think yeah oh my word if I do have to go to a nursing home or retirement center or am I going to lose all my money.

>> Right.

Let's talk about that.

>> So there's never there's no reason to lose all of your money.

It breaks my heart and I would say other elderly attorneys have the same impression when they hear the story that gosh, mom lost all of her money.

She went to the nursing home and we sold the house.

We sold the farm.

We went through the inheritance and there really is no reason to do that.

And when we're talking about asset protection, Sandy , we're really talking about doing it in advance.

>> That's preplanning preplanning or after you're already at the facility or shortly going to facilitate more crisis planning.

So it in my opinion it's always preferable to do it in advance if we can create types of trusts that folks can use to put inappropriate assets into those trusts and if they're there for a designated period of time, five years or more for Medicaid benefits for three years or more for VA benefits, we're able to reach out and and get those benefits for Medicaid, get those benefits from VA while protecting our assets.

If we didn't do that preplanning and we already have an admission to a nursing home to memory care unit generally if you're working with an elder law attorney you typically if you're married can protect all assets, all assets if you're a single person we typically say all real estate and maybe half or more of your of your other assets.

>> Why do it?

Why I mean why is it different?

It sounds like it a single person then is punished.

>> Well it's not that they're punished.

It's that they're are if you're married your spouse has the right to a certain amount of money and so an elder law attorney is going to work with you to make sure that we're protecting as much as you can.

There are other processes that are in place that are recognized by Medicaid, recognized by the VA that an elder law attorney is going to implement in order to protect those assets.

So it isn't that you're being punished.

It's just that those ways of protecting assets are different if you're a single person versus if you're a married person.

So there's no there's not punishment per say it's that you're taking advantage of those opportunities that are there.

So for example, if I was a arried person filing my tax return, I might have more credits that I could take as a married person if versus if I'm a single person and I'm filing singly I wouldn't have as many deductions.

So you're not necessarily punished when you're filing your state and federal tax returns but there are different deductions that you can take if you're married versus if you're single.

So if you think about it that way and you think about it in relationship to protection of assets and getting those Medicaid benefits or getting those VA benefits, it's kind of the same mindset that there are just certain approaches or protections that we can implement if you're a married person that we can't implement if you're a single person it's just so confusing.

>> There's so much to say to you as you get older.

>> There's so much you have to know.

Yeah, I think that it's true what the most important things that you would tell our viewers are a client that you might have that come to you for the first time.

>> Yeah, great question.

I think one of the most important things for everyone to have in place and it seems so simple is a durable power of attorney.

We need a durable power of attorney that permits the individual that you're appointing called an attorney.

In fact you're allowing that person to take certain steps or those steps that are necessary in order to protect your assets should you have that out of hand.

>> Attorney in fact and a durable so the same thing the name of the document is Power of Attorney.

>> OK, durable part means if I become incompetent it's still in effect power of attorney is your appointing someone and the person that you're appointing their title is attorney in fact OK you're appointing someone that can handle your financial affairs on your behalf.

I would also say in response to your question not only do we want a durable power of attorney in place but you'll want something called a health care representative designation which Indiana now includes living wills language if you want it to.

I also like to see HEPA waivers separate HIPPLE waivers in place even though it's buried in that health care representtive designation.

I think hospitals and doctors offices are used to seeing a separate form so I'd like to also have a hippo waiver hippo stands for health insurance portability Accountability Act.

It's a mouthful but it allows someone to be able to see your medical records in order to assist you in making medical decisions.

>> Speaking of medical records and papers and whatever it it's it's not confusing.

It's more annoying maybe like if you're going to the hospital room for just a procedure or you know, whatever X-rays anything like so many forms that you have to fill out and they're very lengthy.

You don't have time to read them.

They just say sign here, sign here and you're signing five or six things.

>> Yeah.

So what I encourage folks to do is when you have the health care representative designation prepared, when you have your living well prepared, you have a waiver prepared, send it to your primary care physicians office or if your primary care physician is part of a larger conglomerate similar to the larger conglomerate so it can be uploaded to your medical file.

So when you go into the doctor's office you go to the hospital and they say do you have an advance directives?

Do you have a living well?

Do you have a health care representative designation you can say I sure do.

In fact you should have it on file.

You should have it in my record.

But that that HIPPLE waiver every time you go in for procedure they'll have you sign a release and you can think of it like in order for them to speak to the insurance company they can't just speak to the insurance company about what procedure they perform for you.

>> You need to release them so that they can contact the insurance company and be paid for the service that they performed.

>> OK, all right.

Well sorts it out a little bit.

>> I still find it very annoying.

OK, here's a question that James has called in about.

>> He says What advice do you offer to families who are disagreein about inheritable assets?

>> So that's probably a typical it's just this is very typical.

I think that my advice would be if you're appointing the person to be your representative at the time of your passing or to be the trustee the time of your passing, make sure that you're picking the right person, you're picking that mediator, you're picking that person.

It's strong enough to be able to withstand other family members complaining and having an issue.

