Can you sue for Bedsores or Pressure Sores?

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2019 Law Firm added Free Booklet

Bedsores should not happen while in a nursing home or hospital. Often they are due to neglect and negligence.

Bedsores, Pressure Sores or Decubitis Ulcers are not the fault of the patient. At a hospital or nursing home there are federal laws in place to protect patients and assure they get the proper care. When these standards of care are not used sores can develop. Simple duties like turning an immobile patent frequently to relieve pressure, proper cleaning an hygiene are sometimes not provided. If a sore develops the patient has now become a victim. The sores can cause extreme pain and suffering and unfortunately even death. You can sue. And you have every right to do so and get financial compensation. Depending on the case, monetary awards can be in the millions. Below are some of the different types of lawsuits relating to sores.

Medical Malpractice

Medical Malpractice cases arise when a health care practitioner departs from the accepted standard of care in the medical community. In more simple terms, when a hospital, doctor, nurse, practitioner commits a serious error in his/her care and treatment, which results in further injury to the patient. Some common examples are failing to diagnose the bedsore; failing to report bedsores or pressure sores; failing to admit a patient into the hospital for bedsores when necessary; and failing to perform a medical procedure or provide treatment for bedsores that was otherwise indicated.

FREE BEDSORE FACTS BOOKLET>

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Nursing Home Liability

The elderly population frequently suffers due to serious neglect once they become patients or residents in nursing homes or any long term care facility.  Some critical issues relating to sores are: over or improper medication; lack of supervision; inadequate wound care leading to infections; not reporting the issue in a timely manner and overall neglect.

The severe injuries that patients experience along with the constant pain and suffering associated with bedsores are often the result of preventable situations. In our experience in handling these types of cases we have found frequent examples of poor care planning; lack of stimulation; failures to turn and position patients; failure to provided adequate pressure relief devices to patients; and unbelievably, failure to change adult diapers and failure to provide sufficient quantities of food and water. As a result of neglect in Nursing Homes, the illnesses range from severe infections and amputations, to dehydration and, unfortunately, death. Bedsores and pressure sores often lead to further infections and illnesses.

Hospital Negligence

At one time or another we all go to hospitals. While patients there, we have the right to expect quality medical care and treatment.  The unfortunate reality is that there are often tragic outcomes that are the result of medical malpractice which should never occur. This is especially true with bedsores.

Hospital Negligence occurs when there are “departures in the standards of good and accepted medical practices” that one should be able to expect in the local medical community given the current state of medical treatment and technology. These departures in the standard of care can stem from negligent treatment on the part of Doctors, Surgeons, Specialists, Lab Technicians, Physician Assistants, Nurses, Nurses Aides, Therapists, Administrators, Pharmacists and any other member of the Hospital Staff whose conduct, actions, or inaction, causes injuries and suffering that should not have occurred.

Some examples of Hospital Negligence include failure to provide proper medication or medical devices; failure to provide proper monitoring and supervision; failure to order consultations to other medical specialists; failure to diagnose bedsores in a timely fashion; failure to prevent infection and amputation; failure to turn and position the patient resulting in pressure sores, bedsores or decubitus ulcers; failure to perform a medical procedure or surgery properly; failure to warn patient of risks of a surgery or medical procedure; failure to keep family members informed regarding medical decision making; and failure to provide safe and proper discharge instructions.

Wrongful Death

This type of lawsuit occurs when a spouse or close relative has a right to recover when a loved one dies due to the sores or a medical complication that was related to the sores. Recovery is from the at-fault or negligent party. Recovery can include loss of income, services, comfort and society. New York has a very restrictive and complicated wrongful death statute. Our knowledgeable lawyers take you through it one step at a time. We understand that dealing with the loss of a loved one is not easy, so we are extremely sensitive when dealing with family members. Unfortunately, left untreated or not treated in time, bedsores can rapidly progress from stage 1-4 and lead to further complications often resulting in a wrongful death.

If you or someone you know is a victim of bedsores, the first thing to do is get the stage of the sore identified and immediate and proper medical attention. If you think you have a lawsuit then contact me on how to proceed. You can also begin an evaluation online by clicking here. We can even help you get better medical attention at the same time. Feel free to email about these matters at bedsores@RaphanLaw.com

Regards, Brian

You may have signed a Living Will, but scary mistakes can happen at the ER

August 5 Washington Post/Health & Science

“Don’t resuscitate this patient; he has a living will,” the nurse told the doctor, Monica Williams-Murphy, handing her a document.

