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Matthew J. Leonard

Choosing the Right Nursing Home

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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.

Should I Convert To A ROTH IRA?

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What is the difference between a Roth IRA and a Traditional IRA?

Roth IRA is an individual retirement account that offers tax-free growth and tax-free withdrawals in retirement. Roth IRA rules dictate that as long as you’ve owned your account for 5 years and you’re age 59½ or older, you can withdraw your money when you want to and you won’t owe any federal taxes.

A Traditional IRA is a type of individual retirement account that lets your earnings grow tax-deferred. You pay taxes on your investment gains only when you make withdrawals in retirement.

In addition, when planning for an considering long term care planning and possibly needing to qualify for Medicaid, most states do not deem Qualified Accounts such as 401(K)’s and IRA’s and Roth IRA’s as countable resources.

Therefore, the decision to make is: Do I take the income tax hit now and convert to a Roth IRA, or do I wait take it later when I start drawing down on the traditional IRA or 401(K)?

Should I Convert to a Roth IRA?

Roth IRA conversions have been available for many years. Two recent developments suggest that you reconsider Roth IRA conversions for yourself in 2020:

  • The government’s response to COVID-19 significantly raises the Federal deficit, making it more likely that tax rates will be going up in the future.
  • You may be in a lower tax bracket in 2020, which would reduce the tax cost of the conversion.

Both of these factors make Roth IRA conversions more attractive than they were in 2019. The decision as to whether these factors tip the scale in favor of a Roth IRA conversion will require careful consideration. You will need to consider your overall financial plan and make certain assumptions.

Who should do a Roth IRA conversion?

The ideal candidate for a Roth IRA conversion would check off most or all of these boxes:

  • You can pay the tax on the conversion out of a taxable investment portfolio.
  • You expect that you will be in the highest income tax bracket in the future when IRA distributions would be required.
  • You expect that you will not need to withdraw funds from the Roth IRA during your lifetime.
  • You expect that your estate will be subject to estate tax at your death and your spouse.

Who should not do a Roth IRA Conversion?

Some people who should not do a Roth IRA conversion currently are as follows:

  • People who expect to be in a lower tax bracket at retirement.
  • People who can use IRA distributions to take advantage of the lower brackets.
  • People who want to preserve the option of using income from their IRA to offset future medical costs for long-term care or other significant medical expenses, bearing in mind the the principal balances are protected and currently not deemed a countable resource in many states.
  • People who plan to use their IRA for charitable contributions.

Want to discuss how conversion will impact you? Contact us for a no obligation consultation.

SOURCE: LISI Employee Benefits & Retirement Planning Newsletter #737 (June 9, 2020)

Medicare Update 2019

By Estate Planning

Medicare 2019 – Everything You Need To Know

Medicare is an important piece of the American insurance landscape, not only for people age 65 and older, but for all Americans. That said, this benefit is not easy to navigate. Eligible individuals must be thoughtful about the coverage they need, the timing of enrollment, and coordination with other healthcare benefits, if they want to make the most of the Medicare program.

Attached is a report recently published by Northern Trust that recaps the Medicare program and is a good resource for people wanting to learn more.

It addresses the following questions:

  1. What does Medicare cover? Do I still need Private Insurance?
  2. How much does it cost?
  3. I am thinking about early retirement but I am concerned about health insurance coverage and eligibility. What are my options?
  4. I am turning 65 next year and still working, should I transition from private insurance to Medicare and if so, how do I do that?

CLICK HERE TO READ THE FULL REPORT wpi-medicare 2019

Medicare is a critical component of every persons health insurance portfolio but it does not cover long-term skilled nursing. The Medicaid program covers eligible individuals cost for long term skilled nursing, however, there asset and income limits before someone becomes eligible. Generally, a person must have countable assets below $4,000 and monthly income below $10,000 to be eligible. A person who is on Medicare and then transitions over to Medicaid will be required to maintain their Medicare coverage. Medicaid being a welfare program, is an insurer of last resort, whereas Medicare is a primary insurance for people.

