This article will discuss how veteran substance abuse hurts our troops when they return home. And we will discuss the way that we can help them overcome their substance use disorders.

Go to the article by Arrow Passage Recovery (a for-profit addiction treatment source)

IRS Raises Limit For ABLE Accounts
For the first time in four years, the amount of money that people with disabilities can save without jeopardizing eligibility for government benefits is rising.

Source/More: Disability Scoop (Jan. 5, 2022 NAELA eBulletin)

Big-Ticket Drugs That Have Higher Prices in 2022
Drug companies raised the prices on hundreds of medications on Jan. 1, with most prices up 5 percent to 6 percent on average. Pharmaceutical companies increased prices on 460 drugs on Jan. 1, according to drug prices monitored by research firm 46brooklyn.

Source/More: Axios (Jan. 5, 2022 NAELA eBulletin)

Record Number of Americans Sign Up for ACA Health Insurance
A record 13.6 million Americans have signed up for health coverage for 2022 on the Affordable Care Act marketplaces, with nearly a month remaining to enroll in most states, the Biden administration announced Wednesday.

Source/More: Kaiser Health News (Jan. 5, 2022 NAELA eBulletin)

What is the purpose of Supplemental Needs Trusts? 

 
Supplemental Needs Trusts (also known as Special Needs Trusts) are vehicles that can hold assets for a person with a physical or behavioral health disability while still allowing that person to qualify for public benefit programs that have income and resource limitations. Examples of such public benefit programs include Medicaid and Supplemental Security Income (“SSI”). The person who establishes the trust is known as the settlor or grantor, and the person who receives trust funds is known as the beneficiary. In the case of Supplemental Needs Trusts, the beneficiary is the person with a disability. 

What are the different types of Special Needs Trusts?

 
There are various kinds of Supplemental Needs Trusts. A First-Party Supplemental Needs Trust, also known as a Self-Settled Trust or a d4A Trust, is one that is funded by beneficiary. For example, a person may receive monies from a lawsuit settlement, inheritance, or divorce settlement. These assets belong to the person with a disability and can be used to fund a First-Party Supplemental Needs Trust. A Third-Party Supplemental Needs Trust is one that is funded by someone other than the beneficiary. For example, a parent or grandparent may establish a Third-Party Supplemental Needs Trust for a family member. A third type of Supplemental Needs Trust, a pooled trust or d4C Trust, is one that is administered by a non-profit organization. It permits several beneficiaries to pool their trust assets together into a larger trust for investment purposes, while still allowing each beneficiary to maintain an individual trust sub-account. 

How are First-Party and Third-Party Supplemental Needs Trusts different?

 
Federal law governs First-Party Supplemental Needs Trusts. These types of trusts are subject to stricter rules because they hold the assets belonging to the beneficiary while still allowing that beneficiary to qualify for programs such as Medicaid or Supplemental Security Income. First-Party Supplemental Needs Trusts can only be established for a person with a disability who is under the age of sixty-five. They also can only be established by a parent, grandparent, legal guardian, court order, or the person with a disability. These types of trusts are subject to the “sole benefit” rule, meaning that distributions made from the trust cannot benefit anyone other than the beneficiary during that beneficiary’s lifetime. While the sole benefit rule may sound simple, in practice it can challenging, as many distributions can also benefit someone living with or close to the beneficiary. In addition, First-Party Supplemental Needs Trusts have a Medicaid payback provision, meaning that after the person with a disability passes away, the State will be reimbursed for the costs of medical assistance provided to that person from trust funds.  
In contrast, Third-Party Supplemental Needs can be established for someone of any age. As long as the beneficiary does not have the ability to control trust distributions or to revoke the trust, trust assets are not considered an available resource for purposes of Medicaid and Supplemental Security Income eligibility. Third-Party Supplemental Needs Trusts are not subject to the sole benefit rule and therefore these trusts can have more than one beneficiary. In addition, a significant benefit of Third-Party Supplemental Needs Trusts is that these trusts are not subject to the Medicaid payback provision. 

