New York Trusts & Estates

Long-Term Care Planning: Medicare Vs. Medicaid in Yorktown, New York

Although their names are confusingly alike, Medicaid and Medicare are quite different programs.

What is the difference between Medicare and Medicaid? There are strict income and asset guidelines that must be satisfied to be eligible for Medicaid coverage. While Medicare is solely a federal program, Medicaid is a joint state-federal program. Each state operates its own Medicaid system, but it must adhere to federal guidelines to receive federal funds. Federal money pays for half the state’s Medicaid costs, and the state pays the rest.

Long-Term Care Planning

A recent online article in Elder Law Answers responds to this common question: "What's the Difference Between Medicare and Medicaid in the Context of Long-Term Care?" The article answers, explaining that the big difference between Medicare and Medicaid comes down to long-term care planning. Medicaid covers nursing home care, while Medicare typically does not. Medicare Part A covers only up to 100 days of care in a “skilled nursing” facility per injury or illness, and this care must follow a stay of at least three days in a hospital. Although usually covered by "Medigap" insurance, for days 21 through 100, you will be responsible for a $152 daily copay. As the article notes, the definition of “skilled nursing” and the prerequisites for this coverage are quite stringent—few nursing home residents receive the full 100 days of coverage.  Because of this, Medicare pays for less than 25% of long-term care costs in the U.S.

Without other options like paying privately or being covered by a long-term care insurance policy, most individuals are forced to pay their own expenses for long-term care until they become eligible for Medicaid. Also, Medicaid does not offer much in the way of home care (except NY), but more states are providing Medicaid-covered services to those who remain in their homes as a less costly option.

Long-term care planning is a very underutilized and often overlooked part of retirement and estate planning. If you discuss your circumstances with an experienced estate and elder law attorney, he or she can ensure that you have the necessary insurance and/or a strategy that will meet your objectives.

For more information on Elder Law, Medicaid, Medicaid Planning, Paying for a Nursing Home, Long-Term Care Planning, Retirement Planning, Elder Law Retirement Planning, Medicaid Trust Planning, Irrevocable Trust Medicaid Planning, Medicaid Nursing Home Planning, or Medicaid Planning Lawyer ; click to my website.

Reference: Elder Law Answers (August 22, 2014) "What's the Difference Between Medicare and Medicaid in the Context of Long-Term Care?"

Assisting Loved Ones With Assisted Living in Yorktown, New York

Choosing whether assisted living would be the right option can be a complex decision requiring a dispassionate evaluation of the situation and careful consideration.

The challenges of helping an aging parent plan for their late-in-life care can be strenuous. There are financial, medical and even emotional aspects of this type of planning.

By way of a primer, consider reading (and sharing) a recent Forbes article titled “The Basics: Assisted Living For Your Parent.”

Some of the most important issues in planning for late- or end-of-life care include understanding the various kinds of facilities and treatments available. There is, for example, a decided difference between nursing home care and an assisted living situation.

Even within assisted living communities there are many different kinds of facilities, from the large to the small and the homey to the clinical. In the end, you must know what to look for and what is appropriate for the elderly loved one in need of care.

The key, if possible, is to include your loved in the evaluation process. Ensure that they are included in the discussions and options. Otherwise, expect resistance to change because the transition to care away from home is by nature very disruptive on many levels.

Once you know the kind of care needed and your loved one is on board, then comes the question of how to pay for it and how to understand Medicaid, Medicare, and the programs that can help fill the gaps.

Needless to say, this can be a complex process. Be sure to read and share the original article to help you and your loved one make a transition that is right for their circumstances.

For more information on Elder Law, Elder Care, Assisted Living, Medicare, or Medicaid, click to my website.

Reference: Forbes (March 13, 2014) “The Basics: Assisted Living For Your Parent”

A Lesson On Medicaid in White Plains, New York

... This is government insurance for people who have very little money that covers, among other things, the cost of home care and nursing home care when a recipient can no longer care for himself.

What is Medicaid? More than likely you have heard of Medicaid, considering it has been part of the national political debate for some time. But what exactly does Medicaid mean to you and your elderly loved ones?

If you have elderly parents, it is high time to learn about Medicaid and how it works.

Fortunately, a recent Forbes article is a good place to start. The article is aptly titled “Medicaid And Your Parents: The Basics.” Essentially, Medicaid is a program run jointly by the federal government and each respective state government. Think of it as government insurance for, among other things, late-in-life medical care like home care or nursing home care when the one needing care has too limited financial resources.

