John L. Roberts
Certified Elder Law Attorney
John L. Roberts, J.D., is an Elder Law Attorney serving clients in Hampden County, MA. After practicing for 15 years, he confronted the challenges of family caregiving when his own father developed dementia. The experience transformed his practice, enabling him to help clients who are family caregivers from a place of true understanding.
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Question
Paying for assisted living?
In my state (Massachusetts) some assisted living centers have subsidized slots for low income residents who are on SSI. The program in my... In my state (Massachusetts) some assisted living centers have subsidized slots for low income residents who are on SSI.
The program in my state is called Group Adult Foster Care (GAFC) and it pays for services for elders in subsidized senior housing and in assisted living centers such as daily personal care, homemaking, meals, and transportation.
The assisted living center may combine the GAFC services with the room and board which is paid by the resident, and another program called SSI-G. But you do not have to be eligible to receive SSI-G in order to qualify for GAFC.
You may be able to find a housing facility that participates in Senior Care Options (SCO), a Medicaid/Medicare funded program that provides services, benefits and treatments authorized by the primary care physician.
PACE, a Program of All-Inclusive Care for the Elderly, is another program for patients who are eligible for Medicare and Medicaid. The purpose of the program is to help prevent nursing home admissions. If a nursing home admission becomes necessary, the PACE plan pays for the long-term care in the facility. Until that time, PACE can cover costs of assisted living that the resident's income doesn't cover. All services are provided or authorized by the PACE Interdisciplinary Team, except emergency services.
An elder law attorney in your state can guide you to the options and combinations of resources that are available in your area. see more
The program in my state is called Group Adult Foster Care (GAFC) and it pays for services for elders in subsidized senior housing and in assisted living centers such as daily personal care, homemaking, meals, and transportation.
The assisted living center may combine the GAFC services with the room and board which is paid by the resident, and another program called SSI-G. But you do not have to be eligible to receive SSI-G in order to qualify for GAFC.
You may be able to find a housing facility that participates in Senior Care Options (SCO), a Medicaid/Medicare funded program that provides services, benefits and treatments authorized by the primary care physician.
PACE, a Program of All-Inclusive Care for the Elderly, is another program for patients who are eligible for Medicare and Medicaid. The purpose of the program is to help prevent nursing home admissions. If a nursing home admission becomes necessary, the PACE plan pays for the long-term care in the facility. Until that time, PACE can cover costs of assisted living that the resident's income doesn't cover. All services are provided or authorized by the PACE Interdisciplinary Team, except emergency services.
An elder law attorney in your state can guide you to the options and combinations of resources that are available in your area. see more
Question
I am 66 taking care of my 84 year old mom. Can I get paid to care for her?
An elder law attorney in your state can explain the Medicaid programs that can pay for care in your Mom's home. If you don't... An elder law attorney in your state can explain the Medicaid programs that can pay for care in your Mom's home. If you don't qualify as a caregiver host under your state's program, you mom could qualify for a program that pays other caregivers to come into the home, allowing you some time off from the duties. Your mom's monthly income, and her need for care, determine eligibility.
If your mom is a veteran who served during time of war, or was married to a veteran who served during time of war, she can get reimbursement for care expenses with a VA Aid & Attendance pension. The hours that you provide care services every month can qualify as reimbursable Aid & Attendance expenses. The calculation factors in your mom's income with how much she has to spend on medical expenses and care to determine whether she can get a portion of or the full monthly pension amount. ($1,258 during 2019). see more
If your mom is a veteran who served during time of war, or was married to a veteran who served during time of war, she can get reimbursement for care expenses with a VA Aid & Attendance pension. The hours that you provide care services every month can qualify as reimbursable Aid & Attendance expenses. The calculation factors in your mom's income with how much she has to spend on medical expenses and care to determine whether she can get a portion of or the full monthly pension amount. ($1,258 during 2019). see more
Question
My mother sends my brother $500 a month to assist with the rent. Will this be an issue when she has to go on M...
Suggest that your mom talk with an elder law attorney in her home state, to talk about ways she can continue to stay in the least... Suggest that your mom talk with an elder law attorney in her home state, to talk about ways she can continue to stay in the least restrictive living setting (such as her own home).
Your role as POA makes you responsible for disbursing substantial amounts of her money to your brother. It wasn't clear from your question whether your brother is living with your parents. Future Medicaid eligibility will at minimum be complicated by the payments you describe, and at worst could be found to be disqualifying transfers that you are responsible for. see more
Your role as POA makes you responsible for disbursing substantial amounts of her money to your brother. It wasn't clear from your question whether your brother is living with your parents. Future Medicaid eligibility will at minimum be complicated by the payments you describe, and at worst could be found to be disqualifying transfers that you are responsible for. see more
Question
My mother sends my brother $500 a month to assist with the rent. Will this be an issue when she has to go on M...
Suggest that your mom talk with an elder law attorney in her home state, so she can continue to stay in the least restrictive living... Suggest that your mom talk with an elder law attorney in her home state, so she can continue to stay in the least restrictive living setting (such as her own home).
