| Publication Date: | 2021 |
| Electronic Forms: | 31 |
| Available Formats: | Print (730 pages, softcover, 1 volume) |
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| Product #: | 908 |
“This fourth edition of Elder Law in Virginia continues to draw on the extensive experience of members of the Virginia Academy of Elder Law Attorneys (VAELA) to provide substantive information in areas such as long-term care and Medicaid planning, incapacity planning, financial security, housing issues, special needs trusts, and related issues.” – Fourth Edition Introduction by Christopher McCarthy, Immediate Past VAELA President and Editor of this edition
Elder law practice has grown in response to the burgeoning senior population over the past few decades—by 2050, the senior population of the United States will likely double. The response from within the legal community to the needs of this increasing population has been the growth of the practice area known as elder law. Once considered a practice dedicated exclusively to Medicaid planning and other wealth preservation techniques, elder law now encompasses an array of complex issues and disciplines associated with today’s aging and disabled populations. The modern elder law attorney must be versed in both traditional asset protection and estate planning as well as a number of topics related to incapacity, health and long-term care, social security, housing, age discrimination, and elder abuse and fraud. This new planning paradigm is based on relationships and values, not forms and transactions. It also requires the acquisition of new skills, more knowledge, and the ability to advise on financial products and services.
Elder Law in Virginia is the premier treatise in this area of practice for Virginia attorneys. In addition to the substantive issues, the handbook also gives practical information on managing an elder law or Medicaid practice and handling the ethical issues and conflicts of interest that elder law attorneys so commonly face, especially when dealing with agents and those with compromised cognitive abilities.
New topics addressed in the 2021 edition include changes to the Medicaid Manual including CCC Plus Waivers, expanded coverage of financial planning services, special needs trusts strategies, and new cases, legislation, and regulations.
