Long Term Care Myths

According to the U.S. Department of Health and Human Services, someone turning age 65 today will have a 70 percent chance of requiring some long term care (LTC) service and support during the remainder of their life. In the case of women, the typical LTC need will last about 3.7 years compared to men who will need about 2.2 years of care. While approximately one-third of today’s 65-year-olds may not ever need long term care 20 percent of those who do will require it for more than five years.

The statistics are clear; older Americans should be carrying a long term care insurance policy to protect their future but only about 7.2 million Americans 65 years or older currently own a traditional long term care policy, and this number has held steady for the last seven years. While LTC insurance is overall considered expensive and finding the right plan for you in the myriad of insurance products available can be confusing and vary from state to state. According to A Place for Mom, there are seven myths about long term care that anyone age 50 or more should understand.

One myth is that a person has to get rid of all of their assets to receive Medicaid which will qualify them for federally available LTC benefits. In general, the rule is a person is not allowed to keep more than $2,000 in countable assets to be eligible for Medicaid. Exemptions in some states can include your home (if a spouse, minor or disabled child still lives there), assets that cannot be converted to cash, and burial plots or spaces. Also, personal property, one vehicle, and prepaid funerals generally qualify as exemptions. The Community Spouse Resource Allowance rules permit the non-applicant spouse to keep a portion of the couple’s countable assets to prevent them from becoming destitute. Before making any attempt to spend down assets to qualify for Medicaid speak to an elder law attorney as the federal five year “lookback” rules have penalties and exceptions.

No, Medicare will not pay for long term care expenses except in the most specific and narrow of circumstances. Medicare will cover skilled in-home care from a nurse, occupational therapist, physical therapist, speech therapist or social worker for up to 21 days if ordered by a physician. In the case of a skilled nursing facility, Medicare pays for the first 20 days with no co-pays but if the stay is between 21 to 100 days, Medicare only pays a portion, and the beneficiary must pay the balance.

Another myth is that a person thinks they are too young to think about long term care insurance let alone the need to pay for it. The truth is that even under the age of 65 if the person has a chronic illness like diabetes or high blood pressure or in the event of an accident, long term in-home or residential care services may be needed. According to the US Department of Health and Human Services on average, about 8 percent of people age 40 to 50 have a disability that may require long term care services.

Relying on the hope that family will take care of a long term care need is often a myth. While many older Americans are successfully aging in place, in part due to the benefits of technology, unpaid family member caregivers and community organizations are typically not willing and available for long term, intensive caregiving. A family discussion is needed if there is an expectation that a family member is willing and able to take on a long term caregiver role. While many family members are eager to provide oversight through the use of technology, the intensive requirements of long term care are usually more than they are willing to accept.

Most health insurance policies will not cover long term care expenses to any meaningful degree. Some plans will have minimal home care and skilled nursing benefits; however the nature of the plan is short term and is intended to produce recovery and rehabilitation while long term care is generally custodial in nature for the safety, maintenance and well being of a person with a chronic condition. Even some long term care insurance policies will not cover all long term care expenses. There are elimination periods which function as a deductible or after a policy benefit has been exhausted. Specific coverage in long term care varies widely from policy to policy.

Finally, many aging Americans feel that their retirement savings will cover the costs of their long term care. The website A Place for Mom has a financial calculator to help individuals understand their specific needs to cover long term care costs. Currently, the average US national median long term health care cost is about $50,000 for a home health aide which is above and beyond all other living costs. In many situations, in particular with residential care, costs can run hundreds of thousands of dollars over a few short years. Unless a person is independently wealthy, most retirement savings will be spent down very quickly.

Chances are you will need long term care during your lifetime. Being educated about what is best suited to meet your personal financial and health background needs is a significant first step. Next, understand what legal options are available to help you in the event you need significant long term care and may run out of money trying to pay for it. We are here to help. Contact our office today and schedule an appointment to discuss how we can help you with your planning.

