Caregiver Tip of the Month
— Advance Directives for Health Care —
and Power of Attorney for Financial Affairs
Situation. "Mom has been living with us for almost 20 years. She is going to be 70 this year. Do I need a power of attorney? What will it do for me if she has to go to the hospital? Will it make me responsible for her bills? This is something I never really thought about."
Response. It is very important for you and your mother to plan ahead – before an emergency arises and she is unable to give her permission. As much as you may wish otherwise, if you've just taken your mother to the hospital emergency room, it is not enough to say, "I have my mother's Power of Attorney and she has a Living Will. But I don't have it with me. It must be at her house – or in her safe deposit box – or with her attorney." While it may seem unfair, health care directives have absolutely no value unless they can be shown to medical personnel when and where they are needed.
Prepared ahead of time, a health care advance directive is a written document that says how your loved one wants medical decisions to be made if they lose the ability to make decisions for themselves. A health care advance directive may include a Living Will, a Durable Power of Attorney for Health Care, or both.
Most people should have 3 separate advance directives, each one of which has a different purpose:
Living Will – A legal document in which a person specifies which life-prolonging medical measures he or she does, and does not, want to be taken if they become terminally ill or incapacitated.
Power of Attorney for Health Care – A written legal document in which one person (the principal) appoints another person to make health care decisions on behalf of the principal in the event the principal becomes incapacitated (the document defines incapacitation). This instrument can contain instructions about specific medical treatment that should be applied or withheld. While its purpose remains essentially the same, the name of this document can vary from state-to-state; for example, in Florida it is called an Appointment of Health Care Surrogate. (Note: This document must not be confused with what most people call a Power of Attorney; that document usually confers only financial responsibility and has nothing to do with health care.)
Power of Attorney – A written legal document in which one person (the principal) appoints another person to manage the principal's financial affairs. Even though the intent is that the power of attorney will not take effect until the principle becomes unable to handle his or her own affairs, it actually takes effect on the date it is signed, unless otherwise specified. And, unless otherwise specified, the durable financial power of attorney applies only to assets owned directly by the principal, and not to any assets transferred into a trust by the principal. Unlike an ordinary power of attorney, a durable power of attorney remains in effect even after the principal can no longer manage his or her own affairs.
Because of the Patient Privacy Laws and Regulations, these documents are complex and must be written correctly to be usable. For the best results, we recommend that your work with an attorney who specializes in elder law. Check the yellow pages in your local telephone directory, or go to the National Academy of Elder Law Attorneys' web site. You'll find a link in the upper left corner (just below their logo) that will help you locate an elder law attorney.
Important Note #1: A power of attorney means nothing to Social Security and Medicare. To learn how to overcome that problem, see the September 2006 issue of our newsletter.
Important Note #2: Having your loved one's financial power of attorney does not make you responsible for their debts. But, there are exceptions. For example, if you agree to be the guarantor for the payment of their bills, or co-sign a mortgage or other type of loan with your parent, you will be responsible for paying their bills if they cannot pay them.
Important Note #3: Make copies – plenty of copies – of all 3 documents, along with medical information such as current medications and allergies, and doctors' names and phone numbers. Then, put a set in an envelope on your loved one's refrigerator where emergency personnel can readily find it. Put another set in your car's glove compartment. Keep a set a work. If you have to travel to see your loved one, keep a set in the suitcase you usually use. On your next visit to your loved one's primary care physician and all of his or her specialists, give a set to each one of them. And, give a set to everyone in your family who might be involved with your loved one's health care. Bottom line – you cannot have too many copies. Make extras and share them.
Our visitors ask ...
Q. I'm planning ahead for the later years of my retirement. This includes evaluating my options as to where I may be living if and when my health begins to decline. Where can I find official ratings for continuing care retirement communities, independent living facilities, assisted living facilities, and nursing homes. Are there any websites where consumers rate the various communities and facilities based on their own personal experience, or that of an older loved one?
A. Unfortunately, there is no single source of ratings for the quality of care provided by retirement communities, independent living facilities, assisted living facilities, and nursing homes. What information does exist is rather piecemeal and of varying reliability. And, generally speaking, the less care provided by a particular type of community or facility, the less information is available. That said ...
HealthGrades.com is an excellent source of unbiased, inexpensive nursing home ratings. (Click on Find and Compare Nursing Homes.)
The Centers for Medicare & Medicaid Services include their inspection results in free reports available online. While not as comprehensive as HealthGrades, the reports for facilities on your list might alert you to potential problems or special areas of interest. For their latest information, go to Medicare's Nursing Home Compare. For your information, they also offer Hospital Compare and Home Health Compare (the latter includes only home health agencies which provide skilled nursing care and/or rehab therapy, not agencies which provide only companion care and light housekeeping.)
Senior Approved Services is a new and growing national network of health and elder care resources and services that are endorsed by seniors and family caregivers. Among others, these resources does or will include retirement communities, independent living facilities, assisted living facilities, and nursing homes. Each health and elder care business within their directory of services adheres to a code of ethics in its daily operations.
A somewhat more expensive rating service is CareScout.com. Their nationwide ratings cover nursing homes, home health agencies and more than 40,000 assisted living facilities.
Regarding nursing homes and board and care homes (the latter includes assisted living facilities), you may be able to get additional information regarding complaints from your nearest long term care ombudsman. The National Long Term Care Ombudsman website has a locator service (Find your State Ombudsman) directly under their column entitled, Who are Ombudsmen?. (In case you are not familiar with Long Term Care Ombudsmen, they are independent resident advocates, funded by the federal and state governments, who work to resolve problems between residents and assisted living facilities, nursing homes and other residential care facilities.)
