By:  Nicole T. Livingston, J.D. – Associate Attorney – nicole@elvilleassociates.com, 443-393-7696

Some clients are reluctant to share their planning with their family. You may feel the plan is private or needs to wait to be unveiled at the time of your death. Perhaps, you do not want to create tension if you chose one family member over another to act as your executor or power of attorney. Many may be uncomfortable bringing up the topic for fear of the reaction from family members. We have found by explaining your estate plan now and having regular meetings with your executor can prevent problems during the administration process. You can tackle difficult issues while you have an opportunity to express your thoughts and feelings. Waiting for the big reveal after your death can cause some families to break up and never speak to each other again.

A good way to start the discussion is to have a family meeting with your estate planning attorney and other advisors, such as your financial advisors and certified public accountant. At Elville and Associates, we encourage you to schedule this meeting with us. We can lead the discussion and bring up uncomfortable topics in a nonconfrontational style. Explaining how your plan works to your family members will allow them to understand why decisions were made and give them an opportunity to ask questions.

Start with a convenient time and location for family members to meet. Your attorney’s office is a good location because it conveys the seriousness of the discussion and allows for a clear beginning and end time. Allowing family members to participate and ask questions directly to the drafting attorney may clear up misperceptions they may have. This first step opens the door for more discussions in the future to be held in a less structured setting. During this meeting, no financial discussions of the size of your estate or specific values of your assets needs to be discussed. Instead, the meeting can explain the documents you have prepared and what the family can expect upon your death or if you become disabled.

Initially, there may be anxiety associated with the meeting due to sensitive issues that may be discussed. Planning involving a blended family or a beneficiary who may not be financially responsible to control the inheritance that you leave to him or her can be challenging. If trusts are involved, your attorney can explain why and how they are being used. Your values in creating the plan the way you did can be explained and understood by your family while you are living. No one wants to leave a mess behind and opening this discussion during a family meeting is a good first step to take to leave behind a legacy rather than a lawsuit.

You need to discuss with your health care agent your decisions for end of life care. During the estate planning process, you signed an Advance Medical Directive. The family meeting is an opportunity to discuss the decisions you made. If you allowed your agent to have flexibility, then explain what you intended this to mean. For example, you may have requested a feeding tube if you are unable to take enough nourishment by mouth. You can discuss with your agent for how long this may last. If the decision is made for you to enter hospice, let your agent know it is okay to discontinue the feeding tube. At some point, with a persistent vegetative state, a feeding tube may be prolonging your life with extraordinary medical bills. This may not be what you intended. You may have wanted a feeding tube for comfort and now it is a burden. It is difficult to document all the variables in a health care situation which is why it is important to have a discussion now about your health care.

Writing a statement about your goals and values and what is especially important to you during the last part of your life can alleviate stress and anxiety family members experience when trying to make final decisions regarding your life. You can locate this paragraph in Part II: Treatment Preferences (“Living Will”).

Part III of your Advance Medical Directive allows you to state your wishes regarding your funeral and burial arrangements. You may have decided who should make decisions about the disposition of your body, but you may not have discussed with them what you desire. Some funerals involve many decisions that are like planning a wedding; however, the time frame is much shorter – often having to plan everything within a week or two. The decision of burial or cremation is only the beginning. Your agent may have to locate a church and decide on a ceremony. Or you may desire a memorial service with no religious affiliation. Decisions regarding gospel verses or specific bible readings and who will read them, songs and whether you want a choir or a specific soloist, and the type of church ceremony or memorial service and whether a casket or urn is present will all have to be decided quickly. After that a location for a repast might be required which involves food and beverage selections. Notifying friends and family may be challenging to handle alone and often involves coordination of travel and lodging arrangements. Decisions about flowers or donations in lieu of flowers to a specific charity can be challenging if family members do not agree. Often the task of writing an obituary falls on your agent. It can be contentious if family members all want to have input. You can alleviate some of this burden by discussing your wishes now.

One final thought – your agent needs to have access to these documents. Whether you join DocuBank to store your documents or you use a home safe, you need to inform your agent where the original documents are located and how to access the safe if you are placing your documents in one. Providing your agent with copies now is also a prudent decision. After signing your estate planning documents, you have some work to do to make sure that your wishes are properly followed. We feel a family meeting is the best first step to accomplish this task.

Tags: estate planning
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By: Stephen R. Elville, J.D., LL.M. — Principal

They say that if you simply hang around long enough you will likely see it all. This seems to be the case with one new law that was recently passed by the Maryland Legislature, the new elective share law (House Bill 99; Senate Bill 192), otherwise known among lawyers as the “augmented estate” or “new elective share” legislation. This legislation “hung around” for the past several years and finally will become law (effective October 2020). Here is a brief history.

