Tag: medicaid

Elder Law

Understanding Medicaid

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Federal and state Medicaid programs offer comprehensive health insurance and financial protection to millions of Americans. The program helps low-income families, individuals, and people with disabilities receive adequate health care and provides nursing home or community long-term care services. As of August 2022, more than 90.5 million individuals were part of the Medicaid and Children’s Health Insurance Programs (CHIP).

States Follow Federal Guidelines But Have Some Autonomy

Although Medicaid funding is a federal-state partnership, states administer the programs and have some flexibility in determining who to cover, delivery models, and payment methods for physicians and hospitals. States may apply for a Section 1115 waiver to experiment with different implementation approaches as federal statutes require; however, the Secretary of the US Department of Health & Human Services (HHS) determines advanced program objectives.

Medicaid entitlement has two basic guarantees. First, all Americans who meet Medicaid eligibility requirements are guaranteed healthcare coverage. Second, states receive guarantees for federally matched funds without a cap for enrollees’ qualified services. Under current law, nearly all Medicaid federal funding is open-ended, but this may change for cost containment.

According to the Congressional Budget Office (CBO), the federal government pays anywhere from 54 percent to 79 percent of each state’s annual Medicaid outlays, with the states’ picking up the remainder. Beyond enrollment expansion due to COVID-19 for the fiscal year 2022, nearly one-third of states saw upward pressure on spending due to increasing costs for managed care and provider rate increases.

Medicaid Coverage Continues to Evolve

Medicaid began in 1965 and was a cash assistance program for qualifying individuals or families. In the following years, Congress expanded federal minimum requirements to provide more new coverage types, particularly for children, pregnant women, and people with disabilities. The broader health care coverage of the Affordable Care Act (ACA) in 2010 expanded Medicaid to non-elderly adults with qualifying low incomes and continues to meet changing needs.

A Broad Range of Health and Long-Term Care Services

In addition to the Medicaid federal law service requirements, many states provide optional services. These services include physical therapy, prescription drugs, eyeglasses, and dental care. Medicaid expansion for adults is part of the ACA’s ten “essential health benefits,” which include the following:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Pregnancy, maternity, and newborn care
  • Mental health and substance abuse disorders
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventative and wellness services
  • Pediatric services

Medicaid covers the cost of long-term care, including nursing homes and many community-based long-term services. Over half of all Medicaid long-term care spending is for home and community-based services (HCBS), enabling seniors and those with disabilities to live more independently. Emphasis is shifting away from institutional settings, although intermediate care facilities for adults with intellectual disabilities remain a priority.

Privately Managed Care Plans for Enrollees

More than two-thirds of Medicaid beneficiaries account for privately managed care plan enrollments contracting with states to provide comprehensive services. Other enrollees receive their care in a fee-for-service system.

Most states cover long-term services through risk-based managed care arrangements to contain costs. These managed care organizations (MCOs) are comprised of various entities, as some involve physicians while others combine physicians, hospitals, and other providers.

The blended approach of public and private partnerships to provide Medicaid care allows each participating group to function at their highest level, integrating efforts instead of trying to solve issues outside their expertise.

Medicaid beneficiaries have far better access to healthcare than the uninsured and seek medical care before health problems become severe and more costly. The satisfaction ratings of Medicaid recipients are comparable to those rates for individuals with private health insurance.

Conclusions

Despite experiencing low income, the rate of Medicaid enrollment is similar to those with private coverage. Medicaid covers preventative, rehabilitative, and acute health care in addition to costly long-term care for millions of Americans.

Medicaid services account for one-fifth of healthcare spending and receive a lot of attention regarding:

  • Capacity expansion to address addictions, in particular opioids
  • Refining payment and delivery systems
  • Lowering prescription drug costs
  • Refining eligibility requirements
  • Increasing community-based long-term care services

Medicaid funding is a major financial support for hospitals, doctors, nursing homes, and many other jobs in the healthcare sector. Federal matching funds guarantee an open-ended basis to provide flexibility in supporting each state’s population’s healthcare needs.

