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Staying Connected to Family Members in a Nursing Home When Visits are Banned

The spread of the coronavirus to nursing home residents has caused the federal government to direct nursing homes to restrict visitor access, and many assisted livingfacilities have done the same. While the move helps the residents stay healthy, it can also lead to social isolation and depression. Families are having to find new ways to stay in touch.

Nursing homes have been hit hard by the coronavirus. The Life Care Center of Kirkland, Washington near Seattle was one of the first clusters of coronavirus in the United States and is one of the deadliest, with at least 35 deaths associated with the facility. In response, the Centers for Medicare and Medicaid Services (CMS) issued guidance to all nursing homes, restricting all visitors, except for compassionate care in end-of-life situations; restricting all volunteers and nonessential personnel; and cancelling all group activities and communal dining. While these actions are necessary to prevent the spread of the virus, they can leave families worried and upset and residents feeling isolated and confused.

Families are taking varying tacks to keep in contact with their loved ones, many of whom don’t fully understand why their family is no longer visiting. Nursing homes are also helping to facilitate contact. Some options for keeping in touch, include the following:

  • Phone calls. Phone calls are still an option to be able to talk to your loved one.
  • Window visits. Families who are able to visit their loved one’s window can use that to have in-person visits. You can hold up signs and blow kisses. Talking on a cell phone or typing messages on it and holding them up to the window may be a way to have a conversation.
  • Facetime and Skype. Many nursing homes are facilitating video calls with families using platforms like Facetime or Skype. Some nursing homes have purchased additional iPads, while others have staff members going between rooms with a dedicated iPad to help residents make calls.
  • Cards and letters. Sending cards and letters to your loved ones is another way to show them that you are thinking of them. Some nursing homes have also set up Facebook pages, where people can send messages to residents.

In this unprecedented time, families will need to get creative to stay in touch with their loved ones. For more articles about how families and nursing homes around the country are coping with the new restrictions, click here, here, and here.

Medicare and Medicaid Will Cover Coronavirus Testing

With coronavirus dominating news coverage and creating alarm, it is important to know that Medicare and Medicaid will cover tests for the virus.

The department of Health and Human Services has designated the test for the new strain of coronavirus (officially called COVID-19) an essential health benefit. This designation means that Medicare and Medicaid will cover testing of beneficiaries who are suspected of having the virus. In order to be covered, a doctor or other health care provider must order the test. All tests on or after February 4, 2020 are covered, although your provider will need to wait until after April 1, 2020, to be able to submit a claim to Medicare for the test.

Congress has also passed an $8.3 billion emergency funding bill to help federal agencies respond to the outbreak. The funding will provide federal agencies with money to develop tests and treatment options as well as help local governments deal with outbreaks.

As always, to prevent the spread of this illness or other illnesses, including the flu, take the following precautions:
•    Wash your hands often with soap and water
•    Cover your mouth and nose when you cough or sneeze
•    Stay home when you’re sick
•    See your doctor if you think you’re ill

For Medicare’s notice about coverage for the coronavirus, click here.

Social Security Shutters ‘Petri Dish’ Offices in Response to Coronavirus Outbreak

To protect its workers and the public during the coronavirus pandemic, the Social Security Administration (SSA) has suspended face-to-face service to at its field offices and hearings offices nationwide until further notice. Payments to the nearly 70 million Social Security beneficiaries will not be affected.

While in-person appointments will still be made for certain critical services (see below), the SSA is encouraging beneficiaries to transact as much business as possible online using the agency’s website. (If you don’t have an online account yet, click here.)

Certain services also will continue to be available via the agency’s toll-free line, (800) 772-1213 or from local offices’ General Inquiry lines. (For the local office locator, click here.)

Why the Closure?

Budget cuts to Social Security over the years have led to crowded offices and long wait times.  With the advent of the coronavirus outbreak, this went from being an inconvenience to a public health threat.  The union representing the SSA’s 61,000 workers was deeply concerned about the health of the agency’s workforce as well as the danger to the public.

“The offices are petri dishes,” Richard Couture, a spokesman for the union, told The New York Times.  “People are sitting there for a long time, magnifying and multiplying the risk of infection for everyone there, and to people on the outside.”

How to Get in Touch During the Shutdown

Examples of tasks or inquiries that can be accomplished online include:

  • Applying for retirement, disability, and Medicare benefits;
  • Checking the status of an application or appeal;
  • Requesting a replacement Social Security card (in most areas); or
  • Requesting a replacement Medicare card.

(For a complete list, click here.)

Phone services will also be available, although the SSA says it is “focusing on providing specific critical services to people in dire need.” Examples of how the SSA can help by phone include:

  • If you did not receive your monthly payment;
  • If you are currently homeless or at risk of becoming homeless; or
  • If your benefits were suspended and can now be reinstated.