CHAPTER 1: THE ELDER LAW PRACTICE
1.1 INTRODUCTION
1.101 Development of Elder Law as a Specialty
1.102 Unique Challenges Facing Elder Law Practitioners
1.2 THE ELDER LAW PRACTICE
1.201 Unique Aspects of the Elder Law Practice
1.202 Legal Practice Areas Covered
1.203 Cultivating Referral Sources
1.204 Understanding the Aging Process
1.205 Understanding Dementia
1.206 Organizations and Resources
1.3 THE ELDER LAW CLIENT
1.301 The Initial Contact
1.302 The Initial Appointment
1.303 The Client Information Questionnaire
1.304 Identifying the Client
1.305 Payment of Legal Fees by Non-Client
1.4 ETHICAL CONSIDERATIONS WHEN THE CLIENT IS
UNDER A DISABILITY
1.401 Duties Imposed Under the Rules of Professional Conduct
1.402 Other Resources for Ethics Rules
1.403 ACTEC Commentaries on ABA Model Rules of Professional
Conduct
1.404 Client with Impairment
1.405 Communications with Clients
1.406 Conflicts of Interest
1.407 Confidences of the Impaired Client
1.5 PRACTICAL CONSIDERATIONS INVOLVING THE
BLENDED FAMILY
1.501 What Is a Blended Family?
1.502 Marital Agreements
1.503 Beneficiary Designations
1.504 Standby Trusts
1.505 Estate Plans—Contingency Planning
1.506 Trusts—Protective Planning
1.507 Importance of Comprehensive Planning
1.6 COLLABORATION WITH OTHER PROFESSIONALS AND
AGENCIES
1.601 Private Health Care Professionals
1.602 Governmental Representatives
1.603 Certification as Guardian ad Litem for Adults
1.604 The Multidisciplinary Practice Separate Services
Arrangements
1.605 Internet Resources and Professional Associations
1.7 THE ATTORNEY AS FIDUCIARY
1.701 Ethical Rules for Attorneys Acting as Fiduciaries
1.702 The Virginia Rules of Professional Conduct
1.703 Fiduciary Roles
1.704 Statutory Provisions
1.705 Non-Attorney Fiduciaries
1.706 Advantages of Attorney as Fiduciary
1.707 The Drafting Attorney as Fiduciary
1.708 Attorney as Executor/Trustee
1.709 Fiduciary Litigation and Petitions for Court Guidance
1.710 Fiduciary Accountings
1.711 Attorney at Law as Attorney-in-Fact
1.712 Risks of Construction of Powers of Attorney
1.713 Risks and Rewards of Fiduciary Service
1.8 THE ATTORNEY AS FIDUCIARY
1.801 Ethical Rules for Attorneys Acting as Fiduciaries
1.802 The Virginia Rules of Professional Conduct
APPENDIX 1-1: ELDER LAW ESSENTIAL INFORMATION
SURVEY
APPENDIX 1-2: GUARDIANSHIP/CONSERVATORSHIP
ESSENTIAL INFORMATION SURVEY
APPENDIX 1-3: ENGAGEMENT AGREEMENT—MEDICAID
PLANNING
APPENDIX 1-4: ENGAGEMENT AGREEMENT—ESTATE
PLANNING
APPENDIX 1-5: ENGAGEMENT AGREEMENT—GUARDIANSHIP
AND/OR CONSERVATORSHIP APPOINTMENT
APPENDIX 1-6: LETTER TO PHYSICIAN FOR CAPACITY
DETERMINATION—GUARDIANSHIP/CONSERVATORSHIP
PETITION
APPENDIX 1-7 LETTER TO PHYSICIAN FOR CAPACITY
DETERMINATION—TESTAMENTARY
APPENDIX 1-8: ASPIRATIONAL STANDARDS FOR THE
PRACTICE OF ELDER LAW
APPENDIX 1-9: LIST OF ELDER LAW RESOURCE
ORGANIZATIONS
APPENDIX 1-10: LEGAL ETHICS OPINION 1617: ATTORNEY
AS FIDUCIARY; ACCOUNTING FOR FUNDS
AND PROPERTY
APPENDIX 1-11: DISCLOSURE LETTER PURSUANT TO LEO 1515
2.1 OVERVIEW
2.101 The Evolving Role of the Elder Law Attorney
2.102 Adopting Financial Planning as a Core Competency
2.103 Ethical, Competency and Practical Considerations
2.2 WEALTH MANAGEMENT
2.201 The Financial Planning Process
2.202 Client Engagement
2.203 Data Collection
2.204 Financial Analysis
2.205 Plan Design
2.206 Plan Implementation
2.207 Plan Monitoring
2.3 THE ELDER LAW ATTORNEY AS A FINANCIAL
PLANNER
2.301 Determining What Planning Should Be Done
