Mastering Elder Law

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Carolina Academic Press Mastering SeriesRussell Weaver, Series Editor

Mastering Administrative LawWilliam R. Andersen

Mastering Alternative Dispute ResolutionKelly M. Feeley, James A. Sheehan

Mastering American Indian LawAngelique Townsend EagleWoman, Stacy L. Leeds

Mastering Appellate Advocacy and ProcessDonna C. Looper, George W. Kuney

Mastering Art LawHerbert Lazerow

Mastering BankruptcyGeorge W. Kuney

Mastering Civil Procedure 2d eDavid Charles Hricik

Mastering Constitutional Law 2d eJohn C. Knechtle, Christopher J. Roederer

Mastering Contract LawIrma S. Russell, Barbara K. Bucholtz

Mastering Corporate TaxReginald Mombrun, Gail Levin Richmond, Felicia Branch

Mastering Corporations and Other Business EntitiesLee Harris

Mastering Criminal LawEllen S. Podgor, Peter J. Henning, Neil P. Cohen

Mastering Criminal Procedure, Volume 1: The Investigative Stage 2d ePeter J. Henning, Andrew Taslitz, Margaret L. Paris,

Cynthia E. Jones, Ellen S. Podgor

Mastering Criminal Procedure, Volume 2: The Adjudicatory Stage 2d ePeter J. Henning, Andrew Taslitz, Margaret L. Paris,

Cynthia E. Jones, Ellen S. Podgor

Mastering Elder Law 2d eRalph C. Brashier

Mastering Employment Discrimination LawPaul M. Secunda, Jeffrey M. Hirsch

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Mastering EvidenceRonald W. Eades

Mastering Family LawJanet Leach Richards

Mastering Income TaxChristopher M. Pietruszkiewicz, Gail Levin Richmond

Mastering Intellectual PropertyGeorge W. Kuney, Donna C. Looper

Mastering Labor LawPaul M. Secunda, Anne Marie Lofaso, Joseph E. Slater, Jeffrey M. Hirsch

Mastering Legal Analysis and CommunicationDavid T. Ritchie

Mastering Legal Analysis and DraftingGeorge W. Kuney, Donna C. Looper

Mastering Negotiable Instruments (UCC Articles 3 and 4) and Other Payment Systems

Michael D. Floyd

Mastering Partnership TaxationStuart Lazar

Mastering Products LiabilityRonald W. Eades

Mastering Professional ResponsibilityGrace M. Giesel

Mastering Property Law, Revised PrintingDarryl C. Wilson, Cynthia H. DeBose

Mastering Secured Transactions (UCC Article 9) 2d eRichard H. Nowka

Mastering Statutory Interpretation 2d eLinda D. Jellum

Mastering Tort LawRussell L. Weaver, Edward C. Martin, Andrew R. Klein, Paul J. Zwier II, Ronald W. Eades, John H. Bauman

Mastering Trademark and Unfair Competition LawLars S. Smith, Llewellyn Joseph Gibbons

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Mastering Elder Law

Second Edition

Ralph C. BrashierCecil C. Humphreys Professor of LawUniversity of Memphis School of Law

Carolina Academic PressDurham, North Carolina

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Copyright © 2015Ralph C. BrashierAll Rights Reserved.

Library of Congress Cataloging-in-Publication Data

Brashier, Ralph C., 1957- author.Mastering elder law / Ralph C. Brashier. -- Second edition.pages cm. -- (Carolina academic press mastering series)

Includes bibliographical references and index.ISBN 978-1-59460-759-2 (alk. paper)1. Older people--Legal status, laws, etc.--United States. 2. Old age pen-sions--Law and legislation--United States. 3. Estate planning--United States.4. Social security--Law and legislation--United States. 5. Older people--Medical care--Law and legislation--United States. I. Title.

