This document outlines a presentation by Janis Carney on elder law and long-term care planning. It discusses three levels of planning: estate planning, long-term care planning, and life care planning. Specific topics covered include trusts, wills, probate, Medi-Cal eligibility and benefits, VA benefits, capacity issues, conservatorships, and the roles of fiduciaries. The presentation took place on September 26, 2011 in Los Gatos, California.

1. Elder Law and Long-Term Care PlanningLos Gatos Recreation CenterSeptember 26, 2011750 University AvenueSuite 140Los Gatos, CA 95032(408) 354-0200www.css-lawfirm.comJanis Carney, Esq.

2. Janis Carney, Esq.1Elder LawPlanning Needs *Elder Care OptionsCapacity Issues*

3. Janis Carney, Esq.23 Levels of PlanningEstate Planning *Long-term Care Planning *Life Care Planning *

4. Janis Carney, Esq.3Estate PlanningTrusts- Revocable and IrrevocableWillsDurable Power of AttorneyAdvanced Health Care Directives

5. Janis Carney, Esq.4Trust and Estate AdministrationVs. ProbateDistributing Assets -RetitlingCreditor claimsExpense, time, oversight

6. Janis Carney, Esq.5Long-term Care PlanningPre-planning for long-term care involves -Legal concerns -Financial concernsBudgeting How to Pay Asset preservation * -Eligibility for Medi-Cal and VA benefits *

7. Janis Carney, Esq.6Veteran BenefitsService-Connected Disability CompensationDependent’s Indemnity Compensation *Pension for wartime * Vets and their surviving spouses Homebound and Aid & Attendance SupplementsBasic eligibility requirements *Maximum Pension benefit amounts *Planning Strategies *

8. Janis Carney, Esq.7Dependent’s Indemnity Compensation(DIC)Surviving Spouse married and living with the veteran at least one year immediately prior to death$ 1157/mo + A&A &283/moSurviving Dependent Parents or Surrogate Parentsmust be financially in need$ depends on needSurviving Dependent Childrenminors“helpless” (disabled from childhood) separately eligible or eligible with surviving parent

9. Janis Carney, Esq.8DICRequirementVeteran died *either:partially because of service connected disability, or

10. 100% service-connected disabled for 10 or more years immediately proceeding death, or

11. While in service* Provided the veteran's death was not due to the veteran’s own willful misconduct and was not wrongfully or intentionally caused by the claimant

12. Janis Carney, Esq.9VA Improved Pension Basic Eligibility Requirements 1. Veteran served on active duty at least 1 day during a designated “wartime” * period – note: there is NO requirement that the veteran actually served in a combat area or even overseas 2. Veteran served continuously on active duty at least 90 days unless discharged early due to a service-connected disability. (note: period may be longer if entered service during or after 1981) 3. Veteran was discharged other than dishonorably 4. Claimant is aged 65 or over OR permanently and totally disabled not due to own willful misconduct 5. Claimant is financially needy [Claimant: Veteran or the surviving spouse or other dependent of a deceased veteran]

13. Wartime PeriodsWorld War I: April 6, 1917 through November 11, 1918, inclusive. World War II: December 7, 1941 through December 31, 1946, inclusive. Korean Conflict: June 27, 1950 through January 31, 1955, inclusive. Vietnam Era: February 28, 1961 through May 7, 1975, inclusive, if the veteran served in Vietnam during that period. Otherwise: August 5, 1964 through May 7, 1975, inclusive.Persian Gulf War: August 2, 1990 through a (future) date to be prescribed by Presidential proclamation or law.Note: The 1983-1984 Lebanon crisis and the invasions of Grenada and Panama are NOT designated as wartime periodsJanis Carney, Esq.10

14. Pension with Aid & Attendance Maximum Monthly Benefits11A & A* = Aid & Attendance

15. Janis Carney, Esq.12Medi-Cal Long Term Care BenefitsBasic requirements for -Eligibility * -Share of cost * -Recovery *Planning Strategies *

16. Janis Carney, Esq.13Medi-Cal Long Term Care EligibilityApplicant aged 65 or over OR permanently and totally disabledApplicant requires the level of care of a skilled nursing facility or higherApplicant (and spouse, if married) is financially needy Countable assets under $2000 for single applicantCountable assets under $111,560 ($2000 for applicant +$109,560 for well spouse) for married applicant

17. Janis Carney, Esq.14Medi-Cal Share of Cost Calculation(Co-Payment to Nursing Home) Notes: 1. Applicant income does not include his/her spouse’s income2. Income from rental property is net of the following amounts paid from the rental income:Mortgage interest Property taxes, assessments, and insuranceUtilitiesGreater ofactual upkeep and repairs or15% of the gross rental income + $4.17

18. Janis Carney, Esq.15Medi-Cal Share of Cost Calculation(Co-Payment to Nursing Home)All of the Applicant’s income from all sources other than VA Less:Applicant’s medical expenses, such as health insurance premiumsSpousal and child support paymentsSpousal income allowance: the amount needed to bring the spouse’s income up to the Minimum Monthly Maintenance Needs Allowance (MMMNA) amount, currently $2739/monthPersonal Needs Allowance ($35/month)

19. Janis Carney, Esq.16Medi-Cal Recovery1. Claim by state against assets owned by Medi-Cal recipient if single -If single: Due at death- If married: Deferred during life of surviving spouse-No recovery if recipient has a permanently or totally disabled child of any age at time of state’s claimClaim amount is lesser of -Amount state paid for recipient on Medi-Cal-Value of assets belonging to recipient at time of death

20. Reduce/spend assetsConvent assetsTransfer assets (subject to Medi-Cal penalty if with in 30 months if applying for Medi-Cal)Annuities (lots of problems)TrustsReduce income and increase care costsVA and Medi-Cal PlanningJanis Carney, Esq.17

21. Janis Carney, Esq.18Life Care PlanningFocusing on quality of life and careCoordinating health and personal care with legal and financial needs - Applications for Medi-Cal and VA benefits - Preserving Assets to afford better care

22. Janis Carney, Esq.19Capacity Issues2 Levels of CapacityContract (Decision Making) Capacity: Ability to understand and appreciate theRights, duties and responsibilities created by or affected by a decisionProbable consequences for the decision maker and, if appropriate, the person(s) affected by the decisionThe significant risks, benefits, and reasonable alternatives involved in the decisionTestamentary (Will Making) Capacity toUnderstand the nature of the testamentary actUnderstand and recollect the nature and situation of the individuals property Remember and understand the individuals relations to living decedents, spouse, and parents and those whose interests who are affected by the will

23. Janis Carney, Esq.20Conservatorships/GuardianshipsWhen There is No Capacity and Insufficient Legal DocumentsA protective court proceeding for incapacitated adults/childrenAdult/child Protective Service involvementMust prove adult-conservatee is deficient in one of four areasAlertness and attentionInformation processingThought processesAbility to modulate moods and effect