Irrevocable Income Only Trusts: A Valuable Medicaid Planning Tool

The Irrevocable Income Only Trust is an important planning tool

It is no secret that the high cost of long term care can be ruinous. Everything you worked for -- lifetime savings, even your house and retirement accounts -- can all be wiped out in a matter of months to a few years. That is why advance planning, including Medicaid planning, is so important. It is critical for most families that a loved one needing long term care qualifies for Medicaid assistance.

Among the planning strategies used to qualify for Medicaid, one of the most important is transferring assets into an Irrevocable Income Only Trust ("IIOT"). The purposes of the IIOT include (1) to preserve a source of income, (2) to shield and manage assets, (3) to ensure Medicaid eligibility, and (4) to avoid the costs and time associated with probate. IIOTs allow individuals to transfer their assets into a trust as protection in lieu of making outright transfers to their children. Under the terms of an IIOT, the transferor ("grantor") will receive all of the income produced by the assets in the trust for the grantor's lifetime. By transferring assets into an IIOT, the grantor will still reserve some control and retain some interest in the transferred assets -- advantages that are not available when transfers are made outright to individuals. If the grantor places the grantor's home into the trust, then the trust agreement can specifically provide for the grantor to continue to reside in the home for the grantor's lifetime. Because IIOTs are irrevocable, the grantor cannot revoke the trust and reacquire the assets; therefore, the assets are deemed unavailable (and, therefore, not countable) for Medicaid eligibility purposes.

The IIOT can be used to qualify for Medicaid

Under current law, Community Medicaid (i.e., the kind applicable for care at home or at many Assisted Living Facilities) may be available within a couple of months after the assets are transferred into a trust. Institutional Medicaid (i.e., the kind applicable for care at a Nursing Home) would be available after the look-back period expires. The look-back period is the time window within which Medicaid can look to see if assets have been transferred. It is also the period prior to the Medicaid application during which Medicaid will penalize an applicant for transfers within such period. Under current law, the look-back period is now five (5) years.

Assets transferred into a trust more than five years prior to the filing of a Medicaid application will not impact Medicaid eligibility. If, however, a person who set up such a trust ends up needing Nursing Home care before five years elapse, a penalty period would be assessed and some other planning technique would likely have to be employed. If a penalty is imposed because of a transfer to an individual or a trust within five years of a Medicaid application, the period of ineligibility begins when the individual enters a nursing home and is otherwise eligible for Medicaid.

The IIOT can save taxes

IIOTs also offer tax advantages. The grantor is treated as the owner of the trust for income tax purposes. This is valuable because the trust's income tax rates are usually higher than the grantor's income tax rates. Additionally, the IIOT can be drafted to include a special power of appointment for the limited purpose of including the trust assets in the grantor's estate for estate tax purposes. A special power of appointment will also permit a grantor to change his or her beneficiaries. Upon the grantor's death, the trust assets obtain a "step-up" in value. This means that when the assets are distributed to the grantor's chosen beneficiaries, the beneficiaries' bases in the assets for income tax purposes will be the value of the assets as of the grantor's date of death. As a result, the beneficiaries will avoid any capital gains taxes on the appreciation of the trust assets between the date of acquisition and the grantor's death if the property is sold after the grantor's death.

An Irrevocable Income Only Trust can be a valuable tool. It is complex and has many potential pitfalls, so a knowledgeable Elder Law attorney must be consulted.

Remotivation Therapy: What a Concept?

Activity Professionals are presented with new and old therapeutic modalities on a constant basis. Each therapeutic intervention is designed to enhace the quality of life for the client. Today there are a variety of therapies such as pet therapy, music therapy, aromatherapy and vaildation therapy. Each one is well known and used by activity professionals throughout the nation however, there is an under utilized therapuetic technique which is referred to as remotivation therapy that provides a wonderful opportunity for one to explore.

