At the Law Offices of Robert P. Bergman serving Interlaken and the surrounding Santa Cruz County communities, we help families plan for the long-term care and financial security of loved ones with disabilities through carefully drafted special needs trusts. A well-structured trust preserves eligibility for public benefits while ensuring access to supplemental resources not covered by government programs. Our approach focuses on clear communication with family members and fiduciaries about goals, anticipated expenses, and coordination with other estate planning documents such as wills, powers of attorney, and health care directives to create a cohesive plan.
Creating a special needs trust is a thoughtful process that requires attention to the beneficiary’s present needs and future changes in circumstances. We assist in drafting trust language tailored to individual situations, selecting appropriate trustees, and integrating the trust with existing retirement plans, life insurance arrangements, and guardianship nominations. Our offices in San Jose and local outreach to Interlaken allow us to combine practical legal drafting with local knowledge about resources and benefits programs available in California, ensuring the trust works as intended for the beneficiary’s lifetime.
A special needs trust provides financial support for needs that public benefits do not cover while preserving eligibility for Medi-Cal, Supplemental Security Income, and other government programs. It offers flexibility in funding education, therapies, transportation, household items, and quality-of-life purchases without interfering with means-tested benefits. Careful drafting anticipates changes in eligibility rules and personal circumstances, and naming a trustee who understands both fiduciary responsibilities and the beneficiary’s needs helps ensure long-term stability. Families find peace of mind knowing there is a dedicated vehicle for supplemental care and financial management tailored to the beneficiary.
The Law Offices of Robert P. Bergman provide estate planning services for individuals and families across Santa Cruz County and Silicon Valley from our San Jose office. We focus on creating durable, practical plans including trusts, wills, powers of attorney, and health care directives that reflect client priorities. Our practice emphasizes careful explanation of legal options, hands-on document preparation, and coordination with financial advisors and care providers. Clients consult us for matters ranging from revocable living trusts to special needs and pet trusts, trusting that their plans are clear, legally sound, and aligned with family goals.
A special needs trust is a legal arrangement created to hold assets for the benefit of a person with disabilities while preserving their ability to receive public benefits. The trust can pay for items and services that supplement, rather than replace, government-provided care. Establishing the trust requires defining the trustee’s powers and duties, identifying permitted distributions, and setting funding mechanisms such as transfers from family members, life insurance proceeds, or settlement funds. Drafting must consider statutory requirements and the particular benefit programs the beneficiary relies on so distributions do not unintentionally jeopardize eligibility.
There are different types of special needs trusts, including third-party trusts funded by relatives and first-party trusts funded with the beneficiary’s own assets. Each type has distinct legal and Medicaid payback considerations. In California, compliance with state and federal rules is essential to avoid penalties or loss of benefits. The trust agreement should include provisions for trustee succession, accounting, and coordination with other estate planning documents. Thoughtful drafting and ongoing review ensure the trust adapts to changes in law, family resources, and the beneficiary’s needs over time.
A special needs trust is designed to supplement public benefits by covering additional goods and services that improve the beneficiary’s quality of life. Third-party trusts are created and funded by family members, while first-party trusts hold assets belonging to the beneficiary and typically include a Medicaid payback clause. Trust language must specify authorized uses for distributions, trustee discretion, and procedures for handling government claims. Properly structured trusts maintain eligibility for programs while permitting reasonable discretionary spending. Clear definitions within the trust document help trustees make appropriate decisions in everyday circumstances and long-term planning.
Key elements include naming a trustee and successor trustees, specifying permissible distributions, outlining funding sources, and addressing Medicaid payback when applicable. The process includes collecting information about the beneficiary’s benefits, medical needs, and financial situation, drafting the trust document, funding the trust, and educating the trustee on their responsibilities. Ongoing maintenance involves periodic reviews to reflect changes in law or family circumstances, filing required notices, and preparing records for budgeting and potential audits. Clear communication with family members and service providers helps ensure the trust functions smoothly for the beneficiary’s lifetime.
Understanding terminology is essential for making informed decisions about special needs planning. Terms such as ‘payback provision’, ‘beneficiary’, ‘discretionary distribution’, and ‘mainstream benefits’ describe important concepts that affect how trusts interact with public programs. This glossary demystifies common phrases and offers practical context for each term so families and trustees can act confidently. Consistent definitions within planning documents reduce ambiguity and help all parties—family members, trustees, care coordinators, and attorneys—work from the same framework when managing the trust and arranging services for the beneficiary.