Medicaid is an extensive program and varies by state, making it difficult to know what is available to beneficiaries or potential enrollees. Attorneys specializing in Medicaid and disability can help you understand how to benefit from your state’s programs. They can guide your application process, ensuring you receive the necessary benefits.

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

Elder Law, Estate Planning

How Can an Elder Law Attorney Help You?

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With the aging Baby Boomer generation and the increased number of international migrants, the senior population of the United States is growing rapidly. Although the US average life expectancy has seen a slight three-year decline, many Americans, men, and women live well into their 80s, 90s, and beyond. An elder law attorney works with seniors, taking a holistic approach to the legal issues people commonly face as they age. These include matters of housing, physical and financial health, estate planning, and more. There are as many issues as there are seniors, as life circumstances are different for everyone. An attorney who specializes in the host of the problems senior citizens face can be a wise investment.

Whether you have a lucrative business and many assets, or a small home with a modest bank account, estate planning can be overwhelming. However, having your affairs in order is a final gift to your family. An estate plan is much more than creating your will though it is generally the first step. There are multiple types of wills, and while most people think of their last will and testament, there are also living wills, joint wills, pour-over wills that work in conjunction with trusts, and more. The type of will(s) you need to best control what happens to you and your assets throughout your life, and your death, are best explained by an elder law attorney. An elder law attorney specializing in estate planning helps you navigate wills, trusts, guardianships, advance medical directives, and the financial management of life insurance policies, annuities, IRAs, and 401ks. All of these can have tax implications for managing and settling your estate.

Government programs on federal and state levels may be available to seniors. Individual qualifications and the application processes can be complicated and confusing, especially when enrolling for the first time. An elder law attorney can help you understand Medicare Part A (hospital, skilled nursing, some home health, and hospice), Part B (medical insurance covering certain services by doctors, preventative services, medical supplies, and outpatient care). Medicare Part C (Medicare Advantage Plans, a private company insurance plan you purchase that dovetails with Medicare) and Part D (covering prescription drugs). If you are a veteran, programs are available through the Veteran’s Administration and can provide you with further and more specialized assistance because of your military service. Veteran program qualifications can be highly complex, so look for an elder law attorney who is accredited by the Veterans Administration.

Medicaid provides health care benefits for low resource and low-income adults, pregnant women, elderly adults, children, and people with disabilities. If you qualify, you may receive both Medicare and Medicaid benefits. Medicaid qualifiers have their healthcare premiums and out-of-pocket medical expenses covered through the program. Medicaid also includes custodial care and addresses long-term care expenses if you begin living in a nursing home. An elder law attorney understands how Medicare and Medicaid can work to your best advantage.

Social Security benefit amounts change depending on the age range you choose to receive your benefit. You can currently apply and qualify for your benefits at 61 and nine months of age; however, the full retirement age for social security is 67, and cashing in early has long-term consequences for your payout. An elder law attorney can help you determine the best age to receive your social security benefits based on your health and financial situation. Suppose you also receive disability benefits before full retirement age or become disabled at that age. In that case, an elder law attorney can ensure you receive the proper benefits based on your condition. 

Long-term care is known to be an expensive proposition whether you are trying to afford long-term care insurance upfront or pay for it out of pocket if you require it in the future. Not addressing the issue of long-term care is a big gamble to your financial well-being. Morningstar reports that 52 percent of Americans turning age 65 will need some long-term care services in their lifetime. An elder law attorney can help you understand policy premiums and how they can increase if you purchase long-term care insurance. They can also guide you through Medicaid planning or estate planning that can help you qualify for the best financial arrangements for long-term care. Sometimes, it is beneficial to spend down your estate to be eligible for Medicaid, and your elder law attorney will know what is required by law to do it properly.