Remotivation therapy is defined by the National Remotivation Therapy Org. Inc. (N.R.T.O.) as "Remotivation is a small group therapeutic modality innature, desinge to help clients by promoting self-esteem, awareness and socialization." (Remotivation.com) Those who facilitate these groups are referred to as Remotivation therapists. The N.R.T.O. Inc defines a Remotivation therapist as one who uses Remotivation therapy to reach the "unwounded" areas of the patient's personality to get them to think about reality. This is different from other therapies because it doesn't focus on the patient's disabilities. Instead Remotivation therapy focuses on the abilities that the client's have.

The beauty of Remotivation therapy is that anyone can do this therapeutic intervention. This modality occurs in Long term Care, Assisted Living and Adult Day Care settings which can be provided by Social Workers, nurses, chaplains and volunteers. Our clients deal with an interdisclinary team when it comes to their care. If this technique is used it will enhance the quality of life for the clients.

Remotivation therapy is provided in a one to one or in a small group setting. Considering that we have a diverse set of clients in LTC it benefits those who have dementia, need more sensory stimulation and are independent, also clients who are physically and cognitively able to participate but choose not to or choose to do so. Remotivation therapy is a tool that can reach non responsive individuals. This tool aids others with their resocialization skills. This same technique will assist the client in maintaining or improving his physical and cognitive abilities.

A Remotivation therapy session is designed to create fun. The session consists of five structured steps.

STEP I Climate of Acceptance: the therapist greets each member of the group. The facilitator says something positive to each person.
STEP II The Bridge to the Real World: In this step, the facilitator utilizes bounce questions to lead the group to the topic for the day.
STEP III Sharing the world We Live In: this is where a discussion on the topic is held in the everyday world.
STEP IV An Appreciation of the Work of the World: In this step, a discussion is held on the work aspect of the topic.
STEP V Climate of Appreciation: The facilitator individually thanks the clients for attending his/her session. The next meeting is announced.

The Remotivation therapist creates an environment where the client feels safe. In this environment whatever the client says is accepted by the Remotivation therapist in a non-judgmental manner. Thereby a trusting relationship is established between the client and the Remotivation therapist. The Remotivation therapists accepts and appreciated what the client provides. It could be actively paticipating in the session or reaming silent through out the session. It is the gift of their presence that the Remotivation therapist acknowledges.

Remotivation therapy is a wonderful tool to use for the clients. It is a five step process that deals with the client's unwounded part of the brain. The clients do not dwell onthe emotional aspect of the topic because it is objective in nature. As the sessions progress one will see the change in the cleint. Today, I utilize Remotivation therapy in all of my programs in my facility. This increases their self-esteem and socialization, which provides the opportunity for the individual to focus on something other than their illness. After a few sessions the clients are more social and talkative. Remotivation therapy is a wonderful tool which Activity professionals would benefit from because it would enhance the quality of life of our clients.

NRTO Policy & Procedure Manual, 1995, p. 3 < http://www.remotivation.com/DefinitionRM.asp

Person Centered Care - From An Institution To A Home

Recently, person-centered care in nursing homes has been receiving a great amount of attention. Organizations have developed with the sole purpose of advancing the philosophy and approaches of this model of care. More nursing homes have undergone culture change by using a person-centered approach. And, there is an increasing amount of publications written about person-centered care, person-first care, patient-centered care and resident-centered care in nursing homes. Although the philosophy behind this care model is not new, some of the specific approaches and methods used in nursing homes today are rather new and very exciting. It takes a total commitment, from the administration to floor staff, to make person-centered care work. If there has been some hesitancy in implementing this type of care in your facility, its time to get excited about the best way of delivering the most highly individualized care there is. And, yes, you can do it!

First of all, leadership must believe in the person-centered model of care. This is no easy task for some administrators and directors of nursing, who have been used to more traditional forms of care. It involves more than prettying up the facility with more home-like creature comforts. It is a philosophy of care that truly puts the resident in the center of the care process. Routines, schedules and tasks become secondary to the needs, desires and pace of the resident.

Second, leadership must get all employees on board with this type of thinking. Nursing, social services, activities, dietary, housekeeping and laundry, and therapies must be educated and shown the benefits of this kind of care in order to believe that it can and will work in their facility. Skilled nursing homes have traditionally provided institutionalized care under the old medical model that places medication passes, treatments, dinning schedules, and pre-scheduled activities before the needs of the resident. Leadership must emphasize that person-centered care essentially turns this old model of care upside down.

