The holidays are a time for all of us to come together and celebrate. It may also be the only time during the year that families who live far apart from each other can visit, face-to-face. We find this to hold especially true for our Florida seniors who have either moved away from their adult children or whose children have moved out of state.
We encourage you to carve out time during your holiday celebrations to discuss the future with your aging parents. While none of us want to consider a future that includes long-term care it does not mean the conversation should be avoided. Difficult conversations are, for the most part, better to have in person.
It may not seem necessary to have this conversation, especially if your parents are only recently leaving their middle-age years and in relatively good health. We would counter, however, that there is never a wrong time to begin to plan for your aging parent’s potential need for long-term care and their nursing home eligibility. A sudden, incapacitating stroke could leave them with diminished capacity or Alzheimer’s Disease at any time, and we all need planning in place that contemplates these issues. In fact, right now the cost of long-term care in Florida presently exceeds $8,000 per month. Without a plan in place to qualify for nursing home Medicaid in the future, your parents’ assets could be substantially depleted due to long-term nursing home care.
In addition, the community spouse may only retain his or her income plus the portion of the institutionalized spouse’s income necessary to allow the community spouse $2,058.00 in income per month with a maximum to include an excess shelter and a standard utility allowance of no more than $3,161.
It is important to understand that Medicaid is a means-based program. For example, a parent in a nursing home can only own $2,000 of countable assets and be eligible for Medicaid nursing home assistance. The non-institutionalized parent can only own $126,420 in countable assets. This means that your parents will not receive Medicaid assistance if they have too many assets. This is why it is important to begin far in advance of applying for Medicaid eligibility to divert their assets from the countable assets that will disqualify them for Medicaid eligibility to non-countable assets. Presently, examples of non-countable assets can include, but are not limited to, a residence, improvements made to their residence, Individual Retirement Accounts, a prepaid burial account or an automobile regardless of its value.
If your parents wait too long to make gifts of their assets to someone other than a spouse they may be penalized for making the gift too close to the time that they need to apply for Medicaid assistance. Assets given to another person, such as a son or a daughter, at least five years in advance of applying for Medicaid assistance, however, may not give rise to their disqualification for assistance. Further, a good elder care planning tool can be to transfer their countable assets to an irrevocable trust at least five years in advance of applying for Medicaid nursing home assistance.
We know this article may raise more questions than it answers. Planning for elder care issues, at any time, can feel as if you are navigating a long-term care maze. We encourage you not to wait to get the advice you need. Do not wait to schedule a meeting with our office with your parents while you are visiting, or any time throughout the year.
For most of us, the idea of moving to a nursing home can be a difficult subject to discuss. Whether you are a Florida senior who needs to consider moving out of the home or an adult child looking to help your aging parent, you may be confused as to where to start. Where do you find the information you need? How do you know how to choose the right facility for you? How will you be able to afford it?
We deal with each of these questions on a daily basis when we work with our clients and their loved ones. We know the challenges you face and want to be able to help you navigate these issues.
As you complete your research on finding the right nursing home for you or a loved one, you need to have the right tools to review and compare the places you are considering. Medicare does have a resource for you. Medicare has created the Nursing Home Compare Tool. According to Medicare, when using this tool, you may find “detailed information about every Medicare nursing home in the country.” You can perform a search using city, state, and zip code features.
Recently, The Center for Medicare and Medicaid Services (CMS) has made an effort to give consumers even more critical information. We have been watching these chances that were announced to be put into play this year. CMS reported that updates were coming “to Nursing Home Compare and the Five-Star Quality Rating System to strengthen this tool for consumers to compare quality between nursing homes.”
How does this work? According to The Center for Medicare and Medicaid Services:
“Nursing Home Compare has a quality rating system that gives each nursing home a rating between 1 and 5 stars. Nursing homes with 5 stars are considered to have above average quality and nursing homes with 1 star are considered to have quality below average. There is one Overall 5-star rating for each nursing home, and a separate rating for each of the following three factors:
Health Inspections: Inspections include the findings on compliance to Medicare and Medicaid health and safety requirements from onsite surveys conducted by state survey agencies at nursing homes.
Staffing Levels: The staffing levels are the numbers of nurses available to care for patients in a nursing home at any given time.
Quality Measures: The quality of resident care measures are based on resident assessment and Medicare claims data.”
Further, on October 7, 2019, CMS announced more enhancements where “CMS will display a consumer alert icon next to nursing homes that have been cited for incidents of abuse, neglect, or exploitation. According to CMS, this critical move toward improved transparency is yet another way the Agency is delivering on its five-part approach to ensuring safety and quality in nursing homes.”
We know this article may raise more questions than it answers. We also know the challenges you face when searching for nursing home care for yourself or a loved one. We encourage you not to wait to reach out to us and schedule a meeting to find answers to your questions.
November is National Family Caregiver Awareness Month, and there is no shortage of reasons to celebrate. Family caregivers make tremendous personal sacrifices, and provide an enormous social safety net for millions of people in need. According to the Family Caregiver Alliance, more than 43 million of these everyday heroes provided unpaid care to a dependent relative last year. On average, this same research shows they spend about 21 hours a week helping loved ones, with about one-quarter dedicating more than 40 hour a week.
