We all hope to live long and healthy lives. But as we age, our bodies change and we may face new challenges. This can be difficult to accept, but it's important to remember that we still have rights and choices - even as we get older.
For example, did you know that you have the right to choose how you want to be cared for if you become incapacitated? Or that there are options for long-term care that can help you stay in your own home? Or that you can create an estate plan to protect your assets if you need to go into a nursing home?
Making informed decisions about our aging process can be difficult, but it's so important. We need to think about our wishes for end-of-life care, how to make sure our family is taken care of financially if we pass away, and the tax implications of our estate plan. These are all big decisions, but they don't have to be overwhelming.
Take some time today to educate yourself about your rights and choices as you age. It's important to be prepared for whatever life throws our way. And who knows - maybe by doing some planning now, we can avoid some difficult surprises down the road.
Today my guest is Wendy K. Goidel, Esq. Wendy is an attorney with over 22 years of experience in the estate planning and elder law field. She has a unique perspective on the industry, having founded both the Goidel Law Group and Concierge Care Coordination.
Her goal is to help her clients age safely and successfully in the residence of their choice, by providing them with comprehensive care coordination services. She firmly believes that every client deserves individualized attention, which is why she takes the time to learn about them and their families before developing solutions that address their specific needs.
Find Wendy on:
Goidel Law Group PLLC: https://www.goidellawgroup.com/
Hanh Brown: Hi, I'm Hanh Brown, the host of the Boomer Living Broadcast. On the show, we talk about topics that are relevant to baby boomers. And today's topic is Don't let the legal issues of aging catch you by surprise. We all hope to live long and healthy lives, but as we age, our bodies change, and we may face new challenges.
Hanh Brown: Well, this can be difficult to accept, but it's important to remember that we still have rights and choices. Even as we get older, for example, did you know that you have the right to choose how you want to be cared for if you become incapacitated, that there are options for long-term care that can help you stay in your own home, or that you can create an estate plan to protect your assets if you need to go into a nursing home?
Hanh Brown: Making informed decisions about our aging process can be very difficult, but it's also very important. So we need to think about our wishes for end-of-life care and how to make sure that our family is taken care of financially if we pass away. And also the tax implications of our estate plan. Well, these are all big decisions, but they don't have to be overwhelming.
Hanh Brown: So take some time today to educate yourself about your rights and choices as you age. It's important to be prepared for whatever life throws your way. And who knows? Maybe by doing some planning now, we can avoid some difficult surprises down the road. Well, today's guest is Wendy Gudo. Wendy is an attorney with over 25 years of experience in the estate planning and elder law fields.
Hanh Brown: She has a unique perspective on the industry, having founded both the Gole Law Group and Concierge Care Coordination. Her goal is to help her clients age safely and successfully in the homes of their choice by providing them with comprehensive care coordination services. She firmly believes that every client deserves individualised attention, which is why she takes the time to learn about them and their families before developing solutions that address their needs.
Hanh Brown: So Wendy, welcome to the show.
Wendy K.: Hi Hanh. Thank you for having me. Yeah, it's great to be here.
Hanh Brown: Well, Thank you. How are you?
Wendy K.: I'm wonderful. Thank you. I am a baby boomer. I'm at the end of the baby boomer curve, but it's great to be here, and thank you. Great.
Hanh Brown: Great. So where are you calling from, and how is it over there?
Hanh Brown: Um,
Wendy K.: I am located on Long Island, New York. Um, right now we're having a little bit of a grey day, but it's, uh, really live here in your studio, so Awesome. Yes.
Hanh Brown: Well, hey, can you tell us about yourself, maybe both professionally and personally?
Wendy K.: Um, well, professionally, I ended up getting into the elder law estate planning industry based upon my own family situation of being very close with my grandfather, who was also an attorney.
Wendy K.: And he developed Parkinson's disease later in life. And I saw the struggles and challenges that my mother went through while providing care for him. Um, and as a result, I ended up switching gears. I've been practising law for 35 years, and 10 years into my practise, I decided to get into elder law, which was not a practise area when I went to law school.
Wendy K.: That's how kind of nascent it is, and I'm very passionate about it and love to try to help people find solutions. So that they can live safely and successfully, um, in the community and keep them out of restrictive care settings. On a personal note, I love to do outdoor activities like kayaking, hiking, and walking.
Wendy K.: We have a place up in the Berkshires. We like to spend a lot of time with family. So, and, uh, engage in a culture well. Great. So that's me.
Hanh Brown: Great. Thank you. Thank you so much. I appreciate the work that you do, and I'm excited for our conversation today. Okay. So estate planning is very important, as we kind of highlighted.
Hanh Brown: It allows you to make choices about what happens to your assets after you die. And without a plan in place, your loved ones could end up fighting over your estate, or worse, it could fall into the hands of someone you wouldn't have chosen. So when an estate plan can ensure that your wishes are carried out and that your loved ones are taken care of, that is something that we should all consider regardless of.
Hanh Brown: Your age or wealth So let's do a deep dive. Estate planning. Why is it, what is it, and what's included in one?
Wendy K.: Sure. Let's try to break that down. So, I mean, simply put, an estate plan is really your legal, written instructions of what you want done if you become incapacitated or pass away.
Wendy K.: People always say, If I die, well, that's certain; the uncertainty is, um, what happens to us as we age. And whether we are going to end up living with one or more chronic illnesses, comorbidities, and, um, some newer degenerative conditions. So incapacity is something to plan for, and probable incapacity is something that's really important.