Medicaid is “means-tested.” Consequently, having too great an income or too much in assets will disqualify a Medicaid applicant and create a legal hurdle to receiving benefits. In addition, having “assets” is not the same as having the money to pay for care.

For those with assets exceeding the Medicaid limits, “giving” assets away will only disqualify them from Medicaid assistance if the transfers violate the “look back” period designed to keep them from gaming the system. Of course, an elderly individual might have had innocent intentions when they made a disqualifying gift a few years ago and the need for Medicaid was unforeseen. Regardless, such transfers are a red flag when it comes to Medicaid qualification.

Each state is subtly different in its approach, but these are very real rules and they require careful thought and timing. Otherwise, it is easy to run afoul of the rules now and be disqualified from care later. You owe it to your elderly loved ones to start planning for a worst case scenario without delay.

 

For more information on Elder Law and Medicaid visit my website.

 

Reference: Forbes (February 11, 2014) “Medicaid And Your Parents: The Basics”

ELDER LAW / ELDER CARE

Among the many reasons hospitals can be dangerous to your health, if you’re an old person: all that time spent in bed. 

 As we and our loved ones age, we put a lot of effort (and resources) into making sure a hospital bed is available when needed. New research shows that while that hospital bed may sometimes be necessary, getting up and out of it as quickly as possible is key to recovery. As it turns out, the hospital bed is a huge contributor to old-age infirmity, as studies prove that bed-rest and immobility slow healing and stunt recuperation.

A recent New York Times column, “The New Old Age” covered the results of a study conducted by University of Texas physician, Dr. Steve Fisher. Using a step activity monitor (a fancy pedometer), the Texas team found that just an extra 600 steps a day, or about 12 total minutes of slow walking, could significantly shorten hospital stays. Although Dr. Fisher calls for further study, he still offered his optimism, “It’s encouraging to think that small changes can be of broad benefit.”

Though physicians may have advised nursing staff to help the patient ambulate, nurses and aides frequently have little time for these tasks and the patient may not get up and walk enough. Dr. Fisher recommends that family members take the initiative and ask about getting a physical therapist involved early on and about whether the family is permitted to help the patient walk.

One obstacle to an aggressive mobility plan is the risk of falls. Not only are they a valid concern for you and your loved one, but also for the hospital. Since 2008, a fall is grounds for Medicare to refuse to reimburse a hospital for a patient’s care. So, it’s understandable that the hospital might be overly cautious about families helping elderly patients walk. Nonetheless, Dr. Fisher still encourages families to look for safe ways to help elderly patients get up and walk. While falls can indeed be dangerous, the consequences of prolonged immobility may be worse.

 

Reference: The New York Times (June 8, 2011): Escaping from the Hospital Bed

 

 

Driving a Bargain for Long-Term Health Care

There are some things you just don’t haggle about but, perhaps contrary to what you would guess, it turns out that long-term care isn’t one of those things. Long-term care is expensive, to say the least, but as explained in a recent article in SmartMoney, there are some expenses that may be negotiable.

Nursing homes usually will not negotiate fees, but you may be able to negotiate with assisted-living facilities and home health care agencies.

Start by arming yourself with information. You can look up local costs at Genworth.com/costofcare on a map prepared by Genworth Financial, one of the country’s largest long-term care insurers. This can help you compare costs for various types of care in your area. MetLife offers another source of area-specific information at MatureMarketInstitute.com (click on “Research” then “2010 Market Survey of Long-Term Care Costs.”)

Other resources include “Medicare and Home Health Care” which describes the home health benefits that Medicare covers (available at Medicare.gov) and the United Hospital fund’s “Next Step in Care” website for family caregivers.

Other bargaining strategies to keep in mind:

• As if there is a waiting list at the facility. If not, you may have more room to negotiate.
• While nursing homes generally do not discount rates, you may be able to negotiate for extra amenities.
• If a home-care agency has rates at the higher end of your local market, you may be able to get a lower rate if you let them know you are interviewing several agencies and taking cost into consideration.
• If you hire a home-care agency for a significant number of weekday hours, that agency may be willing to discount any extra fees they charge for weekend work.