Other issues, such as employment discrimination, elder abuse, elder fraud, even grandparent visitation rights, fall under an elder law attorney’s scope. An attorney who practices elder law has a more comprehensive list of capabilities to help you through your senior years than those attorneys without expertise in this area.

We focus on elder law.  We would be honored to speak to you about how we can help you come up with a comprehensive legal plan covering many of the topics above so you can enjoy your senior years without unnecessary worry. Please contact our Reno office by calling us at (775) 853-5700. We look forward to hearing from you.

Elder Law, Elder Living

Protections from Spousal Impoverishment

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There are laws that were put in place to protect married couples’ savings from being depleted when using Medicaid. These protections prevent husbands and wives from bankrupting themselves trying to fund care for their loved ones. They originally required states to allow spouses of nursing home residents to maintain a certain amount of both income and assets; in 2014, this protection was extended to married couples whether the care is provided in an institution or at home.

These protections are set to expire in September unless new legislation is passed. If these protections are not extended, some married couples would be at risk of losing their Medicaid coverage unless they enter a nursing home.

Forcibly separating families, forcing individuals to institutionalize their spouses, is a tough policy. Congress should therefore extend these protections. Fortunately, Sens. Amy Klobuchar (D-MN) and Tina Smith (D-MN) would make these protections permanent.

“When you’re caring for a loved one round-the-clock and serving as your spouse’s support system, you’ve probably already worried about how to make ends meet. You shouldn’t have to worry about your savings completely drying up,” Smith said. “Our bill would make spousal impoverishment protections permanent so families can stay together and get the care they need, surrounded by the people they love.”

This particular bill is mostly supported by Democrats, including Richard Blumenthal (D-CT), Sherrod Brown (D-OH), Bob Casey (D-PA), Kirsten Gillibrand (D-NY), Jeanne Shaheen (D-NH), Debbie Stabenow (D-MI), and Chris Van Hollen (D-MD). Several of these supporters

A similar bill, H.R.1343, was introduced to the House in February by two Republicans, Reps. Debbie Dingell (D-MI) and Fred Upton (R-MI).

In the meanwhile, H.R.3253, which would extend the applicability of Medicaid eligibility criteria that protect against spousal impoverishment for recipients of home- and community-based services, passed in the House and is now in the Senate.

If you have questions or would like to discuss your personal situation, please don’t hesitate to contact our Reno office by calling us at (775) 853-5700. You can also read more using the links below.

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Elder Living, Healthcare

Don’t Wait for a Crisis to Discuss Long-Term Care With Your Parent

SchulzeLawGroup

It is unclear whether or not your parent has a plan in place for long-term care. It is a difficult topic to broach; no one wants to talk about death and the financial realities that come with aging.  Instead of having a proactive conversation early in a parent’s aging process, most families have a reactive discussion under high levels of stress and emotions while their parent is experiencing an adverse health event.  The Public Broadcasting Service (PBS) has reported that 85 percent of the time long-term care decisions are made during a medical crisis. The message is clear, be proactive and start discussing the important financial questions with your parent.

Prepare Yourself

Your parent will feel more comfortable and at ease if you have processed your feelings before talking to them.  Conduct research so that you are knowledgeable enough to present a clear and concise set of options for your parent.  Having options allows your parent and family to make decisions and feel in control of the process.  You are seeking progress, not perfection. It may not all become settled in one conversation, but the price of silence about your parent’s plan may be very costly to you.

Review Documents

Two of the most critical personal legal documents are a durable power of attorney (DPOA) and a healthcare proxy. All older adults should have these documents as it gives legal authority to a designated representative to make financial, legal, and health care decisions on your parent’s behalf. If your parent does not have a DPOA and becomes incapacitated, you will have to go to court to get appointed as your parent’s guardian which can be a complicated legal process at a time when your energy is better spent in the care and decision making for your parent. If they do not have a DPOA and health care proxy in place make arrangements for them to meet with a trusted elder law attorney to properly draft the legal documents.

