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    Facing the Reality of Long-Term Care
    Facing the Reality of Long-Term Care
    Facing the Reality of Long-Term Care
    Ebook177 pages1 hour

    Facing the Reality of Long-Term Care

    By Michael Gilfix

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    About this ebook

    You are and should be worried about the cost of long-term care.

    You are reading this book because you are concerned, perhaps worried to your wits' end, about getting and paying for quality long-term care for yourself or a loved one. You are looking for reliable, understandable information about options, different levels of care, and how the potentially devastating cost can be paid.

    This book will deliver. Based on over 40 years’ experience, the authors answer your questions and give you the information you need to develop a plan that works for you. It is "agnostic," in that it does not presume a solution for any given situation. It identifies the three ways the cost can be covered – paying out of your own pocket or "self-insuring," purchasing long-term care insurance, or looking to Medi-Cal and other government programs that can pay all or part of the cost of long-term care. Often, it is a combination of two or all three of these approaches.

    The authors appreciate that these challenges are difficult and emotional. Their goal is to make this complicated world of long-term care – and long-term care financing – manageable for you and your family.

    LanguageEnglish
    PublisherMichael Gilfix
    Release dateDec 23, 2014
    ISBN9780996031219
    Facing the Reality of Long-Term Care
    Author

    Michael Gilfix

    Michael Gilfix is a nationally known authority in the field of law, aging and estate planning. A 1973 graduate of Stanford Law School, he is a Fellow of the National Academy of Elder Law Attorneys (NAELA), a co-founder of NAELA, and a Certified Legal Specialist in Estate Planning, Trust and Probate Law. Mr. Gilfix regularly addresses professional audiences, including attorneys, physicians, certified public accountants, and financial planners, nationally as well as locally.An entrepreneur in the legal field, Mr. Gilfix created the first legal aid program for elders in 1973. He served as Executive Director of that program, Senior Adults Legal Assistance (SALA) of Santa Clara County, for ten years. In 1983 he created the law firm that is today known as Gilfix & La Poll Associates LLP.For over 30 years, Gilfix & La Poll Associates has innovated creative legal solutions to help you manage and plan the future of your estate. Together, we will decide which strategy will best serve your individual needs and those of your beneficiaries. Their future is in your hands and it’s a privilege for us to serve you in this regard.Mr. Gilfix has been a principal speaker for numerous trust and tax symposia at the national level, including the Center for Judicial Education, the American Institute of Certified Public Accountants (AICPA) the New York University Tax Institute, and the National Academy of Elder Law Attorneys (NAELA).Mr. Gilfix is a California legal advisor to Partnership For Caring, the national organization devoted to rights of individuals to make their own health care decisions.A highly respected practitioner and a prolific author, Mr. Gilfix is co-author of Tax, Estate & Financial Planning for the Elderly: Forms and Practice (Matthew Bender) and is the principal author of Medi-Cal and Asset Preservation, a book- length set of materials for practicing attorneys. He regularly contributes to a wide variety of legal journals such as Trusts and Estates Magazine, where his writings have discussed the role of personal values in estate planning, life care communities, and asset preservation planning.Mr. Gilfix holds an AV rating from Martindale-Hubbell, as judged by his peers in the legal profession. This rating, the highest given “... reflects an attorney who has reached the heights of professional excellence, ... has practiced law for many years, and is recognized for the highest levels of skill and integrity.”Mr. Gilfix is a member of the National Academy of Elder Law Attorneys’ Council of Advanced Practitioners. NAELA guidelines state that an attorney must be preeminent in the field of elder and special needs law to hold this title. Mr. Gilfix has a reputation as an experienced, outstanding, and exceptionally skilled elder and special needs law attorneys

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      Book preview

      Facing the Reality of Long-Term Care - Michael Gilfix

      YOU ARE AND SHOULD BE WORRIED ABOUT THE COST OF LONG-TERM CARE.