Williams-Murphy looked at the sheet bearing the signature of the unconscious 78-year-old man, who had been rushed from a nursing home to the emergency room. “Do everything possible,” it read, with a check approving cardiopulmonary resuscitation.

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The nurse’s mistake was based on a misguided belief that living wills automatically include “do not resuscitate” (DNR) orders. Working quickly, Williams-Murphy revived the patient, who had a urinary tract infection and recovered after a few days in the hospital.

Unfortunately, misunderstandings involving documents meant to guide end-of-life decision-making are “surprisingly common,” said Williams-Murphy, medical director of advance-care planning and end-of-life education for Huntsville Hospital Health System in Alabama.

But health systems and state regulators don’t systematically track mix-ups of this kind, and they receive little attention amid the push to encourage older adults to document their end-of-life preferences, experts acknowledge. As a result, information about the potential for patient harm is scarce.

A new report out of Pennsylvania, which has the nation’s most robust system for monitoring patient-safety events, treats mix-ups involving end-of-life documents as medical errors — a novel approach. It found that in 2016, Pennsylvania health-care facilities reported nearly 100 events relating to patients’ “code status” — their wish to be resuscitated or not, should their hearts stop beating and they stop breathing. In 29 cases, patients were resuscitated against their wishes. In two cases, patients weren’t resuscitated despite making it clear they wanted this to happen.

The rest of the cases were “near misses” — problems caught before they had a chance to cause permanent harm.

Most likely, this is an undercount, said Regina Hoffman, executive director of the Pennsylvania Patient Safety Authority, adding that she was unaware of similar data from any other state.

Asked to describe a near miss, Hoffman, co-author of the report, said: “Perhaps I’m a patient who’s come to the hospital for elective surgery and I have a DNR order in my [medical] chart. After surgery, I develop a serious infection and a resident [physician] finds my DNR order. He assumes this means I’ve declined all kinds of treatment, until a colleague explains that this isn’t the case.”

The problem, Hoffman explained, is that doctors and nurses receive little if any training in understanding and interpreting living wills, DNR orders and Physician Orders for Life-Sustaining Treatment (POLST) forms.

Communication breakdowns and a pressure-cooker environment in emergency departments, where life-or-death decisions often have to be made within minutes, also contribute to misunderstandings, other experts said.

Research by Ferdinando Mirarchi, medical director of the Department of Emergency Medicine at the University of Pittsburgh Medical Center Hamot in Erie, Pa., suggests that the potential for confusion surrounding end-of-life documents is considerable. In various studies, he has asked medical providers how they would respond to hypothetical situations involving patients with critical and terminal illnesses.

In one study, for instance, he described a 46-year-old woman who is brought to the ER with a heart attack and suddenly goes into cardiac arrest. Although she is otherwise healthy, she has a living will refusing all potentially lifesaving medical interventions. What would you do, he asked more than 700 physicians in an Internet survey.

Only 43 percent of those doctors said they would intervene to save her life — a troubling figure, Mirarchi said. Because this patient didn’t have a terminal condition, her living will didn’t apply to the situation at hand and every physician should have been willing to offer aggressive treatment, he explained.

In another study, Mirarchi described a 70-year-old man with diabetes and cardiac disease who had a POLST form indicating he didn’t want cardiopulmonary resuscitation but agreeing to a limited set of other medical interventions, including defibrillation (shocking his heart with an electrical current). Yet 75 percent of 223 emergency physicians surveyed said they would not have pursued defibrillation if the patient had a cardiac arrest.

One issue here: Physicians assumed that defibrillation is part of cardiopulmonary resuscitation. That’s a mistake: They’re separate interventions. Another issue: Physicians are often unsure what patients really want when one part of a POLST form says “do nothing” (declining CPR) and another part says “do something” (permitting other interventions).

Mirarchi’s work involves hypotheticals, not real-life situations. But it highlights significant practical confusion about end-of-life documents, said Scott Halpern, director of the Palliative and Advanced Illness Research Center at the University of Pennsylvania’s Perelman School of Medicine.

Attention to these problems is important but shouldn’t be overblown, cautioned Arthur Derse, director of the Center for Bioethics and Medical Humanities at the Medical College of Wisconsin. “Are there errors of misunderstanding or miscommunication? Yes. But you’re more likely to have your wishes followed with one of these documents than without one,” he said.

