Medicaid Planning

Is It Safe for Nursing Homes To Be Open?

August 29, 2020Filed Under: Elder Law, Long Term Care, Medicaid Planning, Senior Health and Wellness

Nurse consoling senior woman holding her hand

As many state officials now begin to ease current Covid-19 restrictions, the May 10th Wall Street Journal (WSJ) reports that the Centers for Medicare and Medicaid Services (CMS) is considering likewise for nursing-home residents and their families.

Since March 13, visitors and communal activities have been banned under CMS restrictions. WSJ obtained a leaked draft of CMS guidelines under which visitors might, at some future time, begin to be admitted to nursing homes. The guidelines reportedly set forth a phased procedure, in which elder facilities able to show lessened or no infection rates could allow group dining and activities, and small numbers of visitors during restricted hours, all with physical-distancing restrictions. It is not yet known when CMS will complete and release these contemplated guidelines.

Covid-19, the disease caused by the coronavirus, is particularly fatal at congregate facilities where the elderly live in a confined environment and are cared for by workers who move from room to room. Data gathered independently by the New York Times (NYT) show that “while just 11 percent of the country’s cases have occurred in long-term care facilities, deaths related to Covid-19 in these facilities account for more than a third of the country’s pandemic fatalities. In 14 states, the number of residents and workers who have died accounts for more than half of all deaths from the virus.”

NYT reporters fear, however, that their totals “almost certainly represent an undercount of the true toll.” Data on residential elder facilities are apparently difficult to obtain because some states release specific information on cases and deaths at specific locations, some states report cases but not deaths, and around a dozen states release very little or no information.

Testing is widely acknowledged to be an important tool in the recovery effort, yet WSJ quotes an expert who reckons that we are around four to six months away from widespread availability. The Infectious Diseases Society of America has published diagnostic guidelines on May 6, but these caution that there are still many unanswered questions. Some of the speedy tests can include false negatives, as to the initial infection, between around 15% and 30%. Click here for more information.

So people who show no symptoms and who have been “cleared” by the faster tests could be walking around thinking they are fine, yet shedding the virus and infecting others. And it is not yet known whether those who have ostensibly recovered from Covid-19 might, or might not, be immune and free to dispense with all precautions. It is crucial, then, that those in the community who might be allowed in to nursing homes should be cleared with the most sensitive test available – and even if so, they could have become infected after having been tested.

There is no telling when these concerns will be addressed with sufficient safety for CMS to release its elder-residence guidelines. Thus, for the moment, the challenge is ongoing to protect our vulnerable elders, many or most of whom are cut off from family and unhappy at having been isolated for more than two months by now.

If you have questions or would like to discuss your particular situation with us, please don’t hesitate to reach out.

Strategies to Help Cover the Cost of Assisted Living

July 31, 2020Filed Under: Medicaid Planning, Senior Health and Wellness

With the price of assisted living rent varying from $2,000 to $5,000 monthly, it’s important to understand the strategies available to help cover these high costs. There are many paths available to offset these costs and the right path for you will determine on the unique circumstances of your past life, current situation, and future wishes.

Depending on what type of care your loved one needs, assisted living can be the most affordable solution when compared to a nursing home ($5,000 to $10,000 or more per month) or long-term in-home care. If closely monitored medical supervision is not necessary for your aging senior, assisted living might be the best financial choice.

The Various Strategies Available to Cover the Cost of Assisted Living

One payment strategy that has become popular is to use Medicaid. If your loved one does not have many financial assets and their income levels are low, this could be the right solution for them. Medicaid varies from state to state both in name and in eligibility requirements. Many states dictate that a senior is eligible if he or she has less than $2,000 in assets, or $3,000 if married.

If you are trying to help a senior with a creative financial strategy by gifting money and other assets to family members, known as “Medicaid spend-down”, the government has a five-year look-back rule regarding financial transactions. There are strict guidelines about Medicaid spend-down. If a senior is caught incorrectly spending down resources to qualify for Medicaid, the penalties are steep, including disqualification from receiving Medicaid for a lengthy period. Also, many states do not cover assisted living under Medicaid, but require the submission of an additional wavier. Be aware that Medicaid assisted living payments are only accepted by some communities and Medicaid beds are usually limited. There can be long waiting lists to enter into a Medicaid financed assisted living facility.

If your senior has a disability, he or she may qualify for Supplemental Security Income (SSI), which is a federally administered program. SSI is the government safety net for those destitute and wholly or partially disabled by illness or injury. SSI is a monthly payment which a senior can use to pay for assisted living. To qualify for SSI, contact the appropriate local Social Security office and provide financial documentation and a doctor certification to attest to your senior’s inability to work because of a medical disability.

If your loved one or their spouse is a Veteran, residential care could be paid for in a variety of situations with Veterans benefits. There is a set of benefits available to those with disabilities or service-related injuries, and there is also another set of benefits called Aid and Attendance, made available to any Veteran or surviving spouse who is both disabled and whose income is below a certain threshold. The Veterans Administration website outlines the complicated process to access benefits. It is extremely beneficial to work with an elder law attorney who knows the details of the programs and can assist with the application.

