<![CDATA[Money and Health - Health.com]]> en daily 1 <![CDATA[Hidden Benefits of Your Health Insurance]]>

Disease management
A buzzword in the insurance world these days is "disease management," which refers to programs that help health-plan members with chronic conditions, such as diabetes or asthma. For diabetics, this benefit could range from a counseling session on nutrition to a full-fledged program including blood monitoring and nurse consultations. Unfortunately, the buzz is often used in selling the plans to employers rather than to employees, many of whom are unaware that these programs exist. "There is a lot of sizzle on the marketing side, but customer service is often not really geared for it at this point. It’s incumbent upon the member to inquire whether there is a disease management program," says Nancy Fase Guernon, director of operations at CareCounsel, a health-care advocacy outsourcing company.

Better mental health benefits
In the past, many benefit plans limited or excluded coverage for mental health conditions. Thanks to the Mental Health Parity and Addiction Equity Act, as of 2010 some insurance plans will be required to offer mental health benefits equivalent to those they provide for conditions such as cancer and heart disease. The new law is expected to expand access to treatment for conditions such as schizophrenia, bipolar disorder, eating disorders, and autism. "The parity act says that if insurers cover medical or surgical benefits, they have to cover mental diagnoses at an equal level," adds Fase Guernon. Some states supplement federal law by passing their own parity laws, she notes, so check with your state department of insurance to determine the level of coverage to which you’re entitled.


Next Page: Coverage for trying to conceive
Coverage for trying to conceive

For couples relying on assisted reproductive technology such as in vitro fertilization (IVF), the cost of treatment can be prohibitive. One cycle of IVF, for example, costs $12,400 on average, according to the American Society for Reproductive Medicine. Fourteen states, including New York and New Jersey, have passed legislation requiring insurers to offer some level of coverage for infertility diagnosis and treatment. In most states, these laws include paying for IVF (although California and New York specifically exclude IVF). For a state-by-state summary of laws related to infertility therapy, visit Resolve (a national infertility association), or the National Council of State Legislatures.

Complementary and alternative medicine (CAM)
A growing number of insurers now cover alternative and complementary treatments such as chiropractic, massage therapy, herbal medicine, and acupuncture, which has been proven to alleviate pain and can ease chemotherapy-induced symptoms such as dry mouth.

You should be aware that coverage of CAM often has higher deductibles than conventional treatments. You may also need to purchase a separate rider to your current insurance in order to get the coverage. Also, even if your insurance does not reimburse for such treatments, it may have a list of CAM providers with whom it has negotiated discounts for members.

"It’s easier to get reimbursed for alternative treatments that are used to provide comfort for the patient, such as black cohosh, which some women take to relieve the hot flashes that are caused by the antiestrogen drugs they are taking to treat their breast cancer," says Otis Brawley, MD, chief medical officer at the American Cancer Society. "But when you’re talking about herbal treatments directed at the cancer itself, it’s very unlikely to get paid for."

Stress, weight loss, and smoking cessation

Insurance companies are increasingly promoting healthy living. If you are diabetic and need to lose weight, your insurer may reimburse part of the cost of a health-club membership, weight-loss regimen, or other program that can help manage your diabetes. If you are suffering from heart disease and are a smoker, your health plan may offer counseling or support programs to help you quit.

"Carriers want people to take better care of themselves because it costs them money when they don’t," says Jamie Charlton, a partner and health-benefits specialist at Saxon Financial Consulting in Cincinnati. "So they are promoting benefits such as health coaches, who help you quit smoking or manage stress."]]> Read the fine print: Your plan might surprise you. (ISTOCKPHOTO) <![CDATA[Laid Off? You Have 62 Days to Get Health Coverage, So Here's What to Do]]>

…One hour
You’re stressed and scared, and not in any mental state to make decisions. Take a few minutes to collect yourself and relax as much as possible. Take slow, deep breaths. In the coming days and weeks you’ll have to make a slew of decisions regarding your health care and personal finances, and you’ll need to stay calm.

…One day
Whether security is waiting to walk you out the door or you have time to clean out your desk, grab the paperwork related to your employer-issued benefits. Carefully read over the fine print on your contract and the terms of your health-insurance plan. Then ask someone from human resources:

  • Am I entitled to a severance package?
  • When exactly will my health benefits expire? (Some health plans expire on the day you are laid off; others might continue until the end of the month.)
  • Is there any room for negotiation? (You may be able to exchange severance pay for extended health benefits.)
  • Do you have any advice for me? (A sympathetic HR employee can be your best ally.)
Don’t leave without asking for a certificate of creditable coverage. This document includes the dates that your health insurance began and ended, and proves that you were covered during that time. You’ll need this to apply to other health-insurance plans.

