Let's Get Organized "Two-gether" to Gather Key Information for Planning Options

There's never a perfect time to get everything figured out but anytime is the perfect time to start considering possibilities.

Where to begin is a question that may naturally arise once one becomes aware that it really is in one's best interest to 'know the road ahead' that one is travelling in life.

From one age and stage to the next whether as a youth planning for summers or schools, a high school student (or parent  or advocate of a student) Thinking About Going to College or onto further studies or even getting a job, teachers and helpers should abound, but it's really often the case that without a 'guiding hand' many doors don't open.

 The opportunities grow over one's life time maybe even to get help with health insurance, housing, heat or SNAP (food stamps) if one's in need or on one's way to greater things. It's Okay to need help but sometimes getting help to get things moving can be daunting.

These challenges whether for new jobs, moves or personal decisions carry on right  through to adulthood, midlife and senior years. Whose on Your Team even if you are a Loner, Independent or otherwise not too socially connected?

Even if you are tuned into the basics, perhaps having helped others who need assistance with rides, errands, getting to appointments or taking small trips, what would it look like if You needed some help getting through your day and routines, travel and appointments?

Sometimes a parent, particularly a full-time caregiver of young children can hardly afford the time to really consider what may be needed to fill their shoes for a day or a week let alone a longer period of time. But planning can be a win-win and sometimes 'life happens' and likely a few people need to step in initially if a main team player needs a break or otherwise is not able to do their usual routine. 

Why not consult some resourses such as nolo.com and use the basic Building A Parenting Agreement That Works for all families to function with a set of instructions that one can personalize for each child over the course of the year.

All families with a custody plan need to have something on file with courts that clarify where a child lives, where each parent lives or other guardians, what the basic living arrangements are (and that may specify legal rights as well as physical and financial support.) Those things would be helpful for people even anticipating having a child or helping care for a family member or grandchild or elder.

There may be intermittent or short-term needs such as summer vacations where supervision and programs are needed. Holidays and days off from school or an elder's usual routine of going to senior center or care program may need other coverage.

There are caregivers through such places as care.com that could assist someone with housecare, pets, children, elders and others. Making a list of local resources for whatever may benefit each person in a household could be a practical help. 

I suggested to our local paper, The Lakeville Journal, that they list the town phone numbers and discuss how people volunteer at schools and in a town to help things function.

They have run a supplement called Towns and Villages for many years now which many people wisely save year-round to have phone numbers and resources handy. Another person also had thought about including a lot more information than I had imagined and maybe other towns do this too.

We used to have The Corner Market Directory (and yes it was online) in print that covered many service people in the CT/NY tri-corner area (near MA.) I had parent resources and recreation directors listed along with faith organizations to plug a gap. This blog serves on many levels to encourage people to learn who is there in each town for them and to network with neighboring ones and online as well to help get more information if not connected to events and programs to enrich their lives.

Lucky for many, the paper is now digitized as well and most towns have websites to help keep the information at people's fingertips. Still there is a digital divide so many people need help accessing what is 'easily found online.' 

Keeping more people connected takes 'boots on the ground and friendly social networkers' as well as practical resources. Libraries, senior centers and faith communities can be natural hubs for people to access information.

Ideally there could be some cell phones and areas for people to use those as well with assistance to get basics like health insurance (which has yearly enrollment times and renewal times as well as requirements for updating personal information on wages, moving, pregnancy or having other family or household changes reported in a timely manner.)

It can take a few years to get a handle on how much information needs reporting and how to upload forms even with assistance if not paying someone to do that.

The idea of keeping 'up to date' on options looms large for people in their 50s on up. The main thing people hear about when turning 50 is joining AARP which can give people a sense of community when it comes to aging as well as some key information about medicare which begins at age 65 for all Americans as the primary kind of insurance that covers much of health care costs but not all unless one gets a supplemental insurance at a monthly fee, unless one qualifies to have the covered due to low income. There's plenty to learn as I have said beginning in one's 50s. 

The main thing no one seems to get a public notice about is that there is a 5 year look back period on how one's assets are used or managed, including any gifts or unaccounted for spending if one is applying for medicaid after age 65. That would mean keeping good records of where one's money went between ages 60-65.

Moreover to not be prone to a penalty or delay of coverage from medicaid, there would need to be five years between when one needs medicaid coverage and when one had transferred their home to an adult child or other responsible relative with or without 'lifetime use' . Life time use may have a monetary value or be something that could be given to someone else, but check with one's attorney as I am not trained in any respect as a legal professional and am not giving legal advice but rather raising topics to seek more information about for one's own benefit.

SInce everyone is on medicare at age 65 (and needs to sign up a few months prior to that date ideally to not have to pay higher premiums for the duration of one's life), at any point after age 65 if one becomes incapacitated in terms of needing help with ADLs (activities of daily living) and/or mobility (and again, look up the criteria for oneself) that requires more than one person to assist the client, then medicaid may be the way to get services covered.

Those services are not covered by the medicare payments, rather one's personal assets would need to be 'spent down' and directed to covering expenses directly or 'out of pocket' until the client had a much lower amount of assets. These figures may vary among states, but Medicaid is a federal program. 

