216-346-7002 BG@BradleyGreene.com

Do I need an attorney to apply for Medicaid?

by | Jul 22, 2016 | Aging, Cleveland, Elder Law, Medicaid Planning

If you or a loved one are applying for Medicaid assistance to help pay for a nursing home stay or long term care, consulting an experienced elder law attorney can help you avoid undue stress and ensure that your family’s assets are managed properly.
Medicaid laws are complicated and with upcoming administrative changes in the state of Ohio – the application process is likely to become even more complex and time consuming in the months following these transitions. Below is a list of five common scenarios in which we often provide support and guidance to our clients.

  1. Real Estate: Not everyone needs to sell their house in order to apply for Medicaid. A community spouse or other qualified family members may be able to remain in your home – there are very specific rules and scenarios around this asset determination.
  2. Married Couples: Often, one spouse requires nursing home care while their loved one stays in their home or apartment. Our guidance can help ensure that assets are divided properly and that the needs of both spouses are met, while the community spouse has as much financial security as possible.
  3. Asset Protection: Very few people qualify immediately for nursing home Medicaid coverage. Most middle-class individuals who need long term care will have to spend down some assets in order to qualify. Medicaid law allows for certain “exempt” assets that do not have to be included in this spend-down.  An attorney can help you make informed decisions about how to spend resources and while keeping the best interest of your family in mind.
  4. Transfer of Assets: Medicaid looks back and reviews any transfer of funds in the five year period prior to application. Planning ahead can ensure that any transfers are proper and allowable – so that future Medicaid applications are not impacted by periods of ineligibility. There are a number of strategies for doing this, but laws are complex and differ in each state. Consulting a legal advisor who is well-versed in the Medicaid laws for your state can ensure that your decision now don’t impact your future security.
  5. Business Ownership: Current or past business relationships, including partnerships, shareholdings and business investments have to be fully disclosed during Medicaid application. This can complicate and delay the application process. A qualified elder law attorney can guide you through the process of reviewing state records and asset valuation to ensure that all legal requirements are met prior to application.

Bradley L. Greene, Esq. is a Life Care Planning and Elder Law firm located in Beachwood, OH specializing in Estate Planning, Medicaid Planning and Elder Abuse – offering personalized support and family guidance through all of life’s transitions.
 
 
 

Contact Us

Phone:

216-346-7002

Fax:

216-381-3865

Location:

5001 Mayfield Rd.
Suite 201
Lyndhurst, OH 44124
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What is a Continuing Care Retirement Community?

by | Jun 16, 2016 | Aging, Cleveland, Elder Law, Life Care Planning, Medicaid Planning, Medicare

Aging in Place: A person can spend the rest of his life in a Continuing Care Retirement Community, moving between levels of care as needed. Continuing care retirement communities are retirement communities with accommodations for independent living, assisted living, and nursing home care, offering residents a continuum of care. 

With all of the options in senior living, it can be overwhelming to decide what type of care is best for you or a loved one. From nursing homes to assisted living and senior apartments – there are many different levels of care to choose from and not all retirement communities offer the same variety of services and support.
The main thing that distinguishes a Continuing Care Retirement Community from a traditional nursing home or assisted living facility is that they provide multiple levels of care at one geographic location. This typically includes long term care, skilled nursing care, assisted living and senior apartments. Some communities also have private homes or condos on the same campus for truly independent living within the larger retirement community.
There are a couple of situations in which this type of setting is ideal for our clients:

  • For married couples in which one spouse is healthy and independent while the other person requires nursing care. Each person might receive different levels of support within the same community.
  • If you/your loved one requires more care in the future, they can stay within the same care system and be cared for by familiar staff. This is particularly helpful when rehabilitation is necessary – residents can go to the skilled nursing unit for therapy, or a brief stay and then return to assisted living or senior apartment afterwards. Residents of the community often get priority placement in facilities where a rehabilitation bed might be hard to come by.
  • In cases of dementia, this limits the need to introduce your loved one to a completely new place and entirely new staff if/when dementia progresses. Moving within the same community might involve less of an adjustment than moving to an entirely new facility.

