Elder Law, Elder Living, Estate Planning, Healthcare

How Do the Stimulus Payments Affect Medicaid?

The federal government has issued direct payments, “stimulus checks”, to most Americans to invigorate the economy after the devastating coronavirus pandemic. This money is to ease the pain of the Covid pandemic and to jump-start the economy.

The stimulus money should have arrived in the same way that Social Security payments or tax refunds are made, either direct-deposited into a bank account or mailed as a paper check. If the money has not arrived, or for guidance in general, consult the IRS website:

https://www.irs.gov/coronavirus/economic-impact-payment-information-center#more. Other options are to call 800-919-9835 or 800-829-1040, or you can visit your local Taxpayer Assistance Center.

Those who are receiving means-tied government assistance, like SSI, VA benefits, or Medicaid to pay for long-term care, need not worry that stimulus money will be counted against them for eligibility. As long as recipients spend the money within twelve months, the money will not push them over the maximum amount they are permitted before they are penalized.

Recipients may use the money to buy new clothing, cell phones or televisions, toiletries, snacks, dental treatment, or improved quality of medical supplies. They may buy an irrevocable funeral trust, to avoid future expense to family members. They may give the money away to family or charities. The money might pay for updating estate-planning documents, or for consulting a geriatric care manager. (Some commentators believe that you could give the money away to family or charities. While this may be OK under federal law, it’s probably best not to take chances with how the states may interpret it. Spend the money, don’t donate it.)

Provided that the money is not spent on what could be called an asset or an investment – like, for example, rare coins or stocks or bonds – the money will not be counted against the asset limit for Medicaid eligibility. And, again, the money must be spent within twelve months. It must not be forgotten-about or left unnoticed in a bank account.

It also must not be misappropriated by nursing homes or assisted-living facilities. If this has happened to you or your loved one, inform the facility manager that the money must be refunded to the resident. Cite the law that carves out the payment from being counted toward federally assisted programs like Medicaid: 26 U.S.C. § 6409.  Or, show them a handout downloadable from the Congressional Research Service.

If the facility will not refund the money, contact your state’s attorney general. Then lodge a complaint with the Federal Trade Commission.

Recipients of assistance, like anyone else, are free to spend their stimulus money. The money is theirs. It is tax-free. It is intended to be spent, and it should be spent, in any way the recipient would like (subject to the conditions above).

This is one time when spending is unquestionably a good thing – for buyers and sellers.

If you have questions or would like to discuss your situation in a confidential setting, please don’t hesitate to reach out. Please contact our Reno office by calling us at (775) 853-5700.

Elder Law, Elder Living, Estate Planning, Healthcare

American Nursing Homes Face a Dilemma

Our country’s nursing facilities are home to the most vulnerable to the COVID-19 pandemic. When the novel coronavirus did hit, these nursing homes became its ground zero as many residents and workers did not receive testing, and staff found obtaining personal protective equipment a struggle. Some facilities tended to downplay the severity of the outbreaks. Couple these issues with some state governments mandating the reintroduction of recovering COVID-19 patients back into nursing home facilities, and the perfect storm came into being. The Washington Post reports that according to the best estimates, about half of COVID-19 deaths have been nursing home residents. Currently, that half represents more than 52,500 of our senior population.

The Wall Street Journal is reporting that according to two studies, nursing home residents who are dying from COVID-19 on average could have expected to live for another decade. Even the more senior residents, 90 and older, with multiple ailments, are losing more than one year of life. These studies challenge the perception that the coronavirus tends to kill elderly people who were likely to die soon anyhow.

A New Perspective on Elder Care

The coronavirus pandemic is forcing us to take a hard look at where our loved one should receive care if care at home is not a safe option. As the number of nursing home deaths continues to increase, the news media is finding it harder than ever to gloss over the unpalatable reality of these deaths.

Now more than ever it is important for families to come together when a decision must be made about a loved one’s care. We help families discuss options for care and how to plan to pay for appropriate care. If you’d like to discuss your particular situation, please don’t hesitate to contact us. Please contact our Reno office by calling us at (775) 853-5700 with any questions.

Elder Law

The Benefit of an Elder Law Attorney

An elder law attorney specializes as a legal advocate for aging adults and their loved ones. Elder law encompasses a wide range of legal matters affecting an older or disabled person. Issues related to guardianship, retirement, health care including advance directives, long term care planning, Social Security, Medicare and Medicaid, and other relevant matters to aging all fall under the umbrella of elder law.