Make sure you have ongoing discussions about your end-of-life preferences with your physician, your surrogate decision-maker, if you have one, and your family, especially when your health status changes, Derse advised. Without these conversations, documents can be difficult to interpret.

Here are some basics about end-of-life documents:

Living wills. A living will expresses your preferences for end-of-life care but is not a binding medical order. Instead, medical staff will interpret it based on the situation at hand, with input from your family and your surrogate decision-maker.

Living wills become activated only when a person is terminally ill and unconscious or in a permanent vegetative state. A terminal illness is one from which a person is not expected to recover, even with treatment — for instance, advanced metastatic cancer.

Bouts of illness that can be treated — such as an exacerbation of heart failure — are “critical,” not “terminal,” illness and should not activate a living will. To be activated, one or two physicians have to certify that your living will should go into effect, depending on the state where you live.

DNRs. Do-not-resuscitate orders are binding medical orders, signed by a physician. A DNR order applies specifically to cardiopulmonary resuscitation (CPR) and directs medical personnel not to administer chest compressions, usually accompanied by mouth-to-mouth resuscitation, if someone stops breathing or their heart stops beating.

The section of a living will specifying that you don’t want CPR is a statement of a preference, not a DNR order.

A DNR order applies only to a person who has gone into cardiac arrest. It does not mean that this person has refused other types of medical assistance, such as mechanical ventilation, defibrillation following CPR, intubation (the insertion of a breathing tube down a patient’s throat), medical tests or intravenous antibiotics, among other measures.

Even so, DNR orders are often wrongly equated with “do not treat” at all, according to a 2011 review in the Journal of General Internal Medicine.

POLST forms. A POLST form is a set of medical orders for a seriously ill or frail patient who may die within a year, signed by a physician, physician assistant or nurse practitioner.

These forms, which vary by state, are meant to be prepared after a detailed conversation about a patient’s prognosis, goals and values, and the potential benefits and harms of various treatment options.

Problems have emerged with the increased use of POLSTs. Some nursing homes are asking all patients to sign POLST forms, even those admitted for short-term rehabilitation or whose life expectancy exceeds a year, according to a recent article by Charlie Sabatino, director of the American Bar Association Commission on Law and Aging. Also, medical providers’ conversations with patients can be cursory, not comprehensive, and forms often aren’t updated, as recommended, when a patient’s medical condition changes.

“The POLST form is still relatively new, and there’s education that needs to be done,” said Amy Vandenbroucke, executive director of the National POLST Paradigm, an organization that promotes use of the forms. In a policy statement issued last year and updated in April, it stated that completion of POLST forms should always be voluntary, made with a patient’s or surrogate decision-maker’s knowledge and consent, and offered only to people whose physician would not be surprised if they die within a year.

This column is produced by Kaiser Health News, an editorially independent news service and a program of the Kaiser Family Foundation.

Anthony Bourdain Left Loved Ones In Limbo But The Heirs Will End Up Better Than Michael Jackson’s

Via The Wealth Advisor Scott Martin Contributor

He lived on the edge and died without warning. The family needed a disaster plan to minimize strain in the worst moments and smooth the financial transition afterward. These are teachable moments.

Anthony Bourdain chased gusto all over the planet, occasionally tracking into war and disaster zones along the way. There were moments when he could’ve gotten in over his head and never come home.

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A personal disaster plan would have been the responsible way to approach that kind of life. From the way news of his death spread last week, it’s fairly clear that level of forethought just wasn’t his style.

That’s a burden on those he left behind. At a moment when they’re already stunned and vulnerable, it’s up to them to make the hard decisions about managing the press, the authorities and the fans.

Let’s hope that his financial situation was in better shape. While the money will never bring him back, it can at least make life without him easier — provided of course it’s managed properly now.

The personal disaster plan

Enterprises, individual professionals and even well-run restaurants have succession plans. But while Bourdain’s life revolved around his personal participation in every venture, there’s no sign that the work can continue without him.

The TV show is unlikely to ever film again. There won’t be any new expeditions and no new episodes beyond what’s already ready to roll.

There won’t be any new books. There’s no archive of unreleased material waiting for a successor organization to release to bereaved fans.