It may also be easier for you/your loved one to receive additional care and services in a senior apartment (and stay there longer) if you live within a system that has a lot of services for residents with higher needs. For example, you might be able to have meals delivered because they are connected with a full service kitchen, etc. Or therapy services can be provided in independent apartment by staff from the Occupational and Physical therapy departments.
Like other residential care settings, there are a variety of ways to pay for the services and support of Continuing Care Retirement Communities. Some services on a private pay basis, while long term care insurance, Medicare and Medicaid may pay for others. Often, there may be wait lists for senior apartments in these type of desirable communities – so planning ahead can be helpful. Some of our clients place their name on a wait list long before they plan to move, even years ahead of time.
For additional information about Cleveland area Continuing Care Retirement Communities, please contact our Care Coordinators. We are happy to provide support and guidance through each stage of the search and decision making process and help you determine the best plan for your personal needs and financial situation.
 

Care for the Caregiver: Recognizing Caregiver Stress

by | Jun 9, 2016 | Aging, Cleveland, Elder Law, Life Care Planning

Do you spend time regularly helping a loved one manage medications, shop, prepare meals and get to doctor appointments? Often, people who provide this kind of unpaid assistance with daily living and medical tasks don’t consider themselves a caregiver. You might think, “I’m just doing what any good son/daughter/spouse/friend would do.”  But according to research, this kind of support holds tremendous value to the American health care system (estimated at $470 billion in 2013) while the long-term emotional, physical and financial implications for those providing the care often gets overlooked.
Many people who provide assistance to aging loved ones have no training or outside support for a role that often becomes increasingly difficult over time. This can have a negative impact on the caregiver’s well-being and often influences the decision to place a loved one in long-term care. This is why our Care Coordinators often tell clients, “The #1 Rule of Caregiving is to take care of yourself first.” Or as the flight attendants like to say, “Put on your own oxygen mask first.”
If a caregiver ignores all of his/her own needs to focus on a loved one, then the well-being of both people are compromised.  The stress of daily caregiving and the financial strain of lost work time can also lead to higher incidences of depression, anxiety, substance abuse and physical illness among caregivers. But thankfully, many of these risk-factors can be decreased or avoided just by noticing the warning signs and seeking out help from experienced professionals.
Caregiver StressWith shorter hospital stays and increased home care technology, the need for informal caregiving will only continue to increase. Procedures like IV medications and outpatient surgery, that used to require a hospital stay and extended nursing care, are now being provided in the community with minimal support from professional staff.  Family members often find themselves doing things they never imagined possible (though often quite well) and don’t know where to turn for guidance and support.
If you or someone you know is in this situation, contact our Care Coordinators who can help you identify the right agencies and services based on your needs. There are a variety of local, state-wide and national programs targeted specifically to caregiver support. Financial assistance is also available in some situations.
You can also visit the following websites for additional information/resources:
Western Reserve Area Agency on Aging Caregiver Support Program
Ohio Department of Aging National Caregiver Support Program

Protecting Seniors from an Increase in Financial Scams

by | May 25, 2016 | Aging, Cleveland, Elder Law

According to a recent Cleveland.com article the incidence of IRS scams across the country is higher than ever before. In fact, a a member of the BLG team recently received an early morning phone call from someone threatening legal action unless she arranged immediate payment of an overdue tax bill. The time of day and anonymous caller ID made her suspicious, so she promptly hung up and did some online research to confirm it was a common scam. But the incident left her feeling unsettled and vulnerable. In a situation like this, it’s easy to imagine how vulnerable, law-abiding senior citizens could be frightened enough to hand over their personal information.
According to a MetLife survey, crimes against the elderly skyrocketed in the last year, and seniors lost $3 billion to criminals through home repair scams, investment scams, and other cons targeting older people. Senior-citizens are particularly at risk for financial scams, and the methods criminals use to target victims are becoming more and more sophisticated. The Consumer Financial Protection Bureau has even established guidelines encouraging banks to institute employee training programs and install software geared toward identifying risk and protecting seniors. This article outlines what Cleveland area banks are doing to comply.
Information is power. So the team at Bradley Greene, Elder Law is committed to sharing current news and resources with our clients and family members to help you avoid some of the most common ways that seniors are targeted. Please don’t hesitate to contact our offices directly if you suspect your loved one has become victim to any of the following crimes or any form of financial abuse:
IRS scams
From email scams leading employers to accidentally release w-2 information to fraudsters and phone call scams that threaten legal action if your “IRS debts” are not immediately paid – please keep in mind that the Internal Revenue Service will never conduct initial contact by phone or email and would never unexpectedly threaten imprisonment. If you receive a surprise phone call (or email message) claiming to be from the IRS, hang up (do not reply) and call your local IRS office if you are still concerned about the issue.
Grandparent scams
The victim receives an upsetting phone call from someone claiming to be a grandchild stranded overseas, asking for money to safely get home. Often the caller sounds young, upset and uses endearing statements such as, “Hi Grandma, please don’t tell my parents.” Well-meaning grandparents have lost thousands of dollars to scammers through hasty wire transfers, so please be aware and be cautious about such call. When in doubt, check it out. Ask the caller a question that only your family member would know the answer to.
Identity Theft
This occurs when a criminal uses someone’s personal information such as account numbers, credit cards or social security number to apply for credit or purchase goods fraudulently. Whether you’re trusting a caregiver who provides services in your home or a friendly neighbor, it’s important to never give out this type of personal information unless necessary.
To Learn More
The Ohio Attorney General’s Office provides a list of other common scams affecting seniors and additional information for how to protect yourself through their website here. You can also request a copy of their scam resource packet or report a potential scam by contacting the Ohio Attorney General’s Office at 800-282- 0515.

