Tag: Long term care

Elder Law, Elder Living

Before Moving Your Parents to an Assisted Living Facility, Follow These Six Steps

SchulzeLawGroup

For aging parents, assisted living communities provide essential care and a sense of calm and peace of mind. Identifying the suitable facility “fit” for your loved one is a journey requiring matching your parents’ needs, budget, and lifestyle with desirable locations. Research and preparation yield the best results when all parties participate by asking questions and engaging in open and honest conversations about expectations.

When your elderly parents need more help than an in-home caregiver can provide, A Place for Mom recommends taking these six steps to learn about assisted living before committing to relocating your parents. If you are unsure if your parents need help, check for any of these eighteen signs that indicate it is time to intervene for their benefit and safety.  

1.    Have a conversation with your family.

Where applicable, include all siblings in the first discussion no matter how far away they may live. If you are the driving force behind calling the meeting, be clear about your capacity to participate and provide care.

If you are already your parent’s caregiver, be honest about how challenging the job is and remind them you cannot perform the duties indefinitely without support. Work at the outset to settle any disagreements. Securing family members’ support is key to providing a smooth transition and reducing your workload. Your siblings may surprise you with input or solutions you may not have imagined.

If your parents are unwilling to listen to your proposed shift in their care, find a quiet moment when you can relay your feelings, observations, and concerns. Though your parents may be in denial, you must listen to them and document their apprehensions as well as their preferences. If they remain unmoved, perhaps employ the services of a professional mediator who can provide all involved a voice in a safe and constructive environment.

2. Understand what assisted living can do to help.

Big life changes can bring about significant stress, particularly with the elderly, who tend to be resistant to change. You can evaluate your parents’ needs with an assessment of their activities of daily living (ADLs). Recognize that assisted living encompasses far more than many people realize, although it is not as involved as memory care or nursing homes. Please do some research to understand what assisted living offers and match it to your parents’ requirements. And while healthy skepticism is reasonable, don’t forget to consider the potential benefits assisted living offers. Finally, speak to a local senior living advisor who has expertise in senior care. A Place for Mom offers free advisor services providing personalized advice and recommendations.

3.     Make a plan to cover costs for your parents’ care.

Cost may be the most significant determining factor when looking for senior living options. Assess what your family can afford monthly and seek out assisted living communities that match your budget. If you are fortunate, your parents may have savings or long-term care insurance that will help defray the costs. Many families must explore other avenues.

Speak candidly to your parents about their finances. The most successful transition plans are born from open, honest dialogue about the critical factors in their move. Assisted senior living can be costly, so bring everything into the open to reduce stress and avoid surprises. Help your parents to understand the prices and costs of assisted living communities. Understand options for care payment, whether private funding or health care insurance, Medicare, or VA benefits.

4.     Virtual tour or pay a visit to a senior living community.

Nothing can replace a trip through an assisted living community. It is better than brochures, photos, reviews, and floor plans. Tour a minimum of three communities that make your short-list. Try to schedule time for your parents to tour as well. Mealtimes can be an excellent time to tour as you can gauge residents’ satisfaction and interaction and the onsite staff. Print out this Community Touring Notes checklist for easy comparison.

5.     Consult several varied sources to determine the best assisted living community.

Talk to as many people as you know to learn from their experiences. Relying on a narrow range of information can lead to bad outcomes. Read senior living community reviews. Learn about your parents’ state regulatory environment, background check requirements, and appropriate agency licensing. Please take advantage of federal programs and speak to the long-term care ombudsman. Their job is to resolve issues related to safety, health, and residents’ rights in senior living communities. Setting up a meeting with an elder law attorney as new resident contracts in assisted living communities can be confusing. Understanding the scope of an assisted living community contract is crucial to identifying what is provided and avoiding unforeseen or hidden costs. An elder law attorney is best for this contract review as they will typically aspire to higher levels of professional conduct as they serve a vulnerable population.

6.     Prepare your parents for the transition to senior living.

Once discussions with your parents are underway, do not delay the move. The more time your parents have to mull things over, the more uneasy they can become about the unknown. Become action-oriented and help them to downsize by consolidating their possessions. Plan and coordinate the move carefully to minimize stress levels for all involved. Senior move managers know what to expect and can help your move run smoothly. Be sure to gather and manage your parents’ legal, medical, financial, and other essential documents to ensure they are not misplaced or lost during the move.

