Electronic Monitoring in Nursing and Assisted Living Facilities
Effective January 30, 2025 the State of Rhode Island enacted a law related to the electronic monitoring of a resident’s room or private living unit in nursing homes and assisted living facilities. The law can be found at RIGL§ 23-17.29, et. al.
The law allows for the use of electronic monitoring devices in residents’ rooms (provided that the resident or resident representative acting on behalf of the resident, as well as the resident’s roommate or roommate’s representative acting on behalf of the roommate, consent to such electronic monitoring in writing). While nothing previously prohibited the use of electronic monitoring devices in rooms, this law puts more structure around the use of such devices. For example, the law calls for the use of standard forms to indicate consent for the use of electronic monitoring devices.
RIDOH is in the process of developing these forms, and additional guidance for facilities on the implementation of this law. These forms will be provided to facilities in the coming weeks. Guidance from RIDOH will follow.
Every year the State of Rhode Island Department of Health and Human Services updates the asset and income limits to be eligible for Long Term Support Services Medicaid benefits – which help subsidize the cost of long-term care for medically needy individuals. Below are the figures that have been published for 2025:
Community Spouse Resource Allowance:
Minimum
$31,584.00
Maximum
Spousal Share (1/2 joint resources as of beginning of period of continuous institutionalization), up to $157,920.00
Resource Allowance for Individual:
$4,000.00 (Medically Needy)
Monthly Maintenance Needs Allowance:
Minimum
$2,555.00
Maximum
$3,948.00
Allowance for Personal Needs:
$75.00 (unless specific circumstances)
Therapeutic Employment:
+$85+(1/2 bal., max. $265) = max. $400
Guardianship, Legal, & Tax:
varies
Community Spouse Monthly Housing Allowance:
$766.50 (unless excess)
Standard Utility Allowances:
$676.00 (no heat/non distinction)
Home Equity Limit:
$730,000.00 Minimum
$1,097,000 Maximum
Divestment Penalty Divisor and Allowable Income Limit:
NEW FOR 2025 – Simplified Eligibility Criteria: Single Nursing Home Applicant
In 2025, a single Nursing Home Medicaid applicant in Rhode Island must meet the following criteria: 1) Income under $2,901 / month 2) Assets under $4,000 3) Require a Nursing Home Level of Care.
The Cranston Probate Courts decision to grant a Petition To Probate A Will over the objection of Appellants, will remain undisturbed as the Petitioner presented evidence to support the testator had capacity to sign estate planning documents, including the Last Will and Testament that was presented to the Probate Court.
Nanci Parenti lived in Cranston, Rhode Island. For almost sixteen years she lived with Mr. Jagolinzer, who had a close friendship with her. In March 2019, Ms. Parenti learned that she had a cancerous brain tumor. Thereafter, treatment did not appear to be successful. In May 2019, she moved to a nursing home and later moved to another nursing home. In October 2011, Ms. Parenti
wrote a will (2011 Will), apparently without the assistance of an attorney.
Attorney Reis met with Ms. Parenti about the prior executed Will. Able to converse with Ms. Parenti in the nursing home, they agreed that Attorney Reis should prepare new estate planning documents. Attorney Reis and Ms. Parenti discussed how she wished to divide her estate, and she described her assets to him. On June 27, Attorney Reis, his office assistant Ms. Cannata, and Mr. Jagolinzer met at the nursing home for Ms. Parenti to sign a new will (June 2019 Will). Ms. Parenti was less communicative and physically drained but understood who Attorney Reis was and that she was signing a new will.
At the signing of the will, Attorney Reis found Ms. Parenti to be competent and understanding of what Attorney Reis was saying but less able to express herself. Ms. Parenti acknowledged that she was signing the will freely.
Ms. Parenti also executed a Health Care Power of Attorney on June 25, 2019, which Mr. Reis and Ms. Cannata witnessed.
Appellants contend that Ms. Parenti lacked the testamentary capacity required to execute her will in June 2019. “It is well-settled that in a will contest, the proponent of the will bears the burden of proof of testamentary capacity by a fair preponderance of the evidence.”
Testamentary Capacity: The 4 point Test
The proponent must establish that the testator:
(1) had sufficient mind and memory to understand the nature of the business she was engaged in when making her will;
(2) had a recollection of the property she wished to dispose of thereby;
(3) knew and recalled the natural objects of her bounty, their deserts with reference to their conduct and treatment of her and their necessities; and
(4) the manner in which she wishes to distribute her property among them.