And the window for him to ever open another restaurant has slammed shut. If he gave much thought to a creative executor to groom the intellectual property he built up in life, again, it would be a surprise.

Otherwise, that person or some other spokesperson he delegated would have stepped up to handle the announcements last week. Instead, everyone looked to Asia Argento, who was understandably shocked and stunned.

The family was quiet. His ex-wife isn’t active on public social media networks and their daughter is only 11. It was up to a colleague to find his body and his network to break the news to the world.

A lawyer, a financial advisor, an agent, a manager: someone could have been authorized to route messaging to the public and make absolutely sure nobody bothered the family.

That didn’t really happen here. There’s no crime in that beyond a missed opportunity to make a tidier transition, whether death comes by surprise or design.

And in the absence of any clear plan on that front, it remains to be seen whether there was a plan to keep his businesses afloat without his personal participation.

Bourdain never really created much of an institution around himself. The copyright on his books was never assigned to any trust, holding company or other entity. While he got production credit on his shows, the actual production company belonged to other people.

There’s no restaurant for his heirs to operate or sell off. He could’ve built a foodie empire to survive him, but evidently wasn’t interested.

His big dream, the Blade Runner themed global food court in New York, stalled last year. Whether that failure to create something lasting preyed on him, we just don’t know.

Again, that level of planning really wasn’t his style. Even if it could’ve made his heirs more comfortable down the road, we would’ve seen the hints years ago.

Healthier, maybe even wealthier

That said, there can be a morbid tinge to building a captive empire of intellectual property and operating businesses. Look at Michael Jackson, who was practically insolvent in life because he’d hoarded other people’s creative output as well as his own.

Jackson’s kids are reportedly billionaires now. He’s the best-selling musical artist in the world. But the cold equations of the estate forced the executors to sell off his songs and back catalog to pay the debts.

Bourdain’s books are seeing a similar posthumous bestseller effect now. Odds are good that ratings of unaired episodes will be the best ever. His daughter will get her piece of that income.

If he left a will — a big hypothetical, all in all — the rights and royalties may well go into a trust for her upkeep now and use when she’s an adult. Otherwise, the money flows into Unified Gifts To Minors Act (UGMA) accounts while the assets themselves sit in Unified Transfers To Minors Act (UGTA) accounts until she turns 18.

Unlike Michael Jackson’s kids, she has an immediate parental guardian to look out for her in the meantime. While mom and dad split up a few years ago, mom is definitely alive and well. As you’ll recall, she’s a professional kickboxer.

Reading between the lines, mom also got the $3 million New York condo as part of the split. She might already have all of the Bourdain cash as it is. Otherwise, sad to say, child support evaporates now.

Whatever Bourdain left behind for his daughter is that support. She can’t touch it for awhile. I hope he made arrangements for someone to monetize his legacy in the here and now.

With the right management, the Bourdain name and likeness stay vibrant and keep generating income. Maybe there actually are book drafts to polish, TV concepts to pitch. There might even be restaurant concepts looking for partners.

The potential here is vast. A creative and savvy executor can turn Bourdain’s name into the empire he never chased in life — maybe even a Michael Jackson scale franchise built on new approaches to food, new grocery models, who knows?

And without the $400 million debt hole Jackson’s heirs started with, right now Bourdain’s survivors are financially ahead of the game. I know it still hurts, but against the inevitability of pain sometimes the only thing we can do is stack the dollar signs.

When his daughter comes of age, she may pick up the family legacy. It belongs to her. That’s the best bequest of all.

 

How to Protect an IRA From Heirs’ Creditors

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When a person declares bankruptcy, an individual retirement account (IRA) is one of the assets that is beyond the reach of creditors, but what about an IRA that has been inherited? Resolving a conflict between lower courts, the U.S. Supreme Court recently (and unanimously) ruled that funds held in an inherited IRA are not exempt from creditors in a bankruptcy proceeding because they are not really retirement funds. Clark v. Rameker (U.S., No. 13- 299, June 13, 2014).

This ruling has significant estate planning implications for those who intend to leave their IRAs to their children. If the child inherits the IRA and then declares bankruptcy sometime in the future, as a result of the Supreme Court ruling the child’s creditors could take the IRA funds. Fortunately, there is a way to still protect the IRA funds from a child’s potential creditors. The way to do this is to leave the IRA not to the child but to a “spendthrift” trust for the child, under which an independent trustee makes decisions as to how the trust funds may be spent for the benefit of the beneficiary. However, the trust cannot be a traditional revocable living trust; it must be a properly drafted IRA trust set up by an attorney who is familiar with the issues specific to inherited IRAs.

