Why a Letter of Competency Should Be Part of Every Senior’s Legal File

With old age comes an inevitable decline in one’s cognitive and mental health, complicating the process for seniors in the midst of their legal planning. If you are a senior who is making arrangements for your future, you might consider adding a Letter of Competency to your file of legal documents. Obtaining a Letter of Competency is especially crucial if you believe there might be any contention regarding the validity of your documents. A Letter of Competency will prevent your documents—such as your will and Powers of Attorney—from being challenged by an incompetency claim. By eliminating any doubts or questions about your mental capacity at the time that your documents were being prepared, you can minimize the chances of familial discord arising.

Prepared Senior with Letter of Competency

Reasons for a Letter of Competency

While it is impossible to predict whether a sibling, grandchild, stepparent, or other family member will challenge the validity of an aging loved one's legal papers, it happens often. Some of these cases even end up in costly and time-consuming guardianship proceedings. Others lead to legal proceedings in which the will of a loved one is contested. These arguments can tear families apart and destroy relationships.

It seems superfluous to ask for more proof of mental capacity when revising or creating legal documents, but there is no harm in prevention and protection. The time and energy required to attend a doctor's appointment and receive a letter of competency is minimal compared to the emotional turmoil and legal costs associated with a trial or investigation by Adult Protective Services (APS).

How a Letter of Competency Works & Who Can Provide One

The certificate of competency is usually written by a primary care physician who is familiar with the patient’s initial physical and mental health changes. In some cases, it may be a good idea to obtain this letter from a doctor who specializes in cognitive or mental health, such as a neurologist or psychiatrist.

Obtaining a letter of competency at the time one’s will, Power of Attorney forms, advance directive, and any other legal documents are drafted and signed will help dispel any suspicions that these documents were produced while lacking the mental capacity to make sound medical, financial, and legal decisions. 

Attorneys are prohibited from helping incompetent individuals change or create legal documents, but the legal definition of incompetence is slightly different from the medical definition of mental capacity. To ensure that a person can make legal and medical decisions about their health care, finances, and property, any doubts about the validity of their documents should be removed.

What a Letter of Competency Includes

A Letter of Competency should be printed on the physician’s letterhead and include the following pieces of information:

  • The patient’s name & date of birth
  • The date on which the patient-physician was first established 
  • The physician’s statement affirming the patient’s ability to make independent decisions regarding finances, legal matters, and healthcare
  • Relevant medical diagnoses & each of their dates
  • The physician’s contact information

In addition to the information mentioned above, it is wise to work with an elder law attorney to determine if any other facts or supporting evidence should be included in the letter. The original letter should be filed with the corresponding legal documentation and kept in a secure location. Your attorney should also have all of your documents, including the letter, readily available. It is recommended that your physician keep a copy of the letter in your medical file as well.

How to Obtain a Letter of Competency

This letter may be requested from a primary care physician with whom the patient is familiar and has an established relationship. The physician should be able to recognize any changes in the patient’s baseline mental and physical health. In certain cases, it may make more sense to request the letter from a specialist in mental or cognitive health.

An attorney should be able to determine when it is necessary to obtain the letter from a specialist rather than a primary care physician.

The basic legal planning recommended for seniors can be a confusing and lengthy process to navigate on your own. Taking every precaution to ensure the legal validity of your documents will reduce the potential for dispute in the future. If you need a highly qualified and experienced attorney to guide you through this process, please contact the Law Office of Inna Fershteyn at (718) 333-2395 to have all of your questions answered,

How to Determine a Senior Needs Help at Home

Ensuring that the needs of our loved ones are met is one of the biggest responsibilities we face as they age. Although we would like our elderly parents to remain independent for as long as possible, there may come a time when they can no longer take care of themselves. It is important to start proper legal/financial planning and research long-term care options ahead of time, before any significant changes in their physical and mental abilities occur. It is crucial that you are prepared to provide them with the necessary support when they start to show signs of needed assistance.

