Why an Attorney Should Help with a Medicaid Application
 Why an Attorney Should Help with a Medicaid Application.

Why an Attorney Should Help with a Medicaid Application

Why an Attorney Should Help with a Medicaid Application.

Elder law attorneys can be very helpful when planning for Medicaid coverage, and they can save money in the long run, ensuring that you (or a loved one) get the best care. Instead of waiting to see how wrong the process can get, says The Middletown Press, it’s best to “Use a lawyer for Medicaid planning” right from the start. Here’s why.

Conflict of interests. When a nursing home refers a family to people for preparing the Medicaid application, very often the person has dual loyalties: to the nursing home who refers them the work, and to the family who will pay them a fee for help with applying for benefits. Whose interests comes first?

Everyone wants the Medicaid application to be successful, but let’s be realistic. It’s in the nursing home’s best interest that the resident pays privately for as long as possible, before going on Medicaid. It’s in the resident or family member’s best interest to protect the family’s assets for care for the resident’s spouse or family.

Why an Attorney Should Help with a Medicaid Application. An attorney has a duty of loyalty only to her client. She also has an ethical and professional responsibility to put her client’s needs ahead of her own.

Saving money is possible. Nursing homes in some areas cost as much as $15,000 a month. While every market and every law practice is different, it would be unusual for legal fees to cost more than a month in the facility. With an experienced attorney’s help, you might save more than her fee in long-term care and probate cost. Most attorneys will consult with new clients at little or no cost to determine what they need and what they want to achieve before paying a larger fee.

The benefit of experience. It’s all well and good to read through pages of online information, but nothing beats the years of experience that an attorney who practices in this area can bring to the table. Any professional in any field develops knowledge of the ins and outs of an area and applying for Medicaid is no different. Without experience, it’s hard to know how it all works.

Peace of mind from a reliable, reputable source. Today we hear a lot about “FOMO,” or fear of missing out. Consulting with an experienced attorney about a Medicaid application will help you avoid years of wondering, if there was more you could have done to help yourself or your loved one.

There are multiple opportunities for nursing home residents to preserve assets for themselves and spouses, children and grandchildren, particularly when a family member has special needs. However, here’s a key fact: if you wait for the last minute, there will be far less options than if you begin planning long before there’s a need to apply for Medicaid.

Reference: The Middletown Press (July 29, 2019) “Use a lawyer for Medicaid planning”

Why an Attorney Should Help with a Medicaid Application.

What’s the Difference Between a Life Estate and an Irrevocable Trust?
What's the Difference Between a Life Estate and an Irrevocable Trust?

What’s the Difference Between a Life Estate and an Irrevocable Trust?

What’s the Difference Between a Life Estate and an Irrevocable Trust? Investopedia’s recent article asks “Life Estate vs. Irrevocable Trust: What’s the Difference?” The article explains that a life estate and an irrevocable trust are two different ways to make certain that assets are transferred to the right party. Each of these has advantages and disadvantages.

A life estate that’s used to gift property will divide the ownership between the giver and receiver. Some parents create a life estate to reduce their assets to qualify for Medicaid. While the parent still has some interest in the property, Medicaid doesn’t count it as an asset. A life estate lasts for the lifetime of its creator and it prohibits the selling of the asset, without the permission of its beneficiaries. Therefore, a parent can’t sell a home without the permission of his children, if they are beneficiaries of the life estate.

If you’re attempting to be eligible for Medicaid and are concerned that your home will disqualify you, ask your estate planning or Medicaid planning attorney about an irrevocable trust. With this trust, if a husband and wife both own a home, the husband can transfer his portion to his wife, and his Medicaid eligibility won’t include the home.

There must be a five-year gap between the creation of the trust and the application for Medicaid. If there isn’t, those funds will be counted as part of existing assets when determining Medicaid eligibility. Therefore, you can’t start an irrevocable trust right before you apply for Medicaid, if you want to receive those benefits.

