Spring 2011 Newsletter
Long Term Care
Ordinarily, Americans prefer to live in the comfort and familiarity of their homes. Whether town or country dwellers, we like to return home to relax at the end of the day. But, what about at the end of life? Again, most people would like the end of life to occur in their homes, but, sadly, that often is not the case. And with people living longer and longer-often with serious illnesses-the need for assistance with the activities of daily living has become the norm for the aging population.Whether one relocates to a facility or remains at home depends upon many factors, and we will explore some of the issues related to those choices in the 2011 Spring and Summer Newsletters.
Home Care
Where possible, most of the elderly would prefer to remain at home, with in-home care when it becomes necessary, rather than being relocated to a facility. In-home care can be extremely demanding on the rest of the family, particularly, where the elderly individual has an elderly spouse who also has health problems. And what if the elderly individual lives alone, with family residing far away? Memory-impairing illnesses provide their own unique set of challenges that must be dealt with individually, as well.
In-home care is very expensive and health insurance covers precious little of it. Other than private-pay, Medicaid can cover some of the expense, if the elderly individual qualifies. In order to do so, the elderly individual would have to receive income that does not exceed $767 per month and resources that do not exceed $13,800.
Naturally, the individual may own a home, the value of which does not exceed $750,000.00, a funeral and burial fund and a car. Unlike institutional (nursing home) Medicaid, currently there is no penalty for asset transfer in order to qualify for in-home Medicaid. However, with budget cuts looming in the not-so-distant future, that exemption may soon become a thing of the past. For now, we elder lawyers continue to utilize this excellent planning device, but that option may not always be available to us.
If one plans to apply for in-home Medicaid, he must do so with a degree of certainty that his application will be granted, especially if asset transfers are contemplated. (A penalty will be triggered where transfers are made to qualify for in-home Medicaid and it turns out that the elderly individual cannot remain in the home, and must be moved to a facility.) The penalty could be very long indeed.
When implementing an in-home Medicaid plan, much of that planning hinges upon the submission of a strong physician affirmation (a doctor's sworn statement) in support of the Medicaid application, referred to as the "M11q." In New York City, that application is no longer submitted to the local CASA office, but to the main office which has been moved from 34th Street in New York City to Brooklyn, at 111 Livingston Street, Fourth Floor. You enter at 14 Boerum Place; in addition, fair hearings will now be conducted from that location rather than the 34th Street office.
Institutional Care
The sad realty is that most elderly people will require institutional care at some point in their end of life-time. That realty includes assisted living, rehabilitation and nursing home facilities. Today, in the New York metropolitan area, many complexes include both nursing home and assisted living divisions; the former accepting payment by Medicaid and the latter not. Nursing home care includes all levels of care, both skilled and unskilled. Insurance does not cover unskilled care indefinitely.
Once Medicare and private insurance coverage have been exhausted-and that coverage varies so check your individual policy-then the individual either pays privately, or applies for institutional Medicaid. In the metropolitan area, nursing home care has reached an average monthly high of $13,500.
Admissions
Admission to a nursing home is often made by way of hospital release. The admissions office acts as liaison between the hospital and the elderly individual and that individual's family. Frequently, the nursing home's case worker or admissions director offers to prepare and submit the Medicaid application on behalf of the elderly individual and her family. During the intake process, the nursing home representative inquires as to the elderly person's assets, and offers a lengthy application to the potential resident to complete.
Almost always, an admissions agreement is offered to the elderly individual and/or that person's family. The patient's family should know that a nursing home may not ask a family member who is not a legally responsible adult to accept financial responsibility on behalf of an elderly person. A person is legally responsible for either a spouse or his or her minor children, only; an individual is not legally responsible for his parent.
Moreover, a nursing home may not make admission contingent on a non-legally responsible person guaranteeing payment. Of course, this would not apply if the family member actually had access to the elderly person's resources. We are talking about a third party's, and not the elderly person's, resources. Come summer, we will continue with our examination of nursing homes, the admissions process and billing. Stay tuned.....
The above list is for general information purposes only. It is not intended to constitute individual legal advice or a specific recommendation to any particular client.
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