2.302 Acquiring Financial Planning Skills and Expertise
2.303 Elder Law Attorneys Providing Financial Planning
Services
2.304 Conflicts of Interest
2.305 Collaboration with Allied Disciplines
2.4 INTEGRATING ELDER LAW PRACTICE WITH FINANCIAL
PLANNING AND INVESTMENT ADVISORY SERVICES
2.401 Services Offered
2.402 Regulation and Supervision
2.403 Broker/Dealer Affiliation
2.404 Elder Law Attorneys as Registered Investment Advisors
2.405 Investment Advisor Registration and Licensing
2.406 State Regulation and Insurance Licensing Requirements
2.407 Elder Care and Long-Term Care Insurance
2.5 FINANCIAL PLANNING ELEMENTS
2.501 General Principles
2.502 Insurance Planning
2.503 Investment Planning
2.504 Income Tax Planning
2.505 Estate Planning
2.6 ADDITIONAL ELEMENTS OF FINANCIAL SECURITY
2.601 Medicare
2.602 Social Security
2.603 Retirement Plans and Accounts
2.7 CONCLUSION
APPENDIX 2-1: CFP® BOARD-REGISTERED PROGRAMS FOR
VIRGINIA ATTORNEYS
APPENDIX 2-2: SECURITY LICENSES
APPENDIX 2-3: DISCLOSURE STATEMENT—FINANCIAL
SERVICES
APPENDIX 2-4: SAMPLE FINANCIAL PLANNING COURSE
CURRICULUM
3.1 HOUSING CHOICES AND THE CONTINUUM OF CARE
3.2 INDEPENDENT LIVING
3.201 “Aging in Place”
3.202 Retirement Housing
3.203 Subsidized Housing (Federal or State)
3.204 Housing Opportunity Through Modernization Act
of 2016
3.205 Virginia Property Tax Relief
3.3 SUPPORTIVE HOUSING
3.301 “Supportive Housing” and “Assisted Living”
3.302 Assisted Living Facilities (ALFs)
3.303 Continuing Care Retirement Communities (CCRCs)
3.304 Adult Foster Care Homes
3.4 NURSING FACILITIES
3.401 In General
3.402 Sources of Law
3.403 Quality Care and Resident Rights
3.404 Admission, Transfer, and Discharge Rights
3.405 Adult Foster Care Homes
3.5 HOME CARE
3.501 Medicare Coverage
3.502 Medicaid Community-Based Care
3.503 Area Agencies on Aging Services
3.6 HOUSING FOR THE INTELLECTUALLY DISABLED
3.601 Funding for In-Home Residential and Group
Home Support
3.602 Micro-boards
APPENDIX 3-1: VIRGINIA UNIFORM ASSESSMENT
INSTRUMENT
CHAPTER 4: PAYING FOR LONG-TERM CARE
4.1 THE PAYMENT DILEMMA
4.101 The Demographics of Aging
4.102 Longevity and Declining Health
4.103 The Nursing Home Population
4.104 Long-Term Care Costs
4.105 Sources of Payment for Long-Term Care
4.2 LONG-TERM CARE INSURANCE
4.201 Availability, Qualification, and Suitability for the Client
4.202 The Lawyer’s Advisory Role
4.203 Regulations, Disclosures, and Policy Requirements
4.204 Lump-Sum Universal Life Insurance/Long-Term
Care Policies
4.205 Accelerated Death Benefits (ADBs)
4.206 Virginia Long-Term Care Insurance Partnership
Policies
4.3 MEDICARE PAYMENT OF LONG-TERM CARE
4.301 Limited Medicare Payment of Skilled Care Costs
4.302 Covered and Excluded Services
4.303 Prohibited Practices Related to Payments and
Charges
4.304 Medicare Benefits for Dually Qualified Medicaid
Beneficiaries
4.305 Medicare Appeals
4.4 MEDICAID BENEFITS FOR PAYMENT OF
LONG-TERM CARE
4.5 VETERANS BENEFITS
4.301 In General
4.302 Aid & Attendance and Housebound Allowance
Program
4.303 Veteran-Directed Home and Community Based
Services Program (VD-HCBS)
4.6 HEALTH AND DISABILITY INSURANCE
4.601 In General
4.602 Health Insurance
4.603 Disability Insurance
4.7 PAYING PRIVATELY FOR CARE
4.701 In General
4.702 Reverse Mortgages
4.703 Annuities
4.704 Trusts
APPENDIX 4-1: LONG-TERM CARE CARRIER RATINGS
FEBRUARY 2017
CHAPTER 5: MANAGING INCAPACITY
5.1 INTRODUCTION
5.2 PLACEHOLDER ONLY
5.201 In General
