WHITEPAPER: AGING WITH DIGNITY

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Scott Pinkerton, CFP®, CIMA®, Managing Director – Investment Officer

Michael Harkins, Vice President – Investment Officer

William L. Mehserle, Jr., Financial Advisor

A Look at Quality of Life, Legal Documents, and Funding to Help Age with Dignity and Independence

Introduction

When you think of the words “Long Term Care,” your mind probably jumps to nursing homes, breathing tubes and helplessness. This paper is not about Long Term Care. Aging with Dignity is about being in control, to know, and to have articulated, what and how your life will evolve. It means having a plan to age safely in your home or chosen living arrangement, to be as engaged and independent as possible, and to move the aging process from one of being scared to being sacred. In this paper, we will talk about you being the person in need of care, but this is only for literary convenience. We could easily mean a loved one or a parent.

The technical definition of long-term care is “a variety of services which help meet both the medical and non-medical needs of people with a chronic illness or disability who cannot care for themselves for long periods of time.”1_{Will you need long-term care (LTC) services? Probably. The US Department of Health and Human}

Resources estimates that 70% of Americans who reach age 65 will need LTC services before they pass.2

Instead of “long term care” planning, we prefer to develop plans to “age with dignity.” Aging with Dignity means that as you age you can maintain your independence and quality of life for as long, and as safely, as possible. We believe that having thoughtful conversations with your loved ones and developing an Aging with Dignity plan we can help diminish some of the fear, prolong your quality of life, and be less of a burden on your family. Plan now, before you need long-term care services, so you can take your time and thoughtfully make important decisions.

Aging with Dignity encompasses three quality of life issues, as well as legal and investment planning:3

1. Quality of Life

a. Who is going to change my light bulbs? b. How am I going to get ice cream?

c. Who am I going to have lunch with? (I know it is supposed to say “with whom”)

2_{http://longtermcare.gov/the-basics/}

3_{Three questions that predict future quality of life.” Joseph F. Coughlin, PhD Director, MIT AgeLab}

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Commentary from Pinkerton Wealth

Management Group of Wells Fargo

Advisors Comprehensive Wealth

Management Team

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2. Legal

a. Do I have all the legal, financial and health documents prepared so that my loved ones can step in easily if the need arises?

3. Financial

a. What are the financial tactics I will use to help fund future costs of care?

Quality of Life

Who is going to change my light bulbs?

I have a friend (I am not making this up!) whose 90 year old dad climbed a ladder, got on his roof and replaced some damaged tiles! Do you want your 87 year old uncle climbing a stool to change a light bulb? These are mundane things but they create an enormous amount of stress and danger. The problem is that we age day by day and we don’t notice our diminished ability to do the things around the house that we’ve always done. God doesn’t ring a bell and say, “Now you need to get some help.” As you age, the effects of shocks to the body can be the beginning of the loss of independence. A fall can often lead to bigger problems. If your goal is to stay in your home, then make your home as physically stress free and safe as possible. Get and wear an emergency responder, consider installing grab bars in strategic locations, eliminate having to lean over awkwardly, install an “adult friendly” bathroom, etc. I hired a professional to do an analysis of my Mom’s home after she fell. We made many of the above-mentioned adjustments to elongate her living independently.

How am I going to get ice cream?

You need to consider how you will be able to continue to do the fun things in life when you can no longer drive. What if you want to get ice cream on a hot summer day? If you don’t live in an area where there are multiple transportation options (walking, public transportation, etc.), you should give this careful consideration. Losing the ability to drive safely is a huge adjustment but there are ways to be able to continue to do the things you love, whether it is volunteering, hobbies, or even working. Do you have access to social activities that keep me engaged active and having fun?

Who am I going to have lunch with?