A payback provision requires that remaining funds in certain first-party trusts be used to reimburse the state for Medi-Cal benefits paid to the beneficiary after their death. This clause ensures compliance with government rules and affects how funds are allocated during the beneficiary’s lifetime. When planning, families should consider how a payback provision influences ultimate distribution of assets and whether alternative funding sources or third-party trusts might avoid payback obligations. Trustees must document distributions and comply with reporting requirements so final accounting to the state is accurate and clear.
A discretionary distribution permits the trustee to decide whether and when the trust should pay for specific items or services for the beneficiary. Trustees use this flexibility to address evolving needs while guarding against distributions that would affect benefit eligibility. Properly written discretionary authority balances the beneficiary’s quality of life with benefits preservation, and includes guidelines or examples to help trustees make consistent decisions. Clear trust language and trustee training reduce the risk of improper distributions that could interrupt access to essential public programs.
First-party trusts hold assets that originally belonged to the beneficiary and often include a Medicaid payback clause to reimburse the state after the beneficiary dies. Third-party trusts are created and funded by parents or relatives and are not subject to payback, allowing remainder assets to pass to other family members or charities. The choice between these types depends on the source of funds, long-term family goals, and whether preserving remainder assets for heirs is a priority. Each type requires different drafting and administration considerations to align with benefits rules.
A trustee manages trust assets, authorizes distributions for allowable needs, maintains records, pays bills on behalf of the beneficiary, and files any required reports. Trustees must balance prudent asset management with flexibility to address the beneficiary’s daily and long-term needs, coordinating with caregivers and service providers. Selecting a trustee who understands fiduciary duties, reporting obligations, and available community supports is essential. Succession planning for trustees and clear guidance in the trust document help ensure continuity and minimize disruptions to the beneficiary’s services and lifestyle.
Choosing between third-party and first-party special needs trusts, pooled trusts, and other arrangements requires evaluating asset sources, the beneficiary’s benefits, and family goals for distribution. Third-party trusts often preserve remainder assets, while first-party trusts may be necessary when the beneficiary owns funds directly. Pooled trusts can offer administrative economies when smaller amounts are involved. Advising on the right option includes reviewing life insurance beneficiaries, retirement plan designations, and potential inheritance pathways. The right structure balances benefits protection with flexibility for day-to-day support and long-term planning.
A limited approach to trust planning can work when resources are modest and the beneficiary’s support needs are narrowly defined, such as short-term therapy or a specific purchase that supplements benefits. In these cases, targeted planning may involve simple third-party language or directing modest funds to a pooled trust to manage distributions efficiently. Families should ensure that even a streamlined plan contains clear trustee instructions, coordination with public benefits, and contingency provisions so that small resources are used effectively without risking eligibility for essential programs.
If government benefits already provide comprehensive care and additional resources are unlikely to be required, a limited planning approach can be appropriate. This might involve preparing a simple third-party trust with clear remainder provisions or maintaining beneficiary-owned accounts while monitoring eligibility. Even when a lean plan is chosen, families should document expectations and name responsible parties to ensure funds are used in ways that support the beneficiary. Periodic review is advisable in case needs change or new opportunities arise to enhance long-term security.
A comprehensive plan is often appropriate when the beneficiary relies on multiple public programs and the family has various asset types such as retirement accounts, life insurance, and property. Coordinating these assets through coordinated beneficiary designations, trust funding strategies, and clear instructions reduces the risk of unintended benefit disruptions. Comprehensive planning also addresses successor trustee selection, tax considerations, and how remainder assets should be distributed, providing an integrated solution that reduces conflict and ensures the beneficiary’s needs remain the focus over the long term.
When families face complex dynamics—multiple potential heirs, blended families, or dependent beneficiaries with differing needs—a broad planning approach clarifies intent and avoids disputes. Comprehensive planning also anticipates future changes in care, including potential guardianship, changes in housing or service providers, and emergency decision-making. By documenting expectations for trustees, naming health care advocates, and aligning financial arrangements, a comprehensive plan preserves the beneficiary’s stability and reduces uncertainty for family members tasked with implementing the plan over time.
