Leadership In Law Podcast

S02E97 Elder Care & Veteran's Benefits with Dementia Diagnosis with Robert Mannor

• Marilyn Jenkins • Season 2 • Episode 97

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The path through elder care and dementia planning can feel like navigating a labyrinth without a map. Nationally board-certified elder law attorney Robert Mannor joins us to reveal how a leadership approach creates better outcomes for families facing these difficult transitions.

Most families facing dementia get fragmented and conflicting advice. Robert shares his "circle of care" approach, combining legal guidance with medical advocacy, care navigation, and coordination across providers. His team bridges home care, facilities, hospitals, and other resources to ensure seamless support for families.

We cover key legal steps for dementia planning, from drafting powers of attorney with "extraordinary powers" to understanding care facility options. Robert shares strategies to protect assets while securing benefits and explains how special needs trusts can safeguard a surviving spouse with dementia.

Veterans will benefit from our discussion of often-overlooked benefits, including Agent Orange presumptive conditions and the importance of applying early to secure retroactive rights. Robert illustrates this with the story of a Normandy veteran who applied too late, leaving his widow without support.

Reach Bob here:
www.mannorlawgroup.com 
https://www.facebook.com/MannorLawGroup
https://twitter.com/MannorLawGroup
https://www.youtube.com/channel/UCSPPFKqm-HlSJPrwSAdVfQg
https://www.instagram.com/mannorlawgroup/
https://www.linkedin.com/company/mannor-law-group/
https://www.tiktok.com/@mannorlawgroup

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Speaker 1:

Welcome to the Leadership in Law podcast with host Marilyn Jenkins. Cut through the noise, get actionable insights and inspiring stories delivered straight to your ears your ultimate podcast for navigating the ever-changing world of law firm ownership. In each episode, we dive deep into the critical topics that matter most to you, from unlocking explosive growth to building a thriving team. We connect you with successful firm leaders and industry experts who share their proven strategies and hard-won wisdom. So, whether you're a seasoned leader or just starting your journey as a law firm owner, the Leadership in Law podcast is here to equip you with the knowledge and tools you need to build a successful and fulfilling legal practice.

Speaker 2:

Welcome to another episode of the Leadership in Law podcast. I'm your host, marilyn Jenkins. Please join me in welcoming my guest, robert Manner, to the show today. Robert is a nationally respected elder law, estate planning and veterans benefits planning attorney. He is one of only 18 attorneys in the state of Michigan to be nationally board certified as an elder law attorney by the National Elder Law Foundation. Bob is an accredited attorney with the Department of Veterans Affairs Office of General Counsel. Bob was previously chair of the State Bar of Michigan Elder and Disability Rights Section and past president of the Michigan Chapter of the National Academy of Elder Law Attorneys. Bob is a frequent speaker and author on legal issues, providing continuing education credits to lawyers, social workers, nursing home administrators, doctors and nurses. I'm excited to have you here, Robert, welcome.

Speaker 3:

Thanks for having me, Marilyn. I'm looking forward to this.

Speaker 2:

Absolutely so. Tell us a bit about your leadership journey and how you got to where you are.

Speaker 3:

Yeah, it's pretty interesting I mean, it's actually a pretty boring story that I started out right out of law school working for some firms. I thought I was going to be a litigator, and I did that for a few years, finally had kind of the courage to decide to go out on my own and, as is the typical process for that, struggled for several years and then realized that the best way for me I don't know if this is for everybody is to have really smart people around me, and so that's where the leadership comes in is to find the right people and let them do their job. And so that's been my experience that I've had limited success when I haven't had the right people around me, but I've been very lucky to find great people as part of my team, and a lot of my leadership is trying to empower people and make sure that they have the resources to do their best work.

Speaker 2:

I love that. Building team is so important and culture as well, as you're growing, yes, fantastic. So thinking about the elder law part and you know we're hearing about dementia diagnosis and that sort of thing what would be explain the steps of that when it happens? Because it is so, it's so terrible as it progresses?

