Life Is Filled with Swift Transitions

Karren Pope-Onwukwe is a prominent elder law and disability rights attorney, bar leader and community activist, her practice centers around helping clients plan for aging, disability, and wealth transfer. She is currently chair-elect of the American Bar Association’s Senior Lawyers Division. She is past president of the Elder Law and Disability Rights Section Council of the Maryland State Bar Association, where she continues to serve. Co-founder and past co-chair of the Elder Law Section of the Prince George’s County Bar Association. In 2020, Karren was appointed to the Maryland Attorney General’s COVID-19 Access to Justice Task Force. In 2018 Karren was appointed to the American Bar Association’s Commission on Law and Aging and the Maryland Financial Consumer Protection Commission. Karren is the 2018 recipient of the Legal Champion of the Year Award from the Maryland Consumer Rights Coalition. In 2017 she was appointed chair of the Elder Law Committee of the American Bar Association’s Senior Lawyers Division and was appointed to the Prince George’s County Adult Public Guardianship Review Board where she continues to serve. In 2013 Karren was appointed vice-chair of the National Bar Association’s Elder Law Task Force. In 2007 Governor O’Malley appointed Karren to the State Advisory Council on Quality Care at the End of Life, where she served until 2017. Karren was chair of the Prince George’s County Executive’s Aging Advisory Committee from 2003-2012. In 2010, Karren was the editor of Practical Approaches to Maryland Guardianship. Karren is past president of the Prince George’s chapter of the Women’s Bar Association of Maryland and has served numerous positions on the board of J. Franklyn Bourne Bar Association and is an active member of Psi Epsilon Omega chapter of Alpha Kappa Alpha, Sorority. Attorney Pope-Onwukwe sits on the following community boards: Trustees of Reid Temple A.M.E. Church and the University of Maryland Regional Health Foundation Board. The Baltimore Daily Record named Karren as one of the 100 Top Women in Maryland for 2004. Karren represented Maryland on the Democratic National Committee from 2004 through 2016.  In 2009 Karren was presented with the Distinguished Alumna Award from the University of Maryland University College (“UMUC”). Karren is the recipient of the Governor’s Leadership in Aging Awards, 2012 Trailblazer Award and the North Atlantic Region of AKA’s 2012 Good Citizenship Award. Attorney Pope-Onwukwe earned a Bachelor of Arts degree from Eastern Kentucky University; a Bachelor of Science degree from the UMUC and a Juris Doctorate degree from the Georgetown University Law Center.  For more information visit www.kpopeatty.com

Acknowledgments

Introduction

Section 1 Foundations of Elder Law 

Chapter 1 Medical Assistance Long-Term Care 





A Note about Involuntary Discharge 



Chapter 2 Guardianship 





Administration of a Guardianship/Conservatorship
Termination of a Guardianship/Conservatorship 
Alternatives to Guardianships/Conservatorships 
A Practice Note on Guardianships 
Supportive Decision Making (SDM) 



Chapter 3 Estate Planning 





Special/Supplemental Needs Trust 
Discretionary Needs Trust 
Statutory Discretionary Trust 
Common Law Discretionary Trust 
A Practice Note on Discretionary Needs Trusts



Chapter 4 Elder Abuse 





Identity Theft 
Internal Revenue Scams 
Grandparent Scam 
Lottery and Sweepstakes Scam 
Phantom Debt Collection Scam 
A Practice Note on Reporting Abuse /Neglect In Nursing Homes 



Section 2 Long-Term Care and at-Home Possibilities 

Chapter 5 Advance Care Planning 





Advance Medical Directive 
General Durable Power of Attorney 
Deeds 
Revocable Living Trust 
Payable on Death/Transfer on Death 
A Simple Will 



Chapter 6 Assisted Living, Home and Community-Based Waivers, Memory Care and Continuing Care Retirement Communities 

Assisted Living 





Group Homes 
Home and Community-Based Waivers 
Veterans Aid and Attendance 
Memory Care Facility 
Nursing Homes 
Continuing Care Retirement Communities 



Chapter 7 Debilitating Disease Strategies 





ALS (Amyotrophic Lateral Sclerosis) “Lou Gehrig’s Disease 
Multiple Sclerosis 
Alcohol Abuse Disorder 
Dementia 
Depression 



Section 3 Ethical Issues and Other Considerations Involving Client Autonomy

Chapter 8 Ethical and Other Considerations Related to Long-Term Care Planning 





Psychiatric Advance Directive/Mental Health Advance Directive 
Mental Health Courts 
Veterans Courts 
Drug Courts 



Chapter 9 Independent Living: Paying for In-Home Care 





Private Insurance 
ABLE Accounts 
Prepaid Debit Card 
Medicare 
Medicaid Planning Trusts 
Long-Term Care Insurance
Veterans Benefits 
Reverse Mortgage 
Home and Community-based Services Waiver 



Section 4 Medical Assistance Long-Term Care Planning Strategies

Chapter 10 Making Informed Decisions about Planning for Medical Assistance Long-Term Care 





Helping Clients Make Informed Decisions About Nursing Home Care
Some Exempt Transfers 



Chapter 11 Get Organized 





Step 1: Protecting the Personal Residence 
Step 2: Protecting Assets/5-Year Look Back 
Step 3: State Medicaid Policy Manual 
Step 4: Income/Allowable Deductions 
Formulate Your Strategy
Estate Recovery 



Chapter 12 Single Individual

Chapter 13 Long-Term Care for Married Couples





Spousal Impoverishment Protections 
Annual Redetermination 
Transferring Ma-LTC to Another State 



Conclusion

Index