Massachusetts Estate Planning & Asset Protection Blog

MA Lags Behind on Dementia Care

Posted by Dennis Sullivan & Associates on Wed, Mar 18, 2015

Massachusetts Lags Behind on Dementia Care Compliance | Massachusetts Elder Care Attorney

 

dementia-2

 

Arlene Germain, the president of Massachusetts Advocates for Nursing Home Reform, said that once the new rules are implemented, they could substantially improve the lives of nursing home residents across the state. She also added, “strong oversight and greater nursing home participation are critical to ensure that the law’s benefits are meaningful and widespread.”

Massachusetts has been slow with its work on updating the process for dementia care compliance checks. The state only handed out its dementia special care checklist for inspectors in December, almost six months after the rules were officially adopted.

The Boston Globe article, titled Dementia care lacks oversight in Mass., data show,” says that despite the delays, state regulators are not conducting spot checks for compliance; they’re already just too busy with routine monitoring of more than 400 nursing homes. The state health department recently announced that its inspectors would now review dementia care during their annual visits to each facility. This is a step in the right direction, but the reality is that many nursing homes will still not be subject to these compliance checks for months.

The president of the state’s Advocates for Nursing Home Reform says the new rules, once fully implemented, could substantially improve the lives of nursing home residents. Increased oversight and greater nursing home participation will be needed to ensure that the law’s benefits are meaningful. Nevertheless, nursing home administrators say they are struggling to comply with the rules due to its expense.

The Massachusetts Senior Care Association reports that many members have spent as much as $30,000 on the required staff training. Those rules, in addition to other general training requirements, are intended to close a loophole that allowed nursing homes to advertise dementia units without providing added training for their workers, specialized resident activities, or safety measures to prevent residents from wandering. Massachusetts is lagging behind the rest of the country on requiring these protections. The original article reports that according to a federal report written in 2005, that 44 other states were already requiring governing training, staffing, and security for facilities that provide specialized dementia care. Regulators believe it was important to mandate the training, because over half of the state’s 41,000 nursing home residents have dementia.

 

For additional guidance, please see The Seniors and Boomer's Guide to Health Care Reform and Avoiding Nursing Home Poverty the book provides important information for families on resources for quality care and protection for loved ones.

At the Estate Planning & Asset Protection Law Center, we provide a unique education and counseling process which includes our unique 19 Point Trust, Estate and Asset Protection Review to help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones, click here for more information. We provide clients with a unique approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

 Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

Tags: Nursing Homes, Nursing Home, dementia, 2015, new regulations

VA is Proposing a 3 Year Look Back Together with a Penalty of Up To 10 Years

Posted by Dennis Sullivan & Associates on Mon, Feb 23, 2015

VA is Proposing a 3 Year Look Back Together with a Penalty of Up To 10 Years | Massachusetts Elder Law Attorney

 

veterans_benefits_lawyer 

On January 23, 2015, the VA took the initiative in proposing new regulations that would hit wartime veterans and their spouses with a penalty of up to 10 years for making gifts, if they wish to qualify for the VA’s Aid and Attendance program.

As readers of this blog know, the Aid and Attendance program is a non-service connected pension can provide as much as $2,120 per month in tax free income to help pay the cost of long term care.  This program is means tested with an asset limit of about $80,000.  Currently, there is no look back period like Medicaid has, so that transfers for less than fair value to individuals or trusts do not result in a waiting or penalty period for benefits.

Federal legislators have introduced two bills since 2012 seeking to impose a 3 year look back. Neither bill has managed to pass both houses of Congress yet though. The VA however, is sick of waiting and is trying to take matters into its own hands.  They have proposed a penalty of up to 10 years that would result from uncompensated transfers. The penalty itself would be calculated by dividing the amount of the transfer by the claimant’s pension rate. 

Other changes include a net worth standard of $119,220 including annual income. In other words, an applicant would need to have no more than $119,220 in assets and annual income combined in order to qualify.  The higher the applicant’s income, the lower the amount of assets they can keep.

