Memory Care with Teresa Youngstrom
Dennison Keller-Elder Law Life Care Planning
[music] Take your partners, Teresa Youngstrom with a better approach to memory care. This is Memory Care with Teresa Youngstrom, our podcast, and I'm so glad you're here today. A really great speaker for you today, I love doing that for you, and I'm going to fill you with all kinds of great information. I have Dennis and Keller, he is a local attorney in Cincinnati and in Northern Kentucky and an elder law attorney, and someone that I get to work with, so great. My clients, residents, need his kind of help, and we've got to talk today a lot about preparing sooner, planning earlier. So again, remember to always like, subscribe, and share so that we can get the word out about better dementia care, but today we're going to focus on elder law attorney, Dennis and Keller. Welcome to the program. Great to be with you, I really appreciate the invitation. Yeah, absolutely, so Dennis, if you can just give a little more of your history, I didn't have your bio in front of me, but if you can give me more about your history, I know you're well-known in Cincinnati, and actually, your face was well-known before being an attorney, so because you were on TV and I knew about you then. So anyway, tell everybody a little more about Dennis and Keller. Okay, well, I appreciate the opportunity to do so. The cliff notes version is that I used to be a television reporter in anchor and in sports and news and whatnot, and along the way, I decided the news wasn't the thing for me. I tell people, I just found religion or lost it all together and became a lawyer instead. So I went back to school, went to law school while I was still working at the TV station. Channel 12 was the most recent stop in Cincinnati. It wasn't terribly recent ago, it was, I think, 2009, I think it was, I probably cut the cord literally and figuratively, but I've done elder law pretty much out of the gate, and the funny thing is that, you know, I always say my travels as a TV guy led me to elder law, and then I certainly did not know it at the time, but I can almost pinpoint the moment that it happened. I was working at Youngstown, Ohio, and I was doing a story on fruitcakes in Youngstown, Ohio, which shows you the hard-hitting journalist that I was. I was on the fruitcake beat, fruitcake beat in Youngstown, Ohio. And I went into this diner because they had the best fruitcakes in town. This thing on the stool was this gentleman who was in his 90s, and this would have been around 1993 or 1994 or so. And I struck up a conversation with this guy, and he gets to tell him the story, and I don't even know how he got onto it, that when he would get sick with congestion as a child, his mother would go out and pick up the horse droppings off the road in front of his house and bring those back into his house and smear him on his chest. And that was this woman's remedy for clearing up her voice congestion, and I'm looking at him like he's from Mars almost. But then, over time, I just kind of did the math in my head. I'm like, "Okay, for him, I'd have been late or early 1900s." Right? I guess that made sense. I mean, I don't know, but then I thought, "Wow, this one guy saw the beginning of car travel, and this one guy saw the beginning of air travel, this one guy went from that and he saw the beginning of space travel, and this one guy lived long enough to see the downing of the computer age, and it just floored me, and God's not true. I never looked at it out the same way again, and it hit me. The wisdom one accumulates in experiences after seven, eight, nine, ten decades on this planet. It's just fascinating, and unfortunately, I think in western cultures in particular, that's not valued as much as it is elsewhere around the world, and so when I got out of school, like by God, I'm doing elder law, and so I've been in practice now for 17 years, and I have my own firm. We have an office here in bluish, and we also have a satellite office over in northern Kentucky. It's probably more than you bargained for. No, that's exactly what I was hoping for. It's exactly what I was hoping for, and I have set through many of your talks, because I too was fascinated with all that was involved in planning for the future and how so many of us get to be in our fifties and almost beyond, and we haven't taken care of business. We haven't got our ducks in a row, and it's so great to listen to you tell the stories about okay, so you in the audience, you have this much money, you put it away here, you over here, and you give scenarios of how people plan for the future and what works out well, and for some did not work out well, and it was just a great presentation because it made me so curious about the ways that we sometimes think we're putting away money, saving it in the bank, and maybe it isn't exactly the best way to be putting away our money. So I know you are such a great educator in that respect too. So maybe let's talk about how early, you know, should we begin planning for these later stages of life? What time is it? So I mean, you know, we always say it's much better to plan early, and I think, I mean, it's such a cliche, but it's so