Elder Law Expert Weighs in on U. S. Healthcare Crisis

Gene L. Osofsky of the law firm Osofsky and Osofsky asserts that U.S. medical care has become a "mountain of cost."

Elder Law attorney Gene L. Osofsky, like many Americans, recently read a feature article in the April 27, 2009, issue of The Nation that gave him pause. The article, entitled "A System from Hell" by Kate Michelman, detailed the tragedy of a family that, despite possessing adequate insurance coverage, has nevertheless been pushed to the brink of destruction." Her young adult daughter was paralyzed when a horse fell on her; her husband, who had been diagnosed with Parkinson's Disease, was then crippled and lost any hope of independence in the twilight of his life, after shattering his hip; and now the mounting medical bills keep on exacting a terrible toll – all this happens to a responsible couple who had seemingly prepared for health-related contingencies. How could this happen in America?" Osofsky asks. Michelman's husband was placed in assisted living after surgeries and hospitalizations for his fractured hip. Ironically, the couple had thought to purchase private long-term care insurance years before their crisis, but although their insurance plan nominally covered long-term care, it did little to address her husband's long-term care in respect to its actual costs. "How does one plan for a situation such as this? Kate Michelman certainly thought she and her husband had planned for every eventuality – she is a well-known and well-to-do public figure, he was a tenured college professor, they had excellent medical insurance, even long-term care insurance, and still it wasn't enough," Osofsky says, "They still found themselves on the brink of losing everything."

According to Osofsky, Michelman's story is frightening "precisely because it could happen, and is happening, to any of us." The unfortunate truth about medical insurance, long-term care insurance, and Medicare/Medi-Cal for those who qualify, is that they often cover "most of the cost" of medical treatment and rehabilitative care. Asserts Osofsky, "Most is woefully lacking when we must face the awful reality of how high the costs actually are. Deductibles, co-payments, share of costs, and uncovered services have become a huge personal obligation, a black hole of debt where accumulated life savings can disappear in a heartbeat." Is there a solution? The key is to enlist the help of committed experts who know how to navigate the convoluted worlds of the medical industry, insurance industry, and government benefit programs. Osofsky suggests "finding professionals who can help you build a plan to make the best use of those systems and what they offer." But even that's not a complete solution. Something needs to change. Concludes Osofsky, "Medical care in the United States has become a mountain of cost that even the young and the healthy ignore at their own risk."

To learn more about East Bay elder law lawyers, East Bay elder law attorney, Medi-Cal planning, Medi-Cal planning lawyers and The Law Offices of Osofsky & Osofsky, visit Lawyerforseniors.com.

2006 California Case Disqualifies "Care Custodians"

Gene L. Osofsky, of the law firm Osofsky & Osofsky, explains how being regarded as a "care custodian" may disqualify a person from being a beneficiary of a testamentary distribution.

"It might seem counterintuitive," says Elder Law specialist Osofsky, "but according to a 2006 case decided by the California Supreme Court, being designated as a 'care custodian' of a dependent adult, may actually disqualify such persons from receiving testamentary bequests." Adds Osofsky, "Only if the person making the testamentary bequest engaged a separate attorney to conduct an Independent Review and affirm that the testator was of sound mind and knew what he was doing, could the bequest be upheld." The law seeks to protect dependent adults from coercive beneficiary disbursements made under duress or as the product of overreaching or undue influence. In certain care settings, California law presumes the naming of a care custodian as a beneficiary of one's Will or Trust to be coercive actions assumptive of an unscrupulous care custodian and therefore void.

The case of BERNARD V. FOLEY (decision handed down August 21, 2006) found that unrelated friends providing ongoing health services to a dependent adult were "care custodians" under the relevant state statute and were therefore disqualified from receiving a testamentary distribution. James Foley and Ann Erman were longtime friends with Carmel Bosco. Ms. Bosco lived with them for two months prior to her death. Foley and Erman assisted her with her daily needs, including preparing her meals, helping her bathe, changing her diapers, and administering oral medications. Three days before she died, Ms. Bosco altered her living trust to make Mr. Foley and Ms. Erman each 50 percent beneficiaries. They had not previously been beneficiaries of the trust.

But Ms. Bosco's relatives protested. Petitioning the court to invalidate the amendment, they argued that Mr. Foley and Ms. Erman were disqualified from receiving a testamentary distribution because they were "care custodians." "Under California law, there is a presumption that donative transfers to care custodians are procured by undue influence," explains Osofsky, "The state Supreme Court merely affirmed that a 'caregiver' under the statute could even be a friend who renders care to a dependent adult without compensation." According to the Court's decision, the definition of custodial care includes uncompensated or nonprofessional care and there is no evidence the legislature intended to make an exception for preexisting personal friends who provide health care services. Concludes Osofsky, "Elders have to be protected from people who would provide them with unprofessional care simply as a pretense to inheriting their assets. The very fact that they require such care puts them in an extremely vulnerable position." But even this can be less than ironclad. "Sometimes persons have legitimate reasons for wanting to make bequests to their non-family member caregivers. In California, this essentially requires two attorneys to be involved, one to perform the Will or Trust and a second to conduct the Independent Review. Is this a trap for the well-intended?"