 

Five Tips for Caring for and Elderly Parent or Relative

Caring for an aging loved one can be emotionally and financially difficult.  Unfortunately, the ordeal is frequently exacerbated by healthcare problems ranging from issues with the physician to end-of-life or funeral decisions. Having recently dealt with the loss of her father, writer Jennifer Openshaw of The Wall Street Journal offers five tips on caring for elderly loved ones  

• Fire Your Doctor. Well, you may not have to fire your doctor, but realize that you can – and maybe you should. Many people don’t realize they can just fire a doctor who is not providing the care and attention their loved one needs.
• Likewise you can fire your home-care provider. Doctors often recommend a home-care provider, and even if you respect the doctor that doesn’t mean that you have to follow their advice or stick with a provider that isn’t working out for you.
• Make End-of-Life Plans Now. It’s very important – for the sake of those around you – to discuss the many details that you’d typically never think about, from life support to feeding tubes. For help thinking through these important decisions now, Florida-based Aging with Dignity has a document titled “Five Wishes” that covers related concerns, issues and questions.
• Shop Funeral Costs. Yes, this is a difficult thing to do, but companies know there are profits to be made amid your grief, and prices (for very similar services) can vary widely from one provider to another. All the more reason to talk these matters through in advance, when your judgment is not clouded by grief.
• Review Long-Term Care Insurance. Review your policy’s stipulations for waiting periods, maximum benefit amounts, etc. A 90-day waiting period is fairly standard, but can be quite traumatic when you’re struggling through it. Knowing in advance what will and will not be covered can make these transitions less traumatic on the family.

 

 

 

Nursing Homes and Lawsuits: Does it Lead to Better Care?

We tend to think of a lawsuit as a kind of slingshot allowing the little guy to take on a daunting Goliath...

Choosing the right nursing home for a loved one is never an easy task. It can be both emotionally draining and logistically daunting. Still, this legwork is vital, especially in light of recent research reported in The New England Journal of Medicine (NEJM) and here in the New York Times Blogs – about the ineffectiveness of nursing home litigation and legal standards.

As the NY Times points out, “We tend to think of a lawsuit as a kind of slingshot allowing the little guy to take on a daunting Goliath – a large nursing home chain, say. If you can’t persuade a facility to provide proper care, if your elderly relative has suffered unnecessarily as a result, then you can sue.”

 We also hope that the risk of such lawsuits serve a preventive purpose, ensuring that nursing home provide the type of attentive care for our loved ones that they should.

If this were true, researchers suggest that we ought to see lawsuits piling up against the worst institutions, and that the better ones would see significantly fewer lawsuits.

Unfortunately, the finding of the NEJM indicates that there is not a significant relationship between the quality of the nursing home (as determined by Medicare and Medicaid surveys) and the risk that one or more lawsuits will be claimed against that nursing home (as determined statistically from records.) “Good” nursing homes stand a 40 percent chance of being sued, while the worst institutions only stood only a slightly greater chance at 47 percent.

 “It seems a fairly modest difference between the very best and the very worst facilities,” concluded Dr. David Stevenson, a health policy analyst at Harvard Medical School and an author of the analysis.

The NEJM goes on to conclude that “The results of this study raise questions about the capacity of tort litigation to provide incentives for improving the quality and safety of nursing home care. It is far from clear that superior performance will be rewarded with substantially lower risks of being sued.”

If this is indeed true, there are broad implications for the nursing home industry and the agencies charged with overseeing it.

But what does it mean to you? It means that in-depth research is key! It might not be enough that there are laws in place to enforce high standards, or that the threat of a lawsuit will force institutions to improve their performance. No, you must do your homework when selecting a nursing home for a loved one.

And, as one writer commented on the NY Times blog, if you have a loved one in a nursing home, you are well-advised to be polite but pushy, persistent and present.

 

 

New Medical Information on Alzheimer's

 For the first time in 27 years, the definition of Alzheimer’s disease is being recast in new medical guidelines that reflect fast-mounting evidence that it begins ravaging the brain years before the symptoms of dementia.

No real breakthrough has been reached yet but, as The New York Times reports, science is ready to rewrite the books on Alzheimer’s disease in a way that may usher in earlier detection and with it the possibility of earlier, more effective treatment.

The National Institute on Aging and the Alzheimer’s Association have come together to issue a new definition and medical guidelines for Alzheimer’s, the first serious reworking of the definition in 27 years. The full onset of dementia, what we classically define as the hallmark of the disease, is now thought of as the final of three progressive stages. Research indicates that the disease affects the brain long before the onset of dementia, and the first stage often shows no outward symptoms at all even as the brain begins to change. The second stage is an intermediary phase where neurological symptoms begin to set in but with little indication of the full extent to come.

The most striking addition to the guidelines concerns methods that assess brain changes, including brain scans and tests of cerebral spinal fluid. These methods measure biomarkers, the physiological indicators that someone is likely to develop dementia eventually, just as cholesterol and blood pressure are biomarkers of impending heart disease.

