Everyone should do some estate planning.

Everyone—regardless of how small their wealth—should do at least some estate planning. 

Some things to consider include:

• A will: This is the most basic of estate-planning documents, yet a Caring.com survey this year showed that more than half of Americans don’t have a will. That’s surprising and troubling all at the same time. A will can provide certainty and clarity and eliminate  the grey areas when property is moving from one generation to the next. Don’t just assume everything will end up with the people you want it to if you fail to leave specific instructions.

• A trust: Not everyone needs a trust, but it often makes sense. Basically, a trust allows you to control your assets from the grave. You can set certain restrictions, which is especially helpful if your kids are young or they don’t really manage money well. That way you may be able to keep them from blowing their inheritance all at once. For example, a restriction might be that they don’t receive the money until they earn a college degree.

• Power of attorney: It’s important to assign someone power of attorney so that if you become incapacitated that person can speak on your behalf and sign important documents. You can also have a living will to outline your wishes, which could help your family make tough decisions about your healthcare.

If you don’t plan for your long term care who will?

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Dying at Home

Most people (70%) want to die at home, in a familiar place surrounded by loved ones. However, only about 25% do. Nearly 50% of Americans die in a hospital, and another 20% die in a nursing home or long-term care facility.

The trend is for more people to die at home, with a 29.5 percent increase from 2000 to 2014, according to the Centers for Disease Control and Prevention. During the same time period, the percentage of deaths in hospitals, nursing homes and long-term care facilities has dropped.

Seven out of ten Americans die from chronic disease, and more than 90 million Americans are living with at least one chronic disease. The Centers for Disease Control (2007) listed the ten leading causes of death in America (in order):
1.
heart disease
2.
cancer
3.
stroke
4.
chronic lower respiratory disease
5.
accidents
6.
Alzheimer’s
7. diabetes
8.
influenza
9.
pneumonia
10.
kidney disease and sepsis.

Almost a third of Americans see ten or more physicians in the last six months of their life. And almost 30% of Medicare’s budget each year is spent on patients who are in the last 12 months of their lives.

According to LongTermCare.gov about 70% of Americans over age 65 will require long-term care. If a person has an extended illness requiring long-term care, long-term care insurance will help cover those expenses whether in a hospital or at home. Studies show that those with long-term care insurance stay at home longer because the insurance provides more money for care. This includes extra money for home modifications like a wheel-chair ramp, a medical alert system and a stair lift.

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It is often the lack of money that prevents people from staying at home when they need care. Who pays for long-term care? In some cases they will spend all their savings and now are forced to rely on Medicaid (welfare health care). With a Partnership asset-protection insurance policy you will be exempt from the Medicaid spend-down requirement, the exemption is based on the total benefits your policy has paid out for care.

More than 80% of patients with chronic diseases say they want to avoid being in a hospital or intensive care unit when they are dying. While dying at home is usually preferred by the patient, it can be difficult for the caregiver. Hospice services can help.

Hospice care is for those in the last six months of their lives. More than 88% of hospice patients are Medicare beneficiaries.

Traditionally, for a patient to qualify for Medicare-supported hospice, a doctor must certify that the patient has: a home, a diagnosis of six months or less to live, a full-time caregiver, and a willingness to give up curative care and receive only palliative care.

In 2016 the Medicare Care Choices Model began offering some patients “concurrent care”: the choice of continuing curative care while starting palliative care and hospice care. An evaluation of concurrent hospice in non-elderly patients showed this plan improves quality of life and reduces costs.

The Medicare hospice benefit emphasizes home care, with almost 60% of patients receiving their care at home as of 2014. Medicare coverage is limited, additional care would be paid for out-of-pocket. Do you really want to spend-down your hard-earned savings and investments leaving open the option that Medicaid will require your estate to repay Medicaid for your care costs? There are 30 states with a filial responsibility law that could require your family to reimburse Medicaid.

Home care is much less expensive. Inpatient hospice services are used when the patient’s pain and symptoms must be closely monitored in order to be controlled, when medical intervention is required to control pain or symptoms, or when the family needs a rest from the stress of care giving.

A hospice team arranges for doctors, nursing care, medical equipment like wheelchairs and walkers, medical supplies, prescription drugs, hospice aide and homemaker services, physical and occupational therapy, speech-language pathology services, social workers, dietary counseling, grief and loss counseling for the patient and family, short-term inpatient care, and short-term respite care.

After evaluation by a doctor, a patient can enroll in hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit extensions. A patient can decide to stop hospice care at any time.

A recently proposed bill, The Patient Choice and Quality Care Act of 2017 (H.R. 2797), aims to give patients and families living with advanced and life-limiting illnesses the information and services they need.

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Have You Had The Conversation?

The Conversation Project is dedicated to helping people talk about their wishes for end of life care. They offer a collection of “Conversation Starter Kits” that you can download for free.

