An End-of-Life Conversation at 29


by Janet Simpson Benvenuti

2020 was supposed to be a banner year. My son was getting married at the end of May; the logistics of planning a destination wedding in Sedona, Arizona had been an all-consuming adventure for his fiance and their friends. As the mother of the groom, I had little to do, and yet he found ways for just the two of us to share this journey together. First, came a call 18 months ago and two trips in secret to our favorite jewelers to pick out a diamond so he could surprise her with a proposal and an engagement party at their favorite restaurant. More recently, he arranged a meetup to select material for the custom suit in which he’ll be married. By February, the planning was finished, with celebrations ahead in three states with his large extended family.

Then, the coronavirus struck. Plans were cancelled, celebrations postponed and, one Sunday, I found myself having a conversation with him that would have been unthinkable a few months ago.

The topic? My end-of-life game plan.

Five years ago, my husband and I updated our estate plan and, more recently, we shifted the responsibilities for handling our finances and health care decisions, if we both are incapacitated, to our two children. It seemed the right time to make the change; they’re in their twenties and we’re about 25-35 years away from our statistical expiration dates.

As viral infections spread, I allowed myself to consider what would happen if both my husband and I were ill, intubated in the hospital, unable to communicate our healthcare wishes or pay our bills. I then did three things:

1. Find Health Care Proxy, HIPAA Authorization and Durable Power of Attorney. I printed copies of our medical and financial powers of attorney and inserted them into a plastic sleeve, like one finds at Staples. I transferred copies of those documents onto a flash drive.
2. Provide Explicit Guidance for the Healthcare Agent and Financial Power of Attorney. I wrote a one page cover letter with specific instructions on how to manage our healthcare issues that included the cell numbers of physicians in the family and contacts at the hospital where we’ll likely be situated. I included how to pay our bills along with the names and contact information for our financial advisor, tax accountant and attorney, and the password to access my computer.
3. Cue up Relevant Advisors to Handle the Situation. I called our financial advisor (who knows all about our financial matters) and gave him our children’s emails and cell information along with specific instructions (in writing) to proactively reach out to them should we become ill.

Then, I invited my son and his fiance over for dinner. Over dessert and coffee, I pulled out a manila file folder. “Although this is unlikely to happen,” I began, I handed him the folder that contained the instructions, our healthy care proxies, HIPAA authorization forms and financial powers of attorney. His fiance sat silently at the table as I talked, later acknowledging that she recently had had a similar conversation with her parents.

After dinner, as my son prepared to leave, manila folder and flash drive in hand, we stood alone in the garage waiting for his dog to run her final laps before their car ride home. “Thanks for having our backs,” I said quietly, out of earshot of his father and fiance. “No problem,” he replied. I nodded and continued, “By the way, there’s a second plastic sleeve in that folder that holds your healthcare proxy. If you go to the hospital, just grab it. I’m your healthcare agent and the admitting physicians will want to see that. I’ll handle your bills, too. Don’t worry.” He nodded silently and reached out to gently rub my back.

The unthinkable is not that his father or I might become infected with the coronavirus and die, although we have no known underlying health conditions that put us at risk. The unthinkable is that he might, too, and in a year that was supposed to be one of joy and a new beginning, this was the last conversation I expected to be having with him.

We’re in the midst of a pandemic, not the flu. Don’t live in denial. Play the “what if” scenarios and tell your family what they need to know.

Since that evening, I’ve slept well, knowing that I’ve done all I can to anticipate the future, whatever may happen. My family and I can now just focus on helping others navigate this challenging time and get back to planning a wedding.

Keep well.

Circle of Life Partners, LLC. All rights reserved.

If You Are Hospitalized During the State of Emergency

by Janet Simpson Benvenuti

The COVID-19 virus has upended all of our lives, none more so than infected family members who need hospitalization. Recently, I asked attorney Alexis Levitt if I could circulate her advice to clients about being hospitalized during this state of emergency. As you know, visitors are not allowed to accompany patients into hospital settings.

Here are her suggestions in how to prepare for that possibility. I’ve added a couple of notations in italics and wrote a separate post about how I prepared my family. As we know, it’s not sufficient to follow this advice; we also need to talk with our family, especially our healthcare agent and financial power of attorney.

