When you are in perfectly good mental health, it can be hard to wrap your head around the idea that you may well become unable to make sound medical and financial decisions at some point in time. Though people are aware of the fact that elders sometimes become incapacitated in this manner, many adopt the “this will never happen to me” stance. This may be a mistake. When you look into the facts surrounding the subject the reality is that a significant percentage of senior citizens do in fact suffer from dementia eventually.

According to the Alzheimer’s Association, one out of every eight senior citizens are suffering from the disease and 40% of people who are 85 years of age and older are Alzheimer’s sufferers. If you include other causes of dementia, upwards of half of the oldest old are indeed suffering from some form of dementia, which can of course strip its victims of the ability to make sound medical and financial decisions.

This is why incapacity planning is so important, and it is usually achieved through the execution of legal instruments called durable powers of attorney. The difference between a “durable” power of attorney and a standard power of attorney is that the durable POA remains in effect after the incapacitation of the grantor. There is also a springing durable power of attorney, and these documents do not take effect until and unless the grantor becomes incapacitated.

When you are executing your durable powers of attorney you must name agents to act in your behalf. Since the person that you would like to see making your medical decisions may not be the best choice for making financial decisions, you can execute two separate durable powers of attorney and name a different respective attorney-in-fact for each document.

To gain a more in-depth understanding of incapacity planning and durable powers of attorney, simply take a moment to arrange for a consultation with an estate planning attorney.

Nirenstein, Horowitz & Associates, P.C. is a member of the American Academy of Estate Planning Attorneys.

The layperson can sometimes become confused about the differences regarding guardianship and conservatorship. If you need to make decisions about adult guardianship and conservatorship proceedings, it is really important that you understand what each one means and how the law is applied in the state where the proceedings will be held. It is also useful to take note that adult guardianship and conservatorship recommendations differ greatly from those relating to minors and individuals suffering from development disabilities.

A guardian is given the responsibility to make decisions on behalf of a person who is judged by the state courts to be incapacitated. Incapacitation can occur through mental illness, physical illness or disability or mental incompetence resulting in the person in question being no longer capable of being able to make and communicate logical and informed decisions.

This incapacity that can lead to a guardian being appointed, and it should be noted that incapacitation can also be caused by extreme use of drugs or alcohol. Once the guardianship is granted, the guardian will be responsible for care arrangements and decisions about medical treatment as well as the placement of the individual.

A conservator takes care of the finances of the incapacitated individual. The conservator is appointed once the candidate has satisfied the responsible court authorities that he or she is capable of looking after the individual’s finances for a period of time that could be short term (if the incapacity is expected to be temporary) or over a longer term for conditions such as dementia.

The conservator is expected to keep records of all income and expenses on a detailed basis and be able to present these accounts at the end of each year for inspection by the interested parties. In certain cases, the conservator will be required to post a bond to act as security for the funds the conservator will be handling.

Nirenstein, Horowitz & Associates, P.C. is a member of the American Academy of Estate Planning Attorneys.

As you prepare your assets for eventual distribution to your loved ones after your death it is a good idea to consider the eventualities that you may be facing during the latter stages of your life. To plan well for the future you have to be able to make intelligent projections, so your expected lifespan is a very relevant piece of information. At the present time the average lifespan in the United States is 78 years, but people are living longer and longer. In fact, the oldest old (people 85 years old and up) are the fastest-growing age group in America. So indeed, it is quite possible that you will live well into your 80s and perhaps longer.

One of the things that you should keep in mind when you consider this type of longevity is the possibility of incapacitation. Though we’ve all heard of it, a lot of people are not aware of just how widespread Alzheimer’s disease has become. According to the Alzheimer’s Association approximately 13% of people who reach the age of 65 have Alzheimer’s disease. 43% of individuals 85 years of age and up have Alzheimer’s, and of course Alzheimer’s causes dementia which can make sound decision-making impossible.

If you were to become unable to make your own decisions due to mental incapacity without planning ahead the court could appoint a guardian to act in your behalf and you would become a ward of the state. This is not something that appeals to many people, and the way that you avoid this fate is by engaging in intelligent incapacity planning.

You can proactively appoint attorneys-in-fact to act in your behalf in the event of your incapacitation through the execution of durable powers of attorney. In this manner you leave nothing to chance, and if you were to lose your ability to make sound decisions trusted people of your own choosing would be empowered to handle your affairs.

Nirenstein, Horowitz & Associates, P.C. is a member of the American Academy of Estate Planning Attorneys.

If you are one of the many who has never given estate planning a whole lot of thought the term probably conjures images in your mind of the classic estate planning document that you hear people talk about in the old movies: the “last will and testament.” Most people are aware of the fact that these documents are used to elucidate your wishes with regard to the distribution of your assets after death. Traditionally the “will” was used to distribute real property, and the “testament” was used to articulate the desired distribution of personal property, but at this point the single term “will” generally suffices.