Talking with loved ones openly and honestly, before a medical crisis happens, ensures that everyone understands what matters most to each individual at the end of life. You can use a starter kit for yourself, or to help others communicate their wishes.

conversation2There are several different kits: for families and loved ones of people with Alzheimer’s or other dementias; how to choose a health care proxy and how to be a health care proxy; how to talk to your doctor or nurse about your wishes; and one for parents of a seriously ill child.

There are starter kits in English, Spanish, Mandarin, French, Hebrew, Korean, Russian, Vietnamese, and Hindi.

Organizations can purchase printed copies to distribute and add their logos.

The cost of care can be devastating, the national average is over $7,000 per month. To plan means to be insured before needing care, even before the diagnosis and not everyone can health-qualify for insurance (Can You Qualify?).

To find out more about long term care insurance see the Guide To Long Term Care

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Blood test coming to diagnose Alzheimer’s disease?

A research team has found a method to detect biomarkers of Alzheimer’s disease in blood platelets. The test uses a ratio between normal and abnormal brain tau proteins to identify those with Alzheimer’s disease and other neurodegenerative conditions.

The researchers found that the presence of abnormal tau proteins corresponds with decreased brain volume in parts of the brain where characteristics of Alzheimer’s appear.
alz.jpg
A non-invasive test for Alzheimer’s disease would help detect people at risk before symptoms develop, and make prevention and early treatment possible.

A study published in the Journal of Alzheimer’s Disease in 2016 described using levels of the protein clusterin to ascertain which dementia patients are at risk of Alzheimer’s. Also, a 2015 study focused on using metabolites in saliva to detect cognitive impairment.

In 2016, 5.4 million Americans were affected by Alzheimer’s disease. For more information, consult the Alzheimer’s @Guide To Long Term Care.


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Assisted suicide in nursing homes creates moral and ethical dilemmas

A court in Switzerland has ordered a nursing home to perform assisted suicide for those patients who want it. Switzerland legalized assisted suicide and has become a destination for suicide tourists – 611 from 2008 to 2012 – since passing the law, including 21 patients from the United States.

The nursing home, run by Christian charity The Salvation Army, claims its religious beliefs forbid helping patients commit suicide. But the court denied The Salvation Army’s appeal.

There is one way the nursing home can avoid helping patients kill themselves: giving up its charitable status and state subsidies.

One concern about assisted suicide is that some people who do not have a terminal illness are choosing to end their lives. Also, there is a risk that elderly people may be pressured into “voluntary” suicide by family members, or their own concerns about the cost of their care.

Find out about long term care insurance in America at Guide To Long Term Care.


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American death rate rises for the first time in a decade; attributed to drug overdose, suicide and Alzheimer’s

For the first time since 2005, the United States mortality rate has increased. There were 729.5 deaths per 100,000 people in 2015, and  723.2 in 2014, according to the National Center for Health Statistics.

Experts say the increase could be connected to an increase in suicides, Alzheimer’s disease, and drug overdoses among white working class Americans.

The national mortality rate has been on a steady decline for years so an increase is unusual. For example, American Deaths per 100,000 people were 885.9 in 2002; 813.7 2004; 815 in 2005; 723.2 in 2014; and 729.5 in 2015. Heart disease and cancer are by far the largest killers of Americans.

The last increase in mortality was in 2005, during a bad flu season.

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Physicians blamed more U.S. deaths on Alzheimer’s disease in 2015 than in 2014. During a period when the age-adjusted death rate for heart disease, cancer, pneumonia and influenza held steady, the age-adjusted death rate for Alzheimer’s disease increased from 25.4 deaths per 100,000 in 2014 to 29.2 deaths per 100,000 in 2015. Some observers say the rise in Alzheimer’s deaths may simply reflect more accurate recording on death certificates.

Drug overdoses rose in 2015. In the second quarter of 2014, the rate was 14.2 per 100,000 and for the same quarter in 2015, it was 15.2. Numbers for the second half of 2015 have not yet been released.

Suicides rose from 12.7 per 100,000 in the third quarter of 2014 to 13.1 in the same quarter of 2015.

Over a 40 year period, Alzheimer’s disease is projected to cost $20 trillion in constant dollars to Medicare and Medicaid alone, rising to over $1 trillion per year by 2050.

For more information and statistics on Alzheimer’s, see Guide To Long Term Care.


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Hillary Clinton meets home care workers

Democratic presidential candidate Hillary Clinton says the country should update the Medicare benefits package to encourage more use of home care, and to reduce the need for nursing home care.

The workers themselves told Clinton that they work long hours for low pay, with meager benefits, and often struggle to make payments on the cars they need to get to clients, or even to pay for bus fare to reach their clients.

Read Rest of Story Here


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