What is a Health Care Power of Attorney?

In a Health Care Power of Attorney, a person known as the "Principal" elects to have another person, known as the "Agent," make health care decisions on his or her behalf. The Power of Attorney becomes effective when the Principal is incapacitated and no longer able to make his or her own decisions. The documents require the certification of at least one physician that the Principal has become incapacitated. A Health Care Power of Attorney can be revoked at any time that the Principal can communicate an intent to revoke. A Health Care Power of Attorney allows the Agent to consent to, prohibit, or withdraw medical treatment. 

What is an Advance Directive?

If an individual wishes to express his or her personal decision about withholding or withdrawing extraordinary medical treatment when approaching the end of life, he or she can do so with the use of an Advance Directive. As a part of the Healthcare Power of Attorney or as a separate document, an Advance Directive (also referred to as a "Medical Directive" or "Healthcare Directive") protects the rights of a patient to refuse or to request medical treatment, thereby enabling the healthcare providers to honor the wishes of their patient. 

What is a HIPAA Authorization?

Federal law, under the Health Insurance Portability and Accountability Act (“HIPAA”) protects the confidentiality of medical records. A separate HIPAA authorization is important because it permits everyone listed on the authorization to receive information from and communicate with physicians. Thus, family members or friends can be included in the health care conversation when critical or end-of-life decisions are being made. 

What happens if I do not have a Health Care Power of Attorney?

In Missouri, a Health Care Power of Attorney is particularly important because, unlike most states, Missouri currently does not have a surrogate decision maker law. Surrogate decision maker laws provide that family members, in an order of priority, can make medical decisions for someone who has become incapacitated. Absent these statutes, medical personnel have no legal guidance on who should make decisions for an incapacitated person who lacks a Health Care Power of Attorney.

The importance of these documents cannot be overlooked. Without them, family members and friends may be forced to petition the court for a guardianship in order to make decisions on behalf of an incapacitated person. The cost and difficulty of these proceedings can be stressful, if not devastating, to all involved. An Elder Law attorney who is experienced in helping clients with these important life decisions can help families in avoiding these pitfalls.

What is an Elder Law Attorney?

Elder Law is a specialized area of legal practice that focuses on the type of client served rather than on the specific legal question involved. An Elder Law Attorney has a practice centered around the issues that impact older adults and people with disabilities. Because the Elder Law Attorney is committed to a type of client rather than a type of law, he or she implements a holistic approach.

What issues does an Elder Law Attorney handle?

An Elder Law Attorney can assist clients and families in preparing for illness and long-term care, as well as planning for the distribution of a person’s estate after he or she passes away. This can include general estate planning techniques, such as the use of wills, trusts, and powers of attorney. Elder Law Attorneys may help with probate matters such as probating the estate of a deceased person or with guardianships and conservatorships.

Elder Law Attorneys also help with planning for and accessing government programs such as Medicaid coverage for skilled nursing or home care, VA benefits, and Social Security disability benefits. They can assist clients with evaluating long-term care providers and insurance policies to help pay for long-term care. Elder Law Attorneys also help families with special needs trusts, which benefit people who are on needs-based government programs, such as Supplemental Security Income (SSI), Medicaid, or VA benefits.

Elder Law Attorneys are committed to advocating for older adults and people with disabilities, and to protecting these populations. An Elder Law Attorney can help prevent and address elder abuse, fraud, or financial exploitation. Most of all, an Elder Law Attorney is there to help families navigate complex situations and to offer legal solutions that attend to a variety of concerns, including financial, housing, familial, emotional, and health issues.

Why is it important to use an Elder Law Attorney?

