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Hospice – A History and Guide

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I had the honor of sitting down and talking with Patti McMurry, who has been with Hospice Cleveland County for 25 years. We’re going to talk about what it is, any misconceptions, what Hospice does, and the other amazing services to the community. 

 

Tell us a little bit about Hospice Cleveland County. 

One thing about our community that we’ve found is that everywhere we go, no matter if they are conferences, seminars, or anywhere, Cleveland County is very unique because our agencies tend not to compete with each other, but to help each other out. It’s a great place to live and raise a family, and then grow old. We took in our first patient 30 years ago, so we’re celebrating that. The Shelby Star will have a 12-page insert all about Hospice Cleveland County: how we were formed and where we are today. As of today, we have taken care of over 10,000 people who have died in Cleveland County. We were one of the first Hospices in North Carolina. 

 

How did you get involved with Hospice?

The way I came to Hospice was that my two grandmothers died in the same year. One grandmother died at the hospital with lots of tubes, every two hours two family members could go in to see her. When it looked like she wasn’t going to live much longer, the nurse came out and said, “Two family members can go and be with her while she dies.” My mother had 7 children in the family, she happened to be the second oldest so she got to be with her mom and everyone else was in the waiting room. Shortly after that, my other grandmother got sick with colon cancer. That happened to be the year that Hospice Cleveland County started and she was one of their first patients. Everybody was at the house; she died in her own bed, all of us were there, all the grandchildren were there and it was two totally different kinds of experiences. That’s how Hospice Cleveland County got started because there were people in our area who had heard about Hospices. 

 

 

How did Hospice start? 

“Hospice” the word actually comes from the Middle Ages. A hospice was originally a resting place for weary travelers. They didn’t have hotels, so if people would allow weary travelers to rest in their home, then they would put a lighted candle in their window and that signaled that travelers could stay. When we built our hospice house and our office where we are now, they were going to let us change the name of the road and we thought really hard about what we wanted to name that road. The name is Windover Heights Drive, and wind needs to go from this place to the next, which is what Hospice does: it helps travelers go from this life to the next life with quality. 

It’s a pretty new concept; the first Hospice in America was in 1974, so it’s very new. Now just about every county in every state in the country has a Hospice. And every country, really, has Hospices. It was similar to the birth experience. Women used to be put to sleep when they had babies: they’d wake up and they’d have a baby. Then, natural childbirth started and things got back to nature, so the concept of death also got that way. 

95% of the people who are asked, “How would you like to die?” response “At home”. Much less than half of the people die at home, and everybody wants to yet there are so many things that prohibit that. There’s so much fear in that and in modern medicine. We’ve had people call to set up an admission time, but they’re afraid. They’re thinking, “If Hospice comes in, Mom’s going to die.” But think about this: Mom is going to die, we all are. But we want to get in there and make that experience as good as possible. The scary part about Hospice is really only the first 30 minutes of that first visit, and I promise – I tell people this – if we come in for 5 minutes to explain to you what we can do, we will leave in 5 minutes if you want us to. But it’s never happened that we’ve had to leave. People are complimentary and relieved, actually. On the first visit, we give them our 24-hour telephone number that they can call for a nurse to come and visit. Even just having that number, whether they call or not, is so much security to them. You don’t have to take somebody to the hospital, you don’t have to wonder about anything. We are so involved in patient symptom control, as well. 

I explained once to a doctor: when people come to the doctor and they’re in pain, they get a prescription for pain medication. But when that person leaves with that prescription, it doesn’t mean they have the money to buy that prescription, it doesn’t mean that they’re aware the pain medication is going to cause constipation. There are other things that go along with this illness in just that one pain prescription that our nurses can really address and have people as comfortable as possible, teach families how to take care of their loved ones. They have that number to call 24/7, grief counselors, chaplains, social workers, and more. Our Director of Nursing has said many times, “The easy part of Hospice work is what the nurse goes out and does: get the symptoms, the pain, and those things managed. But then the hard part of the dying process starts.” It’s those fears and thoughts and dark nights as well as emotional, spiritual, and mental things that people are dealing with. 

One thing that modern medicine has taken away is a human element, because the medical model is about the medications and treatments, etc. 1991 was when the living will and healthcare power of attorney conversation started, and that was because of Cruzan and those different cases where you could keep somebody alive for years, for decades actually. And then the conversation came up, “Do you want to leave that in the medical community’s hands as to preserving life at any cost? Or do people want to include that human element in their end of life situation?” 

 

A large part of the process is not only the death of the patient, but the grief the family members have to endure. How do you include everyone? 

A lot of our focus is the family, Hospice is special in that the patient and the family are the unit of care. So the focus is just as much on the individuals of the family as it is on the patient. Oftentimes we’ll go in and the patients are doing fine; they know what’s coming, they’ve accepted it, maybe they’ve struggled and had a lot of treatments, maybe they’ve suffered a lot and they’re really fine. But for the family members, it’s hard to let somebody go. We’ve had children, we’ve had young people, and we have very elderly people. So our counselors, chaplains, and social workers really help those families come to terms with those things. Sometimes when we come in, patients are relieved that they can finally say, “I don’t want to go to dialysis anymore, I don’t want to have another treatment, and I don’t want to go back to the hospital.” They can say that because they have that support, they know that those team members are going to be there to help the family. 

 

Can anyone get involved with your services? 

You don’t have to be a Hospice patient to attend our support programs. You can receive help from the grief programs and counseling, or any of the social work, the drafting of living wills, healthcare power of attorneys and things like that. But Medicare requires us to talk to our patients and families about living wills and healthcare power of attorneys. I will tell you that things go a lot smoother when those things have been done early, rather than when somebody is in a crisis or they’re sick, during which time you have to make quick decisions. What we try to do is talk to the public all the time about doing healthcare power of attorneys and living wills. Really, the healthcare power of attorney is the most important document. It doesn’t go into effect until a patient can’t make their own decisions. We leave those documents in the home on the first visit and explain that our social workers are notaries who can come out and help. Oftentimes, it’s easy to get a patient to do a healthcare power of attorney and living will when the whole family does them, so we’ll just have the whole family complete their documents at that time. 

Working at Hospice, we know that those documents are important. We’ve seen bank accounts being closed because until a will is probated and those kinds of things, you have to have those things in place. And where’s the life insurance policy? Where’s the burial policy? People don’t start looking for those until they need them. We want to get people to think about things on the front side, meaning before the crisis happens when you have to think about them. People also don’t realize things that happen after the death: you have to change where the money is going to, everything on the bank accounts and who the beneficiaries are. There’s a lot of work to be done, and if you do that on the front side, it’s not scary. 