Under present (still currently existing) Maryland law, a surviving spouse was entitled to elect against the will of his or her deceased spouse to receive one-third (1/3) if there was surviving issue of the decedent, or one-half (1/2) if there were no surviving issue of the decedent, of the “net estate” – basically the net amount of the probate estate. This meant that a spouse with bad intentions could disinherit the surviving spouse by up to two-thirds (2/3) and the surviving spouse could only exercise a right of election over the limited statutory amount of the net probate assets described above. Unfortunately for the aggrieved spouse, this also meant that he or she (likely she) had no right of election over assets owned by the deceased spouse that passed outside of probate (passed via non-probate transfer) such as joint accounts, transfer on death designations (TOD), payable on death designations (POD), beneficiary designations (IRAs, Qualified Plans, and life insurance), and real property passing by life estate deed. As a result, a spouse with bad intentions could disinherit a surviving spouse by sixty-six and two-thirds percent (66 2/3%) of the net probate assets, and one hundred percent (100%) of non-probate assets.

Then, beginning in 1990 and leading up to 2008, two cases Knell v. Price, 318 MD. 501; 569 A.2d 636 (1990), and Karsenty v. Schoukroun, 406 MD 469; 959 A.2d 1148 (2008) changed the status quo, but did not move the needle enough to give a surviving spouse meaningful rights to non-probate property to which they were arguably entitled. Although a full analysis of these cases is beyond the scope of this article, they stand for the proposition that a surviving spouse is entitled to an elective share over an estate broader than the probate estate – an augmented estate that includes not only the traditional net probate estate but also the non-probate assets of the decedent spouse. These cases, especially the latter, established certain tests, approaches, and factors by which a court could determine whether the nonprobate assets of the decedent would be subject to the elective share of the surviving spouse. Although these cases represented progress, an aggrieved surviving spouse nonetheless remained in a situation of great legal uncertainty and disadvantage, considering that more likely than not she would have to engage in costly and protracted litigation to prevail on the issue of electing against the augmented estate of the deceased spouse.

With the passage of the new elective share law, the Registers of Wills and the Courts will take a formulaic approach designed to bring sensibility and fairness to this complex issue, for both spousal and non-spousal beneficiaries. This will most likely be a difficult and arduous process for all parties involved, especially after implementation in 2020. Since most traditional couples – couples where the union was a first marriage and children from that first marriage exist – leave assets for the benefit of the surviving spouse either outright or in further trust, and the non-probate assets of the deceased spouse usually flow by beneficiary designation to the surviving spouse, the new elective share law will have little or no impact those couples. However, and there are many examples too broad in scope to discuss here, two main categories of surviving spouses will be impacted the most, as follows: (1) the second (or more) marriage surviving spouse with or without children of their own; and (2) the disabled surviving spouse.

The surviving spouse in a second, third, or more marriage who has been disinherited by their deceased spouse, usually because he or she has children of their own or other relatives to whom they intend to leave assets at their death (the death of the first spouse to die), will be impacted by the new law. Furthermore, it is important to note that even more impact will inure to the deceased spouse and his or her children because of the new law. The reason is simple – under the new elective share law, where an uninformed spouse in a second or more marriage who with or without the mutual agreement of their spouse leaves assets to their children or other relatives, a very common occurrence), the surviving spouse may thwart the estate plan of the deceased spouse by electing against the probate and non-probate assets of the decedent. This situation may only be legally avoided through the use of pre-nuptial or post-nuptial agreements that specify the waiver of the surviving spouse’s right to a spousal elective share.

Spouses who die leaving a disabled spouse will fare better, and the new elective share law allows for the placement of the surviving spouse’s elective share amount into a testamentary special needs trust (a common practice among elder law attorneys) without exposing that statutory elective share amount to the claims of Medical Assistance. This carve-out exception means that elder care planning for spouses where one spouse has an impairment or other disability can continue unabated – a happy result for the benefit of couples who wish to be proactive under circumstances where choices otherwise seem very limited and where long-term care costs continue to devastate family finances.

In summary, the new elective share law which had previously confounded lawmakers, the Registers of Wills, and others for several years is now the law in Maryland effective next fall (fall 2020). Those persons who plan to disinherit their spouses for bad-intentioned purposes (likely very few), or remarried spouses who plan to leave assets to their children from a prior marriage should they be the first spouse to die (in the new marriage), should take notice of this new game-changing law. Pre-nuptial and post-nuptial agreements, already important asset protection planning tools in and of themselves, will now take center stage as a first and preeminent step in estate planning for many couples, and an important point of client education for all.