…One week

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If your health benefits haven’t expired yet, make doctor’s and dentist’s appointments for you and your family if you're due. Refill prescriptions. Try to squeeze in as much essential health care as you can before the expiration date, because it will almost certainly be more expensive once you lose your employer-provided insurance. If your doc is booked, explain your situation and ask to be notified about cancellations. (Don’t overdo it, however. If you get too many unnecessary tests and checkups in a short period of time, your premiums will likely be higher if you decide to buy health insurance on the open market. And if a checkup turns up a serious health problem, you may even be denied coverage altogether.)

Plan to spend down your flexible spending account (FSA), if you have one, on new glasses, cold medicine, acupuncture—on whatever you can, so your former employer doesn't get to keep your hard-earned savings. Unlike health savings accounts (HSAs), which are portable from job to job and roll over, FSAs are always administered by your employer and must be spent by the end of the company’s “plan year” (plus a 2 ½-month grace period).


Next Page: One month
…One month
Enroll in your spouse’s employer-sponsored plan, if you can. Under the Health Insurance Portability and Accountability Act (HIPAA), you and your dependents can do this ASAP, without waiting until the next enrollment period. Here's the catch: You must request this so-called special enrollment within 30 days of losing your previous health benefits.

…Two months
If you're single or can’t get covered by your spouse, sign up for a COBRA extension. Under the Consolidated Omnibus Budget Reconciliation Act, you and your family have the right to extend your current health plan for up to 18 months after you are laid off. (If your former employer has fewer than 20 employees, you may not be eligible for a COBRA plan.) You will have to pay for 100% of the coverage rather than sharing the cost with your employer, but it is still usually cheaper than buying an equivalent policy on your own.

Keep an eye on the mail. After your employer notifies the insurer that you’ve been terminated, the insurer must inform you of your COBRA rights in writing within 14 days. Once this notice is sent by your insurer—not once you receive it—the clock starts ticking: You have 60 days to enroll in the plan. (If your existing coverage expires after the notice is sent, you have 60 days from the expiration date.)

…62 days
And we really mean 62 days. Under HIPAA, if you go without health insurance for 63 days or more, you will be subject to a preexisting-condition exclusion. When you enroll in a new health plan, the insurer can exclude from coverage any health condition—cancer, heart disease, diabetes—for which you received treatment in the six months leading up to your enrollment. This exclusion period can last for up to 12 months (or 18 months if you join the health plan late), but you can offset it by producing your certificate of creditable coverage, which you remembered to ask for on day 1. If you can prove that you’ve had continuous health insurance for more than 12 months without a gap of 63 days or more, the new health plan will not be able to impose a preexisting-condition exclusion.]]> A layoff doesn’t have to be the end of health-care coverage. (ISTOCKPHOTO) <![CDATA[Do You Really Need That Medical Test?]]>
American Journal of Preventive Medicine found that in 43% of routine checkups of outwardly healthy people, doctors ordered an X-ray, electrocardiogram, or urinalysis—tests that are not recommended for routine prevention under national guidelines.

"There is harm in extra tests, such as exposure to radiation," says Daniel Merenstein, MD, the director of family medicine at Georgetown University and the lead author of the study.

Besides causing stress, excessive testing can eat up funds or insurance coverage. Dr. Merenstein says that in one recent case, a couple had an extensive infertility workup costing thousands of dollars, even though they had been trying to conceive for only six months. (Medically, infertility is defined as trouble conceiving for at least one year.)

"In another study, we found doctors in the Washington, D.C., area were overusing colonoscopies—doing them every 5 years instead of every 10 as guidelines recommend," Dr. Merenstein says, referring to the recommended interval for people whose colonoscopies show no abnormalities. Colonoscopies, which range in cost from $650 for a simple procedure to $2,000 or more if they include biopsies, are important for detecting colon cancer, but they do carry risks of complications, such as bleeding and bowel perforation.

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Superfluous tests aren’t always the doctor’s idea. Bob Phillips, MD, director of the Robert Graham Center, a Washington, D.C.–based research center that studies policy in family practice and primary care, had one 70-year-old patient who asked him to do a prostate specific antigen (PSA) test for prostate cancer. The results were normal, but the man was consumed with worry because his father had suffered from the condition. He sought a second opinion from a urologist, who repeated the PSA on account of this family history. Although the second PSA showed no increased risk for cancer, the urologist recommended a blind biopsy. Sure enough, cancer was found, and the man had his prostate removed, a procedure which left him impotent and incontinent.