One negative of an irrevocable trust is that the founder of the trust relinquishes any rights he has to the home. However, the beneficiary of the trust can’t sell the home, unless he or she is also named as a trustee. Once an irrevocable trust has been created, the trustee can’t take back control of the trust.

Remember that a life estate and an irrevocable trust aren’t always mutually exclusive. It’s possible to place an asset (like a home) in an irrevocable trust and keep a life estate. In that case, you’re irrevocably transferring ownership of your house to the trust. However, you still keep control. In this case, you are permitted to sell the home, remodel, or rent out a room, but the house itself—or the sales proceeds from it—would remain in the irrevocable trust.

In this situation, a parent would also not risk giving their children part of the tax liability that is associated with owning a home. The parent would keep more personal control over the house and wouldn’t need their child’s permission to sell the home. This may be the best option because it would still allow the parents to apply for Medicaid and not have the property count in their assets, but he or she would remain the sole decision-maker for the house.

What’s the Difference Between a Life Estate and an Irrevocable Trust? Both have their pros and cons, but a combination of the two can often be the best answer. Make no moves either way, without the advice of an experienced elder law attorney.

Reference: Investopedia (June 16, 2019) “Life Estate vs. Irrevocable Trust: What’s the Difference?”

 

Use This Checklist When Visiting Assisted Living Facilities
Use This Checklist When Visiting Assisted Living Facilities

Use This Checklist When Visiting Assisted Living Facilities

Use This Checklist When Visiting Assisted Living Facilities. When you are trying to find an assisted living community for yourself or a loved one, you need to do your homework to find at least three candidates that meet all the needs of the future resident. After you have narrowed your search down to those facilities, you should visit each one with the person who will be living there. Know what you want to look for before you visit the first center, so you will get all the information you need from every facility.

It is easy to get overwhelmed in the process of finding the right assisted living community. To help you in this quest, use this checklist when visiting assisted living facilities.

  1. First impressions count. Pay close attention to your initial thoughts and feelings about the center as you approach and enter. Your instincts often pick up on “micro-symptoms” that can indicate a problem, even before you notice the issue itself.
  2. Try to see down the road. Visualize yourself or your loved one actually living at the assisted living community. Ask yourself if you would be happy there. Pay attention to whether you feel comfortable or anxious. Evaluate whether the staff and other residents are friendly and inviting.
  3. Use Smell-a-vision. When you walk through the building, pay attention to the smells. You should not be able to detect any unpleasant odors. Strong “cover-up” scents are also a warning that the place likely has cleanliness issues.
  4. Look for dirt, dust, and grime in the obvious locations and places, like the baseboards and windows. You might be surprised at how many expensive assisted living centers cut corners on cleaning costs.
  5. The staff in action. Watch the staff in action, when they are interacting with the residents. Pay attention to their facial expressions and tone of voice to see if they love their jobs or are merely going through the motions. You should also observe the body language of the residents when they receive care from the staff. Look for any signs of fear, hostility, or resentment. Keep looking until you find a place where both the residents and the staff are happy, warm and friendly.
  6. The proof is in the pudding. Good food is one of the highlights for many people who reside in assisted living. Visit during mealtime and arrange to eat a meal there. Find out if the meals are both nutritious and tasty. Get a copy of the monthly menus to check for variety. Find out the center’s policy, when a resident cannot come to the dining room.
  7. Explore the both outdoor areas and the indoor facilities. Make sure that your loved one would be safe when enjoying some fresh air outside. Look to see if there are adequate sitting areas and tables.
  8. The current residents. You can find out valuable information from the people who already live at the center. Without making them feel uncomfortable, notice whether the residents are well-groomed and wearing clean clothes. Sit and visit with some residents. Let them know you are considering this community for yourself or a loved one. Ask for their advice. Find out if they have to wait a long time for personal care or other services. If so, the facility is likely under-staffed.

Use This Checklist When Visiting Assisted Living Facilities.