Your role as POA makes you responsible for disbursing substantial amounts of her money to your brother. It wasn't clear from your question whether your brother is living with your parents. Future Medicaid eligibility will at minimum be complicated by the payments you describe, and at worst could be found to be disqualifying transfers that you are responsible for. see more
Your role as POA makes you responsible for disbursing substantial amounts of her money to your brother. It wasn't clear from your question whether your brother is living with your parents. Future Medicaid eligibility will at minimum be complicated by the payments you describe, and at worst could be found to be disqualifying transfers that you are responsible for. see more
Question
Where do I get help interpreting my mother's long-term care insurance policy?
An Elder Law Attorney in your mother's state of residence can help you understand the policy, and you'll get other insights on care... An Elder Law Attorney in your mother's state of residence can help you understand the policy, and you'll get other insights on care options and planning.
To get up to speed on the policy terms and features, check the LTC Ins Guide published by the National Association of State Insurance Commissioners:
https://www.ltcfeds.com/epAssets/documents/NAIC_Shoppers_Guide.pdf see more
To get up to speed on the policy terms and features, check the LTC Ins Guide published by the National Association of State Insurance Commissioners:
https://www.ltcfeds.com/epAssets/documents/NAIC_Shoppers_Guide.pdf see more
Question
Who deems someone as mentally competent or incompetent?
Your question is important and well worth talking about with your family members, and the people who care for your mother. A NIH summary... Your question is important and well worth talking about with your family members, and the people who care for your mother. A NIH summary explains how our legal system protects "the principle that all persons are competent to make reasoned decisions unless demonstrated to be otherwise."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181079/
The protection is based on our Bill of Rights, and on law and medical practice in the state where your mother lives. Also, the terms written into her Power of Attorney document determine what powers she has granted to your sister and any powers that she has withheld. Health Care documents can also be tailored to limit and agent's authority and provide directions.
There are different categories of capacity that you have to consider. Capacity to make health care decisions, manage finances, or sign a will document each require different levels and types of capacity.
A Merk manual summary explains how people who have clinical and legal capacity are considered able to make health care decisions. But even if a patient lacks clinical capacity, a physician cannot override a patient's treatment preference unless a court gets involved and finds the patient lacks legal capacity to make the decision.
https://www.merckmanuals.com/professional/special-subjects/medicolegal-issues/capacity-competence-and-incapacity
The NIH Summary does acknowledge that:
"One of the most vexing issues facing physicians is the management of medical treatment when an individual's rational decision-making ability is questionable." But you indicate that your mother is able to express herself rationally, so it is difficult to understand why your mother is being excluded from care meetings.
Regulation of Assisted Living facilities in your mother's state of residence will be according to state or municipal regulations. Federal law protects people who live in a more restrictive nursing home setting. Specified rights include:
"The right to choose a personal attending physician, to be fully informed in advance about care and treatment, to be fully informed in advance of any changes in care or treatment that may affect the resident’s well-being, and (except with respect to a resident adjudged incompetent) to participate in planning care and treatment or changes in care and treatment."
https://www.law.cornell.edu/uscode/text/42/1395i-3
It may be worth contacting an Elder Law Attorney or Geriatric Care Manager in your mother's home state to get some objective guidance and advocacy for your mother. see more
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181079/
The protection is based on our Bill of Rights, and on law and medical practice in the state where your mother lives. Also, the terms written into her Power of Attorney document determine what powers she has granted to your sister and any powers that she has withheld. Health Care documents can also be tailored to limit and agent's authority and provide directions.
There are different categories of capacity that you have to consider. Capacity to make health care decisions, manage finances, or sign a will document each require different levels and types of capacity.
A Merk manual summary explains how people who have clinical and legal capacity are considered able to make health care decisions. But even if a patient lacks clinical capacity, a physician cannot override a patient's treatment preference unless a court gets involved and finds the patient lacks legal capacity to make the decision.
https://www.merckmanuals.com/professional/special-subjects/medicolegal-issues/capacity-competence-and-incapacity
The NIH Summary does acknowledge that:
"One of the most vexing issues facing physicians is the management of medical treatment when an individual's rational decision-making ability is questionable." But you indicate that your mother is able to express herself rationally, so it is difficult to understand why your mother is being excluded from care meetings.
Regulation of Assisted Living facilities in your mother's state of residence will be according to state or municipal regulations. Federal law protects people who live in a more restrictive nursing home setting. Specified rights include:
"The right to choose a personal attending physician, to be fully informed in advance about care and treatment, to be fully informed in advance of any changes in care or treatment that may affect the resident’s well-being, and (except with respect to a resident adjudged incompetent) to participate in planning care and treatment or changes in care and treatment."
https://www.law.cornell.edu/uscode/text/42/1395i-3
It may be worth contacting an Elder Law Attorney or Geriatric Care Manager in your mother's home state to get some objective guidance and advocacy for your mother. see more
Question
VA death pension vs Aid and Attendance?
Thrifty elders often respond well to the idea that care services can be covered by a government benefit or pension. Health and safety are... Thrifty elders often respond well to the idea that care services can be covered by a government benefit or pension.
Health and safety are first priority in your mind, while your mother may be most focused on finances and making the most of available benefits payments.