From Attorney Levitt,

I hope you are all staying home (unless you are an essential worker). I want to share some important points to keep in mind if you are hospitalized during the state of emergency. These apply whether you are hospitalized for COVID-19 specifically, or for any other reason.

1. Keep your Health Care Proxy, HIPAA Statement, and Medication List at your fingertips.

(a) If you are a client of ours, then we enrolled you in DocuBank. Take five minutes now to update your medication list. (Really. Five minutes. I updated mine recently, it was very easy.) If you do not use DocuBank, print out hard copies and put them into a plastic sleeve or envelope.

(b) Keep copies on your phone. You can save the documents to your Google Drive, you can simply keep them attached to an email, whatever you like, so long as they are accessible to you on your phone.

(c) Keep copies on the back of your front door or on your refrigerator. Many first responders will look in these places for emergency medical papers.

2. Advocate to be coded as “inpatient” rather than “under observation.” If you are in the hospital and then transferred to a rehab, how you were coded at the hospital will make a big difference in payment source for the rehab stay.

3. If you are transferred to rehab and told that you will be paying privately, call us (your attorney). Under the State of Emergency, some of the usual coverage triggers for payment for rehab have changed. Nursing home billing offices could be – quite understandably – overwhelmed and perhaps not updated on the temporary changes. We can help.

4. Call us (your attorney) if you need a guardianship or conservatorship. For anyone who has not signed a health care proxy or a power of attorney, the hospital (or rehab) may tell you that you need a guardian or conservator. This is a court proceeding handled by an attorney.

(a) It’s possible that the hospital or rehab attorney will handle the guardianship and/or conservatorship for you, for free. If that is the case, be sure to check in with them as to who they are naming to act as the guardian or conservator, and, if you are not happy with their choice, advocate for naming someone you prefer.

(b) If the hospital or rehab tells you that you need to find your own attorney (or if you are not comfortable using their attorney), then please call our office. This is something that we can handle for you.

Reprinted with permission.

The Guide to Long-Term Care Insurance

by Tobe Gerard, CLTC, MBA, MLS, LIA

We believe that the best all around consumer guide for long-term care insurance that is not state specific is A Shopper’s Guide to Long-Term Care Insurance. Unfortunately, it is not updated every year so we are extremely excited that it has just been updated for 2019 and is now available. This consumer-friendly guide was written and published by the National Association of Insurance Commissioners. We hope that you will find it valuable. Use it as a starting point for the conversation about long-term care and long-term care insurance with your financial planner or insurance agent.

For context, a study of 200,000 claims by PricewaterhouseCoopers found the current average cost of long-term care services is $172,000 for a person who needs assistance with at least two activities of daily living or has some cognitive impairment.

Since 2000, Tobe has committed her professional life to helping people manage the risk of needing long-term care.

Reprinted with permission.

$10 LifeTime Pass to U.S. National Parks

Buy a Pass before August 28, 2017
$10 LifeTime Pass to National Parks

Do you know that anyone 62 and older can get a Life Time Pass to all U.S. National Parks for just $10?

If you, your parents or grand parents love to travel and enjoy the beauty of our National Parks, order a pass before August 28, 2017 when the fee increases to $80.

Here’s a complete list of all American National Parks and Forests.

A Few More Details:
Annual and lifetime Senior Passes provide access to more than 2,000 recreation sites. The passes cover entrance and standard amenity (day-use) recreation fees and provide discounts on some expanded amenity recreation fees. Traveling companions can also enter for free. The Senior Passes admit pass owner/s and up to three adult passengers in a noncommercial vehicle. Children under 16 are always admitted free. Also, at many sites, the Senior Passes provide the pass owner (only) a discount on Expanded Amenity Fees such as camping, swimming, boat launching, and guided tours.

How can I purchase a Senior Pass?
Senior Passes can be purchased at any federal recreation site, including national parks, that charges an entrance or standard amenity (day-use) fee. Proof of age and residency is required. Passes can also be purchased online or through the mail from USGS; an additional $10 processing fee will be added to the price.

Happy Trails!