"At that point, he came back to me very upset about the side effects, and asked me, 'Did I do the right thing?'" says Dr. Phillips. "By age 70, half of men will have prostate cancer, but most don’t end up dying of it. I felt just terrible for him. There’s a good chance he would have lived his life without any ill effects from the cancer."

Question why a test is being done
If your doctor orders an MRI, CT scan, or other medical test, speak up. "Ask why it’s being ordered, what will be done afterward if the results are positive (or negative), and what your risk factors are," says Dr. Phillips. If the answer is simply, "routine screening," the test may be unnecessary. The doctor should have specific reasons, he says.

Some blood tests, such as the complete blood count (CBC), are sometimes done too often. While not dangerous, the costs can add up, especially if you get them several times. "The main thing is, ask your doctor, 'Do I really need this test?'" says Dr. Merenstein.


Next Page: Organize your medical records
Organize your medical records—and share them with all your providers
One reason for unnecessary tests is scattered record keeping. "It helps if your doctor has electronic medical records," says Dr. Phillips. "Frequently, blood tests are repeated because doctors don’t know a test has already been done or because they can’t put their hands on the results. And if you’re also seeing a cardiologist, an endocrinologist, or other specialists, you’re likely to have the same test repeated two or three times."

You can avoid duplication by keeping track of your own records, including copies of EKGs, X-rays, and blood work. Ask for photocopies of lab results and carry them with you when you see specialists.

"Everyone should have one page that shows, this is my last colonoscopy, my last mammogram, my last blood-sugar test," says Dr. Merenstein.

Whenever you are referred to another doctor, Dr. Phillips suggests that you ask for your test results to be shared with other physicians: "Say, 'Here’s the number for my cardiologist, can you fax my results to him?'"

Online health record services such as Microsoft's HealthVault, Google Health, and iHealthRecord offer free and easy ways to compile medical records and track prescriptions. Pay services such as MyMedicalRecords.com and FollowMe even allow you to upload and organize images of MRIs, CT scans, and X-rays, and to have them handy if you change doctors or see specialists.

Shop around for less expensive tests
When you do need to have a test done, it pays to call a few different testing facilities to compare prices. If you’re paying out-of-pocket, or are worried about exhausting your health-insurance caps, you might find that the savings are considerable.]]> Make sure your insurance covers any test your doctor wants to give you. (123RF) <![CDATA[3 Legal Documents Caregivers Need]]>
caregiver, you want to make sure that the person you're caring for is as comfortable and healthy as possible. But that may not be possible if you don't have a few key legal papers. In a worst-case scenario, you might be forced to fight for guardianship in court, a time-consuming and costly process that you can avoid by preparing these simple documents.

1. Power of attorney
A power of attorney is a document by which people designate an agent to act on their behalf in financial or legal matters. "This deals with the business side of life, not the medical side," says Sanford J. Mall, a nationally certified elder-law attorney with Mall Malisow & Cooney, in Farmington Hills, Mich. "And it has nothing to do with how much money you have.”

Anyone with assets can benefit from a power of attorney, says Mall. It is usually a good idea for elderly or sick patients to designate a caregiver as an agent so that the caregiver can sign checks and conduct other banking transactions in support of care.

Some powers of attorney are in effect for a limited period of time and can terminate if the person who authorized an agent becomes incapacitated. If you intend to have a power of attorney in order to make financial decisions for someone who has impaired cognitive abilities and for whom you are providing care, make sure the person drafts what’s known as a durable power of attorney. This allows you to remain the agent even if the person is incapacitated.

2. Health-care proxy
Also known as a medical power of attorney, a health-care proxy enables you to make health-care decisions for someone else. Since there's no telling when an accident can strike, Mall advises everyone to have a health-care proxy, regardless of age. For example, Mall's daughter was in a serious car accident the day after her 18th birthday. When Mall and his wife arrived at the hospital, the staff refused to talk to them about their daughter's condition. "The birthday present for every 18-year-old should be a medical power of attorney," Mall says.

3. HIPAA authorization
The Health Information Portability and Accountability Act (HIPAA) keeps your health information and records private. So unless you authorize in writing someone else to receive that information, your doctors aren't obligated to share any details about your health. "In some states, a health-care proxy does not go into effect unless the patient is deemed incompetent or incapable of expressing his own wishes," says Timothy Wyman, a financial planner and lawyer with the Center for Financial Planning, in Southfield, Mich. "But there are instances where a person might want to have someone else talk to their doctor for them." Remember to give copies of the HIPAA authorization to health-care providers, and make sure you have several more on hand in case you must furnish them.