The impact of the Supreme Court’s ruling may be different in some states, such as Florida, that specifically exempt inherited IRAs from creditor claims. As Florida attorney Joseph S. Karp explains in a recent blog post, Florida’s rule protecting inherited IRAs will bump up against federal bankruptcy law, and no one knows yet which set of rules will prevail. While a debtor who lives in Florida could keep a creditor from attaching her inherited IRA, it is unknown whether that debtor would succeed in having her debts discharged in bankruptcy while still retaining an inherited IRA. We will have to wait for the courts to rule on this issue. In the meantime, no matter what state you are in, the safest course if you want to protect a child’s IRA from creditors is to leave it to a properly drafted trust.

Here’s 6 good reasons you should consider a trust…

Trusts can help you control your assets and build a legacy.

Via FIDELITY VIEWPOINTS 06/06/2018

Key takeaways

  • Trusts can help pass and preserve wealth efficiently and privately.
  • Trusts can help reduce estate taxes for married couples.
  • Gain control over distribution of your assets by using trusts.
  • With a trust, you can ensure that your retirement assets are distributed as you’ve planned.

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If you haven’t stopped to consider how a trust may help you pass your wishes and wealth on, you could be making a critical estate planning mistake. Especially for individuals with substantial assets, protecting wealth for future generations should be top of mind.

“People often fail to appreciate the power a trust can have as part of a well-crafted estate plan, but that can be a costly mistake,” says Rodney Weaver, estate planning specialist at Fidelity. “Trusts are flexible and powerful tools that can be used to gain greater control over how they pass their wealth to future generations.”

A trust is a legal structure that contains a set of instructions on exactly how and when to pass assets to trust beneficiaries. There are many types of trusts to consider, each designed to help achieve a specific goal. An estate planning professional can help you determine which type (or types) of trust is most appropriate for you. However, an understanding of the estate planning goals that a trust may help you achieve is a good starting point. Also, please note that this information is based on current tax law.

Benefits of a trust

An effective trust begins with documentation carefully drafted by a qualified attorney with knowledge of your specific situation as well as current laws. Without the appropriate documentation, you and your beneficiaries may not reap the benefits of a trust, some of which are described below.

1. Pass wealth efficiently and privately to your heirs

Perhaps the most powerful and straightforward way to use a trust is to ensure that your heirs have timely access to your wealth. When you transfer your assets to your beneficiaries through a will, your estate is settled through a procedure known as “probate,” which is conducted in state courts. However, probate is a public, legal process that can carry with it some unforeseen negative consequences for the administration of your estate, including:

  • Delays: Probate proceedings will take time, some may take longer than a year. Additionally, if you own property located in states other than your home state, probate may be required in each such state.
  • Costs: Probate fees can be quite substantial, even for the most basic case with no conflict between beneficiaries. A rule of thumb is that probate attorney’s fees and court fees could take over 4% of an estate’s value.1
  • Publicity: The probate process is public. When your will is admitted to probate, it becomes a public record, to be viewed by anyone who wishes to review it. Such transparency can create unwanted scrutiny.

With proper planning, the delays, costs, and loss of privacy can often be avoided.

You may be able to avoid probate and gain greater control over how your estate is settled by establishing and funding a revocable trust. Because the trust is revocable, it can be altered or amended during the grantor’s2 lifetime. After a grantor’s death, the trust acts as a will substitute and enables the trustee to privately and quickly settle the grantor’s estate without going through the probate process with respect to assets held in the trust.

A grantor can also give the trustee the power to take immediate control of the assets held in trust in the event that the grantor becomes incapacitated (and the grantor generally has the ability to define what constitutes “incapacity” within the trust document). This provision can save heirs the time, financial cost, and emotional distress of going to court to request a conservatorship or guardianship over a loved one. Finally, revocable trusts are dissolvable, meaning the grantor can generally pull assets out of the trust at any point during the grantor’s lifetime.

2. Preserve assets for heirs and favorite charities

If you have substantial assets, you may want to consider creating and funding an irrevocable trust during your lifetime. Because the trust is irrevocable, in almost all circumstances, the grantor cannot amend the trust once it has been established, nor can the grantor regain control of the money or assets used to fund the trust. The grantor gifts assets into the trust, and the trustee administers the trust for the trust beneficiaries based on the terms specified in the trust document.

