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Someone You Love Have Alzheimer’s? Here’s Why They Need An Advance Medical Directive

Advance Medical Directive

Why An Advance Medical Directive Is Important

My wife’s grandfather (we call him Opa) has the last stages of Alzheimer’s. I remember meeting him more than a decade ago and he was vibrant, funny and loved to sing.

Now, at almost 90 years old, he does not remember me and spends his days in bed asking the same questions over and over and over.

Recently my wife called to check on Opa and he was crying hysterically. She asked him what was wrong and his sobbing reply was, “Didn’t they tell you? Your grandmother is gone. She’s gone.” And then he hung up the phone.

Of course, my wife called back immediately and her grandmother answered the phone. She had been standing next to Opa (my wife’s grandfather) the entire time and clearly she was alive and well. However, what was not well was Opa’s memory.

It was heartbreaking to say the least. My wife was visibly upset. She has traveled numerous times to help him when he became sick or was hospitalized. Her grandparents live about 2 1/2 hours away.

But with a young family of our own –  including a special needs child – it’s hard for her to get away. That’s where having an Advance Medical Directive in place has been extremely helpful. Even if my wife cannot be there in person, she can at least talk to the doctors and help make decisions on Opa’s behalf.

Thankfully, before Opa’s Alzheimer’s had progressed too much, he agreed for my wife to be his Healthcare Agent and give her the legal authority to make medical decisions on his behalf.

Advance Medical Directive – Why You & Loved Ones Need It 

An Advance Medical Directive is also known as a health care proxy, durable power of attorney, medical power of attorney, or healthcare agent. The purpose of an Advance Medical Directive is to legally enable an individual to make decisions on your behalf if you cannot speak for yourself or express your wishes about your health. It also helps those individuals and your healthcare providers know about your treatment preferences. Examples of being unable to make medical decisions for yourself include:

• Permanent illness like Alzheimer’s

• Incapacity

• A coma or persistent vegetative state

• If you are having an outpatient surgical procedure and are under general anesthesia

Hospitals, doctors and other health care providers must follow your Advance Medical Directive’s decisions as if they were your own but only if the Directive is properly executed.

By having an Advance Medical Directive, a doctor clearly knows whose direction is to be followed in the event your family disagrees as to what medical treatment you would want.

When Should You Set Up An Advanced Medical Directive?

Now. The unexpected in life happens. It happened to one of our good friends. Our friend received a call that her husband had been in a car accident and was unresponsive. He ended up being in a coma for three weeks. Thankfully there was not a dispute between our friend and her husband’s parents. However, if there had been a disagreement about his medical care, an Advance Medical Directive would have been critical.

Opa named my wife as his Healthcare Agent in his Advance Medical Directive during the early stages of his diagnosis. This is important. If he had signed the document during the final stages of Alzheimer’s, the legitimacy and legality of the Advance Medical Directive could be challenged in court if there was a disagreement within her family about his medical treatment. This is why putting documentation in place before you need it is very important.

How Do You Set Up An Advance Medical Directive?

All 50 states have forms online where you can establish an Advance Medical Directive. However, the state forms do not always address the important nuances of your healthcare decisions. For example, if you are incapacitated and unable to communicate, but not terminal, what do you want your life to look like? Do you want to be somewhere you can have a pet? A room with a view? NetFlix? By having an attorney help you set up an Advance Medical Directive, you ensure that your wishes are complete and clear to everyone involved.

Where Do You Start? 

Start having conversations with your loved ones about your medical wishes. These are not easy conversations, but they are important to ensure that your desires are enacted should you be unable to make decisions about your health.

And if someone you love has Alzheimer’s or other permanent or terminal illness, it’s important to put into place an Advance Medical Directive before their health significantly declines.

Contact Us

Our attorneys specialize in setting up an Advance Medical Directives. I have more than 20 years healthcare experience – working with medical professionals and individuals who need medical help. Further, we’ve personally been through the process with our own families. I can be reached at DJ@JeyLaw.com or 678.325.3872.