]]> Gathering documents now will make the caregiving process easier if unexpected events occur. (GETTY IMAGES) <![CDATA[How Do You Ensure the Care of a Chronically Ill Spouse if He Outlives You?]]>
study in the Journal of the American Medical Association found that people who were caring for a spouse and experiencing strain were at 63% greater risk of death than non-caregivers.

A caregiver’s death is not only heartbreaking for the family that loses a beloved member; it also creates uncertainty about how the surviving spouse will be cared for. Here are some steps to consider in making sure your spouse gets the care he or she needs if you are no longer living.

Plan early
As the old saying goes, "Hope for the best, plan for the worst." Talk to your family about who will step in to care for your spouse in the event that you pass away or become seriously ill. Who will be responsible for medical decisions? Who will keep track of the finances? What resources will be available to pay for care if you are not providing them yourself?

Make it official
To ensure that there is a seamless legal transition, both you and your spouse should, via powers of attorney, designate an agent who can make health-care and financial decisions on your behalf. (At the same time, you should communicate your wishes in these matters to the person you designate.)

If you die without naming an agent, your children or other family members could face a legal morass. They won't necessarily have the authority to make important financial and medical decisions for your ill spouse. Experts suggest that you review your powers of attorney and any other relevant documents every three to five years. This allows you to reiterate your wishes and, if necessary, take into account any changes that may have occurred in your life, such as a child or other designee who has moved away.


Next Page: Consider establishing a trust
Consider establishing a trust
One of the most important considerations when leaving a spouse behind is how his or her care will be paid for. When one spouse dies, the couple’s assets ordinarily pass automatically to the surviving spouse, even in the absence of a will. This isn’t always a good thing, however. Establishing a living trust—so called because you fund it while you’re alive—is one way to avoid the problems that can occur if you let your spouse inherit everything directly.

If your assets pass to your spouse, and he or she has not designated an agent using a power of attorney, a court-appointed guardian will have to be named. If assets—including real estate and bank accounts—are transferred to a trust, on the other hand, a trustee will already be in place and the money will be designated for your spouse’s care. Using a living trust instead of a will also obviates the need for probate, the often lengthy and costly process by which a court settles an estate (including any disputes over the will).

When you establish a trust, you should name yourself as the trustee and also name a successor to administer the trust if you die or become incapacitated. "If you have the trust set up, and you fund the trust, then the successor trustee can step in much more easily to help the chronically ill person take care of their affairs," says Constance Stone, a certified financial planner with Stepping Stone Financial in Chagrin Falls, Ohio.

Bequeathing your assets directly to your spouse, moreover, can disqualify him or her from government assistance programs. Medicaid, for instance, sets very low asset ceilings for eligibility ($2,000, typically, though it is higher in some states). As long as you fund the trust more than five years before your spouse applies for Medicaid, the trust can hold the assets you leave your spouse without being considered his or her personal property, thereby allowing your spouse to be eligible for Medicaid. "Then the assets in the trust can be used to pay for things other than what Medicaid pays for," says Peter J. Strauss, a partner in the firm of Epstein, Becker & Green P.C. of New York.

Living trusts aren’t appropriate for everyone, however, and the relevant laws are complex. To learn more about trusts, contact an estate-planning attorney or a certified elder-law attorney. The National Academy of Elder Law Attorneys features a searchable directory on its website.]]> Don't assume you'll be there to pay the bills for your sick spouse. (GETTY IMAGES) <![CDATA[Should You Get Disability Insurance?]]>

While government programs such as Social Security provide disability benefits, the eligibility requirements are strict: Your disability must be expected to last for at least a year and the government must conclude that you are incapable of any gainful employment. Also, the benefits may fall well short of your lost income. A 40-year-old making $60,000 a year, for instance, can only expect about $1,700 a month from Social Security in the event of disability.

There is another way to guard against the worst-case scenario. Disability insurance can provide some financial security—and peace of mind—if you’re unable to provide it yourself.

What is disability insurance?
Disability insurance, also known as disability income insurance, replaces a portion of your income—typically between 50% and 70%—if you are no longer able to work due to sickness or injury. (No insurer will agree to replace all of your predisability income, the rationale being that you would have little incentive to return to work.) "Your ability to earn an income is likely to be your largest financial asset," says Marvin Feldman, president and CEO of the Life and Health Insurance Foundation for Education in Arlington, Va. "It's worth protecting."