 

How is Hospice funded? How does one pay for Hospice care? 

This is something I think the public does not realize: when you are a Hospice patient, Medicare has a benefit called a Hospice benefit for in home care. That benefit pays for everything that Hospice does. It pays for the staff, it pays for the equipment that has to be rented, it pays for oxygen, it pays for any supplies. It’s the benefit that kicks in before the supplement, which also covers 100% of all the medications that the patient is taking. So sometimes we can get in there and save patients and families thousands of dollars a month, because anything pertaining to that illness – heart disease, which is our primary diagnosis, or anything else you may have that you need medication for – is paid for 100%, even if it’s over the counter. A lot of people don’t know that. The only criteria to be a Hospice patient is the doctor feels like if the illness follows its normal course, that the patient will live 6 months or less. Now, we’ve had patients for a lot longer than that, but our median length of stay is 11 days. That means 50% of our patients die within 11 days after we admit them. So they’re not able to access that Medicare benefit and get all those things paid for. That is the one thing about Hospice care that keeps me awake at night, is knowing that there’s so many people who could benefit from having that support of the staff that they can call, but also financially. Being sick is very expensive.  

While at the facility, some of our beds are residential that have a daily room and board fee. It’s about $140 a day. But everything else is paid for. If you’re in the GIP, which is like an in-patient or crisis – similar to a hospital – it’s paid 100%. So that Medicare benefit is so incredibly important. We work with a Hospice pharmacy, so all the medications are ordered by the nurse and they’re delivered right to the patient’s door. We’ve got a lot of elderly people in Cleveland County who are our patients; they can’t get in the car to get a prescription or go to the drug store and wait on their medications. So we try to make everything as comfortable and in the highest quality possible. The nurse orders the medicine, Hospice Medicare pays for it, it’s delivered right to the door so that people can spend their time doing the things that they enjoy. 

One last comment: anybody can make a referral to Hospice. If you know anybody that is suffering or seems to not be getting better, anybody can call our office anonymously, give us a name, and we’ll talk to the doctor to see if their eligible, and if they’re not we just file that away. If they are, it can be the greatest gift that you can give to somebody. 

We’re very proud of the work we do and the relationships we’ve forged with the patients. We’ve named the rooms in honor of the people who we’ve cared for, so it’s a compliment to our staff and the patients that have worked together. 

If you want to contact the office, our number is 704-487-4677.

Call me if you have any questions:

Greg McIntyreGreg_Full
Elder Law Attorney
McIntyre Elder Law
123 W. Marion Street, Shelby
704-259-7040

Client Communication and Education – The Importance of Technology

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Hunt at night

My son Jordan and I recently took a small trip to Campbell Law School in Raleigh, North Carolina and North Carolina State University. While there, we visited the Hunt Library on NC State’s Campus, which is an absolutely amazing facility that really shows the benefit of being at the forefront of technology. This library had what’s known as a book robot – this is a small robot that has you plug in the book you want and will then go and get it in the warehouse to bring it to you. Wow! We were also in a group room that had whiteboards for walls, and my son was fortunately able to do some of his Calculus on them.

Being in that library inspired me to touch on a subject that some people tend to shy away from. I want to talk about the place of technology in Elder Law. I know there are some individuals and companies who would be hesitant in bringing technology into that field. It scares people, I know that. But in my experience, the seniors I count as my clients are extremely up on technology: they’re on Facebook, they navigate email, they do it all. You’ve heard me talk about our eDocs Access Program, which we’re very proud of. This system allows any of our clients to have access to their important healthcare documents 24 hours a day. Stored on the eDocs system are exact copies of the documents, and clients enjoy bank-level security through the system. When they log in, they have a wallet card which lists their login information. They can also access the program from a mobile device, tablet, or other computer to get to all the documents that they need. Now, this comes in handy if you are going on vacation or have a healthcare incident while away from home, heaven forbid. 

Transmission of information is also key for keeping the lines of communication open with the seniors and other clients that I welcome to my office. As you browse the website, you’ll notice that there are a plethora of different options that you can peruse in addition to the blog posts. These include videos and interviews, different social media links, and other forms of relevant content. To ensure that communication is consistent, I have even established a newsletter sign-up right on the front page of the site. Clients and non-clients alike can enter their information and receive the latest news and information that my company generates about Elder Law and the advances that are being made in that field.

Communication and technology are thus key when it comes to Elder Law in keeping the seniors and other clients involved. My goal in this process is not just to be your attorney that drafts wills and powers of attorney; my goal is to be an attorney who develops a culture which sparks excitement, interest, and facilitates communication. 

These are some of the many ways that incorporation of technology can help seniors protect their hard-earned assets and legacies. Constant involvement and distribution of information is therefore essential to this process.

Call me if you have any questions:

Greg McIntyreGreg_Full
Elder Law Attorney
McIntyre Elder Law
123 W. Marion Street, Shelby
704-259-7040

Pre-Need Funeral Planning

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The planning tool that I want to highlight this week is known as Pre-Need Funeral Planning. This is a great benefits planning tool for long-term care Medicaid planning. In essence, those who choose to participate in this pre-planning opportunity can place $10,000 to $15,000 in a trust or insurance account with a reputable funeral home and that money is exempt from the Medicaid spend down. The unused portion is then generally distributed directly to the heirs/children of the deceased. In order to gain more insight into this process, I interviewed Cecil Burton, a long-time friend of mine and owner of Cecil M. Burton Funeral Home and Crematory. Cecil’s been in this area of practice for years now, and from him you can learn about the importance of pre-need funeral planning and why it’s a vital part of planning as you age.

How long have you been in the funeral business?
Close to 40 years. I’m third generation in this. I grew up in it.

How did you get into this industry?
I attended Gupton-Jones College of Mortuary Science in Atlanta, but then got my funeral and embalming license, so I’m an embalming and funeral veteran. Then after that I got my crematory license and opened my own crematory about six years ago, so I’m a certified crematory operator.

Why is it important to choose the right person to do your funeral planning and to do pre-needs funeral planning?
Well, it’s essential that you pick the right funeral home because we’re just like any profession, we have our good people and our bad people. 90% of them are good and do a good job, but you need to go and inspect the facilities and make sure that the people have their licenses and are certified to do pre-planning because in the state of North Carolina you have to have a license to do pre-planned funerals.

Full Video of interview on Pre-Needs Planning Here:

In order to be a licensed funeral rep, you have to have two licenses to be able to do a pre-planned funeral. We have a lot of people who are pre-planning their funeral now just for Medicaid reasons, the spend down. We put the money into an insurance trust where it gets interest on your money but it’s tax-free interest. We also do business with people who just want to pick out their stuff and lock in the price. We do that, too. You can pick your stuff, lock in the price, and it doesn’t matter how long it takes, it’s taken care of.