Under the proposal, expenses related to independent living facilities would not count as care costs.  This would mean that veterans with dementia, or other degenerative diseases who can no longer safely live in their own homes but who don’t yet need assistance with the activities of daily living will not be able to include the cost of that facility in an effort to qualify for the VA benefit. Daily living activities are things like such as bathing, dressing, eating, toileting and transferring. Finally, the applicant’s home will remain an exempt asset towards the net worth limitation only if the lot on which it sits is less than 2 acres.

These changes will dramatically reduce the ability of many veterans to qualify for this important benefit.  The new regulations have been submitted for public comment.  To fight these changes, everyone who cares about veterans must respond no later than March 24, 2015.  You can send your comments through http://www.regulations.gov or by mail to Director, Regulation Policy and Management (02REG), Department of Veterans Affairs, 810 Vermont Ave. NW., Room 1068, Washington, DC 20420 or by fax to (202) 273-9026.  Comments should include that they are in response to “RIN 2900-AO73, Net Worth, Asset Transfers and Income Exclusions for Needs-Based Benefits”.

 

Click here to access our free report on Aid and Attendance Benefits.

At the Estate Planning & Asset Protection Law Center, we provide a unique education and counseling process which includes our unique 19 Point Trust, Estate and Asset Protection Review to help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones, click here for more information. We provide clients with a unique approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

 

 Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

Tags: long term care, Nursing Homes, veterans benefits, Nursing Home, wartime veteran, Veteran, federal, look-back, VA benefits, penalty, 2015

Why Retitling Assets to Your Spouse to Qualify for Medicaid May Not Work Part 2

Posted by Dennis Sullivan & Associates on Fri, Feb 20, 2015

Why Retitling Assets to Your Spouse to Qualify for Medicaid May Not Work Part 2 | Massachusetts Elder Law Attorney

 

nursing-home-brochure

 

A few weeks ago we were discussing Angela’s dilemma.  Her husband, Peter, has Alzheimer’s disease and is going to need some care at home.  Angela is concerned that he will need nursing home level care sooner rather than later and she wants to preserve their primary home as well as their vacation home.

The problem is that Peter does not have long term care insurance so they will have to privately pay for care until he qualifies as eligible for Medicaid.  Angela can keep the primary home and $119,220 in assets and still be eligible. Unfortunately, all their other assets, including their vacation home, will need to be spent down before Medicaid will cover his care.  She can’t simply take Peter’s name off the deed to their vacation home like she had hoped she could.

So, what are their options?  It may still be possible to transfer the second home to a trust and try to get through the 5 year look back.  Peter doesn’t need nursing home level care yet, and if his decline in health is slow enough, it may be possible to continue paying for the care he needs for the next 5 years.  This option would mean that they would have to spend their other savings during that time frame and if they can’t quite make it, maybe their children or another family member can help to pay for Peter’s care.  If not, Angela can always sell the vacation home if there is no other option.

Another approach for Angela to consider, she could also sell both homes and then buy one primary residence with the proceeds from both sales.  While this option doesn’t accomplish what Angela really wants, keeping their vacation home in the family, it does help preserve their assets for any future needs she may have as well as increase the amount that she will be able to be passed on to her family when she is gone.  If a family member can purchase the property from her, or take a mortgage to do so, then it can stay in the family like she wanted.

So where does Angela go from here?  We told her that a transfer to trust is definitely worth considering since we don’t know how Peter’s illness will progress.  The lesson here is an important one:  Angela should have called us much earlier, when both Peter and Angela were still healthy, not after Peter’s diagnosis.  It would have made it much easier to get through Medicaid’s 5 year look back and Angela would have been able to rest easy knowing she had secured their vacation home that she and her family have enjoyed for years.

As it stands now, she could set up the trust that meets Medicaid requirements, make the transfer and hope for the best to make it through the current five year look back period. If the ten year look back period ever passed, it would not make sense given Peter’s illness.

 

For additional guidance, please see The Seniors and Boomer's Guide to Health Care Reform and Avoiding Nursing Home Poverty the book provides important information for families on resources for quality care and protection for loved ones.

