5 star quality rating system

Finding the Right Nursing Home: Don’t Rely Entirely on the Five-Star Quality Rating System.

5 star quality rating system

The Five-Star Quality Rating System was created in 2008 by the Centers for Medicare and Medicaid Services (CMS). It has become a popular tool for families to find a quick summary of a given nursing home’s overall level of quality. CMS posts its ratings on the medicare.gov website.

Unfortunately, the accuracy of this rating system is open to question. An investigation by the New York Times, in particular, reveals a number of shortcomings. Let’s begin by looking at how the system operates.

Ratings are based on a combination of self-reported data from 15,000-plus nursing homes, as well as on-site examinations conducted by state health inspectors. A nursing home’s overall score, its star rating, depends on the results of the inspection, the amount of time nurses devote to residents, and the quality of care received by residents.

To evaluate the rating system’s reliability, the New York Times created a database with millions of payroll records to analyze the amount of hands-on care residents actually received in nursing homes. The Times also examined 373,000 reports by state inspectors, and the financial statements 10,000-plus nursing homes submitted to the government. Additionally, The Times was able to access data that is not readily available to the public.

This investigation revealed that nursing homes had submitted inaccurate information, thereby making themselves look safer and cleaner than they actually were. Other erroneous information included exaggerated levels of staffing, underreporting the use of potentially hazardous antipsychotic drugs, and minimizing the number of health problems and accidents among residents. Worse, when even highly rated nursing homes were inspected by CMS investigators in person, they were just as likely to fail the inspection as pass it; information submitted by nursing home operators and owners was rarely audited; nursing homes may have been tipped off before unscheduled, impromptu inspections; and inspectors frequently minimized violations they discovered at highly rated nursing homes, which allowed these facilities to maintain their stars.

All of this is troubling, to say the least. It suggests that a nursing home’s five-star rating should be taken with a grain of salt, or perhaps even a shakerful. It also reminds us of the importance of closely scrutinizing every aspect of a given nursing home oneself. AARP provides a detailed checklist to help you evaluate a nursing home on a wide range of crucial criteria. Download the checklist here.

Alphabet letter wooden blocks with words GIVE in child and parents hands. Family and charity concept

Giving to Charity Wisely During the Holidays

Giving to charity concept: Alphabet letter wooden blocks with words GIVE in child and parents handsAs we enter the holiday season, many of us will consider making gifts to charity. It is estimated that nonprofits receive 40 percent of their annual donations between Thanksgiving and New Year’s Day.

If you are thinking about giving to charity this season, the Better Business Bureau (BBB) Wise Giving Alliance offers the following tips to help ensure your gift goes to legitimate organizations and does the most good.

Beware of similar names when giving to charity

Charities seeking support for the same cause often have similar names. Before making a donation, be sure you have the exact name of the charity to avoid a case of mistaken identity.

Review the charity’s website carefully

A responsible charity should have a website that provides the following information: its mission and programs, measurable goals, and concrete descriptions of its achievements. In addition, you should be able to find information about the charity’s finances. Bear in mind that the type of work a charity does will impact its costs.

Be cautious about highly emotional appeals

Marketers sometimes exploit the holidays and create highly emotional pleas to donors. Try not to make an impulse decision based purely on emotion. Instead, do some research to verify that the charity in question is legitimate and operates ethically.

Think twice before giving to unfamiliar organizations requesting donations outside public buildings

The holidays also bring a higher number of donation requests from people standing in front malls, grocery stores, and other public property. If you are not familiar with the organization, don’t succumb to pressure to make an immediate giving decision.

When in doubt, check with state charity officials

In many states, charities must register with the office of the attorney general before soliciting donations. Checking with the appropriate office in your state is an easy way to determine whether or not an organization is legitimate. You can find this information on the National Association of State Charity Officials (NASCO) website.

Avoid charities that do not disclose requested information to BBB

Even though participation is voluntary, charities that do not disclose any of the information requested by BBB WGA should raise a red flag. To find out if the charity you have in mind has provided requested information, visit Give.org.