Significantly, while the gift could use up some or all of a grantor’s lifetime gift tax exclusion, any future growth on these assets generally will not be includable in the grantor’s estate and therefore will escape estate taxes at the grantor’s death. The individual lifetime federal gift tax exclusion is set at $11.18 million for 2018.

Irrevocable trusts can also serve several specialized functions, including:

  • Holding life insurance proceeds outside your estate. Generally, without trust planning, the death benefit payout from a life insurance policy would be considered part of an estate for the purposes of determining whether there are estate taxes owed. However, this is not the case if the policy is purchased by an independent trustee and held in an irrevocable life insurance trust (ILIT) that is created and funded during the grantor’s lifetime, with certain limitations (please consult your attorney).

    Despite not being subject to estate taxes at death, the life insurance proceeds received by the ILIT can be made available to pay any estate taxes due by having the insurance trust make loans to, or purchase assets from, the estate. Such loans or purchases can provide needed liquidity to the estate without either increasing the estate tax liability or changing the ultimate disposition of the assets, as long as the life insurance trust benefits the same beneficiaries as the estate does. In particular, this means that illiquid assets like real estate, or tax-inefficient assets like taxable retirement accounts, may not have to be sold or distributed quickly to meet the tax obligation.

  • Ensuring protection from creditors, including a divorcing spouse. An irrevocable trust, whether created during your lifetime or at your death, can include language that protects the trust’s assets from the creditors of, or a legal judgment against, a trust beneficiary. In particular, assets that remain in a properly established irrevocable trust are generally not considered marital property. Therefore, they generally won’t be subject to division in a divorce settlement if one of the trust’s beneficiaries gets divorced. However, a divorce court judge may consider the beneficiary’s interest in the trust when making decisions as to what constitutes an equitable division of the marital property that is subject to the court’s jurisdiction.

Keep in mind, though, that irrevocable trusts are permanent. “The trust dictates how the funds are distributed, so you want to fund this type of trust only with assets that you are certain you want to pass to the trust beneficiaries, as specified by the terms of the trust,” cautions Weaver.

3. Reduce estate taxes for married couples

For a married couple, a revocable trust may be used as part of the larger plan to take full advantage of both spouses’ federal and/or state estate tax exclusions. Upon the death of a spouse, the assets in a revocable trust can be used to fund a family trust—also known as a “credit shelter,” “bypass,” or “A/B” trust—up to the amount of that spouse’s federal or state estate tax exclusion. The assets held in the family trust can then grow free from further estate taxation at the death of the surviving spouse. Meanwhile, the balance of the assets in the revocable trust can be transferred to the surviving spouse free of estate tax pursuant to the spousal exemption. At the death of the surviving spouse, of course, these assets may be included in the surviving spouse’s estate for estate tax purposes.

The estate tax-free growth potential for funds in a family trust can be significant. Say, hypothetically, that you and your spouse live in Florida, which does not have a separate state-level estate tax, and have a net worth of $12 million. If one of you dies in 2018, that spouse’s revocable trust can fund the family trust with $11.18 million without paying any federal estate tax. Over the next 20 years, this $11.18 million could grow in value, all of which would remain outside the surviving spouse’s taxable estate.

4. Gain control over the distribution of your assets

By setting up a trust, the grantor is able to establish ways that the assets are to be passed on to the beneficiaries. For example:

  • Distributions for specific purposes. A grantor can stipulate that the trustees of a trust shall make money available to children or grandchildren only for college tuition or perhaps for future health care expenses.
  • Age-based terminations. This provision can stipulate that the trust’s assets shall be distributed to heirs at periodic intervals—for example, 30% when they reach age 40, 30% when they reach age 50, and so on.

If you are charitably inclined, you may also want to consider establishing a charitable remainder trust, which allows the grantor, and possibly the grantor’s spouse and children, to receive an annual payment from the trust during his or her lifetime, with the balance transferring to the specified charity when the trust terminates. The grantor may also receive an income tax charitable deduction based on the charity’s remainder interest when property is contributed to the charitable remainder trust.

For more on charitable trusts, read Viewpoints on Fidelity.com: Charitable giving that gives back.

