Planning for Life

Lack of Family Support Exacerbates Future of LTC

Posted by Harry S. Margolis on November 2, 2021

By Harry S. Margolis

We've reported on both the importance of family caregivers and the underfunding of paid caregivers, both because they're underpaid and because it means we don't have enough of them. Now comes a study from the Center for Retirement Research at Boston College that concludes that we don't have enough family to go around either.

Part of a series about the need for long-term care, the Center finds that about a fifth of seniors will need no assistance during their lives, 38% a moderate level of care, and about a quarter a high level of care for three or more years.  Of this assistance, historically 64% has been provided by informal caregivers, mostly family members, at no cost, and the remaining 36% is paid for, mostly by Medic aid (22%).

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Topics: long-term care planning, baby boomers

Limited POA Does Not Make Trust Countable SJC Rules

Posted by Harry S. Margolis on July 27, 2021

By Harry S. Margolis

In Patricia A. Fournier vs. Secretary of the Exec. Office of Health & Human Services (SJC-13059, July 23, 2021), the Supreme Judicial Court finally puts to rest a MassHealth argument that property in an irrevocable trust may be countable if the grantor retains a limited power of appointment to charity. The SJC had left this question open in the prior case of Daley v. Secretary of the Exec. Office of Health & Human Servs., 477 Mass. 188, 203 (2017).

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Topics: long-term care planning, MassHealth, irrevocable trust

Will You Leave Your Children a Negative Inheritance?

Posted by Harry S. Margolis on February 2, 2021

By Harry S. Margolis

negative-inheritance-estate-planning-attorney-Wellesley-MA-02481Will you leave your children a “negative inheritance?” The term (which was likely first used in the study of economics by Boston University Professor Laurence Kotlikoff) describes the situation in which the costs to children of caring for aging relatives outstrip any gifts or bequests they might receive in return.

Those costs may be financial, physical, and emotional, as children and other relatives give up jobs and homes to care for family members. The following posting to the is not unusual:

My parents are in their mid-eighties and continue to live at home. We sold our large home 2 years ago and moved in temporarily with my parents while awaiting the purchase of our new home. Alas I discovered how much they needed more care than just each other during our stay. My husband and I now stay at my parents home and we do not even visit our own home. I quit my job last summer to increase the level of care necessary for them. We pay all their bills except for food as well as our own bills. I am taking CNA classes so that I may continue to take care of them at home as opposed to the option of nursing home care. We are now dipping into our personal retirement savings to continue to care for them.

While a supermajority — 91% — of boomers report being “generally pleased to be helping their parents,” according to a survey by Putnam Investments, it doesn’t relive the negative effects it may have on a caregiver's own life. There are many steps parents can take to reduce, if not eliminate, the burden they may become on their children as they age. These include:

  • Doing proper estate planning so that children can step in to manage finances and make health care decisions when necessary.
  • Moving to housing that you can navigate if you're no longer able to go up and down stairs.
  • And that is close to your children so they can easily check in on you or pick you up for appointments.
  • Purchasing long-term care insurance to pay for care costs, if you can afford it.
  • Doing Medicaid planning if you cannot.
  • Having a family meeting to discuss your wishes should you become incapacitated and discussing the roles in your care to be carried out by different family members.

Taking these steps can help reduce the out-of-pocket costs of your care as well as the stress family members will experience when they have to step in. They can also help preserve and enhance family bonds, thus avoiding perhaps the worst potential "negative inheritance."


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Topics: long-term care planning, baby boomers, negative inheritance

1989 MassHealth Plan Works Like a Charm in 2020!

Posted by Harry S. Margolis on October 24, 2020

By Harry S. Margolis


Here's a note I recently received from one of the other attorneys in our office:

Was just on the phone with a client who worked with you in 1989. He came back in when his Dad died in 2005 and again now that that his Mom has died at age 102. His Mom had been in a nursing home covered by MassHealth. The house was protected with a life estate deed and $200,000 in savings was protected in an irrevocable trust. Nothing is going through probate and everything will receive a step-up in basis. Thought you would like to know you did a great job in 1989 and despite all of the changes in the law, it still worked. (Also I was in 4th grade then, just saying, the firm does have longevity.)