true, and I think that's the case of every facet of life. I mean, I don't know of a situation on any sort of continuum where, hey, it's better if I wait till the last minute, and that is certainly true on what we view as the elder care continuum, because things happen very, very quickly. It doesn't seem like they do when you're talking about a lifetime of 70, 80, 90 years, but they really do, because the problem is most people don't deal with this stuff until they absolutely have to. And even if they do deal and have some of these frank conversations, it always seems to focus on, well, I'm going to save for my retirement. And then what happens when I pass away? We call that the bridge of the elder care continuum, but almost nobody focuses on what happens in between those two, what happens? And I've got my nest egg, and then I have a chronic care diagnosis that's going to attack my nest egg to the point where I might not have anything left, and whatever will or trust you did for your end of life planning is pretty much moot, because there's no money left. And so that's one of the things that we focus on here is what happens in that in-between stage. Got it, and it's interesting to look at statistics of how many folks our age have no intention of ever needing a retirement community, or to live in a situation like that, but yet so many of us end up living in those situations. So you're just right on track. I remember it, like in my 20s, someone teaching me a little bit about savings and vestings, and they said something like it was a three-legged stool, and you got your pension, right? And you got the government, you got your savings, but how many people my age have pensions, you know, or have our three-legged stool? And so anyway, yeah, I just, I love the topic. Well, one of the big misconceptions out there is even if you have the three-legged stool, all three legs is a stool, which if a few or a few people have anymore, is the fact that they believe somehow there is some magic bullet out there that's going to pay for long-term care, right? Whether it's nursing home or memory care or whatnot, they think, oh, yeah, my health insurance or Medicare will cover that or something, but I mean, newsflash, there is no magic bullet out there. I mean, you might fall and break a hip and go to rehab, and yeah, Medicare will cover a couple of weeks of your rehab at the nursing home after that, but after that, you're on your own. And unless you have long-term care insurance, you know, you're either privately paying at what can be 12, 11, to 13, $14,000 a month, or you've got long-term care insurance. And, you know, if you don't have the funds to do that, then you're looking at Medicaid potentially. Right, exactly, and I agree a hundred percent of the huge misconception out there. And of course, folks that I deal with regularly think, well, mom's got to go to memory care and Medicare will pay for that, and I'm like, no, no, that's going to be private pay, and we're going to have to have that conversation, and probably I'm sending him over to Dennis and Keller to get more information, and we do work like that a lot. But what are some additional steps to consider though, right? To make the process a little easier for myself, for my family, where do we go? The first thing that you have to have, and I think any elder law attorney will tell you this, is you've got to have a financial power of attorney, and it's got to be a good one. Not all powers of attorney are created equally. Some have very basic powers, but sure, you can pay my bills, and that's very, very helpful. And thank God you have that, and you need that. But do you also potentially want enhanced powers, right, and enhanced powers? The problem with enhanced powers are they can be dangerous to you, right? I mean, an example of an enhanced power would be, if you're my daughter Theresa, I give you the authority in my financial power attorney document to take assets, my assets, and give them to yourself, even while I'm alive. Now, hopefully, your listeners on your podcast and your viewers were saying, "Wait a minute, I don't want to do that." But there's caution there for good reason. But what if you want to transfer your house to your child, because your child has been living with you and taking care of you all these years? And if you don't have that power in there, and you've lost capacity to sign that document yourself, because you've got dementia, without that getting power, you're not going to be able to do it. If you go on to Medicaid, there is a thing called Medicaid estate recovery, which means after you pass away, the state circles back around, but try to get paid back for the care that they've given to you. It also applies that there are spouses, too, but the thing with spouses, the nice thing in Ohio, anyway, is that they don't go after those assets until both spouses pass away, and they only go after the assets that were in the Medicaid recipient's name. So the first steps you always take when you have one spouse going on Medicaid, as if it all possible, you transfer that house and those assets over to the healthier spouse's name. And again, if I don't have a power of attorney with gifting authority