Finally, you may wish to speak with your State's Attorney General's Office and your local Better Business Bureau office. Ask if any complaints have been filed with them regarding the retirement community or long-term care facility in which you are interested. Your State's Attorney General's Office may also be able to tell you which state department regulates the financial aspects of continuing care retirement communities.
Daily Living Solutions
— products for seniors —
As we grow older, it often becomes difficult to use many everyday products because of arthritis and other conditions. If you or a loved one needs a little help – or a lot – we've selected a group of practical and affordable solutions from our affiliated merchants to help overcome those limitations.
Whether you are looking for yourself, or to help an elderly senior continue living in their own home, you'll find a wide variety of supplies and accessories – raised toilet seats, safety rails, incontinence supplies, large-handle eating utensils, pain relief, diabetic supplies, pill splitters and crushers, big-button telephones, canes, walkers, rollators, wheelchairs – and much more.
Everything is sorted into convenient categories in our Solutions for Seniors section.
Caregiving – Finding the money for care at home
A variety of resources can help pay for care at home. We discuss these resources in some detail in our article 12 tips to help you find money (and free resources) for care at home.
Caregiver Tip #2
— Tax Deductions for Medical Care —
(a timely reminder originally published in our February 2005 issue)
Facility-Based Care. All nursing homes, most assisted living facilities, and some independent living facilities (usually those that are part of a continuing care retirement community) provide some medical services for their residents. According to the Internal Revenue Code (Section 213), a portion of the fees paid to the facilities may qualify as a tax-deductible medical expense. The tax-deductible portion is often referred to as the medical care component. It applies even if a resident is not living in the facility primarily for medical reasons.
Early each year, each facility should provide its residents with a written statement that shows the medical care component. If your (or your loved one's) facility has not done so by mid-February, ask them to prepare the statement for you. You'll need it before you can finish filling out your (or your loved one's) tax returns.
Financial Support. If you provide more than half of your loved one's financial support, even if they live in their own home, you may be able to claim them as a dependent on your federal income tax return, and possibly deduct some of their medical expenses. See a qualified tax accountant for more guidance regarding the IRS requirements.
If your mother and/or father moves into your home, you might also qualify for a tax-deduction, regardless of whether you do or don't modify your home to accommodate them.
If you do modify your home, at least a portion of the expenses you incur for modifying your home COULD be deductible in the year you pay them. (FYI: Section 213 defines tax-deductible medical and dental expenses.) Whether you actually can deduct those expenses depends upon many variables including:
1. Does your mother or father qualify as your dependent for tax purposes?
2. Is your tax accountant intimately familiar with Section 213 as it pertains to qualified long-term care expenses? Or, can he or she read the Internal Revenue Code just as well as anyone else? (You want the first type of accountant!)
For more insight as to what the IRS rules are (including the definition of a dependent for tax purposes), Section 213 is explained in IRS Publication 502 (to see it, simply click on the underlined link – it may take a few minutes to download if you use a dial-up connection).
If any of these situations might apply to you, we highly recommend that you discuss them with a qualified tax accountant.
Our visitors ask ...
Q. I am currently living with my father who is 85. He has become quite dependent on me to do a lot of the everyday things such as general clean up of his home, yard work, getting the garbage to the curb every week, and all the tasks of running his home. I am facing surgery this Spring. What services are available to him and myself when I am unable to do these everyday tasks to keep our home running smoothly?
A. First, call the Eldercare Locator or check out their website. Developed by the U.S. Administration on Aging, the Eldercare Locator is a free public service. It helps older people and their caregivers find local support services to help them live independently and safely in their homes and communities for as long as possible. Look for the resources you need by following the easy directions on their website (click on the link above). Or, call their toll-free telephone number 1-800-677-1116, between 9 am and 8 pm weekdays, Eastern Time.
Second, check out BenefitsCheckUp.org online. Millions of older adults are eligible for federal and state benefits, but are not receiving them, including assistance to pay Part B and Part D premiums for Medicare benefits. This is unfortunate because these programs can help with housing, meals, transportation, health care, prescription drug costs, legal services and utility bills, just to name a few.
Benefits CheckUp is a service of the National Council on the Aging, a non-profit organization. It helps older adults quickly and easily find out which benefits they qualify for, and how to get them (many are available regardless of income). This is a free service and is completely confidential. It does not require your name, address, phone number, Social Security number, or any other information that could be used to identify you.
Simply complete the online questionnaire. In a few minutes, you'll have a list of programs for which you or your loved one most likely qualifies, including phone numbers and addresses. It also includes step-by-step instructions on how to apply for the benefits. To visit Benefits CheckUp, click on http://www.benefitscheckup.org/.
Third, even though it will cost more than the other resources described above, what you are looking for is called respite care. Respite, a break for caregivers and families, is a service in which temporary care is provided to a child or adult with disabilities, or chronic or terminal illnesses, and to persons at risk of abuse and neglect. Respite can occur in out-of-home and in-home settings for any length of time, depending on the needs of the family and available resources. Check out the ARCH National Respite Network's website. Use their National Respite Locator Service to locate respite services; it's at the bottom of their web page at http://www.respitelocator.org/index.htm.
Recommended Reading and Videos
Many excellent books and videos can help guide you through the caregiving process. For our recommendations, including a brief description of each one, click here.
For more helpful information from our website, click here. To see previous issues of this newsletter, click on Archives.
Aging Solutions is a free service of:
Solutions for Seniors, Inc.
1051 E HILLSDALE BLVD
FOSTER CITY, CA 94404
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