An older family member who legally prepares for their aging process helps their family members by addressing day to day issues that affect their actual care through proper legal documentation should the senior become incapacitated. Seniors often falsely assume that a close family member, including a spouse, will automatically be able to make decisions on their behalf if something goes wrong with their finances or health. Postponing legal document preparation through an elder attorney generally winds up being more problematic and expensive to a senior’s estate and wellness.

Many seniors find making legal preparations uncomfortable at first, as the task forces them to confront and assess their mortality. Further into the process, many aging adults experience relief, having removed the fear of the unknown of aging to the best of their ability. Legal preparation can keep a senior from health or financial ruin if they become incapable of making informed decisions regarding these matters. In the absence of legal documents, their family is left with the expensive and time-consuming process of petitioning the courts for legal authority to act on their loved one’s behalf – referred to as establishing a guardianship. By planning early and making sure the correct legal documents are prepared stress on the senior and the senior’s loved ones is greatly reduced.

Personal choices regarding end of life care and the disposition of assets and property outlined in legal documentation guarantees that your wishes will be respected by law. This documentation is especially important for seniors when a family member might seek control over the process, whether moral or self-serving, to follow their whims when handling your wellbeing when you are most vulnerable. Besides adhering to your expressed wishes, having your choices documented relieves family members from guessing what you want.

When preparing for your aging process, seek out a well-regarded attorney who specializes in elder law. While many general practice attorneys may have some experience with elder law topics, regulations are ever-changing and complex. It is best to find an attorney who specializes in elder law so that you get the best and most up-to-date advice.

Proactively address your aging process with a qualified elder attorney to ensure your wishes are carried out now and in the future, regardless of what happens with your health. Both you and your loved ones will garner invaluable peace of mind knowing that your wishes are known and legally documented. We would be happy to help you with your planning, and we look forward to hearing from you. Please don’t hesitate to contact our Reno office by calling us at (775) 853-5700.

Elder Law

Legal planning Related to Alzheimer’s Disease

Currently, there is no cure for the more than 5 million Americans who have Alzheimer’s disease. Projections by the Alzheimer’s Association (alz.org) are that by 2050 more than 14 million Americans will suffer from this disease. What can you do if you are medically diagnosed with Alzheimer’s? Aside from following the advice of your medical doctor an important step in your overall estate plan is an advanced directive to ensure your future wishes are met when you are no longer able to think or communicate clearly because of your disease progression. Having an advanced directive that accurately and legally reflects your financial and health care wishes allows you to focus on enjoying your life knowing you are doing all that you can to address your future circumstances.

You may already have advanced directives. It is a general term for various documents like a living will, instruction directive, health care power of attorney, and health care proxy. Now that Alzheimer’s disease is the 6th leading cause of death in the US, a newer advance directive specifically addressing dementia is becoming more common and is called the Alzheimer’s Disease and Dementia Mental Health Advance Directive.

An advanced dementia directive takes a comprehensive look at living with Alzheimer’s. Issues like where you will live, coping with profound changes in intimate relationships, how to finance your care, your preferred caregiver and healthcare agent, care of your pets, when you stop driving, and more. The essence of a dementia directive is to make life decisions that will span the course of time you survive with the disease. Life expectancy after a diagnosis of Alzheimer’s can range from as short as three years, with an average of eight to ten years, and as long as twenty years. Your advanced dementia directive provides you a measure of control and a sense of relief that your intentions are known when the time comes when you can no longer communicate them effectively. This document also serves as a detailed guideline for your loved ones to follow.

Some advanced dementia directives may even include an end of life strategy known as “voluntarily stopping eating and drinking” or VSED.  A VSED is considered a legitimate way to hasten death and is used in cases of terminally ill patients. Originally a VSED addressed a patient experiencing physical decline while maintaining cognitive function. In the case of Alzheimer’s, a VSED addresses the opposite issue of cognitive decline. Most people, when faced with a future of being mentally unfit in a body that will not quit, prefer to find an exit strategy they consider has a modicum of dignity. A VSED can prevent distressing situations for yourself and your family system.

Though requests for VSED are currently uncommon there is a groundswell of patient-driven need. This need says that if incapacitated through dementia, their choice is not to endure what can be a long physical decline while cognitively absent. Most people do not want life prolonged beyond the point where they are participating in it. Still, state and federal laws have to catch up to VSED as, by law, long term care facilities are required to offer daily meals with feeding assistance if necessary.

