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questionToday, more than ever, you need a Living Will. Discover the 10 most common questions you need answered so you too can have peace of mind.

1.  What is an advanced health care directive? Advanced health care directives are written instructions that communicate your wishes regarding care and treatment should you no longer be able to make your own health care decisions.

2.  What are the components? An Advanced Health Care Directive includes:

          •  A Living Will which outlines your medical and treatment choices

          •  Health Care Power of Attorney - the person you appoint to make medical and treatment decisions when you are no longer able to do so yourself.


3.  How are they used?   If you are no longer able to make choices regarding your health care, these documents will communicate to your physicians what treatments you want or don' t want such as artificial administration of food and fluids, or even the use of CPR or a breathing machine. 

4.  When do they become effective?   These forms are only effective when you cannot communicate your desires yourself. It may be used in situations where you are terminally ill and will die soon. In that case, life-sustaining procedures that only prolong the dying process will be withheld as you have indicated. Another time they will come into play is if you suffer from an event or illness that leaves you permanently in a coma. Because situations are varied, it becomes important to be as clear as you can, and make sure your POA understands your desires.

5.  What happens if I don't have one?   Ever state has a hierarchy that is followed that describes who is your next of kin and who will make decisions for you. For instance, if you are a minor child, it will be your parents. If you are an adult with a legal spouse, that person becomes your decision maker. It becomes complicated when family members/significant others disagree about what your desires are. This is why these forms are so important. 

6.  Can I change my mind?   You can change your mind about what you have written and who you choose as your decision maker at any time by destroying the old forms and making a new one. Make sure the new forms are given out to those that need them such as your decision make, family/significant others, health care provider, hospital, etc. 

7.  If I have a living will, does that mean I won't get treatment?   This is a common misconception, and the answers is no. These forms do not mean NO CARE. You should always get the care and comfort that you require. 

8.  Where do I get these forms?   Often times, your health care provider or hospital will have them. However, it's best if you do them before you ever see these providers. You can obtain them from your attorney, or there are several online sources where you can get state specific documents for free. 

9.  Do I need to see a lawyer?   No. You can fill these forms out yourself following the form directions.. That said, if you situation is sticky, it would not hurt to get professional legal advice. In most states the forms do not have to be notarized. Make sure you get the required witnesses to sign these forms. They cannot be relatives or employees of your health care provider, hospital, clinic, etc. 

10.  Where can I find more information?   Online, http://www.LawHelp.org provides free information for most states.  Most state departments of health or your state legal association will be able to point you in the proper direction.

© 2005 Barbara C. Phillips, MN, NP.   Are you living with Vibrant Intent?  Do you want to experience the Joy, Magic, and Wisdom of Successful Aging?  Celebrate with us as we explore these issues and more.  Receive your complimentary copy of “Celebrating You: 50 Tips for Vibrant Living” at http://www.OlderWiserWomen.com


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If you’re the parent of a disabled child, you’re probably concerned with the uncertainty of your child’s financial future and the realization that you will not always be around to provide for him.

The national public health insurance coverage for individuals age 65 and over is called Medicaid. Massachusetts has its own public health insurance coverage for residents in the Commonwealth called MassHealth. This program provides many community based services, and it is designed for low to middle income individuals.

Through it, people who meet certain financial and medical eligibility requirements may receive benefits including basic health insurance, prescription drug coverage, hospitalization, ambulance service, and personal care assistance at home. MassHealth also provides the elderly with alternatives to funding their medical care. Four of the major ones are explained below.

 

(1) MassHealth Standard

MassHealth Standard is a program that allows certain individuals the ability to gain access to medial care from doctors, hospitals and pharmacies and certain medical providers who accept MassHealth Payments. It is offered to several categories of individuals including individuals over the age of 65.

MassHealth Standard has financial requirements in order to qualify for the coverage. An individual age 65+, may not have countable assets in excess of $2,000, and a married couple may not have more than $3,000. In determining eligibility, essentially all assets are counted except those that are exempted by law or that are “inaccessible” to the individual. Such examples include assets that have been held for over sixty (60) months in (1) an allowable irrevocable trust; (2) an annuity that has been annuitized, or (3) a brokerage account titled with another as joint tenants with rights of survivorship, such that both owners’ signatures would be required to access the asset. In addition, monthly income limits based on percentages of the Federal Poverty Guidelines are required for eligibility. An individual’s monthly income may not exceed 100% of the Federal Poverty Guidelines. In 2005, this is $776 for individuals and $1,041 married couples. If individuals over age 65 do not meet the eligibility requirements of MassHealth Standard, they may become eligible by reducing their assets or meeting a deductible.

