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Right Idea, Wrong Conclusion

In this edition of Crisis Corner: Right Idea, Wrong Conclusion

We do a lot of consultations about Medicaid planning.  Many of them involve at least on child of the person who might need benefits.  In those consultations we will occasionally hear a child admit that they are doing the planning because they want to get something when mom and dad are gone, which is the wrong idea, but is also refreshingly honest.  More often, and usually heartfelt, we hear something along the lines of: “We don’t care about inheriting anything, it is mom’s/dad’s money and they should spend it.”  That is usually followed with calculations that range from grossly optimistic, i.e. “Mom is already 89 and has $100,000 in savings which should easily pay for her care for the rest of her life”; to “Based on the doctor’s prognosis, net income, and monthly expenditures with an expectation that care costs will increase over time, mom should have enough money to outlive her prognosis by about eighteen months.”

The problem with “letting them use their money on themselves” is that it assumes Medicaid planning is designed to save money for the sake of saving money.  It is great to reassure someone that by planning with us they will be able to leave a little something for their children or loved ones when they are gone.  Whether the kids want/need the inheritance or not, it is comforting to a parent to feel like they are helping their children.  It is the same reason that retired parents, on fixed incomes, sometimes insist on paying for meals out with their very successful, employed, children.  However, the real purpose behind Medicaid planning is to ensure the quality of life for the person receiving benefits.  It is not enough to make it to the end before you run out of money if the end comes with a low quality of life.

There are a few things that can cause a drop in quality of life when Medicaid planning is skipped in favor of spending every dime:

One of the things that we see more often than we ever imagined is a client out living the most optimistic predictions of doctors.  The most extreme case of this was a client who came to me more than 13 years after being diagnosed with four different Stage-4 cancers and given a life expectancy measured in weeks.  We have also had 94 year old clients driven to my office by their 96 year old spouse, and at least one client that came to me and got onto Medicaid just after his 101st birthday.  With the pharmaceuticals available today people are living longer and longer lives and planning your needs around the idea of dying by 90 does not work for many people.

If you outlive your life expectancy by a significant margin and you do not plan ahead to save assets or to move into a community that will eventually accept Medicaid, you could end up out of money and with no option except living in a skilled nursing facility (SNF).  Some SNFs are much nicer than others and in some situations they are the most appropriate setting from a medical stand point but, in general, living in a SNF should be the absolute last option for most people.

I started working in Medicaid planning in 2015.  At that time many adult family homes (AFHs) started in the $3,000 to $3,500 per month range and topped out around $6,000 to $7,000 per month for clients with very high care needs.  At that time there were also many AFHs and Assisted Living Facilities (ALFs) that took Medicaid with 0-12 months of private pay (the time you have to live in the community before they will accept Medicaid as a form of payment).  Today, it is hard to find an AFH that is less than $5,500-6,000 per month for low care levels and up to $9,000 or more for higher care levels.  Additionally, the most common private pay period is now 2-3 years and some communities are asking for up to 5 years.  In that same time, many of my clients have seen an increase of about $10 to $20 per month in their Social Security income.  Care communities are not the only place you will see this increase in costs.  Over the last six years I have seen the average cost of hiring in-home care rise from $10-15 per hour from an individual or $20-25 per hour for an agency to $20-25 for an individual and $30-40 for an agency.

I cannot account for the increase in charges by these communities, other than supply and demand and charging what they think the market can bear, but the lengthening private pay periods is not surprising at all.  In 2015, Medicaid would often approve $100 to $180 per day for care in a non-skilled nursing facility (nSNF) community (about $3,000 to $5,500 per month), which was lower than the private pay numbers but not significantly lower.  Today, Medicaid often approves $100 to $180 per day for care in an nSNF community.  Instead of losing 0-20% of the income they could get from private pay, they are losing up to 50% or more by accepting Medicaid. 

Increasing base costs of care, at home and in communities, are not the only unexpected costs that might spring up.  Let’s assume you find a community that has a base rate of $3,500 per month plus care costs based on need and they guarantee that the rates will not change once you move in, except with increased level of care.  Often this looks something like “Level 1 Care – $1,500; Level 2 Care – $2,000….”  Now let’s assume you are the client who very carefully calculated that mom would have 18 months of extra money left because you assumed that she would gradually move from Level 2 to Level 4 over the three years she has left.  Then six months after moving to a community she has a massive stroke that she only partially recovers from.  It does not shorten her three years but it jumps her instantly from Level 2 to Level 5, where she will remain for the next 2.5 years.  People with devastating health issues tend to develop more health issues and at a faster rate than those who are mostly healthy to start with.  I have had clients that move into a community and then have an episode that literally doubles their care cost within the first few months of living there.