You’ve handled funerals for my family and many families in this area, in Cleveland County. Just to dispel the myths of a funeral home and things like that, it can really be – in my mind – it’s almost a ministry. You’re meeting and greeting families and helping them through an extremely important time in their lives, wouldn’t you say?

Our goal is to help them. It is a ministry, that’s what we say about our occupation. And what we want to do is help the family, guide them through the process, but also celebrate the life and honor the person who passed away, and help the family to honor the life that lived. That’s what we try to do and help them go through all the steps.

If somebody comes to you and says, “McIntyre at McIntyre Elder Law told me to come over here and I need to do a pre-needs funeral plan,” go through the steps; what would you do for that person?
Well, we’d find out what their needs are. Sometimes they have brothers or sisters who want to be in the process of picking out a casket or the vault for the cremation, and they can’t be here physically, so we’d help them. Then sometimes people want to just put money aside. We put that into a trust, and we trust 100% of the money and that way the money will get tax-free interest until the person passes away. For Medicaid, it has to be an irrevocable trust. This means they divorce themselves totally from that money; they can’t get that money out until that person dies. The money will sit in interest and then if something does happen, they have the principle plus interest to pick out the casket, the vault for cremation services when the brothers and sisters can be in on it.

Now, we have some people where the brothers and sisters are local and they want to go ahead, come in, and pick out the casket and vault for the cremation services to go ahead and pay for it, lock in the price. We do it that way also. That’s called inflation proof, which means you’re locking in the price. If you just put money in, it’s called a standard contract, which is the second type. Both of them for Medicaid have to be irrevocable. If you’re not doing Medicaid, you can always make it revocable meaning you can get the money out anytime you want, interest plus principle.

But it’s still your money, it’s still a countable asset under the Medicaid long-term care payment rules, and you’d have to deal with that aspect of it.
Right. One thing about a revocable contract, you can always make it irrevocable down the road. You can roll it over into irrevocable trust, but if it’s irrevocable you cannot roll it back. You’d have to get a judge.

How can people contact you if they want to know more information?
They can call my office at 704-480-8383.

Call me if you have any questions:

Greg McIntyreGreg_Full
Elder Law Attorney
McIntyre Elder Law
123 W. Marion Street, Shelby
704-259-7040

Health and Rehabilitation at Peak Resources

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In my never-ending quest to discover all available options to seniors, I had the privilege of sitting down with Kris Thompson, the Executive Director at Peak Resources. We spoke briefly about the services that Peak Resources offers, what families and seniors should look for when choosing a nursing home, and the many benefits awarded to individuals who become a part of this incredible system.

See the full video interview here:

 

What are your responsibilities as Executive Director at Peak Resources?
I’m pretty much responsible for everything that goes on at the facility. The financial part, the business part, making sure we meet at the rules and regulations, which in healthcare and with nursing homes, there is an awful lot. I’m also involved in the healthcare part of it. There is a director of nursing in the department of nursing that oversees her staff and makes sure that the healthcare aspects of the nursing home are met.
What should a senior look for when choosing a nursing facility? What should the family of the senior look for?

Location. Everyone talks about real estate, which is very important. It’s crucial that you’re going to feel comfortable visiting, so you want to be close. If you have to drive across town and deal with a lot of traffic, that’s probably going to be burden and a factor that keeps you from visiting. Individuals who enter nursing homes shouldn’t lose contact with their family members. I would also recommend that you go through the facility and tour, just do a walk-through. Most facilities would be glad to do that and have a representative walk through with you to answer questions and point out things that the facility offers. As you’re walking around, look for common sense things such as this:

 

  • Are there any pervasive odors that you notice throughout the facility?
  • Are the residents of the facility happy? Are they socializing and doing different activities? 
  • Are the staff members happy? If they are happy with their job, that is going to be reflected in their performance and how they interact with residents. 

Positive communication is one of the most crucial components that a nursing home resident can have. Is it a warm and welcoming environment? That’s always a good thing. 

 

All facilities are also required to have their 25/67, which is their annual survey where the state comes in with nurses, pharmacists, and dietitians. It is state required to make sure that the employees are doing their job. You won’t see a federal survey every year, but you’re guaranteed that each year the state one will be conducted. They come in and look at all of those rules and regulations, they are making sure that the residents are getting the treatment that they need. They ensure that they are not being taken advantage of and that they can have access to their money right there. 

Most facilities have the shopping aspect. On Fridays, we take everyone to the Wal-Mart to go out shopping, and if the resident doesn’t feel like going out, he/she can give the list to an employee who is managing the funds to go pick up personal items that the resident needs. 
Not all nursing homes are health and rehab facilities, is that correct? 


Right, and that’s usually part of the Medicare benefits. Most people have Medicaid Part A or Part B. That’s going to cover if they’re coming in from the hospital. For most people right now, unless it’s coming through a bundle payment part of Medicare, you’re required to have a three-day hospital stay. You want to make sure that if you are in the hospital, that it is a stay and not an observation because then you are qualified to use your Medicaid Part A benefits. If you meet that criteria – of which therapy or wound care is a part – you can use your Medicaid Part A benefits. 

So if you’re going to be there at the facility 100 days, that first 20 is covered at 100%. The next 80 days is paid 80%, so there is a 20% co-pay. The supplement would pay that 80% if you have the supplement. Now, if you have long-term care insurance, it would pick up for that deficit and pay. 
Does the supplement stop paying if the prognosis of the patient worsens?

 

Yes. When it comes to the Medicare criteria, the therapist will set up goals, such as, “I want him to be able to walk 10 feet in 5 days”. So if the patient is not increasing and making progress – and there’s a little bit of leeway there. Some people might have other stuff going on. They say you can refuse three times, but after that the therapy is going to be required, which is going to drop the Medicare Aid benefits and the supplement, as well. 
Say if it’s a 10-bed facility, maybe 50% to 80% of the beds are certified, and that can also be with Part A, too. You can have them duly certified with Medicaid and Medicare, or one of each. Of course, if you have Medicare and you’re not in the certified bed, Medicare is not going to pay, so the home would advise you of that. 

 

You meet with families from time to time, and you have folks at the facility who are trained to meet with the families to ensure that they have their affairs in order and can find a way to pay for the services and qualify them for the process. Is that right? 