Often a parent will have a will, retirement account information, and insurance policies that have not been revisited or updated in years, sometimes decades. When was the last time your parent reviewed beneficiary designations? Family circumstances change, and the birth of a child, death, or divorce can affect how your parent may want beneficiaries designated. It is best to review financial and insurance data annually with your parent and make adjustments if necessary. For example, if the parent’s children are grown it might be best to cut back on the amount of life insurance they carry to save money on annual premiums.

Long Term Care Plan

Address the issue of long-term care. According to the PBS, a full 70 percent of all seniors will need some long-term care as they age. Even if your parent is healthy today odds are they will require long-term care and the costs are staggering. Some life insurance companies will add a long-term care rider to an existing policy. Medicaid also can cover some long-term care costs, but neither standard health insurance nor Medicare will cover your parent’s long-term care expenses.

Meet the Team

Ask your parent about their financial advisors and request a brief introduction to them.  Find out who they are and how you might contact them in the event your parent is unable to do so. This information will allow you to keep an eye on your parent’s accounts and be confident the advisors are trusted, objective, and well versed in elder financial issues. Oversight by you in a slightly detached way provides your parent privacy and independence about their finances but allows you to protect them from unscrupulous advisors. 

Understand Filing System

The last thing you need to discuss is where this vital information is filed so that before a crisis hits you know where to find the important documents, online passwords, and forms of ID you will need to facilitate your parents well being. While you do not have to see all the specific contents of the information, particularly the financials, knowing where they keep the data is critical in a crisis. Remember that as your parent ages they may start to change the location of the information. Check with them a couple of times a year to ensure the information is still in the same place and physically look to be sure it is.

Discussing your parent’s strategy is best begun while they are healthy.  Proactive planning is the best way to help your family as your parents age.  Contact our office today and schedule an appointment to discuss how we can help you and your family.

Elder Law, Healthcare

Divorce and the Effects on Medicaid

SchulzeLawGroup

Every so often, marriage comes later in life as it did for Wanda and Harry. This was their second marriage, and both had children from the prior marriages. The couple wanted their children to inherit from their respective parents, so Harry and Wanda signed a prenuptial agreement to keep their property clearly separated.

Unfortunately, Harry was then diagnosed with Alzheimer’s. Medical bills piled up, his condition worsened, and soon Wanda was no longer able to care for him at home. But the cost of nursing-home care was formidable.

The Medicaid program is designed to help pay for that staggering cost. However, before a couple can be eligible, the rules require that the assets of both spouses are counted to pay for the care of one, even if only one spouse needs the care. Prenuptial agreements do not matter. The Medicaid rules count the assets of both spouses together. Wanda would be permitted to keep some of her property for her own use – but this would not be enough for her to maintain her standard of living, pay for her retirement, and still leave enough for Wanda’s children to inherit.

Wanda heard that divorce might solve this dilemma. The couple’s assets would get separated in the divorce proceedings and, after that, only the property designated as Harry’s would be applied to the cost of his care. He would spend that down, Medicaid would then step in, and Wanda’s share would remain her own.

But Wanda didn’t like the idea of a divorce that would be only “on paper,” because she had no intention of deserting Harry in his time of need. Harry’s children weren’t happy, either. And if the divorce was going to work as intended, the couple should probably consult not just one but three professionals – an elder law attorney, a financial planner, and a divorce lawyer.

But this plan would involve expense, possible family unrest, and uncertainty as to whether a court would approve the plan. The divorce strategy comes with significant downsides.

Early planning is best, to consult an elder law attorney at least five years before the need for Medicaid arrives. If that is not possible, an experienced elder law attorney can find other, less-fraught ways than divorce.

Early planning if possible, though, is always best. If we can be of assistance, please don’t hesitate to reach out. Please contact our Reno office by calling us at (775) 853-5700.