Being compassionate to your parents is vital during this life transition. Involving all family members in a constructive dialogue to create a positive approach to the move is critical. Some parents may make a move with relative ease, while other parents may present more challenges. For the best possible experience, follow these six steps to help your parents move to an assisted living community.

If you or your parents would like to discuss options for paying for long-term care, we would be happy to help. We help families plan for the possibility of high long-term care costs and to understand payment options available, like Medicaid or programs offered by the Veterans Administration. It’s important to understand these options to avoid running out of money while paying for long-term care.  We can also help by reviewing facility contracts when admitting a loved one to assisted living or a nursing home. 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 Living, Healthcare

Termination of Home-Health Care Services Is Becoming More Common

SchulzeLawGroup

Many Americans are getting their Medicare benefits cut as home health providers, including occupational, speech, and physical therapists, social services, as well as skilled nurses are saying: “Your husband (or whomever) is not going to get better, so we will have to discontinue our services as Medicare will not pay for it.”  Termination of care is swift, often within 48 hours of delivering the message, and the home health care chores fall to the family system or must be paid for out of family funds. So what changed?

PDGM Figure 1

Significant changes began on January 1, 2020, as to how Medicare pays for home health services. Medicare has altered its billing approach from a therapy delivered model (the more therapy you receive, the higher the payments billed to Medicare) and changed it into a reimbursement system known as the Patient-Driven Groupings Model, or PDGM. Medicare Advantage plans have separate rules and are not affected.

The Centers for Medicare and Medicaid Services (CMS) provide Figure 1 as an example of how a 30 day period becomes categorized into 432 case-mixed groups for adjusting payment purchases in the PDGM. These 30 day periods are further broken into the following subgroups: admission sources and timing, twelve clinical principal diagnosis subgroups, three functional impairment levels, and three levels of co-morbidity adjustments. During the 30 days, there is only an allowance for one chosen category under the larger color-coded categories. CMS deems this newer approach to be more holistic regarding patient need assessments.

In 2017, the most recent year for which the data is available, for-profit US home health care agencies (approximately 12,000) provided care to 3.4 million Medicare beneficiaries. Home health rates charged were based on the amount of therapy delivered. The more therapy a patient received, the higher the payout to the agency. Due to the change in payment structure, these agencies are cutting back on therapies provided and even reducing the number of therapists employed. They can’t bill enough to Medicare to remain profitable. These new payment conditions are based on a patient’s underlying diagnosis and other case-specific complicating medical factors. As a result, home health care agencies now have a stronger financial incentive to meet the needs of short-term therapy, post-hospital or rehab facility, as well as caring for patients requiring nursing care for complex situations like post-surgical wounds.

CMS believes this new way to assess payments will strike a balance between costs, efficiencies, needs, and outcomes. The members of the National Association for Home Care and Hospice (NAHC) disagree. Data culled by NAHC from home health agencies indicate there will be a substantial reduction of therapy services offered as a result of the PDGM. William Dombi, the association’s president, states that the cuts “may not be a good move” because medically, patients may deteriorate more rapidly without therapy and seek aid in emergency rooms or hospitals.  He also notes the possibility that if more patients end up worse off and go to emergency rooms or hospitals, that this will reflect poorly on home health agencies and can affect their referrals.

Providing the right patient therapy at the right time by home health care agencies is critical to positive patient outcomes. CMS has done extensive analysis of historical data and, through the use of artificial intelligence tools, feel they can better predict what kind of services and how often a patient will need them through the PDGM. Clarifications are being posted online by CMS that deal with early errors in the program and the ensuing turmoil of therapy provision for patients within the new guidelines. It is the hope that more reviews and revisions to the PDGM will strike a better balance between cost and efficiency, patient therapy needs, and outcomes.

Understanding the role Medicare will play when it comes to long term care services can be confusing. We help families plan for the possibility of needing long term care, and how it could be paid for without causing the family to spend everything they have. 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

The Benefit of an Elder Law Attorney

SchulzeLawGroup

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.