Yes, one of the federal regulations is that you have to have  a social worker, and with that they do set up systems. You have to have a business manager that takes care of the billing. The social worker will deal with community resources, and there are options there as far as to help pay or help get them set up in the system. For some families, this is the first time that they are going through the process. Their parents have aged and they have reached that threshold where they need to enter the system. For many, it is a new and unfamiliar process. It can be very complicated, and considering those rules and regulations, they need to know when they meet the qualifications and how to determine eligibility. 

Do you find that most families have planned ahead for this type of situation? 


No, and I think people tend to put it off and not think that this is going to happen to them. If you look at statistics, you have a one in three chance of being in a skilled nursing facility. A lot has changed now because we do have 20-22% of our residents that are short-term that may come for that Medicare Part A, they get the rehabilitation, and then they’re able to go back home to live with their family. Others that return home with receive some type of home health care and sitter. There are a lot of good supports out there. 

However, if someone at the facility feels that there is going to be what is known as an unsafe discharge, meaning the individual is well enough to go back home, but perhaps will not be taken care of the way he/she should in the home, then we are required to notify Adult Protective Services (APS). They would come in and do a home assessment to make sure that it is a safe environment for the senior citizen. Someone has to be home to take care of the senior, administer medication, etc. APS checks all of that out, and if they do not like what they see in the assessment, they’ll step in. That’s not meant to be a big brother system; this is meant to protect the seniors and get their needs met. 

 

If you would like to know more about Peak Resources or speak to one of their employees, you can contact them by phone at 704-482-5396. They are located at 1101 N. Morgan Street in Shelby.

Call me if you have any questions:

Greg McIntyreGreg_Full
Elder Law Attorney
McIntyre Elder Law
123 W. Marion Street, Shelby
704-259-7040

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ACCESS Care with Jane Wright

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Some members of our Elder Law family recently participated in the health fair at the Neal Senior Center in Shelby. This is the second year in a row that our Elder Law office has participated in the event and we even set up a booth in order to talk to seniors about health care options. The seniors that go get to connect with other professional service providers right on the spot, which is great for them.

Communication with seniors is key to ensuring that they are fully knowledgeable about the healthcare options available to them. One woman that I had the pleasure of interviewing who subscribes to that school of thought is Jane Wright of Care Solutions. Care Solutions in Shelby is located across from the formerly-known Cleveland Regional Medical Center, now known as Carolina’s Healthcare System Cleveland. We spoke a bit about ACCESS Healthcare, of which Jane is the President. This is a group that meets and is made up of affiliates. Jane touched on the important issues facing seniors, and what ACCESS does to benefit seniors.

ACCESS is one of the older groups in Cleveland County that has been meeting for 26 years. At its core, it is a large group of healthcare professionals that work to help seniors. They started off with some of the best people in Cleveland County and are running strong. It started around a cup of coffee, and Suzi Kennedy – who I had the pleasure of interviewing not long ago – was an instrumental part of the group’s kick-off. It’s a group that gets together once per month to share in round-table fashion how the respective agencies that comprise the group serve the elder population. They discuss things that occur in the community that need to be addressed, such as elder dental care and other matters.

Some of the matters that they discuss have been on-going. For instance, in 1992, the United Way of Cleveland County took a survey that was known as a needs assessment. That survey revealed three particular areas that needed to be addressed in the county. The first was aging well, the second was senior housing, and the third was care giving. We know that aging well and illness prevention has been addressed and is still being addressed by many different agencies. But the Senior Center is a wellness place where people can go to exercise, socialize, and to have a good, hot lunch. They also offer line dancing and senior games. The Senior Center is a highly organized place that should be more utilized in Cleveland County.

Another option for seniors is the YMCA, which promoted diabetes prevention. This county is highly advantaged due to the fact that there have been so many people for decades who have been willing to give their time to create locations where care givers can go, such as Care Solutions. In addition to the many facilities, seniors have infinite opportunities to drop off their old prescription medicine, such as at the Senior Center. Once they drop off the medication, it is taken care of swiftly and efficiently so that the medication does not find its way into water supplies or anywhere else where it might harm others.

 

Advantages of ACCESS

We are learning from each other and we all sometimes have the same clients, and we know who to refer to for a certain thing. Everybody is so different, each individual story is different. So when they call us, I have to listen and think like a database. I have to process, “What do I tell this individual?”

Instead of having everyone out there doing their own thing, ACCESS provides the members the ability to meet up every four weeks and to discuss what they have been doing and what methods have worked when it comes to senior healthcare. The goal is the same between ACCESS members, and effectively delivers accountability.

Personally, I am in the central part of Cleveland County, so the professionals that I refer the seniors to are going to be a bit different due to my location. I therefore want to know who the professionals are and I want to know the quality of work they do. I will hear back, so the beauty of it is that I get to establish relationships with the people at these facilities, such as Bayada. It is just invaluable that we meet and get to know who is taking care of the seniors.

 

Funding for Care Solutions

We are funded mainly by the hospital. They are our lifeline. They give us our building, our space, our training, all our technology such as computers. They also pay our employees and give us wonderful benefits. They are there for us, plain and simple.

Our manager is Anzie Horn, who is wonderfully connected to the community. We are also funded by Isothermal Planning and Development, which means it’s state dollars that come down from Isothermal to us, so we get that. And then revenues that we take in from private care management, which is very little. We’re still working on our private market, but we are available to come out to those people that can afford to pay. We can meet people at any point. We provide care management to the general population, and we have about five different programs that we manage. The main one that brings in revenue is CAP/DA, and that’s the Community Alternative Program for Disabled Adults. That is a Medicaid program, and if there’s two in the home, the beauty is it just looks at one person’s income. They do have to be nursing home level and do have to have family support. So they can get some hours of help, which we call in-home aid hours. They also get supplies and the person that comes from the agency of their choice can help them do the things that they need to have done in order to be able to live in the home. That’s a Medicaid state program that we manage.

 

Other Programs

We also manage a respite program, which is very close to my heart because I get to manage that one. We recognize that family caregivers who are caring for members in their house 24 hours a day, 7 days a week need a break. There’s a statistic floating out there that around 40% of caregivers pre-decease the person they’re caring for. It’s very important, but it’s an easy program to set up and get going. We served about 40 families last year and were able to give those family care givers the break they needed. We allocate out and give a voucher for these families to choose in-home aid from one of the 50 providers that we have to adult day health out at Life Enrichment.

The other program allows us to serve the people who fall through the cracks. There are many individuals who cannot get Medicaid, yet they may make $1 or $50, to $100 over the Medicaid guideline. They can also have care management under what’s called Community Care Management. If the individual is 60 or above, a nurse and a social worker can come out, evaluate his/her situation, and see what the individual needs to link him/her with the necessary services.