Third, leadership must get residents and families involved in designing, customizing and implementing person-centered care through active participation in one-on-one discussions, resident council meetings, and family focus groups. Administration and staff cannot make all the decisions that go into care without critical input from those they care for. Residents provide important information concerning care issues such as when they like to wake up in the morning and when they like to go to bed, what they like to eat and when they would like to eat, preference of a bath, shower, or some other bathing experience, preference of caregiver, and where they would like to live in the facility. Families offer details on their loved ones history, likes and dislikes, religious and spiritual preferences, past occupations and careers, and hobbies. All of this input helps staff to create a more unique and individualized resident-centered care environment and experience.

Fourth, leadership gathers all of the ideas and information they have collected from residents, families, and staff and rolls out their special version of person-centered care in their building. Their model of care may include breaking down long hospital-like hallways and corridors (which are very common in many nursing homes) into smaller neighborhoods or communities of 6 to 8 residents. They may wish to have caregivers assign themselves to each neighborhood and provide consistent assignments. They may want to provide cross-training for nursing assistants in activities and housekeeping and create a new position: the person-centered specialist. They may endorse natural waking and retiring, liberalized diets, easy access to outdoors, and spontaneous activities 24 hours a day. These are just a few ideas that facilities can include in their journey through person-centered care.

Last, all employees must feel person-centered care in their hearts. This is where real care from anyway. It can also be where true culture change comes from, turning their once traditional and institutional facility into a person-centered home where residents want to live, families want to visit and staff want to work. Employees must also understand something else very important about person-centered care: it is not an end unto itself. Instead, it is a process, a ongoing journey, and one in which mistakes will be made and processes changed in order to constantly improve not only the quality of care in nursing homes, but the quality of life itself.

Renton Assisted Living

The city of Renton's transformation from a fledgling outpost on the trail to Seattle to a dense urban center began in the 1930s when it became home to coal mines and logging equipment manufacturing.

During World War II, the Boeing Airplane Company settled there and the city's population exploded as people moved to the area to work at the manufacturing plant. Renton's booming industry and population have attracted urban development and amenities that can suit the needs of any Renton assisted living resident.

Renton Recreation

Seniors in Renton have numerous options for entertainment. The city offers retail, leisure and recreational activities at The Landing, a retail, residential and dining complex. The Landing is home to several major retail chains, restaurants and a 14-screen Regal Cinema.

Renton assisted living communities are some of the most well adorned in Washington due to their close proximity to the only IKEA store in the state. The Swedish-based furniture retailer is know for its inexpensive yet stylish furnishings. The store's massive warehouse is also home to a restaurant and food store specializing in Swedish cuisine.

Renton Activities

Many assisted living facilities provide a scheduled rotation of activities for their residents, but Renton senior living residents can also find recreational activities and social programs at the Renton Senior Activity Center.

The center offers free, drop-in access for seniors age 50 and older to services such as health screenings, legal advice and weekly transportation to local grocery and department stores.

Renton residents have access to great music performances from the Renton City Concert Band which showcases wind and percussion instruments from local musicians.

The band performs at the Renton IKEA Performing Arts Center which is open year-round and hosts an assortment of musical, dance and other performing arts groups.

Renton Medical Facilities

Seniors can't take advantage all that Renton has to offer if they aren't feeling well, which is why Renton assisted living residents are fortunate to live near Valley Medical Center. Valley Medical Center is recognized for its treatment of stroke, sleep and joint conditions, as well as for providing outstanding treatment for patients with heart, cancer and neurological conditions.

Renton seniors may also visit Overlake Hospital Medical Center in the nearby city of Bellevue. The Overlake is home to a level III trauma facility, a specialized Senior Care program and a nursing program that is part of a national system of training nursing staff about the needs and care for elderly patients.