A life insurance policy can pay for your loved one’s assisted living. Often, seniors have a long-standing policy that was implemented to help family members upon their death, but a life insurance policy can provide financial support now. A process known as “accelerated” or “living” benefits is a “cash out” policy that can have your senior redeem 50 to 75 percent of the face value of the policy. Each amount is based on specific policy conditions as well as individual corporate rules. Some policies can only be cashed out if the policyholder is terminally ill while other companies are more flexible in cash outs. If your senior’s particular company does not allow the policy to be cashed, it can still be sold to a third-party company who usually affords the same 50 to 75 percent face value cash out. That company continues to pay the original premiums until their death, at which time the company redeems the full value of the policy. Finally, if your loved one’s policy is of lesser value, it may qualify for a life settlement option known as a “life assurance” benefit or conversion program, which allows the senior to convert between 15 and 50 percent of the policy value directly into long-term care payments.

Does your loved one have a long-term care insurance policy? It can pay for assisted living care. Policies vary, but once the determination and action is taken to collect on it, those monies can be paid directly to an assisted living facility or to the beneficiary who in turn pays the facility. It is wise to consult with an elder law attorney to help understand individual company requirements to optimize the process of collection.

An annuity can be used to pay for some or all of the senior’s assisted living. If your loved one invests a lump sum into an annuity, they will receive regular payments over a promised time period, usually the rest of their life. The annuity helps to stretch your senior’s budget and guarantee at least some money is coming in, even in the event they live longer than expected. Most annuities allow the beneficiary to continue to receive money regularly even if the purchase premium runs out. If your senior were to live a very long time, they would get more back than they put in and an added bonus is that annuities are oftentimes not fully counted as assets by Medicaid when applying for government assistance. The income is counted but not the value of the asset. It is imperative to seek the advice of an elder law attorney before opting into an annuity as they are complex financial products and a wrong decision could be disastrous.

Reverse mortgages are another strategy to pay for assisted living. If your loved one owns their home outright or has only a small mortgage on it, they can get cash value from their home equity in a lump sum or series of monthly payments. The bank will decide the valuation of the home based on multiple factors like the homes worth, interest rates and the applicant’s age. The borrower can stay in the house until death even if the loan balance exceeds the worth of the home. After death, the loan balance has to be repaid which usually means selling the home. Reverse mortgages were developed to help widows remain in their homes after the primary income earner passed away or if that spouse needed to move into assisted living, leaving the other spouse to reside in the long-time family home. Like annuities, a reverse mortgage is a complex financial product, and it is crucial to receive sound advice from a trusted professional and work with a reputable reverse mortgage company. If only one senior parent is living and they do not want a reverse mortgage, they might consider renting out their home and using a landlord to manage the property. The income from renting the house can be used to pay for assisted living expenses.

Lastly, it is possible to pay for assisted living with a bridge loan, which is a short-term loan of up to $50,000 explicitly designed to provide funds to move a loved one into an assisted living facility or continuing care retirement community. It is an unsecured (no collateral required) line of credit with the intent to finance the first few months of living expenses during the sale of the senior’s home, while the application for Veterans benefits is pending, or other actions that are taken that free up funds. Since the interest rates can range from 8.25 to 12.5 percent, this option is best as a short-term strategy. The other type of bridge loan is called the Capital Access Program. It is a lower interest lump sum loan secured by real estate or other assets that the company deems acceptable collateral. It is designed to help seniors come up with the large upfront entrance fee some senior assisted living facilities require. Both types of loans are based on the usual credit criteria: credit score, credit history, debt to income ratio, and more. The senior or an adult child can secure the loan, and up to six family members can cosign loan applications, allowing the risk to be shared among multiple family members.

If your loved one is healthy enough to successfully live in an assisted living facility, the monthly cost is likely a top factor when considering their options. These are some, but not all of the viable and creative ways to pay these costs. To fully explore the options available and what is best for your senior seek the advice of an experienced elder law attorney and make the best decision for your loved one. Contact our office today and schedule an appointment to discuss how we can help you with your planning and which strategy is best to help your senior pay for assisted living.

If you have questions or need guidance in your planning or planning for a loved one, please do not hesitate to contact our office at (513) 771-2444.

Financial Challenges Facing Seniors…And How to Fight Back

May 22, 2017Filed Under: Asset Protection, Elder Law, Long Term Care, Medicaid Planning

Financial Challenges Facing Seniors…And How to Fight Back

Most of us look forward to a retirement filled with leisure and relaxation, but many older Americans are facing financial difficulties that are destroying their retirement dreams. One article addressed some of seniors’ biggest financial challenges and what they can do to fight back. What follows is a summary of the article.

Historically Low Interest Rates
For almost a decade, the Federal Reserve has kept the federal funds rate at a record low. This might be good if you are refinancing debt, but it is disastrous for those who stay in fixed-income investments such as certificates of deposit, money market accounts, savings accounts and bonds—all long-time favorites of seniors who are more risk-averse than other investors.