in there, and it allows that spouse to sign those documents and give them to his or herself, then you're just stuck. The thing is, if you've become demented to a point where you can't understand that document and you can't sign that document, a lot of times the horse is out of the barn. So if I could give any piece of advice, and if there's one takeaway from this talk here with you, I'd love it for people to go and look at their power of attorney documents, see how old those documents are, even if they're new documents, do they have the enhanced powers? Obviously, if you don't have somebody you can trust, if you don't have a child you can trust and you don't want to give your house to your child or what not, then yeah, you don't want those in there. But if you do have folks you can trust, a good thorough power of attorney with enhanced powers can really help you save a lot of assets in a Medicaid scenario. And it's interesting you talk about them circling back, you know, I've talked to lots of families that are afraid to be the POA, you know, they're like, well, I don't want them coming after me. So can you just kind of explain, you know, I mean, once a person passes, the POA is, I mean, is the power of attorney even, I mean, does that, does that power end right there? Sure, once somebody passes away, the power of attorney authority ends. So any check right and ability you might have had, if it's solely vested in the power of attorney, then that ends and then it becomes okay, who's going to be the executor of the estate or the administrator of the estate or the trustee of a trust and then becomes their authority to do that. So you know, and I understand that the reluctance to get involved, you know, it's as long as you're doing your job as power of attorney, they, they, I've never seen in my practice anybody go after a power of attorney, right? And when I see you do your job, there's a list of duties, right? And when we give a power of attorney out, we attach a list of those duties that's imposed by state law. And they're all really pretty intuitive, like acting good faith. Don't do anything that document says you can't do, you know, those types of things. You know, when you do sign, if you are signing for somebody, this is where you do have to be careful. You want to make sure that you're just not signing your name if you're the agent to a contract or a transaction. Okay. Let me give you a little more tangible example. Let's say that Teresa is my mom, okay? And let's say I'm going to try to admit her to a nursing facility. And I'm there. Nice one. Nice one. Okay, if you're only the very best, but I'm there and, you know, the admissions person's office and they're firing, you know, these papers at me, they're not. I don't want to sign Dennis and Keller, Dennis and Keller, Dennis and Keller, right? Because if I do that, then Dennis and Keller has put himself on the hook for whatever bill doesn't get paid for whatever reason. And then at that point, yeah, they can't come after you because you put your own name to that document. How you'd want to sign is Teresa Youngstrom, comma, by Dennis and Keller, comma, POA, or returning it back. And that POA designation on there, that lets the facility and the world know that, hey, wait a minute, I'm just signing on Teresa's behalf. I'm acting as her agent. It's still her contract and she's the one who's on the hook for it. And that works if someone has dementia? Sure. And that's when you would do that if someone has to. Well, anytime you're acting as power of attorney and you have to understand it's powers of attorney, a good one anyway, and how you want it to be, you're live and hot the moment you sign them, you know, it's not necessarily just if you become incapacitated. See, and a lot of people do think that and I really thought that too for a long time. The best example that I can give you is I think somebody is in the military, you know, let's say they're fighting overseas or stationed overseas and, you know, because they might own a home back in the States and have a family and a car and that, there are bills that need to be paid, right? And so the mortgage has to be paid, the car loan has to be paid or whatever and it's really difficult to do sometimes when you're stationed overseas. And so the military will encourage those folks, hey, get a power of attorney in place so they can pay your bills stateside while you're serving your country overseas. That service member is still completely healthy, mentally intact, right? But that power of attorney is still live and hot, right? Because they've signed that. Now you can put in limitations in the power of attorney that make them what are called springing powers of attorney. So in other words, if I thought right as springing power of attorney for Theresa and I'm her agency say, Dennisin can only act if I'm incapacitated to certify by a doctor or if I've signed another writing that says, yeah, this is an enforced in effect. That sounds wonderful. It sounds like a great protection and I suppose it is, but man, it is a nightmare where you're trying to actually use the thing because I've had this come up over and over again, anybody who's kind of dealt