Speaker 3:

Yeah, and I actually think this comes into the leadership part of it too. It's really difficult, I think, to be really effective advocate for families with loved ones with dementia without being a leader in the field, in the area, and the issue is that there is just so many voices right. When someone, when a family, is faced with this, they're often know intuitively that there's a problem before they seek any advice. But once they start to seek advice, it seems like everyone can come out of the woodwork as far as you know their neighbor, their barber, their, you know the bank, you know manager or the bank teller, certainly their financial advisor, their accountant, sometimes their lawyer, the doctor, the nursing, you know the social worker. And, in my experience, often all of that is either coming from a different perspective or sometimes just not the right answers. And so it's so overwhelming and so confusing for families that what we've had to do is, number one, make sure that we look at everything in a very holistic perspective so that we're not taking one perspective or one side or just limiting our focus, our experience or, you know, the experience of the hospital or the experience of the financial advisor. We try to look at the holistic picture, but then we do.

Speaker 3:

We make a great effort to try to then go out into that community and have this conversation with the folks in the long-term care community, people that work for care organizations, administrators, social workers, even the office folks, the billing managers at different care facilities, the home care agencies, and so we actually call it our circle of care, the home care agencies, and so we actually call it our circle of care.

Speaker 3:

And so our goal is, as part of this process, is to have that conversation and sometimes lead that conversation, so that we the goal is to say, hey, in order for our families, the families that have a loved one with dementia, to get the best services, we all have to work together. At some point we're going to need the home care agency, some point we're going to need the hospital and the social worker. At some point we're going to need some skilled care and rehab. Sometimes we may need assisted living, memory care, and in order to make those trade-offs and those transitions more smooth, we all have to work together. And so, rather than having this be a competitive industry, we really go out and try to make sure that we're having this conversation.

Speaker 2:

We put on events and really just try to be active in that community to try to lead that conversation towards this circle of care. I love that, just thinking of the entire life, of what's going on.

Speaker 3:

And you're helping the planning part for the family members who have the needs. So we are a little bit different. There's a group of lawyers throughout the country that take this perspective. Rather than just doing the legal, financial part of it, we try to take a very holistic view. This is hopefully a growing movement.

Speaker 3:

We interact with a lot of law firms and lawyers throughout the country that have embraced this more holistic process, for example, saying I have social workers on my staff because what we found was that when families are dealing with this, of course they're worried about money. Of course they're worried about how are we going to pay for this. Of course they're worried about making sure that we don't end up in court or that we have the proper permissions in place, we have the proper legal documents in place. But as much as anything, they're worried about quality of life for their spouse or parent. They're worried about if they're making the right decisions. They're worried about making sure, if they are writing checks, that they're not wasting that money on the wrong care, that they're not wasting that money on the wrong care. They're worried about, when they hit a stumbling block or the next thing happens, that they have a plan to move forward and it's just not one crisis after another crisis.

Speaker 3:

So what we do is we call it care navigation, some people call it care planning, but that care planning term is used in a variety of different industries. So we changed it to care navigation where, in addition to the legal and financial, we provide medical and care advocacy and we assign them a care navigator in our office at social workers that can work with the family long term, because we can create the perfect plan that's going to work today and then another shoe drops tomorrow where the one that needs the care has a fall or a stroke or the plan that we set up isn't working properly or there's a new administrator or there's a new caregiver or things like that. So we try to be agile, to be able to help the family once we've helped them, continue to help them as things change and advocate for better care.

Speaker 2:

I see Excellent. So they and thinking about the care for elders and there's the dementia care, the Alzheimer's and the different. What are the differences between the types of care homes?

Speaker 3:

Great question. So it's a little different. The wording is a little different from state to state, but they're all the categories are basically the same, they're just. I noticed in Pennsylvania they use different language than we use as far as the categories and identifying the categories. So the categories are basically the same but every state might call them a little bit differently, sometimes based on their licensing laws, sometimes based on just local vernacular. We were on the phone with, or on a call with, a group out of Pennsylvania and we were talking about a certain food dish and we all thought we knew what we were talking about.