A directive that addresses Alzheimer’s disease and other forms of dementia does not replace the more standard advance health care directive. Most conventional health care directives address cardiopulmonary resuscitation, the use of ventilators, artificial hydration (intravenous fluids) and nutrition (feeding tube), participation in research and clinical trials, organ donation, comfort care, and pain relief services. Having both advanced medical and dementia directives in place not only assures you but also provides relief to your family. Your clearly defined choices can lighten the suffering your own family will feel when you can no longer communicate with or recognize them. Reconciling end of life scenarios is always challenging, but once handled, it frees you up to get on with the joy of living. 

We would be happy to help you determine the correct advanced directives for your needs and desires. Please contact us if you would like to discuss this matter further. Please don’t hesitate to contact our Reno office by calling us at (775) 853-5700.

Elder Law

AARP Creates New COVID-19 Dashboard

As COVID-19 continues to spread among nursing home residents and staff, valuable and accurate data pinpointing areas of concern is often rife with haphazard data collection providing skewed information. The most recent Kaiser Family Foundation data analysis indicates that federal policymakers are slow in meaningful response to the nursing home coronavirus crisis. The increasing loss of life is often due to this inadequate federal and state response during this fall flu season. To better address the concerns, AARP has created a COVID-19 Dashboard that will standardize information collection and provide better data integrity. The 5-point plan aims to save lives by better protecting nursing home and long-term care facility residents at state and federal levels through more accurate data collection and its use in timely responsiveness.

  1. Ongoing testing and sufficient personal protective equipment (PPE) for residents and staff must be a priority. PPE must also be readily available for inspectors and any visitors.
  2. Create better transparency with a focus on the daily public reporting of COVID-19 cases and deaths in facilities. Improving communication with families about transfers and discharges and increase accountability for state and federal funding provided to facilities.
  3. Following federal and state guidelines for safety, ensure access to in-person visitation as well as the continuation of virtual visitation for all residents.
  4. Ensure residents’ quality care via adequate oversight, staffing, and access to in-person formal advocates known as long-term care Ombudsmen.
  5. Reject immunity as it relates to COVID-19 for long-term care facilities.

The AARP Nursing Home COVID-19 Dashboard is a collaboration between the AARP Public Policy Institute and the Scripps Gerontology Center at Miami University in Ohio. The dashboard is a four-week snapshot of the coronavirus infiltration into nursing homes and its impact on residents and staff. The goal is to promptly identify specific areas of concern at a state and national level.

A second dashboard will aggregate and analyze the self-reported data from nursing homes provided by the Centers for Medicare and Medicaid Services (CMS) that cover specific three 4-week time intervals from mid-summer into autumn. This dashboard will specifically gather five key measures from nursing homes: resident death per 100 residents, resident cases per 100 residents, staff cases per 100 residents, percentage of nursing homes without a one-week supply of PPE, and percentage of nursing homes with staffing shortages. There will also be an additional 33 data points providing more information about each category and updated every month. As tracking continues and trends present themselves, additional categories will evolve to follow other measures of interest.

The second dashboard already presents five key findings, including:

  1. Nursing home resident and staff COVID-19 deaths and cases had been on the decline at a national level during the summer. The 2020 flu season brings an uptick to cases, and coronavirus community spread continues to rise rapidly throughout most of the country, increasing vulnerability to nursing homes, staff, and residents.
  2. State trends vary dramatically. Many states with previously high death and infection rates in the summer are improved in the most recent weeks; however other states, particularly in the Midwest, see rapidly increasing rates of cases and deaths in nursing homes.
  3. The variation across states can be as high as about 1 out of every 52 nursing home residents to no resident deaths in the four weeks between September 21 to October 18. Nationally, the same reporting period reported an average death rate of one in every 215 residents.
  4. Direct care staff continues to have infections at a very high rate during this same period from September to October. While more than one-quarter (26 percent) of nursing home residents had confirmed COVID-19 cases, twice as many (53 percent) had confirmed staff cases. More than 90 percent of the nursing home staff tested positive for the coronavirus in the hardest-hit states.
  5. All states indicate nursing homes have a PPE shortage, which is defined as not having a one-week supply of surgical masks, N95 masks, gloves, gowns, and eye protection. In the best-performing state, only 5 percent of nursing homes reported a PPE shortage, while the lowest-performing state had 53 percent of nursing homes reporting a PPE shortage.