practically in the overcare system getting a doctor or a facility to sign off of the fact that yes, Theresa isn't capacitated and she doesn't know what she's doing. She can't hit up financial transactions. It can be really, really challenging because what's in it for the doctor or the facility? Nothing but liability, right? And so even if they do agree to do it, sometimes it can take two, three, four, five weeks to get it done. Not only that, some documents require two statements of incapacity and I've had that come down the pike here in our office and all of a sudden, boom, we've got a house sale pending, all right? We're trying to sell the house so we can pay for care. We got a buyer. We can't close in the transaction because we don't have the statements of incapacity in hand. The power of attorney therefore is not yet in effect and then we lose the seller and then it sits on the market for six more months. I mean, I've seen that play out in my office time and time again. So I'm not a big fan of powers of attorney that requires something to happen before they spring into force. If you have somebody to trust, give them the football, let them run with it at the appropriate time. Got it. That's really good. You know, you've touched on this a little bit, but just let's elaborate how important it is to have an attorney involved because you know people think you can go to the grocery or the local corner store, you know, and get a document and maybe get it notarized. But why is it so important to have an attorney involved, especially an elder law attorney because you understand so much more about this than just your average, you know, just the attorney in town, you know, who doesn't specialize in working with seniors. Right. So I've got a friend and colleague and I'm going to steal his analogy, right? He likens the self help, powers of attorney and the legal zoom type stop to Ikea furniture. Man, it looks good and it's shiny and it just, it just, you know, fits your data together. If you can put in and that's a thing, right? So, but, you know, after a while, you start using that thing on a daily basis, those, you know, screws that were put in with those Allen wrenches, those start to pop out, right? And that's kind of how a power of attorney on a self help format. That's what kind of happened. Yeah. It's, it looks great. It starts to be great. But man, you start using it and started to do some of those more complicated transactions that you often do on the other care continuum and then it's not sufficient. You know, I do a presentation, you may be in sanitary, so I don't know, but I call the top ten mistakes on the elder care continuum and, and, and, and, and, definitely worthwhile. If you're in Cincinnati worthwhile, and number 10 is not hiring an elder law attorney. Now, I know that stuff boy, that's self-sufficient. I always say it's like, you know, the dentist American dental association, you'll get your checkup twice a year. Well, that helps the dentist an awful lot too, not bad, but I mean, it truly, I understand how that sounds. But it is the truth, I mean, if you take a high level of you and you look at the healthcare system in this country in general, right, I mean, it is nearly 20% annually of our gross domestic product, healthcare spending, and everybody in that system has a lawyer, don't they? I mean, your, your doc has a lawyer, your hospital has a lawyer, the nursing home and assisted living facilities, they've got lawyers, the insurance companies that cover all those people, they've got lawyers. Who doesn't have representation? Who doesn't have advocacy on their side, the patient, the resident, until until what? Something goes horribly wrong, and it's now somebody wants to sue somebody, right? You know, there's got to be a better way and we, in fact, there is, and that is again, advocacy on the front end, getting those proper documentations in line, and then having some advocacy to try the tries to prevent that big blow up from happening somewhere down the road. Such good information. I got to, I got to ask you about, I know you guys are different and that's your life care planning law firm. Tell me about the difference. You know, what do you guys do that's different? The focus is solely on estate planning. Sure. Tell me about this. So, what a life care planning firm does, as distinguished against a traditional elder law firm, is a life care planning firm focuses on not just legal advocacy, but also care advocacy. You know, a lot of situations that we encounter, and Teresa, you know, there's all too well. I mean, they just extend beyond the legal ease in the four corners of a document. I mean, I can write you a heck of a trust, right? I can get you on Medicaid, but what happens if your caregiver just doesn't show up three times a week? I mean, is there anything legally that can be done? Practically speaking, no, right? I mean, yeah, breach of contract may be ethereal, okay, but I mean, the result is you're just going to have to go to find a different caregiver, right? And who's that going to be? And, you know, what are good, you know, health care agencies in town and what are some of the not good ones in town and that kind of