ACCESS is an impressive networking group that spreads and shares ideas among members that is prompted by a passion for senior and elder care. Individuals – even seniors – who are interested in being a part of this group can call Care Solutions, which is the portal of entry for care giving and elder care. This was formed by ACCESS and the project took 10 years. The number is 980-487-4777. Callers will speak to a live person, not an answering machine.

It only costs $10 a year to participate, which is an excellent fee for the benefits that are awarded in being a part of this fantastic group. Many people don’t know about these programs, and they are overwhelmed by how to care for their senior loved ones. They’re overworked and stressed, and sometimes the world of medical benefits can be a complicated systems to navigate. Fortunately, there are people like Jane and the members of ACCESS who are trying to make elder care that much easier and more enjoyable for everyone involved.

Call me if you have any questions:

Greg McIntyreGreg_Full
Elder Law Attorney
McIntyre Elder Law
123 W. Marion Street, Shelby
704-259-7040

In Home Care: Alternative Care Options Part II

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In this next feature in my Alternatives to Nursing Home Care series, I have the privilege of highlighting Bayada Home Health Care thanks to the interview I conducted with Amber Mitchell, the Client Services Manager of the Shelby faction of Bayada.

Bayada, as some of you might know, sends people in-home to take care of individuals such as seniors as opposed to sending them to an assisted living or a nursing home. Last week, I was lucky enough to interview Suzi Kennedy – the internationally renowned expert on adult day care and Life Enrichment Centers – to talk about one alternative to nursing home care. Amber was able to graciously provide another alternative, and I am proud to showcase our conversation below.

 

1. What is in-home care?

In-home care can be medical or non-medical services that Bayada can provide to the clients to ensure that while they remain home, they are safe. Bayada is equipped to provide pretty much anything that a hospital or a facility can in the home. It is our mission to keep people in the home, because we know that is where they truly want to be, in the comfort of their own home. Our vision is to help people live safely and comfortably at home with independence and dignity.

 

2. What are some of the services that Bayada provides?

Bayada provides a range of services to adults and children of all ages to assist with adult nursing and assisted care. The services that are mostly medical include the following:

  • Rehabilitation services
  • Hospice (in some areas)
  • Home health
  • Physical, occupational, and speech therapy

 

However, we realize that not every individual might require in-home medical care; some of our clients who are senior citizens simply want someone to help them get up in the morning, get dressed, and be on their way to starting their day. When it comes to services around the house, Bayada is available 24/7 to provide the following:

  • Bathing and dressing
  • Administering of medication
  • Breakfast
  • Housekeeping, such as laundry and other miscellaneous chores
  • Errands, such as help with buying groceries
  • Prescription pick-up
  • General company (some clients simply want someone to read with them)

 

In order to determine the best possible care that an individual requires, Bayada will send an agent into the client’s home and develop a detailed care plan. These are tailored to the individual to maximize the level of care he/she receives. We have worked the entire gamut, from individuals who want only a few hours of company a day, to people who have required constant, hands-on attention due to having a tracheotomy and being placed on a ventilator.

 

3. What are the rates, and how are the services paid for?

Normally the standard rate for personal care services is $23/hour. We do have special discounts if you pay privately. We can offer a discount that cuts the rate to $18.25 per hour, which is lower than the national average. There are also other options for payment. We accept Medicaid through the CAP/DA program, we accept the VA Aid & Attendance program, and if you have a long-term policy that will pay for our services, then we accept that as well. We also accept private payment.

When it comes to providing therapy to an individual as part of the home health care, Medicare will pay for the physical therapy clients receive during home visits. Those visits are usually a few times a week for an hour or so a day. Medicare will not, however, pay for custodial care, which is where a CNA would go in with the bathing and personal care.

 

4. Say I have a loved one who is already in a care facility. Can Bayada still work with him/her?

Yes. In that case, two Bayada offices can come in and help provide services: one is the Bayada Home Health Visit Office, located in Gastonia. It is important to note that they service the Gastonia area. They could come in and provide the medical services, such as physical therapy. The second office to become involved would then be our office in Shelby, where we send the CNA out and provide services for bathing and all personal care. So that takes care of the two components: the medical and the custodial.

We currently have several families who have sought our services so that their loved ones do not have to be completely alone in those facilities. We can provide a CNA to sit with them and keep them company for a few hours, and also provide that extra one-on-one care if they should need it.

 

5. How can people contact you if they want to ask any questions?

Bayada has over 300 locations in the United States, so it is fairly easy to find a location that is close to you.

If you’d like to call the Shelby, NC, office, call (704) 669-4000.
If you would like to come in and have an in-person discussion about care plans, stop by at
1105-3 East Dixon Blvd. in Shelby.

We can also send a clinical manager to your home for a sit-down and talk with your family, should the individual seeking care have trouble traveling.

Visit our website at www.Bayada.com for further information.

If you would like to sit down and discuss your current plan and situation with me, I would be glad to help you out. Give us a call at the office so that we can schedule a time to chat: 704-259-7040.

Call me if you have any questions:

Greg McIntyreGreg_Full
Elder Law Attorney
McIntyre Elder Law
123 W. Marion Street, Shelby
704-259-7040

Adult Day Care and Life Enrichment – Alternative Care Option

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Adult Day Care

One of the more recent options for care has emerged in the form of Adult Day Care centers, which are not only relegated to senior citizens, but individuals who have special needs, as well. I consider myself lucky to be a friend of Suzi Kennedy from the Life Enrichment Center of Shelby, North Carolina. When it comes to taking care of special needs individuals and seniors, Suzi and the people that she works with through the Life Enrichment Center have been upheld as national examples of how to create a system of adult day care that really and truly works. Not long before publication of this book, I had the pleasure of sitting with Suzi to chat about the Center’s history as well as the impact of adult day care in this country. Due to the magnitude of her work, I would be especially honored to dedicate part of this chapter to highlighting what she and the Center have done over the past few decades.

 

Life Enrichment Center: The Beginning

Every success story has an interesting background that cannot be ignored. Suzi, originally from New York, moved down South and began teaching nurse aid classes at a community college. When she took her students to the nursing homes to complete the clinical part of her course, she realized something: most of the elderly patients that they encountered were only in these nursing home facilities because they had no other alternative. There was no one to care for them around the clock at home, and in order to ensure they got the attention they needed, their families had entered them into these facilities. This was in the 1970s, meaning back then there were no assisted living homes, according to Suzi. Nursing homes, at least during that time, seemed the only viable option for elder care.