KF390.A4B73 2014344.7303'26--dc23

2014037529

Carolina Academic Press700 Kent Street

Durham, NC 27701Telephone (919) 489-7486

Fax (919) 493-5668www.cap-press.com

Printed in the United States of America

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vii

Contents

Series Editor’s Foreword xxi

Preface xxiii

Chapter 1 · Elder Abuse 3Roadmap 3A. Introduction 3B. Causes of Abuse 5C. Kinds of Abuse 8

1. Active Abuse 9a. Physical Abuse 9b. Sexual Abuse 10c. Exploitation 10d. Emotional Abuse 11

2. Neglect 12a. Neglect by a Caregiver 12b. Abandonment 14c. Self- Neglect 14

D. Adult Protective Services 151. Lack of Federal Funding 152. APS Provisions Generally 163. APS Principles and Practices 174. The APS Case 17a. Reporting 17b. Investigation 20c. Services 20d. Remedies 21

E. Miscellaneous Matters 221. Limiting the Financial Benefits Available to Abusers 22a. Caregivers 22b. Probate Laws and Estate Benefits 23

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2. Medical Malpractice and Elder Abuse 253. Evidentiary and Criminal Matters 264. Abuse Registries 265. Nursing Home Litigation 276. The Elder Justice Act 28

Checkpoints 29

Chapter 2 · Guardianships and Conservatorships 31Roadmap 31A. Overview 31

1. Generally 312. State Authority 323. The UPC and State Terminology 33

B. When Should a Guardian or Conservator Be Appointed? 35C. The Petition and the Proceeding 36

1. Petition and Contents 362. Jurisdiction and Venue 383. Procedure and Due Process 39a. Notice and Service 39b. GALs and Visitors 39c. Counsel 41d. The Professional Evaluation 42e. Burden and Standard of Proof 42f. At the Hearing 43g. The Least Restrictive Alternative 44

4. The Guardian or Conservator 45a. Priority Lists and the Respondent’s Best Interest 45b. Conflicts and Self- Interest 46c. Letters and Bond 47d. Compensation and Liability 48

5. Temporary Guardianships 49a. Emergency Guardianships 49b. Standby Guardianships 49

D. Fiduciary Responsibilities and Decision Making 501. Best Interest 512. Substituted Judgment 513. Statutory Guidance 52a. The Duties and Powers of a Guardian 52b. The Duties and Powers of a Conservator 55

E. Terminating the Guardianship or Conservatorship 60

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1. Generally 602. Terminating the Fiduciary Appointment 613. Successor Guardian 61

F. Mediation 62Checkpoints 63

Chapter 3 · Wealth Management and Property Transfers 65Roadmap 65A. Introduction 65B. Durable Powers of Attorney 66

1. Alternatives to Conservatorship 662. Uniform Durable Power of Attorney Act 1979 68a. Creation of a DPOA 68b. Agent Powers 69c. Agent Interaction with Court- Appointed Fiduciaries 70

3. Uniform Power of Attorney Act 2006 71a. Overview 71b. Creation, Effect, and Termination 72c. Encouraging Recognition by Third Parties 74d. Agents Generally 75e. Agent Duties 77f. Agent Liability 79g. Agent Authority 80h. Statutory Forms 82

C. Nonprobate Properties 891. Generally 902. Survivorship Properties 90a. The Joint Tenancy 91b. The Tenancy by the Entirety 93c. Joint Bank Accounts 94

3. PODs and Totten Trusts 96a. POD and TOD Accounts 96b. Totten Trusts 97

4. Revocable Trusts 985. Insurance 1016. Gifts 101a. Generally 101b. Causa Mortis 102

D. Probate Properties 1031. Intestate Succession 104

CONTENTS ix

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a. General Patterns of Distribution 104b. Methods of Distribution 105c. Nontraditional Families 107d. Advancements 111e. Family Protection Provisions (Excluding the Elective Share) 111

2. Testamentary Succession (Wills) 112a. Execution 112b. Revocation 115c. Construction 119d. Disinherited Family Members 126e. Will Contests 132

Checkpoints 135

Chapter 4 · Health- Care Decision Making 137Roadmap 137A. Introduction 137B. The Right to Be Informed 138

1. Informed Consent 1382. Disclosure 139a. What Must Be Disclosed 139b. Standard of Disclosure 141c. Physician Defenses 142

3. Causation 143C. The Right to Refuse Life- Prolonging Treatment 143

1. Competent Patients 144a. Bases for the Right to Refuse Treatment 144b. State Interests 145c. Life- Prolonging Treatment Following Patient Refusal 146d. Competency 147

2. Incompetent Patients 148a. Bases for the Right to Refuse Treatment 148b. Role of the Judiciary 148c. The Patient’s Wishes 150d. Evidentiary Standards and the Role of Courts and Legislatures 151

e. Artificial Nutrition and Hydration as Medical Treatment 154D. Advance Directives 155

1. In the Absence of an Advance Directive 1572. Living Wills 158a. Execution and Revocation 158

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b. Language and Interpretation 159c. The Value and Limitations of the Living Will 160