 

5 Things People Forget to Include in Their Will

DJ Jeyaram is quoted in this article published on GoBankingRates and Philly.com. Congrats DJ!

Article by Alaina Tweddale

Many people overlook writing a will until they become parents, launch a business or buy a first home. And even when they do finally craft this important document, estate and financial planning experts say, it is easy to overlook some important details.

We uncovered the biggest things people overlook when drafting a will. Find out if you’re missing a one of these key elements.

1. Alternate Beneficiaries

While most wills include at least one primary beneficiary, it is a common mistake to fail to prepare for a backup plan in the event the beneficiary predeceases the testator.

Furthermore, “it is important to consider whether a beneficiary is capable of inheriting the asset and can manage the asset properly,” said Sandra Martin Clark, partner at the law firm of Manning, Fulton, & Skinner in Raleigh, North Carolina.

Martin Clark says some reasons a loved one should be passed over for beneficiary status include:

  • Age
  • Mental capacity
  • Inability to properly manage assets

“Oftentimes, after a will is drafted and signed, the document is never looked at again until someone has passed away. At that point, it is too late to correct any error or consider a more appropriate planning opportunity,” said Martin Clark.

If the testator’s intent is unclear, or the beneficiary is a minor or found to be incompetent, it can be overwhelmingly difficult and costly to find a solution, Martin Clark said.

2. Provisions for Digital Assets

Digital assets are among the most important things left out of wills today, said Steven J.J. Weisman, an attorney in Amherst, Mass., professor who teaches estate planning at Bentley University, and author of “A Guide to Elder Planning.”

Websites, domain names and online accounts can all have economic value. Planners should also include account numbers and passwords within a will.

“So much of what we do is online or on our computers,” said Weisman. “Without the proper user names and passwords, as well as authorizing someone to have access to these matters, the estate can be severely compromised.”

Information for social media accounts can be important. Although there may not be a monetary value associated with a Twitter handle or a Facebook account, it can be awkward for loved ones to see greetings or birthday wishes posted to the deceased’s wall or news feed.

3. Prearrangements for Pets

Although you cannot leave assets or property directly to a pet, you can – and should – specify a caregiver for your pet, said David Walters, a certified financial planner and portfolio manager with Palisades Hudson Financial Group in Portland, Ore.

Consider naming a secondary caregiver in the event the primary caregiver is unwilling or unable to care for your pet, Walters added. Pet owners can even name a beneficiary for assets earmarked for the care of your pet.

If you do not make any specific provision for your pet’s care, the arrangements may become a source of contention among your loved ones. In the worst case, your pet could end up in a shelter,” Walters said.

4. A Personal Property Memorandum

Personal property mementos can be the most prized items in the estate of a parent or loved one.

“Sometimes, what people fight over are the least valuable items,” said Erik Hartstrom, attorney with Estate Plan Pros in Elk Grove, California.

Examples include a grandfather clock, Mom’s favorite costume jewelry, or even a $1.50 tchotchke Dad kept lovingly tucked in his dresser drawer.

An estate that has heirlooms worth a substantial amount of money can exacerbate the problem.

When there is no written personal property memorandum affixed to the will, beneficiaries may quarrel and sometimes even fracture long-standing relationships.

“Have a conversation with your beneficiaries and find out what is meaningful to each,” said Hartstrom. “You may be surprised.”

5. Trustee and Guardian Designations

It is critical to keep contact and designation information about trustees and guardians up-to-date, said Atlanta-based estate planning attorney DJ Jeyaram.

“This is especially important if both parents or a single parent suddenly passes and there are minors involved,” he said. “The guardians need to be immediately notified to ensure proper care of the children.”

A named trustee and guardian don’t have to be the same person. Without explicit instructions, an unintended new guardian may raise a child, or care for an incapacitated adult. Assets intended for the care of the minor can transfer to someone the deceased did not prefer.

