Eldercare Planning Services

At U.S. Trust, we are committed to addressing the wealth management needs of our clients and their families — as well as their extended families. We see our client relationships as family relationships, and this commitment to our clients and their families is embodied by our ElderCare Planning program, which offers comprehensive services for our clients, including those planning care for themselves as well as for those who will need to provide care for aging loved ones.

A REAL AND GROWING NEED

Have you thought about the cost of health care as you grow older? Have you considered the various types of living and long-term care arrangements that you or your loved ones might need? Do you have a plan to pay for them? Are the necessary financial, legal and medical documents in order and accessible to those who will need them? Is your estate plan up to date?

These are all important questions, but they take on a special resonance and urgency against the backdrop of rising health care costs and an aging population.

THE AGING OF AMERICA

The percentage of people aged 65 and older is expected to increase from about 13% of the total U.S. population in 2012 to about 24% by the year 2060. That's roughly 98 million people aged 65 or older — more than double the number there were in 2012.1

At the same time, Americans are living longer than ever before. Those reaching age 65 can now expect to live another 18 years,2 and the 85+ population is projected to increase from 6.2 million in 2014 to 19.7 million in 2060.1

All of this means increasing demand for elder care services and increasing pressure on families. Among those 70 years old or older who need some help with personal care or routine aspects of daily life, the vast majority receive help from family members. Complicating matters, many of these caregivers are in the "sandwich generation" — that is, they also have children under the age of 18 at home.

More older Americans, longer life expectancies, increasing health care costs and mounting stress and worry for families all point to the growing need for elder care planning and services.

THE ELDERCARE PLANNING PROGRAM

Prompted by these powerful demographic trends — and more specifically our special focus on the elder care concerns of high-net-worth individuals and their families — professionals from across U.S. Trust developed a comprehensive program of elder care services for our clients themselves, as well as for those clients who will need to provide care for aging loved ones.

The program focuses on four key areas:

1. Organizational services

Being prepared to deal with the unexpected becomes more important as our clients and their loved ones grow older. We assist clients in gathering and organizing critical financial, legal and medical information like insurance policies, account ownership and trust documents, and wills and health care proxies, among others. The need to access key documents often arises unexpectedly, such as when a loved one suddenly falls ill.

Assembling documents and sharing them with appropriate family members as early as possible can reduce stress and facilitate their handling later.

YOUR PERSONAL INVENTORY MANAGER (YPIM)

From documenting the location of family and financial records to compiling contact information for doctors and advisors (and much more), this comprehensive workbook can serve as a repository to help keep track of important data. Clients can use the YPIM to arrange their own matters and also to help elderly relatives identify and organize their personal information.

The YPIM can be customized to fit each client's needs. It can include important due dates for recurring items, account numbers, and passport expiration dates, for instance. While the YPIM is designed to be completed for an individual, spouses may wish to combine certain sections to avoid duplication. And for those acting as caregivers, the Caregiver Supplement, which documents information about the individual being cared for, can be a valuable resource.

2. Facilitating care coordination services

When aging relatives can no longer take care of their own needs, families are faced with decisions about what kind of assistance will be required and which facilities can best supply that help. Can a loved one continue to live at home with the help of family members and paid staff? Would that person be happier in an assisted living facility that provides the opportunity to socialize with other people? Or is 24-hour medical supervision offered by a nursing home required? Even once these broad decisions have been made, families must evaluate which facility is the best fit for their loved ones, taking into account services, location, and overall quality and atmosphere of the available options. All of this usually occurs during a period of great stress, when a loved one's health is deteriorating.

One unique aspect of the ElderCare Planning program is the care coordination service that can help clients and their families navigate these unfamiliar waters by offering access to a dedicated team of elder care planning specialists through our partnerships with external organizations.

Services center on coordinating and overseeing medical care: providing referrals for reliable geriatric assessments (a diagnostic tool designed to assess the medical capabilities of elderly patients) and assistance in creating a care plan; assessing long-term health facilities and their entry requirements; finding concierge health care services and elder care specialists; and providing support for family caregivers, including training and recommendations regarding in-home monitoring technology.

Our partners have evaluated hundreds of living facilities all over the United States to identify leading providers. They can help clients assess their own or their loved ones' needs for elder care and identify the most appropriate options. They can also guide clients through the sometimes complex application process. Even if assisted care or a nursing home is not yet necessary, the team can help evaluate other possible living situations— helping a client decide, perhaps, to sell a large family home and move to a smaller, more easily maintained residence.

We can put clients and their families in touch with all the resources of our elder care alliance partners, who work with U.S. Trust clients on a preferred basis and at specially negotiated prices. Referrals are made to our external partners at no charge to clients, and U.S. Trust receives no compensation from these partners for providing these referrals.

PROFILE: SIMPLIFYING LIVING ARRANGEMENTS FOR AN ELDERLY RELATIVE*

When our clients, an elderly couple, decided that the upkeep and maintenance on their family home was too much for them, we helped them arrange to sell their primary residence and move into a smaller one. Through an introduction from their U.S. Trust® advisor, they met with a care coordination professional who helped them decide where they wanted to live, what amenities were important to them and what type of facility would best meet their current and future needs. Because the husband had experienced some health problems in the last few years, the couple decided that they would prefer a facility with medical services on site. They also wanted to live near their daughter's family to stay in close contact with their grandchildren. With assistance from their care coordinator, they chose an assisted living facility that provided access to excellent medical care. Upon selling their current home they moved into their new home, where the couple began to enjoy an active social life, with greater assurance that their health and long-term care needs would be met.