Expect long wait times if calling, however.

In-Person Appointments

In-person help will still be available for a limited list of critical services, including:

  • Reinstatement of benefits in dire circumstances;
  • Assistance to people with severe disabilities, blindness or terminal illnesses; or
  • Help for those in urgent need of eligibility decisions for Supplemental Security Income or Medicaid eligibility related to work status.

If you require such services, you must call in advance; there are no walk-ins at the field offices.

What if you already had a standing appointment or disability hearing scheduled?  If this is the case, the SSA will call you to reschedule or to take care of the issue by phone. Unfortunately, this call may come from a private phone number rather than from a government phone because employees are working remotely and do not necessarily have government-issued phones. Identity theft phone scams where callers impersonate SSA workers were already on the rise, and this will likely only add to beneficiaries’ confusion. Be aware that agency employees will never inform you that your Social Security number has been suspended, demand payment, or seek credit card information.  (Scams taking advantage of the situation have already started.)

For full details on changes to SSA services brought on by the response to the coronavirus, go to the SSA’s Social Security & Coronavirus page, https://www.ssa.gov/coronavirus/

If you are enrolling in Medicare, you can get free counseling from your State Health Insurance Assistance Program (SHIP).  To find your state program, click here.

Medicare is Expanding Telehealth Services During Coronavirus Pandemic

As part of its response to the coronavirus pandemic, the federal government is broadly expanding coverage of Medicare telehealth services to beneficiaries and relaxing HIPAA enforcement. This will give doctors the ability to provide more services to patients remotely.

Medicare covers telehealth services that include office visits, psychotherapy, and consultations provided by an eligible provider who isn’t at your location using an interactive two-way telecommunications system (like real-time audio and video). Normally, these services are available only in rural areas, under certain conditions, and only if you’re located at one of these places:

  • A doctor’s office
  • A hospital
  • A critical access hospital (CAH)
  • A rural health clinic
  • A federally qualified health center
  • A hospital-based dialysis facility
  • A skilled nursing facility
  • A community mental health center

Under the new expansion, Medicare will now pay for office, hospital, and other visits provided via telehealth in the patient’s home. Doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers will all be able to offer a variety of telehealth services to their patients, including evaluation and management visits, mental health counseling, and preventive health screenings. In addition, relaxed HIPAA enforcement (the law governing patient privacy) means doctors may use technologies like Skype and Facetime to talk to patients as well as using the phone.

In addition to Medicare’s expansion, states are also allowing doctors to provide telehealth services to Medicaid beneficiaries. For example, New York will now cover telephone-based evaluations when an in-person visit is not medically recommended. Many other states are following suit.

This expansion of telehealth services will allow older adults who are particularly vulnerable to COVID-19 to stay home and still get medical advice. If you need to see a medical provider during this health emergency, check to see whether they are employing telehealth services. To use telehealth services, you need to verbally consent and your doctor must document that consent in your medical record. For information from AARP on what you might expect during a virtual doctor’s visit, click here.

Estate Planning Is Essential for Unmarried Couples

While estate planning is important for married couples, it is arguably even more necessary for couples that live together without getting married. Without an estate plan unmarried couples won’t be able to make end-of-life decisions or inherit from each other.

Estate planning serves two main functions: determining who can make decisions for you if you become incapacitated and who gets your assets when you die.  There are laws in place to protect spouses in couples that have failed to plan by governing the distribution of property in the event of death. If you do not have a will, property will pass to your spouse and children, or to parents if you die without a spouse or children.

But there are no laws in place to protect unmarried partners. Without a solid estate plan, your partner may be shut out of the decision making and the inheritance. The following are the essential estate planning steps that can help unmarried couples:

  • Joint Ownership. One way to make sure property passes to an unmarried partner is to own the property jointly, with right of survivorship. If one joint tenant dies, his or her interest immediately ceases to exist and the remaining joint tenants own the entire property. This is also a good way to avoid probate.
  • Beneficiary Designations. Make sure to review the beneficiary designations on bank accounts, retirement funds, and life insurance to make sure your partner is named as the beneficiary (if that is what you want). Your partner will not have access to any of those accounts without a specific beneficiary designation.
  • Durable Power of Attorney. This appoints one or more people to act for you on financial and legal matters in the event of your incapacity. Without it, if you become disabled or even unable to manage your affairs for a period of time, your finances could become disordered and your bills not paid, and this would place a greater burden on your partner. Your partner might have to go to court to seek the appointment of a conservator, which takes time and money, all of which can be avoided through a simple document.
  • Health Care Proxy. Similar to a durable power of attorney, a health care proxy appoints an agent to make health care decisions for you when you can’t do so for yourself, whether permanently or temporarily. Again, without this document in place, your partner might be shut out by other family members or forced to go to court to be appointed guardian. If it is important for all of your family members to be able to communicate with health care providers, a broad HIPAA release — named for the Health Insurance Portability and Accountability Act (HIPAA) of 1996 — will permit medical personnel to share information with anyone and everyone you name, not limiting this function to your health care agent.
  • Will. Your will says who will get your property after your death. However, it’s increasingly irrelevant for this purpose as most property passes outside of probate through joint ownership, beneficiary designations, and trusts. Yet your will is still important for two other reasons. First, if you have minor children, it permits you to name their guardians in the event you are not there to continue your parental role. Second, it allows you to pick your personal representative (also called an executor or executrix) to take care of everything having to do with your estate, including distributing your possessions, paying your final bills, filing your final tax return, and closing out your accounts. It’s best that you choose who serves in this role.
  • Revocable Trust. A revocable trust can be especially important for unmarried couples. It permits the person or people you name to manage your financial affairs for you as well as to avoid probate. You can name one or more people to serve as co-trustee with you so that you can work together on your finances. This allows them to seamlessly take over in the event of your incapacity.

Your attorney can help you determine the estate plan that is right for you and your partner.

Resolving Conflicts Between Co-Agents on a Power of Attorney

Having power of attorney over a family member is a big responsibility and sometimes it makes sense to share that responsibility with someone else. But when two people are named co-agents under a power of attorney, conflicts can arise. Unfortunately, if the conflict can’t be resolved, it may be necessary to get a court involved.

A power of attorney allows a person to appoint someone called an “agent” or “attorney-in-fact” to act in his or her place for financial purposes when and if the person ever becomes incapacitated. A power of attorney can name one agent or it can require two or more agents to act together.

If you are acting as a co-agent under a power of attorney, but you and your fellow agent disagree on a course of action or one party has stopped participating in decision making, what can you do? The first thing is to check the wording of the power of attorney document to see if it sets up a procedure for resolving disputes. If the power of attorney itself doesn’t help, you should contact an attorney. The attorney can tell you if your state’s power of attorney laws offer any guidance. There may be a state statute that deals with disputes.

If the dispute still cannot be resolved, the final step may be to file a petition in probate court to let the court decide it. Or if the court finds that one of the agents is not acting according to the incapacitated person’s best interests, it can revoke the agent’s authority. Unfortunately, taking the matter to court takes time and money.

If you are creating a power of attorney and want more than one agent to share responsibility, but want to minimize conflict, you can name two agents and let the agents act separately. Naming more than two agents can get cumbersome and make communication difficult. An alternative to naming co-agents is for the power of attorney document to name agents in sequence. The first-named agent acts alone, but if he or she cannot serve for some reason, the next person on the list will serve.

Make Sure Your Life Insurance Is Not Taxed at Your Death

Although your life insurance policy may pass to your heirs income tax-free, it can affect your estate tax. If you are the owner of the insurance policy, it will become a part of your taxable estate when you die. You should make sure your life insurance policy won’t have an impact on your estate’s tax liability.

If your spouse is the beneficiary of your policy, then there is nothing to worry about. Spouses can transfer assets to each other tax-free. But if the beneficiary is anyone else (including your children), the policy will be a part of your estate for tax purposes. For example, suppose you buy a $1 million life insurance policy and name your son as the beneficiary. When you die, the life insurance policy will be included in your taxable estate. If the total amount of your taxable estate exceeds the then-current state or federal estate tax exemption, then your policy will be taxed.

In order to avoid having your life insurance policy taxed, you can either transfer the policy to someone else or put the policy into a trust. Once you transfer a policy to a trust or to someone else, you will no longer own the policy, which means you won’t be able to change the beneficiary or exert control over it. In addition, the transfer may be subject to gift tax if the cash value of your policy (the amount you would get for your policy if you cashed it in) is more than $15,000 (in 2020, this figure rises every few years with inflation). If you decide to transfer a life insurance policy, do it right away. If you die within three years of transferring the policy, the policy will still be included in your estate.

If you transfer a life insurance policy to a person, you need to make sure it is someone you trust not to cash in the policy. For example, if your spouse owns the policy and you get divorced, there will be no way for you to get it back. A better option may be to transfer the policy to a life insurance trust. In that case, the trust owns the policy and is the beneficiary. You can then dictate who the beneficiary of the trust will be. For a life insurance trust to exclude your policy from estate taxes, it must be irrevocable and you cannot act as trustee.

If you want to transfer a current life insurance policy to someone else or set up a trust to purchase a policy, consult with your attorney.