3. Health- Care Powers of Attorney 161a. Execution and Revocation 161b. Medical Providers and Insurance Companies 163c. Rights and Obligations of an Agent 164

4. The Uniform Health- Care Decisions Act 165a. Definitions 166b. Execution, Interpretation, and Revocation 167c. Optional Form 168d. Surrogates 171e. Guardians 173f. Health- Care Information and Health- Care Providers 173g. Immunities 174h. Statutory Damages 175

E. Assistance in Dying 1761. Generally 1762. Assisted Suicide and the Constitution 1773. State Law: Oregon’s “Death with Dignity” Act 178a. The Written Request 179b. The Attending and Consulting Physicians 180c. The Timing of Requests and the Fifteen- Day Waiting Period 182d. Reporting Requirements; Effect of Death under the Act 182e. Immunities, Liabilities, and Penalties 183

F. Euthanasia 184Checkpoints 186

Chapter 5 · Age Discrimination in Employment 189Roadmap 189A. Overview 189B. Law and Regulations 190C. The ADEA’s General Prohibitions 191D. Covered Employment 192

1. Private Employment 192a. Determining Employee Status 193b. “Twenty or More Employees” 194c. Nonprofit, Charitable, and Religious Organizations 195d. Operations in Foreign Countries 195

2. State and Federal Employment 196E. Employer Defenses and Exceptions 197

CONTENTS xi

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1. Bona Fide Occupational Qualification 1972. Reasonable Factor Other Than Age 1983. Bona Fide Seniority Systems 1984. Bona Fide Employee Benefit Plans 1985. Good Cause 1996. Law Enforcement Officers and Firefighters 1997. Bona Fide Executives or High Policymakers 199

F. The ADEA Lawsuit 1991. Disparate Treatment 200a. Circumstantial Evidence 200b. Direct Evidence 202

2. Disparate Impact 2023. Retaliation 203

G. Procedural Issues 2031. Sixty- Day Waiting Period after Charge Is Filed 2032. Timeliness of the Charge 2043. Civil Actions and Judicial Relief 2054. Waivers 2055. Notices and Recordkeeping 207

H. Remedies 208Checkpoints 210

Chapter 6 · Social Security, Retirement, and Pension Programs 213Roadmap 213A. Social Security 214

1. Generally 2142. History and Highlights 2153. Laws and Administrative Materials 216a. Statutes and Regulations 216b. Rulings 217c. Manuals and Handbooks 218

4. Financing the Program 219a. FICA/SECA Taxes 219b. The Trust Fund 220c. Who Pays for Whom? 221

5. Eligibility for Benefits 2216. The Earnings Record 2227. Covered Employment 2238. Quarters of Coverage 2239. Retirement Benefits 224

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a. Full Retirement Age (FRA) 224b. Delayed Receipt of Benefits 225c. Early Receipt of Benefits 226d. Retirement Earnings Test 227

10. Derivative (or Auxiliary or Secondary) Benefits 228a. Family Members or Ex- Family Members of a Living Worker 228b. Family Members of a Deceased Worker 232

11. Disabled Workers and Their Families 235a. Disabled Worker Benefits 235b. Spouses’ Benefits Based on Disability 237c. Children’s Benefits Based on Disability 238

12. Determining Cash Benefit Amounts: PIA and AIME 238a. Generally 238b. Preventing Windfalls 240c. Government Pension Offset 241

13. Representative Payees 24214. Protection of Payments (“Anti- Assignment”) 24415. Underpayments and Overpayments 24516. Administrative and Judicial Review 246a. Initial Determination 246b. Reconsideration 247c. Hearing 247d. Appeals Council Review 249e. Judicial Review 249

17. Representation of a Claimant 25018. Taxation of Benefits 25219. Reforming the Program 253

B. Other Public Retirement and Pension Programs 2541. Railroad Worker Benefits 2542. Government Employment 256a. Federal 256b. State and Local 258c. Military 259

C. Veterans’ Benefits 260D. Private Sector Pension and Retirement Plans 263

1. Overview of Employee Benefit Plans 2632. Kinds of Plans 264a. Defined Benefit Plan 264b. Defined Contribution Plan 265

CONTENTS xiii

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3. ERISA 266a. Qualified and Nonqualified Plans 267b. Plan Participation 267c. Vesting of Benefits 268d. Retirement Benefits 269e. Spousal Rights 270f. QDROs 271g. Distributions and Taxation 273h. Benefit Claims 280