senior-assistance

Signs a Senior Needs Help at Home

These are typical signs that an elderly person may require home assistance or a higher level of care: 

  • Difficulty Performing Activities of Daily Living 
      1. Bathing and grooming
      2. Dressing
      3. Toileting
      4. Continence
      5. Walking and transferring (e.g., moving from the bed to a chair)
      6. Eating
  • Changes in Physical Function & Appearance
      1. Significant weight loss due to poor diet, difficulty cooking, eating, shopping for food, etc. 
      2. Difficulties with dressing appropriately (e.g. wearing soiled clothing, dressing for the wrong season)
      3. Poor personal hygiene and unpleasant body odor due to infrequent showering
      4. Noticeable decline in grooming habits and personal care
      5. Marks on the body indicating falls or changes in mobility (e.g. bruises, wounds, etc.)
      6. Burns on the skin which could indicate difficulties with cooking
  • Changes in Behavior & Mental Status
      1. Lack of motivation or drive
      2. Loss of enthusiasm for hobbies and pastimes
      3. Trouble with keeping track of time
      4. Failure to return calls to friends and family members
      5. Mood shifts or strong mood swings
      6. Increased agitation
      7. Abuse of power, whether verbally or physically
      8. Changes in sleeping habits (e.g., insomnia or sleeping all day)
  • Neglecting Household Responsibilities
      1. Inability to independently complete instrumental ADLs (activities of daily life)
      2. Changes in household cleanliness and organization
      3. Extreme clutter or hoarding
      4. Stacks of unopened mail, late payment notices, or bounced checks
      5. Unpaid bills, calls from collectors, or utilities being turned off
      6. Spoiled food that doesn’t get thrown away
      7. Little or no fresh, healthy food or overall low food supply
      8. Stained or wet furniture 
      9. Urine odor in the house, which may indicate incontinence
      10. Cookware or appliances with noticeable burn marks could indicate food has been left unattended while cooking or reheating
      11. Failure to maintain outdoor areas, such as landscaping, snow removal or garbage collection
      12. Signs of unsafe driving (e.g., automobile dents and scratches)
      13. Unfilled prescriptions
  • Changes in Cognition, Memory, or Judgment 
    1. Forgetfulness (e.g., forgetting to take medications or taking incorrect dosages, missing appointments, misplacing items)
    2. Increased confusion
    3. Loss of reasoning skills
    4. Consistent use of poor judgment (e.g., falling for scams or sales pitches, giving away money)
    5. Difficulty performing familiar tasks
    6. Frequently getting lost when walking or driving
    7. Repetitive speech patterns
    8. Inability to complete sentences
    9. Impaired word-finding ability
    10. Changes in personality or behavior
    11. Poor personal hygiene 
    12. Inability to recall names of familiar people or objects

If you suspect your parents are displaying any of the warning symptoms listed above, the next step is to talk to them about their changing skills and care requirements. It may be a sensitive topic and lead to rising tension. However, it is extremely importantIt's ideal to talk about the future with elderly parents as soon as possible so that everyone is on the same page and no surprises arise.

Keep in mind that these warning signs do not always indicate that a relocation to assisted living or a nursing home is necessary. Their presence, on the other hand, indicates that daily supportive care is required. Hiring home care allows many families to keep their elderly loved ones in their homes for as long as they can safely do so.

If you need further legal assistance with elder care planning, please contact the Law Office of Inna Fershteyn at (718) 333-2395 to best prepare your legal documents for the future. 

How HIPAA Impacts Caring for Aging Patients

How HIPAA Impacts Caring for Aging Patients 

It's critical to understand the implications of the Health Insurance Portability and Accountability Act (HIPAA) on caregiving if you have worries about an aging loved one's health and are active in their daily care. 

HIPAA-aging-patients

What is HIPAA? 