An Elder Law Attorney has insight into a how different areas of law interact and can impact the client. For example, an Elder Law Attorney can anticipate how estate planning may interact with needs-based programs, such as SSI and Medicaid. Since these programs have income and/or asset limitations, an inheritance can over-resource and disqualify a recipient from these benefits. However, there are specific kinds of trusts that allow people to leave money to such family members without disqualifying them from those benefits.

What can happen if I don’t use an Elder Law Attorney?

Although the use of an Elder Law Attorney is not required, there can be unintended consequences for not using an attorney knowledgeable in this practice area.  For example, an estate planning attorney, who is unfamiliar with Elder Law but who is a skilled estate planning attorney, may not advise against an older adult gifting money to family members. While gifting may not be a bad idea from an estate planning perspective, especially if assets are below the annual estate tax exclusion amount, it may create a problem if Medicaid is needed to pay for nursing home care in the near future. This is because Medicaid imposes a penalty waiting period for gifts made within the last five years.

• Oversee guardianship practice;
• Address key policy issues;
• Improve the current system of guardianship and less restrictive alternatives;
• Engage in outreach, education;
• Enhance the quality of care and quality of life of vulnerable adults.

1. Carol Fletcher, Licensed caregiver, private guardian, volunteer visitor
2. Daniel Musto, Director, Long-term Care Ombudsman
3. David Connors, Judge, Second District Court, WINGS Chair
4. Ellen Silver, Director, Jewish Family Services
5. James Brady, Judge, Fourth District Court
6. James Toledo, Program Manager, Utah Division of Indian Affairs
7. Joseph Taylor, Crisis Intervention Team, Utah State Coordinator, SLCPD
8. Lisa Thornton, Private attorney, activist
9. Kent Alderman, Elder law attorney
10. Nan Mendenhall, Director, Adult Protective Services
11. Nels Holmgren, Director, Utah Division of Aging and Adult Services
12. Patricia Vigo, Latino Liaison, Utah Parent Center
13. Robert Denton, Managing Attorney, Disability Law Center
14. Shannon Alvey, Director, Office of Public Guardian
15. Wendy Fayles, Criminal Justice Mentor, National Alliance on Mental Illness

1. Karolina Abuzyarova, WINGS and Court Visitor Program Coordinator
2. Nancy Sylvester, Staff Attorney, Administrative Office of the Courts
3. Holly Kees, Court Visitor Volunteer Coordinator
4. Julie Rigby, Team Manager, Third District Court 

Utah WINGS accomplishments are:

1. WINGS formed in April 2013 – groundbreaking initiative with funding from the National Guardianship Network with only three other states (OR, NY, TX, UT).
2. Held statewide guardianship summit in November 2013.
3. Published three papers from the summit in the 2014 Utah Bar Journal:
   • “Improving Service Delivery to Protected Persons and Their Guardians”
   • “The Challenge of Submitting Competent Medical Evidence of Incapacity in Guardianship Proceedings”
   •  “Person-Centered Planning and Supported Decision-Making.”
4. Published guardianship webpages here.
5. Created active WINGS listserv, February 2014.
6. Formed Executive Committee, February 2014.
7. International profiling of the Utah guardianship monitoring program at the Third World Congress on Adult Guardianship in Virginia, May 2014. 
8. Adopted organizational bylaws, August 2015.
9. Started collaboration with Social Security Administration and Veteran’s Administration.
10. Established Guardianship Signature Program that provides free and low-cost legal representation to vulnerable adults in guardianship proceedings.
11. Featured panel consisting of Utah WINGS leaders at the 13th Rocky Mountain Geriatrics Conference, September 2015.
12. Organized three public classes for guardians and caregivers on alternatives to guardianship, guardianship procedures, and community resources in fall 2015.
13. Interviewed on KUED, Channel 7 on the guardianship monitoring program in December 2015.

Activities in progress:

1. Create an online training program for the public on guardianship resources.
2. Reach out to the minorities, disseminate information and build partnerships.
3. Translate guardianship web pages into Spanish.
4. Organize live public classes on guardianship in Spanish.