      You are reading this book because you are concerned, perhaps worried to your wits' end, about getting and paying for quality long-term care for yourself or a loved one. You are looking for reliable, understandable information about options, different levels of care, and how the potentially devastating cost can be paid.

      This book will deliver. Based on over 40 years’ experience, the authors answer your questions and give you the information you need to develop a plan that works for you. It is agnostic, in that it does not presume a solution for any given situation. It identifies the three ways the cost can be covered – paying out of your own pocket or self-insuring, purchasing long-term care insurance, or looking to Medi-Cal and other government programs that can pay all or part of the cost of long-term care. Often, it is a combination of two or all three of these approaches.

      The authors appreciate that these challenges are difficult and emotional. Their goal is to make this complicated world of long-term care – and long-term care financing – manageable for you and your family.

      Facing the Reality of Long-Term Care

      Capturing Quality, Avoiding Bankruptcy

      MICHAEL GILFIX, ESQ.

      &

      MARK R. GERSON GILFIX, ESQ.

      A Gilfix Education Publication

      www.Gilfix.com

      FACING THE REALITY OF LONG-TERM CARE

      Copyright © 2014 by Michael Gilfix

      All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means without written permission from the author.

      ISBN 978-0-9960312-1-9

      Gilfix & La Poll Associates, LLP

      2300 Geng Road, Suite 200

      Palo Alto, CA 94303

      650-493-8070

      www.Gilfix.com

      Acknowledgements & Dedication

      Any consequential book is, at heart, a team effort. I received invaluable assistance from attorneys Francis A. La Poll and Myra Gerson Gilfix. Also essential was assistance from Ashleigh Alcock and other members of our remarkable team at Gilfix & La Poll Associates, LLP.

      This book is dedicated to the memory of two individuals who played critical roles in my earliest professional evolution. One is Diana Steeples, an employee of the City of Palo Alto, California in 1973. She encouraged and welcomed me as I established the free legal services program for elders that became Senior Adults Legal Assistance (SALA). With her help, I saw my first clients at the Palo Alto Senior Center, which was then a desk in a downtown library.

      This book is also dedicated to the memory of Murray Halwer. Murray moved to Palo Alto after retiring from a diversified legal career in New York City. He was one of the most vigorous volunteers Senior Adults Legal Assistance (SALA) ever had.

      Michael Gilfix

      September, 2014

      Table of Contents

      Who We Are

      Why We Wrote this Book

      What is Long-Term Care?

      Three Trends that Worry Us about the Future of Long-Term Care Services

      The Spectrum of Long-Term Care

      Everyone Wants to Stay at Home

      Assisted Living

      Residential Care Facilities

      Skilled Nursing Facilities (SNFs)

      Continuing Care Retirement Communities (CCRCs)

      Who Needs Skilled Nursing Care?

      Paying the Cost of Long-Term Care

      Your Pocket, Your Assets

      Medicare

      The Patient Protection and Affordable Health Care Act

      Long-Term Care Insurance

      Hybrid Long-Term Care Insurance

      Medicaid, Medi-Cal in California

      Medi-Cal Myths & Reality

      Medi-Cal, the Cost of Skilled Nursing, and the Medi-Cal Compliant Annuities

      Creative, Alternative Planning Options

      The Child’s Perspective – Caregiver, Supporter, Inheritor

      Too Late for Long-Term Care Insurance or Other Planning – What to Do?

      Paying for Care: Good Options are Available

      Plan to Stay Out of a Nursing Home, Receive Care at Home

      Private Payment

      Reverse Mortgages

      Annuities to Ensure Income Stream

      Long-Term Care Insurance

      Veterans Aid and Attendance Care

      In-Home Support Services

      Medi-Cal Waiver Program: Program of All-Inclusive Care for the Elderly (PACE)

      Life Care Contracts

      Specially Drafted Estate Planning Documents

      Family and Community Support

      The Role of Technology in Home Care

      Sensors

      Robotics

      Video Communication

      Sources of Information

      Information Overload

      Unreliability

      Different Laws, Different States

      You are Aware of the Medi-Cal Program. Now What?

