The Essential Eldercare Handbook for Nevada

Contents

C o n t e n t s • Preface xiii Acknowledgments xv one • An Eldercare Overview 1 The Growing Need for Eldercare 1 When the Time for Care Has Come 3 Make a Plan 4 What, Sell the Family Home? 6 Importance of Early Planning 6 The Caregiving Role 7 Aging, Dementia, and Children 9 Burnout 10 You Can Say No 11 two • Who Needs Eldercare? 12 The Aging Process 12 Common Chronic Illnesses 13 Adult Onset diabetes 14 Arthritis and Osteoporosis 14 Balance Disorders 15 The Dreaded Fall 15 Kidney and Bladder Problems 16 Eye Diseases 17 Lung Disease 17 vii viii Contents Cardiovascular Disease, Including Stroke 18 Depression 18 Dementia 19 Alzheimer’s Disease 20 Tips for Handling Dementia and Alzheimer’s Disease 20 Case Study: The Petersons 22 Taking Away the Keys 23 Dementia and Driving 24 Community Resources 25 Respite Care 25 Support Groups 26 three • There’s No Place Like Home 27 Keeping the Home Safe 27 Halls and Doorways 27 Bathroom Safety Tips 28 Kitchen Safety Tips 28 Bedroom Safety Tips 29 Stair Tips 29 The Cost of “Aging in Place” 29 Emergency Response System 30 Medical History Bracelet 30 More Resources 30 Tips for Handling Incontinence 30 four • Planning for the Cost of Long-Term Care 32 Types of Care 33 Paying for Care 35 Long-Term Care Insurance 36 What About Medicare? 36 Assess Medical Needs and Personal Needs 38 What Can You Afford? 39 Contents ix Determine Income and Assets 39 Financing Home Care Through Reverse Mortgages 40 Cashing in Life Insurance 42 Avoiding Common Financial Mistakes 43 Tax Issues Related to Long-Term Care 44 five • Medicaid Planning 46 Applying for Medicaid 46 Exempt Assets and Countable Assets 47 What Must Be Spent? 47 Joint Accounts 48 Transferring Assets 48 Medicaid Planning for Married Couples 49 Spousal Support 50 Case Study: Division of Assets and Spousal Support 50 Case Study: Equal Division of Assets 51 Case Study: The Income Cap 52 Case Study: Financial Gifts to Children 52 The Medicaid Spend-Down 53 Basic Spend-Down for Married or Single Applicants 53 Spend-Down for Married Couples 54 Trusts 54 Will I Lose My Home? 55 Review Beneficiary Designations 56 Planning Strategies 57 Income Trust Fund 57 Irrevocable Trust 57 Long-Term Care Insurance 58 Case Study: Irrevocable Trust 58 six • Veterans’ Benefits 59 What Is Pension? 59 Medical Needs Test 60 x Contents Income Tests 61 Asset Requirements 62 Benefit When Spouse Needs Assistance 63 Asset Transfers and Tax Implications 64 Asset Restructuring and Spend-Down 65 Veteran’s Spouse Eligibility 66 Applying for VA Pension 67 Supporting Documentation for VA Pension Applications 67 Appointment of Fiduciary 67 Death of Claimant 68 Accredited Agents and Attorneys 68 Notifying VA of Changes 68 Other VA Benefits 69 Case Study: Single Veteran 69 Deductibility of Family Caregiver Payments 70 Case Study: Aid and Attendance 71 seven • Protecting Legal Rights 73 Advance Directives 73 Living Wills 84 Durable Power of Attorney for Health Care 75 Do-Not-Resuscitate Orders 76 Physician Order for Life-Sustaining Treatment 77 Substituted Judgment 78 Living Will Registry 79 HIPAA 80 Improving the Effectiveness of Advance Directives 80 Pain Management 81 Patient’s Rights 82 Right to Autonomy, Dignity, and Respect 82 Right to Manage Own Finances 82 Right to Participate in Plan of Care 82 Right to Be Free from Abuse and Restraints 82 Contents xi Right to Confidentiality 83 Right to Be Fully Informed 83 Right to Choose One’s Own Physician 83 Right to Voice Grievances 83 Right to Privacy 83 Right Against Unlawful Discharge or Transfer 83 Power of Attorney for Finances 83 Elder Abuse and Exploitation 85 Guardianship 87 eight • The Affordable Care Act in Nevada 89 Overview of the ACA 96 Silver State Health Insurance Exchange 91 SHOP Exchange 92 How the ACA Affects Medicare 93 The Costs of ACA 94 nine • Plan Your Estate 96 Trusts 96 Last Will and Testament 97 Case Study: Second Marriage Situations 97 Family Disputes 98 Updating Your Documents 100 Gifts and Loans 100 Special Situations 101 Deed upon Death 103 Nevada Asset Protection Trust 103 Protecting Your Legal Documents 104 After Death 106 Determine How Assets Are Titled 106 Joint Tenancy 107 Payable on Death and Transfer on Death Property 107 xii Contents IRAs, Annuities, and Life Insurance 107 Trust...