Walnut Creek Elder Law Blog

My father spent some of his final months in a large assisted living facility. He was in his late 80’s, and was at times depressed and grouchy. Since the passing of my mother, he would not socialize easily, and would reject the entreaties of the resident ladies in the facility. He also would not participate in any of the activities that the “social director” would arrange. When I would visit my father, he would be waiting for me in the lobby of the facility, sitting alone, and not talking to anyone. When I would meet with him he would say, “Where the hell have you been?” I noticed that there were many other residents just like him, all sitting alone, and not talking to anyone.

 One Saturday I picked up my brother to go with me to visit our father. My brother had a 10 year old Labrador retriever named Gracie. This dog was very friendly, to say the least. She loved everybody, and would make herself at home wherever she was. I asked my brother to bring Gracie with us.

When we arrived at the facility, Gracie pulled us in, immediately went up to an elderly man, not our father, and put her head in his lap! The man was not at all offended, his face lit up, and he started to pet Gracie. My brother apologized and pulled Gracie away. We started to look for my father, and Gracie spotted an elderly lady who was standing up, and leaning against her cane. Gracie walked up to the lady and pushed her snout against the lady’s thigh to say hello. The lady was startled at first, but started to pet Gracie and rub her ears, for which Gracie was grateful.

 Finally, we saw my father, sitting alone in a chair, sitting up straight with his cane out in front of him. Gracie went up to my father, and put her head in his lap. My dad’s face lit up, and he began to pet Gracie. This was the first time my father did not say to my brother and I, “Where the hell have you been?” when we went to visit him.

 After that meeting, we took Gracie with us to visit our father whenever we could. We noticed also that therapy dogs were brought into the facility on a regular basis for visits, which was always a big hit with the residents. Dogs can be very soothing for older people, and for my father it softened him and brought a smile to his face. Studies have shown that after visits with therapy dogs in care facilities, that the loneliness factor is lessened and that the blood pressure of the residents is lowered. You should consider bringing a dog with you when you visit your older loved ones.

Written Michael J. Young, elder law attorney and probate attorney in Walnut Creek, CA and former in-house counsel for title insurance companies. www.WalnutCreekElderLaw.com LawYoung1@Gmail.com 1931 San Miguel Dr., Suite 220, Walnut Creek, CA 94596. 925-256-0298. Mr. Young serves Contra Costa and Alameda Counties, including the cities of Walnut Creek, Alamo, Danville, Concord, Brentwood, Pleasant Hill, Antioch, Clayton, etc. Mr. Young advises clients regarding Probates, Probates with Real Estate, Medi-Cal, nursing homes, asset protection, the VA Aid and attendance pension benefit, and long term care planning. Mr. Young is an Elder Law Attorney and Probate Attorney with offices in Walnut Creek, CA. Walnut Creek Elder Law Attorney, Walnut Creek Probate Attorney

For Medi-Cal qualification for married couples, generally speaking, the ill spouse can only keep $2,000 in liquid assets, plus exempt assets such as the home and IRAs.  In addition, the well spouse, also known as the community or at home spouse, can keep up to $113,640 in liquid assets, plus exempt assets. Any assets above these limits, $2,000 for the ill spouse and $113,640 for the well spouse, and excluding exemptions, will be counted for Medi-Cal qualification.

For planning purposes for a married couple, the Medi-Cal regulations allow us to “transmute” or transfer any assets from the ill spouse to the well spouse. There is no penalty for doing this, and no “look back” penalty period is calculated when the transfer is made between spouses. If the well spouse cannot live on the $113,640 plus exempt assets, we can either petition the court or request an administrative hearing to raise that amount, under the impoverished spouse statutes. In addition, we can make gifting transfers to other family members to lower the $113,640.

We can protect the home from a Medi-Cal lien by “transmuting” or transferring title of the home from the ill spouse to the well spouse. This title transfer must be done correctly on the record, and capital gains and other penalties and issues must be taken into account.      

These regulations which allow for transfers between spouses for asset protection and Medi-Cal qualification, cannot be implemented however, unless the ill spouse has sufficient mental capacity to make the transfers. If the ill spouse has sufficient mental capacity, she can sign the necessary documents. If she lacks sufficient mental capacity, we must look to her estate planning documents, including the trust and financial durable powers of attorney for the powers.