Wendy K.: So I like to break the definition down into kind of three parts of what estate planning really is. And the first part is that I want to control my property while I'm alive. And well, it's because studies show that once control is taken away from a person, that person's financial, emotional, and, um, Medical wellbeing starts to decline rapidly.
Wendy K.: So we want to make sure you can maintain as much control as possible for as long as possible. And then the second part is, I want to plan for myself and my loved ones." Should I become incapacitated? I mean, in the old days, people lived and then died, right? People just don't die anymore. Um, I like to say there's a whole period of time now where we're living with some degree of medical issues or incapacity.
Wendy K.: So this part is really much more important now than it was in the old days, when traditional estate planning just dealt with the passing of wealth at death. And then the third part is that I want to give what I have to whom I want, the way I want, when I want, and when I do die, I want my assets to go to the people I love without unnecessary cost or delay.
Wendy K.: So that's kind of how we break it down into those three segments. So it's really important that everybody has a plan, age 18 and up. Um, you've got to plan and make the difficult decisions, have those conversations, and not leave those decisions to loved ones or other agents. Um, and recognising, as you said, that estate planning is not a one-time or static event,
Wendy K.: It has to change as our lives change. So there are so many issues and triggers that could cause us to need to update our plan. That could include our health. You know, one day we're perfectly fine, and the next day we find out we have, you know, we're diagnosed with a certain condition. Um, our family changed with the birth, death, divorce, and remarriage of anybody associated with our plan mate.
Wendy K.: We need to update our planning. Um, as we age, the laws change, right? Tax laws change, and Medicaid laws change. So there are all these different triggers that would cause us to need to update our plan. So we kind of need to plan with a certain degree of flexibility and recognise that we have to have that plan looked at every few years or as circumstances change.
Wendy K.: Um, Yeah, so there's, I always, I always talk about kind of like the two faces of estate planning and the two different types of planning that are proactive and reactive. So we like to get the education out to people about, you know, the need to, you know, take control of this and plan before a crisis hits.
Wendy K.: So when we're planning proactively, we get to be the ones who make the decisions and put them into writing. Right at that point, you know, when we're relatively young and healthy, we make the decisions, we give the instructions, and we get to stay in control and have access to all of our assets. All the options are available to us in terms of different types of planning that we can do for different types of documents.
Wendy K.: And as a result, there is much less stress, frustration, and anxiety on our part and on the part of our loved ones. So, Ideally, that's when we want to do planning. Unfortunately, we know that human nature causes people to procrastinate. They don't want to have the difficult discussions. They don't want to think about it; they just don't want to do it.
Wendy K.: I'll, I'll, I'll, you know, nothing's going to happen to me. We've heard about all of these kinds of, um, excuses. And then, unfortunately, somebody suffers a health crisis. And either the planning wasn't done or the planning wasn't sufficient, and now they're in crisis mode. And that individual isn't the one that's going to go to the attorney to usually talk about the planning.
Wendy K.: usually family members. It could be a spouse, or it could be adult children. Now they're meeting with an attorney to talk about the plan, and they may not even know what it is that, you know, the loved one who's needing the care wants. So as a result, it is usually You know, that person loses access to and control of their assets.
Wendy K.: The options are fewer, there's less that can be protected, and there's that much more stress, frustration, and anxiety on the part of the family members trying to scramble to put a plan in place, um, in that kind of situation. So that's kind of not what we want to leave. Um, our loved ones are holding the bag and having to do that for us.
Wendy K.: Mm-hmm. Very true. And that's where that old adage comes in: failing to plan is planning to fail. It's kind of pretty apropos in that situation.
Hanh Brown: Yeah, absolutely. So I appreciate the work that you do, and I hope people who are listening now or in the future to this conversation will be more proactive. Right. That's it.
Hanh Brown: So I want to describe a situation that I'm sure you've seen too often, and me as well. So picture this: you're driving home from work and you get a call from your mom. She sounds frantic and says that your dad had a heart attack and passed away. You pull into a driveway and run into the house, where you find your mom in tears.
Hanh Brown: She tells you that your dad didn't have a will. So now the family has to go through probate to figure out who gets This is just one situation where not having an estate can cause turmoil within a family. So estate planning is so important for so many reasons. I guess you mentioned so many already, and can you explain what goes into all the, uh, documentation of the estate planning and what are its primary goals?
Hanh Brown: Do a deep dive.
Wendy K.: on that. Okay. Um, there are so many goals. Um, For estate planning, it has to be customised around each person's unique needs, goals, objectives, and aspirations. Because everybody's family is different, their assets are different. Um, so some of the common goals, like we discussed about managing, you know, the risks of incapacity and delegating healthcare decisions to the right people, you know, keeping
Wendy K.: Control of assets, providing for the needs of a surviving spouse, like you just kind of mentioned in your scenario, and protecting that spouse and the children in the event that their surviving spouse gets remarried. Um, we want to provide liquidity at death. Sometimes people are real estate rich and cash poor, and there aren't funds to pay for funeral expenses, costs, obligations, and mortgages and whatnot.
Wendy K.: So that has to be factored in. And as you said, we need to promote family harmony. We never want to plan anything that's going to cause tension or friction among family members. We already know that oftentimes, we see a lot of, um, Family issues and family strife. And when we do plan, we want to try to minimise that from happening.