The Physical Challenges of Aging in Place

According to AARP aging in place is a goal for 3 out of 4 Americans aged 50 or more. These seniors and near seniors are willing to employ alternative solutions to facilitate this. The alternatives include home sharing (32%), building an additional or accessory dwelling unit (31%) and locating into villages that provide services which enable aging in place (56%). These communities become a source of support and engagement for residents and give a sense of grounding through memories of a long-time home environment.

Seniors who want to reside in a community (aka, age in place) rather than seek residential institutions or nursing homes are mostly dependent on unpaid caregivers and family members for assistance with activities of daily living (ADL). These activities include laundry, self-care actions like bathing and dressing, meal preparation, and transportation. Medicare provides some long-term care services and supports (LTSS); however, the LTSS program falls far short of the need. While the aging population in America is rapidly increasing, lawmakers are slow to respond to the insufficient funding to increase the availability of LTSS for seniors choosing to age in place. The goal of LTSS is not to replace but to supplement the contribution of unpaid family and caregivers. The addition of a Medicare benefit to support family caregivers as they help their loved ones would enable more aging adults to successfully remain in their homes.

Technology has provided some solutions for caregivers, allowing caregivers to monitor their loved one remotely while they stay engaged at work. Smart environmental controls and personal assistants have lightened the load of constant oversight but cannot replace the helping human touch. Nearly 60 percent of seniors who have seriously compromised mobility report being house or apartment bound, while 25 percent of those seniors say they often remain in bed and do not dress daily.

Low tech devices like canes, walkers, ramps, grab bars, shower seats and raised toilets to increase the level of accessibility and safety for aging in place seniors, however, transferring in and out of bed and moving around their homes still provides notable difficulty for many. The senior who wants to age in place is typically independent-minded and therefore have trouble foreseeing a time when help is not a want but a need. Aging adults and their families need to plan to address changing physical capacities before an adverse health event such as an unintended fall or dementia challenges change everything. While aging in place is a great goal for many seniors it requires planning just as if they were planning on moving into an assisted living facility.

Johns Hopkins researchers report 42 percent of older adults who have problems performing ADLs or are living with probable dementia receive no assistance at all from family, friends or paid caregivers. That is a staggering number of unaided seniors. Additionally, twenty-one percent of seniors with a minimum of three chronic conditions and high needs received no assistance at all. LTSS through Medicare will have to make changes to meet the ever-increasing demand for human caregiving.

Approximately 60 percent of at home seniors use at least one low tech device, most commonly for bathing, toileting or in-home movement, throughout their day but their needs multiple as they age. Unfortunately, Medicare does not cover the expenses of most of these nonmedical devices and services. The resulting problem is seniors near, or at the bottom of the income ladder go without assistance, human or device, putting their daily lives in a very precarious position. Hardships for these seniors on the razor’s edge include the inability to pay medical bills or prescription costs, utilities or rent, and some resort to skipping meals to balance out their unaided lifestyle. At best this is heartbreaking, at worst it is inhumane.

The CHRONIC Care Act will allow Medicare Advantage plans to offer supplemental benefits for seniors to cover devices such as wheelchair ramps, grab bars, personal care, and transportation to chronically ill seniors however there are 21 million people who have needs to be met and how this will be paid for is unclear. Meanwhile, the 39 million people enrolled in traditional Medicare are entirely left out of any supplemental benefit. Affordability for at home care is a significant issue on a personal, family, and government level.

Caregivers and assistive low tech devices are an absolute necessity for seniors opting to age in place. The extent of the adjustments senior adults make as their needs become more profound are not well documented. As aging in place is a common strategy now, new solutions and programs must be explored to ensure successful aging.

If your strategy is to age in place, have a discussion early on with trusted counsel and family members to address some of the challenges you will eventually have to overcome. If we can assist you, please don’t hesitate to reach out.

Medicaid Matters: Plan for When Your Ill Spouse Leaves Home

 

You may see it coming: Much as you want to and hard as you try, you just can’t take care of your ill spouse at home any more. At this emotionally difficult time, the last thing you need is the stress of not knowing where to find the money to pay for the steep costs of institutional care.

