The bill relaxes a rule that makes getting specialized care from local doctors difficult for some veterans in rural areas.
The Associated Press investigated this new legislation in a recent article titled “Senate tweaks health law to boost specialized care.”
"Will you still need me? Will you still feed me? When I'm 64?" The Beatles first released these quaint, clarinet-fueled lyrics in 1967 when the loving answer to these questions was a resounding, "Yes!" Traditional marriage vows echo this sentiment in that they presuppose a relationship span that encompasses young and old age, wellness and serious illness, wealth and poverty. However, as modern aging has come to be defined by living longer with chronic care needs, and providing long-term care has shifted to the public sector, with two thirds of long term care services paid for by Medicaid, loving spouses may be forced to answer, "No," to these questions. The future of elder care may depend on divorce.
Aging and care are already expensive and stressful, and even the young Beatles in 1967 wondered if love now would translate into care in old age. It should.
In case you haven’t heard, long-term care needs are expensive. In 2014 the average annual cost of a semi-private room in a skilled nursing facility was $83,114! The majority (70 percent) of people over 65 need some level of long-term care at some point—whether that will be provided in a home, an assisted living center, or a nursing care facility, according to The Huffington Post in a recent article titled “Is Divorce the Best Option for Older Americans?”
"In America" discusses elder law and the way that legal standards and details are changing over time.
What exactly is Elder Law? Why is this so important for Americans?
Elder law is a general term that describes the laws and regulations that affect older men and women. This term can relate to the proper care and guardianship of an older person who requires medical attention and can no longer function without assistance. The recent Insurance News Net article, titled “Elder Law is discussed with host James Earl Jones on "In America,” notes that the range of topics elder law addresses includes divorce among adults over 65 years old and law regarding elder abuse.
In all states, federal Medicaid law provides special protections for the spouses of Medicaid applicants. But states decide how much the non-institutionalized spouse may keep, within a range. Connecticut's allowance — $23,844 — is the lowest. And legislators are calling for an increase.
If this legislation succeeds in reducing the amount of money assigned to the institutionalized spouse, he or she would become eligible for Medicaid assistance more quickly.
The CT Post report, in an article titled “Legislature asked to raise asset level for Medicaid spouses,”says that the bill would affect couples with assets of about $24,000 to $100,000. Right now, when a person tries to qualify for Medicaid, couples will split their assets evenly, and the nursing-home-bound spouse must spend down his or her portion to $1,600. This means if a couple has $60,000, each spouse is attributed $30,000, and the one heading to the care facility must get his or her share down to $1,600. [Note: These numbers can and do vary state by state.] This is typically accomplished by paying for initial nursing home care. Under the state’s new proposal, the community spouse would be able to keep $50,000 in assets.
In continuation of the series on estate and life planning, this column focuses on how Medicaid factors into financial planning for long-term care.
Seniors need to have a plan in place for long-term care, should they need care assistance in the future. A recent article in The Victoria (TX) Advocate titled “How does Medicaid factor into financial planning?” recommends that seniors need a strategy to pay for the costs of long-term care. In some instances, however, some individuals may have to rely on Medicaid if they don't have enough income to purchase long-term care insurance, the assets to pay for care themselves, or they are uninsurable.
Medicaid planning was often thought of as a viable tool for long-term planning. However, estate planning attorneys are now rethinking this strategy. Medicaid planning—which was, in essence, planning to make asset transfers, used to be the primary tool used by seniors considering long-term care costs. However, law changes and the advent of new financial products and plans will work better, they say. Medicaid "planning" is actually a misnomer as most seniors don’t plan to go on Medicaid, but rather experience an urgent care need, and there aren’t any other options. A better alternative is to obtain a long-term care insurance policy.
Arlene Germain, president of Massachusetts Advocates for Nursing Home Reform, said the new rules, once implemented, could substantially improve the lives of nursing home residents. But, she said, “strong oversight and greater nursing home participation are critical to ensure that the law’s benefits are meaningful and widespread.”
The process for dementia care compliance checks in Massachusetts has been slow, as the state handed out its dementia special care checklist for inspectors in December—almost six months after the rules were adopted.
The Boston Globe article, titled “Dementia care lacks oversight in Mass., data show,” says that despite the delays, state regulators are not conducting spot checks for compliance—they’re already just too busy with routine monitoring of more than 400 nursing homes. However, the state health department recently announced that its inspectors would now review dementia care during their annual visits to each facility. But this means some nursing homes may not be subject to these compliance checks for months.