Understanding the differences between the VA death pension vs. Aid and Attendance will make you better able to explain the financial facts.
Consider the specifics of your mother's case in the context of:
1) Service-Connected Compensation vs.
2) a non-service connected VA Pension.
A surviving spouse can qualify for Dependency and Indemnity Compensation (DIC) if the veteran's death resulted from a service-related injury or disease. This IS service-connected compensation, and asset limits and transfer penalties DO NOT apply. Here is the summary of DIC compensation, which can include an extra allowance if the surviving spouse is entitled to Aid & Attendance:
https://benefits.va.gov/Compensation/current_rates_dic.asp#BM01
Aid & Attendance is a NON-service connected VA pension which IS subject to asset and transfer rules.
Here is the VA's summary of maximum Aid & Attendance payments:
https://www.benefits.va.gov/pension/current_rates_survivor_pen.asp
Here is an example of how the VA looks at the unreimbursed medical expenses of a surviving spouse to determine the amount of the Aid & Attendance pension:
https://www.benefits.va.gov/pension/spousepencalc.asp
Talk with a Veteran Agent or Elder Law Attorney near you and determine whether room and board at the assisted living can be considered a medical expense in your mother's case.
Compare the amount she receives now in service-connected compensation with the maximum Aid & Attendance pension amount that would be allowed based on her income and total unreimbursed medical expenses.
If the Aid & Attendance pension would produce greater reimbursement, you have a financial talking point to help your mother chose the safer living environment. see more
Health and safety are first priority in your mind, while your mother may be most focused on finances and making the most of available benefits payments.
Understanding the differences between the VA death pension vs. Aid and Attendance will make you better able to explain the financial facts.
Consider the specifics of your mother's case in the context of:
1) Service-Connected Compensation vs.
2) a non-service connected VA Pension.
A surviving spouse can qualify for Dependency and Indemnity Compensation (DIC) if the veteran's death resulted from a service-related injury or disease. This IS service-connected compensation, and asset limits and transfer penalties DO NOT apply. Here is the summary of DIC compensation, which can include an extra allowance if the surviving spouse is entitled to Aid & Attendance:
https://benefits.va.gov/Compensation/current_rates_dic.asp#BM01
Aid & Attendance is a NON-service connected VA pension which IS subject to asset and transfer rules.
Here is the VA's summary of maximum Aid & Attendance payments:
https://www.benefits.va.gov/pension/current_rates_survivor_pen.asp
Here is an example of how the VA looks at the unreimbursed medical expenses of a surviving spouse to determine the amount of the Aid & Attendance pension:
https://www.benefits.va.gov/pension/spousepencalc.asp
Talk with a Veteran Agent or Elder Law Attorney near you and determine whether room and board at the assisted living can be considered a medical expense in your mother's case.
Compare the amount she receives now in service-connected compensation with the maximum Aid & Attendance pension amount that would be allowed based on her income and total unreimbursed medical expenses.
If the Aid & Attendance pension would produce greater reimbursement, you have a financial talking point to help your mother chose the safer living environment. see more
Question
Can my son be my POA and my two brothers be my witnesses?
If it is properly drafted, the Power of Attorney document can be an effective tool in the hands of your Attorney-in-Fact. It can... If it is properly drafted, the Power of Attorney document can be an effective tool in the hands of your Attorney-in-Fact. It can grant many powers, such as the power to buy and sell your real estate, powers to open and close bank accounts, cash out insurance policies, and transfer assets.
Your question points toward two big areas of consideration:
1) is your son the right person for the job? and
2) what formalities does your state requires to make a valid POA document?
First, the purpose of the Power of Attorney document is to have a trusted person, designated in advance, to manage your financial affairs. The trusted person will be able to manage things for you, if you become unable to speak for yourself. This avoids the need for Probate Court to appoint a Conservator. Nobody wants to put their family through the delays and costs of Probate Court. Is your son the best person for this responsibility?
As you think on this, ask whether you want the agent to be able to transfer assets to himself. If the Attorney-in-Fact is your spouse, that power of "self-dealing" may not matter at all. But if the person you are considering does not already co-own everything with you, maybe you don’t want him or her to have that power.
Also consider whether your agent should be required to account for what he’s doing with your money, and who he or she must be accountable to.
You can reach the best answers to these questions (and many more relevant concerns) by talking with an Elder Law or Estate Planning Attorney who is willing to take the time to understand you and your circumstances.
Second: what are the document signing formalities in your state that are required to make a valid POA document? What are the requirements for witnesses and notarization of the document in your state? Don't leave these issues to guess work, or reliance on general answers provided online.
Even if family members could be considered competent witnesses, do you really want to create potential conflict of interest issues within the family if the POA document needs to be used in the future? Remember, the POA must be acceptable to third party financial, business and real estate entities. Your goal is to avoid and eliminate any questions about the document. Disinterested witnesses who have no connection to you and no claim to your estate fulfill that goal.
Again, to be sure that the document will be valid and acceptable to third parties in the future, you need an Attorney who is responsible for drafting the document to your specifications in compliance with the law in your state. see more
Your question points toward two big areas of consideration:
1) is your son the right person for the job? and
2) what formalities does your state requires to make a valid POA document?