Research a charity’s tax status

Do not assume that every organization claiming to do good is a tax-exempt charity. You can check an organization’s tax status with the IRS Tax Exempt Organization Search tool.

Charitable giving allows you to assist the people and organizations that have come to mean the most to you over the course of your life. It represents a thoughtful expression of your values and can ensure your legacy for generations to come. When done properly, it can also create an income stream and, if you are itemizing deductions, lower your taxes.

We welcome the opportunity to make giving to charity part of your overall estate plan. Simply contact us to discuss your particular charitable goals.

Senior Woman Sitting On Sofa At Home thinking about Social Security

What Women Need to Know about Social Security

Senior Woman Sitting On Sofa At Home thinking about Social Security While Social Security is a crucial component of many Americans’ retirement income, it is particularly important to women. According to the National Committee to Preserve Social Security and Medicare, 48 percent of elderly unmarried women relied on Social Security for 90 percent or more of their total income in 2017.

The Social Security Administration (SSA) has written a booklet detailing what women should know about Social Security. Here are the highlights:


  • If you’ve worked and paid taxes into the Social Security system for at least 10 years, and have earned a minimum of 40 work credits, you can collect your own benefits as early as age 62
  • Social Security benefits are based on your lifetime earnings. SSA adjusts (or “indexes”) your actual earnings to account for changes in average wages since the year the earnings were received. Then, SSA calculates your average indexed monthly earnings during the 35 years in which you earned the most. SSA applies a formula to these earnings and arrives at your basic benefit, which is called your “primary insurance amount”
  • If you become disabled before your full retirement age, you might qualify for Social Security disability benefits if you’ve worked and paid Social Security taxes in five of the last ten years
  • If you receive a pension from a job where you didn’t pay Social Security taxes, such as a civil service or teacher’s pension, your Social Security benefit might be reduced


  • If you are married and both you and your spouse have worked and earned enough credits individually, you can each receive your own Social Security benefit. For example, if you are due a Social Security benefit of $1,200 per month and your spouse is due a Social Security benefit of $1,400 per month, you can receive $2,600 per month in retirement benefits.


  • As a spouse, if you are eligible for benefits based on both your own work record and that of your spouse, you may be required to file for both benefits. If so, you generally receive the higher benefit amount
  • A wife with no work record or a low benefit entitlement on her own work record is eligible for between one-third and one-half of her spouse’s Social Security benefit
  • Most working women who reach retirement age receive their own Social Security benefit because it’s more than one-third to one-half of the husband’s rate
    If your spouse dies before you do, you can apply for the higher widow’s rate. (You’ll find more information about that below)


  • Divorced women who were married for at least 10 years may be eligible for Social Security based on their ex-spouse’s record. This applies only if you are unmarried and not entitled to a higher benefit on your own record when you become eligible for Social Security
  • Some women sign divorce decrees relinquishing their rights to Social Security on their ex-spouse’s record. However, clauses like these in divorce decrees are rarely enforced
  • Benefits paid to a divorced spouse DO NOT reduce payments made to the ex or any payments due the ex’s current spouse
  • Generally, the payment rules that apply to divorced wives and widows are the same as the rules that apply to current wives and widows. This means most divorced women collect their own Social Security while the ex is alive, but they can then apply for higher widow’s rates when the ex dies


  • Widows are eligible for between 71 percent (at age 60) and 100 percent (at full retirement age) of what their spouse was getting before the spouse passed away
  • SSA must pay your own retirement benefit first, then supplement it with whatever extra benefits you are due as a widow to take your Social Security benefit up to the widow’s rate
  • SSA also can pay you a $255 one-time death benefit if you were living with your spouse when your spouse died
  • If you made more money than your spouse (or ex-spouse), then your spouse might be due a survivor’s benefit if you die before your spouse does

You can learn more by reading the SSA publication What Every Woman Should Know, which is available for free.

Couple looking over the medicaid look-back period on their laptop

What is the Medicaid Look-Back Period?