In a worst-case scenario, said Jeyaram, “the children may be put into state custody.”

When you’re ready to put your final wishes on paper, thoroughly consider how you want all aspects of your estate handled – even the seemingly insignificant items. An experienced estate attorney can help you determine all the items you may want to consider when planning your will.

Wills, Trusts, & Estate Planning Client Feedback

Wills, Trusts, Estate PlanningWe love hearing from our clients. We truly believe in spending time with our clients to help them find solutions that best meet their needs.

Here’s a few reviews from some of our clients who we helped set up traditional wills, trusts and estate plans.

“Values Family”

“DJ was extremely helpful in the creation of our will/trust. It was easy to see how much he values family, and he gave us confidence and peace of mind by making a complicated and often difficult process feel manageable.

He was professional yet very personable and made sure that we understood all of the language of the documents. He gave us adequate time and never rushed us throughout the entire process making sure that we had time to think through all important decisions.

He gave us everything we would need to give to all those involved and a very organized presentation of all of our documents to keep.

DJ was wonderful to work with, and I would recommend him to anyone.” – C. Oddi

Originally posted on Google+ 

“Kind and Patient”

“DJ and his team were so wonderful in helping me coordinate my father’s final will, power of attorney and medical directive. The team was kind and patient, explaining all of the steps involved, and assisting with developing the final documents.

As my father was battling a terminal illness, much of our communication was over email. They were very responsive and managed everything with such care.

It was a difficult time in both my Dad’s and my life, but DJ and the team allowed us to check off that box in the process of ‘things to get done,’ so we could focus on the more important things, like spending those last days together.” – L. Efman (sent via email)

“Solid Advice”

“Jeyaram & Associates is outstanding. I can’t say enough good things about DJ Jeyaram. My husband and I needed to create a fairly complicated will. We have multiple properties, 2 children, and 4 grandchildren.

DJ gave us very solid advice. We are so happy he helped us achieve a perfect solution to the distribution of our estate. We’ve already recommended him to several of our friends. Thank you DJ.” – P. Javazon (sent via email)

Contact Us

Need help setting up a will, trust or estate plan? We’re more than to help. Contact DJ at DJ@Jeylaw.com or 678-325-3872.

 

Even If Your Child Doesn’t Receive SSI Or Medicaid, You May Still Need To Set Up A Special Needs Trust

special needs trustSocial Security Disability Insurance (SSDI) is a federal program that typically provides cash stipends to people who have paid into the Social Security system and who can’t work due to disability.  (In some cases, it is possible to receive SSDI even if you haven’t worked.) In most cases, when someone has been eligible for SSDI benefits for two years, the individual also receives Medicare, even if he or she is under age 65.

From a special needs planning perspective, SSDI benefits are fairly easy to deal with because the program does not have an asset limit or a restriction on unearned income, like interest or dividends.  This means that a millionaire who meets the program’s requirements can receive SSDI benefits alongside a completely impoverished person. It also means that from a purely financial perspective, a person with resources doesn’t need to shelter her assets in a special needs trust in order to qualify for SSDI benefits as she would have to do if she were receiving means-tested government benefits like Supplemental Security Income (SSI) or Medicaid.

But this does not mean that SSDI beneficiaries should not have special needs trusts. In fact, there are many benefits to having a special needs trust that go far beyond the ability to maintain eligibility for SSI or Medicaid. For instance, a person with a mental illness may be unable to manage money. A special needs trust would allow that person’s funds to be invested and spent appropriately by a qualified trustee.  In another case, a person with special needs may be able to handle her personal finances but she might live in an environment where she is susceptible to mistreatment by others. In this situation, a special needs trust would provide an appropriate buffer between the beneficiary and the people who would otherwise take advantage of her.

When it comes to special needs planning, you never want to take anything for granted.  Just because an SSDI beneficiary might not need Medicaid and SSI now, it doesn’t mean she won’t qualify for, or require, services from those programs in the future. For instance, an SSDI beneficiary may rely on private health insurance and Medicare, but if she loses her insurance and Medicare doesn’t cover certain medications, it might be incredibly important for that beneficiary to receive Medicaid, which could make a special needs trust essential.