A Place for Mom. “Tips for Touring Assisted Living Communities.” (accessed August 7, 2019) https://www.aplaceformom.com/planning-and-advice/articles/tips-for-touring-assisted-living

 

How Will Baby Boomers Handle Long-Term Caregiving?
How Will Baby Boomers Handle Long-Term Caregiving?

How Will Baby Boomers Handle Long-Term Caregiving?

How Will Baby Boomers Handle Long-Term Caregiving?

Think Advisor’s article, “Long-Term Caregiving Realities Hit Home for Boomers” says that study participants responded that they’d be willing to do these things to provide care for a loved one:

  • Cut spending: 66%
  • Travel less frequently: 41%
  • Move to a new home: 27%
  • Work less: 27%
  • Stop working: 19%

The study also found that boomers are becoming more aware of the likelihood they’ll require retirement care, and are willing to discuss the issue. This group believed that an adult would start to need physical care or assistance at age 70 or older.

About 45% of study participants thought they’d need long-term care at some point. That number is an increase from 36% in 2013. A total of 66% of them reported that they’d had detailed conversations about how they wanted to receive long-term care. Slightly more than half said they’d had detailed conversations about how to pay for care.

How Will Baby Boomers Handle Long-Term Caregiving? About 30% of boomers in the study who were caregivers said they still had to use some retirement savings to pay for health care expenses, compared with 19% of those without caregiving responsibilities.

The U.S. Census Bureau says that older Americans are projected to outnumber children for the first time in U.S. history by 2035. This raises the question of who’ll care for the aging population.

It was no surprise that the study found that women were likelier than men to have caregiving experience. 62% of current or former caregivers among study participants were women and 38% were men. A total of 68% of those with caregiving experience said they knew about long-term care insurance, compared with 59% without such experience.

Experienced caregivers were also more likely than inexperienced boomers to have made preparations for their death. This includes communicating funeral preferences (49% vs. 41%), identifying where they wanted to be buried or cremated (51% vs. 37%) and maintaining an up-to-date estate plan (45% vs. 38%).

Reference: Think Advisor (August 8, 2019) “Long-Term Caregiving Realities Hit Home for Boomers” How Will Baby Boomers Handle “Long-Term Caregiving?

 

Get the Facts About Dementia Care
Get the Facts About Dementia Care

Get the Facts About Dementia Care

Get the Facts About Dementia Care. A person with Alzheimer’s disease or another form of dementia might need to move into a specialized care facility for his own safety and medical care. If you have a loved one in this situation, you need to know about the options available for dementia care in assisted living and nursing home facilities.

Get the Facts About Dementia Care. The Alzheimer’s Association created practice recommendations for nursing homes and assisted living facilities that offer dementia care for residents. These guidelines focus on six care areas:

  • Food and fluid consumption
  • Pain management
  • Social engagement
  • Wandering
  • Falls
  • Physical restraints

Care Recommendations about Food and Fluid Consumption

People with dementia do not always make good choices about the food and liquid they consume. They might not consume enough to meet their nutritional or hydration needs, or they might consume items with little nutritional value. As a result, their health and comfort can suffer.

Facilities that provide dementia care should:

  • Perform initial and routine periodic assessments of each resident’s food and fluid consumption status.
  • Develop procedures that ensure the residents consume proper food and liquids.
  • Make mealtimes enjoyable events, where staff interact with the residents and assess the food and fluid in a pleasant social setting.

Residents with physical challenges that make eating or drinking difficult should receive assessment by qualified professional specialists.

Pain Management Care Recommendations

Because many people with dementia have difficulty communicating, they under-report their pain and do not receive the treatment they need. Untreated pain is one of the main reasons why nursing home residents develop undesired behavioral symptoms and receive psychotropic drugs to manage their behavior, instead of getting relief from their pain.

Dementia care should include:

  • Including pain assessment in every vital signs check, along with pulse, temperature, blood pressure and respirations. Consider pain as the “fifth vital sign.”
  • Routinely treat pain just as one would address problems with any other vital sign.
  • Customize the pain management techniques for each resident, taking into account the individual’s risks, medical conditions, needs and other relevant circumstances.