Wendy K.: We don't want to create problems where they don't exist. So that's really very important to, um, recognise. Um, and then we want to protect assets for all the different kinds of creditors and predators that are out there, including in-laws, taxes, lawsuits, and nursing homes. So those are some of the common goals.
Wendy K.: And tax planning as well, which we could do. You know, I'll talk about it as well, but the planning documents that go into, you know, that plan, um, it really depends upon the situation. So some of the main planning documents—I mean, everybody's heard of a last will and testament— Um, and that is a document in which an individual is going to name an executor or personal representative to manage the assets of the decedent, and it gives them the ability to distribute the assets of the decedent according to the terms of the will.
Wendy K.: But that's after a probate. Situation. Um, you mentioned probates. So probate is a legal process by which a will is taken to court to have it declared valid and the executor appointed. So a will doesn't do anything for us during our lifetimes because first we have to die, and the will has to be basically blessed by the judge.
Wendy K.: Then that individual, who's named as the executor, has the authority to manage the estate. So it's kind of A little more of an arcane document because it neglects the lifetime planning that's really important. But a will is also something that's done when we, um, create trusts. Okay. So trusts have become a very important planning tool for a lot of our clients, for different reasons.
Wendy K.: So they are all different. There are tonnes of different kinds of trusts out there. But basically, we define trust as a legal entity that takes ownership of assets. So essentially, think of it like a contract between three entities. First is the individual who creates the trust, which could be called the settlor, the grantor, or the trust maker.
Wendy K.: That's the person who's putting the assets into the trust. Then we have the trustee, who is the one who manages the trust and makes distributions, and then we have beneficiaries both during their lifetime and after someone passes away. So depending on the type of trust we create, the individual can be all three. It could be the creator, the trustee, or the beneficiary.
Wendy K.: Um, but that's really become the centrepiece of more modern estate planning. Um, so one of the goals is to avoid probate and court proceedings so that we can name trustees in the event that we become incapacitated. Okay. If I'm the trustee of my own trust during my lifetime, let's say I create a revocable living trust. I equate that and analogize that to an open box.
Wendy K.: Whatever you put in, you could take out. So I can maintain full access to and control over my assets. I can make all the distributions. I call all the shots. But if I become incapacitated five years after I make this trust, I've already named successor trustees to step in and manage it. Trust assets, but according to my instructions, that trustee does not have unfettered full discretion to do whatever he or she wants.
Wendy K.: So even if I name my husband as a trustee, he's got to follow my instructions, and that's the best part of it. Right? Um, and then it can also include a whole set of incapacity instructions. So it's going to say how I want to be cared for and how I want my money to be spent if I do become incapacitated and can no longer control everything.
Wendy K.: And then, when I die, that trust avoids probate. So if all my assets are in the trust, then, um, there is no court proceeding when I die. The only, so the A will is a document that, um, that Well controls assets that are in my individual name when I die. So if I own my assets, if I put them into a trust, no probate.
Wendy K.: If I own assets jointly with somebody else or I've named beneficiaries on some of my assets and nothing is in my individual name when I pass away, there is no probate. I don't have to get into a situation where the courts are involved in our affairs, and it's intrusive, and there are a lot of unintended consequences with probate.
Wendy K.: Could take a lot of time. During COVID, we saw a lot of delays. Courts were shut down, and then they were all backed up. It took months and months and months, even years, to get a will through probate so that we could eliminate all of those issues. Less expense, fewer attorney's fees. That's the part that most people like, so they're going to save a lot of time, aggravation, delay, and expense by avoiding probate.
Wendy K.: So, trusts have become very important. And in addition to the revocable living trust, which is often called a well substitute, there are irrevocable trusts that we create for different purposes. A lot of it is for tax minimization or avoidance, um, and also for Medicaid planning, so we can protect assets so that we can become eligible for the Medicaid programme, which we can talk about as well.
Hanh Brown: Now can you touch on the power of attorney and healthcare?
Wendy K.: directive? Sure. Power of Attorney is probably one of the most critical documents that we have. That's where we are naming agents to, um, step into our shoes and handle all of our legal and financial decision-making. So it's really critical that everybody 18 and up has that power of attorney to do that, because otherwise nobody has authority to make any legal or financial decisions for us.
Wendy K.: Even if you're married, your spouse doesn't necessarily have the ability to do that. So we need to name the right agents to do that in the event of incapacity, or we're just unavailable to act. So the power of attorney names an agent that can make all decisions other than healthcare or medical decisions that come into the healthcare proxy.
Wendy K.: Where we're naming one individual at a time who can step in and make all of our healthcare medical decisions in the event of incapacity, or we're just unavailable, we can't communicate for whatever time period, let's say temporary or permanent. Um, typically, it can include organ donation and burial instructions.
Wendy K.: It can include HIPAA compliance. So our agents can have access to our confidential medical information records. Um, and we can also do separate, um, hipaa. Authorization if there are individuals or family members who are not named as healthcare agents, but we want them to be able to access information, such as getting information.
Wendy K.: If you're in the hospital and they want to check in on you and find out, call the nurses station so they'll have authority to do that. Mm-hmm. So those kinds of four documents really, um, comprise a pretty comprehensive estate plan. Mm-hmm.
Hanh Brown: So you've touched on what happens when you don't have an estate plan.