First, the purpose of the Power of Attorney document is to have a trusted person, designated in advance, to manage your financial affairs. The trusted person will be able to manage things for you, if you become unable to speak for yourself. This avoids the need for Probate Court to appoint a Conservator. Nobody wants to put their family through the delays and costs of Probate Court. Is your son the best person for this responsibility?
As you think on this, ask whether you want the agent to be able to transfer assets to himself. If the Attorney-in-Fact is your spouse, that power of "self-dealing" may not matter at all. But if the person you are considering does not already co-own everything with you, maybe you don’t want him or her to have that power.
Also consider whether your agent should be required to account for what he’s doing with your money, and who he or she must be accountable to.
You can reach the best answers to these questions (and many more relevant concerns) by talking with an Elder Law or Estate Planning Attorney who is willing to take the time to understand you and your circumstances.
Second: what are the document signing formalities in your state that are required to make a valid POA document? What are the requirements for witnesses and notarization of the document in your state? Don't leave these issues to guess work, or reliance on general answers provided online.
Even if family members could be considered competent witnesses, do you really want to create potential conflict of interest issues within the family if the POA document needs to be used in the future? Remember, the POA must be acceptable to third party financial, business and real estate entities. Your goal is to avoid and eliminate any questions about the document. Disinterested witnesses who have no connection to you and no claim to your estate fulfill that goal.
Again, to be sure that the document will be valid and acceptable to third parties in the future, you need an Attorney who is responsible for drafting the document to your specifications in compliance with the law in your state. see more
Question
Is an IRA exempt from estate recovery?
Your question about Social Security income is answered with an understanding of the concept of "Patient Paid Amount." The PPA is... Your question about Social Security income is answered with an understanding of the concept of "Patient Paid Amount." The PPA is the total amount of monthly income that must be paid for care, minus the Personal Needs Allowance ("PNA"). The PNA is the small amount that your state allows your father to keep each month for personal needs.
(If you father has a spouse, the spouse gets to keep all of the couple's income, up to an amount called the spouse's Minimum or Maximum Monthly Maintenance Needs Allowance.
The answer to your IRA question depends on the state where your father is located.
For example, my state (Massachusetts) is very restrictive. The IRA will count against the applicant. In my state, the IRA must be cashed out and then spent down for care or for non-countable assets. The only exceptions are found when the Medicaid applicant has a disabled family member to whom the cashed out IRA proceeds can be transferred, or a spouse who can keep an amount up to the Community Spouse Asset Allowance.
(As you know, there can't be joint ownership of an IRA because: it's an Individual Retirement Account.)
But in Kentucky and DC, the institutionalized person's IRA is an exempt asset.
Other states like New York and California are almost as generous. The Medicaid applicant can keep the entire IRA as long as it is paying income to him or her, and the income helps pay for care.
Eight states, including NY and Florida, allow a community spouse to keep an unlimited amount of their own IRA funds as long as the IRA is paying out income.
And, more than a dozen states allow the community spouse to keep an unlimited amount of their own IRA funds even if the IRA is not paying out income yet.
As you can see, talking with an elder law attorney in your state can help you make the best decisions on how to apply and qualify for Medicaid long term care. see more
(If you father has a spouse, the spouse gets to keep all of the couple's income, up to an amount called the spouse's Minimum or Maximum Monthly Maintenance Needs Allowance.
The answer to your IRA question depends on the state where your father is located.
For example, my state (Massachusetts) is very restrictive. The IRA will count against the applicant. In my state, the IRA must be cashed out and then spent down for care or for non-countable assets. The only exceptions are found when the Medicaid applicant has a disabled family member to whom the cashed out IRA proceeds can be transferred, or a spouse who can keep an amount up to the Community Spouse Asset Allowance.
(As you know, there can't be joint ownership of an IRA because: it's an Individual Retirement Account.)
But in Kentucky and DC, the institutionalized person's IRA is an exempt asset.
Other states like New York and California are almost as generous. The Medicaid applicant can keep the entire IRA as long as it is paying income to him or her, and the income helps pay for care.
Eight states, including NY and Florida, allow a community spouse to keep an unlimited amount of their own IRA funds as long as the IRA is paying out income.
And, more than a dozen states allow the community spouse to keep an unlimited amount of their own IRA funds even if the IRA is not paying out income yet.
As you can see, talking with an elder law attorney in your state can help you make the best decisions on how to apply and qualify for Medicaid long term care. see more
Question
Is it shameful to feel relieved when abusive parent dies?
One of the best treatments of this topic I have found to help clients who come to my office for help with elder care planning and estate... One of the best treatments of this topic I have found to help clients who come to my office for help with elder care planning and estate settlement and probate is a booklet by H. Norman Wright called: Experiencing Grief. The author would probably say that yours are healthy emotions that help with healing.
Each chapter in the booklet is 2 -3 short pages, and your question is one of many that are treated with wonderful insight.
After the tree on the front cover, there is only 1 other picture illustration in the booklet. It is a diagram of all the bad feelings that can overwhelm a person if they don't admit and (as the title recommends) experience grieving. It is a picture of serious problems that sprout and spout from "denial" of grief.