There is however another commonly recommended type of will called the living will. Unlike the standard last will and testament the wishes that are communicated in a living will come into play while the testator is still alive. Through the execution of a living will you state your preferences with regard to the types of medical procedures that you would be willing to accept those that you would prefer to refuse if you were to fall into a medical condition that precluded your ability to communicate your decisions in real time.

The issue of whether or not you want to be kept alive through the use of artificial means if you were to fall into a terminal or persistent vegetative condition is at the core of many living wills. However you can be as specific and detailed as you would like to be with the document, and it could be argued that the execution of such an advance health care directive is truly a must for adults of all ages.

You never know what the future holds and accidents and sudden illnesses can befall people in the blink of an eye. If your wishes are not known your family members can find themselves in an excruciating position, disagreements can arise at the worst possible time, and your treatment may not proceed in the matter that you have chosen had you taken the time to state your preferences.

Nirenstein, Horowitz & Associates, P.C. is a member of the American Academy of Estate Planning Attorneys.

Selecting a long term care facility can be an arduous task. We all want the best for our loved ones, and finding the nursing home or assisted living facility that meets your family’s needs is paramount. Fortunately there are resources out there that make this process much easier.

For instance Medicare.gov offers state by state information on long term care facilities. You can enter the state of Connecticut and you will find many facilities listed. You will also find that each facility is measured under a star rating system. The parameters include Overall Rating; Health Inspections; Nursing Home Staffing; Quality Measures; Program Participation (i.e., Medicare, Medicaid); Number of Certified Beds; and Type of Ownership (i.e., non-profit, for profit, church related). The rating system ranges from “Much Above Average” to “Much Below Average”.

Another resource is ucomaparehealthcare.com. This site allows the user to enter the desired state and select from multiple cities. Some of the criteria listed about each facility are how many residents live in the nursing home; how many beds exist in the facility; and the percent occupancy rate in the nursing home.

Although many resources are available for each state, you will still need to do your own research into the facility. When you are ready to start the process of choosing the facility that best suits your needs, you can use the Internet and websites such as the ones listed above to compile a list of options. Next you will want to call the facilities and ask questions. Having a list of questions ready when you make the calls will help you to stay on track.

Next, arrange a visit to the facilities that you are interested in. Meet the staff and observe the residents. Do they seem happy and content?

If you do your the research, engage in some legwork and employ a bit of patience you should be able to ascertain which of the many choices is best for your family.

Nirenstein, Horowitz & Associates, P.C. is a member of the American Academy of Estate Planning Attorneys.

When you are engaged in the process of estate planning the objective is to prepare your assets for distribution after your death. Of course, when you are considering these details you can’t help but think about the last stages of your life as well. This is natural on a personal level, but the matters of estate planning and end-of-life planning are inextricably intertwined on a financial level too. Unless you are in the highest reaches of the upper financial stratosphere how you spend those last years can have a noticeable impact on your legacy.

The fact is that about 60% of senor citizens will need long term care at some point in their lives, with the average length of stay being about two-and-a-half years. As people continue to live longer the odds that you will be unable to take care of all of your day-to-day needs at some point are invariably going to increase. Plus, the costs are getting higher all the time, and this is big news in the elder law community.

In the United States as a whole the average cost of a year in an assisted living facility rose 5.2% to $39,516 in 2010 over 2009 numbers. A year spent in a private room in a nursing home in 2010 would cost you $83,585 on average; in Connecticut that average cost exceeded $137,000. The national annual average represented a 4.6% increase in 2010.

These costs are high, and they are clearly trending upward. One way to be prepared for them is to purchase long term care insurance. The premiums can be rather expensive, but when you do the math this insurance can save you a great deal of money under certain circumstances. The younger you are when you obtain the insurance the less expensive it will be, and you may not be able to find coverage if you wait too long. It is a good idea to do your research, get some quotes, work the numbers, and give the matter some serious consideration.

Nirenstein, Horowitz & Associates, P.C. is a member of the American Academy of Estate Planning Attorneys.

Estate planning is often viewed as a purely financial endeavor. However, there is a health care component as well if you want to be comprehensively prepared for all of the eventualities of aging. It would be ideal if we all passed on without ever having to experience any gradual decline, but unfortunately it doesn’t always work that way. People are living longer than ever, and one of the most surprising demographic trends of our time is the fact that senior citizens are the fastest growing segment of the population. Beyond this, the “oldest old,” which is a term used to describe people 85 years of age and older is the most rapidly expanding subset of seniors.

When you reach these advanced ages the possibility of incapacity is going to become more and more realistic. Planning for it is simply the responsible thing to do, and it can be done by the execution of a few key documents. With a living will you can record your medical preferences so your wishes are known if you are unable to make these decisions in real time at some point. The issue that is central to most living wills is that of whether or not you want to be kept alive on life support should you fall into a terminal condition with no reasonable hope for recovery.