Appropriate pain management can improve the resident’s quality of life.

Guidelines for Social Engagement

Every day, the facility should offer multiple opportunities for residents with dementia to engage in fun, meaningful social activities. The nursing home or assisted living center should consider each resident’s interests and functional abilities. A roomful of residents sitting in their wheelchairs passively watching a staff member perform an activity has little meaning for them, as compared to an event in which the residents can actively participate.

The home should respect each resident’s preferences, including a desire for solitude or downtime. The staff should never force a resident to participate in an activity.

Recommendations about Wandering

Many people with dementia engage in a behavior called wandering. Often, the resident wanders because he is physically uncomfortable, in emotional distress, is bothered by something in his environment, or is looking for social contact.

Facilities that offer dementia care need to encourage the resident to be mobile and physically active, but provide a safe and independent means for him to do so. Some dementia care facilities have hallways that loop around in a circle, so residents can satisfy the need to walk without ending up far from their rooms.

The center should assess the reasons for the individual’s wandering and try to meet those needs.  The facility should also develop protocols that prevent unsafe wandering, including exit seeking.

Guidelines to Prevent Falls

The facility should assess each resident’s risk of falling to prevent injuries. Fall injuries can rob a resident of her mobility. The center should implement measures that reduce the risk of falling. Physical restraints lead to fall injuries. For this and other reasons, nursing homes should avoid the use of physical restraints.

Recommendations on the Use of Physical Restraints

Sometimes a nursing home will use physical restraints under the misguided notion these devices keep residents safe. However, in fact, restraints often harm residents. Facilities should identify the reasons for undesired behavior and address those issues without using restraints. The staff should receive training on restraint-free techniques for keeping residents safe.

Get the Facts About Dementia Care. Every state has different laws, and your state’s regulations might vary from the general law of this article. You might want to talk to an elder law attorney near you.

References:

National Consumer Voice. “Dementia Care.” (accessed August 15, 2019) https://ltcombudsman.org/issues/dementia-care

 

Long-Term Care Costs and Your Estate Plan
Long-Term Care Costs and Your Estate Plan.

Long-Term Care Costs and Your Estate Plan

Long-Term Care Costs and Your Estate Plan.

There are many misunderstandings about long-term or nursing home care and how to plan from a financial and legal standpoint. The article “Five myths about nursing home costs and estate planning” from The Sentinel seeks to clarify the facts and dispel the myths. Some of the truths may be a little hard to hear, but they are important to know.

Long-Term Care Costs and Your Estate Plan.  Myth One: Before any benefits can be received for nursing home care, a married couple must have spent at least half of their assets and everything but $120,000. If the person receiving nursing home care is single, they must spend almost all assets on the cost of care, before they qualify for aid.

Fact: Nursing homes have no legal duty to advise anyone before or after they are admitted about this myth.

Several opportunities to spend money on items other than a nursing home, include home improvements, debt retirement, a new car and funeral prepayment. An elder law attorney will know how to use a Medicaid-compliant annuity to preserve assets, without spending them on the cost of care, depending on state law.

There are people who say that an attorney should not help a client take advantage of legally permitted methods to save their money. If they don’t like the laws, let them lobby to change them. Experienced elder law and estate planning attorneys help middle-class clients preserve their life savings, much like millionaires use CPAs to minimize annual federal income taxes.

Long-Term Care Costs and Your Estate Plan. Myth Two: The nursing home will take our family’s home, if we cannot pay for the cost of care.

Fact: Nursing homes do not want and will not take your home. They just want to be paid. If you can’t afford to pay, the state will use Medicaid money to pay, as long as the family meets the eligibility requirements. The state may eventually attach a collection lien against the estate of the last surviving homeowner to recover funds that the state has used for care.