Reliable, timely data regarding nursing homes and COVID-19 can help facility operators and personnel gain a better understanding of the crisis facing nursing homes and other long-term care facilities. The federal government has begun to require nursing homes to self-report COVID-19 cases and deaths at the national level and ordering testing, providing PPE, issuing guidance for the re-instituting of in-person visits, and more. However, as cases and deaths continue to rise, AARP and other organizations will continue to accumulate data and shine a light on the tragedy befalling nursing home residents to make policy and lawmakers accountable to the crisis. AARP has a webpage providing more information for you or a loved one in a nursing home.

If you have questions about anything you have read or would like to speak to us about planning for you or a loved one, please don’t hesitate to reach out.Please contact our Reno office by calling us at (775) 853-5700.

Elder Law, Healthcare

Creating an effective COVID-19 Vaccine for Seniors is a Challenge

Older Americans, who are the most at risk of COVID-19, are the least likely demographic to respond well to a vaccine. A vaccine shot works by fooling the body into believing it has been infected with a virus, thereby prompting its immune system to fight the intruding pathogen by making antibodies. Unfortunately, as we age, antibody production weakens, part of the process known as immunosenescence. A compromised immune system makes older adults more susceptible to viral and bacterial infections. The Wall Street Journal reports that 90 percent of flu deaths in the US every year are people over the age of 65.

What’s age got to do with the COVID-19 Vaccine?

The thymus, located center of your chest just below the neckline between the lungs, is a major source of pathogen fighting T-cells. Some of these specialized cells help the immune system make additional defenses against infection called antibodies. As we age, the thymus production of adaptable T-cells is depleted as the thymus fills with fatty tissue. The result is an old immune system that is ill-equipped to fight off new viruses. The Center for Disease Control and Prevention (CDC) posted a July 17 analysis of more than 50,000 COVID-19 deaths in the US, identifying that 80 percent were people age 65 or more.

An aging thymus also complicates the development of a COVID-19 vaccine. A vaccine’s design provides instructions to our immune system, which T-cells help to guide appropriately. However, the thymus has exhausted most of its reserve T-cells that adapt to recognize unknown pathogens by the age of 50; thus, the ability to “train” other immune cells to fight is lost. Many vaccines rely on the skill sets of fully functional T-cells.

A Shift from Traditional Methods of Developing Vaccines

Traditionally, the biopharmaceutical vaccine market has concentrated efforts on childhood vaccines. Martin Friede, a coordinator for vaccine and product and delivery research with the World Health Organization (WHO), states, “Up until very recently most of the focus of the vaccine community has been on saving lives of young children. The people who need the vaccine the most may actually be the people in whom the vaccine might not work.” Friede further comments that it isn’t solely about the thymus as individual vitality can translate into different vaccine responses. Some older people may be off to play a round of golf while others may be too frail to walk unaided.

Deputy director of clinical research for the Institute of Vaccine Safety at Johns Hopkins Bloomberg School of Public Health, Dr. Kawsar Talaat, echoes Friede’s sentiments, “We hadn’t been designing vaccines for the elderly for a long time.” Dr. Talaat is helping to facilitate coronavirus vaccine developers to test their shots in older adults. The Food and Drug Administration (FDA) is also working with drug and biotech companies easing restrictions for experimental vaccines to be tested earlier during clinical trials on older adults.

Updates on Testing COVID-19 Vaccine Options

The New York biopharmaceutical giant Pfizer is currently conducting tests for potential COVID-19 vaccines in older people. The company is studying whether increasing the vaccine dosage could better protect the elderly as higher doses in existing flu vaccines make them more effective in older populations. At Moderna Therapeutics, results from a phase-one trial of its novel mRNA vaccine are in; however, a second phase two trial is being conducted specifically for adults age 55 and older. Many biotech and pharmaceutical companies are eager to be the first to introduce a successful FDA approved COVID-19 vaccine.

If the development of a COVID-19 vaccine specifically for the elderly remains elusive, scientists are hopeful that immunizing others around them can make a difference. Vaccinating children, health care workers, and potentially silent coronavirus carriers, could create enough herd immunity and would lower the risk of older people becoming infected. Sometimes it is possible to protect a vulnerable group by targeting other groups around them. Meanwhile, the work continues to find a workable COVID-19 vaccine for the most vulnerable Americans, the elderly.