Suzi got to thinking and tried to come up with some alternatives, but at each turn, she was told that her ideas fell under the category of home healthcare, a practice that was already in full swing. She knew that something besides home healthcare could be done, but she didn’t know what. Then one night, after watching a television program on nursing homes, she saw an adult day care center in California mentioned in the credits. It was then that it hit her: adult day care was the way to go. This lit a fire in Suzi; she called the center, collected some information, and later joined a North Carolina state association of adult day care providers. Not long after, Suzi spoke with the minister of John Knox Presbyterian Church here in Shelby, and they opened their doors for the first time as Life Enrichment Center.

 

Growth and Recognition

1980 was the year that Life Enrichment Center received their first participants: one man and one woman, and they would come to the center twice a week. A year to the day, however, the Center was logging an average daily attendance of 12 people, which – according to Suzi – in the history of adult day care, that’s unheard of. With that level of participation, they opened their doors five days a week and continued to flourish as a not-for-profit organization. In order to have more of an impact on the community, Suzi and board decided that they would accept different types of funding so that they could serve people who had a variety of funding streams, such as Medicaid. To this day, Suzi swears that was one of the best decisions they ever made, thanks to the enormous positive effect it had on their ability to reach more people in need; not just the elderly, but younger individuals with special needs.

Not long after, the Life Enrichment Center was honored with a $500,000 grant from the Robert Wood Johnson Foundation, and was one of only 16 centers in the United States to receive that recognition. One of the main reasons they were chosen was due to the incredible work that Suzi was doing with Alzheimer’s patients. She and a few other people forged the path in the realm of what is known as “behavior acceptance”, which is a practice in interacting with Alzheimer’s and dementia patients that validates their emotional needs. For instance, Suzi had interacted with elderly patients who were distraught over the loss of their parents. Though their parents had passed away a number of years ago, these patients – due to their illness – were convinced that their parents had just died. Instead of correcting them, which would cause an even greater emotional turmoil, Suzi would sympathize with them and say, “I’m so sorry to hear that. Tell me about your parents.” This would greatly comfort the patients, and in a short while, their emotional breakdowns would cease to continue. It was due to this groundbreaking practice that the Robert Wood Johnson Foundation recognized them, and with that newly acquired grant money, they were able to expand even further.

 

Life Enrichment Center: Today

At the time of publication, the Life Enrichment Center posted the following hours of operation: 5:30 AM to 6:00 PM. This means that families who care for their elderly loved ones can bring them to the center, leave them there if they have to go to work and carry out their responsibilities during the day, and pick them up after work. Individuals who are cared for at the center receive two meals a day, breakfast and lunch, as well as an afternoon snack.

The center also features total healthcare nurses who are available during the hours of operation and can carry out any medical procedure that’s approved by the nurses that practice. Individuals at the center can take part in speech, occupation, or physical therapy. The center boasts five levels of care, and at the time of publication, the top charge per diem is $68.

So to recap on the benefits of this center: families who are caring for a senior citizen or a special needs individual can drop them off at the center in the morning, where they will be taken care of in terms of medical attention, therapy, food, and other activities, and they can be picked up in the evening to go home and eat dinner with their families. This is a tremendously positive option for households that want an alternative to nursing homes and assisted living facilities.

There are currently two Life Enrichment Center locations: one in Shelby, the other in Kings Mountain. If you would like to contact the Shelby Center, feel free to call them at (704) 484-0405. To contact the Kings Mountain Center, give them a call at (704) 739-4858.

If you would like to sit down and discuss your current plan and situation with me, I would be glad to help you out. Give us a call at the office so that we can schedule a time to chat: 704-259-7040.

Call me if you have any questions:

Greg McIntyreGreg_Full
Elder Law Attorney
McIntyre Elder Law
123 W. Marion Street, Shelby
704-259-7040

Who are your MVPs?

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One of the most important decisions a sports team can make is the selection of the people on their team, specifically who they are going to place in the various positions to best suit their needs. The Panthers are big in the news right now, just as football season is coming back around, and the city is rallying around them hoping that they will do well. And what happened? The star wide receiver, Kelvin Benjamin, tore his ACL and will be out for a long time. He’ll need about a year for that, so he’s out for the season, which is unfortunate.

Last season he caught 73 passes and scored 9 touchdowns. He’s going to be missed. This event led me to do some thinking: what do you do without your star wide receiver or your MVP? If the Panthers could have planned to not lose him, do you think they would have done it? I do. So how can a team plan and make the right choices to avoid losing their MVP? It is very difficult to do so, because you can’t predict everything that is going to happen.

This is why you have back-ups and alternative players for your team. You absolutely have to have people who are ready to come in and play for you when your MVP is out for whatever reason. I’ve spoken about that a lot, so in regard to your important legal documents – such as your power of attorney and healthcare power of attorney – you want to make sure that your MVP, who is your attorney-in-fact, is a strong player. You also want to ensure that whoever you name to be second in line – a secondary beneficiary, in some cases – will be a strong option to come in and make decisions. If for whatever reason your star MVP becomes unavailable to make the big decisions for you in your life, even temporarily, your secondary should take on this role without a problem.

Different documents require different types of decisions: one requires a financial decision and what you’re going to do to pay your bills and handle your resources. That would be a general durable power of attorney. Then you’ve got someone to be the attorney-in-fact for your living will, someone that you feel can make the decisions that you want made. They’re not always the same person. Therefore, your healthcare decisions are handled by the healthcare power of attorney. And you have to understand, we use those as two totally separate documents; we don’t conflate or try to mix those. We separate those documents so it’s extremely clear which statute we’re operating under and what your wishes are under those documents.

The legislature has actually been very wise in separating those documents, and I’ll tell you why it’s a beneficial decision on their part: sometimes, you don’t want the person who’s making your financial decisions to be the same person who’s making your healthcare decisions. It happens. Most people use the same person, but why might you want these two individuals to be different people?

Some people have family members that could never pull the plug. You want to make sure that you have two different people appointed so that you can ensure that they will honor your wishes. What about people who are in a position to gain from you financially? You most likely do not someone who is about to inherit a lot from you to be making your end of life decisions. It’s common sense.

Many people elect their spouses or their children to be the primary attorneys-in-fact – and rightfully so. But you are going to want to have those subs, those secondary people to come off the bench who you can really count on.

You have also probably heard of the disastrous effects of Tropical Storm Erika down in Florida. I suppose they saw it coming, but didn’t anticipate or understand the devastation that she’d bring with her. This is just another reason why planning is key: you never know when something disastrous and catastrophic will come your way. Erika shut down an entire state, and this comes incredibly close to the 10-year anniversary of Hurricane Katrina. Looking at the history of these events, we can deduce one thing: there are things that can happen in your life that you know are coming, but you don’t anticipate the effects; and then there are events that will completely blindside you and knock you off your feet.

