Linda L. Kordes, Attorney At Law Official Newsletter
Summer 2008
Inside This Issue
Long-Term Care for the Elderly
Home Health Care
Medicaid
Financial Considerations and Institutional Care
Planning is Crucial

Long-Term Care for the Elderly

"Twas sunny skies whilst Noah built his Ark…"

Elderly HandsIn recent months, this office has rendered legal services to a record-high number of families with a single common denominator: an elderly member can no longer take care of himself. Apart from the heartbreak of such a realization, and, at times, that realization can come a bit late, there is the daunting task of dealing with all of the issues commensurate with the problem.

With so many elderly living well into their nineties and beyond, affordable, safe and pleasant home surroundings are at a greater demand than ever. Ordinarily, the elderly prefer to remain at home. In fact, I have never met an older individual who actually opts to leave the familiarity and comfort of her own home to be relocated to a long-term care facility.

However, there are times where the demands of a physical illness or injury, or a mental illness or senile dementia, render the option of relocation to a long-term care facility a better option than home care. When one adds financial constraints, it can seem that the elderly have little choice in the matter.


Home Health Care

The most common scenario encountered by this office presents as follows: a couple, or just widow or widower, is currently living alone in the family home. The children are out of the home and on their own. All is well until something happens, such as a fall or stroke or like event, which creates challenges that the elderly cannot meet. Whether the event is dramatic, or just evolves with time, at some point seeking help for the elderly becomes a necessity.

"Unquestionably, family homes are latent with dangers."

Unquestionably, family homes are latent with dangers. For example, if my eighty-nine year old widowed mother needs to recover from knee surgery, without help she cannot do it; not in her home (where there is only one bathroom on the third floor) or my home (where we have twenty-seven steps in the house) or my sister's home (a small studio on Central Park West.)

Obviously, the above example is a temporary dilemma, and many families make due by pooling their resources over the short term. In the example above, I might work out a schedule with my sister and our respective husbands to assist Mom in her recovery in her home. We would have to rent a commode for the main floor of the house, and hire a home health care worker to take care of Mom during the overnight, when necessary. Medicare will probably not pay for that home health care worker, so those services would have to be paid privately until Mom could be made eligible for Medicaid.


Medicaid

MedicaidOnce Mom qualifies, Medicaid would pay for services in the home which have been authorized by that agency. If Medicaid does not cover all the services required, the family can supplement with private paying for additional services without jeopardizing her Medicaid eligibility.

Medicaid is governmental health insurance for individuals whose assets fall within certain parameters. Assets include income (pension payments, social security, bank interest and the like) and resources (bank accounts, insurance, brokerage accounts and the like.) In order to qualify for benefits, the Medicaid applicant's monthly income may not exceed $725.00 and resources may not exceed $4,350.00; a married couple's income may not exceed $1,067 and their resources may not exceed $6,400.00.

If an individual or couple qualifies for Medicaid, they may receive assistance for home care, apart from other services, but probably not for twenty-four hour care. On its face, this type of medical assistance is designed for the needy, and is ordinarily not much help for working class families.

Frequently, families do just fine working within these parameters in the short term. But what about a different situation, say one like my Uncle Sal's earlier in the year? He had a major heart attack at ninety-one years old, and the prognosis was grim. He simply could not ambulate on his own; he could not take a shower or even make a snack by himself. When alone in his home, he became afraid to allow anyone inside, including a home health care worker. As a result, the family had to find an appropriate long-term care facility. It settled on a well-known facility in Westchester that charged $14,000.00 per month, and the family privately paid for a month until he passed away. But what if his prognosis had been better? How long would his life savings have lasted at that rate, and could the family count on financial assistance from anyone?


Financial Considerations and Institutional Care

While it is true that individuals are admitted to long-term care facilities because of physical or mental conditions that make remaining in the home impossible, it has been my experience that just as many cases, if not more, are based upon financial needs. Why? Because Medicaid allows a husband and wife to retain a lot more assets (income and resources) if the ailing spouse is in a facility and the well spouse remains in the community.

"Medicaid allows certain exempted property: a family home, automobile, funeral and burial fund, among other assets."

In an attempt to avoid the total financial ruin of a middle class couple faced with institutional care costs, when an ill spouse qualifies for Medicaid as indicated above, the well spouse living in the community may have monthly income of $2,610.00 and resources of $104,400.00. In addition, Medicaid allows certain exempted property: a family home, automobile, funeral and burial fund, among other assets. In certain situations, a spousal refusal may be appropriate. In short, that means that a well spouse refuses to support the sick spouse.

It is not difficult to see why families opt for institutional care. Sometimes they really have no choice.


Planning is Crucial

While the above scenario appears bleak, it need not be. Some people opt to purchase long term care insurance, and others opt to see an attorney before the situation becomes emergent, and others opt to do both. Elder attorneys consult with clients and prepare plans everyday. For many families, it is the best investment they can make. Our next issue of the Newsletter will focus on various options to planning and the transfer of assets, spousal issues, and long-term care insurance.

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