Checkpoints 281

Chapter 7 · Supplemental Security Income 283Roadmap 283A. Introduction 283B. Eligibility Requirements 284

1. Who May Be a Beneficiary 2852. Location of the Beneficiary 2863. Marriage of the Beneficiary 2874. Continuing Assessment of Eligibility 288

C. Asset Limitations: Income and Resources 2891. Income 289a. Generally 289b. Countable Income 290

2. Valuing In- Kind Support and Maintenance 2933. Resources 295a. Nature and Ownership of Resources 295b. Countable Resources 295c. Resource Exclusions 296

4. Deeming 297D. The Appeals Process 298Checkpoints 299

Chapter 8 · Medicare 301Roadmap 301A. Introduction and Overview 301

1. A Limited, Federal Health Insurance Program 3012. The “Parts” of Medicare 3023. Related Health Care Concerns, Programs, and Insurance 303

B. Laws and Administrative Materials 304C. The Original Medicare Plans (Parts A and B) 304

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1. Part A 304a. Financing 304b. Eligibility and Enrollment 305c. Coverage 309

2. Part B 319a. Financing 319b. Eligibility and Enrollment 319c. Deductible 324d. Coverage and Coinsurance 324

3. Exclusions and Priority of Payment 333a. Items and Services 333b. Medicare as Secondary Payer 335

4. Appeals and Rights 336a. Limitation on Liability; Notice 336b. The Appeals Process 337

D. Part C (Medicare Advantage Plans) 3401. Generally 3402. Protections for Enrollees (Including Appeals) 3423. Kinds of MA Plans 3434. Other Medicare Plans 345

E. Part D 3461. Generally 3462. Drug Coverage Rules 3473. Points to Consider 3474. Grievances and Appeals 348a. Grievances 348b. Appeals 348

5. Enrollment and Payment 351a. Generally 351b. Premiums and Premium Penalties 352c. Payments 354

F. Medicare/Medicaid “Dual Eligibles” 356G. Medicare’s Future 358H. Medigap Policies 359

1. Generally 3592. Coverage under the Standardized Plans 3603. Right to Purchase 3624. Prices 3645. Consumer Protection Provisions 365

Checkpoints 366

CONTENTS xv

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Chapter 9 · Medicaid 367Roadmap 367A. Overview 367B. Statutes, Regulations, and Administration 368

1. Federal 3682. State 369

C. Benefits 3701. Generally 3702. Availability 3713. Quality Assurance 3724. Fiscal Integrity: Third- Party Liability 373

D. Eligibility and Coverage 3731. Generally 3732. Coverage 374a. Mandatory Coverage: The Categorically Needy 374b. Optional Coverage: The Optional Categorically Needy 377c. Optional Coverage: The Medically Needy 379

E. Income and Resources 3801. Income 381a. Earned and Unearned Income 381b. Countable Income 382

2. Resources 382a. Countable Resources 383b. Spend Down 384

F. Spouses and Institutionalization 3841. Income 384a. Attribution Rules 384b. CSMIA 385

2. Resources 387a. The “Snapshot” 387b. CSRA 387

G. Asset Transfers and Institutionalization 3881. The Five- Year Look- Back 3882. Exempt Transfers 3903. Trusts 390a. Generally 390b. Trusts Exempted from the General Rules 391

4. The Counselor Penalty 3925. Transfers before February 8, 2006 393

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6. Noninstitutionalized Individuals 393H. Medicaid Liens, Adjustments, and Recoveries 394

1. Inter Vivos Liens 3942. Recovery from the Estate 394a. Generally 394b. Long- Term Care Insurance 395c. The Estate 395

I. Procedures 3961. Application 3962. Determinations of Eligibility 3963. Hearings and Appeals 397a. Generally 397b. Hearing Procedures 398c. Local Hearings and Appeals 399

Checkpoints 400

Chapter 10 · Long- Term Care 401Roadmap 401A. Introduction 402B. Who Furnishes Long- Term Care? 403C. Paying for Long- Term Care 405

1. Family Members and Personal Savings 4052. Reverse Mortgage 4063. Life Insurance 4084. Medicaid and Other Governmental Programs 4095. Specialized Insurance for Long- Term Care 409

D. Long- Term Care Insurance 4101. Generally 4102. Coverage and Services 412a. Who Provides Long- Term Care Policies? 412b. What Are the Benefits and Costs? 414