Couple looking over the medicaid look-back period on their laptopMedicaid can pay for the long-term institutional care of individuals who meet certain income and asset requirements. However, if the applicant’s assets and income exceed these limits, he or she may not qualify for Medicaid assistance until the limits are met. Given the high cost of long-term care, people sometimes try to give away their assets before applying for Medicaid in order to become eligible. Of course, state Medicaid agencies want to prevent this, so they require the applicant to disclose all financial transactions made in the last five years. (California is an exception and only requires disclosure of financial transactions made in the last 30 months.)

This five-year period is known as the “look-back period.” In essence, state Medicaid agencies are “looking back” for assets transferred at less than fair market value. If the state Medicaid agency determines that such a transfer was made, it will impose a “penalty period.” And what is the penalty? It is a period of time during which the applicant will be deemed ineligible for Medicaid. The penalty period is calculated by dividing the amount the applicant has transferred by the state’s average cost for private pay institutional care.

Any asset transfer can be scrutinized, regardless of size. Exceptions are not made for gifts to children or grandchildren, charitable donations, or other transfers that seem like “no big deal.” Similarly, informal payments to caregivers or loans to family members can raise red flags. In short, the applicant is considered guilty until proven innocent. The burden of proof lies with the applicant.

It is worth noting that transferring assets to certain recipients will not trigger a penalty period. These recipients include a spouse (or a transfer to someone else if it is for the benefit of the spouse); a trust for the sole benefit of a disabled or blind child; and a trust for the sole benefit of a disabled individual under age 65. The applicant’s home can also be transferred to these recipients without penalty, as well as to all of the following individuals:

  • A child under the age of 21
  • A blind or disabled child
  • A “caretaker child” who resided in the home for two years or more before the applicant required institutional care, and whose care permitted the applicant to delay his or her move to a long-term care facility
  • A sibling who lived in the home during the year preceding the applicant’s move to the institution and who has equity in the property

With proper planning it is possible to protect your assets against the transfer penalty. Even if you have already made asset transfers in the last five years and will be applying for Medicaid soon, we may still be able to protect a portion of your life savings.

Estate planning handwriting sign on the sheet.

Why Your Estate Plan Must Include More than a Will

Estate planning handwriting sign on the sheet.A Last Will and Testament is an essential legal document that allows you to accomplish a number of important goals. You can name your beneficiaries and specify the assets you want them to receive; name a guardian for your minor children; and choose the person you want to settle your estate (known as the Executor).

In short, a Will helps ensure your wishes are carried out after you pass away. However, it does not ensure that your wishes regarding your finances and medical care will be followed if you become incapacitated. For that you will need other essential documents.

Power of Attorney for Health Care

A Power of Attorney for Health Care, also known as a Health Care Proxy, allows you to name a person you trust to make health care decisions on your behalf if you are no longer able to make them on your own. Medical decisions covered by your Power of Attorney for Health Care can include choice of doctors and other health care providers; types of treatments; long-term care facilities; end-of-life decisions, such as the use of feeding tubes; and do not resuscitate orders.

Power of Attorney for Finances

Similar in concept to the Power of Attorney for Health Care, a Power of Attorney for Finances allows you to designate another person to make decisions about your finances, such as income, assets, and investments, when you can longer make them yourself.

By choosing your decision-makers in advance through powers of attorney, you and your loved ones can avoid the expense, stress, delays, and potential for family infighting associated with a court-ordered guardianship proceeding.

Living Will

A Living Will allows you to express your wishes regarding what medical treatments you want, or do not want, in an end of life situation. A Living Will differs from a Power of Attorney for Health Care in that it details your specific wishes, whereas a Power of Attorney for Health Care allows someone else to make health care decisions for you. Another benefit of a Living Will is that it spares your loved ones from having to make difficult decisions about your care without knowing what you would have wanted.

HIPAA Release

A HIPPA Release lets you choose who can receive information about your medical condition. Hospitals and medical providers can be prosecuted for violating the Health Insurance Portability and Accountability Act (HIPAA) if they reveal your medical information to people not named in your HIPPA Release.

To ensure your wishes are carried out while you are alive and after you pass away, your estate plan should include all of the legal documents mentioned above.