At the Estate Planning & Asset Protection Law Center, we provide a unique education and counseling process which includes our unique 19 Point Trust, Estate and Asset Protection Review to help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones, click here for more information. We provide clients with a unique approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

 Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

Tags: Nursing Home Costs, asset protection, Medicaid, Nursing Homes, transfer of assets, retitling assets, 2015

Estate and Long Term Care Planning for Women

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Mon, Aug 18, 2014

 

The Unique Challenges in Women Face with Estate Planning

Estate planning for women

Estate and Long Term Care Planning for Women can be different and full of confusing choices. Women are living longer today than ever before, and you will need an estate plan that can protect you from the new challenges arising daily. Let’s look at some of the more common situations below:

Married women tend to be younger than their husbands and tend to be on their own once their husband passes. Many married women let their husbands do all the financial planning, including their estate planning. Unfortunately this leaves many of them confused, or even blindsided by the oncoming costs that can appear with their estate and long term care options. Second marriages can create a whole new set of issues to deal with as well. Children from both marriages must be accounted for and must know what their responsibilities are going to be as well as fairly dividing their inheritance. For your own sake it would be best if you chose exactly who you would want to have power of attorney as well as whom you wish to have as your healthcare proxy. It is also important to update these documents regularly as many institutions do not accept them if they are more than a year old.

Single or childless women may choose to leave their possessions to close friends, relatives or charities. Without a good, up-to-date estate plan however, that won’t happen. Instead a bureaucrat appointed by the state will decide where your worldly goods will go when you’re gone. And for women living with a partner whom they are not legally married to, their partner won’t see one red cent of your estate unless you have an ironclad estate plan stipulating who gets what.

Your documents cannot do you much good unless they have been updated to reflect your current needs and situation. If you have gone through a separation or divorce you probably do not wish for your former partner to inherit your things or be making medical decisions about you. We have seen many cases where this has happened, and it is too late to change anything. Fortunately situations like this can be avoided by simply updating your documents regularly. At the Estate Planning & Asset Protection Law Center of Dennis Sullivan & Associates we provide clients with a unique Lifetime Protection Program to help keep their documents and plans up to date with any changes in their personal, family and health situations.

You must also consider what will happen if you require long term care and make sure there is going to adequate funding for what you may need in the future. Many people have made the mistake of giving away their savings in order to qualify for Medicaid without consulting a professional first. Not only was this unnecessary, they often still do not qualify because they did not plan for their situation ahead of time. Giving away their assets can even create large penalties if you ever need a nursing home. To learn more about some of the other mistakes to watch out for take a look at The Ten Biggest Estate and Asset Protection Mistakes People Make and How to Avoid Them! For a free report based on the book click here.

At the Estate Planning & Asset Protection Law Center, we help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones.  We provide clients with a unique educational and counseling approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

 

Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

Tags: health care proxy, Estate Planning, Elder Law, asset protection, long term care, Charitable Giving, Nursing Homes, marriage, Beneficiary, elder care, assisted living, estate, assets, coverage, death benefit, surviving spouse, Estate Planning Recommendations

There Are Three Ways to Pay for Long Term Care

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Tue, Aug 12, 2014

The Three Ways to Pay for Long Term Care

VA Long Term Care

As we always explain to people, there are 3 ways to pay for long term care:  The first way is to use your own money.  The second source is long term care insurance and the third is government benefits, primarily Medicaid and the VA Aid and Attendance program.

We have written before in this blog about government benefits, especially Medicaid.  Because long term care is so expensive and so many people run out of money, Medicaid, as a last resort, must always be considered. Unfortunately, the economy is still struggling and tax revenues, which provide the funding for Medicaid, are down.  State and Federal governments are always looking for ways to cut costs and Medicaid is likely to continue to be a target for them.  The VA Aid and Attendance benefit, which has been a help to some, is not a total solution by itself and is also likely to be more restrictive.  Of course, VA benefits have never been an option for the non-Veteran senior population.  As we see fewer World War II veterans, there are fewer Korean veterans behind them, and still fewer Vietnam veterans coming behind them.

Long term care insurance is an important piece as well, unfortunately, all too often we find that too many people don’t have it, and when they do seriously consider purchasing the insurance, just as they start to think that they just might need long term care, it’s too late. They are now too old or too ill to pass insurance underwriting requirements.