When do you need disability insurance?
The short answer: right now. "You want to buy it when you don't need it at all," says Larry Saffer, a registered financial planner and insurance agent in Plantation, Fla. If you wait until you are actually ill, you may be uninsurable. And policies are most affordable when you are young and healthy. Saffer recalls the case of a 34-year-old teacher who, at his recommendation, purchased a disability policy through the school where she worked. She nearly forgot that she had the coverage, since it cost just a few dollars out of each paycheck. But then a medical mistake during a routine outpatient procedure led to emergency colostomy surgery, eight days in the hospital, and several more operations to correct the error. She had to use a colostomy bag for more than a year and was unable to return to the classroom for close to two. Her disability insurance kept part of her salary coming in through it all. "She thought it was a waste of money initially," Saffer says. "But when she needed it, it was there."


Next Page: What kind of policy should you look for?
There are two main types of policies: noncancelable, in which both the premium and the benefits remain unchanged over the life of the policy; and guaranteed renewable, a substantially cheaper option with fixed benefits that allows the insurer to increase the premiums in some cases. The average annual premium for noncancelable policies is around $1,700, according to a 2006 Wall Street Journal report. For guaranteed renewable policies, it’s just over $500.

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Every policy varies in its definition of what constitutes a disability, and when the benefits will begin. Some policies may limit coverage for mental health problems, for instance, while others might require that you be unable to perform any job, not just the occupation you were in when you became disabled. Depending on the premium, the waiting period before the payments start can range from 30 days to 6 months or more. Make sure your policy is broad enough for your needs.

Where can I get disability insurance?
Most employers offer some form of short-term sick leave or workers’ compensation, but many companies (especially larger ones) also offer long-term disability insurance through group health plans. This approach has its limitations, however. Employer-sponsored insurance typically is not portable (that is, you can’t take it with you if you leave your job). Also, if your company pays the premiums, you will owe income tax on any benefits you receive.

The alternative is to purchase a policy through a private insurer. Coverage you buy on your own tends to be more flexible and usually covers a wider range of illnesses. If you do have access to an employer plan, but it is not comprehensive enough, you can also use a private policy to fill in the gaps. Expect to pay 2% to 3% of your annual income for private disability insurance.

Buyer beware
While disability insurance is almost always a good idea, it’s important to be prudent when shopping for a policy. As with any insurance policy, scrutinize the fine print concerning benefits and waiting periods. In these troubled economic times, it’s also especially important to research the insurer and determine whether the company is financially healthy and has a track record of honoring claims. Experts recommend consulting credit rating services such as Moody’s and Standard & Poor’s for financial information, and state insurance departments to investigate complaints and regulatory actions. In recent years, instances of insurers denying disability claims or discontinuing benefits have led to numerous well-publicized appeals and lawsuits.]]> The best time to get disability insurance? Before you need it. (FOTOLIA) <![CDATA[How to Choose Between Home Health Care, Assisted Living, and a Nursing Home]]>
and your bank account. Family and friends can step in to assist, of course, but there may come a point when your loved one needs professional care. Here are some basic options to consider.

Home sweet home
In-home health aides average $19 an hour, and hired companions who don't provide health care are slightly less expensive. Do the math and you'll see that for round-the-clock assistance, the tab can run as high as $170,000 a year, making home care a very costly option.

"It's so expensive because people are basically trying to recreate the nursing facility at home," says Chris Cooper, a certified financial planner and social gerontologist in Toledo. Medicare and private insurance generally do not cover long-term in-home care. So unless you have a long-term-care insurance policy, the cost must be paid out-of-pocket, which may mean liquidating assets or applying for a reverse mortgage.

Despite the expense, "most people try to do what they can to stay at home before placement in a facility," says Nancy Wexler, a Los Angeles–based geriatric care manager and author of Mama Can't Remember Anymore: Care Management of Aging Parents and Loved Ones. The good news is that many people don't need 24-hour care, at least not right away. Someone with a chronic condition like heart disease, for instance, might only need help with specific tasks, like meal preparation or bathing.

To find an in-home aide, ask others who have used one or consult a geriatric care manager. It might cost more to employ an aide through an agency, but if any sort of problem arises, the agency will furnish a replacement quickly. That beats spending stressful days trying to find aides and conducting background checks.


Next Page: Assisted living options
Assisted living
"Assisted living is not as institutional and depressing as many nursing homes," says Joseph L. Matthews, the author of Long-Term Care: How to Plan & Pay for It. "It allows you to have your own living space, but it provides a level of monitoring that most can't afford at home."