Here, Appellee has established that Ms. Parenti possessed testamentary capacity when she signed her will in June 2019. Mr. Reis testified that, despite being less communicative and
physically drained, Ms. Parenti understood what she was doing when signing her will. Mr. Jagolinzer testified that it was clear Ms. Parenti wanted her will to be correct, and Ms. Cannata
stated Ms. Parenti “expressed understanding” what she was signing when executing the will. Mr. Westerman and Ms. Rodriguez, in contrast, testified that Ms. Parenti was in a deteriorating state;
however, they did not see her until after the will was signed and her illness had progressed.
Testimony of Witnesses
Considering the testimony of all five witnesses, the Court concludes that Ms. Parenti had sufficient mind and memory to understand the nature of what she was doing when executing the will. The
only testimony questioning Ms. Parenti’s sound mind was based on an interaction days after she signed the will, with a progressive illness.
The Court finds that Ms. Parenti recalled her property and how she wanted the property distributed, based on the fact that she was able to describe her assets to Mr. Reis and discuss her
intentions for her estate. Testimony from Mr. Reis describing his discussions with Ms. Parenti regarding how to distribute her property suggests that she understood how she wanted the property
distributed and to whom, she knew and recalled the objects of her bounty and she understood the manner in which the property would be distributed.
Each independent witness to the will testified consistently with their affidavits. It is clear that Attorney Reis spoke with Ms. Parenti before the will was executed. It is likely that this
meeting was just four days before the signing of the will, as the power of attorney is dated June 25, 2019. Ms. Cannata and Mr. Reis witnessed the execution of both the Health Care Power of
Attorney and the June 2019 Will.
No Evidence of Lack of Capacity
By contrast, Appellants have not provided any evidence of Ms. Parenti’s mental state when she signed the will or the days leading up to it, such as medical records or testimony that she lacked capacity on the day of signing. The Court cannot rely only on testimony that describes Ms. Parenti’s condition after she executed her will, even if the witness’s statement describes an interaction with Ms. Parenti only days after she signed the June 2019 Will. Rather, the Court was presented with credible testimony from multiple witnesses that support she was of sound mind on the day she signed her will.
Attorney Involvement Involvement
Ms. Parenti sought help from Attorney Reis when she realized her purported October 2011 Will, which she believed was properly executed, had defects that called into question its validity. In an attempt to correct this potential problem, she executed a will in June 2019 with the same general terms as the 2011 Will. She acted so that her wishes would be clear, as to how she desired her property distributed when she passed. There is no claim or evidence here to support that Ms. Parenti was subject to undue influence, and little evidence to suggest that she lacked capacity. Rather, the evidence here tells the story of a seriously ill client seeking help from an attorney to correct a nearly decade-old will that she previously had believed was properly executed, and an attorney who promptly responded to that need.
“For the foregoing reasons, Appellants’ appeal of the probate court’s decision is denied. Ms. Parenti possessed the testamentary capacity to sign the June 2019 Will, which was executed fully in accordance with statutory requirements.”
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 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.
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.
To schedule a remote notary or on-line witnessing of document session – please contact our office at 401-401.648.7000 or email to: mleonard@smsllaw.com
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
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:
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.
My mother is in a nursing home. Can she still deduct this expense?
Yes. For 2018, in certain instances nursing home expenses are allowable as medical expenses.
If you or someone who was your spouse or your dependent, either when the service was provided or when you paid them, is in a nursing home primarily for medical care, then the entire cost including meals and lodging is deductible as a medical expense.
If the individual is in the home mainly for personal reasons, then only the cost of the actual medical care is deductible as a medical expense, not the cost of the meals and lodging.
To determine if your mother qualifies as your dependent for this purpose, refer to Whose Medical Expenses Can You Include and Nursing Home in Publication 502, Medical and Dental Expenses.
The total of all allowable medical expenses must be reduced by 7.5% of your adjusted gross income.
This write-off is only available to filers who itemize. People who qualify for it can deduct insurance premiums paid with after-tax dollars, plus many costs not always covered by health insurance—such as for long-term care, prostheses, a wig after chemotherapy and more.
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.
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.
esident, as well as the resident’s roommate or roommate’s representative acting on behalf of the roommate, consent to such electronic monitoring in writing). While nothing previously prohibited the use of electronic monitoring devices in rooms, this law puts more structure around the use of such devices. For example, the law calls for the use of standard forms to indicate consent for the use of electronic monitoring devices.
cost including meals and lodging is deductible as a medical expense.
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