Elder Living

Understanding CMS Guidelines for Nursing Home Visitation

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Revised guidance for nursing home visitation has been issued by the Centers for Medicare and Medicaid (CMS). It is now possible to have visitation with nursing home residents for reasons other than urgent end-of-life scenarios and, in some instances, may include physical touch. Additionally, communal activities and dining are permissible as long as the social distancing rule of 6 feet of separation, and other precautions are observed. Encouraging outdoor visits is desirable as long as the weather permits. Indoor visits are permissible if no new cases were identified in the previous two weeks, and the facility adheres to the core principles of resident and staff testing, screening, proper hygiene, social distancing, and facility cleaning. 

The CMS memo contains “Core Principles of COVID-19 Infection Prevention” verbatim as follows:

  • Screening of all who enter the facility for signs and symptoms of COVID-19 (e.g., temperature checks, questions or observations about signs or symptoms), and denial of entry of those with signs or symptoms
  • Hand hygiene (use of alcohol-based hand rub is preferred) 
  • Face covering or mask (covering mouth and nose) 
  • Social distancing at least six feet between persons 
  • Instructional signage throughout the facility and proper visitor education on COVID19 signs and symptoms, infection control precautions, other applicable facility practices (e.g., use of face-covering or mask, specified entries, exits, and routes to designated areas, hand hygiene)
  • Cleaning and disinfecting high frequency touched surfaces in the facility often, and designated visitation areas after each visit 
  • Appropriate staff use of Personal Protective Equipment (PPE) 
  • Effective cohorting of residents (e.g., separate areas dedicated COVID-19 care)
  • Resident and staff testing conducted as required.

CMS acknowledges that the previous months of severe visitor restrictions to slow the spread of COVID-19 were at a high cost to nursing home residents’ overall wellbeing. The revision of visitor guidance compassionately addresses resident care needs beyond protection from the coronavirus. 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.”

CMS is also making available Civil Monetary Penalty (CMP) funds to ensure greater and safer access to outdoor and indoor visits. The money can purchase tents for outdoor interaction and clear dividers such as plexiglass can create physical barriers, reducing the risk of transmission during in-person visits. Funding through CMP can also provide 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.

Compassionate care situations now include more than the end-of-life scenarios and are also included in the CMS memo. Verbatim they include but are not limited to:

  • A resident, who was living with their family before recently being admitted to a nursing home, is struggling with the change in environment and lack of physical family support.
  • A resident who is grieving after a friend or family member recently passed away.
  • A resident who needs cueing and encouragement with eating or drinking, previously provided by family and/or caregiver(s), is experiencing weight loss or dehydration.
  • A resident, who used to talk and interact with others, is experiencing emotional distress, seldom speaking, or crying more frequently (when the resident had rarely cried in the past).

In addition to family members, compassionate care visits may now also include clergy or laypersons offering religious or spiritual support that meet the resident’s needs. Personal contact is permissible during these and family visits but only when following all appropriate infection prevention guidance. This more humanized approach to nursing home care encourages facility staff to work with residents, families, caregivers, and resident representatives to identify those in need of in-person compassionate care visitation. Exceptions to compassionate visits occur when facilities have experienced COVID-19 infections within the past two weeks or when a county is experiencing a high positivity COVID-19 rate. In the absence of a reasonable safety or clinical cause, the Centers for Medicare and Medicaid make clear that failure of nursing homes to facilitate in-person visitations can be cause for citations and other penalties as CMS deems appropriate.

CMS understands that nursing home residents derive physical, emotional, and spiritual value and support through family and friend visitations, especially in trying times. No one should be made to endure this pandemic alone, least of all the most vulnerable among us. This new CMS nursing home visitation guidance is designed to help American seniors remain happier, stronger, and more resilient in the face of adversity through the personal support of those who love them most.