Renton Transportation

The Renton transit center is a major mass transit hub where residents from Renton senior living communities can hop on a King County Metro Transit bus to get anywhere within the city limits. From there, they can also catch a Sound Transit double-decker bus for a day trip into Seattle, Bellevue, Tacoma and other nearby cities.

Seniors who have limited mobility may qualify for the ADA Paratransit Program and are eligible to take advantage of Metro's Access transportation service. The Access shuttles are specially equipped to handle wheelchairs and provide shared ride service along existing bus routes.

Renton assisted living seniors can enjoy quality living facilities, first-class medical care, and a wealth of recreational and cultural activities to keep them healthy and engaged. Find assisted living for your loved one by browsing our Renton assisted living page.

Gerontology and How to Get a Job As a Gerontologist

Gerontology is a field that specializes in the study of the social, biological and psychological aspects of elderly people. By researching aging process of the elderly, gerontology can incorporate better rules and regulations to provide the elderly with a better quality of life.

Gerontologists are trained and licensed health care professionals who work with elderly people. They are equipped to analyze all aspects of aging individuals with the exception of disease and sickness. These healthcare professionals generally work in many different settings where aging individuals can be found. Nursing homes, hospitals, and other settings are where gerontology is practiced.

Gerontologists are required to educate and inform the older population by giving speeches, presentations and by providing resources such as writing books, articles and other literature that will increase the knowledge of the elderly individuals. People who pursue a career in this field will have a love of communication and be able to communicate effectively. He or she must be dedicated about the wellbeing of the older population.

There are many different kinds of gerontologists. There is the research gerontologist that researches and analyzes how the aging process affects people in different type of settings. They then use their findings as a means to understand and to enhance the lives of the senior citizens. Those in applied gerontology interact with the older people by communicating and providing assistance to them, their families and anyone they interact with on a daily basis.

In the area of administration, there are administrative gerontologists who are trained to provide management skills by creating programs and services that will be beneficial to the elderly. They help to keep the programs that are already in place running properly.

Gerontologists can have a degree in any related field. A degree in psychology, nursing, sociology, teaching and any other socially related degree can be used to enter this career.

Work Environment:

Gerontologists are able to work in many different types of employment places including nursing facilities, assisted living centers, hospitals, and health offices. They can also teach at schools and colleges and even with other professionals in the health industry to provide a better quality of life for the elderly.

Education:

For those who are interested in pursuing this career will need to take coursework in biology, geometry, algebra, and chemistry while in high school. Bonus courses would be English, psychology and any course that will better prepare you for making the transition from high school to college with a specialization in gerontology.

College Requirements:

A career as a gerontologist requires a high diploma or a GED. Training requires college and university coursework in any field that relates to sociology. A completion of a Bachelors and even a Masters degree is needed to become a gerontologist. Before becoming a licensed and practicing gerontologist a clinical internship may also be required.

Requirements do vary according to which discipline of gerontology you are majoring in; it is best to check with your school to make sure you are fulfilling the requirements necessary for your career.

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Job Outlook for Nurses Is Outstanding According to the Department of Labor

Registered Nurse Report
This comes from the US Department of Labor and is their 2010-2011 Occupational Guide. Here are highlights of the report:

• Registered nurses (RNs) constitute the largest healthcare occupation, with 2.6 million jobs.


• About 60 percent of RN jobs are in hospitals.


• The three typical educational paths to registered nursing are a bachelor's degree, an associate degree, and a diploma from an approved nursing program; advanced practice nurses-clinical nurse specialists, nurse anesthetists, nurse-midwives, and nurse practitioners-need a master's degree.


• Overall job opportunities are expected to be excellent, but may vary by employment and geographic setting; some employers report difficulty in attracting and retaining an adequate number of RNs.


• Employment of nurses is expected to grow by 22% much faster than the average of all occupations


• Nurses with a bachelor's degree are more sought after than nurses without one

One of the most interesting things about the job outlook is that they say that growth in nursing in hospitals will be much lower than in other places like working in doctor's offices, nursing homes, home healthcare and in other parts of the medical field. Just because it is growing slower doesn't mean that there still isn't quite a significant growth in jobs in the hospital setting.