5. Ensure that your retirement assets are distributed as you’ve planned

You may be concerned that a beneficiary of a retirement account will liquidate that account and incur a large income tax obligation in that year as a result. To help alleviate that concern, by naming a properly created trust as the beneficiary of a retirement account at the grantor’s death, the trustee can limit withdrawals to the retirement account’s required minimum distributions (RMDs), required of each beneficiary.

6. Keep assets in your family

You may be concerned that if your surviving spouse remarries, your assets could end up benefiting their new family rather than your own loved ones. In this case, a qualified terminable interest property (QTIP) trust provision can be used to provide for a surviving spouse while also ensuring that at their subsequent death, the remainder of the trust’s assets are ultimately transferred to the beneficiaries identified by the grantor in the trust document.

Building your legacy

The purpose of establishing a trust is to ultimately help you better realize a vision for your estate and, in turn, your legacy. Therefore, it’s important to let your goals for your estate guide your discussion with your attorney and financial adviser as they help determine what kind of trust and provisions make sense for you. It is vitally important that the trust be properly drafted and funded, so that you and your beneficiaries can fully realize all the benefits available.

Download our Free Guide To Estate Planning here>

Let me know if you have any questions or need help setting up the best type of trust for you and your family.

Regards, Brian

Medicaid Applicants & Home Care: Centers for Medicare and Medicaid Services Clarifies Penalty Period Start Date

The Centers for Medicare and Medicaid Services (CMS) has clarified when a transfer penalty begins for Medicaid applicants who are seeking home and community-based services. The penalty period begins when the applicant would begin receiving services were it not for the penalty period.

Brian Raphan, P.C.

After Congress passed the Deficit Reduction Act of 2005 (DRA), CMS issued a guidance letter that a penalty period would not start to run until the date the “individual is eligible for Medicaid and is receiving institutional level of care services” [emphasis added]. But home and community-based services only become “services” once applicants are enrolled in the state’s waiver program and Medicaid is providing coverage. This caused a “Catch-22” for Medicaid applicants who were applying for home and community-based waivers: The penalty period would not begin to run until the applicants began receiving waiver services, but the applicants could not begin to receive waiver services until the penalty had run.

On April 17, 2018, CMS finally issued a new guidance letter, changing the start date of the penalty period to the date the “individual is eligible for medical assistance under the State plan and would otherwisebe receiving institutional level [of] care services” (emphasis added). This means that an applicant for home and community-based services will be eligible once the applicant meets the financial and non-financial requirements for Medicaid eligibility and the level-of-care requirements.

8 Common Mistakes in Medicaid Planning>

 

Proving That a Transfer Was Not Made in Order to Qualify for Medicaid

Medicaid law imposes a penalty period if you transferred assets within five years of applying, but what if the transfers had nothing to do with Medicaid? It is difficult to do, but if you can prove you made the transfers for a purpose other than to qualify for Medicaid, you can avoid a penalty.

You are not supposed to move into a nursing home on Monday, give all your money away on Tuesday, and qualify for Medicaid on Wednesday. So the government looks back five years for any asset transfers, and levies a penalty on people who transferred assets without receiving fair value in return. This penalty is a period of time during which the person transferring the assets will be ineligible for Medicaid. The penalty period is determined by dividing the amount transferred by what Medicaid determines to be the average private pay cost of a nursing home in your state.

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The penalty period can seem very unfair to someone who made gifts without thinking about the potential for needing Medicaid. For example, what if you made a gift to your daughter to help her through a hard time? If you unexpectedly fall ill and need Medicaid to pay for long-term care, the state will likely impose a penalty period based on the transfer to your daughter.

To avoid a penalty period, you will need to prove that you made the transfer for a reason other than qualifying for Medicaid. The burden of proof is on the Medicaid applicant and it can be difficult to prove. The following evidence can be used to prove the transfer was not for Medicaid planning purposes:

  • The Medicaid applicant was in good health at the time of the transfer. It is important to show that the applicant did not anticipate needing long-term care at the time of the gift.
  • The applicant has a pattern of giving. For example, the applicant has a history of helping his or her children when they are in need or giving annual gifts to family or charity.
  • The applicant had plenty of other assets at the time of the gift. An applicant giving away all of his or her money would be evidence that the applicant was anticipating the need for Medicaid.
  • The transfer was made for estate planning purposes or on the advice of an accountant.