Hanh Brown: Right. I want to do a deeper dive because I'm sure it's very compelling. So with the absence of an estate plan, both during life and after death, describe some of the scenarios that you've seen in your
Wendy K.: profession But we've seen situations, unfortunately, where an individual has not signed any of these documents, has not done any planning, becomes incapacitated, and then the family comes to us.
Wendy K.: They don't have the ability to do any planning, whether that's estate planning, long-term care planning, or Medicaid planning, and the only alternative is to petition the court to become the legal guardian of that person. Which is really guardianship. Adult guardianship in the United States is probably one of the worst court proceedings there is.
Wendy K.: It is very intrusive, time-consuming, and expensive. So basically, let's say, I have to petition the court to become the guardian of, let's say, my aunt. And I have to lay out a whole scenario in that petition as to why my aunt needs the appointment of a guardian. So, um, and that court, I'm asking the court to declare my aunt to be an incapacitated person.
Wendy K.: And there's a hearing on the record. Um, and at the end, the court will appoint, let's say, me as a guardian. Now I have. All the powers to, um, make all decisions for my aunt Maybe I don't really know what she would want or have wanted. Um, so that guardian, whether it's a family member or could be a stranger appointed by the court, is going to get paid from that person's assets?
Wendy K.: Um, and all decisions regarding that person's personal needs and property management are all done by the Guardian under, you know, court scrutiny. So, Through proactive planning, That's something for which nobody should ever have to ever, um, uh, petition the court. So that's the worst court proceeding when we have no will. If someone dies without a will, that's a situation where it's called intestacy.
Wendy K.: The person dies in the test state without a will, and now the state rules say who gets that person's property and how. So there's like a pecking order. Usually, the closest heirs by law are the ones who are going to inherit the property. That might not be who you and I want to inherit our property because we failed to plan, and there's no ability to protect the assets for those individuals through the creation of trusts.
Wendy K.: That can be done through a will. Those are called testamentary trusts. So that's not something that we want to have happen. So at minimum, we want to have a will. I definitely do not want to die without a will. Mm-hmm.
Hanh Brown: Mm-hmm. Now, can you explain trust and how that relates to long-term care planning?
Hanh Brown: Sure.
Wendy K.: So if we get to a situation where we need considerable care, whether that's to remain at home in the community, that's ideally where we would want to get that care. In the worst-case scenario, in a skilled nursing facility, the cost of care is extremely expensive. Um, and there are only a handful of funding sources to pay for that care.
Wendy K.: So, um, and we can do a deeper dive into some of these if time permits, but what are the funding sources? There's Medicare, there's long-term care insurance, private pay, and then Medicaid, which is the payer of last resort. And that's a government entitlement programme that will pay for all of our portion of the cost of care, either at home or in a skilled nursing facility.
Wendy K.: But in order to ask Medicaid and the government to pay for the care, you have to show the government that you exhausted all the other payer sources first and came to them last. So there are financial eligibility requirements for that programme. And look back at periods that have to be met. So through trust-based planning in a proactive situation, If someone comes to me today, let's say, and says, Wendy, I want to protect my assets so that in five plus years from now, um, I can apply for Medicaid if I need long-term care,
Wendy K.: We can create a specially designed trust. It's an income-only irrevocable trust, or we call it a Medicaid asset protection trust, into which we can put assets so that they will not be deemed available and counted when determining financial eligibility for Medicaid. So we could put a house in there, we could put bank accounts in there, we could put brokerage accounts in there, and we could put all our assets in there, almost except for retirement assets.
Wendy K.: Those would not go in. So if I create a trust today for you, Han, and me, I put your house and all these assets in it, and you stay healthy and out of a nursing home for the next five years, let's say six years from now, God forbid you need to go to a nursing home. Medicaid's going to look back five years to see what you did with your months.
Wendy K.: Okay, so you put those funds in six years ago? They're outside of the look-back period, but if we put those assets in today and two years from now, you would need to apply for Medicaid. Medicaid's going to look back five years. If you needed a nursing home, they're going to see that you transferred assets into this trust.
Wendy K.: But those are called uncompensated transfers. Those are transfers for less than fair market value. You basically gifted them to this trust, okay? Medicaid will penalise you for that. They'll calculate a penalty period during which time Medicaid won't cover your care. You'd have to pay privately. So there are a lot of nuances and a lot that goes into this.
Wendy K.: But basically, the trust is a vehicle to protect the assets. As long as you get past the lookback periods, the assets in that trust can be deemed available to pay for the cost of care. Right now, in my neck of the woods in New York, a single individual cannot have more than $16,800 in assets in order to become financially eligible.
Wendy K.: certain exempt assets, but that's because you have to basically render yourself indigent to obtain, um, the benefits. So it requires proactive planning. There is planning that can be done in a crisis, but like I said earlier, there's much less that can be protected at that point.
Hanh Brown: Very true. So how can proper planning minimise and eliminate estate taxes?
Hanh Brown: Can you talk about that?
Wendy K.: Sure. Um, estate taxes have become an issue for probably 1% of the population these days, but, um, there are very high federal thresholds for estate taxes. So if I die today with $12 million, I don't pay any estate tax. You and your spouse can both pass 12 million in estates tax-free.
Wendy K.: So basically, you get two coupons. There are states that have state estate taxes as well, such as my State of New York, which is about 6.1 million per person. The federal threshold is going to be pretty much carved in half by, um, 2026, so it's going to open up the doors and the need to do some more state tax planning, but we can do planning where we can better equalise the assets between spouses to take advantage of the two thresholds so we could pass 24.