Still have questions about planning for your future healthcare needs including long term care planning? Contact us for a no cost consultation.

Matt Leonard

Medicaid Eligibility Update

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Rhode Island has updated its rules to become Medicaid eligible.

If you are a Rhode Island resident and you are seeking Medicaid benefits, you should be aware of some recent changes approved by the Rhode Island Department of Human Services as to your eligibility under the program. Final rules are expected to be published and release shortly but here is a recap of the expected changes:

  1. Income cap of $9,581 meaning that if the applicant has more than $9,581 in income, then they can never become eligible for Medicaid, nor can they start the penalty period.  If they have income under $9,581 but greater than $6,700 and they want to start a penalty period, they can do so but cannot get community Medicaid benefits, like Rx copays and doctor bills.   If their income is under $6,700, then nothing changes.    This went into effect in September and is effective for applications for eligibility delivered after 10/1/18.   50-00-2.4

    Changes Are Coming

  2. Long term care insurance is not considered countable income for purposes of the above income cap.   However, once on Medicaid, it would need to be spent as part of the patient share.    50-00-6.5.2(B)
  3. Burial Funds & Irrevocable Funeral Contracts have new limits which are helpful and could affect clients.  The new cap on Irrevocable funeral contracts is $15,000 and anything over that would be considered a countable asset.   40-00-3.5.5 A(1)(f)
  4. Life insurance is now exempt up to $4,000 of cash surrender value, with anything over being countable.  40-00-3.5.5 A(1)(h)
  5. Retirement Funds now have a new definition, but as long as they are income producing and the client gets at least the RMD, then they should still be fine. 40-00-3.5.5 A(2)(g)
  6. Penalty Divisor is $9,581 since mid September.

Like any social program, the figures and rules for eligibility are constantly revisited and updated based on changes in federal law, budgets, and program changes and advances. Staying current on the latest rules is the challenge.

If you or a loved one is facing serous medical issues requiring skilled nursing care, the Medicaid program will help pay for those costs for applicants who have assets and income within program limits. Contact us to discuss your estate plan and if your estate plan should be revised so as to become eligible for these valuable benefits.

What are the Trustee’s Duties?

By News

The Trustee’s Duties

Congratulations. You have been appointed trustee of a trust. That is a strong vote of confidence in your judgment and probity. Unfortunately, it is also a major responsibility. Following is a short description of your duties.

1. Fiduciary Responsibility. As a trustee, you stand in a ‘‘fiduciary’’ role with respect to the beneficiaries of the trust, both the current beneficiaries and any ‘‘remaindermen’’ named to receive trust assets upon the death of those entitled to income or principal now. As a fiduciary, you will be held to a very high standard, meaning that you must pay even more attention to the trust investments and disbursements than you would for your own accounts.

2. The Trust’s Terms. Read the trust itself carefully, both now and when any questions arise. The trust is your road map and you must follow its directions, whether about when and how to distribute income and principal or what reports you need to make to beneficiaries.

3. Investment Standards. Your investments must be prudent, meaning that you cannot place money in speculative or risky investments. In addition, your investments must take into account the interests of both current and future beneficiaries. For instance, you may have a current beneficiary who is entitled to income from the trust. He or she would be best off in most cases if you invested the trust funds to generate as much income as possible. However, this may be detrimental to the interest of later beneficiaries who would be happiest if you invested for growth. In addition to balancing the interests of the various beneficiaries, you must consider their future financial needs. Does a trust beneficiary anticipate buying a house or going to school? Will she be depending on the trust income for retirement in fifteen years? All of these questions need to be considered in determining an investment plan for the trust. Only then can you start considering the propriety of individual investments.