What we have also seen, and what we have written about in the past, is the change occurring as a result of an aging population and poor forecasting by the insurance industry.  Many companies have dropped out of the long term care market altogether.  Others have presented their policyholders with large premium increases with the promise of more to follow each year.  America’s seniors are faced with the choice of paying the increases or cutting their coverage.

So, what other options are there for seniors looking for coverage?  Let’s go back to the first way to pay for care, self-funding or using your own money.  We see so many seniors who fall into one of two categories:  Some have their savings heavily invested in the stock market and other investments that are too risky for someone who could need large amounts of principal to pay for long term care.  If the market drops by 25% or more again like it did a few years ago, many seniors won’t have the ability to hold on till their investments recover. Others have gone the other way and put their savings in bank accounts and CDs that earn less than 1%.  The principal is safe from market fluctuations but they are getting a next to nothing rate of return.  Coupled with Social Security and small pensions, most seniors today have income in the $2000 to $4000 per month range; not enough to meet their monthly expenses without dipping into the principal.

So, is there are another way?  The answer, happily, is yes.  With asset based long term care products, there is a way to self-fund the cost of long term care and have something left for your spouse, children and loved ones.  We’ll tell you more about it in our next blog post, so be sure to watch for it.

At the Estate Planning & Asset Protection Law Center, we help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones.  We provide clients with a unique educational and counseling approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

Tags: massachusetts estate planning strategies, Nursing Home Costs, long term care, Nursing Homes, VA benefit, VA benefits, Massachusetts, Nursing Home, incapacity, senior, Veteran, VA, Nursing Home, long term care insurance

Massachusetts Estate Planning Lawyer | Jill Saved $30,000 - Part One

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Wed, Jan 23, 2013

Medicaid, Medicare, Fiscal Cliff, Seniors, Estate Planning, MassachusettsJill needed help. 

She had cared for her grandfather for years.  When he needed nursing level care she found a nursing home nearby, arranged for him to be admitted and, as agent under his Power of Attorney, spent down his remaining assets.  Jill then scheduled an appointment with a Medicaid caseworker to file a Medicaid application on his behalf.   It seemed to be pretty simple, but problems quickly arose.

Jill gathered her grandfather’s financial records together and turned them over to the Medicaid caseworker at the first interview.  The caseworker completed the Medicaid application with her right there, printed it and had her sign it. She left the office thinking everything would proceed smoothly – that is until she got a letter from the same caseworker telling her that her grandfather still had $30,000 in assets remaining to be spent down.

Jill was confused by the letter.  She was positive that her grandfather had only a few hundred dollars left in his checking account, the only asset he had remaining.  That’s when she called our office for help.  Jill provided us with copies of everything she gave to the caseworker, and upon reviewing everything, we found 2 accounts that were titled in the name of her grandfather, custodian for Jill, with the initials UGMA at the end.

I explained to Jill that UGMA stands for Unified Gift to Minors Account.  Jill said she didn’t even know those accounts existed.  She just gathered together whatever paperwork she could find for her grandfather and turned it all over to the caseworker.   The caseworker insisted that Jill needed to cash those accounts in and pay the nursing home, then her grandfather would qualify for Medicaid.

Next week we’ll reveal why the Medicaid caseworker was wrong and what we did to fix Jill’s problem and get her grandfather help.

At the Estate Planning & Asset Protection Law Center, we help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones.  We provide clients with a unique education and counseling approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops. Call 800-964-4295 to learn more about what you can do to enhance the security of your beneficiaries, digital assets, Estate Plan and legacy.

 Elder Law Attorney, Estate Planning Lawyer, Massachusetts

Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

Tags: Nursing Home Costs, asset protection, Medicaid, Nursing Homes, advanced directives, caregiver, transfer of assets, caretakeer, Medicare

Warning: Congressional Budget Office Considering Medicaid Changes That Will Cost You Hundreds of Thousands in Long Term Care Costs

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Fri, Jan 04, 2013

The Congressional Budget Office (CBO) is reviewing a new proposal to increase the look back period for Medicaid from 5 years to 10 years.  This would mean that you may end up paying more from your savings if you need nursing home care.  The CBO is also reviewing the impact of decreasing the home equity exemption from $750,000 to $50,000, which means your home will be at risk if you or your spouse go to a nursing home.  It is more important than ever that you take the important steps now to protect your spouse, home and life savings before it's too late.  You can protect your home and life savings by taking action now, before these new rule changes take effect.  If you do not, you could end up costing your family its life savings. 