Maybe the plan is for mom or dad to use their money on themselves, but as a backup they move into an ALF that will eventually take Medicaid if they run out of money.  They have a nice private room, a consistent staff of care providers that they know and get along with.  They are bathed at least every other day and have a one-on-one helper with mealtime.  Then they run out of money and apply for Medicaid.  They are approved and the ALF is now receiving $4,000 per month instead of $7,000 per month.  Mom or dad is now told that all of the ALF’s Medicaid beds are in shared rooms, so they will have to move to a new room, the same size or smaller in some cases, and share it with a total stranger.  Baths or showers may decrease to once or twice per week, and meal time might become one care provider sitting at a horseshoe table with six patients.  The staff who provide the daily care may be less experienced and or more randomly assigned, since the more experienced, long-term staff will have their pick of patients and will want to stick to the private payers.

Families can pay the ALF facility to upgrade to a private room, to provide more baths, and to have a one-on-one meal companion.  The problem is that the family has to find the money for those niceties.  With planning that protected some of the assets early on, there would be a source for those costs.  Without planning, that money is coming from the pockets of the family members or it just is not coming.

Why Plan? 

Proper planning makes it far more likely that your loved one will make it to the end of life with the highest quality of care and maybe, just maybe, a little something that they can leave for their children.  The funny thing is that most children will tell you that the quality of life is the more important piece of this and most parents will tell you that the ability to give something to their children is the most important piece.

Will Each of Your Kids Get an Equal Inheritance? How You Handle That Question Can Cause Family Strife – or Prevent It

As you plan ahead for the end of your life, one of the decisions you’ll want to think carefully about is the eventual disposition of your estate. If you plan to leave your assets and possessions to your children – and if you have more than one heir – you’ll have a potentially tough choice to make: do you divide your estate equally, or do you give a different amount to each of your kids?

Equal or Unequal, Your Estate Plan Sends a Message

This recent article from NerdWallet helps us think through that question. “Your estate plan may be your last words to those you leave behind,” writes reporter Liz Weston. “If you’re a parent, you should think carefully about the message you’ll be sending.” The biggest problem is that, unless you make your motives crystal clear, you may be creating a deep divide between your offspring, no matter how noble your intentions.

“Parents who leave their children unequal inheritances risk fueling family feuds,” the article states. “But strictly equal bequests also can cause resentment if the heirs don’t see the distribution as fair.” As wealth planner and author Colleen Carcone told NerdWallet, “Money can cause family discord, and you want to make sure that you are thinking through this and keeping sibling relationships intact.”

“Equal Inheritance” versus “Fair Inheritance” – It Comes Down t0 Perception

Instead of focusing on “equal” or “unequal” division, the NerdWallet article recommends you concentrate on the idea of “fairness.” As Weston writes, “For some people, fair means an equal dollar amount. Others may want to adjust the distribution to deduct financial help they’ve already given, for example, or to leave more to heirs with greater need.” Sometimes an heir who has provided in-home care for a parent receives a larger share. In other families, the offspring who has worked harder in the family business may be entitled to receive more equity than his siblings.

“Each approach has its merits — and problems,” says the NerdWallet article. “With an equal-dollar distribution, heirs may resent their wealthier siblings for getting money they don’t ‘need.’ Similarly, children who received less financial help during the parent’s life may resent those who got more if the estate distribution doesn’t reflect that imbalance.” On the other hand, unequal distributions can also cause hard feelings, as well. “The person getting less than others may view it as a punishment, especially if the amount was docked to reflect past financial help or to account for personal wealth,” writes Weston. “One inheritor I know refers to this as ‘the success tax.’”

The Unique Dynamics of Your Family Should Guide Your Decision

“What matters is how your decision is likely to play out given your family’s dynamics, and that may be differently than you expect,” writes Weston. For example, one family had a son whose wealth far exceed that of his siblings, or even his parents. In spite of this, the parents had planned to divide their estate equally. But when the parents discussed this with their son, according to wealth manager Colleen Carcone, they discovered he didn’t want what they thought. “He said, ‘I would rather have the money go to my siblings, but what I’d really like is that watch collection that Grandpa left you.’”

But in other families, if it’s not an equal distribution, there will be discord. “Leaving one child more than another would ignite those ‘Mom (or Dad) always liked you best’ rivalries that can destroy sibling relationships,” says Weston. As hard as it might be to let your children know your plans ahead of time, it’s an essential step. Otherwise, one planner told NerdWallet, the parents are “just sowing seeds of discord for when they are gone.”