A comprehensive approach offers coordinated protection of public benefits while providing access to supplemental goods and services. It ensures there are clear funding mechanisms, designated trustees, and contingency plans for changing circumstances. Such planning reduces the potential for administrative mistakes that can jeopardize benefits and provides for successor management and orderly transition of assets. Families gain a roadmap for addressing medical, residential, educational, and recreational needs over the beneficiary’s lifetime and for carrying out the family’s long-term wishes.
Additionally, a full estate plan integrates powers of attorney, health care directives, and guardianship nominations so that decision-making in financial and medical matters remains consistent with the beneficiary’s best interests. Coordination with retirement plans, life insurance, and trust funding prevents unintended disinheritance or forced spend-downs. By documenting roles and processes, families reduce conflict and make the administrative burden on trustees and caregivers more manageable, preserving resources and promoting continuity of care and services for the beneficiary.
One of the primary benefits of a comprehensive trust is preserving eligibility for Medi-Cal, Supplemental Security Income, and other benefits. Properly drafted trust provisions and careful funding strategies ensure that resources are used in a way that supplements rather than replaces public benefits. Trustees learn to prioritize expenditures that do not count as income or resources for benefits determinations and to maintain documentation. This protection helps guarantee that essential services remain in place while additional support improves the beneficiary’s quality of life.
A comprehensive plan addresses not only immediate needs but the beneficiary’s future care, housing, and financial management. It aligns trust funding, insurance proceeds, and retirement assets to support lifelong care needs and contingencies. Including successor trustee provisions and clear distribution standards reduces the risk of mismanagement during transitions. Families gain clarity about how assets will support the beneficiary and how any leftover funds will be handled, allowing relatives to focus on caregiving rather than legal and financial ambiguities.
Beginning special needs planning early gives families time to consider options, identify funding sources, and select trustees who understand both financial management and the beneficiary’s support needs. Early planning allows for thoughtful coordination with retirement plans, life insurance, and property that could otherwise complicate benefit eligibility. Documenting goals—whether to preserve assets for others or to maximize the beneficiary’s quality of life—helps guide drafting choices. Regularly revisiting the plan ensures that changes in benefits rules or family circumstances are addressed proactively and that the trust continues to serve its intended purposes.
Effective special needs planning integrates the trust with wills, powers of attorney, advance health care directives, beneficiary designations, and care providers’ plans. Making sure retirement accounts and insurance policies are structured to fund the trust properly avoids unintended disinheritance or forced distributions. Communicating the trust structure to caregivers and case managers ensures distributions align with services and supports the beneficiary needs. Periodic reviews with legal counsel and financial advisors keep documents current and aligned with both family goals and evolving regulatory requirements.
Families consider a special needs trust to preserve eligibility for public benefits while providing for supplemental goods and services that improve the beneficiary’s life. Trusts allow for flexible funding of therapies, adaptive equipment, transportation, education, and enrichment activities without counting against program income or resource limits. They can also protect assets from creditors and provide structured management if the beneficiary cannot manage finances independently. A trust combined with guardianship nominations, powers of attorney, and clear health care directives creates a coordinated plan for long-term security and decision-making.
Beyond immediate financial protection, a special needs trust offers a framework for long-term stability that supports housing, respite care, and future care innovations. It provides a mechanism for family members to leave funds for the beneficiary without jeopardizing benefits and offers an ordered transition of management responsibilities over time. Families gain clarity about their roles, the trustee’s duties, and the beneficiary’s expected supports, reducing stress and the potential for disputes. This planning also helps ensure the beneficiary’s lifestyle and needs remain the central focus across multiple life stages.
Special needs trusts are commonly used after an inheritance, settlement, or receipt of assets by a person receiving means-tested benefits, as well as by parents who wish to provide for a child with disabilities without affecting eligibility. They are also appropriate when planning for long-term care expenses not covered by public programs, or when families want to set aside funds for housing and supportive services. Trusts can be used in conjunction with guardianship nominations, retirement distributions, and life insurance proceeds to create a reliable support structure for the beneficiary.
When a beneficiary who receives public benefits inherits money or receives a settlement, placing proceeds into a properly drafted trust preserves eligibility while allowing funds to be used for supplemental needs. The trust should be established promptly and include clear distribution standards so trustees can use the money for housing, therapies, or other allowable expenses. Prompt action and correct documentation minimize the risk of benefit disruption and ensure funds work as intended to enhance the beneficiary’s quality of life without creating eligibility problems.
