Elder Care Cost

ElCy

I spent $400 with and Elder Care Lawyer to be told it would Cousy $5000 to set up trust and other paperwork and an additional $1000 a year for consultation. Is this average? I could meet with another attorney but it will cost $350 before I get a quote.

Crushed

unless you are in a very high cost area that is a bit high.  I paid 4500 for all legal documents and trust.  no ongoing fee.   Now I;m a lawyer so I had everything fully organized and it took less time so I got a small "discount" of about 500 but I am in one of the most expensive areas in the USA,  When I need more legal services I will pay for them

Pat6177

We paid about half that. I’m sure it varies in different parts of the country (we’re in AZ). Now that you have an idea of the documents that you want, you might be able to get a price range from the receptionist without having to have a meeting with the lawyer. We have consulted with the lawyer since the trust was set up but that was because we got the dementia diagnosis a year after we set up the trust. Was the $1,000 per year just an estimate or something you would have to pay?im curious to see what others say but my guess is that the $5K is high.

Joe C.

I suggest you shop around. I live in MA and CELA generally provide a 1 hour free consultation and then provide recommendations and cost estimate. I interviewed 4 attorneys and got estimates ranging from $1500 to $6000. The higher priced attorneys (2 that quoted $6000) where just trying to sell me an off the shelf package they offer to all clients which actually would not have provided the protection I was looking for. The $1500 Attorney gave me a thorough education on MA Medicare & Trust laws and explained what different types of trust would and would not protect. Then she tailored a package to meet my particular needs.

Stuck in the middle

That's a lot more than I paid in Missouri.

LadyTexan

My initial meeting with the elder law attorney cost $350. It was a very comprehensive meeting. Prior to the meeting, I filled out a slew of paperwork about our financial condition, prior marriages, children, my goals, etc. 

At the meeting the attorney and I discussed if/how I wanted to proceed. I then paid the attorney $3,000 to cover potential cost. The attorney stated that his services probably would not require all $3,000 and I would likely receive a refund when we accomplished what he set out to accomplish.

The attorney re-did my key legal documents will, power of attorney, physician's directive, HIPAA release and my preferred guardian (for me not DH). In addition, I received a comprehensive education regarding Medicaid eligibility in Texas, exempt assets, pooled trusts, the Texas Star+ Waiver program, divorcing DH, guardianship and more.

If I remember correctly, my refund after the work was complete was around $1,500. So all in I spent about $1,850.00.  For context, I had a moderate income ($85,000). DH was already receiving disability from Social Security. We were both under 55 years old. Our combined assets were under $200,000. DH has one adult son. I have no children. DH's legal documents were not re-done.

I have reached out to the attorney on a couple of issues since he completed the initial work. He has been responsive. I am glad I established a relationship with a knowledgeable, experienced attorney.

The amount I paid the attorney was less than the cost of one half of a one month stay in Memory Care. This is important, because it turns out that because of our financial condition, DH should qualify for Medicaid if we decide to go that route. I had no idea. I thought that because we were above the poverty line, Medicaid was not available to us.

mrahope

I must say that I am in the same boat with fees proposed to me by an elder care attorney that seem to be pretty high.  After a free one hour consultation with the lead attorney (virtual) we were given a rate sheet.  For the advance directive/durable power of attorney and related documents the charge was $2,000.  For setting up a trust to protect our assets in the event of needing Medicaid, the charge was $10,000.  I felt like this was exorbitant (the charge for the trust set up) and have not done it.  

I have elected to proceed with the advance directive, etc.  However, it is hard to know what to do about the trust.  My spouse is about to turn 84, has heart conditions and is a two time cancer survivor, his diagnosis at this time is MCI.  I feel confused as to what to do. Do I spend the 10K and bet on him to live long enough to need long term care, or bet on him to meet his end prior to needing it?  And there is a 5 year "look back" period in our state before the trust protection of our assets would kick in.  By that time he would be 89!

I feel horrible having to contemplate these things.  I am trying to be mature about all this but it is very depressing and disheartening.