The estate planning documents must have sufficient expanded fiduciary powers under “gifting” and “revocation” sections in order to make these transfers. Please be advised that most estate planning documents do not have sufficient expanded fiduciary powers, unless an elder law attorney has prepared the documents or has amended the documents. If no such powers exist in the documents, we can go to court on a petition to request that the documents be amended to include these powers.

The best advice is to update your estate planning documents with the recognized asset protection and government benefits planning language while mental capacities are intact.   

Written Michael J. Young, elder law attorney and probate attorney in Walnut Creek, CA and former in-house counsel for title insurance companies. www.WalnutCreekElderLaw.com LawYoung1@Gmail.com 1931 San Miguel Dr., Suite 220, Walnut Creek, CA 94596. 925-256-0298. Mr. Young serves Contra Costa and Alameda Counties, including the cities of Walnut Creek, Alamo, Danville, Concord, Brentwood, Pleasant Hill, Antioch, Clayton, etc. Mr. Young advises clients regarding Probates, Probates with Real Estate, Medi-Cal, nursing homes, asset protection, the VA Aid and attendance pension benefit, and long term care planning. Mr. Young is an Elder Law Attorney and Probate Attorney with offices in Walnut Creek, CA. Walnut Creek Elder Law Attorney, Walnut Creek Probate Attorney

The following is our 2012 CA Medi-Cal Quick Reference Guide. Please refer to our website, http://www.WalnutCreekElderLaw.com for a further explanation of Medi-Cal qualification requirements.

2012 CA Medi-Cal Quick Reference Guide

Community Spouse Resource Allowance

$113,640

This is the amount that the community, or (at home) well spouse can retain in liquid assets. This amount does not include exempt assets, such as the home and qualified accounts, such as IRA’s.

Minimum Monthly Maintenance Needs Allowance

$2,841

This is the minimum amount of income the well spouse can keep. 

 Average Private Pay Rate (Divestment Penalty Divisor)

$7,092

This is the amount the State pays to nursing homes on the Medi-Cal program, minus a share of cost by the applicant. This figure is also used to calculate penalty periods of ineligibility for Medi-Cal.

 Applicant Resource Allowance

$2,000

The applicant can keep this amount in cash, checking, etc.

 Monthly Personal Needs Allowance

$35

The amount of non-exempt liquid assets the ill person is allowed to keep.

Written Michael J. Young, elder law attorney in Walnut Creek, CA. www.WalnutCreekElderLaw.com mike@WalnutCreekElderLaw.com. 1931 San Miguel Dr., Suite 220, Walnut Creek, CA 94596. 925-256-0298. Mr. Young serves Contra Costa and Alameda Counties, including the cities of Walnut Creek, Alamo, Danville, Concord, Brentwood, Pleasant Hill, Antioch, Clayton, etc. Mr. Young advises clients regarding Medi-Cal, nursing homes, asset protection, the VA Aid and attendance pension benefit, and long term care planning. Mr. Young is a Concord Elder Law Attorney with offices in Walnut Creek, CA.

In California, civil and criminal Elder Abuse Laws pertain to persons 65 years of age or older. Under the criminal statutes, elder abuse can occur when someone causes the elder to suffer mentally or physically. Under the civil statutes, abuse can mean neglect, causing financial abuse, abandonment, and physical harm or mental suffering. In addition, under the civil statutes, elder abuse can mean deprivation of care by the custodian of goods or services that the elder needs to avoid mental suffering or pain.

There are red flags to be on the outlook for regarding possible elder abuse, which many of us have seen. One red flag could be that the older person is not given the opportunity to speak for herself. Another red flag could be that the care giver or family member expresses anger toward the elder. A painful red flag is the isolation socially, of the older person. If you see signs of elder abuse, you should report it.

This information is not to be taken as legal advice, and you are encouraged to see an elder law attorney for your particular situation. 