Tags: The New Elective Share/Augmented Estate Legislation
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By:  Stephen R. Elville, J.D., LL.M. – Principal

Many of us remember the Hawaii ballistic missile red alert that was issued in January of 2018, the one that fortunately turned out to be a false alarm. How could such a thing happen? How could a drill go so wrong and cause so much damage? Estate planners, CPAs, and financial advisors are asking themselves similar questions right now about the proposed SECURE Act, except that this may not be a drill – it may be the real thing. The SECURE Act may impact your estate planning in a significant way – in particular, estate planning for retirement plan assets. The SECURE Act (House of Representatives’ version – the 10-year plan) recently passed through the House by way of a 417-3 vote. The Senate is proposing a 5-year plan. Although it is unclear which plan will go forward, it is anticipated that one of the two plans will pass in both the House and the Senate and be signed into law by President Trump soon. If this comes to pass, the new law would go into effect for decedents dying after December 31, 2019 (effective in 2020).

Why is the SECURE Act important and what should you do? The SECURE Act will directly impact the length of time IRAs and Qualified Plans can defer income tax and be stretched. Unlike the current law allowing inherited IRAs to be stretched out in accordance with IRS life expectancy rules, the SECURE Act would limit the stretch out of IRAs to either 5 or 10 years, with some exceptions (including spouses, persons with disabilities, and chronically ill persons). And yes, the Act also applies to Roth IRAs. Before I go any further, let me say right here – there is no doubt the SECURE Act is POTENTIALLY TERRIBLE FOR CLIENTS, and many of our clients are already very upset at the prospect of their estate planning being disrupted, along with lifelong plans to leave children, grandchildren, nieces and nephews, or others retirement plan assets over individual life expectancies thwarted. Nonetheless, all we can do is prepare for the coming changes and get ahead of the income tax planning implications. Along these lines, if the SECURE Act becomes law in its current proposed form, you will need to be aware of the following:

(1) Conduit trusts will no longer be a long-term viable asset protection planning tool – with all distributions being forced out to the beneficiary in 5 or 10 years, this technique will be relegated to the shallow end of the pool;

(2) Accumulation trusts will likely become a tool of choice – however, state law is crucial to success and how much income must be distributed out;

(3) Roth conversions will become a main strategy for dealing with the new law;

(4) Charitable remainder trusts and direct charitable gifts will be utilized as powerful strategies for attaining stretch out for certain clients who are charitably inclined;

(5) Traditional notions such as the deceased spouse leaving 100% of their IRA or Qualified Plan to their surviving spouse may change – for example, it may be advantageous for the surviving spouse to disclaim a certain portion to children, while retaining the balance;

(6) Migrating IRA funds into life insurance will become an even more powerful alternative strategy; and

(7) Some clients may utilize the laws of certain states with no state income tax to gain an advantage.

I hope this brief but critical information about the proposed SECURE Act is helpful to you. I will be discussing the impact of this potential legislation with clients, helping to make sense of the changes that are likely to come, and advising about any needed planning adjustments. If you would like to speak with a member of our estate planning team about this unprecedented situation, please contact Mary Guay Kramer at mary@elvilleassociates. com or Lainey Olson at lainey@elvilleassociates.com. Otherwise, we will be sending out further communications about the SECURE Act as things develop.

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If you are a part of the millennial generation or younger, there is a steady path you can pick that can over time make you a self-made millionaire. It does not require a unique set of skills, specialized knowledge, or even excessive risks. Americans who achieve millionaire and multi-millionaire status using this technique took an average of about 32 years to accumulate multi-million dollar wealth with some achieving it in as early as 18 years. They are called saver-investors, and when you encounter one, at first glance, they might not seem that rich.

Saver-investors typically are ordinary people without any particular advantages in life. They did not come from a wealthy family. Nor did they have unique or advanced skill sets that brought in high salary income. Primarily, investor-savers did not attend elite universities, get advanced degrees, inherit money or own high-end cars, clothes or homes. What saver-investors do have is the disciplined ability to follow two simple rules. The first rule is you must save 20 percent or more of your income and have the discipline to live off of the other 80 percent. The second rule is you must consistently and prudently invest your savings. Prudent investing means doing your homework for each investment vehicle and then continuously monitoring its progress. Typically, a saver-investor puts their money in retirement plans like a 401(k), equities, and real estate and then let valuations grow.

If the key to building wealth is so simple, then why isn’t everyone rich? Quite simply, it comes down to habits, the financial habits of people. It requires enormous fiscal discipline and a long-term commitment to become a saver-investor. It can require sacrifices, like running a side business or working a second job. John Jacob Astor famously said, “Wealth is largely the result of habit.” Long-term wealth creation is built on the foundation of consistent application of sound financial habits.