4. Distributions. Where you have discretion on whether or not to make distributions to a beneficiary you need to evaluate his current needs, his future needs, his other sources of income, and your responsibilities to other beneficiaries before making a decision. And all of these considerations must be made in light of the size of the trust. Often the most important role of a trustee is the ability to say ‘‘no’’ and set limits on the use of the trust assets. This can be difficult when the need for current assistance is readily apparent.

Trustees Has Many Responsibilities

5. Accounting. One of your jobs as trustee is to keep track of all income to, distributions from, and expenditures by the trust. Generally, you must give an account of this information to the beneficiaries on an annual basis, though you need to check the terms of the trust to be sure. In strict trust accounting, you must keep track of and report on principal and income separately.

6. Taxes. Depending on whether the trust is revocable or irrevocable and whether it is considered a ‘‘grantor’’ trust for tax purposes, the trustee will have to file an annual tax return and may have to pay taxes. In many cases, the trust will act as a pass through with the income being taxed to the beneficiary. In any event, if you keep good records and turn this over to an accountant to prepare, this should not be a big problem.

7. Delegation. While you cannot delegate your responsibility as trustee, you can delegate all of the functions described above. You can hire financial advisors to make investments, accountants to handle taxes and bookkeeping for the trust, and lawyers to advise you on questions of interpretation. With such professional assistance, the job of trustee need not be difficult. However, you still need to communicate with those you hire and make any discretionary decisions, such as when to make distributions of principal from the trust to one or more beneficiaries.

8. Fees. Trustees are entitled to reasonable fees for their services. Family members often do not accept fees, though that can depend on the work involved in a particular case, the relationship of the family member, and whether the family member trustee has been chosen due to his or her professional expertise. Determining what is reasonable can be difficult. Banks, trust companies, and law firms typically charge a percentage of the funds under management. Others may charge for their time. In general, what’s reasonable depends on the work involved, the amount of funds in the trust, other expenses paid out by the trust, the professional experience of the trustee, and the overall expenses for administering the trust. For instance, if the trustee has hired an outside firm for investment purposes, that expense would argue for the trustee taking a somewhat smaller fee. In any case, it makes sense to consult with a professional experienced with trust work who can guide you on what would be normal fees considering all of the circumstances.

In short, acting as trustee gives you a wonderful opportunity to provide a great service to the trust’s beneficiaries. The work can be very gratifying. Just keep an eye on the responsibilities described above to make sure everything is in order so you no one has grounds to question your actions at a later date.

The Collapse of Private Long Term Care Insurance

By News

A Cautionary Tale of the Long Term Care Insurance Marketplace

By 2050, the U.S. will have almost 90 million people aged 65 and over, and more than half will need long-term care at some point. Yet only a sliver of that group can afford long term care insurance. As of 2015, private insurance covered less than 10 percent of U.S. spending on long-term care — and the private market has been shrinking.

Medicare covers only a short period of care after a person has been hospitalized. That leaves Medicaid, the state-administered program for long term care. The paperwork involved is a protracted ordeal, especially for those with physical and mental impairments, and the rules to qualify are strict and complex.

The reality is – the private insurance market is on life support so understanding Medicaid is critical. Schedule an appointment to learn the rules.

Nothing illustrates this more than General Electric and its Long Term Care Products. The company’s troubles with long-term-care insurance show the challenge of caring for an aging population.

Insurance Policy

Long-Term Care Insurance Policies have hurt many insurance companies balance sheets.

General Electric’s multi-billion-dollar loss in a unit that sold long-term-care insurance is a blow from which the iconic company is still reeling. But it’s also a harbinger of a much greater challenge for society at large: paying to care for the growing number of Americans who can’t look after themselves.

GE’s travails stem from the early 1990s, when insurance companies began developing a new line of business, offering policies that, in return for regular premium payments, would cover the cost of a nursing home or other long-term care if the need arose. With the baby-boom generation approaching retirement, sales took off. By 2007, some 7 million policies were in force, generating almost $10 billion a year in premiums.