MassHealth Standard provides the following benefits for eligible applicants: inpatient and outpatient hospital services, doctor and clinic visits, pharmacy services, hearing aids, medical equipment and supplies, x-rays and laboratory work, adult foster care, long-term adult day health care in a medical facility (nursing home, hospital, etc.) and transportation services. In addition, if a person is eligible for MassHealth Standard and Medicare Part A and/or B, MassHealth will pay their Medicare premiums, co-payments and deductibles.

(2) MassHealth Limited

MassHealth Limited is a program for individuals who meet the financial requirements for MassHealth Standard, as stated above; however, they are non-qualified aliens, and therefore, do not meet the Citizenship and Immigration rules under MassHealth.

MassHealth Limited provides benefits for emergency medical care only. The benefits include, but are not limited to, inpatient and outpatient emergency care, visits to the emergency room, and pharmacy services to treat medical emergencies.

(3) MassHealth Senior Buy-In / MassHealth Buy-In

The MassHealth Senior Buy-In and the MassHealth Buy-In programs are designed to assist individuals age 65 and over with payments of Medicare premiums, deductibles, and co-payments.

The MassHealth Senior Buy-In program requires that an individual must be entitled to Medicare Part A. The financial eligibility requirements provide that the individual has income less than or equal to 100% of the Federal Poverty Guidelines. An additional $20 is added to the income limits because $20 of that individual’s monthly income is not counted when determining eligibility for MassHealth. In 2005, the monthly income standard is $796 for individuals and $1,061 for a married couple.

The MassHealth Senior Buy-In program also provides asset limitations for qualification, $4,000 for individuals and $6,000 for married couples. The MassHealth Senior Buy-In program offers payments of Medicare Part A and Part B Premiums and for deductibles and co-insurance under Medicare Part A (inpatient hospital care and certain other services).

The MassHealth Buy-In program only offers payment of all or part of the Medicare Part B premium for individuals whose monthly income is between 120% and 135% of the Federal Poverty Guidelines.

(4) MassHealth CommonHealth

The MassHealth CommonHealth program provides benefits to those individuals who do not qualify for MassHealth Standard. It is designed for community residents who are disabled and working.

The MassHealth CommonHealth program does require an individual to meet asset limitations in order to qualify for the coverage. However, if the individual’s income exceeds certain limits, he or she may be required to pay a one time deductible or monthly premium.

The above-mentioned four categories of coverage are a few examples of the many programs provided by MassHealth to assist an individual age 65 or over with his or her medical care. Navigating through the various MassHealth benefits can be difficult, so it is recommended that an interested party contact the MassHealth office or a qualified attorney specializing in Elder Law for assistance. MassHealth may be a significant part of minimizing the rising costs of health care in Massachusetts, but it is important to understand the potential benefits and choose the best available option.

Attorney Brett Kaufman is a partner in the law firm of Schlossberg, LLC, with offices in Braintree, Massachusetts.  Mr. Kaufman is a member of the Firm's Trusts and Estates Department. He concentrates his practice in the area of tax, estate planning, and estate administration.  You may contact Attorney Kaufman at (781)848-5028.

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No well-planned retirement should be without long term care insurance. It is the very cornerstone of retirement security." - Suze Orman. We now take it a step further – no Estate Plan should ignore long term care insurance.

Long-term care can happen to anyone at anytime. Celebrities such as Montell Williams was 42 when he was diagnosed with multiple sclerosis, the late Christopher Reeves was 42 when he became paralyzed following an equestrian accident and Michael J. Fox was only 30 when he was diagnosed with Parkinson’s disease. Although, you can't always predict your need for long-term care, you can protect your assets, preserve your choice of care, and reduce the burden on your family by buying long term care insurance.