3. Policies Providing Special Benefits under Federal Law 419a. Tax- Qualified Policies 419b. State Partnership Policies 420

4. When Are Benefits Provided? 422a. Maximum Benefit Limits 422b. Trigger Mechanisms 423c. Elimination Period 423d. Restoration of Benefits 424

5. Where Are Benefits Provided? 425a. Facilities Covered 425

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b. Alternatives to Nursing Home Care 425Checkpoints 427

Chapter 11 · The Home 429Roadmap 429A. Introduction 429B. Private Dwellings 430

1. Home Ownership 430a. Monitoring and Home Modification 430b. Family, Friends, and Community Programs 431c. Paid Caregivers in the Home 431d. Reverse Mortgages 433e. Selling the Home (Tax Consequences) 436f. Donating the Home 439

2. Rental Units 440a. Government Assistance Programs 441b. Age Discrimination and Accommodations in Housing 442

C. Congregate Living 4451. ALFs and CCRCs 4452. Board and Care Homes 4463. Nursing Homes 447a. Generally 447b. Nursing Home Costs and Comparisons 449c. Federal Laws and Regulations 449d. Private Actions against Nursing Homes 469

Checkpoints 471

Chapter 12 · The Professional Responsibilities of the Lawyer 473Roadmap 473A. Introduction 473B. Lawyer Competence 475C. Scope of Representation and Allocation of Authority 476D. Diligence, Communication, and Fees 477E. Confidences and Conflicts of Interest 480

1. Confidences 480a. Fiduciary Representation 481b. Joint Representation 482

2. Conflicts 484a. Generally 484b. Consent 484

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c. “Who’s the Client?” 485d. The Drafting Lawyer as Fiduciary or Attorney for the Fiduciary 486

e. Client Gifts, Bequests, and Business Transactions 487F. The Client with Diminished Capacity 489

1. Generally 4892. Protective Action 4903. Client Confidences 4914. Emergencies 4925. Advance Directives and Other Legal Documents 492

Checkpoints 494

Mastering Elder Law Master Checklist 495Chapter One · Elder Abuse 495Chapter Two · Guardianships and Conservatorships 496Chapter Three · Wealth Management and Property Transfers 497Chapter Four · Health- Care Decision Making 498Chapter Five · Age Discrimination in Employment 499Chapter Six · Social Security, Retirement, and Pension Programs 501Chapter Seven · Supplemental Security Income 502Chapter Eight · Medicare 502Chapter Nine · Medicaid 503Chapter Ten · Long- Term Care 504Chapter Eleven · The Home 505Chapter Twelve · The Professional Responsibilities of the Lawyer 506

Index 507

CONTENTS xix

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Series Editor’s ForewordThe Carolina Academic Press Mastering Series is designed to provide you with

a tool that will enable you to easily and efficiently “master” the substance andcontent of law school courses. Throughout the series, the focus is on qualitywriting that makes legal concepts understandable. As a result, the series is de-signed to be easy to read and is not unduly cluttered with footnotes or cites tosecondary sources.In order to facilitate student mastery of topics, the Mastering Series includes

a number of pedagogical features designed to improve learning and retention.At the beginning of each chapter, you will find a “Roadmap” that tells youabout the chapter and provides you with a sense of the material that you willcover. A “Checkpoint” at the end of each chapter encourages you to stop andreview the key concepts, reiterating what you have learned. Throughout the book,key terms are explained and emphasized. Finally, a “Master Checklist” at theend of each book reinforces what you have learned and helps you identify anyareas that need review or further study.We hope that you will enjoy studying with, and learning from, the Master-

ing Series.

Russell L. WeaverProfessor of Law & Distinguished University ScholarUniversity of Louisville, Louis D. Brandeis School of Law

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Preface

I thank my colleagues Donna Harkness, William Kratzke, Janet Richards,Dorothy Wells, and Nicholas White for their insightful comments and sug-gestions on drafts of various chapters of this book. I am grateful to MeeladHanna, Emma Redden, Richard Townley, and Shannon Wiley for their re-search assistance and to Cheryl Foshee Edwards and Linda Hayes for their ad-ministrative assistance.I also thank the students in my Elder Law classes at the University of Memphis.

Their passion and commitment provide a constant source of inspiration. Theirinterest and curiosity provide a constant opportunity to learn new things andto see old things afresh. Their stories and the stories of their families providea constant reminder of the increasing importance of Elder Law and of the needfor lawyers to serve America’s growing elderly population.

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