Many people will also include a durable medical power of attorney and a durable financial power of attorney. With these instruments you name attorneys-in-fact that are empowered to make decisions in your behalf in the event of your incapacity. You may want to appoint one person as your health care proxy and another to act as your financial attorney-in-fact depending on the specific strengths of each individual.

Taking the time to put an incapacity plan in place is good for you, but it is also the responsible thing to do for your family. You are letting them know exactly how you would like to proceed rather than forcing them to wrestle with these potentially difficult decisions on their own.

Nirenstein, Horowitz & Associates, P.C. is a member of the American Academy of Estate Planning Attorneys.

Advance health care directives are important components to your estate plan, and what they do is record your medical preferences so that your wishes are known should you be unable to communicate them at some point in the future. With a living will you state the medical procedures that you would be willing to accept and those that you would prefer to deny. When you execute a durable medical power of attorney, who empower a person of your choosing to make medical decisions in your behalf if you cannot make them for yourself.

These two legal instruments are key when you are planning for the possibility of incapacity and potential end-of-life scenarios, but you also have to consider the ramifications of the Health Insurance Portability and Accountability Act. This act was originally passed back in 1996 to require those who are in possession of your health care information (such as insurance companies and health care providers) to keep it confidential.

As you might imagine the details of the law as it was finally passed down by the Department of Health and Human Services in 2001 are rather complex. Each health care provider is not expected to scour the guidelines before making judgment calls on a case-by case basis, so hospitals implement their own rules based on their interpretations of the HIPAA. So when you see a doctor in the hospital this physician will be bound by that hospital’s regulations concerning the HIPAA.

So, they may not feel as though they can discuss the details of your case with family members or the health care proxy you named unless you have included a HIPAA release in your estate plan. It is important to recognize this and sign a release, which can be part of your health care proxy or medical power of attorney or a separate stand-alone document.

Nirenstein, Horowitz & Associates, P.C. is a member of the American Academy of Estate Planning Attorneys.

One of the profound demographic realities of our time is the fact that the population of the United States is getting older. There are a number of factors that contribute to this, including lower birth rates, the “baby boomers” reaching their senior years, and the steady advances in medical technology. As a result, the field of elder law is expanding, and those who are engaged in long term retirement and estate planning must take this ever-increasing longevity into consideration.

MetLife has conducted a comprehensive survey that puts the financial impact of long-term care under the microscope. For nursing homes they analyzed the average daily costs for both private and semi-private rooms. The national average for a private room in 2010 was $229 per day, which is over $85,000 per year; this is an increase of 4.6% over 2009. The cost of a semi-private room was $205 a day or $74,825 annually, which is a 3.5% increase over 2009.

The cost of residing in an assisted living facility has also gone up significantly over the last year. Across the country the average annual rates for living in an assisted living community increased by 5.2%. In 2009 the average annual cost was $37,572; in 2010 that figure rose to $39,516.

In Connecticut, the costs are considerably higher that the national averages. Those living in a nursing home in the state can expect to pay an average of $345 per day for a semi-private room and $376 for a private room.

In an era when it is logical to expect that you may be living well beyond your 85th birthday advance planning has become all the more important. When you are analyzing your financial situation and making plans for the twilight of your life, it is a good idea to recognize the fact that you may incur nursing home, in-home care, or assisted living facility expenses at some point in time, and they are considerable and on the rise.

Nirenstein, Horowitz & Associates, P.C. is a member of the American Academy of Estate Planning Attorneys.

As you plan for your twilight years you have a lot to keep in mind from a financial perspective. Nobody wants to expect the worst, but it may be a good idea to prepare for it while expecting the best. With this in mind, there are those who pass away suddenly without showing any signs of advanced illness, but the reality is that most of us are going to experience a gradual decline.

At some point in time you may find it impossible to take care of your day to day personal needs for yourself, and the costs of assisted living facilities and nursing homes are quite high and getting higher. Under certain circumstances Medicaid may be of assistance, but most people would prefer to remain totally solvent throughout their lives.

One resource that is available to many veterans that can help to defray the high costs of long term care is the Veterans Aid and Attendance Pension. This benefit should not be confused with the retirement pension that veterans receive after completing a minimum of two decades of service. Veterans A & A is something entirely different, though people who are receiving a retirement pension may be eligible to receive this benefit as well.

This benefit is intended to assist veterans who need help with their basic physical needs, like bathing, eating, getting dressed and undressed, etc. The length of service requirement is very modest. If you have served at least 90 days on active duty with a minimum of one of them being during a time of war, you meet the qualifications. A single veteran who is eligible for the Veterans A & A Pension can expect to receive up to $1,632 each month, and this can be used to help cover in-home care as well as assisted living facility or nursing home expenses.

Veterans A & A eligibility can have a significant impact on your long term planning. If you think you may qualify, it would behoove you to contact the Veterans Benefits Administration to obtain detailed filing information.

Nirenstein, Horowitz & Associates, P.C. is a member of the American Academy of Estate Planning Attorneys.