Lunch is more than a meal—it's an occasion. Who you have lunch with may be a good indicator of your social network. It is critical to keep making friends, especially younger ones! Even with adequate finances, living alone without a robust circle of social support can threaten healthy aging. Today, more than 40% of women over 65 years old live alone in the United States. Consequently, planning where, and with whom, to retire may be as important as how much it will cost. For example, a home in the mountains may be alluring as you approach retirement, but it may lead to an inadequate network of friends, or complete isolation during old age.4

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Finally, is there a spouse/loved one who is providing care? It is important to develop “guideposts” in advance to indicate when additional care is needed. Needs often evolve slowly and each days new challenges might not mean a significant change from the day before, but when reviewed cumulatively, the care effort could quickly overwhelm and even endanger the care giver. Talk with loved ones and develop guideposts to know when you might need to increase the level of help.

I remember an octogenarian once told me aging is about learning to live without things. We have all learned to cope with the loss of a loved one. We may need to prepare for losing the ability to drive and/or personal strength and/or stability. After knee and shoulder surgery, I have had to give up basketball. However, there are things we should never have to be without: friends, community engagements, safe living environment, nutrition, and giving.

Legal

Do I have all the legal, financial, and health documents prepared so that my

loved ones can step in easily if the need arises?

Do not procrastinate! See your attorney and make sure you have all the needed legal documents. It is important that your loved ones know where these documents are kept. If they are stored in your safety deposit box, then you need to make sure they can access them. Make sure your loved ones know what bills you have and how to pay them.

The documents you will generally need include a will, power of attorney (POA), health care surrogate, and health care directive. Your will details how you want your assets distributed after you die. The power of attorney allows someone to step in and manage your finances when you need them. Finally, the health care surrogate allows someone to make health care decisions for you. The health care directive is often referred to as a “living will” and speaks to end of life issues.5

Another issue to consider is how your loved ones will pay your bills. Perhaps a loved one can cover your costs until the legal documents are processed. Perhaps you will want to have a joint checking account with your POA. We prepare a Comprehensive Wealth Management plan for select clients. Embedded in this plan is our Aging with Dignity module, which has a series of questionnaires to discuss with loved ones. Feel free to email or call for our questionnaire—clients tell us it has been an invaluable resource.

We also recommend that you put together a health and personal information journal. This pocket-sized document lists your medications, doctors, personal information that may be needed by your loved ones in an emergency. It is critical that your loved ones (or health surrogate) be prepared to be your advocate and to represent you when you have medical issues. Contact us for a complimentary copy.

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Financial

What are the financial tactics I will use to help fund future costs of care?

The statistics can really be scary: 40% of American women over 65 live alone and need LTC. LTC can cost up to $90,000 per year and can quickly drain resources that took a lifetime to accumulate.6

The majority of “uses” of LTC are not long stays in a full nursing facility but rather getting the help you need which may only cost a couple of thousand dollars a year. When some “industry experts” talk about LTC usage, they lump a lot of services together to build a high usage rate. For example, let’s say you have a hip replacement and before you leave the hospital you are moved to the “transitional care” unit within the hospital. That’s defined as LTC. Let’s say you need someone to come by your house three times a week to help you clean and grocery shop. That’s defined as LTC. Let’s say your spouse helps you take your medications and “get around.” That’s defined as LTC. The point is that just because a lot of people need help with their day-to-day activities, does not mean that they are paying exorbitant amount for the services. Nor should LTC costs be belittled; they can financially devastate a family. Having a plan to fund LTC services will help with decision making when the stress of deteriorating health rears its head.

The first question I ask when developing the fiscal component of a client’s Aging with Dignity plan is “are they married?” Many people fear having a LTC event that forces them to spend a lot of their wealth and could potentially leave their spouse financially destitute. However, if you are not married this issue is often mitigated. If you chew through your assets, it means your kids inherit less. For many, this is not a preferred outcome but it isn’t devastating either.

Another question I ask is how much money do you have? Let’s face it, insurance, by definition, will be a waste of money for the majority of people who buy it. That is the way insurance works. The insurance industry knows that if they have a pool of LTC insurance buyers of 10,000 people, perhaps 9,000 of them will never get out anything close to what they put in. However, of the 1,000 that do draw benefits, they will really need them. This is the same way your homeowners and auto insurance works.

My rule of thumb is that if a client is married or cares a lot about leaving an estate, and they have assets between $300,000 to a $1.5 million, then they should strongly consider LTC insurance. If they have less than $300,000 they should consider Medicaid planning and if they have over $1.5 million they should consider self-funding. Let’s discuss these three strategies in more detail.