By now, you have most likely thought of your MVPs – this could be your husband, your wife, your children, or other close family members and friends, and that’s great. But now you need to start thinking about the other players on the team. Who is going to be your offensive lineman? You want the right player for the position, and you want the right tools for the job. So when I sit down with clients, I’m going to talk to them about who they’re putting on their team and what documents they have in their toolbox.

For instance, if you’re planning for a Medicaid situation, you may do a tenants in common deed, which is where you piece out a percentage of a property and gift it to a family member – in this case, maybe one of your MVPs such as your child. Thankfully, that’s not countable under a nursing home Medicaid or a long-term care Medicaid where there’s a 5-year look back period. That’s a different deed you can use for planning purposes, another tool in your box. Under a VA Aid & Attendance planning purpose, however, we might want to gift a property that’s down the road from your home, where you have a small rental on there. It might be a good play for you to keep that in the family. You could deed that directly to a family member or a child, thereby once again calling on your MVPs to move that asset and have it not count. Good news: there is no look-back period for veterans for VA Aid & Attendance planning, where you can get an extra income per month to use when you need it to cover the cost of nursing home or assisted living care. An individual veteran can actually get up to $1,750 per month; they just have to have served one day during a war time event. And I don’t mean in the thick of battle, I mean within the military sometime during a war.

Different situations therefore require different tools for the job, just like different players are fit for different positions, and different plays are used against various sports opponents. You have to know what tool to use for the job, and what play to make on the field.

So let’s say you enter into long-term care – and let’s face it, 70% of us will fall under that category eventually. You want to make sure that what you have, your assets and everything else, are protected are inheritance for your children. To do this, you’re going to need to research and pick the right tools. Deeds are a great starting point to see what play you can make and what you can do to ensure that your money stays in the hands that you want it to.

One play that you can make is using the traditional life estate deed. This tool has been around for years and years, and the property can be passed automatically to the remainder beneficiary without having to go through probate. It’s going to pass directly to the grantees on the deed. Seniors, for instance, can reserve a life estate for themselves so that the two of them control it until the last one of either of them passes away. The life tenant also maintains complete control of the property while he/she is still alive. Liens are not usually attached to the real estate if the deed is recorded after the death of the life tenant.

So if you are in good health and you are a senior, and you’re using life estate deeds to put beneficiaries on your property, it could be a good tool for you to use. The drawback, in my opinion, of a traditional life estate deed – besides the fact it doesn’t avoid the look back period – is it doesn’t allow you to change your mind. Let’s say you want to sell that property or mortgage the property. You have to get your grantees or beneficiaries, whoever they are, to come in and sign off on the sale or the mortgage of that property. Life estate deeds therefore do not grant as much control on the part of the seniors as I would like to see.

Pre-planning is therefore so important. You don’t want to find yourself scrambling at the last second when your star wide receiver is out on an injury and you have no one else to rely on to make those important calls in your life. You want to have someone reliable to come in off the bench and keep the game going. In the long run, it will save you precious time and money.

If you would like to sit down and discuss your current plan and situation with me, I would be glad to help you out. Give us a call at the office so that we can schedule a time to chat: 704-259-7040.

Call me if you have any questions:

Greg McIntyreGreg_Full
Elder Law Attorney
McIntyre Elder Law
123 W. Marion Street, Shelby
704-259-7040

Should I Use an Attorney or a Non-Attorney when Engaging in VA Aid & Attendance Planning?

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Earlier this week, I took a trip up to one of my favorite places in North Carolina – the mountains. My wife and I decided to take a couple’s excursion to enjoy the last remaining weeks of the summer. Now, we both love our kids. But sometimes, as you parents all know, it’s great to get away from time to time, especially to an area that is as majestic as the mountains of my home state. The only time of year that is better to go to the mountains is the fall, when the leaves change and the colors start to emerge.

But I also love to get up to the mountains to do some thinking and clear my head so that I can approach my job with clarity. Now that I’ve been able to do that, I want to talk to you about VA Aid & Attendance planning.

Recently, at a gathering of various elder law attorneys and some groups affiliated with my niche, someone posed a question to me that I’d like to address and answer for all of you. The question that I was asked was as follows:

“Should I use a financial institution or some kind of financial outfit to handle my VA Aid & Attendance planning?

The short answer is no, you should not go to a financial outfit to help you handle matters of VA Aid & Attendance planning in place of an attorney.

Let me explain the dangers in going to a financial group for your VA Aid & Attendance planning. Let’s say you’ve got a benefit coming in of $1,700 per month, and your social security is $1,000 per month. That $2,700 might help you in your payments toward the monthly in-home care bill, if you should require that type of care. However, if you require more extensive care, such as going to an assisted living facility or a nursing home, then your costs are going to increase dramatically. I’ve seen these types of facilities cost a minimum of $5,000 a month, with a high of $12,000 per month. Of course, this depends on the level of care that you require and the standard of the facility that you potentially enter.

That being the case, your VA Aid & Attendance isn’t necessarily going to cover those fees. The financial company may therefore move around your assets to try to get you qualified for VA Aid & Attendance, and they’ll do it in such a way that the money will come back to you using certain financial tools. Why would they want to move around assets in the first place? Because some of them claim that they can help you qualify for VA Aid & Attendance just by doing so.

Now, VA Aid & Attendance is a well-liked pension program, one that I promote heavily, and one of the reasons for that is because there is no look back period. Now, in North Carolina, there is a three-year look back period called special assistance Medicaid, which is a type of Medicaid that covers assisted living care. There is also a five-year look back period for the Medicaid that covers nursing home or long-term care. You might be in great shape now and not require these types of care, but if you improperly move around assets under the Medicaid rules just to qualify for VA Aid & Attendance, and then you incur a healthcare crisis, you are going to be in a bad situation. You may very well be disqualified or incur a penalty period in trying to get Medicaid to come in and pay for the healthcare costs if you don’t actually have the monthly funds to cover them.

This is what I call practicing law without a license. If you’re a company out there, hear me now: People who do this are practicing law without a license by doing that type of planning, without doing it under a lawyer’s care and ignoring the Medicaid elephant in the room that’s right around the corner. There are many other issues associated with this practice, too, that I might get into in another blog post. But let me say this: I’ve worked with a lot of great financial people who really care about seniors and really know a lot about how to protect seniors. However, if you are working with or know of a financial company that is trying to qualify you for VA Aid & Attendance by pushing financial products, they’re only interested in selling those products that help you qualify. They’re not interested in whether you’re going to be disqualified for Medicaid down the road or really going to end up losing the coverage you may need. And as a result of that penalty period, don’t forget you are going to have to pay all that money back.