5.202 Presumption of Capacity
5.203 Mental Ability
5.204 Defining Capacity
5.205 Causes of Incapacity
5.206 Undue Influence
5.207 Attorney Assessment
5.208 Medical Evaluation
5.209 Four Basic Legally Relevant Criteria
5.210 Level of Evaluation
5.3 LAST WILL AND TESTAMENT
5.201 Testamentary Capacity
5.302 Incapacitated Adult with Testamentary Capacity
5.303 Unnatural Dispositions
5.304 Testator’s Free Will
5.305 Proponent’s Burden of Proof
5.306 Undue Influence
5.4 PROTECTION OF INCAPACITATED PERSONS
5.401 Financial Exploitation—Criminal Offense
5.402 Reporting Abuse, Neglect, or Exploitation
5.403 Obtaining Attorney Fees When Protecting
Incapacitated Individuals from Fraud
5.5 POWER OF ATTORNEY
5.501 The Virginia Uniform Power of Attorney Act
5.502 Governing Law
5.503 Creation
5.504 Capacity
5.505 Effectiveness of a POA
5.506 Possession of the POA
5.507 Durability
5.508 Agent
5.509 Federal Agency Requirements for POAs
5.510 Recordation
5.511 Letter of Instruction Interpreting Distribution Powers
5.512 Litigation
5.513 Liability for Breach of Duty
5.514 Reimbursement and Compensation of the Agent
5.515 Third-Party Acceptance of and Reliance upon a POA
5.516 Agent’s Resignation
5.517 Termination of the POA
5.518 Agent’s Certification
5.6 ADVANCE MEDICAL DIRECTIVE
5.601 In General
5.602 Terms Used in the Act
5.603 Individual Rights Not Limited
5.604 Capacity Determinations
5.605 Certification of Incapacity
5.606 Recertification of Incapacity
5.607 Communication-Related Disabilities
5.608 Notice to Patient and Agent
5.609 Restoration to Capacity
5.610 Creation of an AMD
5.611 End-of-Life Decisions
5.612 Medical Power of Attorney
5.613 Oral AMD
5.614 Agent’s Standard of Care
5.615 Patient Protest
5.616 Working with the Physician
5.617 Protected Health Information
5.618 Virginia Health Records Act
5.619 Incorporation of a Letter of Instruction or
Memorandum
5.620 Life Insurance
5.621 Advance Health Care Directive Registry
5.622 Court Intervention
5.623 Statutory AMD Form
5.624 Revocation of an AMD
5.625 Health Care Decision-Making if an AMD Is
Inadequate, Incomplete, or Absent
5.7 DURABLE DO NOT RESUSCITATE ORDER
5.8 PHYSICIAN ORDERS FOR SCOPE OF
TREATMENT (POST)
5.9 TRUSTS
5.901 Definitions and Background
5.902 Requirements for Trust Creation
5.903 Benefits of Trusts in Incapacity Planning
5.904 Drawbacks of Trusts in Incapacity Planning
5.10 GUARDIANSHIPS AND CONSERVATORSHIPS
5.1001 In General
5.1002 Definitions
5.1003 Petition Against a Minor
5.1004 Venue
5.1005 Jurisdiction Generally
5.1006 Continuing Jurisdiction
5.1007 Court’s Discretion to Decline Jurisdiction
5.1008 The Petition
5.1009 Guardian ad Litem
5.1010 Notice of Hearing
5.1011 Answer
5.1012 Evaluation Report
5.1013 Court Hearing
5.1014 Filing Fees and Court Costs
5.1015 Order of Appointment
5.1016 Qualification of Guardian and Conservator
5.1017 Duties and Authority of Guardian
5.1018 Duties and Authority of Conservator
5.1019 Termination of Conservatorship
5.1020 Petition to Expand the Appointment of a Guardian
or Conservator
5.1021 Petition to Modify or Terminate the Appointment
of a Guardian or Conservator
5.1022 Additional Issues
5.11 ALTERNATIVES TO GUARDIANSHIPS AND
CONSERVATORSHIPS
5.1101 In General
5.1102 Limited Guardianships
5.1103 When Conservator or Guardian Need Not Be
Appointed
5.1104 Joint Tenancy
5.1105 Payment of Federal Benefits
APPENDIX 5-1: CAPACITY WORKSHEET FOR LAWYERS
APPENDIX 5-2: FOLSTEIN MINI-MENTAL STATUS
EXAM (MMSE)