A good elder law attorney will know how to help the family meet those requirements, so that the adult children are not sued by the nursing home for filial responsibility collection rights, if applicable under state law. The attorney will also know what exceptions and legal loopholes can be used to preserve the family home and avoid estate recovery liens.

Long-Term Care Costs and Your Estate Plan. Myth Three. We’ve promised our parents that they’ll never go to a nursing home.

Fact: There is a good chance that an aging parent, because of dementia or the various frailties of aging, will need to go to a nursing home at some point, because the care that is provided is better than what the family can do at home.

What our loved ones really want is to know that they won’t be cast off and abandoned, and that they will get the best care possible. When home care is provided by a spouse over an extended period of time, often both spouses end up needing care.

Long-Term Care Costs and Your Estate Plan. Myth Four: I love my children equally, so I am going to make all of them my legal agent.

Fact: It’s far better for one child to be appointed as the legal agent, so that disagreements between siblings don’t impact decisions. If health care decisions are delayed because of differing opinions, the doctor will often make the decision for the patient. If children don’t get along in the best of circumstances, don’t expect that to change with an aging parent is facing medical, financial and legal issues in a nursing home.

Long-Term Care Costs and Your Estate Plan. Myth Five. We did our last will and testament years ago, and nothing’s changed, so we don’t need to update anything.

Fact: The most common will leaves everything to a spouse, and thereafter everything goes to the children. That’s fine, until someone has dementia or is in a nursing home. If one spouse is in the nursing home and receiving government benefits, eligibility for the benefits will be lost, if the other spouse dies and leaves assets to the spouse who is receiving care in the nursing home.

A fundamental asset preservation strategy is to make changes to the will. It is not necessary to cut the spouse out of the will, but a well-prepared will can provide for the spouse, preserve assets and comply with state laws about minimal spousal election.

When there has been a diagnosis of early stage dementia, it is critical that an estate planning attorney’s help be obtained as soon as possible, while the person still has legal capacity to make changes to important documents.

The important lesson for all the myths and facts above: see an experienced estate planning elder law attorney to make sure you are prepared for the best care and to preserve assets.

Reference: The Sentinel (May 10, 2019) “Five myths about nursing home costs and estate planning”

 

Medicaid to Pay for Caregiver Services
Medicaid to Pay for Caregiver Services.

Medicaid to Pay for Caregiver Services

Medicaid to Pay for Caregiver Services.

If you have a loved one who needs caregiver services, you might be looking for ways to help the person pay for the care. Your state might offer assistance with more services, or might not cover some of the items in this article, but here is a general overview of government programs that can pay for some caregiver services.

Short-Term Caregiver Services and Medicare

If your loved one is eligible for Medicare, he might get a limited amount of short- term care through Medicare. The requirements for these services include:

  • He is recuperating from an injury or illness.
  • His doctor expects him to return to his previous level of health.
  • He meets the Medicare eligibility criteria.
  • His doctor created a plan of care for him.
  • The services are reasonable and necessary to treat his illness or injury.
  • He only needs the services on a temporary basis.

If your loved one does not need medical treatment or needs services 24 hours a day, Medicare will not provide an aide. Medicare does not give assistance for personal services only. Help with preparing meals, dressing, bathing and similar items are personal care and not covered under Medicare in the absence of necessary medical treatment.

Long-Term Care to Stay Out of the Nursing Home

The government realized it can be far less expensive to provide services that allow a person to continue living at home, rather than pay for residence in a nursing home. When a person lives at home, she pays for her housing, utilities, insurance, food and other expenses.

One such plan is the Program of All-Inclusive Care for the Elderly (PACE). If your loved one is a Medicare or Medicaid enrollee, he can get nursing-home level care in his own home. The recipient does not have to pay a deductible or copayment for the services, medical treatment, or even prescription drugs. PACE can provide skilled nursing, hospice and an in-home caregiver. It is whatever his PACE health care team decides he needs.