A key benefit of an assisted-living community is that, should your loved one's health deteriorate, services are already in place to provide extra care in the same facility. He or she can start with a basic apartment and live independently, with services such as cleaning, meals, and transportation taken care of. If additional assistance is needed—with dressing, bathing, or walking, for example—that help is available. The level of medical care depends on the facility, but most can’t offer the kind of round-the-clock professional medical attention that's common in a nursing home. The average cost for assisted-living facilities in the United States is just under $3,000 per month (more than $35,000 per year), according to a 2007 market survey conducted by MetLife. In a growing number of states, at least some assisted-living services are covered under Medicaid, the government health-care program for low-income people, but most people pay for it themselves or through a long-term-care insurance policy.

When researching assisted-living facilities, be sure to read the fine print. "As soon as you need something more than the basics, they raise the rate considerably," cautions Wexler. Also, you can't assume the facility will automatically up the level of care when your loved one’s health situation changes, warns Matthews. You'll need to monitor the situation to make sure he or she is getting the proper treatment.


Next Page: What you need to know about nursing homes
Nursing home
A nursing home is a last resort for most people, who often end up there after a hospital stay or severe illness. For example, a heart attack might put someone into a rehab facility and leave him too ill to return home. Or a person's health might deteriorate to the point where so much care is needed at home that it's no longer financially feasible.

"If you need a lot of care, and you don't have family who can help, a nursing home is the most practical choice," says Matthews. Annual costs range from less than $50,000 to nearly $200,000 a year—a fortune, but potentially less expensive than hiring home health aides. If your loved one spends down all his or her assets, Medicaid will pay for most nursing-home care at a facility that accepts the plan. Don’t bother giving away all your parents' assets a month before moving them into a facility, however. Federal law now requires a five-year look-back period to prevent just this type of activity.

When you choose a nursing home, look for the signs of a good facility.
  • Don't take the staff's word for how great things are. Talk to residents and their families. The staff should willingly put you in touch with some contacts. This is one of the best ways to evaluate any facility.
  • Evaluate with your nose. If it doesn't smell good, follow your nose elsewhere. After visiting a few, you will be able to tell the difference.
  • Sample some meals. "When you become old and sick, a lot of your life revolves around meals," says Matthews, "so make sure the food is good." Meals also are an excellent opportunity to observe the nature of the interactions between the staff and residents, he says.
  • Find out the staff-to-resident ratio. This can be tricky to uncover, cautions Wexler. You might be told one thing by the facility's honchos, but nursing homes are chronically understaffed and there's a tendency to stretch staff-to-resident ratios beyond what's reasonable. Casually ask a low-level staffer how many nurses there are. A ratio of 1 registered nurse for every 15 residents is the national average, according to the Centers for Disease Control and Prevention’s National Nursing Home Survey, but many facilities routinely go above that.
  • Pay attention to detail. According to Cooper, you can tell a lot about a facility and the attentiveness of its staff by looking for small signs. Is the piano tuned? Is the air conditioner humming well? If the staff is taking care of small details, they're also taking care of big ones.
  • Get a recommendation from the pros. Your local Area Agency on Aging is a good resource and will know about nursing homes that accept Medicaid. Geriatric care managers are often very familiar with private nursing homes. They do a lot of due diligence on them and over the years develop a sense of what makes a good nursing home and what doesn't.
  • Check that the nursing home is accredited by the Joint Commission, a nonprofit organization that certifies health-care organizations and programs. Once you've narrowed your choices down, contact your local Better Business Bureau to see if the facility has drawn any complaints or government actions.
  • Ask to see the results of the home's latest inspection.
  • For a fee, companies such as CareScout can provide ratings of facilities.
Remember, even after choosing a facility, your loved one will only get the best care if you make yourself visible and stay involved.]]> Caregiving options can be costly, but it’s possible to find a solution that makes your budget—and your loved one—happy. (GETTY IMAGES) <![CDATA[Special-Needs Trust: How to Ensure the Care of Your Disabled Child]]>

"People with disabilities are now living long lives," says Chris Cooper, a certified financial planner in Toledo. "They're living into old age and getting old-age problems like Alzheimer’s and arthritis, so they're dependent much longer." In conjunction with government assistance, a special-needs trust can ensure that your child is set for life.

What is a special-needs trust?
A special-needs trust, also known as a supplemental trust, is a safe place to park assets for your disabled child. First of all, the trust is protected; if you are sued, go through a divorce, or have your will contested, the funds cannot be touched and there will never be an interruption in available money for your child. Second, by giving money to the trust rather than directly to your child, he or she will continue to qualify for government assistance programs. "You can give money in such a way that the state doesn't view it as an asset or a resource," Cooper says.