thing. Those are the types of situations, again, that don't have much of the legal solution, but that's what's keeping families up at night, you know? And so lawyers, say, or God, I'll let Hanley knows, and that's why we have nurses and social workers who are on staff here, who help families navigate families through that care maze while the legal side of the practice does traditional legal work, right? So the wills, the trustees to your plan, the past with turning the Medicaid planning, that's going on, but at the same time, you're getting care advocacy from folks who have been in town in the system working for decades and decades. And I think we counted it up, I think just the care side has 120 years, I think, of elder care experience combined. That's just a lot of knowledge to draw from, and we like it when clients do that. Let me take advantage of that knowledge base. Yeah, I think your law firm was the first one that I encountered that actually had a nurse on staff. You know, there were some that had social workers, but to have a nurse on staff, wait a minute, a nurse that goes out to see clients, I would sometimes meet them, I'd be out to see a client and here I'm running into your nurse, I'm like, wow, I had no idea. Right. But that is, I just think that's so far above and beyond. Oh, thank you. And just to be clear, I mean, the nurse is not taking your blood pressure, right? Yeah. And she is not dressing wounds and things like that. She is there in advocacy role because it's not quote unquote, this is going to come out wrong. Just a nurse, right? I mean, nurses are fantastic. I'm not just lying on that. I know that. Right. But what I'm saying is it's a nurse who's worked in a nursing home for 30 years and one of the other nurses used to be a nursing home administrator, right? That's the combination of the medical background and the knowledge of the care system in the community. That's what it gives us. It's worse. And yeah, it's a heck of an advocate to have on your side. I mean, shoot, you know, my dad's been gone about three years now. And at one point, my dad passed away cancer and he had to have surgery and they removed his colon and he was in the hospital for like five days. And they come to me on a Friday, the hospital does and says, okay, we're going to discharge your father. Where do you want him to go for rehab? Now, I'm an elder law attorney, right? And so at least I should know what questions to ask or at least I'm working knowledge better than most of what's in town and what's not. I was like, so, so what did I do? My, I called, I called one of our elder care coordinators and I'm like, okay, they're discharged in my dad and they were, should I send them, and they said, send him here down. And they did. And he got great care. You know, half the battle in life is known who to call, just known who to call. And it's especially important on the elder care continuum known who to call and the care side of the team to absolutely know who to call, that's for sure. Gotcha. Do you guys work at all guardianships and things like that? Yeah. So I will serve occasionally as guardian of the estate, right, which means I'm handling somebody's money for them. We generally don't serve as guardian of person, but again, our folks kind of serve as advocates and give a roadmap to whoever is the guardian of the person. So yeah, we get involved that way. Okay. And do you ever guide the family on so, so they need to become the guardian? Is it true that someone like one of my clients, do they have to give permission to allow someone to be their guardian? How does that work? No, so, I mean, usually if they're sharp enough to give you permission, then you're just going to do a power of attorney and try to do it with the guardianship process altogether. Right. Because guardianship process is a court process and expensive and it's invasion of privacy because it's a record that's online, dah, dah, dah, dah. So it's quite the contrary. If I'm going for guardian over my parent, essentially what I'm doing is letting, telling the court, Hey, my parents in Compton, they can't make decisions. I need to make them for them, even against their will sometimes. And so that's, that's when a guardian is appointed. Gotcha. Gotcha. Gotcha. Gotcha. Denison, this time has gone by so quickly. It has, hasn't it? I know. And I love it. I love this information. I love it. I love it. I love it. It's a great service that you're doing. You're doing a really great service for this podcast, for sure. Well, I appreciate it. We're trying to send it out far and wide because people really do need this information. And the whole point is they really do need to plan soon or don't they? So let's get this information out to people. Listen, I just want to thank you for being here. Thanks everybody who tuned in. Hey, make sure you like, subscribe, and share the podcast is going great and it's thanks to you. Thanks to people like you that are hungry for this information and are getting it out there and we just so appreciate it. So I'm Teresa Youngstrom. My company is a better approach to memory care. And I appreciate you being here today. Just keep in mind everybody, you got this. [BLANK_AUDIO]