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elder law

Oct 04
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Choosing the Right Nursing Home

By Uncategorized

What Nursing Home Is Right For My Loved One?

When families are advised that their loved one will need skilled nursing care, one of the first questions they will ask is are there any facilities that we recommend. There are a lot of factors that go into deciding if a particular facility is right for your family member. Some of those factors to consider are:

  • Proximity to where advocates and family members reside – having family visit regularly and being engaged in the care and services provided to their loved ones is critical to ensure they receive the best possible care
  • Understanding the level of care needed: certain facilities are geared toward particular conditions. Understanding a facilities specialty, if any, is important to determining if there is a fit.
  • Know how you are going to pay for the care. Once the family members Medicare benefits are exhausted, and you still require skilled nursing, understanding how to pay for the care needed and developing a path to Medicaid which will help subsidize the cost of nursing home care is critical.
  • Private Pay versus Medicaid – when visiting a facility, know what forms of payment they accept. The overwhelming majority accept Medicaid but a few do not. Follow the link in this article to find out if your facility accepts Medicaid.

Understanding The Different Levels of Care

A Nursing Home (NH) is a facility that provides 24 hour 7 day a week medical care and supervision.

A Skilled Nursing Facility (SNF) provides skilled nursing (examples: wound care, pain management, or bowel/bladder training),  and physical, occupational or speech therapy services. A SNF may also be referred to as a sub-acute rehab. Medicare may cover up to 100 days in a skilled nursing facility if you have met very specific Medicare eligibility guidelines.

Medicare does NOT cover ongoing long-term Nursing Home care. You may require additional care after your Medicare coverage ends. You may choose to pay the nursing home privately, use long-term care insurance or apply for state Medicaid.

A nursing home may also provide long-term care.

Ranking All Rhode Island Nursing Homes and What Payment Options They Accept

Since 2002, Healthcare Quality Reports has published information on the quality of care administered by nursing homes, including data on resident and family satisfaction and care outcomes. If you know in advance that you or a family member will need nursing home care, this information can help you compare nursing homes and choose among them. You can also visit nursing homes or ask friends and family for their thoughts and experiences.

The RI Department of Health’s Healthcare Quality Reporting Program has developed a Nursing Home Summary Report to help you compare Nursing Homes and choose among them. To find the most recent LIST OF NURSING HOMES and REPORT CARD click here. 

The PDF that the above link takes you to assembles many of the key pieces of information that any family will need when making an initial assessment of What Nursing Home is Right For My loved one!

Still have questions about how to proceed? Call me at 401-600-0143 for a no obligation consultation.

ELDER LAW - ASSET PROTECTION

Helping families help their loved ones.

May 15
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BREAKING NEWS: UPDATED MEDICAID FIGURES

By Uncategorized

NEW ALLOWABLE INCOME LIMIT and MONTHLY PENALTY DIVISOR

Rhode Island Department of Human Services – Medicaid Long Term Support Services – has advised that The Allowable Income Limit for 2022 through 3/31/2023 is $9.961 per month. Effective August 1, 2023 the new allowable income limit will be increased to $10,190.00 per month.

This figure is also used as the Penalty Period Divisor for calculating disqualifying transfers of assets. Meaning, for every $10,190 of assets transferred away where something of value was not received in return, will cause a disqualification of one (1) month of LTSS Medicaid benefits for the Applicant for those benefits.

A link to the Rhode Island Regulation on Eligibility Determinations (210-RICR-40-00-3) announcing the change can be found here. You will find the reference on page 9 of the proposed rule.

 

Nov 23
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FRAUD: The “F” Word of Estate Planning

By Uncategorized

Fraud is a label to run from – not walk from

As an attorney that practices in areas of law that have both local and national scope – reading and reviewing scholarly writings and recent case decisions is critical to staying current. From these readings, we come to learn and respect the work done by other attorneys and how they are best representing their clients and their interest.

One such article came across my desk entitled “Medicaid Planning Technique Didn’t Work Exactly as Intended” a link to the full article can be found HERE.

The article examines what could be best described as a case study of one attorneys recommendations to a client who was retained to assist the family with Medicaid planning and qualification. As the title infers, the plan did not work out as explained and the clients goals and objectives were not carried out with the suggested plan proposed and enacted by the attorney. Fraud ruins any thought of a clever estate plan – and once that genie is let out of the bottle – it is hard to get it back in.