Lillian Palermo tried to prepare for the worst possibilities of aging. An insurance executive with a Ph.D. in psychology and a love of ballroom dancing, she arranged for her power of attorney and health care proxy to go to her husband, Dino, eight years her junior, if she became incapacitated. And in her 80s, she ended up in a nursing home as dementia, falls and surgical complications took their toll. He sings her favorite songs, feeds her home-cooked Italian food, and pays a private aide to be there when he cannot. But one day last summer, after her husband disputed nursing home bills that had suddenly doubled Mrs. Palermo's copays, and complained about inexperienced employees who dropped his wife on the floor, Mr. Palermo was shocked to find a six-page legal document waiting on her bed. It was a guardianship petition filed by the nursing home, Mary Manning Walsh, asking the court to give a stranger full legal power over Mrs. Palermo, now 90, and complete control of her money.
A New York Times article titled "To Collect Debts, Nursing Homes Are Seizing Control Over Patients" states that few people are aware that a nursing home can do this. Guardianship cases are usually confidential, but the Palermo's situation isn't uncommon.
More than 12 percent of guardianship cases are brought by nursing homes. Many of these may have been brought as a means of bill collection, which was never intended when the New York legislature enacted the guardianship statute. Some courts have ruled that this legal tactic by nursing homes is an abuse of the law, but these petitions—even if unsuccessful—make families spend time and money in costly legal ordeals.
When asked about long-term care insurance, one senior said, "I've thought about it. I don't think it's worthwhile to buy at my age." She's 83. "I've thought about it but I really haven't looked into it," another woman said. Others simply don't want to talk about it. But a don't-ask-don't-tell attitude toward paying for long-term care isn't an effective strategy for the 75 million baby boomers, the oldest of whom will start hitting age 70 in 2016.
A recent article in the Memphis Daily News, titled "OK, Baby Boomers: Time for Some Hard Decisions," reminds us that care for seniors can come from family members or from outside services such as adult day care, assisted living centers, home-care services and nursing homes. These services often include assistance with daily activities, home health care, respite care, hospice care, adult day care, care in a nursing home, and care in an assisted living facility.
People pay for long-term care by using personal resources, long-term care insurance, and Medicaid if they qualify. Medicare, Medicare supplement insurance, and private health insurance typically don't pay for long-term care. Individuals may also look to other resources such as veterans' benefits, Social Security, community services, and family caregivers.
One attorney calls it the "Get out of Dodge plan"—the best way to keep your assets intact before applying for Medicaid to cover nursing home costs. New Jersey is one of the most restrictive states when it comes to permitting residents to preserve assets for their benefit while Medicaid pays for nursing home care. In the Garden State, there are steps that should be taken before applying for Medicaid, the government insurance program for people of all ages who are too poor to afford health care including long-stay nursing home care. Nursing homes can cost $120,000 a year in New Jersey, sometimes more.
Even though Medicaid is a federal program that's regulated by each state, the way in which the money is distributed can vary. Restrictive states are siding with protecting public money over letting individuals and their spouses keep assets, the Asbury Park Press article titled "Protecting assets: Three things to know before Medicaid" explains. So your retirement strategy can be quite different based upon your state of residence. Not everyone can Get Out of Dodge, meaning not everyone can move into a second home in Florida.
But do-it-yourself planning may not be the way to go. Elder law and Medicaid planning is constantly changing, and your assets can easily be wiped out by nursing home costs without careful planning. For example, when a husband places his wife in a nursing home, their home may be excluded from assets that must be spent for nursing home care before Medicaid pays for it. So the husband is still able to live there. However, if the husband dies before the wife enters the nursing home, it gets complicated: the house could be lost to the nursing home for the cost of her care.
Consulting financial and tax advisers as part of planning the retirement process is essential to get the health-care piece covered. Enjoying truly golden retirement years means a lot of different things to different people, but it should include planning for long-term health care now so we obtain the end-of-life care we desire without becoming a burden on our children or the state.
According to a recent article in cincinnati.com, titled “Consider health care when retirement planning,” long-term health care may be a considerable expense during our retirement years, with most of this spent during the last three years of life.
Health care spending has outpaced inflation over the past decade—from a 6percent increase to just 2.5 percent for core inflation.
Houston Estate Planning and Elder Law Attorney Blog