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Topics: long-term care planning, MassHealth lien, life estate

System Failures: Policing, Public Health, Education, Housing, Long-Term Care

Posted by Harry S. Margolis on June 14, 2020

By Harry S. Margolis


System Failures in the United States

The coronavirus pandemic and murder of George Floyd have laid bare the failures of public health and policing in the United States. Those failures are not news. We've known that we spend much more per capita on health care than any other nation with uneven results and a system where a health event can bankrupt a family.

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Topics: long-term care planning, MassHealth, Medicaid

States Experiment on Long-Term Care, But Where's Massachusetts?

Posted by Harry S. Margolis on September 3, 2019

By Harry S. Margolis

Long-term-care-margolis-and-bloomIn an recent article in The Boston Globe, "As costs mount, states scramble for new ways to pay for late-in-life care," reporter Robert Weisman describes initiatives in states around the country to pay for the growing costs of caring for seniors around the country. While the average cost of care for older Americans will be $266,000 according to one projection, only 7% of Americans over age 50 have long-term care insurance. This huge gap falls both on individual families and state Medicaid programs, MassHealth in Massachusetts.

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Topics: long-term care planning, long-term care insurance

MassHealth Held to Violate Notice Requirements in Trust Cases

Posted by Harry S. Margolis on July 3, 2018

By Harry S. Margolis


In the combined cases of Jean Maas v. Mary Lou Sudders (Suffolk CA No. 18-129-D) and Henry Hirvi and Eva Hirvi v. Mary Lou Sudders (Suffolk CA No. 18-845-D), Superior Court Judge Douglas H. Wilkins finds that in denying applications for MassHealth benefits in cases involving trusts, MassHealth fails to satisfy the requirements of federal regulation 42 C.F.R. sec. 431.210 (b) that it explain the reasons for the denial.

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Topics: trusts, long-term care planning, MassHealth

John Oliver Explains Guardianship

Posted by Harry S. Margolis on June 5, 2018

By Harry S. Margolis

On his HBO show, Last Week Tonight with John Oliver, the host provided a scary and funny explanation of how guardianship works, ending with a public service announcement by William Shatner, Lily Tomlin, and others explaining steps you can take to avoid the guardianship.



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Topics: long-term care planning, guardianship, family caregiving, elder law, elder care, healthcare

MassHealth Planning is Not for Everyone

Posted by Harry S. Margolis on August 15, 2017

By Harry S. Margolis


Everyone who is retired or considering retiring faces the question of whether they have enough money, especially now that few people have pensions that pay for life. This involves a number of unknowns, including how long they'll live, their investment returns, and their living costs. But the biggest uncertainty is whether they'll need long-term care.

The Query

Following are excerpts from an email I recently received from a long-time client:

The only thing that frightens me is that I will run out of funds sooner than later. Let me reassure you first of all. I feel fine, in fact I’m in very good health, active, living independently, driving, traveling, socializing, etc etc. I’m now 88 years old (89 in January) and people “can’t believe how well I look”!

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Topics: MassHealth planning, long-term care planning

Is Medicaid Planning Ethical?

Posted by Harry S. Margolis on July 26, 2017

By Harry S. Margolis

In his most recent personal finance column, New York Times reporter Ron Lieber Medicaid-planning-Masshealth-coverage-long-term-care-Wellesley-MAaddresses "The Ethics of Adjusting Your Assets to Qualify for Medicaid." As Lieber explains in this and prior articles, Medicaid has become the primary source of payment for long-term care services in the United States. But it is essentially a health care program for the poor and has set asset, and sometimes income, limits for determining if someone is poor enough to qualify for benefits.

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Topics: MassHealth planning, long-term care planning, Medicaid

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