Speaker 3:

But in Pennsylvania that food dish is drastically different than what it would be out of Michigan, and so that's true, for you know all these things. So in Michigan we start off with home and maybe some home care, so that's a level of care, and then we can look at what resources maybe we can bring into the home, maybe even what resources we might have for paying for that care. In Michigan it would be primarily through veterans benefits, community resources or different types of Medicaid that we have in Michigan and every state's going to have similar options like that veterans benefits, community resources and different forms of Medicaid as opposed to Medicare. The next step up and this is a distinctive category, we would call it independent living in Michigan. The distinctive category, we would call it independent living in Michigan. Other states might call it something different, but the key distinguishing factor is that we write two checks. We have one check for room and board. An entirely separate company provides the care in that independent living and so often the care might be sort of a la carte, where we're just paying for the things that we need. But what distinguishes independent living from the other categories is that there's two different companies involved and there's a number of reasons to do this for liability purposes and, frankly, to give the family, more independence, things like that. But the idea is sometimes that can be very helpful because they are two separate companies. Often it makes it easier to get government resources like veterans benefits or Medicaid services or community resources to come in, because we have separated the care from the room and board.

Speaker 3:

The next step up would be something in Michigan and I chuckle because Michigan has not updated their licensing titling for probably since the 50s, and so the terminology that's used here is a little bit old fashioned. But they call them adult foster care homes, and so adult foster care homes is a licensing that we have in the state of Michigan. You're going to find this everywhere. They might call it different things, but the concept of adult foster care is it might be a house in a neighborhood, so some people in other states might call it a group home, which I don't like that terminology either. But the idea is it's a house where we have a number of residents that need some services and need some care, but they might eat dinner at a dining room table and they might be able to sit out on the back porch at night, and there might be pets there. You know things like that. So it's usually typically a smaller place, six to ten residents, adult foster care.

Speaker 3:

Next step up from that would be assisted living or memory care. Now, in some states those are going to be very distinct. Assisted living, memory care In Michigan, memory care would be classified as assisted living just a different form of assisted living. Memory care would be classified as assisted living, just a different form of assisted living. In other states that might be a licensing issue, where something is licensed as a memory care as opposed to assisted living. But those are where you are paying for both room and board and the care provided. The main difference on memory care is it's a more secure. It's harder to get out.

Speaker 1:

Yeah.

Speaker 3:

It's more protected and, ideally, the caregivers are more used to it. With memory issues, you know if they're, if you're working every day and you're working with some people that have memory issues and some people that have a broken hip, it can be very easy to lose your patience with somebody that has memory issues and asking the same question over and over again. But if everybody in your unit and your caregiver in that unit, if everybody's like that, hopefully you've gotten specific training and a level of patience where you're getting more used to working with folks with memory issues. And then the top level of care. Well, there's really two top levels of care.

Speaker 3:

One would be what we normally call skilled care. It could be called nursing home or skilled care. And then there's always the hospice houses. There is some hospice houses left. You know hospice is a big issue now From the standpoint. You get hospice anywhere. You get hospice in your home, hospice in assisted living, but there are a few places that are really designed for your last days and there used to be a lot more, at least in Michigan. There's a handful of them still left and it's designed really to make your last days the most comfortable to be.

Speaker 2:

And that can be in your home, if that's what you choose.

Speaker 3:

Absolutely.

Speaker 2:

Excellent. So you touched on money and the different options when it comes to dementia care, talking about estate planning and what needs to happen, especially if it's maybe an early diagnosis. How would that work on the family? We always hear about the caretakers that are the ones that are having a lot of stress because they're now needing to be trained on that and the patient's level, and so what would be the best steps to take?