One habit is to eliminate distractions by learning how to say no often. If something is not aligning with your goals and dreams and will keep you from moving forward, it is a distraction and should be eliminated. When you do say yes, say it infrequently. Say yes to the things that are directly tied to your goals and dreams. Every day you need to learn something new. Grow your financial literacy and develop new skills. Use this new knowledge or expertise often to maintain and perfect your skills. Save money because it gives your options, empowers you, and gives you freedom. Opportunities are only as good as the financial resources you have to take advantage of them. Surround yourself with other like-minded individuals because social circles influence our feelings, thoughts, and behaviors. Calendar your day by the hours or even half hours to be highly effective. Isolate blocks of time in pursuit of those things that will help you build a foundation for success through financial independence. Finally, develop patience. Acquiring wealth as a saver-investor takes time. When things get tight in day to day life, remember to survive until you thrive. It isn’t good luck that is going to make you wealthy; it is the persistence of good financial habits that will.

Part of living off 80% of your income includes choosing to live a modest life. Warren Buffett famously still lives in his first home purchased in 1958. Drive an ordinary car and wear simple clothes and jewelry. If you have children, send them to public schools. If they need more or better education, then supplement their learning by teaching them or signing them up for free online courses. There has never been a better time for humans to become knowledgeable about how to gain wealth. The internet has put a wealth of information in the palm of our hands. If you genuinely want to be wealthy, then develop good habits, live beneath your means, and employ the saver-investor method.

The next step is to plan to protect your wealth. Give us a call to discuss your planning options or options for if you’re planning for a loved one. You can reach any of our six locations in Maryland by clicking here to send us a message or by calling us at (443) 393-7696.

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When a loved one enters hospice care, the whole point is to provide peace of mind and comfort to the patient and the family. And yet a lack of regulation, oversight, and available information means that isn’t always the case.

The HSS Inspector General has found that, between 2012 and 2016, health inspectors cited 87% of hospices for deficiencies. In 20% of hospices, these deficiencies were serious – serious enough to endanger patients. For-profit hospice agencies are more likely than to have non-profits, likely because decreasing staff increases profit margins.

There aren’t many options for the Centers for Medicare and Medicaid Services (CMS) to discipline hospices. They can drop hospices from the Medicare program, but they can’t assess fines or install temporary management. Many complaints can’t be substantiated, and even when they are, that information doesn’t become readily available to consumers. CMS could put citations for deficiencies and complaints on their website for consumers, Hospice Compare, but they don’t.

The CMS Inspector General has recommended that legislators strengthen hospice standards, increase inspections, streamline the complaint and investigation process, and improve accountability and availability of information. Whether we will see improvements in the near future remains to be seen.

Choosing long term care for a loved one can be challenging. We help families find good long term care and work with them on how to pay for the care. If you would like to talk about your needs, please don’t hesitate to reach out.

You can get in touch with any of our five Maryland offices by clicking here to send us a message or by dialing (443) 393-7696.

Read more at:

• https://www.npr.org/sections/health-shots/2019/07/09/739471717/hospice-oig-reports
• https://www.latimes.com/local/california/la-me-lopez-hospice-complaint-20190216-story.html
• https://www.latimes.com/california/story/2019-08-09/hospice-mother-california-complaint

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By:  Jeffrey D. Stauffer – Community Relations Director

As one of only fifty (50) Client Care Programs in the United States accredited by the Client Care Academy in Boston, Elville and Associates’ Client Care Program (CCP) mission is to provide Members with the comfort and assurance that their estate and elder law plans will stay updated over the passage of time and that clients and their families receive the education they need. The attorneys and staff at the Firm work diligently to deliver Member services that stand out for their excellence and integrity, and most importantly, that elevate how families are cared for. As the CCP recently surpassed its three-year anniversary, Member benefits continue to grow in scope and depth. As a Member organization, you will want to be sure to take advantage of all the benefits to which you are entitled through the CCP. These benefits include:

Access to Attorneys and Staff

The members of our team will be reasonably available to answer your questions, either by telephone or email, whenever and as often as you would like, including in-person meetings as needed.

Client Education Services

The CCP will provide regular educational workshops for our client Members, their families, successor trustees (and other fiduciaries), and planning team. The topics of these workshops vary and have recently included changes to the trust and estate tax laws, what successor trustees should do if you become disabled and when you die, how to maximize your Social Security benefits, estate and trust administration, and much more. Each fall we will also invite you to our annual Client Education Event.

Document Updates

Our attorneys will review your estate planning documents whenever you reasonably request, and at least every two years, and we will update your planning as the laws change, when your personal situation or goals change, and as the nature and value of your assets change. This will ensure that your estate plan will always be up-to-date.