How to Include Cryptocurrency in an Estate Plan

The growing popularity of cryptocurrency means it is increasingly something that must be considered when planning an estate. If you own cryptocurrency, providing instructions in your will is a must.

Cryptocurrency is virtual money that exists only in digital form. The most popular cryptocurrency is Bitcoin, but there are many different types. Usually the only way to access the funds is through a computer, using a personal passcode.

Unlike a bank account, there is no physical record of the currency, so if you own cryptocurrency it is essential that you declare it in your will and also let the person who will be handling your estate (your fiduciary) know about it. Also, unlike with a bank account, the fiduciary does not have to provide a death certificate or power of attorney in order to access the currency. As long as the fiduciary has your passcode, he or she can take control of the currency. This means you need to be sure that your fiduciary is someone you can trust with this information.

You do not want to put the passcode directly into your estate planning documents, which if they go through probate could become public documents. Instead, simply list the cryptocurrency as an asset in your will and put the instructions on how to access it in a separate document that is also referenced in the will. The instructions should be as specific as possible, and it can be updated as needed. If you lose the passcode to the currency, it may not be possible to recover it, so it is important to store it in a safe place, like a safe deposit box.

Your attorney can help you make a plan for your digital assets.

Bank Pays Price for Refusing to Honor Request Made Under a Power of Attorney

A durable power of attorney (POA) allows the person creating the POA, called the “principal,” to name a trusted agent who can act on his behalf in almost any situation. But because of the risk of abuse, many banks will scrutinize a POA carefully before allowing the agent to act on the principal’s behalf, and often a bank will refuse to honor a POA. Bank of America rebuffed a Florida agent’s request that funds be withdrawn from the principal’s account. The agent fought back in court and won a $64,000 judgment against the bank.

Clarence Smith, Sr., named his son, Clarence Smith, Jr., as his agent under a POA. When his father no longer wanted to manage his own finances, he asked Clarence Jr. to step in as his agent. Clarence Jr. reviewed his father’s account activity and became suspicious about some withdrawals from a bank account that Clarence Sr. owned jointly with a friend from his retirement community.

Acting as his father’s agent under the POA, Clarence Jr., asked Bank of America to transfer $65,000 from the account into a new account that listed only his father as the owner. Before doing so, Bank of America contacted the other person named on the account. When she told the bank that she did not want the funds withdrawn and also accused Clarence Jr. of stealing his father’s money, Bank of America refused to honor Clarence Jr.’s request. The other account owner then withdrew all of the funds from the account and placed them into her own account, effectively preventing Clarence Sr. from accessing his own money. Clarence Sr. died several weeks later.

Clarence Jr. sued Bank of America under a Florida law that imposes penalties on financial institutions that refuse to honor reasonable requests from agents named in properly executed POAs. A jury returned a verdict against the bank and awarded $64,142 to Clarence Sr.’s estate. The jury found that Bank of America had not acted reasonably when it rejected Clarence Jr.’s request, even though the joint owner of the bank account had not agreed to the release of the funds.

While this case clearly illustrates the conflicts that can arise through the use of a POA, it also raises the issue of the proper use of joint bank accounts in estate planning. Under most state laws, when two or more people own “joint” bank accounts, each of them has the right to the entire account, no matter whose money is actually in the account. While joint accounts can often be useful, sometimes, as in this case, joint owners or their agents can disagree about the use of funds in the accounts. When that happens, the party who makes it to the bank first often wins. Your attorney can explain the pros and cons of joint ownership, draft an effective POA, and assist family members when disputes arise.

Accounting for Gifts and Loans to Children in Your Estate Plan

No parents want their children to fight among themselves after they are gone. Sadly, conflicts often arise, especially when a parent has gifted or loaned money to one child and not others. However, a few key words in your estate plan can minimize the potential for conflict.

If you give money to one child, the other siblings may claim that the child should receive a reduced share of your estate.  You can forestall such disputes by making your intent clear in your estate planning documents. For example, the document could state that you are not making any adjustments based on gifts. This would make it clear to everyone that no one should receive a reduced share. Alternatively, you could specify the gifts that have been made and explain why one child is receiving a reduced share.

Loans are another problem. These can be addressed in a number of ways, depending on your intent. Verbal loans are difficult to prove, so consider including a provision in your estate planning documents stating that all verbal loans are a gift. If you have any outstanding verbal loans that you don’t want to be a gift, then make sure you put these in writing. If you want the loan to be an advance against inheritance, this can also be specified in your estate planning documents. To avoid a child claiming the loan was forgiven, you can require that the forgiveness be in writing.

The important thing is to make sure your estate planning documents clearly convey your intent. Be sure to consult your attorney to ensure your documents provide the guidance you want regarding gifts and loans.

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