Speaker 3:

Yeah, it's really interesting. So the most important thing for me is that we have what I would call the lifetime documents, and the lifetime documents are financial power of attorney, medical patient advocate privacy waivers. Those are really important because if we're going to, you know somebody, particularly somebody with dementia, they may not be able to get permission or participate in the plan. So you know, if we got a diagnosis and we want to plan ahead which we absolutely should then one of the things we need to do is build in that flexibility, so build in the ability to make the plan work when the time comes, because if there's a good chance that the person with dementia might not be able to fully participate at that time which brings us to a couple of issues. One is often we need a stronger worded power of attorney that has additional authority we call it extraordinary powers that gives additional authority to those people that we have an extreme amount of trust in maybe our spouse, maybe one of our kids and we say, okay, we know we're giving extra authority. That might be risky if it was somebody that we didn't fully trust, like the ability to move money and move money out of your name, which that sounds dangerous if somebody else can move money out of your name without you knowing about it, but by the time you have full-on dementia, you might not be able to give permission for that, and those might be some of the things that we need to do. Even transfers between husband and wife could be considered a transfer that is not allowed unless we have specific permission to do that. So that's the most important thing. There are some other things that we think about, of course making sure we have a plan for what happens after death, and one of the odd things is that most people this is a we're going high level here, because a lot of folks don't know about this I think, in just about every state, because this is based on federal law, there is an option to say well, what happens if the healthy spouse dies?

Speaker 3:

The caregiver spouse dies. Most of these cases, we have a caregiver spouse and we've got a spouse with dementia. Okay, most of these cases, we have a caregiver spouse and we've got a spouse with dementia. So if the caregiver spouse dies first, what does the will and trust typically say?

Speaker 3:

Give everything to the spouse with dementia, and that might not be ideal for a variety of reasons, but the Medicaid you know federal Medicaid rules actually contemplate this and says well, you could set it up so that it says upon the death of the healthy spouse, the caregiver spouse, everything goes into what's called a testamentary special needs trust for the spouse with dementia and anything in that testamentary special needs trust with the spouse with dementia is exempt for Medicaid. So it's one of the things when we do have somebody come in early enough and they can authorize this and we can have a full discussion about it and everybody's clear on what the consequences are. It's a way to have a plan now for what if the caregiver spouse that we're relying on so much, what if they die? Then we have a plan for making sure that the surviving spouse is protected.

Speaker 2:

And would you have another executive? I'm sure is not the word. Would you have someone, a secondary person that would step up at that point?

Speaker 3:

Exactly, it has to be that way. So a testamentary trust would actually be housed in the caregiver spouse's will. That's basically testamentary. The wording of the trust is in the will of the deceased caregiver spouse's will. That's basically testamentary. It creates that the wording of the trust is in the will of the deceased caregiver spouse. And then of course we have to have somebody appointed to manage that special needs trust for the surviving spouse and make sure that the money is spent properly. But they also have the option of pursuing Medicaid without having to spend on those assets.

Speaker 3:

Okay, yeah, because I know there's some real details when it comes to Medicaid and how much you can and cannot have in order to access those benefits. That's what we do, is we try to find those places where we're able, especially with a married couple, or, if we're able to do this testamentary special needs trust, able to protect assets and still qualify for Medicaid. You know, when you think about Medicaid versus Medicare, we turn 65, we get Medicare. We pay a premium, but we get Medicare at age 65.

Speaker 3:

So if you get one disease, like heart disease, and you have open heart surgery, it's almost all paid for, especially if you have a supplemental policy. But if, instead of heart disease, you get Alzheimer's, medicare and insurance don't really pay anything for that care. So it's odd that you know you get one disease, you're covered. You don't. It's not going to affect you financially. You get a different disease and the initial expectation is that you have to impoverish yourself before you get any help. Built in the law, as with every government program, there's ways that you can find safe harbors and protections and deductions and all these things. And that's my job is to figure out where we can qualify for the care that we need without having to impoverish ourselves.

Speaker 2:

Great, I love that. The education of the family, exactly. And is there, at what point is it best to decide to do, like, say, the medical power of attorney? Is it? Do you think it's when you get married, when you retire? I mean, people are like I don't want to think about that kind of stuff, but you know we really have to.