Will this affect medical practice just yet? Not quite. For now, the guidelines specify that Alzheimer’s biomarkers should not yet be put into widespread use, but used only with patients enrolled in clinical trials. That is because scientists cannot yet standardize the test results.

The importance, according to Dr. Pierre Tariot, director of the Banner Alzheimer’s Institute in Phoenix, is that we understand the disease to be a very long process. “The notion that Alzheimer’s disease is a continuum that has an extensive pre-symptomatic phase is a very important message to get out.”

If you or a loved one are coping with or care-giving for someone with Alzheimer’s disease, please visit our website. Consulting with an elder law attorney sooner rather than later could help preserve your future options … and assets. 

 

 

ELDER LAW / INFORMAL CAREGIVERS

 Nearly 62 million Americans already care for another adult at least part-time, an expensive and time-consuming undertaking.

 The demand for informal caregivers (such as family members) is expected to increase by more than 20 percent in the next 15 years – and by 85 percent in the next 40 years – as baby boomers age, according to data from the U.S. Department of Health and Human Services. Nearly 62 Million Americans already care for another adult at least part time. A recent article from SmartMoney’s Catey Hill, offers advice on the hidden costs of being an informal care giver.

1. Caregiving may be taxing to your own health. Caregivers of all ages have a heightened risk for chronic health problems. With so much time and resources dedicated to supporting a loved one, oftentimes too little attention is paid to your own health. One solution is to carve out time to deal with your own health issues, perhaps by enrolling your loved one in a support group, adult day-care, or by hiring a personal aide for a day or two a week.
2. Your career might suffer. Again, with the loss of time and the added stress of care giving, you may miss out on opportunities to advance your career. Try to maintain a balance in your work schedule. If you’ve established yourself as a strong performer, consider negotiating flex-time or even work-from-home arrangements with your employer.
3. You may have to delay your own retirement. In the past year, 57 percent of caregivers tapped into their own retirement saving to cover the costs of caring for their loved ones. When you add to that the fact that 63 percent of caretakers suffer a reduction or loss of income because of their responsibilities, it’s clear that retirement planning for caretakers can become particularly problematic. Shore up your finances by taking advantage of assistance programs. Some states even allow informal caregivers to get paid for their services through Cash and Counseling programs. Also, look into the possibility of compensation from long-term care insurance program or from your loved one themselves. And, be sure to maximize available care giving tax deductions, including a deduction of up to $3,650 for taking care of a qualifying relative.
4. You could be sued – by members of your own family. You may run into family trouble and disagreements about where the money is to come from and who is to pay, as well as about who is to care for the elderly and thereby put their time and direct effort into it. If you anticipate – or experience – these types of problems, it may be best to consult with a qualified elder law attorney to help iron-out specific plans, and communicate those to the entire family.  

 

 

Paying for a Caregiver

 

A 2009 survey found that 14.5% of the U.S. population – about one of every seven of us – is responsible for the care of a disabled person age 50 or over, up 28% since 2004.  Increasingly, the elderly disabled are paying family members to care for them in family home. This raises a number of issues.

In their November 2010 issue, Financial Advisor magazine takes stock of the situation and urges caution and awareness. It may seem odd, unnecessary, or even heartless, but they advise that the arrangement be legally formalized, reported, and in some cases even treated as employment. The reason is two-fold.

Firstly, by formalizing and documenting the arrangement, you make it legally acknowledged and transparent for both the care-giver and care-recipient. As the recipient of care, you may be able to claim an income tax deduction all or part of the payments as qualified medical expenses. Additionally, your payments will be well-documented, should Medicaid eligibility ever become an issue. Without this documentation, the unidentified transfer of funds to family members could be seen as an attempt to cheat the system.

Secondly, simply establishing a legal process for payment of care can help open up family dialogue, and raise awareness – especially among non-care-giving family members. Arrangements of this nature are bound to put stress on all parties, but dialogue, contractual understanding, and compensation can help smooth over difficulties for the care-receiver, the care-giver, and other family members. The care-receiver has a vital say in the arrangement, can avoid feeling like a “burden,” and remain a vital part of the family. Family members can discuss who is to administer care or how exactly they can support one another in fairly supporting the care-receiver. For that matter, too, sibling squabbles can be lessened when it comes to inheritance and estate arrangements if the family care arrangement is legally recorded.

Foresight, solid financial planning, and an awareness of the extent of any care arrangements are vital. You can learn more about long-term care and other elder law issues on our website.