Low Trust in the Stock Market
The recession provided an opportunity for long-term investors to snap up stocks at attractive lower prices. But for many seniors, it was a reminder of the volatile nature of the stock market which is contrary to their more conservative investing approach. Many of them stayed in their low-yielding fixed-income investments and lost out on the subsequent gains of the rebounding market.

Fight back: Be willing to invest a portion of your investments in the stock market. It’s one of the few places you can invest your money that, over the long term, will outperform inflation. And with people living longer today, your savings will need to last longer than before.

Rising Health Care Costs
Medicare doesn’t cover all medical costs, and out-of-pocket expenses can be substantial. One survey found that 20% of seniors did not see their doctor because of the out-of-pocket costs. Also, the costs of drugs, diagnostics and medical devices continue to rise.

Fight back: Use some of your savings, investment income or work income to purchase supplemental health insurance that will help cover medical expenses not covered by Medicare.

Social Security Issues
According to the Social Security Administration, more than half of all couples rely on Social Security for at least 50% of their retirement income, and almost half of unmarried seniors rely on it for at least 90% of their retirement income. But the cash reserves that supply this income are in trouble and, unless Congress addresses the problem soon, they could run out by 2033.

Unfavorable Job Market
Going back to work is an option for many seniors who have little retirement income or rely heavily on Social Security income. Yet it takes older workers longer to find employment and they are often competing with younger workers who are willing to accept lower wages.

Fight back: Working longer at your current job may be a viable option. You may also be able to find paying work in a hobby or avocation. You may even be able to start a small business to supplement your income.

Debt…and Feeling Obligated to Help Adult Kids
Fully 45% of all homeowners over the age of 62 still have a mortgage payment. Many have credit card and other consumer debt. Of those age 60 and over, who are no longer working, 43% admitted to helping their adult children pay their bills. Many seniors have student loan debt for themselves, their children and dependents going to college.

Fight back: Learn to say “no,” especially if your retirement funds are limited. This is your retirement, and your children and grandchildren need to respect that. If you are earning extra income, use some of it to pay off your debt.

See full article here: https://www.fool.com/retirement/general/2015/05/17/the-7-biggest-financial-challenges-senior-citizens.aspx

Warning: An Alzheimer’s Tsunami is Coming and We Must Prepare

April 24, 2017Filed Under: Education, Elder Law, Long Term Care, Medicaid Planning, Senior Health and Wellness

Warning: An Alzheimer’s Tsunami is Coming and We Must Prepare

That’s the message from Andrew Tisch, chairman of Loews Corporation, co-founder of the

political reform group No Labels, and Vice Chair of the U.S. Global Leadership Coalition.

In a recent article, Mr. Tisch describes how we are unprepared for the enormous costs we will

soon be facing from a huge upswing in our aging population and the resulting number of

Alzheimer’s patients.

As he points out, in 2010 there were 11.4 million Americans over the age of 80. By the year

2050, due to the power of modern medicine, there will be over 32 million. But amid that laudable

success is a glaring problem: One in two people who reach their 80s will get Alzheimer’s, and

the American health care system isn’t even remotely prepared to deal with that.

The annual cost to care for people with Alzheimer’s and other dementias is already $226 billion,

with Medicare and Medicaid picking up 68% of the costs. If recent trends continue, he states, the

annual cost of Alzheimer’s could reach $1 trillion, in current dollars, by 2050, costing Medicare

and Medicaid almost $700 billion—about one-fifth of the federal government’s current budget.

Mr. Tisch calls for Washington to dramatically increase the amount of federal money going to

Alzheimer’s research. While disease research of all kinds is worthy and important, he states,

Alzheimer’s stands apart for the destruction it wreaks on families and finances. Five million

Americans currently have Alzheimer’s and the disease’s impact spreads far beyond those who

have it. Every person with Alzheimer’s requires three people—children, spouses, friends and

health care workers—to serve as caregivers. This can be a full-time job, and it often takes a

financial, emotional and physical toll on the caregivers and their families.

The National Institutes of Health (NIH) allocated almost $1 billion to Alzheimer’s research last

year, but funding is behind what researchers need and what other diseases already receive. The

treatments available now only treat symptoms and do not prevent, slow or reverse the disease.

Researchers believe a significant boost in funding could lead to breakthroughs in the coming

years. Dr. Greg Petsko of Weill Cornell Medical College states that “if NIH doubled research

funding for Alzheimer’s tomorrow, it would kick the whole machinery of grant making and

academic and pharmaceutical company research into a higher gear.”

President Trump’s budget proposal includes an 18% cut to the NIH budget as part of a broader

effort to slash discretionary spending. However, a bipartisan group of a dozen senators have

written a letter to President Trump asking him to increase funding for Alzheimer’s research. As

Mr. Tisch puts it, a potential cure for Alzheimer’s should not go undiscovered for lack of a few

billion dollars in a $4 trillion-dollar annual budget.

Is It Safe for Nursing Homes To Be Open?

Strategies to Help Cover the Cost of Assisted Living

The Various Strategies Available to Cover the Cost of Assisted Living

Financial Challenges Facing Seniors…And How to Fight Back

Warning: An Alzheimer’s Tsunami is Coming and We Must Prepare

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