Speaker 3:

So it's funny that you ask. A couple of years ago I was on a trip we were actually in Iceland and my daughter was with me and on a whim I said you know, miriam, go ahead and videotape me with this. Falls behind me and ask me the question, because she was about ready to go to college and I said ask me the question hey dad, I'm going to college in the fall. Is there any legal documents I need before I leave? And we went viral with that video. We had about 2 million views on that, so I thought that was pretty cool. But my answer was if you're 18, you need these documents. And I know that seems a bit extreme, but I think, in particular if you're 18 and going off to college, you need these documents Because most kids, 18 year olds, are still pretty dependent on their parents and their parents don't have any authority anymore once they turn 18.

Speaker 3:

So if you're in the hospital and you don't have a medical power of attorney or a medical patient advocate or at least a privacy waiver, the parents might not have access to help you. If you get arrested in college, you know the parents might not have access because of the privacy waivers and other things. So I encourage everybody over 18, but particularly if you're going off to college to get a financial power of attorney, medical patient advocate and privacy waivers and when we did go viral, there were certainly, you know, a lot of kids that would be like I'd never give my parents that authority. Okay, that's cool. This isn't for everybody.

Speaker 3:

A lot of kids that are 18 are still very dependent on, you know, mom scheduling the doctor's appointment or you know dad making phone calls on doctor's appointments or whatever it is, and so it's a good idea. Now, if I'm saying 18 years should have it, then it means pretty much everybody that's an adult should strongly consider it, and it's a relatively simple process. Yes, it's not fun to think about these things, but it's relatively simple, and of course, then they have to be updated as time goes by, because you get married. You probably changed it from your parents to your spouse. You get, you know, kids grow up. You probably change it from your sister as the backup to maybe one of the kids as the backup.

Speaker 2:

And so they do have to be updated through the years. I think it is interesting. I've spoken with other estate planning attorneys and a lot of parents don't realize that you know when you move into the dorm at 18, if something does happen, you've got nothing. The doctors, hospitals, don't have to tell you anything.

Speaker 3:

There is a form that most universities use that is similar but it's specific to the university. So, while they are signing forms as part of their admission, where they can give these permissions to the parents, that my point is. Even if you have that form, not everything happens on the university campus.

Speaker 2:

True, true. So you focus on veterans benefits as well. So let's touch a little bit about the government benefits for veterans that you know when they need to afford this type of care, what is available specifically for veterans?

Speaker 3:

So there's three main areas. You know, obviously there's so many categories of veterans benefits, but there's three main areas that I think people need to know about. You know one that most people understand at least. Maybe don't know all the details, but is the service connected? You were injured somehow in service. It might be PTSD. It might be that you were exposed to Agent Orange in Vietnam. It might be that you were, you know, shot, and so many people understand at least the concept of that. That's a really important one to pursue. We often have veterans choose not to. They're like oh well, there's veterans that have it worse off than I am, so we'll let them do it Now. It's really important because you might need this later in life.

Speaker 3:

I had a good friend of mine finally convinced his dad to apply for benefits for PTSD from World War II. He participated in the primary invasion on Normandy Beach and it was some of the stories he told me were just horrific. Just, you know, saving Private Ryan, it was very much like the movie and so he finally applied when he was 89 years old, something like that Relatively quickly got 100% benefit and it came with a lot of these benefits and then he died a year later and he probably could have had that for 20, 30 years. That would have made his life a whole lot easier. But the worst part of it was his widow. His wife lived for several years after that and she was not able to get it because he didn't have it long enough. And so it's important to if there's a chance that you can qualify for one of these service-connected services, just get the application in, even if you're discouraged by the VA from applying, just get the application in because you can go retroactive back to an application. But you're never going to get retro. Typically you're never going to get retroactive unless you submit an application. So it's really important, even for those veterans that you know really don't want to deal with the paperwork or whatever.