I would also say that if you're in that position of serving as the trustee or in the position of servng as personal representative that you're very thorough with your accounting, you're very transparent with what's going on.

>> People get this notion that it's taking too long or money is missing or somebody is taking advantage which does happen but not the majority of the time.

So my advice would be if there's a disagreement happening in the family that the person that's been appointed may be incredibly transparent about what's going on if somebody questions what the value of the home is or what the value of a certain item of personal property is often boils down to dollars and cents.

Don't just get one appraisal get to get two appraisals an average.

>> So if there's a hunch that was Mom's and everybody loves the Hutch and one person thinks it's worth lots of money and somebody else says it's worth nothing, have it appraised complete transparency we even sometimes recommend if the family is really disagreeing about the value of something have a public auction that can attend the public auction.

They can bid on it.

That tells you what the true value is.

You may very well be paying less than you ever thought you would be and so be transparent.

>> Make sure that the person that's in charge is very thorough with their accounting markdown every penny and share that with great frequency with those folks in the family.

I think it also starts at the beginning when the individual that's putting their estate plan together that they're speaking with the their counsel and they're being very clear to say gosh, I've got six kids and let me tell you three of them do not get along and we're going to be really having some challenging situations here.

So think it through when you're putting your estate plan together and speak to the counsel, your attorney that you're working with about what techniques can we put in place?

What can we implement to make sure that I'm diminishing the amount of disagreement in the family?

How is it we can resolve those issues?

Sometimes the person in the family should be serving as the personal representative or the trustee and sometimes not.

>> Maybe you need somebody outside the family.

It's a disinterested third party so those six kids that don't get along, they can hate that person.

>> They can hate the person that's outside the family.

But and so sometimes we bring in a professional trust department to serve as the trustee.

They're going to handle the estate or they're going to distribute the assets from the trust and and those times it's it oftentimes happens where we just can't get along in the family.

>> But transparency is the key.

OK, I like that.

I like that and that's really probably the best communication anybody.

>> Yeah.

Communication right.

So there's no disagreement among the siblings.

OK, so we've talked about inheritance assets.

We did have one here on the show an auctioneer who does an estate sales.

>> Yes.

And I thought it was pretty cool.

Now they can do them online.

You can even bid online but he was talking about how they decide the price of everything.

It's they don't just guess that you know, they research or have specialists in their companies or even at that time as they're going through everything in your house to determine a cost .

>> So they're probably more complete than maybe you might be and guess so that's my point to saying hire a professional appraiser.

>> Yeah.

So hire that person if people are if there's that much disagreement in the family spend a few hundred dollars, get the appraisal.

Nobody can challenge you.

You're not the person in the hot seat now the appraiser was the one that determine the value if there's still a debate hire a second appraiser.

The appraisal the span is typically really very close.

There is not there should not be a great discrepancy in what folks are determining the value to be.

But in my opinion that's one way to remove the heat from the person that's in charge of divvying it up and placing it in somebody else.

Also we oftentimes see an auction in the family so everybody wants mom's hutch.

Everybody wants mom's looking in the room here cocktail table.

>> So OK, so here's the appraised value.

Here's the we hired the expert now are you willing to pay that?

>> Yep.

To kids are willing to pay it.

OK, let's do a family auction.

Who's willing to pay that value plus a dollar plus ten dollars plus twenty dollars and eventually right whoever gets it spends a little bit more money gets the item.

>> I will tell you though if you don't want to spend money on having the the appraiser come in you can auction it off publicly at the beginning of my career that the auctions that we did for personal property are the tenth in the front yard and somebody there with a microphone and the gavel and that doesn't take place anymore .

It's all done digitally.

It's done electronically online.

You have people from across the United States, around the world bidding on certain things.

>> I also tell you it oftentimes when there's a disagreement in the family about something, it really isn't necessarily about the value of it.

There's oftentimes something kind of in the background that's called sentimental.

>> Yes, it could be this sentiment.

It could be that, you know, Mom promised me I was going to be getting that but they never put it in the will.

They didn't put it in the trust.

So regardless of what mom said, it doesn't necessarily mean it's going to go to that person.

But oftentimes there's something in the background that's actually agitating the situation.

But but I'm I'm a huge fan of auctioning those things off and determines the true fair market value of it and takes the pressure off of the individual that was appointed and that's good advice for sure.

>> Anything you can do to simplify things and to avoid having to have although sometimes it's a good thing but having to have probate judge make all those decisions if you can stay out of court it's it will save you so much grief and so much money and when you're in court that can create a grudge that can create hard feelings that never goes away.

>> Yeah.

See what did you learn a lot.

>> Thank you Brian.

Thank you Sandy .

You'll see Brian again next month here on life they had meanwhile I hope you all continue to watch us here on Wednesday night at seven thirty to be safe and stay healthy to Nugen Law; specializing in estate planning and elder care law, emphasizing independence and quality of life.

Serving Indiana, Ohio, Michigan, and Florida.

More information at NugenLaw.com.