Asset Review, Tracking and Updating

We will provide regular reviews of your estate plan asset funding and alignment, and will also provide regular funding and alignment updating to ensure that your trust or will-based plan is fully aligned and will work as it was intended.

MIDEO® Consultation and Card (**NEW**)

In the first-of-its-kind partnership in the country, Elville and Associates and The Institute on Healthcare Directives have partnered to offer MIDEO® (My Informed Decisions on VidEO) to our members. MIDEO® is a personalized card with your critical healthcare information on the front that also hosts by video, accessible by a QR code scan, your prerecorded wishes for resuscitation and other healthcare choices. By providing an accurate, up-to-date, easy to review video of you speaking, your personal MIDEO® card will accurately allow your wishes and choices to be carried out correctly by medical professionals. For more information about MIDEO® and The Institute on Healthcare Directives, please contact Community Relations Director Jeff Stauffer, visit www.institutehcd.com or contact Ms. Brandi Monroe at the Institute at monroe@institutehcd.com.

Family Heritage Video

Members are encouraged to participate in their own archival family video production at the Elville Creative Studio in Annapolis. Family members may express themselves and share whatever they want for future generations to remember — their wishes for family, values important to them, old stories they want to pass down for generations to come, and much more. There are no limits and the creative possibilities are endless.

Family – Advisor Meeting

Within sixty (60) days after your estate plan is completed (or as soon thereafter as you can arrange for all of your family to participate), we will provide you the opportunity to have a family meeting, to include members of Elville and Associates, your family members, and your financial and professional advisors (those persons who will implement your plan) so we can answer any of their questions, explain how your planning works, and explain how to settle your estate plan upon your passing. The importance of the Family-Advisor meeting cannot be understated.

Coordination with Advisors

Our staff will be available to consult with your financial advisors, accountants, insurance professional, and geriatric care managers. If you do not currently have one of these all-important advisors available to you, we will work in partnership with you to find an appropriate professional relationship that fits your family’s needs. Our staff will also provide copies of your documents should you so request.

Additional Participation Benefits – DocuBank and Everplans

We will provide free notary public services as and when needed and will provide copies of your estate planning documents to your advisors and others upon your request. You will be enrolled in a health care document retrieval service called DocuBank which provides 24-7 access to your medical records and other documents. You will also have the option of enrolling in Everplans, a state-of-the-art, secure digital archive for all of your essential information (everything your loved ones will need should something happen to you).

Elville and Associates’ first CCP Continuing Legal Education Event of the year, “Navigating Longevity,” was held on Saturday, March 16th on the Arnold campus of Anne Arundel Community College. Led by one of the region’s most soughtafter speakers, Ms. Ellen Platt, MEd, Certified Rehabilitation Counselor and Certified Geriatric/Life Care Manager with The Option Group, members and their families were taken on a journey through geriatric care management; cognition, brain health, and dementia; care options; and taking care of the caregiver.

Summertime means fun in the sun, trips to the beach, cookouts, and the CCP’s annual Social Event! On Sunday, July 21st, members and their families enjoyed an evening showing of the smash-hit musical, “Grease,” at Toby’s Dinner Theatre in Columbia. After a dinner buffet was served before the sold-out show, guests were taken back to the 1950s with Danny, Sandy, the T-Birds and Pink Ladies! A stellar cast brought the timeless classic to life as they acted and belted out “You’re the One That I Want,” “Summer Nights,” Hopelessly Devoted to You,” “Greased Lightnin’” and more to the delight of the audience.

Elville and Associates’ is pleased to announce its 7th annual Client Event will be held on Saturday, October 12th, 2019 from 8:30 to noon at the Retreat and Conference Center at Bon Secours in Marriottsville. This year’s theme is “What Families Need to Know about Planning for Loved Ones with Disabilities.” Along with a superb lineup of presenters, delicious food, door prizes, gift baskets and concert ticket giveaways will highlight the morning, and entertainment will once again be provided by the Max Vanderbeek Jazz Group – a professional jazz trio led by one of the Elville Center for the Creative Arts’ finest school partners and music directors, Dr. Maximus VanDerbeek of Wiley H. Bates Middle School in Annapolis. Presentations will include “Financial Planning for Special Needs,” “The State of Special Needs Planning Today,” “An Overview of Waiver Programs,” “Special Needs Planning and the Augmented Estate,” and a “General Legislative Update.” Invitations will be forthcoming in mid-September, and we kindly ask that all RSVPs are finalized by October 4th. Seating is limited and the event will “sell out,” so contact our office to reserve your seat soon!