Proving that a transfer was made for a purpose other than to qualify for Medicaid is difficult. If you innocently made transfers in the past and are now applying for Medicaid, consult with your elder law attorney. Medicaid Planning without a qualified attorney can lead to costly mistakes. To read more about common Medicaid Planning mistakes people make visit my website by clicking here.

Regards, Brian

 

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Stepmothers and Estate Planning: Who inherits?

Via Quentin Fottrell https://www.marketwatch.com/story/my-stepmother-inherited-my-fathers-estate-when-he-died-what-can-i-do-2016-11-18

Dear Moneyologist,

My dad passed away five years ago. He did leave a will on how he wanted his estate to be dispersed, but only if his current wife was also deceased. She was not, so she got everything. My question is: When she passes, is she required to honor our dad’s will? She has remarried, which is fine and I’m glad she’s happy. My dad has four biological children from his first two wives, and had none with the third wife, his widow when he passed away. We don’t want to take anything from our stepmother, we would just like our dad’s will honored when she passes. Is this even possible? Thank you for your time. They resided in South Carolina at the time of my dad’s passing.

Daughter Left Out in the Cold

Dear Daughter,

When it comes to inheritance, children usually fare better than stepchildren.

Your father’s wishes were honored, I’m afraid to say. He wanted everything to go to his wife and, in the event that she predeceased him, wanted his estate divided between his four children. But she didn’t and she inherited the whole kit and caboodle. You could talk to your stepmother about anything of special sentimental (or monetary) value, but if she chose to leave you anything that belonged to your father in her will it would be out of goodwill rather than legal necessity.

It may be that your father had meant to write a will that divided his estate more evenly between his wife and children, but that’s not what happened here. In this case, any non-probate assets — jointly owned bank accounts between your stepmother and late father, and any life insurance policies or brokerage accounts where your stepmother was named as beneficiary — will go to her. Anything that goes through probate (that is, the court process) will also go to her.

Ooops! Did you choose the wrong executor?

You finally got around to making your Will. You deserve a sigh of relief. But did you choose the right executor? Or have you burdened an unqualified or unwilling relative and put your Will at risk to be contested?

Generally speaking, the first person that comes to mind to be one’s executor is often an adult child or other family member, followed perhaps by a close friend. These individuals may be honored that you asked them, and will often accept this important duty. Some may even accept the duty despite not wanting the burden, just so they do not insult you.

Your choice of executor may be an emotional one, but also should be chosen based upon what is best for your estate, probate, and your needs. Choosing the executor of your estate is not a task to take lightly. An executor is the person responsible for managing the administration of a deceased individual’s estate. The time and effort involved will vary with the size of the estate. Even the executor of a small estate will have important duties that must be performed correctly, or the executor may be personally liable to the estate or the beneficiaries. One of the many jobs of the executor is to take an accurate inventory of the deceased individual’s assets. This includes making a list of all bank, brokerage and retirement accounts, insurance policies, real property, and any other assets the deceased owned. An inventory of personal effects, antiques or other valuables must be tabulated as well. A list of the estate’s inventory must ultimately be presented to the probate court for review.

This can be a very time-consuming task, and it may mean going through the deceased individual’s personal data or paperwork for information, interviewing heirs, or checking ownership documents at the local town hall. The information presented to the court is expected to be accurate and complete, so that the beneficiaries receive their inheritance on a timely basis. Of course, the executor must probate the deceased person’s Last Will, which may involve locating and notifying the person’s heirs. As if the demands of the probate process aren’t enough work, creditors must be paid, and final income tax returns must be filed. If the estate is large enough, a state and federal estate tax return may be required as well. Once this is complete, distributions to the estate’s beneficiaries must be calculated and dispersed. Of course, if the deceased person’s Last Will is contested, the executor must oversee this process as well. This may put an additional wedge between friends and/or family members. Further, it can add months and perhaps even years to the process, as well as some unwanted stress for the executor.

Tax laws and state and federal estate tax exclusion rates may be different than when the Will was written. If the surviving spouse plans to file for estate tax portability, an estate tax return may need to be filed even if no tax is owed.

Feel free to call me for an opinion on your choice of executor. If you prefer, I may also act as your executor if you do not have a qualified person in mind. This may remove the potential burden it can place on others and offer many efficiencies and time saving as well.

To learn more about the duties of an executor click here>

Regards,

Brian

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