Families often wish to provide regular supplemental support to improve the beneficiary’s daily life, such as paying for outings, adaptive equipment, or non-covered therapies. Creating a third-party trust funded by parents or relatives allows these distributions while protecting access to government programs. Defined trustee authority and examples of permissible spending help guide decisions and ensure consistent treatment across time. Regular reviews and open communication among family members help sustain the plan and adapt to changing needs or financial circumstances.
As beneficiaries age, planning for future housing, supported living, and long-term care becomes increasingly important. A special needs trust can fund residential supports, home modifications, and services that allow the beneficiary to live safely and comfortably. Trustees can coordinate with social workers, housing providers, and health care professionals to allocate funds appropriately. Including successor trustees and contingency plans in the trust reduces administrative gaps and ensures the beneficiary’s living arrangements remain stable even if primary family caregivers are no longer available.
We provide local assistance for families in Interlaken and nearby communities, helping to design and implement trust arrangements that reflect individual circumstances and California rules. Our office, located in San Jose, works with local service providers and county agencies to ensure the trust coordinates with Medi-Cal and other benefits. We offer practical guidance on trustee selection, funding strategies, and documentation so families can make informed choices. Our goal is to make planning straightforward and reliable so the beneficiary’s needs are consistently supported over time.
The Law Offices of Robert P. Bergman focus on creating practical, well-drafted estate plans that address special needs and benefit coordination. We guide clients through the selection of the appropriate trust type, trustee arrangements, and funding mechanisms such as life insurance or retirements plans. By integrating powers of attorney, advance health care directives, and guardianship nominations with the trust, we help families create an organized framework for both daily support and long-term transitions. Our approach emphasizes clear communication and documentation to minimize future uncertainty.
Working with our firm means having a dedicated point of contact to explain complex interactions between trust distributions and public benefits, and to coordinate with financial and care professionals. We prepare trust documents that are practical to administer, with clear discretionary standards and reporting practices. Families receive counsel on trustee responsibilities, funding timing, and compliance with Medicaid payback rules when applicable. By addressing these matters up front, the trust is more likely to function as intended and provide consistent supplemental support without risking benefits.
Our practice serves clients across Santa Cruz County and San Jose with an emphasis on individualized planning. Whether the need is to draft a third-party trust, set up a first-party trust with appropriate payback language, or coordinate a pooled trust arrangement, we provide guidance tailored to each family’s goals. We also assist with related documents such as pour-over wills, certification of trust, HIPAA authorizations, and guardianship nominations, ensuring the full estate plan supports both immediate needs and long-term objectives for the beneficiary.
Our process starts with a detailed intake to understand the beneficiary’s benefits, medical needs, and family goals. We then recommend an appropriate trust structure, draft the trust and supporting documents, and discuss funding strategies. After execution, we provide trustee guidance and recommendations for coordinating with benefit agencies and service providers. We schedule follow-up reviews to adapt the plan as needs or laws change. This step-by-step approach ensures the trust is both legally sound and practical to administer for day-to-day support and long-term care.
During the initial assessment, we gather information about the beneficiary’s current benefits, medical and support needs, and family resources including retirement plans, life insurance, and potential inheritances. We discuss short-term and long-term goals for supplemental support and whether preservation of remainder assets for heirs is a priority. This stage also identifies potential trustees and any immediate funding needs. Collecting comprehensive information at the outset allows us to recommend a trust structure that aligns with both legal requirements and the family’s objectives.
We review the beneficiary’s eligibility for programs such as Medi-Cal and Supplemental Security Income to understand income and resource limits that affect planning options. This assessment helps determine how trust distributions should be structured to avoid counting as income or resources. We analyze current entitlements, pending applications, and any upcoming changes that could influence trust design. Proper benefit review allows us to recommend wording and distribution guidelines that help preserve eligibility while meeting the beneficiary’s supplemental needs.
At this stage we identify potential funding sources such as gifts from relatives, life insurance proceeds, retirement account designations, or settlements. We advise on timing and beneficiary designations so assets flow into the trust in a manner that supports both benefit preservation and long-term goals. When necessary, we recommend alternatives such as pooled trusts for smaller sums. Clear instructions on funding avoid unintended distributions that could jeopardize benefits and ensure the trust will be able to serve its intended purposes.