If you have a loved one in a nursing home, check with the facility to see how or whether their visitation guidelines have changed. It may take time for local facilities to consider these new guidelines and make changes that are consistent with the recommendations from CMS.

We would be happy to discuss any questions you have, including how to choose appropriate long term care and how to pay for it. We can recommend legal ways to help ease the cost of long-term care and protect your savings and home. Please contact our Reno office by calling us at (775) 853-5700 to learn more about your legal options.

Elder Law

Debunked Myths of Long-term Care

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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 Living

Alternative Views on Facility Living with Alzheimer’s Patients

SchulzeLawGroup

As the aging population rises, Alzheimer’s Disease is also on the rise for elderly moving into nursing home facilities. The National Institute of Health (NIH) Library of Medicine reports the most common form of dementia is Alzheimer’s disease, accounting for approximately two-thirds of all diagnosed cases of dementia. Alzheimer’s is also one of the most expensive diseases to treat and often results in financial strain on families trying to find and pay for the best care. In the past, care in facilities often resulted in Alzheimer’s patients being separated from others. However, as you’ll read below, facilities are now exploring better ways to treat Alzheimer’s patients while living in a facility.

Medical breakthroughs that increase our understanding of how to best treat and introduce disease modification therapies for people living with Alzheimer’s and other neurodegenerative diseases provides future hope. However, according to the Alzheimer’s Association, there are already more than 5.8 million Americans living with Alzheimer’s disease. These individuals may not live long enough to benefit from new therapy discoveries since new treatments must undergo rigorous testing and clinical trial phases. Current projections indicate that unless some of these medical breakthroughs have practical applications very soon, more than 14 million Americans will be clinically diagnosed to be living with Alzheimer’s by 2050, with many more struggling in the long-preclinical phase of the disease.

As senior living facilities become more saturated with dementia patients in all stages of progression, there is a shift underway towards non-segregated memory care living. Alzheimer’s patient reintegration into general senior living residence status is shifting dementia care into a human-centric model. It provides insights and lessons into eldercare facility living, its providers and staff, family members of residents, and all of the patients, not just memory care patients. This human-based approach is a kinder, more medically practical and appropriate, and in the long term, a more cost-effective method for facility residents who have dementia.

Before there were outcome-based clinical research findings to support the segregating of dementia patients care facilities began creating stand-alone memory care units, floors, and facilities.  Families knew their loved ones were safely locked away in a highly monitored unit, and staff could focus their training and efforts in a more specified range of care. Because this isolation model became overwhelmingly profitable for business operators, it became the de facto standard of memory care operation. Profits were trumping the human condition. At the outset, it seemed rational enough to put like-patients together, yet because everyone’s memory disease progression is unique, the concept was flawed. Living circumstances for humans is an emotional experience, and the sad outcome for assembled memory care patients was faster disease progression in their isolated, shrinking worlds. This accelerated mental decline was partially due to the lack of broader social and emotional connection with non-dementia residents. It seems integrating patients of all types and generations enriches and expands what residents can do, creating a diverse human model focusing on the positive aspects of life and personal interaction.

Some of the conditions all aging adults share, not just those living with dementia, include difficulty hearing and seeing, finding mental focus more demanding, becoming more concerned about being in large crowds, and noises that increase their stress levels. For a community of residents, no matter what the patient illness, facilities can create an atmosphere that addresses these common concerns. These shared needs include not only medical care but activities that are available in a 24-hour cycle and the encouragement of socialization in smaller, quieter circles. Interactions among residents in this calming style of environment tend to create friendships organically and provide enriching connections among patients irrespective of their illness type. The overall common conditions of aging require sameness in approach, no matter how varied the residents’ medical conditions are.

Technology that allows for digital wrist monitoring of patient location and vital signs permits ease of monitoring residents, particularly as they wander their living space.  Even the proper lighting, carpeting, and circular hallway architecture reassure residents’ feelings of safety, comfort, and familiarity, which appeals to all, regardless of diagnosis. When an entire senior living facility is dementia friendly, and all staff is trained in memory illness and care, every employee can add value to a resident’s enjoyment of life from the medical professionals to the social workers to the landscapers.