If it seems too good to be true – it probably is

The case is a lesson for both client and attorney. Just because you can do something – does not always mean you should. Deciding on an estate plan with the goal of qualifying for Medicaid benefits is something that must weigh all of the factors and rules. Knowledge of family dynamic, conflicts, tensions, and history are as important as understanding the rules of Medicaid eligibility, assets and income.

Fraud is a badge that does not wash off easily. Having to defend yourself or others from being accused of absconding with the assets of an elderly loved one is not something anyone wants to envision. There are legal consequences – which translate into strained relationships and possibly property and certainly financial penalties with the ultimate loss of liberty.

The author of the article makes the following suggestions when selecting an elder law attorney to work with:

  1. Be careful about selecting your lawyer. Do you want someone who really knows estate planning and/or Medicaid planning? Check out their reputation, their online information, and recommendations from friends and colleagues. Did you meet the lawyer at a promotional seminar at the public library or a local restaurant? Make sure you’re not being sold something you don’t really want or need.
  2. Does a particular Medicaid planning technique sound almost too good to be true? Be suspicious and ask for input from others.
  3. When a lawyer agrees to meet with you and your family member together, that suggests something troublesome. We are supposed to represent just one person, not a whole family. Recognize that your interests and those of your family member might differ, and respect the lawyer’s efforts to maintain that separation.
  4. Recognize that even though an idea — and particularly a Medicaid planning technique — might work, it might also have unintended secondary effects.

 

Nov 13
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RMD Tables To Be Updated

By Uncategorized

Required Minimum Distributions: RMD’s

Section 401(a)(9) requires most retirement plans and individual retirement accounts to make required minimum distributions (“RMDs”) over the lifetime of the individual (or the lifetime of the individual and certain designated beneficiaries) beginning no later than such individual’s required beginning date (generally, April 1 in the year following attainment of age 72). This minimum amount is determined by dividing the individual’s account balance by the applicable distribution period found in one of the life expectancy and distribution tables (the “Tables”).

On November 12, 2020 the Department of Treasury is scheduled to publish final regulations updating the Tables, which is in response to an Executive Order issued in August of 2018 directing the Secretary of the Treasury to review the Tables to determine if they should be updated to reflect current mortality data.

RMD’s Tables are being updated

Longer Life Expectancies Reflected

The updated Tables will generally reflect longer life expectancies than presently reflected in the current Tables last published based on 2003 mortality rates. For example, the current Tables use a life expectancy of 25.6 years for a 72-year-old for purposes of calculating the RMD while the updated Tables will use a life expectancy of 27.4 years. This will result in reduced RMDs, enabling individuals to retain larger balances in retirement accounts to account for the possibility of living longer.

The updated Tables will be effective for distributions beginning on or after January 1, 2022 and will include a transition to ‘re-set’ the life expectancy for certain individuals already receiving RMDs based on the prior Tables. For example, an individual who attains age 72 in 2021 will be required to take an RMD no later than April 1, 2022. The updated Tables will not apply to calculate the individual’s 2021 RMD (paid on or before April 1, 2022), but the updated Tables will apply to the 2022 RMD (paid on or before December 31, 2022). The regulations do not include periodic automatic updates to the Tables. Instead, the Treasury and IRS will review the Tables at the earlier of 10 years or whenever a new study of mortality experience is published. The final regulation and new Tables can be found here.

Impact on Medicaid and Estate Planning

RMD’s are a factor that every estate planner must consider into calculations of income and assets for Medicaid eligibility. Understanding the new tables and income that will be forced out to a individual or spouse is important to know as there are minimum and maximum income limits. A personal consult with an estate planning attorney can best illustrate the impact this will have on your plan.

Apr 18
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Will I Ever Live In A Nursing Home?

By Uncategorized

How Much Care Will You Need?

The duration and level of long-term care will vary from person to person and often change over time. Here are some statistics (all are “on average”) you should consider:

  • Someone turning age 65 today has almost a 70% chance of needing some type of long-term care services and supports in their remaining years
  • Women need care longer (3.7 years) than men (2.2 years)
  • One-third of today’s 65 year-olds may never need long-term care support, but 20 percent will need it for longer than 5 years

Distribution and duration of long-term care services

Type of care Average number of years people use this type of care Percent of people who use this type of care (%)
Any Services 3 years 69
 

At Home
Unpaid care only 1 year 59
Paid care Less than 1 year 42
Any care at home 2 years 65
 

In Facilities
Nursing facilities 1 year 35
Assisted living Less than 1 year 13
Any care in facilities 1 year 37

Who Pays for Long-Term Care?