For more information attend one of our Trust, Estate & Asset Protection Workshops by calling (800) 964-4295 (24/7) or visiting www.SeniorWorkshop.com.


You can also download a new report on the Biggest Mistakes in Estate & Asset Protection Planning...and How to Avoid Them by clicking here.  The report covers how you and your loved ones can avoid costly mistakes in this post-fiscal cliff enconomy. 

Tags: trusts, Elder Law, asset protection, long term care, Nursing Homes, assisted living, assets, alzheimer's activities, Attorney

Massachusetts Elder Law Attorney | High Senior Accident Fatalities Rate Concerns Experts

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Fri, Dec 07, 2012

Video of 88 Year Old Man Driving on the Wrong Side of the Highway Crashing With a Police Car

Senior, Driver, Lawyer, Massachusetts, Elder Law, Care

More accidents among the elderly

The majority of drivers 65 and up are good drivers, cautious and courteous, according to police, but research shows older motorists are involved in a disproportionately high share of traffic deaths.

Nationally, drivers 65 and older account for 16 percent of all drivers and 8 percent of all miles driven, but account for 17 percent of all traffic fatalities in 2010, according to TRIP, a national transportation research group.  Data show drivers over 65 also experience more crashes per mile driven than any age group except 16-year-old drivers.  Furthermore, the crashes are 1.7 times more likely to lead to serious injury or death than drivers age 25 to 65. The reasons for this, according to MDOT, include that older drivers have diminishing physical, sensory and cognitive capabilities, and they're usually more fragile.


Senior Driver Tells Police she "Did Not Know Where She Was"

On July 17 at 2:45 p.m., a 90-year-old Auburn woman was driving on the Veterans Bridge from Auburn to Lewiston when she suddenly crossed the center line, crashing head-on into a vehicle driven by a woman with three children. Authorities initially feared there would be fatalities; ultimately two adults and three children were treated at local hospitals.

The elderly driver told police she “did not know where she was” after getting gas at BJ's. All she knew, she said, was “she needed to make two left turns in Lewiston to get her husband's medications.”

Recent changes in traffic patterns leading onto the bridge, even if they're “well signed,” can lead to confusion, especially among elderly drivers, Auburn police Chief Phil Crowell said.

How aging influences driving

Driving is a complex task. As we age, changes make driving riskier. Changes brought on by aging — including slower reaction time and weakened vision — start to negatively influence driving ability as early as age 35. Driver experience compensates until about age 75, when, for many, aging “overtakes the benefits of driver experience.

The aging process also means a reduction in physical abilities for things like turning your head to see if a lane is clear. Also, taking multiple medications, which is common among older citizens, can slow reaction time. These kinds of changes happen to everybody.


87 Year Old Driver Kills 2, Injures 5 by Crashing Into“Ride for the Fallen” Motorcycle Procession

On Aug. 25 in Westmoreland, N.H., a vehicle driven by an 87-year-old man crossed the center line and drove into a procession of oncoming motorcyclists, killing two riders. The bikers who died were 59 and 41 years old. Five others were injured. The procession was part of the annual “Ride for the Fallen,” honoring Army Spc. Justin Rollins, who was killed in Iraq in 2007. The elderly driver told police at the scene he couldn't explain why he turned and ran into the motorcycles. The man died from injuries a few days after the crash.

What You Can Do

It is time to remedy this problem – with a driving refresher safety course. Attending "Safe Driving for Seniors", a safe driving program we are hosting in association with AAA on Wednesday, January 22 at 11:00 am in Wellesley.

"Safe Driving for Seniors" is designed to help senior drivers be safer while staying behind the wheel longer. The program is specifically for drivers 55 and older. It delivers tips and techniques to help experienced drivers compensate for changing vision, reflexes and response time; understand how prescription medications may affect driving; and drive defensively in a variety of situations.