The Health Insurance Portability and Accountability Act, or commonly known “HIPAA,” has a significant impact on providing care for loved ones. This federal law was passed in 1996 to preserve the privacy of a patient’s medical information. It mandates that health care providers and insurers maintain medical information private and safe. Unless the patient gives explicit permission, this information cannot be shared. This gives people more control over their health information and the ability to regulate who has access to it.

Why Sign a HIPAA Authorization? 

A senior can provide their caregiver access to essential information about their care by signing a HIPAA authorization form. A caregiver who has complete awareness of their loved one's medical and treatment history is in the best position to make quality care decisions in the future. There are two major factors to consider when allowing access to medical records. Caregivers should be able to communicate directly with a senior’s doctors to coordinate treatment and care between medical entities, and dispay medical bills on the senior’s behalf.

Without these clear approvals, a family caregiver's ability to properly act on behalf of a senior may be limited. Unless a family member has been nominated as a personal representative with a valid healthcare power of attorney (POA), the privacy rule prevents access to complete medical information.

If the person you are caring for has not already created and signed a POA form, it is a good idea to have them sign a HIPAA release and keep copies on hand. This will ensure that medical entities have no doubt that they are permitted to interact with you and any other family members to whom your loved one has provided permission.

Seniors should talk to their health-care providers about how to put it in writing that only certain persons are authorized to see their medical records. If this is a concern for you, you can also put it in writing that you do not want particular people to have access to your medical information.

For more information about providing high-quality care for senior loved ones or to discuss long-term care planning, please contact the Law Office of Inna Fershteyn at (718) 333-2394.

Understanding the Medicaid Look-Back Period and Penalty Period

If you need help with paying for healthcare costs and have low-income and limited resources, you might qualify for Medicaid. Medicaid is a federal and state program that offers medical and health coverage for people with low incomes and limited assets who otherwise cannot afford paying for health care. In order to be eligible you must meet strict financial eligibility requirements both during the application process and after you have qualified.

medicaid look back penalty period

Financial Eligibility Requirements for Long-Term Care Medicaid 

Many low-income seniors find that their countable assets and/or income exceed the Medicaid restrictions in their state. They must carefully reduce or "spend down" extra funds on things like medical expenditures, house improvements, a prepaid funeral plan, and so on in order to meet the financial requirements. Gifting—giving away money or assets for less than market value—is not permitted as part of a Medicaid spend-down strategy.

The Centers for Medicare and Medicaid Services (CMS) devised a system for analyzing all applicants' financial histories to prevent seniors from simply giving away all of their assets to family and friends and then depending on Medicaid to pay for their long-term care. The following sections review the ins and outs of the Medicaid look-back period, as well as what happens when a senior decides to transfer assets.

The Medicaid Look-Back Period

Medicaid only looks at applicants' previous financial information for a limited period of time. This is known as the Medicaid Look-Back Period. Each state's Medicaid program has slightly different eligibility standards, but most states look at all of a person's financial transactions five years back (60 months) from the date of their qualifying application for long-term care Medicaid benefits. (This timeframe is only 30 months in California.)

There is no difference between the number of gifts an applicant made and to whom the gifts were given during the Medicaid Look-Back Period—barring a few exceptions, which will be discussed later on. If a senior's money or assets changed hands for less than FMV in the five years leading up to their application date, they will incur a penalty period during which they are ineligible for Medicaid.

The Medicaid Penalty Period

If a senior files for Medicaid and is found to be otherwise eligible, but has gifted assets within the five-year look-back period, they will be prohibited from receiving benefits for a specified amount of months. This is known as the Medicaid Penalty Period and there is no limit to how long a penalty period can be. 

For example, if you write a check to a family member for $14,000 and apply for Medicaid long-term care within five years of the date on the check, then Medicaid will delay covering the cost of your care because you could have used that money to pay for it yourself. The penalty period begins running on the date a senior applies for Medicaid coverage, not the date on which they gifted the money.