      When Do You Seek Legal Advice?

      Living at Home with Indications of Memory Loss and Dementia

      Planning to Protect Your Residence

      You Are About to Enter a Skilled Nursing Facility

      You Are Already In a Skilled Nursing Facility

      Act Now, the Law Will Change

      Medi-Cal Eligibility

      Single Individual

      Married Couple – Protections for the Spouse Who is Still at Home

      Protect Your Assets and Qualify for Medi-Cal

      Protect Your Residence!

      Court Petition to Increase Asset Protection for the Spouse Living at Home

      Court Petition or Administrative Hearing to Increase Income Protection for Spouse Living at Home

      Conversion of Nonexempt Assets to Exempt (Protected) Assets

      Life Insurance

      Retirement Accounts

      Hire Family Members to Provide Services

      Use of Annuities

      Transfer of Cash and Other Nonexempt Assets

      Ensuring Protection for the Nursing Home Resident

      Other Strategies Exist

      Tax Implications of Asset Preservation Planning

      Gift and Estate Tax

      Capital Gains Tax

      Property Tax

      Income Tax

      Ensuring Quality of Care in Long-Term Care Settings

      Cookies and Thorns

      Nursing Home Ombudsman and State Inspection

      Professional Care Management and Oversight

      The Last Resort: Litigation

      Relationships Matter

      The Critical Role of Estate Planning Documents

      One Stop Shopping: The Ideal LTC Planning Approach

      An Objective, Professional Review of Your Situation

      Assessment of Personal Finances to Identify the Optimal Blend of Long-Term Care Insurance, Investment Strategies, and Government Benefits Eligibility

      Coordination of Home and Personal Care

      Identify Appropriate Technology to Maximize Quality of Care and Security

      Patient Advocacy

      Financial Management – Trustee Services

      What Can We Provide? How Close Are We?

      In Conclusion, Be Proactive

      Appendix: Directory of Organizations that Can Provide Assistance

      Who We Are

      MICHAEL GILFIX, ESQ.

      Michael Gilfix is a nationally known authority in the fields of estate planning, elder law and Special Needs Trusts. Mr. Gilfix is a 1969 graduate of Stanford University, where he graduated with distinction and was elected to Phi Beta Kappa. Mr. Gilfix is also a 1973 graduate of the Stanford Law School.

      Mr. Gilfix created the first free legal aid program for elders in the nation in 1973 and served as its director for ten years. That program, Senior Adults Legal Assistance (SALA), still thrives in Santa Clara County, California. He is a co-Founder of the National Academy of Elder Law Attorneys (NAELA) and a Fellow of the Academy. He was founder of California Law Center on Long-Term Care. He is also a Certified Legal Specialist in Estate Planning, Trust, and Probate Law. He is a founding member of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys. Mr. Gilfix is an Advisory Board Member of the Academy of Special Needs Planners (ASNP).

      Mr. Gilfix is annually identified as a Super Lawyer in the field of Estate Planning and Probate. He is a Certified Specialist in Estate Planning and Probate by the State Bar of California.

      Mr. Gilfix is a Contributing Editor for Elder Law for Trusts & Estates magazine. Mr. Gilfix is on the National Advisory Board of Elder Counsel.

      He has been a principal speaker for numerous trust and tax symposia at the national level, including the American Institute of Certified Public Accountants (AICPA), the New York University Tax Institute, the Southern California Tax and Estate Planning Forum, the National Academy of Elder Law Attorneys, and the Academy of Special Needs Planners (ASNP).

      A highly respected practitioner and a prolific author, Mr. Gilfix is co-author of Tax, Estate & Financial Planning for the Elderly: Forms and Practice (Matthew Bender). He regularly contributes to many other legal journals and publications, including Trusts & Estates and Estate Planning magazine. He is frequently

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