The insurers miscalculated. Claimants lived longer than expected — perhaps because people prudent enough to buy the insurance were more careful about staying healthy. But longer lives meant more people needing long-term care. Medical costs rose, and investment returns fell short. To cover their obligations, companies had to increase premiums (as far as regulators allowed) and, like GE, take big charges against earnings. Penn Treaty was forced into liquidationleaving policy holders to rely on meager state guaranty funds.

Tempting as it may be to blame regulators, that wouldn’t be fair. True, they could have allowed more premium increases sooner, and they should always demand that companies have ample equity to absorb losses. They’ll need to investigate GE’s accounting. But new insurance products are inherently risky, and companies are bound to make mistakes. Officials shouldn’t be expected to catch risks that actuaries can’t foresee.

Rather, the debacle illustrates a troubling truth: Private insurance can’t handle this problem by itself.

Understanding the rules as to the Medicaid program is critical for all persons. Failure to anticipate long term care nursing costs can wipe out an entire lifetime of savings. Call us to discuss how to protect your lifetime savings while still qualifying for Medicaid.

CLICK HERE TO READ THE ENTIRE ARTICLE ON BLOOMBERG.

Medicare and Late Sign Up Penalties

By News

Medicare Should Warn Enrollees on Steep Late Sign-up Penalties

For many Americans entering retirement, it comes as an unwelcome surprise: Medicare premiums become much more expensive if you do not sign up on time. The program tacks on a 10 percent penalty on monthly Part B premiums for each full 12-month period of late enrollment, and you keep on paying the penalties for the rest of your life.

The aim is to avoid “adverse selection,” which occurs when people sign up for coverage only when they think they will need it. That helps keep premiums lower for all Medicare enrollees.

Medicare Enrollment Form

But a heads-up would be nice. And that is the intent of the Beneficiary Enrollment Notification and Eligibility Simplification Act (BENES Act), a bill introduced with bipartisan support last week in the U.S. Senate (companion legislation was introduced in the House of Representatives earlier). It would require the government to send a notification letter in the year before your 65th birthday – the first date of Medicare eligibility.

The letter would explain the enrollment rules, and – importantly – how Medicare interacts with other insurance coverage you might have.

Roughly 750,000 Medicare beneficiaries paid late enrollment penalties in 2014, according to the Congressional Research Service (CRS). That is less than 2 percent of enrollees, but for those who do pay the penalties, the bite is painful. On average, total premiums for late enrollees were 29 percent higher, CRS reported. 

Medicare is the primary source of health insurance for seniors, and choosing the correct Medicare plan is important. However, it only provides for 100 days of skilled nursing care. Planning for those potential costs are a critical component for anybody, regardless of when you sign up for Medicare.

Want to discuss your plan for paying for your care needs today and in the future? Contact us to discuss how you can plan for future long term care needs that are not covered by Medicare.

Matt Leonard

Chasing millions in Medicaid dollars, hospitals buy up nursing homes

By Uncategorized

A wrinkle in Medicaid’s complex funding formula gives nursing homes owned or leased by city or county governments a funding boost of 30 percent per Medicaid resident. The money is sent to the hospitals, which negotiate with the nursing homes over how to divvy it up.

Westminster Village North, a nursing home and retirement community in Indianapolis, recently added 25 beds as well as two kitchens to speed food delivery to its residents. It redesigned patient rooms to ease wheelchair use and added WiFi and flat-screen televisions. This fall, it’s opening a new assisted-living unit.

The nursing home can afford these multimillion-dollar improvements partly because it has, for the past five years, been collecting significantly higher reimbursement rates from Medicaid, the state-federal health insurance program for the poor.

The changes began when Hancock Regional, a county-owned hospital 15 miles away, began leasing Westminster Village North. A wrinkle in Medicaid’s complex funding formula gives nursing homes owned or leased by city or county governments a funding boost of 30 percent per Medicaid resident. The money is sent to the hospitals, which negotiate with the nursing homes over how to divvy it up.