WINGS brings together professionals in the fields of law, social work, medicine, aging services, Veterans Administration, Social Security Administration, non-profit agencies, private guardians, healthcare associations, AARP, Alzheimer’s Association and others. Connections are established between agencies that sometimes served the same population but did not communicate with each other or provide referrals. WINGS widens the understanding of gaps in the area of guardianship and beyond, and offers a platform for a dialogue, coordination and face to face learning opportunities. Large bureaucratic structures started sharing information, and that, hopefully, will make the life of vulnerable adults and their caregivers and guardians easier. 

WINGS chair  
Second District Court

Karolina Abuzyarova
801-578-3925
WINGS and Court Visitor Program Administrator
Utah State Courts

• Alternatives to guardianship (including supported decision-making);
• Support for lay guardians; and
• Person-centered assessments.

• Training, Education & Supports for System Partners;
• Support Services for Family, Lay & Prospective Guardians; and
• Protected Person Advocacy and System Access.

• Oregon WINGS produced a brochure entitled “Guardianship in Oregon: Explained in Brief for Medical and Other Care Professionals.”
• Oregon WINGS produced a booklet for families entitled Options in Oregon to Help Another Person Make Decisions: Guardianship, Conservatorship and Other Options in Oregon.
• Oregon WINGS is completing a person-centered planning tool for guardians.
• Oregon WINGS expanded key materials on an existing aging and disability site to create a consumer friendly web page on the Aging and Disability Resource Connection site that collects in one place all resources concerning decision-making options.
• Oregon WINGS was profiled nationally at the 2014 conference of the National Adult Protective Services Association; and at the Spring 2015 conference of the National College of Probate Judges. 
  

• Pre-Commencement Issues;
• Models of Guardianship; and
• Post-Appointment Issues.

There are few reported cases that refer to the National Guardianship Association Standards or any other standards for guardians.  Cases referencing standards include:

• Guardianship of Doyle, 778 N.W.2d 342 (Mn. App. 2010); and two unreported Minnesota cases that involved the same guardian, same issues and issued the same day —Guardianship of Hohenauer, 2010 Minn. App. Unpub. LEXIS 94; and Guardianship of Langa, 2010 Minn. App. Unpub. LEXIS 90.
• Guardianship of Stamm, 2005 Wash. App. LEXIS 3030 (unpublished court of appeals decision).
• Major v. Rowe (In re Stephens), 965 So.2d 847 (Fla. 2007).
• Guardianship of Fowler, 198 Wash. App. 1023 (2017). In ordering a guardian to disgorge excessive fees, the court noted that the guardian had violated (unspecified) standards of practice and fiduciary duties.

In a handful of states, state-specific standards have resulted from a combination of private and public initiatives.

Some states, such as North Dakota and Alaska, have adopted the NGA Standards by statute or by rule.  NGA’s Standards also served as a template for the development of state-specific standards in California, Texas, Arizona, and Washington.  In Oregon, an optional guardianship certification process requires compliance with standards similar to NGA’s.  New Hampshire has court-adopted procedures based on NGA Standards.

Congruent with national organizational efforts, some state guardianship associations, such as the Minnesota Association of Guardianship and Conservatorship, have adopted state-specific standards of practice. The court cases listed on this page indicate how courts are applying various standards of practice.

At this time, there are study committees considering the adoption of state-specific cases in Ohio, Idaho, and Oregon.

Many states have guardianship handbooks or brochures offering guidance to guardians or potential guardians, but these do not have the force of law.