Senior Housing: Who Advocates for the Residents?

by Janet Simpson BenvenutiSeniors Laughing

74 million Baby Boomers are entering Elderhood and they won’t Age Quietly. While most will age in place, some will transition to Assisted Living or Continuing Care Retirement Communities (CCRCs). The latter require a significant financial investment upfront with care services provided later in a resident’s aging process. Concerned about the financial stability of these entities and the absence of regulations, one advocacy group, the National Continuing Care Residents’ Association has formed and is gaining momentum. With affiliates in nine states and more joining the network, their mission is to assure that “their communities are well-managed and properly regulated.” If your parents or grandparents are in a CCRC, have them check out this organization. Yes, indeed. The Boomers are Coming!

c Circle of Life Partners, LLC. All rights reserved.

Thinking about Buying Long-Term Care Insurance? Read this first.

confusion-005by Tobe Gerard, CLTC, MBA, MLS, LIA

There are many questions posed by prospective clients when they are first considering long-term care insurance (LTCi), but most begin with the disciplined questioning of the Socratic method: Who? What? When? Where? Why? How?

Who is buying? Couples and single women.

What are they buying? 50% of our clients buy traditional LTCi and 50% buy a hybrid policy that combines LTCi with life insurance. That is a huge shift from just five years ago when traditional LTCi made up 90% of our sales.
>Traditional LTCi Policies Current policies are less robust than years ago, typically they provide $4,500/month or $6,000/month, 3 or 4 year benefit period, 3% compound inflation. Couples almost always purchase the “shared” rider.
> Hybrid LTCi Policies Clients most often re-position $100,000 to fund a policy. The benefits range from $4,500 to over $6,000/month depending upon age, gender, and dollars contributed to fund the policy. The sweet spot appears to be policies that have a six year benefit period and 3% compound inflation.

When are they buying? Most people purchase LTCi in their fifties, but our clients range from 46 to 71.

Where are they buying? The states that have the most “insured lives” are CA, TX, NY, FL, IL, PA, OH, VA, NJ, WA, and MN.

Why are they buying? These are the top six reasons people purchase a LTCi policy.
#1 A desire to protect assets.
#2 A desire not to be a burden to family and other loved ones.
#3 A desire to have choices on where to receive care.
#4 A desire not to rely upon the government for their care.
#5 They have experienced using LTCi for a relative (parent, grandparent, spouse) and saw what a gift LTCi was to the family.
#6 They have experienced caring for a relative without LTCi and they saw how it drained the family’s resources financially and emotionally.

How are they buying? Many clients have been referred to us by their financial advisor, their attorney, or their accountant, although some people purchase policies through their employer; some buy through affinity groups such as college alumni associations or professional associations that offer members a discount; and others search online and buy a policy remotely from an insurance agent who sells by phone in multiple states.

Editor’s Note: For decades, the author has provided families with guidance about selecting long-term care insurance policies as well as how and when to trigger a claim. To help you become a more savvy consumer, we’ve asked Tobe to become an ongoing contributor to our blog.

Reprinted with permission from Tobe Gerard.

c 2016 Circle of Life Partners, LLC. All rights reserved.

Are You One of the Village People?

by Janet Simpson Benvenuti

Next Thursday, June 30th, I’m heading to Cape Cod to join the Village People. I won’t be donning my cowboy boots or singing “Y-M-C-A” but I will be leading a fun, community-wide conversation about aging and aging in place with Neighborhood Falmouth, one of the first virtual retirement villages in the United States. Joining our conversation will be experts in law, financial planning, home care and senior housing along with working daughters juggling aging parents and teenage children, Baby Boomers planning for their own longevity, and a random cowboy or two. If you’re heading to Cape Cod for the fourth of July, especially if you’ll be spending time with your older relatives, stop by and join the conversation. Learn why fewer Baby Boomers will be using senior housing. No singing skills required.

Here’s where we’ll be on Thursday, June 30, 2016, 7pm-8:30pm: Unitarian Universalist Fellowship of Falmouth, Sandwich Road, Falmouth.

c2016 Circle of Life Partners, LLC. All rights reserved.

Broads Talk Money, Careers and Families

Professional Womenby Janet Simpson Benvenuti

On June 5th, I’ll be joining a panel of financial advisors in Boston to discuss the unique financial challenges that women need to manage over the course of their lives and careers. As members of 85 Broads, we are committed to the economic empowerment of women. As founder of Circle of Life Partners, I’m committed to helping adult children – men and women – successfully support their aging loved ones without negatively impacting their careers, health or financial well-being.