About half of Westminster’s residents are on Medicaid, so the new funding was substantial.

“We have seen amazing changes and created a more homelike environment for our residents,” said Shelley Rauch, executive director of the home.

Nearly 90 percent of Indiana’s 554 nursing homes have been leased or sold to county hospitals in the past 14 years, state records show, bringing in hundreds of millions in extra federal payments to the state.

Even though Indiana’s nursing home population has remained steady at about 39,000 people over the past five years, Medicaid spending for the homes has increased by $900 million, to $2.2 billion in 2016, according to state data.

Today, more than two-thirds of Indiana’s Medicaid long-term care dollars go to nursing homes. The U.S. average is 47 percent.

The funding enhancements were pioneered in Indiana, but hospitals in Pennsylvania and Michigan also have used the process. Advocates say it has been a key factor in helping to keep Indiana’s city and county hospitals economically vital at a time when many rural hospitals nationwide are facing serious financial difficulties.

 

Critics contend that the money flow has not significantly improved nursing home quality. Furthermore, they say, it has provided incentives to steer patients to nursing homes rather than lower-cost options, such as home health care or community-based daycare centers.

Joe Moser, who until May was Indiana’s Medicaid director, acknowledged while in office that more people were moving to nursing homes rather than staying in their homes, and said it was due in part to the hospital-nursing home marriages. “It is a factor that has contributed to our imbalance” in care choices, he said.

Daniel Hatcher, a law professor at the University of Baltimore and author of “The Poverty Industry,” a book published last year, said this funding arrangement is a bad deal for the poor because it takes a large portion of Medicaid dollars targeted for services for low-income nursing home residents and sends it instead to hospitals to use as they please.

That undercuts the purpose of the Medicaid program, he said.

“The state is using an illusory practice and taking away money from low-income elderly individuals who are living in poor-performing nursing homes,” he said. He noted Indiana is ranked near the bottom of states for nursing-home quality by several government and private reports. Among them is a scorecard from Families for Better Care and the AARP scorecard.

But proponents of the practice say that even when hospitals get most of the money, it is well spent.

Marion County Hospital and Health Corp., the large safety-net hospital system in Indianapolis, owns or leases 78 nursing homes across the state, more than any other county hospital.

Sheila Guenin, vice president of long-term care there, said the hospital keeps 75 percent of the additional Medicaid dollars and the nursing homes get the rest. Still, the additional money has improved care. The transfer of the license to the hospital has kept several nursing homes from closing and increased staffing rates at many others, she said.

About 40 percent of the county hospital’s nursing homes have five-star ratings from the federal government, up substantially from 10 years ago, Guenin said. Among the improvements at the nursing homes were the addition of electronic health records and of high-capacity emergency generators to provide power in a natural disaster.

Still, some patient advocates said the extra funding is flowing to hospitals and nursing homes with little public accounting. Ron Flickinger, a regional long-term-care ombudsman in Indiana, said, “A lot of extra money is being spent here, but I’m not sure patients have seen it benefit them.”

Medicaid, which typically covers about two-thirds of nursing home residents, is jointly financed by the federal and state governments. States pay no more than half the costs, although the federal match varies based on a state’s wealth. In Indiana, the federal government pays about 65 percent of the costs.

The enhanced nursing home payments began in 2003 when a county-owned Indianapolis hospital decided to take advantage of Medicaid rules to bolster its bottom line. In this case, the hospital purchased a nursing home, then provided the money for the state to increase what it spent on the home to the federally allowed maximum.

That increase, in turn, drew down more federal matching funds. Since the federal remittance was larger than the hospital’s contribution, the hospital got back its initial investment and divided the extra money with the nursing home.

Other county-owned hospitals in Indiana slowly followed suit.

All the Medicaid funding for nursing homes should be going to those homes to care for the poor, not shared with hospitals to use as they choose, he said.