Do not think of LTCI as nursing home insurance. And, the knock on LTCI is paying expensive premiums for something you may never need. The landscape of the LTCI industry has drastically changed over the last 20 years. LTCI has expanded from simple nursing home coverage to covering care in assisted living facilities and in an individual's own home. In fact, most claims are not nursing home related, but instead are for in-home care and assisted living care. In 2007, the average cost of a private room in a nursing home in eastern Massachusetts was $302 per day or $110,285 annually, the monthly rate for a private one bedroom at an assisted living facility was $4,754 or $57,042 annually and cost of a home health aide ranges about $20-30/per hour.

Long-term care goes beyond medical care and nursing care to include all the assistance you could need if you ever have a chronic illness or disability that leaves you unable to care for yourself for an extended period of time. Though older adults most frequently use long-term care services, a young or middle-aged person who has been in an accident or suffered a debilitating illness might also need long-term care, as seen with Montell Williams, Christopher Reeves and Michael J. Fox, etc. Again, if it is your goal to remain in your home, you will need financial assistance.

Generally, those who need long-term care are left to privately pay for it themselves. Our Government has made it clear through various curtailments and cutbacks that it is not the obligation of the Government to provide this benefit to its citizens. Combined with the fact that our society is living longer, and an increased cost of healthcare, there is every indication that LTCI is a solution to our changing society. Long-term care is not fully covered by Medicare, Medicare supplemental coverage (also known as Medigap insurance), or standard health insurance policies. That leaves most of us with two options when faced with such expenses: privately pay out-of-pocket or rely on long-term care insurance. Most people choose to privately pay out-of-pocket; however, due to the rising costs of long-term medical care, this option should be seriously reconsidered. As the above indicates, the cost for care has risen over the years, and will continue to rise in the years to come. Paying for your own care has two significant problems. First, and the most obvious, is that it quickly depletes your assets that could have gone to your family upon your death, or your remaining years. Second, and not so obvious, is that family members providing your care can suffer lost time, lost wages, missed events and missed opportunities. How do we place a value on that?

LTCI coverage is not limited to any type of care or daily rate. LTCI policies are tailored according to the premiums you can afford. You can go to any facility your LTCI policy covers, and you don't have to sell, spend down or gift away your assets to pay for your care. One of the difficulties in shopping for long-term care insurance is that the different policies are almost impossible to compare. When shopping for long-term care insurance make sure you take your time and compare the features of several policies. The following is list of features you should carefully examine before purchasing a long-term care policy.

Company Reputation and Legitimacy. It's a good idea to deal with companies, which know the business and have been stable in the past. This is due to the fact that it may be several years before you need the policy and it's difficult to change companies when you're older and have developed medical problems. Make sure the insurance companies under consideration are licensed in your state and that they carry favorable financial ratings from well-known ratings agencies such as A.M. Best Company, Moody's Investor Services, Inc. or Standard & Poor's Insurance Rating Services.

Adequate Daily Benefit. Long-term care policies generally limit benefits to a maximum dollar amount or a maximum number of days and may have separate benefit limits for nursing home, assisted living facility, and home health care within the same policy. For example, a policy may offer $150 per day up to five years of nursing home coverage and only up to $80 per day up to five years of assisted living and home health care coverage. To determine how much coverage you need, research the costs for facilities in your area you wouldn't mind using and then figure out how much of the bill you could financially contribute to the cost of the facility. It is not an all or nothing approach. It should be viewed as a subsidized approach.

Length of Elimination Period. This is like a deductible and works like one. The length of the elimination period is the period of time the insured must wait before the policy will begin to pay benefits. Most policies range from zero to 180 days. You will have to privately pay for long-term care expenses while you wait. Typically, the longer the elimination period, the lower the premium. Again, how much can you afford? You need to be reasonable in your approach.

Benefits Protection. The daily benefit you buy today may not be enough to cover higher costs years from now. A 3% inflation rate can cut the value of your dollar in half in 25 years. Therefore, you should consider that your policy include an inflation adjustment feature to ensure that benefits stay in line with rising care costs. A rule of thumb some advisors follow is that purchasers under age 70 should purchase an inflation rider and those over age 70 need not.

Policy Eligibility. Long-term-care policies carry exclusions for preexisting conditions, which usually won't be covered for six months or a year after a policy is in force. You should find out if the policy requires certain benefit triggers to determine when you will be eligible to receive benefits. Such triggers could include activities of daily living that the insured needs help with, such as bathing, eating, and dressing; cognitive impairment, such as Alzheimer's disease; or a prerequisite hospital stay for nursing home benefits.