Free and open to non-members, encourage the women in your life – colleagues, spouses, sisters, and college-aged daughters – to join us and learn how best to avoid or navigate financial mistakes and increase financial confidence. Click HERE to register.

June 5th, 5:30 – 8:00 PM
Federal Reserve Bank of Boston
600 Atlantic Avenue, 4th Floor
Boston, MA

Panelists:
Cathy Burgess, Morgan Stanley, CFP, ADPA
Janet Benvenuti, Circle of Life Partners, Founder
Deirdre Prescott, Sandy Cove Advisors, President & Founder
Dionne Gumbs, Wealthrive, Founding Partner

Moderator:
Kathleen McQuiggan, 85 Broads Boston Chapter Co-President

© 2014 Circle of Life Partners, LLC. All rights reserved.

Know Your Money: The True Cost of Long Term Care

Calculating the Cost of Care

Calculating the Cost of Care

by Janet Simpson Benvenuti

Recently I asked our financial advisor to do some retirement planning and estimate expenditures through the end of my life. To my surprise, my husband and I both are going to die at age 87 (for the record, I will predecease him), spending $100k/year in today’s dollars for each of the last three years of life. Amused, I wondered where I would find care for $100k in Massachusetts. The last assisted living facility with a memory unit I visited cost $8700/month without hairdressing or a personal care attendant. I’m sure to need both. And only three years of care? Prudently, one would plan for at least six, and with any history of longevity or cognitive impairment, I would plan for 12.

That same day, I spoke with a different financial advisor whose 91 year old client has Alzheimer’s disease. He and his spouse reside in Connecticut and spend a more typical $15,000 a month for assisted living with an aide for additional support, $180,000/year. When I reminded that advisor that home care for someone with Alzheimer’s disease is tax deductible as a medical expense, she expressed surprise, unaware of IRS Publication 502.

What’s going on here? Why are financial advisors so ill-informed about the true cost of care?

Quite simply, few people, including financial professionals, understand the extraordinary cost of long-term care and the options available to manage expenditures wisely in the last decade of life.  Effective financial planning requires more than just the skills to create an investment portfolio or project future expenses, but integrated knowledge about finance, elder law, insurance, health care and inexpensive community resources for aging in place. It’s why I founded Circle of Life Partners.

I’ve been guiding families through the aging journey for years, yet I still find the numbers shocking. Recently, I received a call from a family of three adult children who were growing concerned about their mother’s ability to care for their father safely at home. He was three years past his initial diagnosis of Alzheimer’s disease and the family felt he might be best served by moving into an assisted living facility with a memory unit although he did not have long-term care insurance. I calculated the price tag for nine years in a highly-regarded memory unit and subsequent skilled nursing care, $835,000- $1.25 million. Using an adult day health program or a part-time companion suddenly seemed a much more reasonable option.

Last week, I wrote about the Bipartisan Policy Center (BPC) launch of a new initiative on long-term care led by former Senate Majority Leaders Tom Daschle (D-SD) and Bill Frist (R-TN), former Congressional Budget Office Director Alice Rivlin, and former Wisconsin Governor and Secretary of Health and Human Services Tommy Thompson.  BPC’s Long-Term Care Initiative will propose a series of bipartisan policy options in late 2014 to improve the quality and efficacy of publicly and privately financed long-term support services. Read the white paper here to learn more and follow their work @BPC_Bipartisan.

Let’s hope they can get their arms around this issue. Until they do, I’ll continue guiding families to the resources they need, until I need the same support, at age 84.

©2014 Circle of Life Partners, LLC. All rights reserved.

Listen to Bipartisan Policy Center discuss Long-Term Care

Lonely adult child and parentby Jan Simpson Benvenuti

On Monday, April 7th at 1pm EST, the Bipartisan Policy Center in Washington, D.C. will host an event to discuss sustainable ways to finance and deliver long-term care services. The numbers are staggering. Today, there are 12 million seniors, veterans and disabled adults who need long-term care support and services; that number will jump to 27 million by 2050. As anyone who has cared for a loved one can attest, the time, energy and expense involved in supporting an ill family member can easily deplete a family’s resources, compromise the health of the family caregivers, and disrupt careers and relationships. Listen to the broadcast here.

 

© 2014 Circle of Life Partners, LLC. All rights reserved.