The length of the penalty period is determined by the total amount of assets gifted by the applicant and their state's specific "penalty divisor," which is the average monthly cost of a long-term care facility in that state. (The divisors may be the averaged daily expenses in some jurisdictions, and several states even employ divisors that are particular to nursing home costs in individual counties.) These figures are published annually by each state’s Medicaid program.

Who Pays During Medicaid Penalty Periods?

When a senior requires care but has spent down all of their assets (inadvertently) and is no longer covered, one might wonder who pays for their care. If a senior has gifted countable assets during the look-back period and needs nursing home care, they will have to pay for it out of pocket until the look-back period is over and the senior can apply for Medicaid without difficulty, or until the penalty period expires and they are eligible for coverage.

Exemptions and Exceptions to Medicaid Gifting Rules 

Medicaid penalties do not apply to all gifts.

One exemption you may receive is a “child caregiver exemption” for transferring assets to a child who has taken care of you for at least two full years. For example, if your daughter's care allowed you to put off moving into a nursing home, then transferring your home into her name for less than fair market value would not be penalized. Even if a senior applies for Medicaid within five years after the transfer, the "child caregiver exemption" still applies.

Another exception to the rule is a gift (or the creation and funding of a trust) for a kid who is blind or disabled under the Social Security Administration's standards. No penalty will be imposed on such a gift, regardless of its size.

Finally, gifts between spouses are never subject to any penalties. There is no need to impose a penalty on such transactions because both spouses' entire assets are counted when one spouse applies for long-term care Medicaid.

Successfully applying for Medicaid is a complicated and difficult process, and is rarely something you do on your own. Mistakes can have long-term financial consequences for a family. If you or someone you know plans to apply for long-term care Medicaid, please contact the best elder lawyer who can guide you through the application process at the Law Office of Inna Fershteyn at (718) 333-1233. 

When POA Isn’t Enough: Authorizations Needed to Act on A Loved One’s Behalf

Family caregivers are often given the responsibility to access private documents/information regarding their loved ones due to the large amount of paperwork that might arise pertaining to their personal care. Caregivers often feel bombarded with signing, filing, mailing, or faxing such documents, which is where Power of Attorney documents (POAs) come at hand, saving time and stress. In some cases, a few organizations require their own documentation to approve contributions in one's affairs. An individual should never take on this lengthy process by themself. To minimize the risk of making a mistake that may cause dire consequences down the road, the best approach is to hire an elder care attorney.

POA May Not Be Enough

Hiring a Power of Attorney is Crucial for Seniors and their Caregivers 

Elder law attorneys specialize in legal concerns that affect older individuals, their spouses, and their children—specifically the medical and financial aspects of them. A Power of Attorney document allows certain individuals who are identified as “the agent” to legally make decisions on behalf of another person who is identified as “the principal.” The individual is then granted power upon the principal’s personal matters. It is evident that such preparations cannot be legally processed without such documents being authorized. 

However, POAs are not always apodictic. The actions an agent can or cannot take on behalf of a principal, as well as when their powers commence and stop, might differ depending on how these papers are written. Caregivers may run into issues when attempting to utilize POA forms for healthcare and money to oversee the care of seniors if they are not correctly prepared or interpreted. Long before incapacitation becomes a concern, families should prepare these legal documents. When a loved one is unexpectedly disabled due to an accident or sickness, POA paperwork can allow agents to step in and help handle the situation—provided those documents are prepared appropriately.

Some Entities Do Not Accept Power of Attorney 

As useful as POA’s are, third parties such as banks are reluctant to approve such financial documents due to the possibility of fraud, in which case they may be held responsible for any harm that results. 

Such banks take an extended period of time to verify the legitimacy of a financial Power of Attorney and may even want to speak with the attorney who finalized it. In addition, they might also require that the agent and/or future POA sign a written statement declaring that they are operating legally, therefore absolving the other party of all liability. Nonetheless, there should be no issues arising besides the time-consuming process of being approved as a POA. 