Wendy K.: Million estate tax-free. So, um, rather than giving all of my assets directly to my husband, let's say, and he might have more than the threshold, that's not true. Don't worry about it. That's why I'm still working. Um, I can put them in a trust in my will so that He can have access to income and principle, but those assets won't be counted in his taxable estate when he passes away.
Wendy K.: So we can make sure that we can eliminate or minimise any estate tax that way. Um, there are also different techniques and trusts that we can use to transfer assets into irrevocable trusts to get assets out of our taxable estates and also to freeze the values so that any future growth on those assets will be outside of our taxable estates.
Wendy K.: So there's a whole, there are so many, it's like an alphabet soup of different acronyms, of different types of trust that can be used for different purposes to either eliminate or minimise the payment of state taxes, um, when we pass away or when the second spouse passes away. So it really requires a lot of, um, financial analysis, tax analysis, and working as a team with our clients, their financial advisors, their CPAs, and their tax professionals to analyse everything to see which techniques would work the best and what the family goals are too.
Hanh Brown: Yeah, yeah. This underscores the importance of proactive planning for all of these. Documentation. So can you talk about what your take is on some of the main concerns of individuals age 65 and up? What do you think they're worried about?
Wendy K.: I think they're mostly worried about, well, obviously, their health, being isolated and lonely, and all of the financial issues.
Wendy K.: Um, I think well, through COVID, we saw a lot of that with social isolation and loneliness, which were big issues and also affected the health of these individuals as we aged. But I think that the long-term care costs and expenses are really the looming disaster out there.
Wendy K.: Um, that's, I. I heard that long-term care costs are the number one cause of middle-class bankruptcy for people who are, um, you know, older—for older adults, 65 and up. So, um, if we don't factor those probable costs into our retirement planning, that could really create a crisis situation. I mean, we can't just wake up at 65 and decide, Oh, it's a good time to retire.
Wendy K.: I think I'm going to, you know, go play golf and, like you said, have a martini on the beach, and I'm going to live this great life. I met with my financial advisor, and I figured out how much income I needed. Cover my lifestyle and whatnot, but, oops, I forgot to factor in the health costs and the long-term care costs.
Wendy K.: So, as you know, I don't know. I'm sure, like in your family, your parents probably worked hard to leave you better off. I'm working hard to leave my kids better off, because what I'm hearing out there is that the, you know, our children, the, you know, the The generations that are coming up aren't going to have the same quality of life and income earning potential as the baby boomers and the greatest generations.
Wendy K.: So, um, There are things that we can do with certain financial products—life insurance, long-term care insurance—to kind of, um, create wealth for the next generation. Or if we have to spend our earnings and our wealth to pay for our care, at least we're still leaving a legacy and an inheritance for, you know, our children and younger.
Wendy K.: Um, relatives. So really planning for all of that is critical, not just putting our heads in the sand and thinking that we don't have to address those issues of ageing and the cost associated with that, because a lot of people don't have a clue as to how expensive it is to pay for the care that they need.
Wendy K.: And where are they going to get that care? They only know about nursing homes, but they don't know about the fact that there are all different types of care that can be provided at home. But those costs could also simulate the cost of a nursing home. Mm-hmm. Mm-hmm. Extremely expensive.
Hanh Brown: Right? That's. Upcoming in our discussion, but I concur with you.
Hanh Brown: Yeah. But I want to reiterate everything that you're saying. Yeah. I think folks who are, let's say, 65 plus are in their mid-fifties. I'm worried about the same thing, you know, and I, because I'm caring for my, uh, mom who has dementia, my mother-in-law who has dementia, and my father-in-law is doing pretty well.
Hanh Brown: But my point is, maybe I'm not looking at it in terms of me, but I'm certainly the generation caring for my parents who are in that place. And clearly, you know, Most people are concerned about whether or not they have enough money to live comfortably, stay healthy and active, and have someone that they can rely on in case of an emergency.
Hanh Brown: And for many seniors, they still want to feel like they're in control of their lives and their future and that they have options even as they get older. And, uh, you know, they're concerned about losing their independence.
Wendy K.: Yeah. Well, that is a major consideration. So if we try to take control by planning,
Wendy K.: Then we can have options to stay in control. And really, as we age, I think we have, and if we need that level of care, at some point, I think we kind of have to ask ourselves certain really critical questions and not difficult questions. Isn't it like, where would you want to live? Right. You want to stay in your, you know, single-family home, where you raise your family.
Wendy K.: Do you want to downsize? Do you want to live in a warmer climate? Do you want to live near your family? You know, and you know, think about where, you know, who would take care of you. Right. It's really a critical consideration, you know. Gone are the days where adult children took their ageing parents and grandparents into their own homes to provide the care.
Wendy K.: You know, and would we want our children to even provide that type of care for us? I mean, um, I heard one attorney joke that, um, he should have had seven daughters and named them Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, and Sunday, right? Yeah. One for every day of the week. Yeah. But, um, That doesn't.
Wendy K.: Very true. Yep. Right. That doesn't happen. I know. I'll tell you a quick anecdote. I have two kids. Um, my daughter's 26-year-old Alexandra, and my son's 29-year-old Mitchell Um, when Mitchell was about 12, he turned to me one day, knowing what I did for a living, and said, Mom, when you turn 90, I'm putting you into a nursing home.