To learn more about the CCP, its many benefits and how to become a member, please contact Mary Guay Kramer, Client Care Program Coordinator, at 443-741-3635 or mary@elvilleassociates.com.

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By:  James M. Dore, J.D.

Consider the following scenario – a couple got married and had two children, a son and a daughter. After many years of marriage and raising the children into adulthood, the wife took ill and passed away. In the year following his wife’s death, the husband executed a Last Will and Testament that named his two adult children as legatees, and designated the daughter as primary Personal Representative (PR) of his estate and the son as the alternate PR. Several years later, the husband remarried. This second marriage lasted over ten years and was by all accounts a happy one. Although the husband allegedly made statements to several individuals about his desire and need to update his estate plan to provide for his new spouse, he never took formal action to do so. After the passage of more time the husband ultimately died, leaving his widow to deal with an outdated estate plan.

Several weeks after her husband’s funeral the widow received a letter from the husband’s daughter, who was acting in her capacity as PR of the husband’s estate. In her letter the PR alleged that because the widow was not named in her late husband’s Will, she was not entitled to inherit from her husband’s estate. The PR enclosed a check payable to the widow in the amount of $10,000.00—purportedly given the widow as some sort of consolation– along with a “Waiver and Assignment” by which the PR asked the widow to waive her right to the estate and assign the entirety of her interest thereto to the son and daughter.

Although the relationship between the widow and her husband’s children was cordial, it was not close. Further, the widow was not a native English speaker and, despite being fluent in two other languages, her English was not strong. Unsure of her rights and not wanting to make waves, the widow signed the Waiver and Assignment and returned it to the PR. She did not deposit or cash the check.

The widow was left unsettled by the situation and, questioning whether she did the right thing, sought the advice of friends a few days after returning the signed Waiver and Assignment to the PR. Upon learning of the widow’s predicament, her friends wisely urged her to seek counsel experienced in probate law and estate litigation.

The widow’s counsel immediately took action to revoke the Waiver and Assignment, and to claim the widow’s Elective Share of her late husband’s estate pursuant to Section 3-203 of the Estates & Trusts Article of the Annotated Code of Maryland.

The foregoing case study presents another example of why proper estate planning is important, especially when important changes such as subsequent marriages occur. If you would like to learn more about estate planning or if you have questions or concerns regarding your current estate plan in anticipation of important life changes that may be forthcoming, please call us at Elville and Associates. We are ready to assist you.

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The traditional senior housing market is undergoing a profound change. In 2018 senior housing occupancy fell to an eight-year low, even as the senior population continues to increase, as competition for the younger baby boomer market is ramping up and forcing a change to more traditional independent and assisted living options. Active adult concepts like Margaritaville are addressing this market segment that is turned off by the idea of “senior living.” Atria Senior Living is in a joint venture with Related Companies to build $3 billion in senior luxury housing in major metro areas while overall multifamily development with an intergenerational mix of renters is also fragmenting the traditional senior housing market. Occupancy challenges in traditional independent living and assisted living communities are also finding the retention of a reliable workforce to be a continuing challenge. The truth is that the advent of smart home technology and on-demand services ordered via a smartphone, as well as home care aides, are enabling apartments and single dwelling living for more extended periods than ever before. Younger seniors tend to want to age in place for as long as possible.

In the skilled nursing arena, Medicare fee-for-service payment reform brings forward three major provisions: the change to the case-mix classification system, the skilled nursing facility Value Based-Purchase Program, and the skilled nursing facility Quality Reporting Program. The case-mix model focuses on the patient’s condition and resulting care needs rather than the number of care services provided to determine Medicare payment. The Value Based-Purchase Program shifts Medicare payments from volume to value-driven. Finally, the skilled nursing facility Quality Reporting Program is designed, through innovation, to provide meaningful, quality measure reporting, a reduction of paperwork, and a lowering of administrative costs.

These and other changes in Medicare are helping to create an influx of capital into the senior care market incentivizing innovative partnerships and cross-continuum service development. Investors and providers will be partnering with Medicare Advantage payors, retail giants, home health, pharmacies, technology, and other provider groups to reinvent and manage the quality and cost of senior care housing, products, and services. This influx of investment capital combined with technology is destined to create fresh ways to approach senior living needs and the services that provide for them. Web-based platforms and data analytics software continues to address the battle for the retention of the health care workforce while Telehealth solutions are enabling elders in rural markets to reach providers and connect with specialists. Voice recognition software is increasingly being integrated into resident units whether they are private homes or pay for service facilities. Partnering opportunities and joint ventures will continue to create new service models that will, in particular, meet the needs of home and community-based services.