Equal Inheritance or Not, Parents Should Leave Behind a Detailed Letter

Whether or not you have a family meeting while you’re living – and we strongly recommend that you do – NerdWallet also urges you to leave behind “a detailed letter explaining the thinking behind your decisions. Such letters can head off disagreements about what you said and what you meant.” This will make your wishes unambiguous, and it will also help children grasp your reasoning. “Make sure that [your children] understand why you did what you did,” Colleen Carcone told NerdWallet. “Nobody wants to leave a legacy of family disharmony.”

At Life Point Law, we want to offer our services in facilitating a family conference where some of these vital issues can be aired under the guidance of an experienced attorney. These conferences can take place in person, with appropriate social distancing precautions in place, or electronically. Please contact our offices for information.

Creating an Ethical Will: How a “Legacy Letter” Can Help Communicate Love, Lessons, and Values to Those You Leave Behind

As we age, many of us begin to think about the concept of “leaving a legacy.” Too frequently, however, the focus turns to money, as if the only legacy that truly matters when we die is a pile of cash, a portfolio of real estate, or a healthy business. But as this recent Kiplinger article point out, when we consider the things of value that we bequeath to our heirs, it’s important to consider the elements of our legacy that are intangible. This kind of inheritance, often spelled out in a document called an Ethical Will, can impact your family far more than money.

Ethical Will: An Ancient Practice with a Modern Application

The definition of an ethical will – sometimes referred to as a legacy letter – is simple, according to Abby Schneiderman who co-founded a company called Everplans.  It’s a document that you have prepared to “communicate values, experiences and life lessons to your family.”  Wikipedia traces the concept to Old Testament times, and calls an ethical will “a document that passes ethical values from one generation to the next.” The practice, says Wikipedia, has become more widespread in recent years, used as an aid to estate planning, as a way of ensuring appropriate end-of-life care, and as a means toward a spiritual healing tool.

The Kiplinger article spotlights Minneapolis hospice director Barry Baines who says he first came upon the concept of an ethical will in the 1990s. “He and his colleagues were working on a project about existential pain at the end of life. A dying young man told them his nonphysical pain was a 10 out of 10. Even though this patient was a husband and father, ‘he told us, “I feel like I’m going to die and there won’t be any trace that I was ever on the Earth.”’” After Baines suggested that the man work with a chaplain to create an ethical will, the man said “his spiritual suffering had dropped to zero.”

Ethical Wills: Do-It-Yourself or Professional Assistance

Baines since has written a book called Ethical Wills: Putting Your Values on Paper, and has co-founded a company that, according to Kiplinger, “offers both guidance for creating ethical wills and trains facilitators — such as financial planners, hospice workers and those who work in faith communities — about how to help people fashion their own legacy letters.” Baines acknowledges that people can write a legacy letter or ethical will by themselves, but sometimes professional help can provide necessary support and encouragement.

“While the task may seem daunting,” says Kiplinger, “most people’s ethical wills aren’t long, perhaps only a page or two.” Professionals suggest that a good starting place can include “personal history, favorite things, academic and professional life, religious and political views, and hopes for the future.” Some people get creative and include a PowerPoint slide show depicting things they love. You can attach favorite recipes, photos, or keepsakes. It’s up to you what you choose to include.

Ethical Wills Can Be Intentional – or Accidental

“Legacy letters can even be accidental,” Kiplinger states. One woman “discovered a two-page typewritten letter from her uncle that was saved by his brother —her father — while clearing out her parents’ house in the early 2000s. Her uncle had written the letter in 1963 on the back of a church bulletin shortly after his only child had died in an airplane crash. Although the family sent hundreds of letters back and forth between Iowa and Michigan, this was the only one saved.”

This cherished letter, which contains simple advice about doing things that matter – taking walks, staying mentally healthy, keeping an open mind, and practicing tolerance – was never intended as a “legacy letter.” But that’s precisely what it turned out to be.

No Life is “Too Ordinary” for an Ethical Will

If you think you have little of value to leave as an ethical or moral legacy for your family, says the Kiplinger article, think again. “For many, leaving an ethical will seems like a grandiose idea, that their lives are too ordinary or unsuccessful for them to have valuable insights to share. But the struggles are where life lessons come from.” One idea is to write your letter when you reach a milestone in life, such as becoming an empty-nester, retiring, or reaching a significant birthday. These life events can prompt times of personal introspection.

Finally, your ethical will can provide benefits for you as well as for your loved ones. “The document can also be one of self-reflection for how you want to live the rest of your life,” the article concludes. The process of putting down on paper can trigger some healthy questions, including “What do I stand for?” and “What matters most?”