The facts may surprise you.

Consumer surveys reveal common misunderstandings about which public programs pay for long-term care services. It is important to clearly understand what is and isn’t covered.

Medicare:

  • Only pays for long-term care if you require skilled services or rehabilitative care:
    • In a nursing home for a maximum of 100 days, however, the average Medicare covered stay is much shorter (22 days).
    • At home if you are also receiving skilled home health or other skilled in-home services. Generally, long-term care services are provided only for a short period of time.
  • Does not pay for non-skilled assistance with Activities of Daily Living (ADL), which make up the majority of long-term care services
  • You will have to pay for long-term care services that are not covered by a public or private insurance program

Medicaid:

  • Does pay for the largest share of long-term care services, but to qualify, your income must be below a certain level and you must meet minimum state eligibility requirements
  • Such requirements are based on the amount of assistance you need with ADL
  • Other federal programs such as the Older Americans Act and the Department of Veterans Affairs pay for long-term care services, but only for specific populations and in certain circumstances

GOOD TO KNOW

Like public programs, private sources of payment have their own rules, eligibility requirements, copayments, and premiums for the services they cover.

Health Insurance:

  • Most employer-sponsored or private health insurance, including health insurance plans, cover only the same kinds of limited services as Medicare
  • If they do cover long-term care, it is typically only for skilled, short-term, medically necessary care

There are an increasing number of private payment options including:

PLAN BEFORE YOU HAVE A NEED

Planning for the eventuality of needing long term care is critical in reducing stress and uncertainty. Meeting with an Elder Law attorney familiar with the rules of Medicaid qualification is a step in the right direction. Contact our office for a no-obligation consultation to see if developing an estate plan with the goal of Medicaid qualification is a right fit for you.

Apr 06
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Probate & Estate Administration During COVID-19

By Uncategorized

Probate Challenges and Estate Administration Roadblocks During COVID-19 Corona virus Pandemic

Many of our clients are in the midst of settling the estate of a deceased loved one or have just had a loved one pass away and are wondering what comes next. An event such as this has both personal and legal consequences. Below are observations on issues that may immediately present themselves.

• Immediate steps may be limited by circumstance. If someone has just died and the cause of death is unknown, public health officials may limit the immediate steps one would usually take until the cause of death is determined and no known COVID-19 risk exists. Depending on circumstances, there may be some delay in physically getting access to the premises, securing them and searching for a will and other documents if they are not in possession of the family or the decedent’s attorney. It is always wiser to have one’s original estate planning documents safely secured off the premises and make sure a trusted individual has access to the storage place.

• Once access is permitted, secure the premises if they become unoccupied. Subject to the necessary steps to ensure everyone’s safety (which may include disinfecting) the nominated personal representative may take steps, such as changing locks, necessary to secure the physical contents and financial documents which may remain in the home. These steps can be taken before one’s official appointment. If additional or condominium fees must be paid to allow enough time for an orderly inspection, appraisal, or the like, this can be treated as an expense of the estate.

• The legal process of estate administration can begin and continue. While the probate courts of the states in which we conduct estate administrations have limited or closed off physical access to the public, emergency hearings (conducted telephonically) continue and many routine documents can be e-filed. Routine non-contested wills can still be allowed; while reduced staffing at courts may stretch the time frames somewhat, these processes, at least for the present, continue as before. Where that time frame may cause harm to a beneficiary or in some cases, the assets, if the court deems such circumstances an emergency, a hearing to rush the appointment of a temporary fiduciary, called a “executor” or “special personal representative,” can be requested.

• Most financial activities can be conducted. With overnight shipping, and technologies such as scanning, secure e-mail, electronic funds transfers, and electronic document signatures, most financial transactions can be conducted virtually once the identities of the parties are established in a fashion compliant with the financial institution’s practices. Thus assets can be transferred to estate or trust accounts, sold and reinvested if desired in order to properly pay estate expenses and distribute funds to beneficiaries. Notarizations still require physical presence although there is a move afoot to accept signatures performed over a videoconference.

• Once appointed, electronic communications are vital. As a fiduciary, personal representatives and trustees must take special care to maintain transparency and good chains of communication with each other and the beneficiaries. In a typical administration, one or more introductory or status meetings may occur between co-fiduciaries and the attorney, some with beneficiaries present. Since these will not occur during this unprecedented time, most communication should be in writing. Email has become the standard, often with multiple co-recipients.