Speaker 3:

And one other thing about that service connected anybody that was in Vietnam. There's a whole big list of diseases that have been attached to Agent Orange and it's called a presumptive condition. Now, so that presumptive condition makes a big deal because they say, okay, we presume you were exposed to Agent Orange. You don't have to prove you were exposed to Agent Orange if you were in Vietnam or around Vietnam. And then they presume, if you have certain diseases like Parkinson's, ischemic heart disease, diabetes all those very common diseases that they presume it was because of your exposure to Agent Orange and you're entitled to benefits, and some of those benefits can really help you with paying for things like home care or assisted living or nursing home or daycare or those types of things later in your life.

Speaker 3:

The next program would be a program that is often called aid and attendance. It's a little bit of a misnomer, but it's basically for anybody that doesn't have service connected but it served during a wartime period. They don't have to have served in the war. They could have been in Germany during Vietnam, but if they served during that wartime period and they have medical expenses now, this one does have some asset limitations. So if you have, this is really only for folks that have limited assets under about $150,000, plus you can have a house, plus you can have cars, plus you can have a bunch of other exempt items. But if it's, you know, if you have more than $150,000 in cash, then you probably have to spend down a little bit first and then the final program that gets overlooked is just the medical services.

Speaker 3:

So VA doctors have a little bit more flexibility to order continuing care than a regular doctor. So under Medicare you're not going to get a home health aid. Medicare typically doesn't authorize a home health aid. They might authorize a physical therapist or a nurse to come by a couple of times a week, but not a home health aid. That's going to prepare meals, help you get dressed in the morning, you know all those types of things. Va doctor can prescribe that. Now they might not call it prescribing it. That's basically what it is. A VA doctor has that authority to authorize a home care and other types of care too through the medical services. So that's one that's often overlooked too.

Speaker 2:

So you would say it's absolutely worth it too, if you're a veteran, to pursue the benefits that you've earned.

Speaker 3:

Yes, and you can sign up, at least to be in the system for medical services online. You can go to the VAgov and sign up and see what you're eligible for with that third category of medical services.

Speaker 2:

I love that. This has been incredibly informative. I really, really appreciate your time today. I know that our listeners might want to connect with you, ask you some more questions and maybe even find out where your CLEs are being so that they can get some education, because I know some home administrators would be definitely interested in that. Where would be the best way for them to connect with you?

Speaker 3:

Well, you can contact the office, 800-990-6030, or our website is mannerlawgroupcom, and probably those are the best ways. We're also on YouTube and most of the social medias, things like that, but if you want a direct contact, that would probably be the best way. Either call or check out our website at mannerlawgroupcom.

Speaker 2:

Fantastic. We'll make sure that we have that phone number and those links in the show notes for us today for anybody that wants to reach out to you. Thank you so much for your time. This has been really good and good information and I hope everybody takes notes, and especially the veterans out there. Apply, get your name and get the application in so the date's recorded.

Speaker 3:

Thank you, marilyn, I enjoyed talking to you.

Speaker 2:

Thank you so much. Thanks for joining me today for this episode. As we wrap up, I'd love for you to Thank you so much me on LinkedIn to keep up with what I'm currently learning and thinking about, and if you're ready to take the next step with a digital strategist to help you grow your law firm, I'd be honored to help you. Just go to lawmarketingzonecom to book a call with me. Stay tuned for our next episode next week. Until then, as always, thanks for listening to Leadership in Law podcast and be sure to subscribe wherever you listen to podcasts so you don't miss the next episode.

Speaker 1:

Thanks for joining us on another episode of the Leadership and Law podcast. Remember, you're not alone on this journey. There's a whole community of law firm owners out there facing similar challenges and striving for the same success. Head over to our website at lawmarketingzonecom. From there, connect with other listeners, access valuable resources and stay up to date on the latest episodes. Don't forget to subscribe and leave us a review on your favorite podcast platform. Until next time, keep leading with vision and keep growing your firm.

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