Your thoughful post points toward the path to healing that all of us need to seek. see more
Each chapter in the booklet is 2 -3 short pages, and your question is one of many that are treated with wonderful insight.
After the tree on the front cover, there is only 1 other picture illustration in the booklet. It is a diagram of all the bad feelings that can overwhelm a person if they don't admit and (as the title recommends) experience grieving. It is a picture of serious problems that sprout and spout from "denial" of grief.
Your thoughful post points toward the path to healing that all of us need to seek. see more
Question
What to do with a tax refund?
Medicaid regulations in your state include "non-countable assets" and services that you can acquire for your mother using her tax... Medicaid regulations in your state include "non-countable assets" and services that you can acquire for your mother using her tax refund.
You may also be compensated for your work, if you have a Caregiver Contract with your mother.
Talk with an Elder Law Attorney for ideas on how to help your mother. The legal work is another service that can be paid with the refund that would otherwise become "excess assets" if you keep it for more than 1 month. see more
You may also be compensated for your work, if you have a Caregiver Contract with your mother.
Talk with an Elder Law Attorney for ideas on how to help your mother. The legal work is another service that can be paid with the refund that would otherwise become "excess assets" if you keep it for more than 1 month. see more
Question
Will Medicaid count a condo that my sisters and I inherited from our dad as our mother's asset if we deeded it...
The answer to your question is determined by the Medicaid regulations in your state that govern "disqualifying transfers." If... The answer to your question is determined by the Medicaid regulations in your state that govern "disqualifying transfers."
If your mother applies for Medicaid in the future, you will need to take a definite position on how your back-and-forth transfers of the condo fit into those regulations.
It sounds like your mother could claim she only returned to you and your sisters something that you had gifted to her. But you need the expertise of an Elder Law Attorney who has worked with Medicaid applications and who understands Real Estate law in your state.
In retrospect, you can see the value of working with an Elder Law Attorney from the very beginning, when you and your sisters first inherited the condo (before you sign and file deeds involving real estate).
The perspective of a potential Medicaid application in the future gives you and the Elder Law Attorney a timeline for making the best decisions on real estate transfers at each step of the journey.
By following up the "step transactions" that you have already made with the planning work of an Elder Law Attorney now, you give your mother the best chance for a smooth application process, if it is needed in the future.
Select an Elder Law Attorney who will be able to follow up any opinion and advice provided now with the service of Medicaid application preparation and filing in the future. see more
If your mother applies for Medicaid in the future, you will need to take a definite position on how your back-and-forth transfers of the condo fit into those regulations.
It sounds like your mother could claim she only returned to you and your sisters something that you had gifted to her. But you need the expertise of an Elder Law Attorney who has worked with Medicaid applications and who understands Real Estate law in your state.
In retrospect, you can see the value of working with an Elder Law Attorney from the very beginning, when you and your sisters first inherited the condo (before you sign and file deeds involving real estate).
The perspective of a potential Medicaid application in the future gives you and the Elder Law Attorney a timeline for making the best decisions on real estate transfers at each step of the journey.
By following up the "step transactions" that you have already made with the planning work of an Elder Law Attorney now, you give your mother the best chance for a smooth application process, if it is needed in the future.
Select an Elder Law Attorney who will be able to follow up any opinion and advice provided now with the service of Medicaid application preparation and filing in the future. see more
Question
My mother is in a nursing home. Can we move into her house rent free?
ForKing has supplemented the question post by explaining: her mother has a "partnership policy." This indicates that her mother... ForKing has supplemented the question post by explaining: her mother has a "partnership policy." This indicates that her mother has a Long Term Care Insurance policy.
Here is how the National Association of Insurance Commissioners explain Long-Term Care Insurance Partnership Policies:
"In some states, there are long-term care insurance partnership policies that help you manage the financial impact of spending down to meet Medicaid eligibility standards. When you buy a partnership policy, you’re protected from the normal Medicaid requirement to spend down your income and assets to become eligible."
An Elder Law Attorney in your state could help you coordinate LTC policy benefits with the Medicaid spend down, application for eligibility, and your plans for the house.
A complete discussion of LTC Insurance Partnership Policies is at:
https://www.ltcfeds.com/epAssets/documents/NAIC_Shoppers_Guide.pdf see more
Here is how the National Association of Insurance Commissioners explain Long-Term Care Insurance Partnership Policies:
"In some states, there are long-term care insurance partnership policies that help you manage the financial impact of spending down to meet Medicaid eligibility standards. When you buy a partnership policy, you’re protected from the normal Medicaid requirement to spend down your income and assets to become eligible."
An Elder Law Attorney in your state could help you coordinate LTC policy benefits with the Medicaid spend down, application for eligibility, and your plans for the house.
A complete discussion of LTC Insurance Partnership Policies is at:
https://www.ltcfeds.com/epAssets/documents/NAIC_Shoppers_Guide.pdf see more
Question
Will Medicaid pay for a private personal care aide?
