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It’s All In The Genes

In a recent article I wrote for Trusts & Estates, a magazine for estate-planning professionals (October 2012), I looked at the latest ability to glean genetic information, and how it may affect estate planning and taxation issues.

"It's All in The Genes" touched on the Genetic Information Nondiscrimination Act, known as GINA, which was signed into legislation in 2008 by then-President George W. Bush. The intent of GINA was to ensure that, as researchers continue to discover ways in which individuals may be genetically predisposed to certain illness, they are not then discriminated against in the areas of health coverage, insurance, and employment.

GINA was signed in at the federal level; California also passed its own version of the Genetic Information Nondiscrimination Act, which is intended to cover a broader area than the federal legislation. It bars genetic information discrimination in the areas of education, employment, housing, lending, and public accommodations. GINA as it currently stands federally does not include privacy protection when it comes to life insurance, disability insurance or long-term care insurance. How genetic information will be used in those instances in the future is still uncertain. While individuals would want to keep their medical information private, genetic information that affects life expectancy is of obvious relevance to life insurance underwriting decisions and other areas where medical issues and insurance issues come into play.

Genetic research is still, in many ways, in its infancy. What the future holds for genetic research will surely have far-reaching legal repercussions. For example, genetic information may inform an individual of likelihood that he will develop Alzheimer’s Disease. With that information, he is likely to consider how the cost of long-term care can be paid while protecting assets for his family. He may make tax-wise changes in his investment and estate planning.

Michael Gilfix is an estate planning attorney in Palo Alto California and is one of the pioneers of elder law. To learn more, visit Gilfix & La Poll Associates LLP at

Long-Term Care: An Overview

"Long-term care" is the term used to describe care services for an adult who needs help and care, either in-home or in a care facility. The best time to plan for a long-term care option for you or a loved one is years before it is ever needed. Pre-planning and preparation for "what if" is always better than having to make last-minute, emotionally laden decisions.

There are different types and different levels of long-term care, including:

Home Care. Home care encompasses care from home aides or personal assistants, people who come to your home to help with bathing, dressing and personal needs. They may also do light housekeeping, assist with shopping and do minor errands. Personal assistants and home aides usually are not medically trained and do not cover medical issues. A home health care nurse or attendant with medical training can also be hired to provide basic medical care, such as dispensing medication, checking blood pressure, changing dressings, etc.

Day Programs. Day programs offer meals, activities and social interaction for adults who do not need 24-hour care, but may wish to go on supervised trips to museums, concerts, and shopping, or to get exercise and attend classes. Some day programs also provide transportation to and from the care center and offer some medical services.

Senior Housing. Senior housing may include different configurations of independent rental apartments, with a central hub for meals and socializing, as well as housekeeping and scheduled activities.

Assisted Living. An assisted living facility is more hands-on, with on-premises staff members who oversee bathing and dressing as well as meals, housekeeping and medications.

Nursing Home. A nursing home has 24-hour nursing care. A nursing home may be a long-term residence for an individual who needs full-time care, or may be a shorter duration stay for someone recovering from surgery, an illness or an injury.

What level of care you choose depends on what services you will need, and what services you can afford. Many people erroneously believe that Medicare will cover their long-term care needs, but Medicare is a federal program for people over age 65 as well as for those with certain disabilities, and generally does not pay for long-term care. Medicaid is state-federal program that is designed for people with certain low-income requirements and limited assets. Importantly, Medicaid (Medi-Cal in California) is the only government program that can pay all or a portion of nursing home care.

Unexpected long-term care can deplete even extensive savings and retirement reserves. The most prudent way to prepare for the likelihood that long-term care will be needed in the future is to sign up for long-term care insurance. Just as with health insurance, signing up for a policy and making monthly premiums will ensure that your long-term care will be covered.

If you do not have long-term care insurance and the need for such care has arisen, you need to learn about planning steps you can take to protect your assets and maximize availability of government programs such as Medicaid/Medi-Cal.

It is important to work with an elder law or estate planning attorney at Gilfix & La Poll to ensure that you get safe and affordable care while simultaneously protecting your assets.

Michael Gilfix is an estate planning attorney in Palo Alto California and is one of the pioneers of elder law. To learn more, visit Gilfix & La Poll Associates LLP at