Wendy K.: And I said, Mitchell, what about if I'm a young 90-year-old and I don't need it? It doesn't matter. You're in a nursing home. So I turned to my daughter and said, Well, what would you do? She gave me a much better answer. So, yeah, my point is, you know, Mitchell's not going to be my carer. So he's out of the question as a carer and out of the will.
Wendy K.: out of the will. That's a joke. But really, I mean, he's a good kid. I have great kids, but the thing is, I wouldn't want my children to make those decisions and provide the care. I wouldn't want them to help me with my activities of daily living. They can manage my care, right? Yeah. They can, you know, break the checks from my money, but I don't want them providing that care.
Wendy K.: So, We have to kind of take that control back, yeah. You know, and you know how it is, how would we pay for that care? So, mm-hmm. Just,
Hanh Brown: As we talked about before going live, I'm the youngest of 10, so my mom and dad have eight girls, so we do have somebody Monday or Tuesday.
Wendy K.: See, that's not a joke in your family. Well, it's similar.
Wendy K.: We're
Hanh Brown: Not that near, so there are only about five of us that are near my mom. They do rotate, and I thank God for that.
Wendy K.: You know? So what, two of you have to do double duty then? That's what, yeah. Wow. Your parents were smart. Yeah. Planned that. Well, they have
Hanh Brown: eight girls, two boys, and then, I think, 29 or 30 grandchildren.
Hanh Brown: And great-grandchildren. But my dad passed away before it happened that he had great-grandchildren. And my mom has dementia. I know you recognise
Wendy K.: Yeah. If you could remember all those names, even at your age, I would be amazed. The whole family Yeah.
Hanh Brown: All right, so let's talk about the options for care and the average cost of care.
Hanh Brown: If you have, you know, I mean, I have some idea, but go ahead and give me your take on the options for care and the cost associated with that.
Wendy K.: Sure. Um, well, the options are really going to be different, and the costs are going to be dependent on the kind of care that you need and where you live in the country. Right, and the level of care
Wendy K.: But I mean, we could start with the least restrictive, which is staying in our home and paying for some care. And that could be companion care or, you know, some kind of home health aid and whatnot. Um, Genworth puts out a study every year on this, so you can go to genworth.com and kind of type in your area.
Wendy K.: But in my area, in the metro New York area, the average cost of care at home, let's say one shift, seven hours a day, 12 hours a day, seven days a week, is going to be somewhere close to $11,000 a month. Or about $130,000 annually. And then just double that. If you need split-shift care, So if you need two people, one during the day and one to be up at night, that could double that cost, um, per year, which is more per year.
Wendy K.: So it's astronomical. Um, um, Other types of care we could provide, we have clients who will participate in adult day programmes, social models, medical models, adult day programmes. So that could be, let's say, five days a week for six hours a day. That provides socialisation, meals, and activities. A medical model will also have, you know, some healthcare or medication management associated with it.
Wendy K.: Sometimes transportation costs could be anywhere between $1,300 a month and closer to $16,000 a year. Um, and we have people who stay home partly and then also go to the day programme. So it could be a combination of care at home and during the day. Programme. Assisted living communities are another location where we can, um, have a residential option where, you know, we could sell our single-family homes and move into a more social model where we have an apartment, meals, transportation, and a whole slew of activities.
Wendy K.: Um, that could be anywhere between $6,300 a month on average and $75,000 a year. Actually, in my area, it's usually more like $10,000 a month. So very expensive. Um, and then The most restrictive If we can't stay home, assisted living isn't an option, and independent living isn't an option. Skilled nursing facilities.
Wendy K.: So, um, right now, the average cost in my area of New York is somewhere around $600 a day. So it could be about $18,000 a month, right? So you could see how quickly you could become destitute by paying for that type of care. So that's where the proactive planning comes in. So we can try to, you know, minimise or figure out what the funding sources are for that care so we don't become destitute.
Wendy K.: Mm-hmm. We can have options.
Hanh Brown: Right. Right. So that's the highest level of care, and that's 24-hour supervision. And you're talking about roughly 20,000 where you
Wendy K.: per month? Yeah, it's about $18,000 a month right now in New York. And that will just rise? It depends where in New York you are. Right where I live, it's close.
Wendy K.: It's, as we used to say, $500 a day. Now it's more like $600 a day. That kind of care.
Hanh Brown: Okay. So let's talk about funding sources. Okay. There are a variety of funding options available, and I guess many people are not sure how these funding sources work or which one is best for them, so can you take a closer look at what they are?
Hanh Brown: I think there's like government funding, Medicaid, Medicare, veterans,
Wendy K.: what else? Right? Sure. Well, the main funding sources people talk about are Medicaid and Medicare, so there's a lot. Widespread but erroneous belief that, uh, Medicare and Medicaid both pay for long-term care. Medicare does not pay for long-term care.
Wendy K.: Medicare will pay for, um, up to 20 days in rehab, but after a three-day hospital stay, stay after day 20. It'll pay a portion from days 21 to 100 with a copay that's usually covered by a supplemental or Medigap policy. Um, and there's no guarantee that Medicare's going to cover all 100 days. So that's usually short-term rehab.
Wendy K.: So, you know, my mother fell broke. Her hip is in, you know, the hospital, and then she's discharged to a rehabilitation facility. Medicare covers the first 20 days. Of that rehab. But after a day, let's just say she's lucky, she gets up to day 100, day 101. If she's still in that facility, it's private pay.