APPENDIX 5-3: LEGAL CAPACITY QUESTIONNAIRE
APPENDIX 5-4: GENERAL DURABLE POWER OF ATTORNEY
APPENDIX 5-5: CONSENT TO RELEASE HIPAA-PROTECTED
INFORMATION
APPENDIX 5-6: ADVANCE MEDICAL DIRECTIVE
APPENDIX 5-7: DURABLE DO NOT RESUSCITATE ORDER
APPENDIX 5-8: TRUST PROVISION—CARE OF GRANTOR
IN EVENT OF GRANTOR’S INCAPACITY
APPENDIX 5-9: ADDENDUM FOR PROTECTED IDENTIFYING
INFORMATION
APPENDIX 5-10: PETITION FOR APPOINTMENT OF GUARDIAN
AND CONSERVATOR
APPENDIX 5-11: ORDER APPOINTING GUARDIAN AD LITEM
APPENDIX 5-12: NOTICE TO RESPONDENT OF MOTION
FOR ORDER APPOINTING GUARDIAN AD LITEM
APPENDIX 5-13: NOTICE TO FAMILY OF MOTION FOR
ORDER APPOINTING GUARDIAN AD LITEM
APPENDIX 5-14: CERTIFICATE OF COMPLIANCE WITH
NOTICE REQUIREMENT
APPENDIX 5-15: PHYSICIAN’S EVALUATION REPORT
APPENDIX 5-16: PETITION FOR PROCEEDING IN CIVIL CASE
WITHOUT PAYMENT OF FEES OR COSTS
APPENDIX 5-17: AFFIDAVIT OF INDIGENCE
APPENDIX 5-18: ORDER OF INDIGENCE
APPENDIX 5-19: ORDER APPOINTING GUARDIAN AND
CONSERVATOR
APPENDIX 5-20: REPORT OF GUARDIAN FOR AN
INCAPACITATED PERSON
CHAPTER 6: SPECIAL NEEDS TRUSTS
6.1 INTRODUCTION
6.101 In General
6.102 What Is a Special Needs Trust?
6.103 Purposes of Special Needs Trusts
6.104 Uses and Misuses of Special Needs Trusts
6.105 Special Needs Trusts and Malpractice
6.2 PUBLIC BENEFITS OVERVIEW
6.201 In General
6.202 Benefits Not Based on Financial Need
6.203 Benefits Based on Financial Need
6.3 SELF-SETTLED SPECIAL NEEDS TRUSTS
6.301 In General
6.302 Drafting Rules for (d)(4)(A) SNTs
6.303 Other (d)(4)(A) Trust Provisions
6.304 Drafting a (d)(4)(C) SNT
6.305 Alternatives to a Self-Settled Special Needs Trust
6.4 THIRD-PARTY SPECIAL NEEDS TRUSTS
6.401 In General
6.402 Drafting Rules
6.403 Additional Trust Provisions
6.404 Form of Trust
6.405 Interface with Other Aspects of Estate Plan
6.406 Special Needs Trust for Surviving Spouse
6.5 DISTRIBUTIONS AND DISBURSEMENTS FROM
SPECIAL NEEDS TRUSTS
6.501 In General
6.502 Effect of Income and In-Kind Support and
Maintenance on SSI Eligibility
6.503 Medicaid Requirements
6.504 State Requirements and “Decoupling”
6.6 ADMINISTRATION AND TAXATION OF SPECIAL NEEDS
TRUSTS
6.601 In General
6.602 Notification and Reporting Requirements
6.603 Trustee Powers and Duties
6.604 Trust Taxation Issues
6.605 Investment and Management of Trust Assets
6.7 LITIGATION ASPECTS OF ESTABLISHING SPECIAL
NEEDS TRUSTS
6.701 In General
6.702 Establishment Process for Inheritances and Excess
Funds
6.703 Establishment and Administration Process for
Matrimonial Law
6.704 Establishment Process for Personal Injury Claims
6.8 CONCLUSION
6.9 BIBLIOGRAPHY OF SPECIAL NEEDS PLANNING
RESOURCES
APPENDIX 6-1: SELF-SETTLED SPECIAL NEEDS TRUST
APPENDIX 6-2: THIRD-PARTY SPECIAL NEEDS TRUST
APPENDIX 6-3: ATTORNEY CERTIFICATION FOR SURVIVOR
BENEFIT PLAN ANNUITY
7.1 INTRODUCTION
7.101 Medicaid Services Generally
7.102 Funding and Administration of Medicaid
7.103 Sources of Law and Regulation
7.104 Financial Limitations, Standards, and Thresholds
7.2 CATEGORIES OF NEED IN THE ELIGIBILITY
DETERMINATION
7.201 SSI Recipients
7.202 80% Federal Poverty Level (FPL) Applicants
7.203 Medically Needy Applicants
7.3 GENERAL ELIGIBILITY CRITERIA FOR “MEDICALLY
NEEDY” APPLICANTS
7.301 The Evaluation Process
7.302 Marital Status of Applicant
7.4 CITIZENSHIP, IDENTITY, AND RESIDENCY CREDENTIALS
FOR NON-MEDICARE/SSI ENROLLEES
7.401 Proof of Identity and Citizenship
7.402 Virginia Residency Requirement