Once the trust structure is selected, we draft the trust document with detailed distribution standards, trustee powers, successor trustee provisions, and any required Medicaid payback language. We also prepare complementary documents such as pour-over wills, advance health care directives, powers of attorney, and certification of trust. After client review and necessary revisions, we coordinate signing and notarization, and provide clients with final executed documents and instructions for funding and administration. Clear documentation minimizes ambiguity and supports smooth trust management.
Drafting should include specific examples of permissible distributions, guidance on discretionary decision-making, and procedures for documenting expenditures. Clear trustee powers help trustees respond to everyday needs while preventing distributions that would affect benefits. Including successor trustee designation, removal and replacement procedures, and accounting requirements promotes continuity. Well-drafted documents reduce disputes and make it easier for trustees to balance financial stewardship with the beneficiary’s quality of life.
After the documents are finalized, we assist clients in executing and notarizing the trust and related instruments, then provide practical guidance on transferring assets into the trust. This includes beneficiary designations for retirement accounts, titling of accounts or property, and coordination with insurance carriers. We also advise trustees on establishing trust banking procedures and recordkeeping. Correct execution and funding are essential to ensure the trust operates as intended and provides the anticipated protections for the beneficiary.
Following execution and funding, we provide trustees with guidance on managing distributions, maintaining records, and coordinating with benefits agencies. We recommend periodic reviews to reflect changes in the beneficiary’s needs, family circumstances, or legal rules. When requested, we can assist with annual accounting, modification petitions if necessary, and coordination with financial or care professionals. Ongoing engagement helps ensure the trust continues to serve the beneficiary effectively and adapts to new developments over time.
We help trustees understand how to document expenditures, prepare simple records for benefits agencies, and make discretionary distributions consistent with the trust’s goals. Practical advice includes suggested budgeting practices, how to handle requests from caregivers, and approaches to paying for housing and services without affecting eligibility. Training reduces the chance of costly mistakes and supports a stable flow of supplemental resources for the beneficiary, while preserving access to necessary government-provided care.
Periodic review ensures the trust stays current with changes in law, benefits programs, and the beneficiary’s needs. Reviews may result in amendments, funding adjustments, or trustee succession planning. We also assist when circumstances require court petitions, such as trust modifications or Heggstad petitions to transfer assets into the trust. Regular evaluation and timely adjustments help maintain the trust’s effectiveness and prevent unanticipated disruptions to the beneficiary’s supports and services.
A special needs trust is a legal arrangement designed to hold assets for a person with disabilities while preserving eligibility for means-tested public benefits such as Medi-Cal or Supplemental Security Income. The trust pays for supplemental goods and services that public programs do not cover, like therapies, transportation, adaptive equipment, and recreational activities. Drafting must specify permitted uses and trustee discretion so distributions do not count as income or resources for benefits determinations. Trusts come in different forms depending on who provides the funds and how the trust is structured. Proper drafting, trustee training, and funding coordination with retirement accounts and insurance beneficiaries are essential to ensure the trust functions as intended and the beneficiary continues to receive public benefits without interruption.
A first-party trust holds assets that originally belonged to the beneficiary and typically includes a provision requiring reimbursement to the state for certain benefits after the beneficiary’s death. This structure is used when the beneficiary receives funds directly, such as a settlement or inheritance. A third-party trust is funded by someone other than the beneficiary, often parents or relatives, and generally does not require a payback to the state, allowing remainder assets to pass according to family wishes. Choosing between these options depends on the source of funds and family goals. Understanding the legal implications and Medicaid payback rules helps determine which structure best preserves benefits while meeting long-term objectives for the beneficiary and the family.
Funding a special needs trust requires planning to make sure transfers or designations do not inadvertently count as the beneficiary’s available resources. Options include directing inheritances or life insurance proceeds into a third-party trust, naming the trust as a retirement account beneficiary with appropriate tax planning, or establishing a pooled trust for smaller sums. When a beneficiary receives funds directly, placing them into an appropriate first-party trust promptly can protect eligibility. Coordination with financial institutions and benefit agencies is important, and trustees should maintain clear records of transactions. Legal guidance ensures that funding methods comply with program rules and that distributions are structured to supplement public benefits rather than replace them.