Medicare Demystified: Understanding Observation Status

by | May 12, 2016 | Aging, Cleveland, Elder Law, Medicare

Over the last several years, many unsuspecting seniors and disabled persons have been opening the mail to receive large bills for health care procedures and medications they assumed were covered during a recent hospital stay. Even worse, some patients have transferred to rehab after a hospital stay only to find out their skilled nursing care wasn’t going to be covered and they would be billed at a cost of over $400 per day for care they needed to recover from an illness or injury.
These situations are both a result of a technical, financial loophole in Medicare billing called “Observation Status” – and thankfully, as of August 2016 hospitals will be required to notify patients in writing if their stay is not going to be covered, so there should be less surprises in the mailbox.
But that doesn’t make the billing issue any easier to understand, and it doesn’t ensure that people who need hospital care will be able to afford it. Here are a few of the key points you need to know about Observation Billing, Medicare Part A/B coverage and Skilled Nursing Rehabilitation.
Outpatient Services – Covered under Medicare Part B (Outpatient Insurance) includes medical services that are typically performed in the community such as doctor visits, lab work, x-rays and some home health care.
Observation Status – If the hospital determines that they are “watching you” overnight or collecting information to determine an accurate care plan and diagnosis, then you are probably being admitted under “Observation Status.” This means that any medications and services provided for pre-existing conditions will likely be billed under Medicare Part B, probably at a much higher rate than anything you would pay if you were getting those same meds from a local pharmacy.
Inpatient Hospital Services – Covered under Medicare Part A (Hospital Insurance) and includes all hospital services, including semi-private rooms, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies. This includes the care you get in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, long-term acute care hospitals.
Qualifying Stay – This is the Medicare requirement that says in order for someone to have Skilled Nursing Facility (SNF) rehabilitation covered under Medicare Part A, he/she must be admitted to an INPATIENT hospital bed at midnight for three nights in a row. The tricky part is that if the hospital is billing your stay as OBSERVATION status, then you don’t qualify for the SNF benefit coverage.
How to reduce the costs of care:

  • If you are being admitted under observation status, ask the hospital staff if you can bring in medications from home. Cleveland Clinic and University Hospitals both have policies in place regarding this process. This can drastically reduce the expense of Outpatient/Observation Care because medication is often the highest part of bills that patients receive.
  • You also have a right to question your bill. Errors are not uncommon, and rates are often negotiable for patients who are willing to pay their bill in full. Don’t hesitate to contact our Care Coordinators if you need help navigating this process.
  • Finally, if you need rehab, but a SNF stay isn’t going to be covered, consider going to assisted living or supportive senior apartments where there is staff to help you. The cost of these will be lower than paying privately for a bed at rehab facility. Your doctor can then order Home Care services for nursing care, home health aides and physical and occupational therapy which can be billed under Medicare Part B at a much lower out-of-pocket cost that nursing home care.

There is still much work that needs to be done in order to avoid burdening seniors with the expense of care under the current Medicare guidelines and legislation has been put forth by Senator Sherrod Brown that would allow Observation Status to be considered a qualifying hospital stay for skilled rehab benefits. He presented this bill with the support of many Cleveland-area hospitals and nursing homes including Cleveland Metrohealth and Menorah Park, but the Improving Access to Medicare Coverage Act has not received the congressional support it needs to become law.
 