Medicaid regulations are different in every state, and each state has different terms and jargon to describe the resources available You... Medicaid regulations are different in every state, and each state has different terms and jargon to describe the resources available
You mentioned that your mother is eligible for "Medicaid Long Term Care." Is your mother going to be a resident in a facility, or is your mother still living at home, in the community?
If she is living in the community, your state's Medicaid program will have reimbursement plans to pay caregivers, but you have to fit the services into the framework of your state's program.
My state (Massachusetts) offers Adult Foster Care (AFC) for people who cannot live alone safely, and who have a family member or trusted friend who wants to devote time and attention that provides 24-hour care. AFC pays the caregiver an annual tax free stipend. The program is sometimes called by the names of agencies that serve as the overseers of the host caregiver: Adult Family Care and Caregiver Homes.
Another program in my state, Personal Care Attendant (PCA), allows you to hire a son, daughter or any family member (but not a spouse). The program pays for home care services for people who need daily assistance with ADLs. But the elder must submit time slips to a "fiscal intermediary" which processes payroll checks and income tax withholding.
Community Choices is a program that provides as much support/services as needed for people who are clinically frail enough to qualify for immediate nursing home admission.
Senior Care Options (SCO) combines Medicare and Medicaid.
To get specific answers to questions about Medicaid payment for care in your state, talk with your local Aging Services Access Point or an Elder Law Attorney. see more
You mentioned that your mother is eligible for "Medicaid Long Term Care." Is your mother going to be a resident in a facility, or is your mother still living at home, in the community?
If she is living in the community, your state's Medicaid program will have reimbursement plans to pay caregivers, but you have to fit the services into the framework of your state's program.
My state (Massachusetts) offers Adult Foster Care (AFC) for people who cannot live alone safely, and who have a family member or trusted friend who wants to devote time and attention that provides 24-hour care. AFC pays the caregiver an annual tax free stipend. The program is sometimes called by the names of agencies that serve as the overseers of the host caregiver: Adult Family Care and Caregiver Homes.
Another program in my state, Personal Care Attendant (PCA), allows you to hire a son, daughter or any family member (but not a spouse). The program pays for home care services for people who need daily assistance with ADLs. But the elder must submit time slips to a "fiscal intermediary" which processes payroll checks and income tax withholding.
Community Choices is a program that provides as much support/services as needed for people who are clinically frail enough to qualify for immediate nursing home admission.
Senior Care Options (SCO) combines Medicare and Medicaid.
To get specific answers to questions about Medicaid payment for care in your state, talk with your local Aging Services Access Point or an Elder Law Attorney. see more
Question
My mother is in a nursing home. Can we move into her house rent free?
Your question seems to be about Medicaid Estate Recovery in the future. The first question to ask is: can your mother be eligible for... Your question seems to be about Medicaid Estate Recovery in the future.
The first question to ask is: can your mother be eligible for Medicaid now, since she still has ownership of a house?
The answer depends on the ownership arrangement. Is your mother the only owner of the house? Did she set up a Life Estate arrangement in past years? How long ago?
You are best served by talking with an Elder Law Attorney in your state who can explain how your mother's situation fits into the Medicaid regulations in your state.
When you understand the current status of the real estate you can make good decisions about next steps involving the house, which factor into planning an application for Medicaid. see more
The first question to ask is: can your mother be eligible for Medicaid now, since she still has ownership of a house?
The answer depends on the ownership arrangement. Is your mother the only owner of the house? Did she set up a Life Estate arrangement in past years? How long ago?
You are best served by talking with an Elder Law Attorney in your state who can explain how your mother's situation fits into the Medicaid regulations in your state.
When you understand the current status of the real estate you can make good decisions about next steps involving the house, which factor into planning an application for Medicaid. see more
Question
When my will says that the house is to be sold & divided up between 4 children & 1 of the children wants the h...
The postings in answer to this question suggest several scenarios for settling an estate and distributing the home equity to the children.... The postings in answer to this question suggest several scenarios for settling an estate and distributing the home equity to the children.
The best plan for you depends on your circumstances. An Estate Planning - Probate Attorney in your state who understands your facts can give you the insights you need to make a good plan.
Topics to cover with the Attorney include:
your health and whether it's likely that you will need long term care in the future;
whether you want to keep your options open to cash out the home equity and use it for a new living situation in the future;
any mortgage debt currently on the house.
Discussing these topics helps the advisor recommend Probate and non-Probate methods; Will substitutes like Trusts and life ownership arrangements for real estate could provide alternatives.
If the house is paid for, and your Will is an interim plan to cover unexpected sudden death, the Probate process would give the surviving child who wants the property a chance to refinance and buy out the other siblings.
If the Will based plan stays in effect and you need Medicaid in the future, your state's Medicaid agency will be able to recover from the Probate estate for any expenses incurred after age 55.
In my state (Massachusetts) the way to think about Medicaid for people over age 55 is: it's free, unless you have a Probate estate.
https://www.medicaid.gov/medicaid/eligibility/estate-recovery/index.html
https://www.law.cornell.edu/uscode/text/42/1396p see more
The best plan for you depends on your circumstances. An Estate Planning - Probate Attorney in your state who understands your facts can give you the insights you need to make a good plan.