Medicaid

The government has a program called Medicaid. We do not advocate nor help clients plan for Medicaid. This is a very specialized legal area and we refer clients to appropriate legal counsel. The purpose of Medicaid planning is to qualify a sick spouse for Medicaid while sheltering assets for the surviving spouse.

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LTC Insurance

There are two types of LTC policies that we use: traditional LTC insurance and Life Insurance with a LTC rider.

Traditional LTC insurance is kind of like health insurance. The consumer can shop for various features like the amount of premium, inflation adjustments, benefit amount and duration. You pay an annual premium that is “use it or lose it.” Meaning that if you don’t need LTC care, the premiums you’ve paid are lost. Some important considerations include how difficult is it to qualify for coverage; in other words, how hard is it to get the insurance company to pay? What is the company’s rating and does the insurance policy reimburse the LTC care provider or do they pay the policy holder a check (endowment)? The reimbursement contract will generally be cheaper but the endowment contract allows you more flexibility.

Life Insurance with LTC riders are becoming a more popular LTC option. This specialized life-insurance policy is a unique type of life insurance that effectively combines LTC protection with a life-insurance death benefit. With these policies, the value of your death benefit is available to pay for covered extended health care services after the elimination period has been satisfied. Also, your policy’s benefit value could be increased up to 200% or more of the initial specified death benefit to help you meet long-term care expenses. This type of policy avoids the “use-it-or-lose-it” aspect of traditional LTC insurance. With specialized life insurance, if no long-term care benefit is paid prior to death, an income-tax-free death benefit will be paid to the policy owner’s beneficiary upon death. In addition, some policies offer a return-of-premium feature that, as the name suggests, returns the original premium to the policy owner if the policy is surrendered prior to a claim being filed.

For example, a healthy woman age 60 can purchase a $100,000 single premium policy that would provide her with $570,000 in LTC benefit, and a $190,000 death benefit if no LTC claim is filed. This approach usually means a lower benefit amount per dollar invested and doesn’t offer any inflation adjustments.7

This information is hypothetical and is provided for informational purposes only. It is not intended to represent any specific return, yield, or investment, nor is it indicative of future results. Reminder: Any guarantees are based on the claims-paying ability of the issuing insurance company.

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Self-Funding

Many clients have an annual spending budget 150% or greater than the average cost of a nursing home. In other words, if your investment plan allows you to spend $125,000 or more per year, then the cost of a nursing home won’t be a radical change from your current spending. If this is the case, you may actually spend less in a nursing home than you are spending today. If this is your situation, then you likely don’t need insurance. You’ll be able to cover the cost out or your normal spending budget. For clients in this situation, I describe LTC insurance as a “want” and not a “need”. Some feel more comfortable with extra insurance and often opt for life insurance with the LTC rider.

Aging with Dignity, helping change the aging process from being scared to sacred, can be radically advanced by having these important conversations with us and your loved ones. Have a strategy to keep yourself physically safe, engaged, and having fun. Make sure you have the legal documents prepared and have a plan to cover costs. Stress comes from not knowing and being out of control. We can’t predict the future but having a game plan that is drafted before it is needed is a great way to help ensure that you Age with Dignity.

Pinkerton Wealth Management Group

of Wells Fargo Advisors, LLC

P: 941-408-8557 | TF: 866-209-8557

4242 S Tamiami Trail, Venice, FL 34293

www.PinkertonWMG.com

Wells Fargo Advisors did not assist in the preparation of this report, and its accuracy and completeness are not guaranteed. The opinions expressed in this report are those of the author(s) and are not necessarily those of Wells Fargo Advisors or its affiliates. The material has been prepared or is distributed solely for informational purposes and is not a solicitation or an offer to buy any security or instrument or to participate in any trading strategy. Additional information is available upon request.

Wells Fargo Advisors and its affiliates do not provide legal or tax advice. Transactions requiring tax consideration should be reviewed carefully with your accountant or tax advisors. Any estate plan should be reviewed by an attorney who specializes in estate planning and is licensed to practice law in your state.

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