Finally, there is one particular type of special needs trust, called a first-party special needs trust, that is specifically designed to hold the beneficiary’s own assets. In most of the examples above, this is the type of special needs trust that would be required. Unfortunately, only a parent, grandparent, guardian or court can establish a first-party special needs trust for the beneficiary, even if she is completely competent to create a trust on her own. Therefore, if the parent or grandparent of a person who receives SSDI has the capability, it is probably a good idea for him to create the trust for his child or grandchild, on the off-chance that it will have to be used later, instead of relying on an expensive and time-consuming court process.

There are lots of reasons to have a special needs trust beyond merely qualifying for government benefits.  If you or a loved one receives SSDI and doesn’t have a special needs trust, our attorneys can help you determine the best estate planning option to meet your needs. Contact DJ Jeyaram at DJ@Jeylaw.com or 678.325.3872.

RSVP For Free Legal Workshop: Katie Beckett/Deeming Waiver Appeal & Special Needs Trusts

IEP Education LawTwo Things Every Special Needs Parent Should Know

1. How to Win A Katie Beckett Appeal: A presentation on how to appeal a Katie Beckett denial. Almost all applications are initially denied. Learn how to prepare and what to expect – and when to engage a lawyer.

2. Protecting Benefits With Special Needs Trusts: Learn the basics on what a special needs trust is and how it works. We’ll also talk about the ABLE Act and how it works with a special needs trust.

  • When Friday, September 11 at 10:00 am to 11:30 am
  • Where: FOCUS main office | 3825 Presidential Parkway, Suite 103 – Atlanta, Georgia 30340
  • Who : DJ Jeyaram, Esq. – attorney and special needs parent

Please RSVP to Elizabeth@focus-ga.org with your name and the word “Trust” in the subject line by September 1st.

About FOCUS

FOCUS offers comfort, hope, and fun to families with children who are medically fragile or have significant developmental or physical disabilities through a variety of programs. http://www.focus-ga.org/

 

 

 

Without A Will, A Court Could Decide Custody Of Your Child

wills, Trusts and Estates10 Tips On Choosing The Right Guardian

Sadly, during the past couple of weeks, we learned of the passing of several friends and acquaintances. All of their passings were sudden. A heart attack. A car accident. A sudden mystery illness. An aneurism. To be honest, we became a bit leery about answering our phones.

Death isn’t something we like to think about, let alone talk about. However, these past few weeks were a stark reminder of how important it is to make sure we prepare for the future and to make sure our families are protected – especially if you have minor children.

We often assume that a member of our family – maybe a sister or our own mother – will automatically be given custody of our children if something happens to us. However, this is not true unless you have a will, trust or estate plan in place that specifically names them as guardians. Without a legal plan in place, anyone can request custody and a judge will decide with whom your child/children will live with.

As a result, it’s imperative to establish a will and choose a guardian for your child.

Following are some things to consider when choosing the right guardian:

  1. Age – How old is the person you’re considering to assume custody of your child if you pass? You want to make sure the potential guardian will be around for a while to raise your child.
  1. Ability – How is the health of the potential guardian? Does he/she need a lot of medical care? Is he/she emotionally stable? How many other children does the potential guardian already care for? Does he/she have a demanding job or a job that requires him/her to frequently travel? You wan to select someone who is going to be physically present and give your child the attention he/she needs – especially since your child will already be dealing with loss and grieving.
  1. Already established relationship with your child – Does the potential guardian already know your child and have an established relationship with him/her? Imagine being forced to live with someone you don’t know. Add on the stress of losing a parent. It’s imperative that your child know and be comfortable with the potential guardian.
  1. Location – Where does the potential guardian live? Is this somewhere you’d want your child to live? If you currently live in the city and your potential guardian lives in a small, remote town – would your child be happy and thrive? Does the potential guardian live in a good school district or are there good private schools nearby?
  1. Family values – Finding a potential guardian with the same family values can be challenging – but it’s perhaps one of the most important criteria to consider. Is this individual willing to instill and be supportive of your family values – especially if they do not mirror yours?
  1. Parenting style – Does the potential guardian believe in time outs? Is education important? Is the potential guardian strict or nurturing? You’ll want to choose someone who reflects your parenting style to minimize the stress and confusion on your child.
  1. Stable and loving – Selecting a guardian who can provide a stable environment for your child is critical – especially as your child will be grieving. Your child will look to the guardian for emotional and physical stability. Is the guardian in a stable relationship? Is his/her spouse open to being a guardian as well?
  1. Willing and want to serve as guardian – Taking on custody is a big responsibility. While some family members may love your child – assuming custody and providing for his/her every need is a different story. It’s important to have open and honest conversations about potential guardians to see if they want to serve as a potential guardian. Now is NOT the time to try and avoid hurt feelings. Your child’s well being and future is what’s most important.
  1. Character – Does your potential guardian have a court record of drug or alcohol abuse or a criminal history? If so, a court will reject and override your selected guardian. You want to select someone who will serve as a good role model for your child.
  1. Back up – Life happens. Your designated guardian may become incapacitated or have a change of heart upon your passing. It’s critical to have a back up potential guardian to ensure your child has a safe, loving and stable home.

It’s important to remember that a guardian is NOT required to financially support your child. As a result, it’s important when you’re setting up your will, trust or estate, to legally earmark funds for your child in a trust. Then, you will need to select an individual to oversee the disbursement of the money in the trust. This person is called a trustee. Often times, the trustee is different from your child’s guardian.

Selecting a guardian for your child can be a difficult decision – but it’s an important one. By legally documenting your wishes for your child/children, you help ensure that your loved ones are cared for and that a custody battle does not publicly play out in court.

Once you’ve carefully thought about and chosen a guardian for your child, we encourage you to consult with an attorney to help document your decision so that it becomes legally binding.

If you have questions or would like assistance, please contact DJ Jeyaram at DJ@Jeylaw.com or 678.325.3872

What to Do When Your Special Needs Child Turns 18 | Financial Support

Special Needs Trust

The financial planning steps you take when your special needs child turns 18 will establish the foundation for your child’s support and well being for the rest of his or her life.

If you make the wrong decision during this transition, it could affect your child well into the future – often when we’re no longer here to care for him or her.

Therefore, as parents of special needs children, it’s important for us to understand our options when planning for our children’s financial future.

Most special needs planning begins with a look into whether a child needs and qualifies for Supplemental Security Income (SSI) for support. SSI is a means-based program for people with disabilities and provides a limited monthly cash benefit of about $733 a month, the exact amount depending on the state and whether the beneficiary receives housing or income from other sources.

In and of itself, this payment may or may not mean much for a child’s financial future, but SSI eligibility also comes with a much more important benefit — access to Medicaid. For this reason alone many families, especially those with children who have major medical expenses, pursue SSI benefits despite the program’s severe income and asset limits. SSI can also be the ticket into vocational training and group housing services.

Once a child reaches age 18, she qualifies for SSI based on her own income and assets. In order to receive benefits, the child must meet the government’s disability standard, have less than $2,000 in assets and receive minimal income. Each dollar of unearned income (including any direct payments of cash to a beneficiary, along with additional reductions for in-kind payment for food and shelter) and every two dollars of earned income reduces a beneficiary’s base SSI award by one dollar.

If the SSI benefit reaches zero because of this reduction, SSI coverage ends. Despite these restrictions, an SSI beneficiary needs only a $1 award in order to retain her Medicaid benefits, so careful planning in this realm carries great rewards.