How does a special-needs trust interact with government programs?
Many children with special needs—a category that comprises a wide array of medical, behavioral, developmental, learning, and mental-health conditions—qualify for government assistance programs such as Medicaid, which covers most medical services and housing, and Supplemental Security Income, which provides a monthly stipend for basic living needs. These programs are administered on the state level; though eligibility requirements vary, in most states your child cannot have more than $2,000 in assets. If you or a relative bequeaths more than that to your child, it should be placed in a special-needs trust; otherwise he or she can be disqualified from government programs.


Next Page: How do I set up a special-needs trust?
How do I set up a special-needs trust?
Initiate the trust as soon as you determine that your child may not be capable of supporting himself. If your child's development improves and he is able to earn a living, great—the trust can always be dissolved and the funds returned to you or given to the child. Special-needs trusts are complicated animals, however, and rules vary from state to state. You should find a financial planner who deals specifically in this area of the law.

How do I fund the trust?
Although you can fund the trust with your estate or the proceeds of a life insurance policy, Ron Pearson, a certified financial planner in Virginia Beach, Va., who specializes in families with special-needs children, recommends that you do it throughout your lifetime. Should you die unexpectedly, the trust will already be operational and able to provide your child with money. You should also inform your extended family about the trust so that relatives don't inadvertently disqualify your child. Aunt Edna's thoughtful $10,000 inheritance should be left to the trust, not the individual.

How will my child use the trust?
The money is doled out by a trustee, either yourself or someone you designate. The funds can be used anytime, not just after your death. For instance, you might make use of government programs to provide basic expenses like medical care and housing, while using a special-needs trust for "enhanced care that improves the quality of life," says Pearson. Pearson, the father of two developmentally disabled sons who live in a group home, says he gives his sons money from their trusts that they mostly spend on country music CDs. You could also use the money for medical equipment or care that Medicaid doesn’t cover.]]> A special-needs trust can take some worry out of raising your disabled child, as it helps ensure that he or she will continue to qualify for government assistance programs. (ISTOCKPHOTO/HEALTH) <![CDATA[Why Your Parents Need a Living Will]]>

Q: What is a living will?

A: A living will, sometimes called an advanced health directive or a medical power of attorney, is a legally enforceable document that identifies a patient's end-of-life wishes. It can specify that you want the cessation of treatment under a specific set of conditions—when you want to "pull the plug," in other words. Most people draw the line in one of three ways.

  • If they're in a coma or a persistent vegetative state and there's no hope for recovery.

  • If they're not in a coma, but have lost so much cognitive function that the doctor feels there's no hope for recovery.

  • If there's a terminal illness with no hope for recovery.
A living will does not authorize someone else to act on your behalf for medical decisions. You need a health-care proxy for that.

Q: Who should have a living will?

A: Anybody who is older than 18 and competent. If you are sure you don’t want to be put on artificial support, and don’t want to have extraordinary measures used to sustain your life, then you should sign a living will. Remember the case of Terri Schiavo: Her husband and her parents fought a seven-year legal battle over removing her feeding tube, with some 20 judges ruling on whether there was sufficient evidence that she would want to stop treatment. If it had been in writing, would you need 20 judges, or all the heartache and family strife? No.


Next Page: What to include in your living will
Q: How do you get a living will?

A: In many cases, state bar associations have forms available online. They may not be exactly what you want, but at least they're a starting point. If you work with a lawyer, you won't have to worry about whether the form is good or bad. Plus, you may want something very specific in your document that the form doesn't cover; a lawyer can help you with that. Each state has its own requirements for what you need to do to make the document legally enforceable, such as the number of witnesses and who can sign as a witness. These guidelines, which can affect whether the document is legal or not, should be spelled out on your state's bar association site. You may also be able to find living will resources at local hospice groups. Some hospitals offer the forms for patients or visitors.

Q: What should a living will say?

A: I recommend that a living will respond broadly to what a person wants—it’s hard to anticipate every possible specific scenario. However, there might be individualized specifics. Take my grandmother, for instance. On the one hand, she believed that "where there's life, there's hope," but on the other, she never wanted to be intubated because she had it done once and found it to be the most excruciating experience. Also, she didn't want a doctor to perform any chest compressions on her, even if she could die without them, because she was weak and her ribs could be easily cracked. So the document we drew up for her had to take all that into account.

Q: How do you talk to your parents about getting a living will?