Advance planning is a must. As soon as you can – ideally at least five years before serious health problems arise – take advantage of many elder attorneys’ willingness to talk with you for free, or for a modest initial-consultation charge.

We are here to help you navigate the complexities of the Medicaid program. This is a governmental fund available to meet the staggering expense of institutional care, but the ins and outs of the qualification rules are complicated and mistakes can be costly. Here’s a thumbnail to help you grasp what your attorney will be telling you.

 

 

“Resources” and “Income”: The Difference

Medicaid assistance is available only to those who own very little. The Medicaid rules determine what “owning very little” actually means. A person can only own around $2,000.00 of what Medicaid calls “resources.”

Resources include cash in the bank, CDs, the cash value of insurance policies, investments, and the like. Income includes regular paychecks, Social Security, or payments received for child support. Both income and resources are potentially “counted” by Medicaid as “available.” To qualify for assistance, available income and resources must be carefully spent or transferred away.

 

Exempt Resources

Some resources are not counted or, in other words, are exempt. This means the Medicaid rules exclude them from adding up to the $2,000.00 limit. These resources are sheltered from Medicaid’s requirement that the applicant must spend down almost everything before assistance will be available.

A married couple’s residence, one motor vehicle, household goods and furnishings, medical equipment, jewelry, and other items are exempt. This means that an ill spouse can still qualify for Medicaid assistance even if the couple owns those resources. There’s no need to give them away or sell them to qualify.

The distinction between “exempt” and “non-exempt” assets can be tricky, though, and should first be assessed by a qualified elder-law attorney before any action is taken.

 

What the Well Spouse Can Keep

The Medicaid rules permit a spouse who remains at home to keep a portion of the couple’s resources. This is known as the “community spouse resource allowance” (CSRA). Of course you’d like to see the well spouse keep as much as possible within the CSRA limits. Planning can arrange the distribution of resources to make that happen.

Here is where the difference matters between “resources” and “income.” Medicaid distinguishes between the well spouse’s income and the couple’s resources. Resources over the CSRA limit must be spent down or carefully transferred. As to income, the well spouse can keep it up to a certain level, so he or she will have enough money to live on. The Medicaid rules call this the “monthly maintenance needs allowance” (MMNA).

For example, if the well spouse gets Social Security benefits of only $500.00 a month, but her allowed MMNA is as high as $2,000.00, it makes sense to convert some of the couple’s resources into raising her income up to the MMNA limit. This is not a simple matter, though, and should be done only on the advice of a qualified elder-law attorney.

Planning for Medicaid eligibility can be complicated. Please consult an elder-law attorney as soon as possible. The sooner you plan, the more strategies are available to protect your resources. An initial consultation with a qualified elder-law attorney, for free or for a modest amount, could save you many thousands of dollars.

Don’t delay.

Estate Planning, Elder Law, What’s the Difference?

Estate Planning, Elder Law, What’s the Difference?

The short answer: Both share similar concerns. The longer answer? The differences make all the difference.

The Concerns are Similar

No matter what age we’re in, life can deliver some hard knocks. Hope for the best, but plan for the worst. We can get into accidents, especially when we’re young and under the impression that we’ll live forever. Whom would we like to be there for us if we can’t speak for ourselves? If we can’t pay the bills? Decide about our health care?

Both estate planning and elder law attorneys help you choose people you trust to stand in your shoes when you can’t speak for yourself.

As adults, we start families and assemble worldly goods. If we’re thinking realistically, we want to make sure our families are taken care of and who gets our property if the worst happens to us.

Both estate planning and elder law attorneys help you with those questions. Both kinds of attorneys also know how to protect your estate from tax burdens and to avoid the expense and delay of court proceedings.

The Differences Make All the Difference

Elder law expertise becomes crucial when we get older. We’re living longer, healthier lives – but nobody knows when we, or those whom we love, will get too sick to make decisions or to live independently.