Wendy K.: That's where we get that $600 a day. So, you know, the billing department's coming in with a nice big, you know, invoice to be paid. So, um, it doesn't pay for help at home with your activities of daily living or your instrumental activities of daily living. So that's where After the Medicare days are exhausted or we don't get any Medicare days, we have to look at other sources.
Wendy K.: So private pay, look, if we have, you know, considerable income and assets, we can self-insure, we can pay for our own care, or we can pay the premiums associated with obtaining long-term care insurance, which is something that we are always encouraging our clients to look at. And that's the insurance that would cover the cost of care, either at home or in a skilled nursing facility.
Wendy K.: So let's say I pay $5,000 a year right now for my premium, so if I need the care, that's going to pay for that $18,000 a month bill. Right. So there are a lot of factors that go into determining what that premium is going to be, including my age, my health, and, um, the daily benefit. So there's a daily benefit that's paid.
Wendy K.: It could be two dollars a day or it could be 300 dollars a day. It just depends, uh, upon that level of, you know, daily benefit elimination periods where you are in the country. So there are a lot of factors that go into determining what that premium is. But long-term care insurance is a payer source.
Wendy K.: If we, you know, you said VA benefits, there are benefits that are available to, um, veterans aid attendance benefits that could be used to defray some of the costs, but typically they are not going to cover as much as necessary. Um, some people will get a mortgage on their home, either a conventional mortgage or a reverse mortgage, to pay for, let's say, their living expenses.
Wendy K.: And then they will look to, let's say, the Medicaid programme to cover the cost of care. And Medicaid is the payer of last resort, like I said earlier. So it's a government benefit programme that, if you If we are medically and financially eligible, it will pay all of our portion of the cost of care. So in New York, there's community Medicaid and chronic or institutional Medicaid.
Wendy K.: Mm-hmm. So community Medicaid, like it sounds, is to pay for care in your residence. So that could be, again, your single-family home. Um, it could be a home you downsized into an apartment, a co-op, or a condo; it doesn't matter. But care could be brought in and paid for through the programme. So now
Hanh Brown: Medicaid has copayments and deductibles, which means the patients have to pay a certain amount of money.
Wendy K.: Medicare, For Medicare, right? So there is a copay of $194 and 50 cents right now for Medicare to cover those days, 21 to 100, and that's where the Meap policy, if you obtain one, can cover that. And the things that you know, straight Medicaid or traditional Medicaid isn't covering. But that's not going to cover anything.
Wendy K.: Any long-term care needs past day 100 That's where you have to look for other funding sources for care. Or hopefully become eligible for Medicaid. So we have a lot of chronically ill individuals who are dual eligible and receive Medicare and Medicaid to cover the cost of care. Mm-hmm. So,
Hanh Brown: Medicaid eligibility: please correct me if I'm wrong: do you have to be a US citizen or legal resident?
Hanh Brown: You've got to meet a certain income requirement. Pregnant or a parent of dependent children, elderly, or disabled.
Wendy K.: Right. So those are criteria, right? So in my practise, we're mostly dealing with the elderly and disabled, and those are not covered by Medicaid as health insurance. It's Medicaid that covers the long-term care expenses.
Wendy K.: So that's where the dual comes in—you know, if you're 65 and up, you have Medicare that covers your health insurance, right? Yeah. Prescription drugs, hospitalisation, all of those doctors, and then Medicaid will cover the cost of care. So for the long-term care needs that you have, the long-term supports and services that you receive in the community or in skilled nursing
Wendy K.: So two very distinct programmes, um, with You know, Medicare is not a programme that has financial eligibility requirements. You're automatically entitled to Medicare benefits for people 65 and older, as opposed to Medicaid, where you have to become financially eligible for that programme. Mm-hmm.
Hanh Brown: All right, so let's talk about challenges facing older adults in the healthcare delivery system.
Hanh Brown: What is your take?
Wendy K.: on that? Um, there are a few of them. Yeah, there are plenty. There's plenty. You could probably do a whole podcast on that. Yeah. I've always felt that there's an alarming shortage of geriatricians and paid carers in the workforce at a time when this age cohort is just burgeoning.
Wendy K.: It's just growing. There are probably about 13 million Americans who require long-term care. There aren't enough people trained in this specialty to address the real, complex needs of the elderly and those who are dealing with chronic illnesses, neurodegenerative diseases, or sometimes both. Um, and I think it's largely due to economics and just the current healthcare delivery system, and that geriatrics is a lower-paying profession.
Wendy K.: But it is, it's, it's something that, I think there's a crisis in that, um, Hospitals that aren't equipped to really deal with, um, geriatric patients. And we need more, let's say, geriatric inpatient care units where, you know, they're designed to really address the complex needs of the elderly. So they go into the hospital because of a broken hip.
Wendy K.: They're not leaving with greater problems when they're discharged. Um, and just the lack of training: of the different individuals who are dealing with the elderly, they need to be better trained, and there needs to be better coordinated care for this population. Um, ageism is a problem in the healthcare delivery system.
Wendy K.: Um, and fewer people are entering, you know, the paid caregiving workforce. And, you know, at a time when more people were leaving that workforce for better-paying and less-demanding jobs, I mean, caregiving is probably one of the most difficult and demanding jobs out there. Um, so instead of being a carer, I could get a job in, you know, an Amazon warehouse and make a lot more money with more benefits.