Yes, special needs trusts can be used to fund housing and residential supports that enhance the beneficiary’s safety and independence. Trust distributions may cover rent, home modifications, supportive living arrangements, and services that are not fully provided by public programs. Careful planning ensures payments do not count as income for benefit eligibility. Trustees often coordinate with service providers and case managers to allocate funds appropriately and document housing-related expenditures. The trust should include language addressing long-term residential needs and successor trustees in case caregiving arrangements change. Proper documentation and accounting help preserve benefits while ensuring housing stability, and trustees should consult with legal counsel and housing professionals when making significant housing arrangements or long-term commitments.
What happens to trust assets after the beneficiary dies depends on the trust’s type and language. In first-party trusts with Medicaid payback provisions, remaining funds may be used to reimburse the state for Medi-Cal benefits provided during the beneficiary’s lifetime. Third-party trusts can direct remainder assets to family members, charities, or other beneficiaries as the trust creator intended. Clear remainder provisions in the trust document prevent confusion and help families plan for eventual distribution. Families should consider how they want any leftover assets handled and include specific instructions in the trust. Naming contingent beneficiaries and providing guidance for trustees reduces the risk of disputes and ensures the trust’s final distributions reflect the grantor’s wishes.
Choosing the right trustee means picking someone who will act responsibly, keep accurate records, and make distribution decisions that preserve benefits while meeting the beneficiary’s needs. A trustee should be comfortable coordinating with caregivers, service providers, and benefits agencies. Families sometimes nominate a trusted relative in combination with a professional or corporate trustee to balance personal knowledge and financial administration. It is also important to name successor trustees and provide clear instructions in the trust regarding discretionary distributions and accounting. Trustee training and access to legal and financial advice help trustees fulfill their duties and reduce the likelihood of mistakes that could jeopardize the beneficiary’s benefits or financial security.
Special needs trusts can have tax implications for both the trust and the beneficiary, depending on how the trust is funded and managed. Third-party trusts usually do not create taxable income for the beneficiary when distributions are used for allowable expenses, but trust accounting and interest income may have reporting requirements. First-party trusts funded with the beneficiary’s assets can affect tax filings and may require careful handling of income and expenditures to comply with tax rules. Consulting with a tax professional familiar with trust taxation is advisable when establishing and administering a special needs trust. Coordinating tax planning with trust design ensures that distributions, investments, and beneficiary support are handled in a way that minimizes tax complications and supports long-term goals.
Special needs trusts can be modified under certain circumstances if the trust document includes amendment provisions or if a court permits changes when conditions warrant. Life events, changes in benefits rules, or the beneficiary’s evolving needs may require adjustments to trustee powers, distribution standards, or funding mechanisms. When modifications are necessary, the parties should follow the document’s amendment procedures or seek court approval if unilateral changes are required. Regular reviews help identify needed updates before problems arise. When a trust must be modified through court proceedings, legal assistance ensures the process addresses the beneficiary’s best interests and complies with applicable state and federal laws, maintaining benefit protections and administrative clarity.
Life insurance proceeds and retirement accounts are important funding tools in special needs planning, but they require careful handling. Naming a trust as the beneficiary of a life insurance policy can direct proceeds into the special needs trust to provide ongoing support without affecting benefits. Retirement accounts require particular attention because distributions may have tax consequences; designating the trust as beneficiary should be done with tax implications and distribution rules in mind. Coordinating beneficiary designations, plan rollovers, and potential tax liabilities helps ensure these assets bolster the trust effectively. Working with legal and financial advisors enables families to use these resources to provide sustainable support for the beneficiary without creating adverse tax or benefits outcomes.
After receiving an inheritance on behalf of a beneficiary who receives public benefits, the immediate step is to protect eligibility by determining whether the funds should be placed into a special needs trust or a pooled trust. Prompt action is often necessary to avoid counting the inheritance as an available resource for benefits determinations. Gathering documentation and discussing options with legal counsel ensures funds are handled in compliance with program rules. Next, identify appropriate trustee arrangements and funding methods, such as directing proceeds into a third-party trust or establishing a first-party trust with proper payback language if the funds belong to the beneficiary. Clear communication with benefits offices and thorough recordkeeping help preserve eligibility and allow the inheritance to be used to improve the beneficiary’s quality of life.
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