It’s understandable, but not wise, to postpone thinking about these things. Delay or denial can mean that entire savings get wiped out paying for nursing homes. Misconceptions about government benefits can forfeit eligibility for them. If you want to retire from your own business, do you have a plan for a smooth and profitable transition? What quality of life can you protect? What housing arrangements can be made? What is the wisest allocation of financial resources to protect against as many foreseeable contingencies as possible?

This is where we elder law attorneys come into our own. We can help you face these difficult questions with your and your families’ best interests at heart. What we know can go far to spare you the distress and anxiety if you were caught unprepared. We know how Medicaid, Medicare, and Social Security work. We can help you manage retirement income benefits. We can steer you to financial arrangements necessary if you or yours need long-term nursing care.

These are difficult, complicated questions that require particular knowledge to answer. We elder law attorneys have studied long and hard for that knowledge. We have learned how to help you plan to enjoy the life you have, plan for when life becomes harder with age, and have something left over for your legacy.

Estate planning is only the beginning, contact our office to get started.

 

Tips for Purchasing Special Needs Housing

If you or a loved one is searching for physical, developmental or special needs housing, there are some tips to consider before you begin the process. The US Department of Housing and Urban Development (HUD) website lists state, local government, and other organizations that can help you. At the federal level, the agency also provides information about HUD’s Section 504 regulations that define federal financial assistance, in particular, Section 811 outlines its program for Supportive Housing for Persons with Disabilities. It is important to research what assistance is available before contacting a realtor.

Once you have a strategy in place to utilize available programs to minimize costs, it is time to think about the housing location. Is the special needs individual employed or a student? Can they drive a car or do they need to be near public transportation to get to work or school? If the individual is a K-12 student, pay particular attention to school and after-school programs. Research what is available as many schools have programs for children with special needs that are offered outside of the standard school zoning in some neighborhoods. Also, take into account the proximity of hospitals and doctors. Consider the location of shopping (food and otherwise), dining and entertainment.  Be sure to note whether there are any restrictions regarding support animals (if relevant to you or your loved one).

Once the location list is narrowed down talk to others who have faced the same special needs housing challenges; whether it is a support group, school parent message boards, housing assistance advocacy group, or online forum you can save a lot of time and money by learning from others who have gone before you. In these discussions ask a lot of follow up questions. Dialing into the details can help save you missteps in your process.

Once you have identified a general location that meets some of the criteria above, it is time to canvas the availability of appropriate homes. When thinking about the layout and design of a home consider the rambler or ranch style house. They have a long low profile, very few stairs to navigate (if any) and have minimal exterior and interior decoration. These rambler attributes make the home reasonably easy to modify.

If mobility is an issue, look for a house with smooth floorings such as hardwood floors or laminate flooring. Smooth surfaces provide easier access to shower and bathroom areas. Also, check to see that the doorways in the home are wide enough to accommodate a wheelchair. Assess how many modifications would be required to address your or your loved one’s needs while remaining within a budget. Grab bars, ramps, and other similar amenities are reasonably simple to add, and some states, cities, and counties will help pay for the modifications.

Not only are there federal, state and local agencies to help you meet the requirements of special needs housing, there are also lenders and realtors who specialize in financing and purchasing this type of home. A good lender and realty agent will be familiar with the agencies and government programs that can help their client get approved for a loan and maneuver the housing marketplace for the right fit.

Realtor.com, Zillow, Homesnap, and Redfin are just a few of the online options to explore real estate from your home or mobile device. Just plug in an address of a home in the area that meets your criteria and you will get stats on that home as well as an aerial map of the neighborhood that allows you to click on and get information about homes that are not currently on the market but may be soon.

Realize this process takes time. Identify a strong, competent real estate agent who understands your special needs parameters and is willing to put forth the time to find the right special needs housing solution for you. Also, speak with a trusted attorney to ensure you have maximized all potential program benefits available to you. Buying a home is probably the biggest purchase you will make in your life. Buying a home that accommodates special needs adds a layer of complexity that should be well thought out before hiring a realtor.

If you have questions or would like to discuss your particular situation, please don’t hesitate to reach out.

Practice Areas