Authorizations Needed to Manage a Senior’s Care

A SSA Authorized Representative

Helping a loved one or assigned senior with Social Security applications is possible with the correct documentations, one can apply to be their authorized representative by completing the SSA-1696 Appointment of Representative Form. 

SSA Representative Payee

You must apply to become a representative payee if you want to actively help a Social Security recipient manage their retirement payments and/or Supplemental Security Income (SSI). All beneficiaries who are unable to manage their own payments must have a representative payee according to the Social Security Administration.

While this may be the authority you're searching for, it's important to note that it comes with a lot of responsibility. This work necessitates a thorough recording of all a beneficiary's benefits and how they are utilized, requiring attentive and responsible individuals. If there is no family member or acquaintance available to hold the “rep payee” title, the SSA will designate another qualified beneficiary to hold such recipient benefits. 

VA Fiduciary Designation

Administering veteran benefits also requires its own process. Obtaining POA authority is not a satisfactory requirement for the U.S Department of Veterans Affairs (VA). The VA will request the appointment of a fiduciary if a physician or a court of law determines that a veteran (or surviving spouse) is incapable of handling his or her money. A close friend or relative is readily available to fulfill such a position as long as the VA successfully and thoroughly conducts a close investigation of such individuals’ competence. If there is no family member or acquaintance available to hold responsibility for the veteran, the VA will designate another qualified beneficiary to hold such recipient benefits. 

Medicare Authorization 

It is important to note that Medicare will not provide disclosed health information to an assigned caregiver regardless of relationship to the agent. There must be a written authorization already submitted and approved by the Centers for Medicare and Medicaid Services; verbal permission is also an accepted option. Medicare enrollees may be able to speak and answer simple questions over the phone, giving their caregivers permission to disclose coverage data. If you and your loved one are unable to speak on the phone together, consider attempting to “include them” using your cellphone or other three-way calling device to keep all parties on the same page.

The "1-800-MEDICARE Authorization" Form can be filled out and mailed in or done over the phone with the help of a customer service professional. Please note that certain private insurance companies frequently have their own processes for these documents, so make sure to ask about their unique permission needs.

Be Proactive About Caregiver Documentation

Keep in mind that many problems may be addressed with a combination of goodwill, clear explanations, and reasonable inquiries asked of the appropriate individuals when advocating for your loved one or assigned “agent.” If you're unsure, ask to talk with a supervisor. If no one is available, or if no amount of logical conversation appears to be working, you have the right to consult with legal counsel. 

If you are in need of highly qualified and experienced help regarding a Power of Attorney issue, please contact the Law Office of Inna Fershteyn at (718) 333-2394 to have all of your authorization questions answered.

Why Elder Law Attorneys Aren’t Just For Seniors?

An Elder Law Attorney serves as an advocate for the elderly and their loved ones when it comes to the legal issues related to healthcare and financial assets. Individuals who have reached an old age or are approaching the 65 benchmark should consider hiring an Elder Law attorney to assist them with the matter of retirement, social security, Medicaid, long term care planning, guardianship, disability, etc. An Elder Care Attorney will address the importance of creating an estate plan composed of a will, trust, health care proxy, power of attorney, and letter of intent in order to effectively prepare for the future. There are numerous benefits to hiring an Elder Law attorney, some of which include guidance in long term care planning, assistance in creating a durable power of attorney, aid in receiving Social Security benefits, and protection against elder abuse. Elder Law Attorneys are specialists in their field, as they have much experience handling similar cases related to the specific needs of seniors. The attorney will utilize a holistic approach in ensuring that the key issues pertaining to long-term care, housing, well-being, and financial asset protection adhere to the wishes of the elderly individual. In terms of requiring assistance in creating trusts and wills for an elderly loved one, an esteemed Elder Attorney will be able to guarantee that the documents have the individual’s best interests at heart. The lawyer will work with you to protect your assets in the best manner possible to ensure that necessary payments are made on the home and other personal costs, while making sure that there is no form of financial exploitation of assets that could harm your loved ones.