We help seniors and their families deal with challenges around appropriate care and how to pay for it. If you would like to discuss your situation with us, please don’t hesitate to reach out.

If you’d like to discuss your particular situation, please don’t hesitate to reach out. Please contact our Reno office by calling us at (775) 853-5700 with any questions.

Elder Law, Elder Living

Seniors Stay Socially Engaged While Socially Distancing with the help of Technology

We have come to know that successful, healthy aging is contingent upon connection to those around us. The opportunities for people to laugh, move, and learn together is foundational to aging success. Enter the coronavirus pandemic to change all of that. Now aging Americans must stay socially engaged while maintaining a physical distance. This issue touches us all from senior wellness professionals, medical staff, families, inter-resident connections, and those aging in place at home and alone. The internet of things, and the virtual links it creates, is a great solution to implement in a socially distanced, troubling pandemic world.

Virtual technology tools were becoming more ubiquitous before the coronavirus. Yet, the need for emotional well-being as the especially vulnerable aging population of America became isolated was the accelerant solution to address the problem. Fitness classes ranging from tai chi to yoga and other forms of movement became available in droves of senior online classes. Connecting with family members or health professionals through telemedicine also became crucial as regular visitations and routine medical appointments became impossible.

Virtual tools provide a great advantage for social distancing as no meeting space is required. Senior interaction with tech tools has brought new learning and skills opportunities, providing a sense of connection, purpose, and pride. Older adults share their newfound prowess in video messages, multi online person chats, and more. Grandparents and grandchildren find common ground in a technological world, and grateful parents/adult children are happy for the means to address the social isolation problem and create stronger inter-generational family ties.

Beyond the connection of friends and family, technology brings email, instant messaging, social media sites, brain games, wellness bingo cards, music, even virtual cruises with daily ports of call to keep seniors connected in isolation. Many aging adults associate full-length feature films with a movie theater and do not realize they can watch nearly anything they want via streaming services, 24 hours a day, whenever they choose.

While the internet and these technology tools provide virtual interaction and entertainment, not every senior who needs it can afford a tablet computer or laptop. Many communities are holding campaigns to raise funds for those in need of these digital devices. Nursing homes can receive a stipend from the Centers for Medicare and Medicaid (CMS) through the Civil Monetary Penalty (CMP) fund. Funding through CMP provides communication aids such as tablet devices and webcams that enable virtual visits. However, each facility has a limit of $3,000 to ensure a balance in distributing CMP funds. Because these items may be shared among negative COVID-19 residents, it is critical to avoid entering highly personal information into device applications or programs. Shared tablets are not a good way to check bank accounts, shop online, or have your senior pay bills.

Be wary of too much learning too quickly for a senior. Don’t overwhelm the aging adult with the technology, rather focus on what it provides. Slowly introduce different aspects of the technology and be certain the senior has a firm understanding of how to repeat the process to get online or risk creating frustration. Also, educate them that even though they can Skype, Zoom, et al. with others does not mean their loved ones or friends will be available at all times for them. Set a schedule for meaningful connections, managing their expectations to keep them from cycles of disappointment. Share successes, experiences, even failures with residential staff, other family members, and residents. Find out what works the best overall. Keep the strategy simple for the best results.

Be aware that seniors without strong social connections before covid-19 may feel incredibly left out. The technology connecting people doesn’t work if there is no one to communicate with on the other end of the virtual line. Residents without existing social networks typically rely on the now non-existent shared dining room and community events for interaction, and they may now be left behind. These residents need more assistance in learning how to join online classes and interactive communities that share like interests. Senior Americans unfamiliar with the internet of things do not understand the scope of what is available to them. CMS Administrator Seema Verma states, “While we must remain steadfast in our fight to shield nursing home residents from this virus, it is becoming clear that prolonged isolation and separation from family is also taking a deadly toll on our aging loved ones.”  Help your loved one to leverage digital technology and the internet to stay connected during the coronavirus pandemic. There is still hope and human connection available, and vulnerable and isolated seniors are in desperate need of both.

If you have questions or would like to discuss your personal situation, please don’t hesitate to contact us. Please contact our Reno office by calling us at (775) 853-5700.

Elder Law

Debunked Myths of Long-term Care

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. Please do not hesitate to contact our Reno office by calling us at (775) 853-5700.