The PACE requirements include:

  • Enrollment in Medicaid or Medicare
  • Being 55 years or older
  • Meeting his state’s certification rules for needing nursing home-level care
  • With PACE services, he can live safely in the community.
  • He lives in an area that PACE serves. Some states do not participate in the PACE program.

If your loved one is not on Medicare or your state does not offer the PACE program, he might qualify for Home and Community-Based Services (HCBS), also called the waiver program. This program can help your loved one get a high level of care at home, so she does not have to move into a nursing home or another institutional facility.

The requirements for and services of the Medicaid waiver program vary from state to state. In general, she needs to:

  • Be enrolled in Medicaid.
  • Meet her state’s criteria for level-of-care and functional eligibility.
  • Have a plan of care from her doctor.
  • Meet the income and asset restrictions for her state.

Once she qualifies, depending on the circumstances, she can get a home health aide, skilled nursing, hospice, adult day services and personal care. Some states offer meal programs, transportation to medical care, case management and help with shopping, bill paying and other services. There are other needs that must also be addressed. 

Medicaid to Pay for Caregiver Service. References:

AARP. “Need Help Paying for Your Loved One’s Caregiver?” (accessed June 12, 2019) https://www.aarp.org/caregiving/home-care/info-2018/help-paying-for-caregiver.html?intcmp=AE-CAR-LEG-EOA2

 

Worried about a Spouse Needing Nursing Home Care?
Worried about a Spouse Needing Nursing Home Care?

Worried about a Spouse Needing Nursing Home Care?

Worried about a Spouse Needing Nursing Home Care?

The six-figure cost of nursing home care is worrisome for those who are married, when a spouse has to go to a nursing home. Lets take an example, Tom has had some major health issues in the past year and Louise is no longer able to care for him at home.

In this case, the couple live in Pennsylvania, where nursing home care statewide is $126,420 a year ($342.58 per day). The state has a Medical Assistance program that is a joint state-federal program that will pay for nursing facility care, if a person meets both the medical and financial criteria.

Tom has met one of the major Medical Assistance threshold requirements, because he is “nursing home facility clinically eligible,” which means that a doctor has certified that due to illness, injury or disability, Tom requires the level of care and services that can only be provided in a nursing home.

What will happen to their assets?

In 1988, Congress passed the Medicare Catastrophic Coverage Act, which created a process of allocating income and resources between a spouse who needs to live in an institutional setting and the spouse who can continue to remain in a community setting.

Tom and Louise’s resources are divided into two buckets: one that is exempt and the second that is non-exempt.

The family home, care, and pre-paid funeral, if that has been done, are exempt or non-countable assets.

Everything else, whether they own it together or individually, is considered non-exempt. In Pennsylvania, Louise’s IRA is the exception. However, that is not the same in every state.

Louise is entitled to keep one half of what they own, with a maximum of $126,420, as of January 1, 2019. This is her “community spouse resource allowance.”

Anything else they own, is used to pay for Tom’s nursing facility care or purchase a very select group of “exempt” assets, like a replacement car or the cost of a prepaid burial.

They would have needed to give away their resources, at least five years preceding an application for Medical Assistance. If they have given money away in an attempt to preserve some of their assets, that would have changed the timeline for Tom’s being eligible for care.

Louise needs income to live on, so that she is not impoverished. She is entitled to a monthly minimum maintenance needs allowance of $2,058 and a maximum needs allowance of $3,150.50. These numbers are federally adjusted and based on inflation.

The numbers that must be examined for Louise’s income are her Social Security benefits, Tom’s Social Security benefits, any pension either of the two may have and any other income sources. She can keep her income, as long as she does not go over a certain level.

Worried about a Spouse Needing Nursing Home Care? Sounds scary? It is. This is why it is so important to do advance planning and have an ongoing working relationship with an attorney with experience in estate planning and elder law. There are changes over time to address the changing circumstances that life and aging presents.

Reference: Pittsburgh Post-Gazette (April 29, 2019) “Married and concerned about one of you going to a nursing home?”