If you’ve got a private financial outfit that’s trying to do this type of planning, call me. My number at work is 704-259-7040. You can talk to me directly. Those of you who are engaged in this practice, call me and I’ll tell you why you’re practicing law without a license, and I think you ought to be sued in the state of North Carolina and every other state in the union.

Call me if you have any questions:

Greg McIntyreGreg_Full
Elder Law Attorney
McIntyre Elder Law
123 W. Marion Street, Shelby
704-259-7040

 

 

Who Wants to Know the Basic Differences in Different Deeds to Compare and Contrast??? Ooo… Ooo… Me, Me!!!

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“I get questions multiple times per day regarding the differences in one deed versus another.  I wanted to put together this short piece to give a short summary and comparison of a few types of deeds.  You SHOULD NOT engage in deed planning without consulting an attorney first!  I can say I am EXTREMELY proud to bring you this and it will be a portion of a book due out this fall: Saving the Farm…”

Greg McIntyre

Name: Lady Bird Deeds

Function: Lady Bird Deeds allow you to reserve a life interest in a property. While you are alive, you retain full control over your property and are allowed to sell, mortgage, or gift the property. When you pass, your property then goes to the person that you’ve named the future interest holder, such as your son or daughter. The person you name receives the property when you pass away.

History: Legend has it that President Lyndon B. Johnson used this deed so that he could transfer real estate and property to his wife, “Lady Bird” Johnson. What really happened was that Jerome Ira Solkoff, an attorney from Florida, first drafted this type of deed back in 1982. He used the names of President and First Lady Johnson in his example, and their names stuck.

Benefits: You can avoid probate in passing your property/real estate when you pass away. You can also maintain your eligibility for Medicaid and keep the property in your family that would have otherwise been taken to pay those healthcare costs that are incurred by your incident.

States that recognize Lady Bird Deeds[1]:

  • Arizona
  • Arkansas
  • California
  • Colorado
  • Florida
  • Hawaii
  • Kansas
  • Minnesota
  • Missouri
  • Montana
  • Nevada
  • New Mexico
  • North Carolina
  • Ohio
  • Oklahoma
  • Texas
  • Wisconsin

 

Name: Tenants in Common Deeds

Function: Deeds that allow two or more people to own property together, most times it is a joint ownership of real estate. The people that sign the deed and thus gain ownership of the property all own it equally, and can give up their ownership at any time. 

This differs from the other two types of shared tenancy, which are as follows:

  1. Joint tenancy: in which the parties involved have undivided ownership of the property or real estate in question.
  2. Tenancy by the entirety: reserved for married couples, in which the two are treated as a single entity and thus their ownership is shared as though they were a single person.         

Those who are married and are engaged in a Tenants in Common Deed are encouraged to have a Right of Survivorship, meaning the real estate will pass directly to the person that he/she designates upon death. This can be a spouse or a child.

History: Though Tenants in Common Deeds have been around for decades, they became very popular nationally in the 1990s when the housing prices in the country began to bubble and increase. TICs therefore became one of the only ways that people could afford to buy houses, if they were able to own them alongside someone else or with more than one other person. Many state legislatures, however, have been deliberating shared or concurrent tenancy for more than 100 years.

Benefits: The owners of the property can elect someone to whom their share of the real estate is automatically transferred upon their death. What’s more, if they have a Right of Survivorship – usually between a married couple – then the share of the real estate will be transferred automatically to the surviving spouse without going through probate.

Another benefit is that people who are engaged in a TIC are able to apply for fractional loans, meaning that each individual involved can have his or her own mortgage.

 

All states recognize Tenants in Common ownership of property[2].


Name: Joint Tenants with Rights of Survivorship

Function: (Other name for joint tenancy) Joint tenancy implies that there are at least two people who agree to legally share an equal percentage of the property or real estate. Upon signing the document, the people are instantly engaged in a “right of survivorship”, which means that if one of the individuals were to pass away, the other individual are granted ownership of the property and the share of the deceased is passed to them. For instance, if three people enter a joint tenancy and one passes away, the remaining two now own 50% of the property.  

Joint tenancy with Rights of Survivorship does not allow one single individual to make mortgage or sale decisions with the property; a decision of that caliber has to be made unanimously.
History:
Joint tenancy, especially with rights of survivorship, have been around for centuries, and originated in the 13th century in England[3]. It wasn’t until the 19th century, however, that women started to be considered eligible for joint tenancy; before then, it was strictly the men who were entering into joint tenancies[4].

Benefits: When the spouse passes away in a joint tenancy, property ownership is automatically granted in full to the surviving spouse without having to go through probate. Because the joint tenancy with rights of survivorship also applies to financial accounts, such as brokerage accounts. All persons involved have equal access to the assets in the account, and can make investment decisions with those assets in the account.

 

States that recognize Joint Tenants with Rights of Survivorship: All EXCEPT the following[5]:

  • Alaska
  • Oregon
  • Tennessee

Name: Traditional Life Estate Deed

Function: Used to transfer property automatically from one individual to another when the former passes away. While a person is alive, he/she can decide to enter into a traditional life estate deed with another individual, stating that upon death, the property listed in the deed will automatically go to the designated person. The person who wants to leave his/her property is called the “life tenant”, while the recipient of the property when the life tenant passes is the “remainder beneficiary”.

History: Life estate deeds have also been around in the United States for a few centuries, and were used specifically to allow sons to inherit their parents’ property.

Benefits: The property can be passed automatically to the remainder beneficiary without having to go through probate. The life tenant can also maintain complete control of the property while he/she is still alive. Liens are not usually attached to the real estate if the deed is recorded after the death of the life tenant.

 

States that recognize Joint Tenants with Rights of Survivorship: All EXCEPT the following:

[1] http://www.lawlesher.com/lady-bird-deed/

[2] http://www.apiexchange.com/articles/pdf/Tenant%20In%20Common%20Ownership%20(168).pdf

[3] http://www.americanbar.org/newsletter/publications/gp_solo_magazine_home/gp_solo_magazine_index/solo_lawyer_real_estate_joint_tenant_probate.html

[4] http://suffolklawreview.org/wp-content/uploads/2014/02/Fischer_Note.pdf

[5] http://thismatter.com/money/wills-estates-trusts/joint-tenancy.htm

[6] http://www.rabalaislaw-metairie.com/2013/11/19/there-are-no-life-estates-in-louisiana-but-we-do-have-usufructs/

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