Need to speak to an attorney about issues your confronted with during the Pandemic, call our office 401-274-0300 for a no cost phone consultation.

Apr 10
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Auditor’s report depicts disarray in R.I. social service programs

By News

The report issued on the roll-out of the computer system shows continued problems

The Rhode Island Department of Human Services (“DHS”) which administers the Medicaid program has been attempting to roll out a new computer system for several years. The system was designed to speed up application review and automate the application process to an on-line system. Unfortunately per the auditors report, the system is still experiencing issues. 

For those attorneys who assist elder clients with Medicaid applications this has been a challenging time. Medicaid will pay for the nursing home care needed by these elderly clients who have less than $4,000 in countable assets. It is stressful to family members who have submitted applications for coverage, who have a loved one being cared for at a nursing home, and not knowing if their application has been approved. They fear the consequence of an unexpected denial and how that may impact a spouse or the recipient.

Applicants can wait months or years prior to receiving an approval of their application.

Rhode Island law requires DHS to pay nursing homes for any care given patients who have applications pending for greater than 90 days. This law has allowed payments to go out, facilities to get paid, and patients to receive the care they need, until the application is approved.

Fortunately, the reports also states that things are improving and applications are being reviewed quicker and more accurately. The employees at DHS have done an admirable job overcoming a challenging roll-out but still have much work to do.

Source: Auditor’s report depicts disarray in R.I. social service programs

If you or a loved one wants to learn more about qualifying and applying for Medicaid benefits, please contact our office for a free consultation.

Apr 09
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Caretaker child exception can protect residence of Medicaid recipient

By News

Caretaker Child and Medicaid Qualification

Children are often confronted with difficult decisions when time and age catch up with their parents. Many children have been pushed into the role of being primary caregiver for their parents. The motivation stems from the very reasonable wish to keep parents at home for as long as possible despite health and medical issues of parents that indicate the parents need additional assistance with activities of daily living.

When children assume the role of caregiver to their parents with the goal of being able to avoid nursing home care for parents, there are benefits to this arrangement. Beyond the obvious advantage of the peace of mind of knowing you are doing all that you can keep your parents comfortable.

When a parent reaches the point in life where medical needs are increasing, it is prudent for the surrounding family to contact an elder law attorney who can explain the necessary and proper documents to have in place for parents so that children can assist with the parents legal and medical needs.

Children often become caregivers for parents.

In addition, the elder law attorney should be prepared to introduce you to the Medicaid program and how it works for people who are expected to need skilled nursing and long term care.

Family should advise the elder law attorney about any children living at the home caring for a parent. These facts create a unique opportunity to protect the home of the parent from possible long long term care costs while still maintaining Medicaid eligibility.

If a child lives with a parent of the two (2) year period before the parent needs to enter into a nursing home, an if the child had not been with the parent the parent would have had to live in a nursing home, the parent can transfer the home to the caretaker child without being disqualified from Medicaid benefits. The parents doctor needs to certify to this arrangement and time frame for this exception to the transfer penalty to work.

The below link to an article explains some of the things that will need to be demonstrated to take advantage of this Medicaid planning opportunity. In Rhode Island, the rules are similar to the attached article but concerned individuals should meet with an elder law attorney to discuss the caretaker child exception as it applied to their facts.

Source: James Contini column: Caretaker child exception can protect residence of Medicaid recipient

 

Want to lean more? Contact our office for a no-cost consultation.

Feb 12
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New drug to treat Alzheimer’s disease under study at Butler Hospital

By News, Uncategorized

Alzheimer’s disease and estate planning

When caring for and planning for an individual, we address the financial and legal aspects of caring for a loved elderly one. These planning considerations do not happen in a vacuum. The decisions we make rely on the medical issues, complications and opportunities available to us. Knowing about treatment options and emerging science is critical in planning for future needs. Alzheimer’s disease robs cognitive ability and causes those who are afflicted to need long-term skilled nursing care.

When medical breakthroughs are occurring on diseases the are often require long term nursing care, we must share and learn as to their success and progress. Such studies and advancements are occurring at Butler Hospital in Providence, Rhode Island as evidenced by the attached link to an article published by the Providence Journal.

Source: New drug to treat Alzheimer’s disease under study at Butler Hospital

 

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