Other interesting things in the report are that in some areas of the country they are having such a difficult time attracting nurses that employers are offering relocation assistance (money to relocate), signing bonuses which are cash bonuses when you officially agree to work for them, family friendly scheduling and other incentives to attract qualified candidates.

In 2008, here were the median wages of nurses:

• Employment services (those who work as head hunters) $68,160


• General medical and surgical hospitals 63,880


• Offices of physicians 59,210


• Home health care services 58,740


• Nursing care facilities 57,060

The report also talks about the types of jobs that nurses have and their responsibilities and the opportunities for advancement. Here are some of the interesting points about registered nurse advancement:

• Most RNs start out as staff nurses in hospitals


• Many RNs go on to become advanced practice nurses such as nurse practitioners, nurse anesthetists or nurse midwives


• Many nurses in the hospital environment find advancement opportunities in management and supervisory positions in the hospital


• Many nurses move their career into the business side of healthcare. It isn't uncommon for nurses to go academically to get an MBA degree and enter the business world and it is not unheard of that nurses go on to become lawyers.

It is important to remember that healthcare is a big business that hires many people who work very far from the patient's bedside. In many, many of these jobs, it is really important that the people have a real and tangible healthcare background. Nursing provides that background.

It is also worthwhile to keep in mind that there are several important factors that are driving the increase in the need for nurses. Firstly, the aging population means more sick people. The baby boomers are getting into their 60s and the need for more healthcare at that age increases dramatically. That means there is a need for more nurses. Secondly, whatever healthcare reform looks like, it will likely increase the access many people have to healthcare. People who couldn't afford healthcare or it wasn't a financial priority will be able to get healthcare under the new programs being discussed. This will drive the demand for more doctors.

You've Done Your CNA Training, What's Next?

No doubt that once you've fully completed your CNA training you'll want to find a job in your local area, so you're going to need to understand the employment options available to you. The good thing about being a CNA is that you can pretty much work any where you like in the health care setting you just need to find the right job for you.

The remainder of this CNA training article will aim to provide you with the facts relating the employment prospects of newly qualified Certified Nursing Assistants.

There are several employment options open to you as a newly qualified CNA, you just need to have a good look around the local health care providers in your area. When you're searching for a job consider that there are 4 main types of CNA employment on offer, these include the following:

• Home care employment


• Hospital employment


• Long term care employment


• Doctor's surgery employment

The first and also the most popular type of CNA employment is working within the clients home, more and more these days people want to stay in their own homes for as long as they can without having to go into long term care facilities, this is where the home based CNA comes in. The home healthcare CNA cares for someone in their own home, this means that the person can stay in their own home and maintain their own independence whilst still receiving the care and support they need. The duties of the home based CNA include things like shopping, cleaning, cooking, washing, assisting with personal hygiene needs and nutritional support.

The second type, and most commonly available type of CNA employment is that in the acute sector, I.e. within the hospital based setting. Within the acute care sector CNA's work directly alongside registered nurses and other registered practitioners, for this reason the role can be a lot more fast paced and challenging at times. The duties of the hospital based CNA are often a little more technical based, offering you the opportunity to care for patients who are undergoing surgery and medical intervention. Such patients require things like blood pressure, pulse, optometry, respiration and blood glucose monitoring, something which you don't do in patient homes.

The third type of CNA employment is that in the long term care setting, this includes nursing homes and residential care homes. Duties within the long term care facility can often be similar to those in the home setting, including things like washing, dressing, feeding and bathing. Working in a nursing home setting can be rewarding since you get to know the residents you're looking after, however it can also be emotionally demanding at times. One of the major positives of employment within the long term care setting is that the availability is growing slowly due to more and more people living longer.

The final type of CNA employment is that within a doctor's office or GP practice, this is one f the slowest paced jobs and is usually an option for those older CNAs who are looking for something a little less physically and emotionally demanding.

Whatever your choice, your CNA training will set you up for each of the above settings, however it will only be your own experience and time which will give you the true skills needed to succeed in each area.