Written Michael J. Young, lawyoung1@gmail.com, elder law attorney in Walnut Creek, CA. www.WalnutCreekElderLaw.com mike@WalnutCreekElderLaw.com. 1931 San Miguel Dr., Suite 220, Walnut Creek, CA 94596. 925-256-0298. Mr. Young serves Contra Costa and Alameda Counties, including the cities of Walnut Creek, Alamo, Danville, Concord, Brentwood, Pleasant Hill, Antioch, Clayton, etc.

We do Alzheimer’s planning in our lawfirm. This type of long term care planning includes, in part, the preparation of estate planning documents. These specialized documents contain required, updated language for asset protection and government benefits planning regarding Medi-Cal and the VA Aid and Attendance Improved Pension Benefit. Part of the planning may also include asset protection of the home and monetary assets.  

However, a big part of Alzheimer’s planning involves working with the family of the loved one who is afflicted with this disease. Alzheimer’s disease can last many years, and our relationship with the families we represent can be very long. As an example, my mother in law, who has Alzheimer’s disease, and who turns 90 next month, has been in a board and care facility for the last 10 years. Other than the disease, she is fairly healthy for a 90 year old.  She does not recognize her three “girls”, but she is being well cared for.  

Currently, there is no cure for Alzheimer’s, but there are treatments and services that will make life more bearable for the Alzheimer’s patient, and his or her family.  We offer  support for our clients and their families, regarding resources for care as part of the  long term care planning. We also encourage our clients and their families to become knowledgeable about the disease. For additional information regarding Alzheimer’s planning, please feel free to contact our office.

This information is not to be taken as legal advice, and you are encouraged to see an elder law attorney for your particular situation. 

Written Michael J. Young, lawyoung1@gmail.com, elder law attorney in Walnut Creek, CA. www.WalnutCreekElderLaw.com mike@WalnutCreekElderLaw.com. 1931 San Miguel Dr., Suite 220, Walnut Creek, CA 94596. 925-256-0298. Mr. Young serves Contra Costa and Alameda Counties, including the cities of Walnut Creek, Alamo, Danville, Concord, Brentwood, Pleasant Hill, Antioch, Clayton, etc.

The VA Aid & Attendance Pension Benefit is available for wartime veterans or their surviving spouses. For 2011, a single veteran can receive up to $1,644 per month, and $1,949 if married. The widowed spouse can receive up to $1,056 per month. This benefit is most helpful for payment of in home care, assisted living facility and board and care costs.

For qualification, the VA takes into account, among other things, income and assets. If the applicant’s income and assets are too high, he may not qualify. That is where planning by your elder law attorney, who is certified by the VA, comes in. In addition, when we plan for the VA Aid & Attendance Pension Benefit, we also plan for Medi-Cal benefits at the same time. Medi-Cal pays for nursing home costs after your Medicare days are used up. Nursing homes in our area can cost upwards of $7,500 or more per month. If you plan for VA alone, without taking into account the more stringent Medi-Cal rules at the same time, you may become eligible for VA but ineligible for Medi-Cal.

Beware of being asked to purchase an annuity to qualify for VA. We have been informed by clients and others that there are annuity salesmen out there, who are also usually not certified by the VA, who will ask you to purchase an annuity for VA qualification. I understand that they usually do not tell you about the annuity at first. The purpose for the sale of an annuity, from a legal perspective, is at best unclear, and is generally viewed by the elder law legal community as unnecessary.  Your elder law attorney can best help you with asset protection and planning, within the Medi-Cal and VA regulations, without the sale of annuities. Medi-Cal also has stringent requirements about annuities, which could make the Medi-Cal applicant either ineligible for Medi-Cal, or require him to pay more than necessary in the share of cost, which money goes from the applicant to the nursing home.  We receive calls from individuals, and their families, who are quite angry that they have purchased an annuity for VA qualification, angry that they do not understand what the purpose of the annuity was, and would like to know how to reverse the process. Your elder law attorney, who is certified by the VA, can best help you with long term care planning, asset protection, VA and Medi-Cal qualification, and estate planning at the same time, legitimately and within the regulations.

Written Michael J. Young, lawyoung1@gmail.com, elder law attorney in Walnut Creek, CA. www.WalnutCreekElderLaw.com mike@WalnutCreekElderLaw.com. 1931 San Miguel Dr., Suite 220, Walnut Creek, CA 94596. 925-256-0298. Mr. Young serves Contra Costa and Alameda Counties, including the cities of Walnut Creek, Alamo, Danville, Concord, Brentwood, Pleasant Hill, Antioch, Clayton, etc.