3. Wealth planning services

With longer life expectancy come increased concerns about health and mobility, retirement, and overall financial well-being. Whether we're talking about nursing homes, assisted living or home care, living and mobility arrangements are among the key expenditures people over the age of 65 will likely incur at some point in their lives.

In addition to providing important educational resources about the financial issues related to aging, our ElderCare Planning program can help clients (and often their parents and other loved ones) with important financial planning for longevity, including budgeting assistance, retirement asset planning, the analysis of long-term care insurance and assessments of other ways of financing long-term care arrangements. In areas where we don't provide on-the-ground resources, such as long-term care and life insurance agreements, we have established alliances with premier providers.

Through dialogue with you and your aging loved ones, we can develop strategies that fit your family's unique needs for wealth planning in these critical later years.

4. Estate planning services

U.S. Trust has a history of helping families pass their wealth from generation to generation, developing expertise in wealth transfer planning services. This knowledge and experience is the core of our business, and our capabilities are truly comprehensive, ranging from multigenerational planning to agent for trustee, revocable and other trusts; gifting and philanthropy; coordination of beneficiary designations across generations; wills; durable powers of attorney; health care proxies and estate settlement services. We address these topics with our clients every day, but we've also made them part of the ElderCare program for anyone who needs assistance. Health care proxies and living wills are a particular focus of the estate planning services in our ElderCare Planning program. While these documents are not related to one's financial wealth plans, having them in place can be essential to help ensure that the care provided better reflects an individual's wishes.

Whether you or your loved ones already have an estate plan in place and simply need to fine-tune it to align with current priorities, or the planning process is just beginning, we can provide in-depth experience and insight.

PROFILE: PROVIDING FOR MEDICAL CARE DURING A FAMILY VACATION*

Our client wanted to take his elderly mother and his daughter on an extended trip to Europe, introducing the young girl to the cities that he and his mother had loved. The mother, however, had become frail and required regular medical treatments to maintain her health. Through U.S. Trust's identified network of care coordination providers, medical services were prearranged for the mother, should she require them, in the foreign cities they planned to visit. During the trip, the mother did experience one health setback, which required a doctor's visit, but the family was able to take care of her needs easily by seeing one of the doctors who had been identified by the external partner. The entire family enjoyed an extended vacation without the stress of worrying about how to take care of the mother if she became ill.

For more information on this topic, please contact your U.S. Trust® advisor.

1 U.S. Census Bureau, "Projections of the Population by Age and Sex for the United States: 2015 to 2060," U.S. Census Bureau, released December 2014 (most recent released by the U.S. Census Bureau Data on Population Projections, National Population Projections).
2 Centers for Disease Control and Prevention, "Health, United States: 2012, Life expectancy at birth, at age 65, and at age 75, by sex, race, and Hispanic origin," Centers for Disease Control and Prevention, 2012 (latest data available).
The information and views contained in this article are for informational purposes only and do not provide investment advice or take into account your particular investment objectives, financial situations or needs and are not intended as a recommendation, offer or solicitation for the purchase or sale of any security, financial instrument, or strategy. Any opinions expressed herein are given in good faith, are subject to change without notice, and are only correct as of the stated date of their issue.
This publication is designed to provide general information about ideas and strategies. It is for discussion purposes only, since the availability and effectiveness of any strategy are dependent upon each individual's facts and circumstances. Always consult with your independent attorney, tax advisor, investment manager and insurance agent for final recommendations and before changing or implementing any financial, tax or estate planning strategy.
*Case studies are intended to illustrate products and services available through U.S. Trust, Bank of America Private Wealth Management. The case studies presented are based on actual experiences. You should not consider these as an endorsement of U.S. Trust or as a testimonial about a client's experiences with us. Case studies do not necessarily represent the experiences of other clients, nor do they indicate future performance. Investment results may vary. The investment strategies discussed are not appropriate for every investor and should be considered given a person's investment objectives, financial situation and particular needs. Clients should review with their U.S. Trust advisor the terms, conditions and risks involved with specific products and services.
The 2015 U.S. Trust Insights on Wealth and Worth® survey is based on a nationwide survey of 680 high-net-worth and ultra-high-net-worth adults with at least $3 million in investable assets, not including the value of their primary residence. Respondents were equally divided among those who have between $3 million and $5 million, $5 million and $10 million, and $10 million or more in investable assets. The survey was conducted online by the independent research firm Phoenix Marketing International in February and March of 2014. Asset information was self-reported by the respondent. Verification for respondent qualification occurred at the panel company, using algorithms in place to ensure consistency of information provided, and was confirmed with questions from the survey itself. All data have been tested for statistical significance at the 95% confidence level.
U.S. Trust operates through Bank of America, N.A., and other subsidiaries of Bank of America Corporation. Bank of America, N.A. and U.S. Trust Company of Delaware (collectively the "Bank") do not serve in a fiduciary capacity with respect to all products or services. Fiduciary standards or fiduciary duties do not apply, for example, when the Bank is offering or providing credit solutions, banking, custody or brokerage products/services or referrals to other affiliates of the Bank.

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