Wendy K.: Right, right. than being a paid carer. So, Right. There's a lot. The list goes on. The list goes on. We can talk about it; the list goes on; we can talk for hours about it.
Hanh Brown: Yeah, and I see, you know, many challenges that older adults in the healthcare delivery system are dealing with. I think it's the way society views ageing.
Hanh Brown: Like you mentioned, whether it's ageism or just no regard for older adults And they see ageing as a time of decline. And this view can have a very negative impact on our ability to provide quality healthcare to older adults. And some might even believe that we should just leave the elderly to die and that they're no longer worth our time and resources.
Hanh Brown: I mean, not only is this wrong, but it's also very shortsighted. They have a lot to offer society, and they deserve access to quality healthcare. I think the attitude that we all can take on is that we have to provide older adults with the quality healthcare that they deserve and make sure that the healthcare system is age-friendly by supporting resources and focusing on improving the health of older adults.
Hanh Brown: And I think it's very complex. The healthcare system is very complex for anyone, particularly older adults who are facing more health issues. You know, it's complex enough for me to navigate. So I can't imagine trying to help my, let's say, parents or folks in their seventies and eighties.
Hanh Brown: It's hard for them to understand all the nuisances, the steps, who to talk to, copays, and, you know, just everything. And I think sometimes older adults find it challenging to communicate their needs and preferences to healthcare providers. Right. I feel like they just have a window of
Wendy K.: time, right?
Wendy K.: If you have three minutes in a medical appointment, you don't have the time to address all those issues and needs. But I mean, navigating the healthcare delivery system and government entitlement programmes is daunting enough for people like us, let alone for people who are even older and dealing with, um, you know, maybe some cognitive decline.
Wendy K.: So, we really need to be educated, and people need advocates. People need people who are able to speak for them and advocate for them, whether it's family members or professionals. Advocating for the best care possible is critical to successful ageing. Um, you know, they may not have the vocabulary or the knowledge.
Wendy K.: Never having dealt with these issues. And like you say, it catches you by surprise, right? Yeah. So really understanding that there are other professionals out there who can assist when needed as well and where you can get the right education, knowledge, and information that's required so that you don't make some, you know, mistakes down the road and you can kind of curate the best kind of care plan and lifestyle for yourself as much as possible.
Wendy K.: It's so
Hanh Brown: important. And we didn't even mention the cost. The cost of prescription medications and all treatments can be prohibitive for many people. Yeah. So, um, the list goes on. So I think the more that we can do to be advocates for older adults planning their future in all regards, the better we are going to be.
Hanh Brown: We have a couple more; however, in closing, do you have anything else that you would like to add?
Wendy K.: Um, I, I, I think that it's just, it's important if you haven't done planning to, you know, seek out the services of the right professionals. You know, if you're going to go to an estate planning attorney, make sure that person also understands the issues around ageing.
Wendy K.: Perhaps if you're 65 and up, just like you should go to a geriatrician for your medical, Needs, healthcare needs. Seek out the advice of an elder law attorney as well. And ideally, an elder law attorney who understands the importance of coordination, care coordination, maybe works with a social worker like we do in our office so that, you know, you work as a team with the right individuals to, like I said, curate the right plan both on the care side and on the legal and financial side.
Wendy K.: So it really does take a village. As has been said in the past, having the right people on the team, getting the right information, and constantly updating that plan when necessary is really, really critical. Because you need to make sure that your plan's going to work for you when you need it to work for you.
Wendy K.: Right? I could have made a plan 20 years ago, but my life has changed, right? So whatever I put in place 20 years ago isn't going to work for me, my family, or my needs today. So it has to. Looked at and updated when necessary. Mm-hmm. Mm-hmm. But working with the right people
Hanh Brown: critical. Yeah. Well, thank you so much.
Hanh Brown: I appreciate your work and the wealth of knowledge that you brought to the conversation, and I believe it adds value to anyone that's listening and watching. So thank you so much.
Wendy K.: Thank you. It's been a pleasure. Yeah.
Hanh Brown: Thanks so, As baby boomers age, they often face several legal issues that can be confusing and overwhelming, such as recovering healthcare.
Hanh Brown: Long-term care, estate planning, retirement planning, and end-of-life planning are all important considerations that have a significant impact on a person's quality of life. So it's important to remember that these decisions don't have to be made all at once. You can take your time and think about what's best for you and your family, and of course, update them as time progresses.
Hanh Brown: But it's very important, and I urge you to be proactive about planning for the future. Waiting until a crisis arises can be very costly, stressful, and full of turmoil, and, um, it may not be possible to make the best decisions in the heat of the moment. So if you're a baby boomer approaching retirement age, take some time to think about your legal options.
Hanh Brown: There are lots of things to consider, but don't let that scare you. The most important thing is to get started and move forward, and you're not likely to regret it. So, um, an upcoming event On October 25th, we're going to have a discussion on how baby boomers Entrepreneurs create a digital plan to attract their ideal customers.
Hanh Brown: So join us then, and thank you so much. I'll see you next week.
Hanh Brown: Thank you for listening to another episode of the Boomer Living Broadcast. I know you have a lot of options when it comes to podcasts, and I'm grateful.
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Hanh Brown: senior population. We want to help them have a great experience as they age.
Hanh Brown: Thanks for tuning in. Until next time.