ElCy

Wow!!! That seems ridiculous. I spoke with a friend of mine who is a lawyer. She suggested that I should speak to a trust attorney who would probably set up trust for under 1500. Imma newbie though, so I don’t know if it makes a difference if you use a regular attorney for the trust. I’m going to speak with one though.

DrinaJGB

There is an awesome article regarding elder care costs and caregiving on:

  vox.com---for some reason this site does not let me paste in the link(.Frustrating!)

  It is well worth reading, however, as it addresses the entire caregiver dilemma facing this nation today, so you might to google it.

  Entiled- Elder- care- family- costs- nursing- home- care.

ElaineD

Dear ElCy,

I asked my excellent financial advisor of 30 years if we should get an Elder Care Attorney to help us with setting up a trust to protect our assets as well as filing for Medicaid, etc. 

He told me that since ALL of our assets are in 401K accounts it would cost us a great deal in higher taxes the year we set up a trust.  401K accounts have to be cashed out in order to be put in trust.  Cashing out our 401K accounts all at one time would increase our income by a very large amount (over $800,000) and we would be in a much higher tax bracket for that year, as a result.  It would cost us a great deal to cash out the 401K accounts to put them into a trust.

His advice:  spend down the assets slowly over time, to meet our needs.  When the assets are 'gone', we would then apply for Medicaid.  This would be easy since there would be no issue of assets.

I am 79 and my husband is 82.  We also have LTC accounts which would supplement our income by $48,000/year for 6 years, for each of us.  So if we are both in AL/MC that would add $96,000/year to our income.  The LTC care payments are NOT TAXABLE if all of the money is spent on AL/MC.

Because my husband is MY caretaker, I would have to go with him to Assisted Living and Memory Care.  He helps me to dress and shower, so I am already eligible for LTC coverage.  But I don't have to begin the LTC payments as long as he is caring for me.

And of course we both have Social Security Income and small annuities.

I have enrolled others in Medicaid, in my career, so when the time comes, I could do that paper work myself.  And if I cannot do that paperwork when the time comes, my son and his wife (doctor and OT) will do it, or more likely pay to have it done for us.

The harder thing would be to find a facility that accepts Medicaid.  Our current Senior Living Community does NOT accept Medicaid.  I have identified one Community that accepts Medicaid, near us.  So that would be a possibility.

These are some considerations.

ElaineD

DrinaJGB

And the other caveat according to the above-mentioned article is the fact that when you need Medicaid there is a long waiting list for services---sometimes 3 years. SO what do you do in the meantime? It's a Catch 22 situation for sure. You either have to be ridiculously rich or poor, but even spending down to the point of poverty level you are not exactly guaranteed that help will be available to you at the time you need it.

We have all the necessary legal documents and have for years, but I am pondering this whole Medicaid trust stuff lately, and am not sure if it is the way to go. It almost makes more sense to take money and do a garage conversion apartment for possibly needed caregiver to live in plus food and gas salary after a thorough screening has been conducted. That's what the very rich often seem to do. It really is a double-edged sword.

Jo C.

Our first meeting had no fee.  An entire Trust, Will, DPOAs, HIPAA Waivers, etc. were done.  He suggested unless something in our life changes, to have a followup appt. every three years as laws do change.

NOTE:  We did NOT have to cash in our 401Ks, everything is still the same; no tax hit.

Paid about $4,000 for a very, very thorough set of documents, and he also spent much time with us several times answering questions that popped up and more discussion

J.

caberr

Joe C I also live in MA.  We had a trust drawn up 13 years ago before my DH got ALZ.  We have a revocable trust.  The attorney at the time said it would save our house etc in case either one of us became ill.  

We have since had the trust updated with a new lawyer but it is still a revocable trust.  

I am just curious what type of trust did you get?  