Tips for Communicating with Nursing Home and Assisted Living Staff

by | May 4, 2016 | Aging, Cleveland, Elder Law, Medicaid Planning

Tip 2Trusting other people with the care of a loved one can be an emotionally difficult journey, and it’s important to feel comfortable addressing any concerns that come up along the way. The following strategies can help you keep the lines of communication open and determine if/when an issue is serious enough for genuine concern.
EXPECT A PERIOD OF ADJUSTMENT
Minor challenges and misunderstandings are an inevitable part of any residential care setting. Especially during the first few months, as the staff gets to know your loved one and you become familiar with the culture of the community. Whenever possible, we encourage families to visit facilities and consider all of your options long before you need care. Many places have a wait list of a year or more, and you can use this time to touch base regularly with the admissions staff, developing a connection that will make things easier when it’s time to move.
GET SOCIAL
Become an involved part of the community and get to know the staff who are providing care and services. Try to visit at different times of day and check in at the front desk or nursing station each time you visit. Make a point to learn the names and roles of as many care providers as possible, expressing appreciation and personal interest in them. These connections will create a network of people who you can depend on for information, support and assistance as you navigate your loved one’s care needs.
SHOW UP FOR MEETINGS
Plan of Care meetings are typically scheduled at least once every three months to review each resident’s physical, social, emotional, spiritual and dietary needs. A representative from each department will be present to provide updates on care and adjust their plans as needed, with your input. Some families find it helpful to keep notes between meetings about any minor issues or concerns and then talk about everything at this time. Even if it seems that nothing has changed since the last meeting, this is still an important time to connect with staff and strengthen your partnership.
GO TO THE SOURCE
Whenever possible, unless there is an issue of safety, try to ask questions and address minor concerns with the person who is directly involved in that aspect of care. For example, instead of going to the nursing supervisor when you’re unhappy with how your loved one is dressed or the upkeep of her clothing – ask the nursing assistant or laundry aide what they recommend to help keep clothing more organized and see if they can suggest anything to resolve the issue.
KNOW WHEN TO ESCALATE A CONCERN
Naturally, we all wish that everyone would provide our loved ones with the same level of care attention we would give them at home. While this may not always be possible, most issues can be easily resolved with a direct conversation and a collaborative spirit. It is reasonable to expect that your loved is treated with dignity and respect, while being kept safe at all times.
Any time a resident’s safety is at risk – the appropriate response is to bring the issue to the attention of the Administrator and/or Director of Nursing immediately. These concerns must always be taken seriously, and if you do not feel confident about how an issue is resolved, there are methods in place to help advocate for your loved one. Phone numbers for the Long Term Care Ombudsman and the Department of Health should be readily accessible in all facilities.  You can also contact our experienced Care Coordinators to help you assess the situation, ensure your loved one’s safety and determine if/when additional action is appropriate.
WRITE IT DOWN
Whenever possible, keep a record of any significant events, questions or concerns regarding your family member. This could be as simple as putting a quick note on your calendar, but we suggest keeping a notebook or folder dedicated specifically to your loved one’s care. One way this can be helpful is to offer perspective on situations – while it may seem like your parent is losing a lot of weight, maybe the notes will indicate it hasn’t been as much as you thought. Or if any concerns do need addressed with facility staff, your records can
provide valuable information to substantiate your concerns.
KEEPING PERSPECTIVE
Thankfully, most people who care for the elderly are genuinely kind and have good intentions for the services they provide. And most problems can be resolved with a little patience, flexibility and honest dialogue. Developing a trusting relationship with caregivers can take time, but is always worth the effort. We hope the strategies above are helpful as you navigate all the decisions and conversations that are ahead for your family.
At the Life Care Planning and Elder Law office of Bradley L. Greene, Esq., our clients’ quality of life is our first priority, and we strive to ensure safety and peace of mind for both you and your loved ones. Please don’t hesitate to reach out if you need assistance in any way. We have experienced many of these caregiving obstacles firsthand, which underscores our commitment to helping support other families through every stage of the process.
Bradley L. Greene, Esq. is a Life Care Planning and Elder Law firm located in Beachwood, OH specializing in Estate Planning, Medicaid Planning and Elder Abuse – offering personalized support and family guidance through all of life’s transitions.