Of course, estate planning can help you accomplish many other goals as well. For example, with a Revocable Living Trust your estate won’t have to go through probate. This will expedite the distribution of estate assets to loved ones and keep your financial information private. A Revocable Living Trust also allows you to stipulate when and under what conditions your heirs will receive their assets, which is useful if you think your children are not yet mature enough to handle an inheritance. Other tools, such as an Irrevocable Trust, can protect your assets against threats like long-term care costs, divorce, creditors, lawsuits, and more.

We invite you to contact us at your earliest convenience to discuss your unique planning needs and goals.

Woman preparing home budget, using laptop and calculator. Woman going through bills, looking worried. Shot of a senior woman using a laptop and calculator while working from home

Should You Be Concerned About Changes to the Step-up in Basis?

Woman preparing home budget, using laptop and calculator. Woman going through bills, looking worried. Shot of a senior woman using a laptop and calculator while working from homeWhenever a new president takes office, “discussions” about taxes are sure to follow. During his campaign, President Biden proposed a number of changes to the tax code that would affect wealthy Americans. One proposal, however, could impact people of more modest means: modifications to, or the elimination of, the basis step-up rule.

What do we mean by step-up in basis? Basis, in this case, refers to the value of an inherited asset for tax purposes. One could use the value of the asset when it was originally purchased, or one could use the value of the asset when the original owner passed away and the asset was bequeathed to a beneficiary. The latter value could be considerably higher than the original purchase price.

A step-up in basis uses the higher value, the “stepped-up” value. Assessing the value of an inherited asset in this way translates into lower capital gains tax liability. Let’s look at a hypothetical example.

Say an investor purchased 1000 shares of stock at five dollars a share, meaning the investment was originally worth $5,000. Over time, the value of the stock increased to 25 dollars per share and the original investment was now worth $25,000, a gain of $20,000. When the investor passed away, she left that stock to her son. Without a step-up in basis, the son could be responsible for paying capital gains tax on that $20,000 increase in value. However, with a step-up in basis, any capital gains tax would be based on the stepped-up value of $25,000. If the son sold the stock at the same price he inherited it, he would not have to pay capital gains tax on the $20,000 increase in the value.

The step-up in basis also applies to other appreciated assets, such as a house. Let’s say a property that originally cost $200,000 was worth $400,000 when the original purchaser passed away. If the house was left to the purchaser’s daughter, the step-up in basis would mean the daughter doesn’t have to pay capital gains tax on the $200,000 increase in value (from $200,000 to $400,000). Instead, the value of the property would be “stepped up” to $400,000 for tax purposes.

You can see how the step-up in basis can dramatically lower one’s capital gains tax liability. Eliminating it could have serious financial consequences for the beneficiaries of appreciated assets.

It is important to note that the elimination of the step-up in basis, or even a modification of it, is by no means a certainty. According to the Tax Policy Center, efforts to eliminate the step-up in basis were made in 1976, 2001, and 2015. And while several senators have announced a bill designed to put an end to the step-up in basis, the passage of such a bill could prove difficult in an evenly divided senate. President Biden’s latest proposal would eliminate the step-up in basis to gains over $1 million, with protections for farms and family-owned businesses given to heirs.

For now, it’s all talk. Fortunately, with proper planning, it is possible to protect your assets, inherited or otherwise, against changes to the tax code.

We invite you to contact us at your earliest convenience to discuss your unique planning needs and goals.

Mature woman helping elderly mother with paperwork

Myths and Misconceptions about Probate

Mature woman helping elderly mother with paperworkSimply put, probate is a legal process for settling debts and distributing assets after a person passes away. There are many myths and misconceptions about the probate process, the most common of which we will dispel here.

If the Decedent Had a Will, His or Her Estate Won’t Have to Go Through Probate

While a will allows you to choose the executor of your estate, name a guardian for your minor children, and convey your wishes about who receives your assets after you pass away, it does not allow your estate to avoid probate. As a matter of fact, part of the probate process involves determining the validity of a will.

The Only Way to Avoid Probate Is to Create a Trust

Trusts are powerful estate planning tools capable of helping you accomplish a wide range of planning goals, including probate avoidance. However, having a trust is not the only way your estate can avoid probate. Assets held in joint tenancy with rights of survivorship, payable on death accounts, and multiple party accounts with financial institutions can also avoid probate.