When aging in place is no longer a viable strategy a senior is faced with where to go next. Marketing senior housing to the younger baby boomers is changing, and it is data-driven. In particular, the adult Gen X children of these seniors are helping their parents to make informed decisions, and they typically get their information from online sources. Social media has become a tech tool replacing older marketing models of senior housing communities. Operators can tell their stories, address negative reviews, promote positive news items, and create conversations. Gen X adult children will be looking at social media platforms to get real and varied opinions to validate their parents’ choices.

As Medicare Advantage increases its integration in the overall health care system, data collection and its conclusions are more critical than ever. Potential residents will also be addressing concerns about health care data. More data is being gathered than ever before by Centers for Medicaid and Medicare Services (CMS) on hospital readmission rates, the prevalence of falls, and other related health information and consumers will demand to know what these statistics are before entering into a contract with a senior living community.

Seniors are being presented with more living options than ever before and the competition for their dollars will keep providers in the senior living industry highly focused and fiercely competitive. Questions facing seniors include: How and where do you want to live as you age? Are you well informed about the changing options available to you? Do you have a plan in place that is legally documented for the stages of your senior life? We can help. Give us a call and let’s start planning together.

Get in contact with Elville and Associates at any one of our five Maryland locations by sending us a message here or by calling us at (443) 393-7696.

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By:  Lindsay V.R. Moss, J.D. – Partner

New rules regarding eligibility for VA pension (Aid & Attendance) were implemented by the Department of Veterans Affairs (VA) on October 18, 2018. The new rules are quite comprehensive, but they can also provide more opportunities to qualify for these important benefits. The major changes are outlined below.

1. Look-back and penalty period. There is now a look-back period of 36 months when applying for needs-based VA Aid & Attendance. Any asset that was transferred for less than fair market value during the 36-month period immediately preceding the pension application will result in a penalty period, not to exceed five years.
2. Exceptions. There are a few exceptions to the new transfer penalty rule:
3. No penalty will be assessed if the transfer was to a trust established for a child who was incapable of self-support prior to age 18.
4. There is no transfer penalty imposed if the claimant’s net worth would have been below the net worth limit already (see figures below), regardless of the transfer.

• A claimant will not be subject to a penalty period if the transfer was the result of fraud, misrepresentation, or unfair business practices related to the sale of financial products.

1. Only transfers that occur on or after October 18, 2018, will be subject to the lookback and transfer penalty rules.
2. Annuities may be penalized. If the annuity can be liquidated, then it is counted as an asset. If the annuity cannot be liquidated, then distributions from the annuity are considered income. If the annuity was purchased during the look-back period, then a penalty will be imposed.
3. Calculating the penalty period. The divisor used to calculate the penalty is the Maximum Annual Pension Rate in effect as of the pension application date, at the rate of the aid and attendance level for a Veteran with one dependent. In 2019 this figure is $2,230, and is applicable to all claimants, regardless of marital status. The penalty period will be recalculated if all or part of the gifted money is returned.
4. Net worth. Now there is a bright-line rule regarding the net worth of a Veteran. For 2019, this figure is $126,420.00, which is also the maximum Community Spouse Resource Allowance (CSRA) amount allowed by Medicaid. This number will increase annually with the cost of living increase issued by the Social Security Administration. If the Veteran or other claimant has a net worth over the threshold and therefore does not qualify for benefits, he or she can spend-down assets by purchasing goods or services for fair market value for any household relative.
5. A home/residence owned by the Veteran is not included in the net worth calculation.   However, there is a two-acre limit imposed on the home/residence. If the claimant’s home/residence is over two acres, then other rules apply and the value of the property in excess of two acres may potentially be included in the net worth calculation.
6. The value of “personal effects suitable to and consistent with a reasonable mode of life” is not included in the asset calculation. This would include personal transportation vehicles and most household goods.
7. The annual income of the claimant and certain dependents is included in the calculation of net worth. However, reasonable and predictable unreimbursed medical expenses can be deducted from income.
8. More medical expense deductions. The new rules provided an additional Activity of Daily Living (ADL) to include assistance with ambulating within the home. The rules also define Instrumental Activities of Daily Living (IADLs) and set out specific instances when expenses for care that include ADLs and IADLs may be deducted from income. The rules also specific when room and board at a care facility other than a nursing home may be deducted from income as a medical expense.

Please contact Elville and Associates if you have questions about these new rules, or if you would like to discuss whether you or your loved one might qualify for VA pension benefits.

Tags: Lindsay V.R. Moss, VA Aid
Posted in Blog | Comments Off on New VA Aid & Attendance Rules as of October 18, 2018

The increasing number of seniors and near-seniors experiencing dementia in the United States is on a rapid rise. A hallmark of cognitive decline is a long pre-clinical phase followed by an actual medical diagnosis that progresses from early to middle and late-stage dementia. Poor memory, agitation, confusion, and understandable fear of the future are some of the first characteristics a senior may experience as cognitive decline takes hold. It is a frightening diagnosis for anyone’s future well-being.