The strategy, promoted by consultants advising hospitals and nursing homes in Indiana, is used heavily there because of the plethora of county-owned hospitals. But the federal government is tightening the rules about such payments.

Texas has secured Medicaid approval for a similar strategy starting this month, but federal officials have made the extra funding dependent on nursing homes meeting quality measures, such as reducing falls. Oklahoma is seeking to get federal approval as well.

And in a rule released last year, the federal Centers for Medicare and Medicaid Services announced that it would gradually force states to shift to payment systems that tie such reimbursements to quality of care. Michael Grubbs, an Indiana health consultant, said that rule does not stop the Indiana hospital funding program, but it’s unclear that it will last.

Nursing-home operators in Indiana say the financing arrangement has helped them keep up with rising costs and improve care for residents.

Zach Cattell, president of the Indiana Health Care Association, a nursing-home trade group, noted the number of nursing homes in the state earning Medicare’s top, five-star rating has increased 9 percentage points since 2011. He said the percentage of high-risk residents with pressure ulcers and those who are physically restrained also dropped significantly.

“The money has meant a great deal to us,” said Gregg Malot, director of business development at Pulaski Memorial Hospital in northern Indiana. “I don’t see this as a loophole but see it as an opportunity for small, rural community hospitals to improve our quality and access to care.”

His hospital is the only one in Pulaski County. The extra Medicaid revenue from having acquired 10 nursing homes statewide — about $2 million a year — has helped finance the purchase of the hospital’s first MRI machine, so doctors don’t have to rely on a mobile unit that used to come twice a week, he said. The hospital also spent some of the money to add a computerized system to monitor patients’ vital signs.

Steve Long, chief executive of Hancock Regional Hospital in Greenfield, said his hospital recently built two fitness centers in the county with help from the extra Medicaid dollars that resulted from its acquisition of Westminster Village.

He rejects the notion that additional Medicaid money reduces the hospital’s incentive to add home- and community-based care in the community. He said new Medicare financing arrangements, such as accountable care organizations, give the hospital motivation to find the most efficient ways to care for patients after they leave the hospital.

But he acknowledged the hospital benefits from seeing more patients go to nursing homes licensed under its name.

“Welcome to health care — it’s a complex and confusing environment where we have all different competing incentives,” Long said.

 

Source: Chasing millions in Medicaid dollars, hospitals buy up nursing homes

R.I. 10th most expensive nursing home costs in the U.S.

By Uncategorized

Rhode Island has the 10th highest nursing home costs in the nation at an average of $94,170 annually, according to Caregiverlist’s August report.

Caregiverlist Inc., which connects seniors and professional caregivers with eldercare options, said Rhode Island bumped Maine for having the 10th most expensive costs in the country. Rankings were based on the daily prices of shared rooms in nursing homes.

Caregiverlist said that with 87 nursing homes, the average cost for a shared room in a nursing home in Rhode Island is about $258 a day. In comparison, Texas has the lowest annual cost – a shared room there costs $115 a day. Alaska, due to its low population and remote location, has the highest daily cost for a shared room at $751, according to Caregiverlist spokeswoman, Julie Northcutt.RI Nursing Home Costs

Rhode Island’s average daily shared room cost also is lower than that of Connecticut and Massachusetts, where average daily costs of semi-private rooms total $321 and $289, respectively.

A private room in Rhode Island averages $263 a day. Hawaii has the highest costs for a private room at $488 a day, followed by the District of Columbia at $371 and Connecticut, $351. The least expensive daily cost for a private room is in Missouri at $145.

Caregiverlist said the Rhode Island nursing home with the highest overall Caregiverlist star rating is the privately-owned, 122-bed Briarcliffe Manor in Johnston, which received 4.6 out of 5 stars. Caregiverlist said five is the best rating for a nursing home, while one is the worst.