Elder Law Attorneys Aren't Just for the Elderly

Benefits to Hiring and Elder Care Attorney:

1)Guidance in long term care planning

In the case that an individual’s physical and mental health declines, a long-term care facility is typically the most effective plan of care for the individual. When considering which long-term care facility is most effective for your loved one’s needs be sure to also note that the payment plan for this facility is within your price range. An Elder Care Attorney can assist you in obtaining long-term care insurance that will help cover the expenses of care, as prices are on the rise in NY. In the case that long-term care insurance is out of your financial budget, an Elder Care Attorney can assist in qualifying for Medicaid. You are guaranteed to make the best long term care decision possible for your loved one if you seek proper instruction and assistance from an experienced attorney.

2)Assistance in creating a durable power of attorney

A durable power of attorney serves to grant a third party the ability to make decisions and take actions on behalf of the individual who has become incapacitated, as they are no longer able to make decisions independently. An Elder Care Attorney prefers a durable power of attorney rather than just the typical power of attorney because the durable document remains functional even after the individual loses the ability to make decisions for themselves. On the contrary, the typical document would only function if the individual has not become mentally incapacitated. An attorney will guide you through the process of filling out this document to ensure that your future is well planned for. 

3) Aid in receiving Social Security Benefits

An Elder Care Attorney works to guarantee that you are receiving all of the benefits you deserve based on your current age and overall health. Once you reach the age of 67 you are subject to receive the full Social Security benefits. If you have reached this age and are not receiving your full benefits, an attorney will advocate on your behalf and work to grant you your benefits. If you have a disability and are subject to receive disability benefits, then the attorney will assist you in obtaining those benefits by following a similar legal procedure. According to NY State regulations, Social Security Disability Insurance (SSDI) guarantees that you may begin collecting benefits after 6 months since the start of your disability. With the support of an esteemed Elder Care Attorney, you will certainly receive all of the benefits you rightfully deserve.

4)Protection against elder abuse

With the current foundation, research has shown that many elderly residents in nursing homes are facing unjust treatment. An Elder Care Attorney will work with you by representing your loved ones who have been the victims of physical violence, emotional mistreatment, or financial fraud. The attorney will not just provide guidance on the following steps, but will ensure that justice is served and your loved one will never be treated in this manner ever again. The attorney will advocate for the rights of your loved one to guarantee that they are being properly cared for and looked after, especially during these troubling and challenging times.

So, In Sum, Why Elder Law Attorneys Aren’t Just For Seniors?

Elder Law Attorneys work to assist individuals in creating a plan for their future to ensure that the individuals interests and best wishes are clearly declared. These individuals are not always seniors. As a matter of fact, it is recommended that you hire an Elder Care Attorney prior to the age of 65. It is always better to be prepared for anything, rather than procrastinate on preparing for your future. Many individuals fall victim to the assumption that they have an unlimited period of time left to get all of their assets and legal information together. The unfortunate truth is that life is inexplicable and unexpected events can occur at any point in time. In the case that an individual does not have an elder care in place prior to the point in time when they biome incapacitated, then their loved ones must embark in the costly and lengthy process of earning the legal authority to act on their loved one’s behalf. It is encouraged that you avoid waiting because the guardianship legal procedures associated with waiting too long to create an elder care plan are very complex and expensive. If individuals do not take the time to create a will, then they will not be able to decide how they would like their assets to be distributed or how their minor children would be cared for. The court would then be responsible for distributing your assets and estates, which may not align with your wishes. It is certainly better to be well prepared ahead of time, rather than at a loss when the time comes. Make the decision today to protect yourself and your loved ones by hiring an Elder Care Attorney to draft all of your legal documents and create a plan for the future. 

For Elder Care inquiries please contact the Law Office of Inna Fershteyn at 718-333-2394 to best prepare your legal documents for the future.