Topics to cover with the Attorney include:
your health and whether it's likely that you will need long term care in the future;
whether you want to keep your options open to cash out the home equity and use it for a new living situation in the future;
any mortgage debt currently on the house.
Discussing these topics helps the advisor recommend Probate and non-Probate methods; Will substitutes like Trusts and life ownership arrangements for real estate could provide alternatives.
If the house is paid for, and your Will is an interim plan to cover unexpected sudden death, the Probate process would give the surviving child who wants the property a chance to refinance and buy out the other siblings.
If the Will based plan stays in effect and you need Medicaid in the future, your state's Medicaid agency will be able to recover from the Probate estate for any expenses incurred after age 55.
In my state (Massachusetts) the way to think about Medicaid for people over age 55 is: it's free, unless you have a Probate estate.
https://www.medicaid.gov/medicaid/eligibility/estate-recovery/index.html
https://www.law.cornell.edu/uscode/text/42/1396p see more
Question
Any insight into "No progress" criteria for medicare rehab (SNF) 100 day benefit?
Years after a Federal Court tried to end this misunderstanding about Medicare coverage, the Center for Medicare Advocacy says it... Years after a Federal Court tried to end this misunderstanding about Medicare coverage, the Center for Medicare Advocacy says it "still regularly hears from beneficiaries facing erroneous 'Improvement Standard' denials in home health, skilled nursing facility, and outpatient therapy settings."
The Center encourages Medicare beneficiaries and their families to appeal unfair “Improvement Standard” denials, even though Medicare patients "and their families should not be in a position of having to educate providers, contractors, and adjudicators about Medicare policy."
They advise patients "and their families to continue citing to the Jimmo Settlement and related materials when challenging denials."
But the most effective way to avoid the need to fight a Medicare appeals (which is not likely to succeed) is to engage the physicians and caseworkers before the time they must make a decision to terminate their Medicare billing.
A Geriatric Care Manager or Advocate who understands the patient's needs, the medical providers, and their billing practices, gives you the best chance to gather the facts needed to continue care paid by Medicare. Hire the advocate as soon as the patient is in the hospital, before being discharged to a facility, and you give yourself the best chance to better results.
These professional Advocates are privately paid by the patient. But the cost is worth the benefit of having an objective advocate working alongside you and your family.
https://www.medicareadvocacy.org/jimmo-implementation-update-where-is-cms/
https://www.rd.com/health/conditions/save-money-fighting-hidden-hospital-policy/ see more
The Center encourages Medicare beneficiaries and their families to appeal unfair “Improvement Standard” denials, even though Medicare patients "and their families should not be in a position of having to educate providers, contractors, and adjudicators about Medicare policy."
They advise patients "and their families to continue citing to the Jimmo Settlement and related materials when challenging denials."
But the most effective way to avoid the need to fight a Medicare appeals (which is not likely to succeed) is to engage the physicians and caseworkers before the time they must make a decision to terminate their Medicare billing.
A Geriatric Care Manager or Advocate who understands the patient's needs, the medical providers, and their billing practices, gives you the best chance to gather the facts needed to continue care paid by Medicare. Hire the advocate as soon as the patient is in the hospital, before being discharged to a facility, and you give yourself the best chance to better results.
These professional Advocates are privately paid by the patient. But the cost is worth the benefit of having an objective advocate working alongside you and your family.
https://www.medicareadvocacy.org/jimmo-implementation-update-where-is-cms/
https://www.rd.com/health/conditions/save-money-fighting-hidden-hospital-policy/ see more
Question
Need advice when dealing with elder care lawyers....
Your explain how you have met with several Elder Law Attorneys, and end up feeling even more confused than when you first asked for advice... Your explain how you have met with several Elder Law Attorneys, and end up feeling even more confused than when you first asked for advice about what to do next for your father.
When providing a client with the technical legal information needed to make long-term care decisions, the view of the Elder Law Attorney is toward protecting quality of life with the assets and resources that are available.
Try approaching your advisors with definite statements about what you have decided to do next. Decision making is difficult in the midst of declining health. Try to give the advisor a definite understanding of what you and your family want to do.
If you have decided to move your father to assisted living, the Elder Law Attorney can determine the deficit between the monthly rent and your parents' monthly income.
If you have decided to sell the house, consultation with a Real Estate Broker can determine how much the market will give you in sale proceeds. That can provide basis for a projection of how long the money will last to cover the monthly deficits.
You mentioned that you are a remainder owner of the property. That fact can determine whether, or how much, capital gains tax must be paid on the sale proceeds. Have the Elder Law Attorney advise you on the real estate closing. It may still be possible to get a full Principal Residence Exclusion from any capital gain if you rearrange the ownership of the house before it is sold.
Elder Law Attorneys must be able to understand the progressing care needs of clients. Without this perspective, Medicaid planning and efforts to protect or set aside assets are, at best, incomplete.