• In 1977, the U.S. Senate Special Committee on Aging issued a report entitled Protective Services for the Elderly: A Working Paper (86-528-0). 
• In 1987, the U.S. House Select committee on Aging, Subcommittee on Health and Long-Term Care, convened a hearing on guardianship and issued a report entitled Abuses in Guardianship of the Elderly and Infirm: A National Disgrace, (Comm. Pub. 100-641).
• In 1989, the U.S. House Select Committee on Aging issued a report on model standards to ensure quality guardianship and representative payeeship services, based on Guidelines for Guardianship Service Providers by The Center for Social Gerontology. 
• In 1992, the U.S. Senate Special Committee on Aging held a Roundtable Discussion on Guardianship (Serial No. 102-22) to examine the federal role in adult guardianship reform.
• In 2003, the U.S. Senate Special Committee on Aging held a hearing entitled Guardianship Over the Elderly: Security Provided or Freedom Denied (Serial No. 108-3). 
• In 2007, Sen. Gordon Smith, Ranking Member, and Sen. Herb Kohl, Chairman, U.S. Senate Special Committee on Aging issued a report entitled Guardianship for the Elderly: Protecting the Rights and Welfare of Seniors with Reduced Capacity.
• In 2011, the Subcommittee on Administrative Oversight and the Courts prepared a report for the U.S. Senate’s Committee on the Judiciary entitled Protecting Seniors and Persons with Disabilities: An Examination of Court-Appointed Guardians. 

Special needs planning has always been challenging. Small factual differences can have a huge impact on appropriate outcomes. Planning has become even more challenging with the Social Security Administration denying trusts due to a few ill-chosen words. The recent changes in our federal government will likely create even more obstacles in providing an effective plan for persons with disabilities. How do planners draft in this era of uncertainty? How can professionals advise trustees when choosing to make a disbursement or not? Our speaker will review the most common mistakes he encounters in reviewing trusts and provide practical tips on how to avoid these landmines. (Part 2 will be presented in the following session)

How to get your client into a Skilled Nursing Facility

Presented by Kathleen Day-Seiter

• Elder Law Attorneys Oppose Rules Change to VA Pension Program, Military.com
• Proposed Benefit Changes Could Hurt Veterans, InsuranceNewsNet​

• Utah Law Review, Symposium Issue on Third National Guardianship Summit Standards of Excellence

• Uniform Law Commission Website

• Social Services Block Grants Dear Colleague Letter - FY 2013 Allocations Update
• Administration for Community Living - Estimates of Sequester Impact for State Formula Grant Programs Under the Older Americans Act
• National Council on Aging - Congress Fails to Stop Sequester

Created by the state legislature in 1927, the State Bar is a public corporation within the judicial branch of government, serving as an arm of the California Supreme Court. All State Bar members are officers of the court.

Membership in The State Bar of California affords attorneys the right and privilege of practicing law in this state. The bar's integrated network of functions and services — many of them mandated by law — protects the public and assists attorneys in meeting their professional obligations.

These sites offer a variety of Special Needs resources.

Go to Care.com website  -  Ten organizations and resources for individuals with special needs 

Go to CHC website  -  100 Best Disability Blogs and Websites

The Consumer Affairs site article discussing the different types of senior living options.

 
Go to Consumer Affairs website

The Synergy Summit is a nonprofit collaboration among the leadership of the major accounting, legal, and financial service organizations in the United States. Together, these groups represent more than 200,000 lawyers, accountants, financial advisors, philanthropic gift planners, and insurance and other professionals. Synergy Summit helps bring quality estate, financial, and charitable planning information and services to the public through multidisciplinary partnerships and projects.

Go to Synergy Summit website

The Consumer Financial Protection Bureau (CFPB) Office for Older Americans released four easy-to-understand booklets to help financial caregivers. The Managing Someone Else’s Money guides are for agents under powers of attorney, court-appointed guardians, trustees, and government benefit fiduciaries (Social Security representative payees and VA fiduciaries).

The guides help people acting as fiduciaries in three ways:

• They walk them through their duties.
• They tell them how to watch out for scams and financial exploitation, and what to do if their loved one is a victim.
• They tell them where to go for help.