There are important aspects to learn about one's residential home which likely is a main asset of value. If a person owns their home, there may be ways to transfer the home to a spouse, an adult child who cares for one parent for two years or to a sibling who lives with the client for a year and has a financial investment  in the home (and therefore some ownership possibly with a title needing to reflect that but I'm not sure. I just heard about this aspect recently from an elder law attorney giving a talk to a large group.)

Since these factors come into play after one turns age 65, which 10,000 Americans do everyday according to an online resource, possibly ElderLaw.org, there is a need to consider whether one would benefit from transferring one's home or buying a home and putting it in an adult child's name or sibling (who is responsible and trustworthy and healthy etc as their could be a risk their life may impact how they use the home or keep their agreement if a person is expecting or formally having lifetime use.)

Doing that kind of transfer before one is 60 years old would allow for the house to be 'off the list' of considered assets when one turns 65 and becomes a medicare member as well as a potential medicaid recipient who would need to pay medicaid costs from their own resources.

If one is 65 or older and needs medicaid coverage, one can transfer one's home to not have it counted into the 'medicaid spend down' to one's spouse, or to a sibling who has lived with them for one year and has a monetary interest as in partial ownership of the home, or to an adult child who has lived and cared for the parent for two years. 

If one has a lot of money in savings that may be prone to being needed for medicaid, using some to buy a car before going on medicaid and improving one's home would be reasonable things to consider since there may be ways to save one's home or at least to enjoy it while living in it. That may improve the value which would eventually be a benefit for the home and whoever owns it or if it did need to be sold with proceeds going toward one's medical bills.

These are common considerations that many people may pursue legally and ethically but some people may feel they want to put as much of their assets toward paying future medical bills as possible, maybe foregoing the option to allow family or possibly another caregiver to benefit from their home's value.

Whoever gets to live in the home would possibly be facing similar challenges about owning the home depending on their health and age but there may be value to 'buying time' even if a few years to consider options.

A home may be held in trust for a minor child or one with a disability, so there is much more to learn. These are some basic considerations to get the conversations going (while one takes time to gather information into a file.)

Paying close attention to one's medical and dental health and even one's mental health is important as one gets older to understand the requirements of living independently (or even with one's spouse or family.)

The medical needs can change particularly if there are mobility concerns, dental matters that go unchecked (such as with a gum infection which can become rather serious and require antibiotics if not extractions but check with Chinese herbalists who may be able to offer herbs that would prevent extractions being necessary.) Being proactive about one's health, sleep, diet and moderate exercise as a doctor recommends along with diabetic educators and reputable sites may be more valuable in many respects than one can anticipate.

Staying mobile and engaged in positive social interactions and routines, but not too much stress and exposure to cold or people who are not healthy is a good strategy for the most part.

Keeping a journal of what one eats, medications if any that are taken, supplements and activity or outings in general can help one appreciate patterns that can inform one and supporters what one's normal routines are and when appointments are needed (and hopefully kept regularly) for vision, driving 'assessments voluntarily' with a willingness to listen to those who may have insights or concerns. 

There are other posts on this blog covering these kinds of matters as well plus many good sites online. Reviewing a few health tips monthly and incorporating 'better habits' slowly over time and with support is another secret that can prove very valuable.

There is much more information online such as at ctseniorlaw.com and CTElderLaw.org. Speaking to an attorney and gathering specific information about the value of one's home (an appraisal for the real value of the home not for real estate selling purposes) or whatever the attorney would require would be helpful.

Taking time and having support to consider who might be reasonable to discuss options and share information with regarding any particular individual's situation would be an important step. It's not just knowing information but helping a small group of individuals close to the person needing it all understand what is at stake and how things may be addressed in a reasonable, caring, competent manner over time, likely months if not years. 

Who the natural networks may include could be family, friends, a person from an advocacy group or senior center or other people recommended by people in one's faith community or local social work or non-profit (or possibly for-profit) consultants. Village to Village and Elder Services are programs in Massachusetts that benefit seniors, with the former having an annual fee and Elder Services being free for consulting.

In the Northwest Corner of CT there is CHORE services which helps people 'age in place' and have social support as well with regular help by the same chore worker(s.) These models may be helpful to others and encourage more groups to form supportive groups.

Making a list of information for each person to have their name, address, birth date, phone numbers for home, work and cell, emails and other contact support people with their phone numbers, addresses and emails who one has given permission to discuss matters (but not make decisions unless one has clearly specified that.) A durable POA, power of attorney form, a health care representative and health care directive (stating one's wishes for specific medical interventions or with holding of those) would all be important to include in a binder or folder of information. 

One would also list  the names, ages and birth dates of one's spouse or partner, one's children, grandchildren, one's brothers and sisters and parents (living or another sheet those who are deceased for reference.) Other contact information such as address, phone and email for these people would be helpful to have even on another list for notifying about health or other concerns as you may wish to indicate.