A child who became disabled before reaching 22 years of age can also collect Social Security Disability Insurance (SSDI) based on a parent’s work record if either of his parents has worked enough quarters to collect Social Security and is already receiving Social Security benefits or has died. Under SSDI, the “adult disabled child” of the Social Security beneficiary receives a monthly benefit check, as long as he doesn’t perform substantial work, defined as earning more than $1,090 a month. After receiving SSDI for two years, the adult disabled child also begins to receive Medicare, a substantial benefit.

Often, adults who became disabled as children receive SSI benefits until their parents retire, at which point they transition to SSDI, which is usually preferred both because it may offer a higher monthly benefit and because the beneficiary no longer needs to be concerned about SSI’s strict rules on other sources of income and savings. On the other hand, the switch to SSDI can be problematic if it means that the adult child loses eligibility for Medicaid or other programs.

If a child has more than $2,000 in assets when he reaches age 18, rendering him ineligible for SSI, a parent, grandparent or court has the power to create a special trust, known as a “(d)(4)(A) ” or “first-party supplemental needs” trust to hold his savings. Any assets held by the trust do not count against the $2,000 asset limit for SSI, allowing him to qualify.

One requirement of such trusts is that when the beneficiary dies, any funds remaining in the trust must be used to reimburse the state for medical care the trust beneficiary received during his life. Because of this payback provision, planners often encourage trustees to pay for a child’s supplemental needs from a (d)(4)(A) trust before using other assets, in order to limit the state’s collection later on.

Finally, many families create trusts known as “third-party” supplemental needs trusts in addition to (d)(4)(A) trusts.  As long as families fund these trusts with their own assets (never with their child’s funds) and give the trustee complete discretion to distribute the funds for a beneficiary’s care, the funds held in the trust will not count as the child’s assets. Furthermore, these trusts do not have to contain a payback provision, allowing families to place significant amounts of money into the trust without worrying that the government will receive a large portion later on. The trusts can then provide a child with special needs with services and care he may not receive from other sources throughout his life.

You don’t want to wait to plan for your child’s transition out of childhood. We can help you start planning for the future today. Contact DJ@Jeylaw.com or 678-325-3872.

Special Needs Trusts & Estate Plans – When’s The Right Time?

DownSyndromeGirlNow.

As a parent or guardian of a child or adult with special needs, one of our main concerns is what will happen to our loved ones when we pass? Who will take care of them? Will they have enough money? Will they be OK?

And while most of us try NOT think about dying, it’s an important step in ensuring that our loved ones will be protected and cared for upon our passing. Putting into place a special needs trust is something we can do to help ensure that our child or adult ward will be well cared for and have a high quality of life.

Too many times we’ve seen families devastated by the sudden loss of parents or guardians. Now is the time to plan and put into place a legal plan that will help protect your loved ones and their government benefits.

Eligibility for many government benefits are determined based on the resources your child or adult ward holds in their name. If they have too many resources, even by just one dollar, they may not qualify for, or may even lose, benefits such as Supplemental Security Income (SSI) and Medicaid.

Even if your child or ward does not currently receive government assistance, he or she may need it in the future. A special needs trust is a way to protect their current resources and future benefits. Through a special needs trust you can leave assets to your child or ward without negatively impacting his or her government benefits.

Government benefits only cover basics such as food, clothing and shelter. Through a special needs trust, a designated trustee for your loved one will be able to provide your child or adult ward with access to things such as:

  • a personal care attendant
  • out of pocket medical and dental expenses
  • vacations
  • home furnishings
  • vehicles
  • hobbies
  • and education.

Jeyaram & Associates has extensive personal and legal experience with setting up special needs trusts and estate plans. Please contact DJ Jeyaram at DJ@Jeylaw.com or 678.325.3872

Jeyaram & Associates Celebrates 8 Years Offering Healthcare, Administrative, Corporate and Estate Planning Law

Congratulations DJ Jeyaram!Congrats

This week marks the eighth year Jeyaram & Associates has offered Healthcare, Administrative, Corporate and Estate Planning law.

www.jeylaw.com