It said the cost of rooms at Briarcliffe are slightly higher than the average Rhode Island nursing home at $325 and $300, for single and double rooms, respectively, but are not the costliest in the state.

This story was written by Lori Stabile and published by the Providence Business News on August 9, 2016 www.pbn.com.

Concerned with protecting your life savings from the high costs of nursing homes in Rhode Island?

Learn about the options available. Contact our office for a no-cost consultation to discuss what steps you must take now before it is too late.

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Medicare and Long Term Care

By Uncategorized

Doesn’t Medicare Pay for Most Long Term Care Needs?

Drawing of Medicare with Stick Men and Clipping PathNo. Even though many people mistakenly believe that Medicare will take care of most long term
health needs
, it pays for less than 2% of the cost. A survey conducted by AARP (American Association of Retired Persons) showed that 79% of those expecting to need nursing home care incorrectly believed that Medicare would pay.

 

Medicare will pay for long term care in a nursing home only if the following requirements are met:

A. Skilled care is being provided to the individual in the nursing facility. Skilled care is continuous 24 hour per day care provided by licensed medical professionals under the direct supervision of a physician. Only about ½ of 1% of all nursing home residents receive skilled care. Most residents get either intermediate” (4.5% of nursing home residents) or “custodial” care (95% of nursing home residents).

Intermediate care refers to occasional nursing and/ or rehabilitative care under the supervision of skilled medical personnel. It is often referred to as intermittent care and may include physical therapy, occupational therapy, speech therapy, etc.

Custodial care often involves non-medical personnel such as nurses’ aides who provide assistance with the activities of daily living including bathing, eating, toileting, transferring and dressing.

B. The nursing facility is a “Medicare participating” nursing facility. Many nursing homes will not qualify under this requirement.

C. The nursing home care must follow (within 30 days of discharge) at least a three day hospital confinement. Most often those who require nursing home care do not enter directly after a hospitalization. Often individuals are simply aging and finally realize they cannot manage any more at home or in a relative’s home. Since nursing home confinement frequently does not follow a hospitalization, many states now prohibit prior hospitalization prerequisites in long term care policies.

D. In the past in order for Medicare to pay in a skilled nursing facility, the care the individual received had to be “restorative” in nature. The patient had to be getting better. However, on January 24, 2013, the U.S. District Court for Vermont approved a settlement in the case of Jimmo v. Sebelius which states that Medicare provided skilled care may not always have to meet the expectation of improvement. Generally, if an individual meets the four aforementioned requirements (of skilled care, Medicare participating facility, a 3 day prior hospitalization and care that is “restorative” in nature- now a somewhat unclear term-) Medicare will pay all of the costs of the first 20 days and the individual pays $161 for an additional 80 days (in 2016, adjusted annually). (At a current daily nursing home rate of about $250 or more, one obviously cannot depend on Medicare to pay for most of the cost for these other 80 days.) Beyond day 100, Medicare will pay nothing.

Medicare will pay for long term care in a home health care situation only if the similarly stringent and difficult to meet requirements are met. Home health care coverage includes part-time or intermittent skilled nursing care, physical therapy, and speech therapy, through a Medicare Certified Home Health Care Agency. If the patient requires skilled nursing, physical therapy, and/or speech therapy and if the individual is confined to the home and is under the care of a physician, Part A of Medicare can pay for some other services.

A typical individual who requires nursing home or home health care is someone with a physical disability who simply needs help with the activities of daily living -someone who is simply aging. Medicare will not pay for such custodial care. Alzheimer patients, Parkinsonians, stroke victims, and those who have other organically related mental disorders, form another large group of those who need long term care. Typically, since these chronic ailments of aging don’t “get better,” Medicare benefits are not available.

The bottom line is simple: A wise person will not count on Medicare to pay for long term care services.

So what is a person supposed to do? Contact our office to discuss what long term care planning means to you.

Source: This article is an excerpt from LISI Elder Care Law Planning Newsletter #17 (March 3, 2016)

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