This information is not to be taken as legal advice, and you are encouraged to see an elder law attorney for professional advice.

Written Michael J. Young, lawyoung1@gmail.com, elder law attorney in Walnut Creek, CA. www.WalnutCreekElderLaw.com mike@WalnutCreekElderLaw.com. 1931 San Miguel Dr., Suite 220, Walnut Creek, CA 94596. 925-256-0298. Mr. Young serves Contra Costa and Alameda Counties, including the cities of Walnut Creek, Alamo, Danville, Concord, Brentwood, Pleasant Hill, Antioch, Clayton, etc.

This information is not to be taken as legal advice, and you are encouraged to see an elder law attorney, who is certified by the VA, for professional advice.

It is highly recommended for the older person, that their estate planning documents be put in place as early as possible, in order to help guard against elder financial abuse. It is when the older person begins to show signs of a loss of mental capacity, that financial predators step in to take advantage of the older person. We have been seeing more and more of this lately, possibly because of a downturn in the economy.  

Older persons should consider preparing their estate plans right away, especially for instance, if there are beginning signs of dementia, a diagnosis of Parkinson’s disease or cancer, or if the older person has fallen. You will be able to pick who you know and trust as your health care agent and agent under your financial durable power of attorney while you still have good mental capacity.

If you are uncomfortable with appointing family members for these rolls, consider appointing a professional fiduciary. California has a rigid licensing program for professional fiduciaries, and they can be used in these positions in order to avoid financial abuse. Professionial fiduciaries are able to assist early on with bill paying and money management.

Unfortunately, the highest percentage of financial abuse and exploitation of the older person, involves the elder’s family members. Many times it is a child who has been dependent for support on the older parent. This child is usually unemployable, in financial straights, won’t work and many times has substance abuse problems. Many times they will badger their parent into giving them money. The parent gives in, just to get them off of his or her back. I have seen children who are completely exasperated that their parents are living so long! The children want their inheritance now, and don’t see why they should have to wait!

Other signs of elder financial abuse can include large bank withdrawals that the older person cannot explain, or a new friend or housekeeper gaining access to bank accounts. Another sign of problems is that bills are not being paid.

When the estate planning documents are being prepared, also consider asset protection and government benefits planning language to be included in the various documents. If the older person loses capacity, the asset protection plan can still be implemented.

Written Michael J. Young, lawyoung1@gmail.com, elder law attorney in Walnut Creek, CA. www.WalnutCreekElderLaw.com mike@WalnutCreekElderLaw.com. 1931 San Miguel Dr., Suite 220, Walnut Creek, CA 94596. 925-256-0298. Mr. Young serves Contra Costa and Alameda Counties, including the cities of Walnut Creek, Alamo, Danville, Concord, Brentwood, Pleasant Hill, Antioch, Clayton, etc.

This information is not to be taken as legal advice, and you are encouraged to see an elder law attorney for professional advice.

When my elderly father would come to visit me, I would ask, “Where’s your cane Dad?” He would say that he didn’t need it, and that he was trying to build up his strength. He needed to use his cane though, because he would hang onto me or my brother, or hang onto whatever was close to him, like a lampost, etc.  One evening on a weeknight at about 3:00 a.m., my father called me to tell me that he had fallen. It was bad, in that he cut his head, and we had to take him to the emergency room.  He was badly shaken, and it took a long time for him to recuperate.

Injuries from falls from older people is a real concern. Statistics show that once an older person has fallen, they are likely to fall again, unless precautions are taken. Injuries are the fifth leading cause of death among older people, and 80% of those injuries are the result of falling. For older women, falls can more often cause bone fractures because of osteoporosis.  My older clients remind me of my parents, and I encourage them to use their canes or walkers.

We often receive calls from the loved ones of older persons who have fallen.  Many times it is a wake up call to get things in order, such as wills, trusts and other estate planning documents. The concern for planning for long term care for the older client becomes more critical.