A: The best way to have that conversation is proactively. Have it in advance of anyone needing a living will. Even if your parents put off your initial approach, at least you've planted the seed. And even in states where next of kin can legally make an end-of-life decision for someone, a living will can at least let you know what your parents want. I recently had a situation where a man who had a terminal illness came to see me to do his end-of-life planning, including a living will. At his funeral, his daughter came up to me said, "When we got the call from the hospital that a decision needed to be made about Dad, we pulled out all the documents and read what he wanted. It was such a comfort knowing that he thought about these things and was specific about what he wanted."

]]> Want the peace of mind that comes with having a living will? A lawyer can help you navigate your state’s laws. (FOTOLIA) <![CDATA[How to Continue to Live at Home as You Age]]>

"The people for whom it is hardest to stay in their house want to stay the most," says Elinor Ginzler, coauthor of Caring for Your Parents and the director of livable communities at AARP, the Washington, D.C.–based lobbying group for older Americans. The good news: It may very well be possible. By carefully thinking through your options before you're in poor health, your home environment can meet your needs for the rest of your life. Here are some suggestions.

Modify your house

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Narrow hallways, slippery floors, steps—homes are filled with hazards for an aging person. Research suggests that making modifications and repairs can prevent about a third of home accidents. "Falls are the leading cause of death and disability among older people," says Ginzler. Increase safety with these simple, quick methods.

  • Remove throw rugs to prevent tripping

  • Install motion-sensor lighting to make nighttime trips to the bathroom less perilous

  • Use a no-skid spray on slippery floor surfaces like tiles and linoleum

  • Install grab bars in tubs and on stairs

  • Remove knobs on cupboards and replace them with lever handles, which are easier to grasp
Of course, you may want to make more extensive renovations to your home, such as installing ramps or redesigning kitchens and baths. Think about working with a certified aging-in-place specialist (CAPS), a builder who has been trained by the National Association of Homebuilders to assess the improvements you may need.

Enlist your family
Make sure your family knows you wish to remain in your home as long as possible. You can do that in an advanced care directive, which lays out the type of care you want toward the end of your life. Better to have forthright discussions up front so that you can discuss how your desire to stay at home can be achieved. Adult children may not realize that parents can be safe at home if the right modifications are made.

Consider long-term-care insurance
Paying someone to care for you in your home can be enormously pricey. At an average of $19 an hour, the services of a home health aide can add up to more than $3,000 a month for 9-to-5 care, Monday through Friday. Medicare, the government insurance program for the elderly, and private health insurance usually don't cover long-term care. To get this kind of help in your home, you must either pay for it out-of-pocket or use long-term-care insurance. Policies differ, but long-term-care coverage often kicks in if you are unable to perform at least two activities of daily living—like bathing, dressing, going to the toilet, or feeding yourself—for 90 days. It tends to be most affordable when purchased in middle age, long before most people develop health-related disabilities.

meet your needs for the rest of your life. Here are some suggestions.

"It's really a product that works best for people who think it through early," says Ginzler. "It's rarely appropriate for someone in his 70s, and less appropriate for people who have acute, chronic conditions."

Find the money in your house
If you own your home, a reverse mortgage lets you convert the equity in your home into cash. "Quite often the house is the largest asset people have and it can be a good source of money," says Katana Abbott, a certified financial planner in Commerce, Mich., and the founder of Designated Daughter, a support network for caregivers. Those funds can then be used to hire a home help aide or make renovations.

The more equity you have in your home, the more cash you can borrow. "A reverse mortgage is a good way to pay off what remains of your first or second mortgage, and free up cash to pay for medical expenses," says Barbara L. Steinberg, a certified financial planner and registered financial gerontologist in Lincoln Park, N.J. The loan only comes due if you sell your home, move out, or pass away. In the last case, your heirs can either sell the home or pay off the loan balance themselves—if you owe more than the home is worth, the lender takes the loss.

You must be over the age of 62 to qualify for most reverse mortgages. In general, the older you are and the more your home is worth, the more equity you can access. (The AARP has an easy-to-use reverse mortgage calculator on its website.) For reverse mortgages insured by the Federal Housing Administration, you may borrow up to $362,790 (depending where you live), as long as your home is appraised for more than that amount. You can receive the money in several ways: a lump sum payment, a line of credit, monthly payments, or some combination of all three. Closing costs are subtracted from your remaining equity, so there are few out-of-pocket expenses.

There are a few drawbacks: Fees on a reverse mortgage are higher than on a regular mortgage, so it makes most sense if you intend to stay in your home for several more years. You also will not be able to leave the house unencumbered by debt to your children, which can be a factor if they have an emotional attachment to it.]]> Taking equity from your home can help older people stay solvent. (123RF)