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Tommy the pinball wizard and the denizens of pachinko parlors know just how life works. Every choice we make sets us on a path toward another. Inevitably, the choices narrow.

Planning your life for the future

We buy insurance – health, car and, if we are smart, disability. 40% of disability occurs before age 65.

We build up a 6-12 month emergency fund to carry us between jobs.

We save to buy a home, something which involves a continuing commitment of time and money but also offers long term security and an improved credit rating.

We may decide to have children, precious if financially useless, and start saving for their education. We buy life insurance.

Somewhere along the line we may start contributing to an IRA and a 401k.

Busy living, we rarely think about medical directives, durable powers of attorneys, long term care and wills until we are empty nesters. Often we do not think about them until we see what happens to our parents, aunts or uncles or those of our friends.

By then, our options may be more limited.

The “sweet spot” for buying long-term care insurance is said to be in our 50s. Too many of us develop a chronic condition in our 60s. One-quarter of the people who apply for long-term care insurance do not meet the underwriting standards.

40% of disability occurs before age 65. A special needs trust should also be established before then. If it has not been, a contribution can still be made to a master pooled special needs trust – but a penalty period will apply if the person later needs nursing home Medicaid.

By 65 we should have chosen a Medicare plan and applied and checked the box to lower our property taxes with the Central Appraisal District.

If we chose a Medicare Advantage plan, by 70 we should try to switch to traditional Medicare. Statistically, it will be less expensive. We are also less likely to be working after age 70 and so likely to benefit from a Medicare Supplement plan which eliminates co-pays in exchange for a monthly premium.

In our 60s or 70s we are likely to lose our parents. Some of them may be able to leave something for us to inherit. We will need it to pay for our own long term care costs, especially if we had taken time off or taken a job which paid less in order to help them or care for children.

If we are married, one of us will probably outlive the other. We need wills which provide that is the surviving spouse is disabled (and most of us will be), her inheritance will pass to a special needs trust for her benefit, sometimes called a spousal care protection trust. That form of trust is not counted in determining Medicaid eligibility. It can be used to pay for things Medicaid does not and supplement the measly $60/month personal needs allowance for someone in a nursing home.

As we age, our assets, energy and social connections all decline. We may become less interested in technical matters and in the outside world. We become more vulnerable to scam artists and to neglect. We need safety nets. We need good documents, with checks and balances, and good agents, with good backup.

In our 60s and repeatedly, at shorter intervals, it is time to revisit the powers of attorney and other documents we may have signed years ago. We need to let people know what we want and do all we can to assure that we get it. It is not enough to appoint a daughter agent under a Medical Power of Attorney and a son agent under a Durable [Financial] Power of Attorney. We need to attach a letter describing the medical care we want – and what we don’t want. We need to accompany our Advance Directive to Physicians with a Statement of Intent for End of Life Care and review these regularly. What look unacceptable to us standing up may become much more manageable when we are lying down.

We need to have “the talk” with family, friends and doctors – not once, but repeatedly as our outlook and our options change. Your elder lawyer has booklets that can guide you.

For help, Schedule a Consultation today.


Elder law attorney, Terry Garrett, is a member of the National Academy of Elder Law Attorneys and is active in the Texas and Austin Bar Associations. She graduated with honors from Cornell University. She was on the Dean’s List at Wharton Business School. She earned her J.D. at Columbia Law School, receiving the Parker Award and a Mellon Fellowship.

She assists families of people with special needs, people planning for the retirement years and people administering estates.

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