7.5 AGE, BLINDNESS, OR DISABILITY REQUIREMENT
7.501 “Aged”
7.502 “Blind”
7.503 “Disabled”
7.6 INSTITUTIONAL STATUS REQUIREMENT
7.601 Virginia Auxiliary Grant Program for Assisted
Living Residents
7.602 Institutional Status Defined
7.603 Pre-admission Screening for Institutional Status
7.7 INCOME ELIGIBILITY AND “SPENDDOWN”
7.701 Income Test for Initial Eligibility
7.702 Medicaid Spenddown
7.8 POST-ELIGIBILITY INCOME DEDUCTIONS
7.801 Determining “Patient Pay”
7.802 Deductions from Patient’s Income
7.803 Patient Pay for Married LTC Recipients
7.804 Spousal Monthly Maintenance Allowance
7.805 Dependent Family Member Allowance
7.9 CONTRIBUTIONS FROM THE COMMUNITY SPOUSE
7.10 “COUNTABLE” AND EXEMPT RESOURCES
7.1001 Countable Resources
7.1002 Exempt (Excluded) Resources
7.11 COMMUNITY SPOUSE RESOURCES RULES
7.1101 Purpose of the CSPRA
7.1102 Calculating the CSPRA
7.1103 Resource Eligibility Dates
7.12 TRANSFER OF ASSETS OR RESOURCES
7.1201 Purpose of Transfer Limitations
7.1202 Attempts to Impose Criminal Liability for Prohibited
Transfers
7.1203 Meaning of “Transfer”
7.1204 Limited Reach of Transfer Rule
7.1205 “Penalty Period” for Prohibited Transfers
7.1206 Imputed Transfers of Assets
7.1207 Transfers by Spouses
7.1208 Exempt Transfers
7.1209 “Undue Hardship” Exemption from Transfer Penalty
7.1210 The “Look-Back” Period for Transfers
7.13 MEDICAID PLANNING STRATEGIES
7.1301 Planning for Initial Eligibility
7.1302 Suggested Dispositions of Excess Resources
7.1303 Conversions to Cover a Period of Ineligibility Because
of Asset Transfers
7.1304 Transfers That Precede Institutionalization
7.1305 Divorce Following Transfer of Assets to Community
Spouse
7.1306 Purchase of EE or I United States Savings Bonds
7.14 MEDICAID RECOVERY FROM TRANSFEREES
7.15 ESTATE RECOVERY
7.16 MEDICAID RECIPIENTS AS ESTATE BENEFICIARIES
7.17 THE MEDICAID APPLICATION
7.1701 The Application Form
7.1702 Authorized Representative of Applicant
7.1703 Processing the Application
7.1704 Retroactive Coverage
7.1705 Required Information and Verification
7.1706 Notice of Action
7.1707 Right of Appeal
7.18 APPEALS
7.1801 Right to and Basis of Appeal
7.1802 Policies and General Procedures
7.1803 Notification Requirements
7.1804 Appeal Validation and Agency Appeal Summary
7.1805 Fair Hearing Procedure
7.1806 Continuation of Medicaid Coverage During Appeal
and Remand
7.1807 Informal Review Through Local Agency Conference
7.1808 Appeal of Administrative Decision to Circuit Court
7.19 MEDICAID COMMUNITY-BASED CARE WAIVERS
7.1901 Background
7.1902 The Virginia Waiver Programs
7.1903 Funding
7.1904 Qualification for Services
7.1905 Access to Services
7.1906 Elderly or Disabled with Consumer-Direction
Waiver (EDCD)
7.1907 CBC Waiver Spenddown
7.20 THE PACE PROGRAM IN VIRGINIA
7.2001 Introduction
7.2002 Availability in Virginia
7.2003 Organizational Requirements
7.2004 PACE Services Offered
APPENDIX 7-1: MEDICAID APPLICATION FORM
APPENDIX 7-2: ASSET TRANSFER UNDUE HARDSHIP CLAIM
FORM
APPENDIX 7-3: WAIVER OF ELECTIVE SHARES IN SPOUSES’
ESTATES
APPENDIX 7-4: BURIAL FUND DESIGNATION FORM
APPENDIX 7-5: INTENT TO TRANSFER ASSETS TO THE
COMMUNITY SPOUSE
APPENDIX 7-6: CHECKLIST OF NEEDED VERIFICATIONS
APPENDIX 7-7: NOTICE OF ACTION ON MEDICAID
AND FAMIS
APPENDIX 7-8: ADVANCE NOTICE OF PROPOSED ACTION
APPENDIX 7-9: NOTICE OF APPEAL FROM DENIAL OF
BENEFITS
TABLE OF AUTHORITIES
INDEX
EDITOR:
AUTHORS:
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