It Takes Years to Complete the Probate Process

We’ve all heard stories about celebrities and wealthy families fighting over estate assets for years on end. And if you are expecting an inheritance, it can seem like years before probate is completed and you actually receive your inheritance. The truth is that while probate can be frustrating, time-consuming, and fraught with delays, the vast majority of estates are settled within a year and oftentimes require considerably less time than that. Most states also allow for what is known as a summary probate when an estate is small and other conditions are met. Summary probates can be completed in a few months. Factors that influence the amount of time required to probate an estate include the number of beneficiaries, the size and complexity of the estate, disagreements between beneficiaries, will contests, the lack of a will, and situations where the decedent had a large number of creditors or debts.

It’s Best to Name the Oldest Child as Executor of the Estate

An executor is the individual who administers an estate during probate. You can name your executor in your will. (If there is no will, the court has the authority to select a “personal representative” to administer the estate.) Although many people want their oldest child to serve as executor, doing so is not a requirement. In fact, it may not even be the wisest choice. Given the importance of the executor’s role and the numerous responsibilities involved in the probate process, you should put a great deal of thought into choosing your executor.

The Cost of Probate Is So High That There Will Be Little Left in the Estate for Beneficiaries

While probate can be expensive, it typically costs less you might think. The cost varies greatly based on where the estate is probated, but it generally falls within a range of three to seven percent of the estate’s value. Many of the factors that influence how long probate takes also impact its cost, particularly the size and complexity of the estate and whether disputes arise between beneficiaries.

We can create a plan to help ensure your estate will not have to go through probate. If you are responsible for probating an estate, or think you will be soon, we can guide you through every stage of the process. Contact us today to get started.

Wife Talking To Depressed Senior Husband At Home

A New Treatment for Alzheimer’s Disease and the Controversy Surrounding It

Wife Talking To Depressed Senior Husband At HomeThe Food and Drug Administration (FDA) has approved a drug purported to slow the progress of Alzheimer’s disease. However, the decision is not without controversy. A recent article by AARP explores this subject in some detail. Here is a synopsis.

The drug, Aducanumab (brand name Aduhelm), was approved on June 7th. While it does not cure Alzheimer’s, it is the first Alzheimer’s medication available in almost 20 years and the only drug that could slow the progression of the disease. How? Testing indicates the drug can break up sticky plaques of protein that accumulate in the brains of many people suffering from Alzheimer’s. Health officials believe that by removing these plaques, Aducanumab may slow the rate of cognitive decline associated with Alzheimer’s. Other drugs currently on the market focus only on addressing symptoms, not causes, of the disease.

The FDA’s approval is conditional, however. Biogen, which developed the drug with Eisai, must conduct additional studies to prove Aducanumab works the way it is intended. If the drug fails to do so, the FDA can withdraw its approval. Other issues surrounding the drug include its price. Biogen estimates that therapy will cost approximately $56,000 per year and it is unclear whether private insurance or Medicare will cover it.

Even so, advocacy groups such as the Alzheimer’s Association have applauded the FDA’s decision, calling it a landmark moment. “We know that slowing decline, particularly with early diagnosis, could add days, weeks, months, maybe even years of active life for individuals and families,” said Kristen Clifford, chief program officer at the Alzheimer’s Association.

Disagreements Within the FDA Over the Drug’s Approval

In November of last year an FDA advisory committee voted against the approval of Aducanumab. Why? Two identical studies produced quite different results. In one study, participants with early onset or mild forms of Alzheimer’s saw their symptoms diminish after being given high doses of the drug. These folks showed signs of improved memory and were better able to manage activities like paying bills and shopping. Unfortunately, participants in the other study did not exhibit similarly positive outcomes.

Of the 11 members on the FDA’s advisory committee, 10 voted against the approval of Aducanumab. After it was approved anyway, three members of the committee resigned. While the FDA does not have to accept the recommendations of advisory committees, it typically does so. In this case, the agency used an accelerated approval process designed for new drugs that offer significantly better results than existing treatments in situations involving life-threatening or serious illnesses.