Elder Law, Elder Living, Estate Planning, Healthcare

Will the Cost of Long-Term Care lead to the Loss of My Home?

People work hard all their lives to own a home, and it is often their most valuable and significant possession. Homeownership is the American Dream. So, when health begins to fail and the need for long-term care arises, we often get this fear-filled question from our clients: will they take away my home?

The enormous and on-going costs of nursing-home care are astronomical, on average around $8,500.00 a month depending on location. The joint federal and state Medicaid program foots the bill for one in four of around 75 million recipients in this country. This is an enormous drain on government funds. To recoup some of those costs, then, the Medicaid rules permit states to take the value of a recipient’s home in some cases, to reimburse the program for funds it has expended.

Yet, because a home is such an essential family possession, the rules treat a primary residence as exempt – that is, its value is not counted as available to pay for nursing-home care from the home-owner’s pocket, before Medicaid kicks in. The home is protected, to a certain extent, for the benefit of Medicaid recipients and their close relatives.

That protection can be lost, however. The value of the house can be counted against a Medicaid applicant, and benefits denied or curtailed, when:

*     A home-owner has no living spouse or dependents, and

*     The owner moves into a facility permanently, with no intent to return home, or

*     The owner dies.

In other words, as long as the owner expresses the intent to return home, and the owner’s spouse or disabled or blind child live in the home, the home will not be counted against the owner for Medicaid-eligibility purposes.

Once the owner passes, however the state may place a lien on the home, to secure reimbursement of the value of the Medicaid services the owner received. This lien makes it impossible to sell the home or refinance a mortgage, without first paying the state what it may be owed.

As elder law attorneys we know a number of ways to protect homes from this kind of attachment. If you come to us at least five years before you anticipate needing nursing-home care, we can preserve your home or its value such that Medicaid will not count it, or lien against it, at all.

Or, if a child moves into the home and cares for an ailing parent for two years, permitting the parent to stay home and out of a nursing home, the house can then be given as a gift to that child without any Medicaid penalty or disqualification. Ordinarily, Medicaid heavily penalizes giving away property, but this is one exception.

There are other strategies available. The home can be given to a disabled child without penalty or disqualification. Or, you might keep the right to live in the house for your lifetime and deed the remainder interest to others, who will then own the house after you pass. However, each strategy comes with risks that must be fully explored before determining the correct one.

An overall plan that is tailored to suit each individual, and to meet as many contingencies as possible, requires juggling a number of puzzle-pieces. There is no one cookie-cutter solution. The key is to plan before you or your spouse may need nursing-home care.

As one piece in the overall picture of a balanced estate plan, we can help you save your home. We welcome the opportunity to work with you, please contact our Reno office by calling us at (775) 853-5700.

Elder Law

The Importance of a Living Will

It is important to lay out your preferences for life-sustaining medical treatment with a living will. It is often accompanied by a health-care proxy or power of attorney, which allows someone to make treatment decisions for you if you are incapacitated and the living will does not have specific instructions for the situation at hand.  “Living will” and “advance directive” are often used synonymously, but a living will legally only applies after a terminal diagnosis, whereas an advance directive is much more comprehensive and includes the health care proxy.

As of 2017, only around one in three American adults had an advance directive for end-of-life care prepared. Those who are older than 65 are more likely to have an advance directive prepared than those who are younger, as are those have chronic illness more likely than those who are not. People may be unwilling to prepare these documents because they fear that they won’t necessarily reflect their wishes at the time they become relevant; sometimes patients become more willing to undergo treatments they rejected when they were younger as they age and develop medical problems. However, the documents can be changed as long as they are witnessed and potentially notarized (depending on current law). And if you continue to communicate your values with your proxy, they can make decisions based on your most recent preferences.

So why is a living will important? It reduces ambiguity which can prevent family disputes during what is already a difficult time. It may seem like something that can be put off, but life is unpredictable; one never knows when these documents could become relevant. Furthermore, it needn’t be a hassle. A living will is a straightforward document, however it’s important to work with legal counsel to make sure your beliefs are properly stated. Other health care documents should also be prepared at that time, like a health care power of attorney that designates a person to make health care decisions for you if you are unable.  Once you have signed any documents make sure you keep them updated, especially if you change states, and be diligent in communicating with whomever you named to act on your behalf.

If you need a living will or health care power of attorney or already have one that you would like reviewed, contact our Reno office by calling us at (775) 853-5700.

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