Uncategorized

Why Veterans Benefits Planning is Vital for Aging Veterans

SchulzeLawGroup

The COVID-19 virus is not going away as many had hoped. And studies have shown it is deadlier for those over the age of 65. Individuals living in senior living communities, such as independent living, assisted living, memory care, and nursing homes have the highest risk of becoming infected and possibly dying from the virus or a secondary illness, such as pneumonia, after being weakened from the virus. For many families, providing long term care for a loved one in the home has become an even bigger priority than normal. In-home care can be costly, which makes the Aid and Attendance Benefit provided by the Department of Veteran’s Affairs of critical importance to help pay for such care.

Veteran Aid and Attendance Benefit

The Aid and Attendance Benefit, technically called the Improved Pension Benefit, is a cash benefit paid to wartime veterans that are over the age of 65 and require another person to assist them with activities of daily living, such as bathing, dressing, feeding, and assistance with incontinence, or requires a protective environment due to mental decline. The Aid and Attendance Benefit is also available to similarly disabled spouses of deceased wartime veterans that are over the age of 65. It is this need for assistance with care or a protective environment that has the family looking into long term care facilities for their loved one.

The Aid and Attendance eligibility rules also require the person receiving the benefit to have limited income. Simply put, all income of the applicant and the applicant’s spouse must be offset by the medical expenses of the applicant and the applicant’s spouse. Any income not offset by medical expenses reduces the amount of the benefit. Under the Aid and Attendance rules, when the wartime veteran or surviving spouse requires assistance with activities of daily living or a protective environment, paying an in-home caregiver to provide that care is a medical expense. It does not matter whether the caregiver is a child or hired through an agency.

Current Veteran Benefits

For 2020, the maximum benefit paid to a married wartime veteran is $2,266 per month. The maximum benefit paid to a single wartime veteran is $1,911. The maximum benefit paid to a surviving spouse of a wartime veteran is $1,228. Working carefully through the math, if a married wartime veteran needs long term care and has a household income of $4,000 per month, he or she will need to spend $4,000 per month on medical expenses to receive $2,266 per month. That veteran likely already has medical expenses in the form of two Medicare and two Medicare supplement premiums, as well as possibly two Medicare prescription supplements. The remaining income needs to be spent on additional medical expenses, specifically an in-home caregiver.

The family must now decide the best way to navigate paying the in-home caregiver. If the couple has children, perhaps the remainder of the household income can be paid to a child, or split among the children, as payment for caregiver services. In many cases, using a child or children as a caregiver allows for flexibility in the amount a caregiver is paid. The income calculation can be manipulated to net out at exactly zero, instead of going into the negative. This allows the veteran to use the $2,266 per month benefit to pay for the couple’s non-medical living expenses.

Other Veteran Benefits for Caregiving

The other option is to hire a caregiver from an agency. This option is more expensive than using a child as a caregiver, but it comes with the added benefit of ensuring taxes are withheld and workers’ compensation insurance is provided in case of an accident. If the family wants the income calculation to net out at exactly zero, the veteran typically will not get as many hours of service from the caregiver hired through an agency compared to hiring a child since an agency typically charges a higher per hour rate. This would work well for a veteran that does not need a lot of care, or that has a wife and/or children that can cover the additional hours of care for free. Otherwise, the agency will need to be paid to provide the additional hours of service, which means the $2,266 benefit paid by the Department of Veterans Affairs will also be used to pay for the care and the couple will have to use assets to pay for the couple’s non-medical living expenses.

The Aid and Attendance Benefit also has an asset limit the applicant must meet, along with a penalty for giving assets away and a 3-year period to look back at the applicant’s assets to see if any gifts were made. These rules should not dissuade a wartime veteran or surviving spouse from seeking this benefit. The need for long term care will only increase. The cost of care will only increase. And now the COVID-19 virus makes it critical that everything possible is done to protect this vulnerable community.

If you have questions or would like to discuss whether you or a loved one may qualify for Veterans Benefits, please don’t hesitate to reach out. Please contact our Reno office by calling us at (775) 853-5700 to learn more about your VA planning options.

Elder Law

Debunked Myths of Long-term Care

SchulzeLawGroup

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.