A diagnosis of Alzheimer’s can strike fear and worry in America’s aging population because of the emotional, physical, and financial upheaval associated with it. An older person might recognize the onset of some memory problems and become terrified, thinking about Alzheimer’s and the possibility of being relocated from their home and community to a dementia unit. There is a sense of dread that you may never feel seen, heard, and loved again by other people. Interpersonal relationships and connectedness are a hallmark of the aging communities in America. AARP reports large percentages of technology use in older Americans is related to interpersonal connections like email, viewing photos of family and friends, and using social media and the internet. Even in digital spaces and experiences, elderly community residents are looking to create personal networks, connecting to the world at large. The human spirit inclines to be expansive.

Appropriate social and physical environments play a significant role in healthy aging. Compartmentalizing memory care patients into homogeneous units will increase their memory decline, isolate their human connection, and spiral the patient into an ever-shrinking world of interaction, often making them non-verbal. Alzheimer’s patients who experience higher levels of social integration respond conversely, expanding their horizons as they experience and feel the extension of human love and support. There is no one set of symptoms for Alzheimer’s patients, and all patients are on their own trajectory of the disease. Mistakenly putting them together in a one size fits all approach of care has been a disservice to their health and well being and to the future care of others who will become afflicted with Alzheimer’s. The memory care model is shifting for the better and not a moment too soon.

We help families who have a loved one with dementia. We explore possible sources to help pay for care, like Medicaid, and we make sure our client’s wishes are stated in properly drafted legal documents. If you have a loved one with dementia, give us a call and let’s work on a plan to ensure your loved one has the best care possible, and their home and savings are protected. If you have questions, please do not hesitate to contact our Reno office by calling us at (775) 853-5700.

Uncategorized

Giving Gifts While on Medicaid Can Be Risky

SchulzeLawGroup

Mabel’s children were concerned that Mabel would need long-term nursing-home care in the near future. It was the holidays, and Mabel always got a lot of joy out of generosity. But her children had heard that people in Mabel’s circumstances should not give gifts.

The concern is real. For Medicaid to cover the huge expense of nursing-home care, Mabel would have to show that she owned nothing more than around $2,000. And she must also show that she had not given away money or assets over the prior five years (2.5 years in California). That Medicaid rule – the “look-back period” or the “transfer penalty” – would charge Mabel dearly for her generosity. Depending on the size and number of gifts, the penalty could be substantial.

Many wrongly think that there is no penalty for gifts of up to around $15,000 annually. That misunderstanding confuses tax law with Medicaid law (and it also misstates tax law, but that’s another subject). The Medicaid rules are entirely different from the tax rules. In the Medicaid context, gifts of any amount that are given during the look-back period can be penalized.

There are exceptions. These include gifts to spouses and siblings under certain circumstances, disabled children, and children who are caregivers and who live at home with the elder for a span of time. But overall, gifts and Medicaid do not go together. The Medicaid rules are complicated and the consequences for mistakes can be very costly. There are a number of options to protect assets and still qualify for benefits, but these options must be weighed with great care. This is why it’s best to consult attorneys who, like us, are qualified by experience and expertise in Medicaid law.

There is one harmless deception Mabel’s children might consider, to keep Mabel happy and still satisfy the Medicaid rules. The children might help Mabel fill out checks for all the gifts she’d like to give, together with a greeting card for each gift. Everybody could thank Mabel, tear up the check later, and tell her what they “bought” with that amount. It may be that that little device would be worth it, so Mabel could enjoy the holidays too.

Otherwise, the sooner you consult a qualified elder law attorney, the more other options may be available. If we can be of assistance, please don’t hesitate to reach out for a consultation.