When symptoms begin to show there are some relatively simple technologies available that will enhance the senior’s at home safety and provide a level of comfort as they begin their first steps in what can multi-year journey of dementia. These technology tools can reduce feelings of overwhelm for caregivers and their loved ones who are living with the disease. While some of the devices may seem quite simple to those without problems of cognition they can improve the quality of life for all involved.

People living with dementia often confuse day and night and can become distraught as they argue with a caregiver about time. A specially designed clock for those with dementia can alleviate the confusion and allow a caregiver to maintain routine behaviors. Some of these clocks do not give the actual time but rather a simple display design identifying morning, afternoon, evening, and night. Other clocks will display the date, time of day and day of the week in on either a 12 or 24-hour display which can be particularly helpful to a veteran who lived their life on military time. The clock also has a multilingual feature and can be set in 8 different languages.

Google has a screensaver clock app that is visible at all times displaying the day of the week and morning, afternoon and night. Many clock app designs allow for thousands of options allowing intensive customization. Finally, combination clocks with large magnifying aids and numbers offer both digital and analog, the day of the week, and more – all in oversized text.

Adaptive phones and video chat devices that are preprogrammed with frequently dialed numbers on large buttons or with picture identification allows a dementia patient ease of use in staying connected to loved ones. Staying in touch with friends and family is essential to the well-being of seniors experiencing cognitive decline. Often, a person living with dementia will forget what a person said or did, but they seem to be able to remember how it made them feel. The senior might hang up the phone after a FaceTime or Skype and not remember who they just spoke to but still feel better for it.

If the senior lives alone, electrical appliance use monitoring can alert a caregiver if an appliance has not turned on or off. This tool plugs into a power strip or wall outlet and can provide additional safety for the senior at home alone in the event a stove was left on, as well as let a caregiver know if the senior is remembering to eat or cook for themselves by monitoring the kitchen appliances.

People with dementia could wander and even become lost. Wearable GPS location and tracking devices have many options that can alert a caregiver what room in the home a loved one is occupying. If they walk outside to retrieve their mail and forget to come back in a caregiver can be alerted remotely and perform a location and wellness check. If the senior does not get out of bed and move to the kitchen for breakfast or a recliner to watch television a caregiver will be alerted. Anything that is outside of the expected routine of the senior with dementia can become an alert to a caregiver.

Companion care robots have several positive benefits in the homes of people with dementia. Robots can decrease rates of neglect or abuse by assisting an overwhelmed human caregiver. When a caregiver’s workload is reduced through the use of robots, they have more time to focus on human interaction, typically with a better attitude. Caregivers can then become better listeners and observers as well as have time to identify and address key patient issues. In the absence of a human caregiver a chatbot, similar to a smart home assistant, can bring conversation, daily reminders, read or play games and answer questions for a person living with dementia. Companion care robots are a new standard of caregiving because of the multitude of tasks it can perform and alerts it can provide.

Smart home environmental controls can adjust thermostats and turn lights on and off providing a safer and more comfortable living space. They are also capable of sending alerts via smartphones in the event of an unforeseen event or change in patterned patient behavior. Smart homes coupled with in-home cameras are a great way to ensure the safety of a person with dementia. Cameras that allow two-way conversation as well as provide a visual projection of medication sites, relaxation areas and more allow a remote caregiver to monitor their loved one’s movement. Alerts are sent if no motion has been detected for a set time.

Medication management and reminder messages provide additional support for a person living with dementia at home. Whether a high-tech pill dispenser or pillbox marked with days of the week, a vibrating alarm on a watch or scheduled audible reminder from a smart assistant or chatbot can help keep a patient taking the correct dosage of medication at the proper time. Medication management through technology tools helps avoid a potentially catastrophic situation of incorrect or no dosage.

These technology tools are useful to all seniors living at home but especially to those suffering cognitive decline. Establishing repeatable, patterned behavior through these tools creates a structure that alleviates some of the more frustrating aspects of losing memory. Caregivers can focus on the more human-oriented tasks and loved ones from far away can maintain a connection as well as monitor the well-being of their family member. As a family, and even in the absence of a dementia diagnosis, setting these tech tools in place is a smart idea for a senior living at home alone.

We hope you have found this information useful. If you have questions or would like to discuss your particular situation, please don’t hesitate to reach out to any of our five Maryland locations by clicking here to send us a message or calling us at (443) 393-7696.

Posted in Blog | Comments Off on Dementia Patients Have Tech Designed Specifically for Them