Specifying if anyone in one's immediate family has a disability, when it began and whether that person receives Social Security Disability Income (SSDI), Supplemental Disability Income (SSI) or other programs from State or Federal Social Services would be good to list as well.

 Noting who is helping one manage one's financial affairs or who might need help with managing such affairs that one would want to leave part of one's estate to (house, land, money or other) would be helpful to note as well.

Listing one's assets (and making a video and taking pictures for insurance purposes) with the type (house, primary residence or other real estate), the owner(s), the market value, mortgage amount and who that is with including contact information.

In addition to houses and land, cars with year, make, model and value, other vehicles, jewelry, collections, boats or airplanes should be noted. Note whether any of those are covered by insurance. On a separate paper the information can be clarified along with insurance company policy numbers, contact information and payment amounts.

Note whether one has a safety deposit box at which bank and by whom and  how it is accessed.

List financial assets including checking, savings, stocks, bonds (including savings bonds, IRAs, mutual funds, money markets, CDs, etc.)

List life insurance in terms of the owner, the insured, the company and policy number, the group number (if any), face value, cash value and beneficiary for each person and policy.

List any gifts you may have made, noting the type of asset, to whom, the value and the year made.

Note if you have filed a Gift Tax Return.

List other assets (leases, debts you own and other), Business Interests, Trusts.

List your Monthly Income from Social Security-Retirment, SSDI, SSI, Employment, Veterans Administration Benefits, Annuity, Pension and Other

List your health insurance information. Note if you are on Medicare and Supplement the number, the effective date and premium amount. If insurance is from an employer, list the company, the policy number, group number, effective date and premium amount. If you have Long Term Care Insurance, list the company, whether there are policy limits (and note how many years) and policy dollar limits (the total amount and daily amount.)

(Note that sometimes while policies seem secure a group benefit may change so read the fine print to understand the possiblities of a policy not covering as much as initially indicated. Have someone with the right skill review the material as well.)

 If you are on Medicaid (Title 19 or XlX) list the number and type. 

If you have a prepaid funeral contract, list the funeral home and the amount expended.

List any other liabilities and describe the nature and amount due.

When getting ready to discuss matters with an attorney or other experts and concerned trustworthy people on your team (even in advance of seeing an attorney such as other family and advocates even if exact numbers and information not shared, perhaps with some things blacked out as needed) gather together important information as listed above as well as the following.

Any wills or trusts, living wills (regarding health care matters and one's appointment of health care agents or representatives, powers of attorney, long term care policies, deeds to real estate, annuities, life insurance policies, current bank, IRA, investment and annuity account statements, prenuptial or marital agreements, proof of disability (if pertinent), guardianship or conservatorship documents.

These kinds of issues have many steps to do, some research online can be helpful, likely there is much more advice about how to go about pursuing these important matters with a friend or other support person if not team over time. Keeping track of basics is important for everyone to do early in life and then to 'keep track over time.' Having a timeline of one's life, from birth through the decades with the years marked off (even in 5-year increments if young) would make sense.

Appreciating where one has been, what one has accomplished and learned from others, who one has helped, where one has lived and gone to school, relationships, partnerships, children or others one has cared for can help one take not of who and what has made one's life meaningful. Rounding the corner into midlife and elder years is an honor in itself, to have one's wits and health, some wealth and wisdom all add up to being a team leader, not just a team player which of course is of huge value as well. 

The Five Wishes is recognized in many states as a valid 'health care form' to name one's wishes and one's representative(s.) Ideally that would be updated yearly or every few years. Each state may have a form online, so that may be best to file as well so that it meets all the guidelines and would be accepted in other states as well (as likely The Five Wishes would be.)

Taking time to watch movies or online videos about 'facing the tough stuff in life, whether a change in relationship status, difficult health news, or making plans for the future which may include end of life planning can be done with others to grow in courage and connections to valuable resources. We have shared a memorial service online on youtube.com of our son Kaelan Palmer Paton who passed from this world at age 16 in 2009. He was rescuing his friends from dangerous water and another person was able to save a friend so only he passed that difficult day which happened to be his last day of high school as a freshman.

There are many valuable lessons to consider about that kind of experience, primarily to value one's life, family and friends and to live with safety and agreements to not take unnecessary risks especially in dangerous areas and without adult skilled supervision (at appropriate places.)

There is a great value in seeing one's children and others one cares for regularly and not letting elders or others who may need assistance have to ask for help or be isolated 'of their own choosing' too much. Sometimes people become depressed or overwhelmed and it is difficult to ask for help or know what kind of help one needs. There are many efforts to help more people appreciate being team players even for people facing serious illness (dementia or other challenges that are more common after 80 years of age.)

Ideally everyone would be willing to have driving assessments to maintain safety as a shared goal, with many options for rides that are affordable. Thanks for considering these matters and sharing a bit at a time. The outreach done by Suzanne O'Brien and others in the end of life doula movement, through her programs on www.doulagivers.com (which offers a free online program for community awareness) and other organizations in one's community can be a valuable step in 'breaking the ice' and sharing good advice about making plans for our modern world to embrace life (and one another) in this shared journey of living fully and graciously all of our days.