Inspiring Hope for the Future

In addition to the contention over approval and the high cost of treatment, there are other challenges associated with Aducanumab. For example, not everyone with Alzheimer’s disease will qualify for treatment. Only about two million of the six million Americans currently living with Alzheimer’s are in early stages of the disease and show signs of the sticky plaques that Aducanumab attacks. Determining the presence of these plaques requires costly brain scans and spinal taps that are unavailable to some patients, and the infusion therapy itself may be difficult to access if a patient does not reside near an infusion center. There have also been some troubling side effects, such as tiny brain bleeds or temporary swelling of the brain, which must be closely monitored.

However, according to Jeffrey Cummings, a research professor in the Department of Brain Health at the University of Nevada, Las Vegas, Aducanumab’s approval will foster additional research. “Seeing the fact that we can sort of crack the code of Alzheimer’s disease is just so meaningful, because it will attract funding, which will allow us to test more drugs, which will allow us to eventually make more approvals.”

A recent analysis authored by Cummings notes that there are currently 126 different therapies being tested in clinical trials. Some of these therapies, like the new drug aducanumab, attack the sticky plaques of protein. Others go after different aspects of the disease. Meanwhile, researchers have made great strides in understanding how to preserve brain health and cognitive functioning throughout the aging process using nonpharmacological strategies such as exercise, diet, and controlling blood pressure.

Let us hope that one of the new drugs, or a combination of therapies, will be the key to ending Alzheimer’s disease. Soon!

We invite you to contact us at your earliest convenience to discuss your unique planning needs and goals.

Woodhouse model sitting on laptop

A Change to the Rules Governing Reverse Mortgages Provides Greater Protection for Non-Borrowing Spouses

Wood house model sitting on laptopA reverse mortgage is a loan that allows homeowners age 62 or older to borrow against the equity in their homes and receive a lump sum, a fixed monthly payment, or a line of credit. Reverse mortgages are often used by seniors to augment their income in retirement.

Federal laws governing reverse mortgages have evolved over the years. In May, the Federal Housing Authority (FHA) issued a new rule increasing protection for non-borrowing spouses—that is, the spouses of individuals with reverse mortgages who are not named in the loan itself. Let’s take a brief look at the recent history of reverse mortgages to understand why this change is important and how it will benefit non-borrowing spouses.

In the past, if one spouse was under 62 years of age, he or she could not be named in the loan if the couple wanted to get a reverse mortgage. This had the potential for financial catastrophe. If only one spouse was on the mortgage, and that spouse passed away, the surviving spouse would have to repay the loan or be faced with eviction from the family home.

The Department of Housing and Urban Development made a change to this rule in 2014 that offered greater protection for some surviving spouses. The change stipulated that a couple with one spouse under the age of 62 could get a reverse mortgage if the underage spouse was classified as a “non-borrowing spouse.” Then, if the older spouse passed away, the non-borrowing spouse could remain in the home as long as he or she established, within 90 days, his or her “right” to do so. This right could be established in a number of ways, such as through a lease, a court order, or an ownership document.

Unfortunately, the 2014 change only applied to reverse mortgages taken out after the law became effective and it did not protect the spouses of borrowers who were forced to leave the family home due to medical problems.

The FHA’s new rule corrects these shortcomings and increases protection for the following:

  • All non-borrowing spouses rather than just those whose reverse mortgages went into effect after 2014
  • Non-borrowing spouses of borrowers who resided in a care facility for 12 consecutive months or more
  • Spouses who were in a committed relationship with the borrower when the reverse mortgage was initiated but could not marry because of same-sex marriage prohibition… as long as the couple married before the borrower passed away

In addition, the new rule eliminates the requirement for non-borrowing spouses to show they have a title or legal right to stay in the family home.

Sadly, the new rule fails to protect spouses who weren’t married to the borrower when the reverse mortgage was initiated (with the exception, again, of same-sex couples who were unable to marry legally). Nor can the non-borrowing surviving spouse receive a reverse mortgage’s remaining balance.

We invite you to contact us at your earliest convenience to discuss your unique planning needs and goals.