The program will be hosted by John Paul, host of the well known radio program, "Car Doctor".  Mr. Paul also writes for AAA's Horizons publication and the Boston Globe and is AAA's Traffic Safety Manager.

To learn more about the Safe Driver Program or to reserve your seat, call (781) 237-2815.  Join other smart local Seniors and Boomers as they learn essential and little known driving safety tips from AAA and the Estate Planning & Asset Protection Law Center.  Seating is limited and reservations are required.


Tags: Elder Law, Nursing Homes, elder care, senior drivers, senior driving, senior

Massachusetts Elder Care Attorney | In Home, Assisted Living, or Skilled Care? What Should You Consider?

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Fri, Oct 05, 2012

How Should You Spend Your Money?
The Delicat
e Balance of Care Options: 

In Home, Assisted Living, or Skilled Care?  What Should You Consider?

 

Seniors all around the country are concerned about their future,especially finances and health care.  The stock market,  investments and retirement accounts have fallen in recent years, but medical and nursing home costs continue to rise. Americans today are living longer than ever before. On average, those who reach age 65 can expect to live well into their eighties. In fact, the average life expectancy in the United States recently reached an all-time high of 78.7 years and the Census Bureau estimates that in the near future the average life expectancy will be into the low 90’s. This blog discusses in home, assisted living, and skilled care to help you decide which care option is best.

 

Click Here to Download the Senior & Boomers Guide to Health Care Reform & Avoiding  Nursing Home Poverty

 

When you or a loved one become unable to completely take care of yourself, the question, "What care option is best?" becomes important to answer. While it is important to consider one's personal  needs and desires, it is equally important to consider what the future may hold in terms of changes in the type of care needed. With care being so expensive today, you may want to look into applying for VA benefits or Medicaid or some newly available community resources to help pay for your care.  There are a number of options available so it is might be time for some careful consideration and planning for the care that may be needed at some point during your lifetime. Perhaps NOW would be a good time to consider that you may need to take personal responsibilty for some costs that may be facing you and your family at some point during your lifetimes.  The following is meant to help you understand in more detail what needs to be considered as you evaluate your options.assisted living, medicaid, in home care

 

In Home Care

One option people tend to start with is an in-home caregiver. You can obtain an in-home caregiver either independently, or through an agency. If you have a non-agency caregiver for which there is no record of payment, as many people do because it can be more cost effective, it is vital that you enter into a written caregiver contract with that caregiver. This will allow you to prove to VA, and eventually Medicaid, if needed in the future, that this caregiver was paid at fair market value and at a certain amount per hour. You must also obtain the necessary medical opinions indicating that the caregiver is a necessity, and then document the caregiver expenditures. Once there is a physician's opinion, a contract in place and documentation of the caregiver expenditures, a VA application or Medicaid application.  You will be better positioned to submit. 


VA Benefits May Help

It is important to know that, in order to qualify for VA Aid & Attendance benefits, your unreimbursed medical expenses must exceed your income. For example, if you have a monthly Social Security income of $1,800, and pursuant to the caregiver contract, you are privately paying a private caregiver at the rate of $15 per hour for 40 hours a week, the result is a monthly expenditure of $2,400 per month. This would more than offset your $1,800 per month Social Security income, thereby potentially enabling you to qualify for maximum VA benefits of about $1,700 per month.  It is important to note that a Bill has been proposed that would add a 3-year lookback period, making it more difficult to qualify.  The window of opportunity is closing and it is critical that you act now if you think you qualify.

 

How Long is Too Long to Spend Monies on In Home Care?

Let's say you have an in-home caregiver and have been paying them for a while. The question now becomes "How do I plan for the day that I run out of cash, and require either assisted living or nursing home care?" The problem with in-home caregivers is that you can expend all of your monies with them. When you run out of assets with a caregiver at home, you will not have built any goodwill with a Medicaid facility, which you are now asking to care for you for the rest of your life. It is important for you and your family to understand that at this point, while you may want to stay at home, if all of your funds are depleted from paying for an in-home caregiver and your health is declining, then you will subsequently have no money to offer as "key" money to a facility, either assisted living or skilled care, when and if you need to move from home to a higher level of care.

