A few months ago, we wrote a blog discussing the various resources you can access on the Mass Gov site for elders and caregivers. Yet, as mentioned in a recent blog post, Palliative Care and Making Life More Wonderful, palliative care and end of life planning are an under discussed topic. So, today we wanted to share with you more government resources that you might find useful regarding health care proxies, hospice and palliative care.
According to an article from U.S. News, “7 Red Flags to Watch for When Choosing a Nursing Home”, if you are going about it correctly, choosing a nursing home should take many days and many conversations. When going through the process, while there are several great things to be on the lookout for, there are also red flags to keep an eye out for:
When you are visiting a nursing home you will not only want to look around, but you will want to pay attention to what you hear. Is it chaotic? Or is there loud overhead paging? These kind of loud noises can contribute to agitation.
Looking into potential nursing homes or other senior care facilities? or thinking ahead about the process? One aspect you will want to consider is whether or not the facility is a for-profit or not-for-profit. In an article from U.S. News, “Nonprofit Versus For-Profit Senior Care – Is There a Difference?”, it is suggested that you might want to take this into consideration.
According to David G. Stevenson, an associate professor of health policy at Vanderbilt University Medical Center in Nashville, studies have shown that the typical not-for-profit senior care facility is higher quality than a for-profit which typically more poorly perform. That is not to say that there are not wonderful for-profit facilities, but data does show that when considering senior care locations a good place to start is looking into not-for-profit, as they tend to have better outcomes.
The downside is that the majority of senior care options are structured around for-profit which can make it hard to find a not-for-profit in your area. While it is important to consider the ownership status of a senior care option, there are several other aspects to examine when doing your research.
The answer “It depends” is not much of a comfort when considering how college savings accounts will be treated for Medicaid purposes. However, it is, unfortunately, the most accurate answer. There are several factors that must be considered:
1. What type of account you used to set aside the college money;
2. How and when you funded the account; and
3. Whether you still have access to the money.
A recent nj.com article asks, “Will my college savings be counted for Medicaid?” If you can liquidate an account and access the money that you deposited, Medicaid will typically expect you to do so to fund your own care for as long as possible. Another challenge is that Medicaid will always penalize gifts. Odds are good that the funds you added to these college accounts are gifts.
Medicaid is far more important to more Americans than most people know. It does provide healthcare for the poor, but it also pays for long-term care health care and nursing home care for millions of Americans.
Radio station WTOP in Washington, DC recently posted an article, “Why Medicaid matters to you,” which says that long-term care in the U.S. is extraordinarily expensive: the median annual cost of a private room in a nursing home is more than $92,000. A shared room costs more than $82,000. Expect these prices to continue to increase, since costs have risen by 19% since 2011. Similarly, the median price for care in an assisted living facility exceeds $43,500 and those seniors who want to stay at home with the help of an in-home aide from a home care agency pay $20 an hour or $175,000 a year for round-the-clock care. In Massachusetts, costs of a nursing home is now approaching $15,000 per month or $180,000 per year.
Strict income and asset limitations are part of the guidelines when applying for Medicaid, according to a recent article in nj.com, “How trusts fit in with Medicaid planning.” Since this is a needs-based government program, administered by each state, qualifying for assistance requires proving a financial need.
To prevent people from just making quick transfers of their property, either outright or in a trust, to qualify for the Medicaid program, there’s a penalty period imposed on transfers made within five years of applying for Medicaid, known as the “look back” period.
Buying long-term care insurance as early as possible is critical, but if you missed that opportunity and you or a loved one is now facing long-term care, you need to know what your options are, including Medicaid requirements. As recently explored in NJ.com’s article, “Spending assets before Medicaid kicks in,” there are certain assets that will have to be drawn upon before you or a loved one is considered eligible for Medicaid.
Unfortunately, many people fail to consider the cost of long-term care until it is too late. Then on top of already dealing with the stress of needing long-term care, having not planned ahead leads to the additional pressure of figuring out how to afford the care while being unwell. This care can cost more than $150,000 a year in Massachusetts. Long-term care facilities are paid using a resident’s assets in order for them to move in and remain at the facility. Those assets include Social Security, pensions, investments, real property, and any other assets.
If you think, the only reason to have an estate plan is so that your heirs can inherit your assets— think again. Estate planning includes preparing for medical emergencies, as discussed in a recent article appearing in twincities.com, “Your Money: Medical power of attorney: the missing piece of too many estate plans.”
Preparing for medical emergencies means determining the person who will look out for your best interests, if you are unable to advocate for yourself. In short, it involves naming someone you trust as your healthcare proxy.
A living will, or advanced care directive, are important documents in your estate plan. However, you will also need a health care proxy to help ensure that you are getting the kind of care you would want in the event that you are unable to communicate for yourself. A health care proxy is a document that designates the individual(s) you would want to make these health care decisions in your stead. The designated person is your health care agent or representative.
For families of seniors who need but cannot afford long-term care, the idea of losing the family home is upsetting. To make the best possible decision, you need to understand the rules and how they apply to different care situations. Consider a widower who owns a home worth $220,000 and whose only income is Social Security. The only other assets he owns are his late wife’s jewelry valued at $100,000. Does he have to sell his wife’s jewelry and, as asked by nj.com, “What happens to your house with Medicaid?”
In this case, and in many other cases, the answer is based on whether the parent will be staying at home or moving into a facility for long term care services.
Elder law attorneys play an important role in the lives of the families and individuals they help. These attorneys focus on the needs of older and disabled adults, as reported in The (Fort Worth TX) Star-Telegram article, “Elder care attorneys can help with long-term care, Medicaid.” Their practices focus on Medicaid planning, guardianship (which often becomes very complex), veteran’s benefits and issues that impact elderly and disabled individuals.
One thing most seniors don’t plan for is long-term care. Many people are trying to pay for long-term nursing care. A focus of elder law is how an elderly person can pay for it. With this in mind, the majority of long-term care is paid for by Medicaid, so understanding how that program integrates with estate planning is important. For example, you wouldn’t want a bequest in someone’s estate planning to adversely impact your Medicaid planning. A family member may be ineligible for Medicaid if they inherit something, which can be an especially big complication for families with a special needs individual.
Completing the Medicaid application can also be a challenge. Elder law attorneys see many of their clients’ applications initially denied. An experienced attorney can help you prepare the application to have the best chance at being approved, or may be able to successfully appeal. It might be a mistake at Health and Human Services (HHS). The best way to do this is to ask for the assistance of an elder law attorney and do it before you try to fill out the application yourself. People who apply on their own may be denied and won’t question it—or even realize that they can question it.
Some people worry that their parent will go broke before they need costly end-of-life care and they’re afraid that Medicaid patients received substandard care. However, they should receive the exact same care as a private pay or short-term disability in the nursing home. Even so, you should look at several facilities, speak with residents and staff, and observe the conditions before making a choice.
There is also a lot of bad information floating around about Medicaid eligibility. Some believe they won’t qualify. However, some assets, like a house and vehicles, are exempt when qualifying for Medicaid. This allows the community spouse — the one remaining at home — to continue to support themselves.
When selecting an elder law attorney, make sure he or she specializes in this area of elder law. At Family Estate Planning Law Group, this is an important part of how we care for clients and their families. For more information, explore our website and contact us to schedule your consultation today!
Reference: The (Fort Worth TX) Star-Telegram (October 14, 2016) “Elder care attorneys can help with long-term care, Medicaid”