Joe C.

cabarr, In MA my understanding is the only way to completely protect an asset (house) is an irrevocable trust. I think technically what the lawyer told you is correct, “if one of you gets ill” the house is protected as the custodial spouse can keep the house but I don’t think that applies to other assets over the $130,000 threshold that the custodial spouse is allowed to keep. The problem is if both spouses eventually need long term care then I don’t believe a revocable trust protects the house. In MA the “legal test”  to protect an asset in a trust is that you no longer maintain control over the assets and I was told that with a revocable trust you maintain control. MA Medicaid has even tried to go after assets in irrevocable trust but they lost the court challenge to that attempt. The case was in 2015 and a interestingly a new member of my support group was actually the plaintiff in that case as it was his mother-in-laws house they were going after. I am not a lawyer, I am only stating what I believe to be the case. It might be worth asking the attorney what would happen to the assets if you both get ill.

Below is an article on MA Medicaid challenging irrevocable trust.

 https://blog.eldercounsel.com/big-win-for-irrevocable-trusts-in-massachusetts

caberr

Joe C.  thank you for the information.  I am going to make an appointment with the lawyer to see what I need to do.

DrinaJGB

JoeC--Ditto for here in Texas an irrevocable trust is the only one that should be obtained to protect assets. You are no longer the owner of the funds but the trust is and a spouse cannot be the trustee, but a child can be or a third party.

The problem I keep pondering is from experience with an irrevocable family trust--when my DH was in ICU for months two sisters conspired with an attorney to change the irrevocable family trust with an amendment taking away my DH's inheritance rights and putting full control in the hands of the two sisters.It was a shocking revelation in the midst of so much pain to learn of their betrayal to their critically ill brother who was actually always the named trustee along with an older sister. Both were removed as the murder of crows swooped in for the kill---reeking of greed.

A irrevocable trust cannot be changed after death of one of the founders. Yet here we are.

  I had to get an attorney in 2012---it is still ongoing with a light finally being visible at the end of a very long expensive and painful tunnel.

SO---as you can see my "trust regrading irrevocable trusts" is dubious indeed. It has cost us a fortune to fight something that should never have even been an issue, but greed sprang forth and here we are. Fair warning.

Crushed

DrinaJGB wrote:

There is an awesome article regarding elder care costs and caregiving on:

  vox.com---for some reason this site does not let me paste in the link(.Frustrating!)

  It is well worth reading, however, as it addresses the entire caregiver dilemma facing this nation today, so you might to google it.

  Entiled- Elder- care- family- costs- nursing- home- care.

https://www.vox.com/the-goods/22639674/elder-care-family-costs-nursing-home-health-care

(you have to use Control-V to paste

susan4665

My DH also has dementia from a Brain Injury related to a motorcycle accident caused by a non licensed teen.  I did pay the elder lawyer a large fee to help get Medicaid.  They talked me through the spend down process etc.  I'm very happy I had a house as that's where the money went and left me with no mortgage and I was able to keep my retirement funds.  Medicaid was approved and it helped that I was self paying a facility that took Medicaid.  I am alone in my journey, several adult children but none want to see their father, they are children from a previous marriage.  There is no way I could work and take care of my DH.  He needs help 24/7.  Saw him yesterday and he thinks I'm his previous wife.  It's been 2.5 years and I still sob most days when I think of who he used to be.

Crushed

Just to help

An irrevocable trust can still be "changed"  it just can be revoked.  The allowed changes are specified in the trust.   The most important is what is called the power of appointment  

 That is a feature which allows a specified person to change the beneficiaries.

 It is probably the most fertile source of litigation regarding trusts.  

This is not my field so just take this as a sort of general warning

We had a case  where there was a trust  and  a power of attorney  Rotten son had the power of attorney.  He used the power of attorney to substitute himself for the dementia husband as trustee.  He then used the power of appointment to shift money from the  Wife's children to his own children.  (all the children were beneficiaries so he could do this.) None of this was discovered until the wife died.   He had paid her the income during her lifetime.  Real mess   

White Crane

Dear EICy, I have seen two elderlaw attorneys and they both offered a free consultation.  The first one explained everything to me and then said he would set everything up for $10,000!  I nearly choked!  Our wills and DPOA's were already done so he would not have to do those.  The second one I talked to told me a lot of the same things as the first attorney.  At the end, she handed me a rate sheet and said it would probably cost $1,200 to set everything up.  A far cry from $10,000!  We live in Missouri.