 

Can You Stay Too Long in an Assisted Living Facility?

Going to an assisted living facility may not be the answer either, though. The result can be the same in an assisted living facility as it is with the private caregiver. Once you run out of money at an assisted living facility, they will ask you to leave. All the goodwill you built with the assisted living facility becomes worthless when you then enter a skilled care facility, to which you now have no money to offer, and with which you have the eventual hope of Medicaid eligibility.

 

A Balanced Approach

A better approach would be to balance the situation by staying at home with a caregiver, or staying in an assisted living facility, as long as possible, but not spend down to the point where you do not have at least enough assets to cover one year of private pay at a Medicaid skilled care facility in order to make yourself an attractive candidate for the facility of your choice.

 

Thus, while the extra $1,700 per month from the VA may help keep you at home longer, don't stay at home or in an assisted living facility too long, putting yourself in the position to not have available monies to make you an attractive candidate for a skilled care facility. Keep in mind that a skilled care facility may eventually take Medicaid, and you may need such a higher level of care in the future, which can be very expensive.  This will require some initial "key" money payment to the skilled care facility. This is a very delicate balance that you can only achieve with your eyes wide open and with sensitivity to your wishes, while also being circumspect about protecting yourself now, as well as in the future.

 

At the Estate Planning & Asset Protection Law Center of Dennis Sullivan & Associates, we help people and their familes with our unique conseling & educational process.  Our process starts with a health assessment designed to help people better understand their options as well the time frame in which they'll likely need help, whether at home or in an assited living facility.  Our team of professionals then evaluates the families options based on their health needs and financial circumstances and help determine which significant resources may be available. In some cases we can even help people qualify more more resources than they thought would be available and are able to help people qualify for resources much sooner than they would otherwise have been able. 

 

For more information on how our team of professionals can help you, call (781) 237-2815 today.  We also invite you to attend one of our free educational Trust, Estate, & Asset Protection Workshops.  Seating is limited and registration is required.  To register Click Here or call (800) 964-4295 (24/7).

Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

Tags: Estate Planning, Medicaid, Nursing Homes, elder care, assisted living, veterans benefits, VA benefit, Massachusetts, caregiver, in home, skillled care

Massachusetts Elder Law Attorney | Is Routine Important to a Person with Alzheimer's?

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Wed, Sep 26, 2012

Is routine important to a person with Alzheimer's?
For a senior with Alzheimer's, life can be confusing and scary enough. And anything new is often perceived as a threat. So... yes, routine is very important!elder law, attorney, Massachusetts
 
People with Alzheimer's are slowly slipping away... from themselves as well as from us. To them, routine is familiar and reassuring.
 
If you're a caregiver, developing a routine will help you manage.
 
In addition to routine, there's another "R" that's important - "Ritual." If your loved one is accustomed to checking the doors before he goes to bed, let him... even if you've already done so. If he likes a glass of milk, it's OK. If he says he can't sleep, encourage him to get up and do the rituals again. It will be comforting to him. And easier for you.
 
There are lots of daily activities you can make into a routine, such as eating at certain times, taking medicine, checking the mail, bathing, running errands, taking a walk, walking the dog, doing laundry, reading the paper, or watching her favorite TV show. Even little things - like drinking water every hour - can be made into a routine (and, in this case, it's healthy!). And don't forget to make relaxation time a part of the routine - for both of you.
 
However, there's a third "R" you should definitely avoid - "Rigidity." For example, if your loved one isn't enjoying one activity, move on to another - even if it isn't "time" for that activity. Learn to go with the flow.
 
If you're caring for a loved one with Alzheimer's, we know there are always questions running through your mind. We can help answer them.

To gain free online access to the Complete Alzheimer's Resource Kit, which contains care tips as well as other useful information on Alzheimer’s disease, please visit www.BostonMemoryLawyer.com

Click Here to Download  The Alzheimer's Resource Kit

At the Estate Planning & Asset Protection Law Center, we help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones.  We provide clients with a unique educational and counseling approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

Tags: Estate Planning, Alzheimer's Disease, Elder Law, Nursing Homes, Massachusetts, caregiver, routine

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