Written Michael J. Young, lawyoung1@gmail.com, elder law attorney in Walnut Creek, CA. www.WalnutCreekElderLaw.com mike@WalnutCreekElderLaw.com. 1931 San Miguel Dr., Suite 220, Walnut Creek, CA 94596. 925-256-0298. Mr. Young serves Contra Costa and Alameda Counties, including the cities of Walnut Creek, Alamo, Danville, Concord, Brentwood, Pleasant Hill, Antioch, Clayton, etc.

Most estate planning documents are prepared for what happens when we die. They are not prepared for what happens if we don’t die. With regard to the trust, if one spouse dies, for instance, everything goes to the other spouse. When the second spouse dies, everything goes to the children. During the lives of the spouses, all assets stay in the trust. If any gifting is allowed, it is not to exceed $13,000 per year per child. If there is no trust, the financial durable power of attorney will usually not provide for any gifting or asset protection.

But what if we want to do Medi-Cal or VA Aid & Attendance Benefit planning, and the makers of the trust or the makers of the financial durable powers of attorney have lost their mental capacities. For this planning, we at times will transfer assets, including the home,  from the ill spouse to the well spouse. We might also make transfers of various assets from parents to the children or to other loved ones.  The language to do this type of planning, 99% of the time, is not included in the typical estate planning documents. If the makers of the documents have lost their mental capacities, we cannot do this planning, and may have to go to court to reform the documents. As a result, long term care planning should include updating the estate planning documents to include government planning and asset protection language.

This blog is for informational purposes only and is not legal advice. You should consult an elder law attorney for your particular case, and before you proceed with any planning.

Written Michael J. Young, lawyoung1@gmail.com, elder law attorney in Walnut Creek, CA. www.WalnutCreekElderLaw.com mike@WalnutCreekElderLaw.com. 1931 San Miguel Dr., Suite 220, Walnut Creek, CA 94596. 925-256-0298. Mr. Young serves Contra Costa and Alameda Counties, including the cities of Walnut Creek, Alamo, Danville, Concord, Brentwood, Pleasant Hill, Antioch, Clayton, etc.

When choosing an assisted living facility for a loved one who suffers from dementia, certain things should be taken into account regarding the facility. More and more assisted living facilities can now accommodate residents with various levels of dementia. Some facilities have separate wings or dementia units. I have visited many assisted living facilities, and have many clients with loved ones in assisted living facilities. In addition, I have made personal observations about the quality of care for persons with dementia in these facilities.

Music: My wife’s mother, who is 89, has advanced Alzheimers disease, and has been in an assisted living facility for a number of years. Although she does not seem to recognize her children, she does respond very positively to music. When music is played for her, or if someone performs or sings for her, her face lights up. She smiles, and tries to sing. I have noticed this for many residents with dementia, when I have played jazz piano for them in various facilities. Also, on researching the subject, it seems that music is processed and understood through a different part of the brain, usually with positive results.   As a result, find out if the facility you are interested in arranges for music to be played or performed for the residents on a regular basis.

Religious Services: Another item to take into account, is whether the facility is consistent with your religious beliefs. If the resident and family are religious, it will be important for them to have the facility provide religious services for their loved one during all phases of dementia. When my father, who was Catholic, was in an assisted living facility,  I know that he cherished receiving communion every week.  

Behavior: Find out whether the facility will be able to accommodate your loved one during all stages of the disease process. Plan for the future, as the disease may progress and become worse. Ask the facility what behaviors would trigger them to say that they can no longer accommodate your loved one. Also, ask how they would handle the behavior of your loved one if he or she becomes aggressive, loud, or acts out. You will find out more if you are very specific.  

 Written Michael J. Young, lawyoung1@gmail.com, elder law attorney in Walnut Creek, CA. www.WalnutCreekElderLaw.com mike@WalnutCreekElderLaw.com. 1931 San Miguel Dr., Suite 220, Walnut Creek, CA 94596. 925-256-0298. Mr. Young, who also advises on Medi-Cal qualification, asset protection, nursing homes and the VA Aid & Attendance qualification, serves Contra Costa and Alameda Counties in CA, including the cities of Walnut Creek, Alamo, Danville, Concord, Brentwood, Pleasant Hill, Antioch, Clayton, etc.