While deserving of high-praise, it is worth noting that family caregiving dynamics can lead to family strife. Typically, the bulk of care responsibilities falls on one person, known as the primary caregiver. It is important for spouses, adult siblings, and other relatives to understand all that this entails including, but not limited to, diminished personal and professional opportunities, basing routine life decisions around the well-being of the dependent person, and high-levels of emotional stress.
When combining the rigors of assisting with daily activities, such as meal preparation, bathing and dressing, as well as transportation and medical support, caregiving can be downright exhausting. As a result, family caregivers often struggle with taking care of themselves and with having feelings of being taken for granted.
A primary caregiver, however, should acknowledge any resentments they have with siblings, spouses, and other relatives stemming from their choice to volunteer to provide dependent-care. Practical steps to resolve conflict can be taken once a basic understanding of roles is achieved. Let us share a few examples with you here:.
Family caregivers should share important medical and health information without oversimplifying or holding back.
Relatives should keep in mind that dependent loved ones may say things that are not necessarily true.
Family caregivers should be able to ask relatives for help, but without infusing guilt or anger. Caregiver relatives need to oblige whenever possible.
Commit to healthy, timely communication, and do not let stressful issues tear your family apart.
Even the most “functional” families bring baggage to the table when addressing important care decisions, especially regarding items like powers of attorney, financial management, and health care estate planning. We encourage you not to wait to meet with an elder care attorney who understands these issues. He or she can have the added benefit of serving as an objective third-party who is immune to emotional family disputes, while providing expert legal guidance on important matters. Do not wait to contact our law practice with your questions this November and throughout the year.
Did you know Baby Boomers are a designated group of people who were born between 1946 and 1964? In fact, 76.4 million people were born during that 22-year period. This group comprises about one-quarter of the U.S. population.
A Baby Boomer born before 1954 is at least 65 years of age and is accordingly entitled to Medicare medical assistance if he or she has received Social Security credits for 40 quarters of coverage. This means he or she has paid into Social Security for at least 10 years.
A person aged 65 and older who has not received credit from Social Security for 29 quarters of coverage has to pay a $437 per month premium in 2019 for Medicare coverage. An individual who has 30-39 quarters of Social Security credits must pay a $240 per month premium in 2019 for Medicare coverage. Persons of any age who have end-stage renal disease or amyotrophic lateral sclerosis can also receive this coverage at no cost. Likewise, a person who has received Social Security disability benefits or Railroad Retirement Disability Income for 24 months or longer is eligible for Medicare.
A person under 65 years of age is only categorically entitled to Medicaid medical assistance if his or her income is less $12,060 per year and his or her countable assets are less than $2,000. Fortunately, persons under age 65 with expensive health care needs may still be entitled to the Medicaid share of cost program. This is for people who make too much money to qualify for regular Medicaid but not enough money to pay for their healthcare needs.
This program essentially allows people to subtract their medical expenses from their income and qualify for Medicaid if and when their medical expenses reach a certain amount determined by the Department of Children and Families. The day a person’s health care expenses for the month exceed his or her share of cost, Medicaid coverage begins. From that day until the end of the month, the person has full Medicaid coverage. On the first day of the next month, a person is again without coverage until health care expenses exceed his or her share of cost.
These are critical considerations for both our Florida Baby Boomer clients and their loved ones.
Knowing just what health care coverage you are entitled to and what is paid for needs to be a priority, especially during the annual Medicare Open Enrollment period. Remember, in almost all instances, there is a provider who will cover custodial long-term care needs. We can plan forward with you and your loved ones for these expenses. Do not wait to contact us to schedule a meeting.
We often find that adult children and their aging parents will come to our office and present to us, their newly recommended estate planning attorney, a last will and testament that is at least twenty years old. This estate planning document nominates a brother or a sister as a guardian for the minor children. It also provides for the assets to be distributed on death to a bank trust company that is to retain the assets in trust until the children have attained age 21.
One of the problems with this estate plan, which needs updating, is that the youngest of the children is now age 25 and the eldest is age 35. In addition, the bank nominated in the last will and testament to serve as the trustee is no longer in business. Further, if there was a trust agreement, it was never funded.
In this scenario, we are fortunate that the parents lived these many years and it was not necessary to use the estate plan, or even fund the trust. In situations like this, one of the ways we can help the parents is by drafting a new estate plan that corrects these issues. For example, the new trust agreement could dispense with the need for a guardian of minor children and name a trust company now in existence to serve as the trustee.
The parents, however, have aged to the point that a new estate plan alone is not sufficient for them. The parents need their own updated advanced directives in the event of a disability. Therefore, the parents will also need to consider signing, at a minimum, durable powers of attorney, health care surrogate designations, and living wills.
Further, they need to consider long-term care planning.
An estate plan alone will not be sufficient to help them be able to afford the high cost of long-term care in an assisted living facility with memory care or a skilled nursing home. Medicare is also not able to help with the cost of the daily custodial care. The parents need an estate plan but also an elder care plan that can help them plan for how they will be able to afford long-term care and not lose their lifetime of savings.
We work with parents and adult children each day to tackle this difficult issue.
The key is to not put off this type of planning as time is of the essence. If you have questions on this or any issue, we encourage you to contact us to schedule a meeting.