The lesson to take from Montell Williams, Christopher Reeves and Michael J. Fox’s unfortunate circumstances is that you should buy a long-term care policy long before you expect to need benefits. You cannot wait until catastrophe strikes to then decide that you need it. How much does it cost? It depends on age and the above criteria; however for a 60 year old couple, you can figure the cost will be between $2,000.00 and $5,000.00, depending on the package. It is deductible and can be discriminatory in a company sponsored benefit plan. Since we cannot predict our future, medical conditions resulting in long-term care can happen at anytime which make you uninsurable and at risk of losing a significant portion (if not all) of your assets to provide for your care.

Attorney Brett Kaufman is a partner in the law firm of Schlossberg, LLC, with offices in Braintree, Massachusetts.  Mr. Kaufman is a member of the Firm's Trusts and Estates Department. He concentrates his practice in the area of tax, estate planning, and estate administration.  You may contact Attorney Kaufman at (781)848-5028.

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Not long ago I received a note from a woman in her mid twenty’s expressing her fear of aging. She felt it was out of control and only keeping her from growing into the woman she is meant to be.  She does not think poorly of older women, and in fact started her note with “I have seen many gracefully aged women and thought they are fantastic.”

However, she then continued listing some of the things that she is fearful of such as weight gain and the loss of identity, youthful looks, attractiveness, freedom, style and personality (especially around becoming a mother.  There are also those unknown fears which she sums up as the “loss of God knows what.”

Sadly, this young woman’s fears are not unfounded. Many cultures in our world are youth oriented. We are bombarded daily with advertisements to look younger, thinner and more hip. TV, magazines, and music videos dictate our hair styles, fashions, and behaviors. Not only that, but if we happen to be old enough to have gray hair or any FINE lines around our eyes, we are directed to the appropriate product to erase any signs of aging.

Is it any wonder that many of us are fearful? The stereotypes around us are so misleading!
We see images of “little old ladies” that may walk hunched over, are poor, and at the mercy of dishonest people. While some images show men aging with distinction, we also see women who are just old, dry and helpless. Hogwash!.

While it is true that our bodies and minds do change with age, I happen to believe that we really do get better as we mature. So, allow me to address some of the fears listed above.

•  Loss of Identity. I’ve only, in the past few years really begun to learn who I am. I’ve come into my own. I’m more self confident than ever before (and I still have a way to go!).

•  Loss of Youthful looks. I’m going to be 49 in a few days. I do not wish to look like 25. Granted I don’t have lots of wrinkles (only a few very fine lines…they are staying, thank you!) and have only a bit of gray hair that I’ve been cultivating for many years.

•  Weight gain. Yes it’s common, but it’s not the rule of thumb. You might notice a slight change in figure even without gaining weight. There is actually a health benefit to being a few pounds heavier, rather than be very thin as you age.

•  Loss of attractiveness. I’ve found that my own definition of beauty changes over time. I happen to think that women are actually more attractive. There is a depth and beauty that comes only with age.

•  Loss of freedom and personality.  I’ve heard many women say aging gives them a freedom that is just not possible when we are younger. I think this is especially true for those of us that are mothers. When we become mothers, we take on a role that is 24/7. However as our children grow, we begin to carve out time and activities that are just for ourselves.

•  Loss of style. While I’m not sure I understand this fear, I do know that with age, I find freedom to create who I am without the dictates of the latest, greatest fashion. Since we are more sure of ourselves, we have the freedom to experiment and play with who we are, and the image we want to put out there for the world to see. Personal Style at it’s best!

While some look at growing older as a time of loss, many women see this time of their lives differently. There is so much growth that happens as we age especially in the emotional, spiritual and yes, physical arenas.  In order to make the most of getting older, it is vital that you live your life in a vibrant and healthy manner. Smile and laugh daily. Read. Eat well. Sleep well. And always engage in stimulating physical activity or at the very least exercise.  Most of all, celebrate your journey through this life.

Barbara C. Phillips, NP, is the founder of NP Business™ and Nurse Practitioner Business Owner™, and works with NPs to get started and grow their own business. To learn more and to become a member of "Nurse Practitioner Business Owner," visit Nurse Practitioner Business Owner.

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