At worst, asset-protection advice without a sound understanding of clients' needs can cause the family to misunderstand how financial resources and care programs in your state can be coordinated to prevent a nursing home admission.
https://www.irs.gov/pub/irs-pdf/p523.pdf
26 U.S. Code § 121.Exclusion of gain from sale of principal residence
https://www.law.cornell.edu/uscode/text/26/121 see more
When providing a client with the technical legal information needed to make long-term care decisions, the view of the Elder Law Attorney is toward protecting quality of life with the assets and resources that are available.
Try approaching your advisors with definite statements about what you have decided to do next. Decision making is difficult in the midst of declining health. Try to give the advisor a definite understanding of what you and your family want to do.
If you have decided to move your father to assisted living, the Elder Law Attorney can determine the deficit between the monthly rent and your parents' monthly income.
If you have decided to sell the house, consultation with a Real Estate Broker can determine how much the market will give you in sale proceeds. That can provide basis for a projection of how long the money will last to cover the monthly deficits.
You mentioned that you are a remainder owner of the property. That fact can determine whether, or how much, capital gains tax must be paid on the sale proceeds. Have the Elder Law Attorney advise you on the real estate closing. It may still be possible to get a full Principal Residence Exclusion from any capital gain if you rearrange the ownership of the house before it is sold.
Elder Law Attorneys must be able to understand the progressing care needs of clients. Without this perspective, Medicaid planning and efforts to protect or set aside assets are, at best, incomplete.
At worst, asset-protection advice without a sound understanding of clients' needs can cause the family to misunderstand how financial resources and care programs in your state can be coordinated to prevent a nursing home admission.
https://www.irs.gov/pub/irs-pdf/p523.pdf
26 U.S. Code § 121.Exclusion of gain from sale of principal residence
https://www.law.cornell.edu/uscode/text/26/121 see more
Question
Has anyone hired private caregivers "under the table" and if so, how did it work out? What advice would you h...
If you plan to hire caregivers yourself, you’ll need to understand: 1 - Your state’s wage and hour laws and the federal Fair Labor... If you plan to hire caregivers yourself, you’ll need to understand:
1 - Your state’s wage and hour laws and the federal Fair Labor Standards Act regulations issued by the U.S. Department of Labor;
2- IRS and your state’s income tax reporting and withholding requirements; and
3 - Reasons why you must protect yourself and your in-laws, and their caregiver, with unemployment insurance and workers’ compensation coverage.
Domestic workers are household employees, not independent contractors. The employer must withhold the employee’s Social Security and Medicare contributions and pay a matching portion. At the end of the year, the employer is responsible to provide their employee with a Form W-2 reporting wages paid and taxes withheld.
Violations of the FLSA can surface when the IRS or your state's Department of Revenue catches a family’s failure to file employment taxes. You may find an ideal caregiver, who assures you she will take care of taxes on her own, using a Form 1099 issued by a family member.
But when the caregiver goes to her accountant the following year, he may say she was mis-classified as an Independent Contractor, and then file a Form 8919, which reports the individual’s share of uncollected Social Security and Medicare taxes. The Form 8919 gives the caregiver credit for Social Security quarters corresponding to her wages and names the family member as the responsible employer.
This is only one of the risks that you take if you decide to hire "under the table."
An Elder Law Attorney and/or accountant in your state can help you spot the issues. There are also nationally recognized online payroll services that help people comply with the wage and hour laws governing caregiver employees. see more
1 - Your state’s wage and hour laws and the federal Fair Labor Standards Act regulations issued by the U.S. Department of Labor;
2- IRS and your state’s income tax reporting and withholding requirements; and
3 - Reasons why you must protect yourself and your in-laws, and their caregiver, with unemployment insurance and workers’ compensation coverage.
Domestic workers are household employees, not independent contractors. The employer must withhold the employee’s Social Security and Medicare contributions and pay a matching portion. At the end of the year, the employer is responsible to provide their employee with a Form W-2 reporting wages paid and taxes withheld.
Violations of the FLSA can surface when the IRS or your state's Department of Revenue catches a family’s failure to file employment taxes. You may find an ideal caregiver, who assures you she will take care of taxes on her own, using a Form 1099 issued by a family member.
But when the caregiver goes to her accountant the following year, he may say she was mis-classified as an Independent Contractor, and then file a Form 8919, which reports the individual’s share of uncollected Social Security and Medicare taxes. The Form 8919 gives the caregiver credit for Social Security quarters corresponding to her wages and names the family member as the responsible employer.
This is only one of the risks that you take if you decide to hire "under the table."
An Elder Law Attorney and/or accountant in your state can help you spot the issues. There are also nationally recognized online payroll services that help people comply with the wage and hour laws governing caregiver employees. see more
Both parents with varying degrees of dementia live with my husband and myself now. Any advice about lookback?
Make it easy on yourself by talking with an Elder Law Attorney in your state who can show you how to make all the payments from your parents' funds conform to what a Medicaid case worker will expect to see when the time comes to apply for benefits.
If you invest the time and money needed now for Medicaid care planning, you won't be in panic mode if time runs out on your ability to provide at home care for one or both of your parents.
A written caregiver contract and rental agreement, documented with receipts for supplies and itemization of services you provide during the lookback period, are the foundation for a successful application.
You can't expect the Medicaid case worker to approve a retrospective agreement with disjointed records that are difficult to understand. see more