To learn more about East Bay elder law lawyers, East Bay elder law attorney, Medi-Cal planning, Medi-Cal planning lawyers and The Law Offices of Osofsky & Osofsky, visit Lawyerforseniors.com.

Pros and Cons of Joint Accounts

Probate can be a difficult process. But using joint accounts to avoid it may not always be a good idea.

If you are thinking that joint accounts are a foolproof way to escape probate and funnel dollars to loved ones as a sort of "poor man's estate plan," think again. Circumstances exist when a joint account is an excellent option. But the instrument has its pitfalls as well, and if misused or entered into without caution, joint accounts can pose serious risks. Adding a loved one to a bank account may seem like a prudent action, but such actions can impact Medicaid planning or even make your account "fair game" for your loved one's creditors.

Applications for Medicaid long-term care coverage can be tricky. States are obliged to examine the applicant's assets to determine eligibility. Although a joint account may include two or more names, states tend to make the assumption that the applicant is the owner and entirely responsible for the total funds in the account, irregardless of who might have contributed to the account. Imagine your name is on a joint account. You enter a nursing home. The state is still likely to assume that the account's assets are yours – especially without proof otherwise. Realize also that proving anything is a lot more difficult from inside a nursing home, or even an assisted living facility, when you might not have ready access to your papers and files as you did within your home sweet home back when you were well and able.

It can get worse. What if you or the other joint owner of the account decides to take monies out of an account that is already under state scrutiny? This can be perceived as "improper transfer of assets" for Medicaid purposes, which may have an adverse effect upon your eligibility. You or the other joint owner could become ineligible for Medicaid for a period of months or perhaps years. In fact, if a joint owner is removed from an account, it can appear suspicious to investigators. Example: Your parent enters a nursing home. You decide to remove your parent's name from the joint bank account. Again, this simple action, prudent on its face, can be construed as an improper transfer of assets.

Remember that an account remains exposed to all the account owners' creditors. If your son is added to the account and falls behind (or worse, defaults) on his credit card debt and gets sued, guess who is on the hook? Under laws currently in effect, a credit card company can confiscate the money in your account to pay off your son's debt. Another pertinent question revolves around trust. Can you completely trust the person you are adding?

Viable alternatives to joint accounts do exist. A consultation with your attorney specializing in Elder Law may suggest a durable power of attorney or else a well-considered trust instrument. Seek out a qualified Elder Law attorney near you.

Gene Osofsky is an East Bay elder law attorney in California. Gene Osofsky specializes in Medi-Cal planning, wills, probate, trusts, nursing home issues, special needs planning, and disability planning. To learn more about East Bay elder law lawyers, East Bay elder law attorney, Medi-Cal planning, Medi-Cal planning lawyers and The Law Offices of Osofsky & Osofsky, visit Lawyerforseniors.com.

Great Recession of 2009 Makes Power of Attorney Essential

The Durable Power of Attorney is no longer a luxury. For your Elder Law counsel, it has become essential.

It is the worst economic downturn since the Great Depression of the 1930s. The decline and associated roller coaster ride on Wall Street has made durable power of attorney into not just a luxury when it comes to planning your estate, but an absolute necessity. Some Elder Law attorneys have come to view the instrument as even more integral to contemporary estate plans than a Will or Trust.

A Dow Jones newswire column is a case-in-point. It presents the cautionary tale of a female elder who had recently lost half of $6 million in savings. The losses were incurred almost entirely on the stock market. The woman's woes only intensified when she became incapacitated, and her relatives were stymied when attempting to shift her investments, becoming increasingly frustrated as various remedies were attempted as damage control measures. But they lacked legal authority to take these corrective steps. An inherent irony was that the woman had once executed a power of attorney in case she ever were to become incapacitated, but the issue had become moot as the person she'd nominated had died and she'd neglected to name a successor. If dead men (or women) tell no tales, it's also true that dead friends, no matter how trusted, cannot follow through with their power of attorney responsibilities.

Such columns have also tackled what many consider to be the thorniest question when executing a power of attorney. Is there someone you can actually trust with this power? Trust is always a thorny issue, but perhaps it is better to avoid naming someone if one-hundred percent trust has yet to be established. In fact, the powers of attorney instrument has become the subject of frequent "horror stories" in recent years, especially since the onset of our current Great Recession. In fact, exploitation of vulnerable elders by rascally persons misusing their powers of attorney roles is becoming epidemic.

But this doesn't make the instrument less necessary in these difficult times, assert Elder Law experts such as Gene L. Osofsky. If someone trusted can be found, and if proper safeguards are in place, such as deciding who retains originals of the power of attorney document prior to when the instrument may be needed, then it can work well indeed. A power of attorney can take effect immediately or can become effective only when the subject is incapacitated as defined in the document and confirmed by a physician. In 2009, the need for a durable power of attorney has never been greater.

Gene Osofsky is an East Bay elder law attorney in California. Gene Osofsky specializes in Medi-Cal planning, wills, probate, trusts, nursing home issues, special needs planning, and disability planning. To learn more about East Bay elder law lawyers, East Bay elder law attorney, Medi-Cal planning, Medi-Cal planning lawyers and The Law Offices of Osofsky & Osofsky, visit Lawyerforseniors.com.