216-346-7002 BG@BradleyGreene.com

Guide to Paying for Long Term Care

by | Aug 5, 2016 | Aging, Cleveland, Elder Law, Life Care Planning, Medicaid Planning

Estate-planning-attorney-beachwood-ohio
Long term care is expensive.

According to the Ohio Department of Medicaid, the average rate for a semi-private nursing home room in the state of Ohio is more than $6,300 per month. Our current estimates for Cleveland and surrounding communities is closer to $9,000 per month, and these costs are expected to increase by at least 25% in the next ten years.

Factors such as age, health status, income level, family dynamics and geographic location all impact the cost of senior care. In some situations, such as recovery from surgery or accident, short term nursing home care may be covered by Medicare or your private health insurance. But care that goes beyond short-term recovery does not fall under this benefit. So how do people pay for long term care?
Out of Pocket: Very few people are in a position to pay privately for extended nursing home care. Based on the monthly estimates mentioned above, it would cost approximately $100K for one year of care in a Cleveland-area facility. The average length of stay in a nursing home is just over two years, but progressive illnesses such as dementia often involve long term care of five years or more. Even if you think you might have enough savings and investments to cover the full cost of such care, we still suggest talking to a qualified professional who can help guide you through the process and ensure that your assets and financial future are secure.
Long Term Care Insurance: Over the last 20 years, Long Term Care Insurance has become a popular option for those who anticipate they may need care in the future. Typically, the policy will pay a daily rate for home care, assisted living or long term care based on a number of factors that differ with each plan. These policies are most cost effective when purchased at a young age, as premiums increase the older you get. And high premiums don’t always ensure that a plan will cover the entire cost of long term care.
For example, if you have Social Security income of $2000 per month and your policy pays $100 per day ($3000/month), this equals a total of $5000 per month to cover care expenses. If the cost of care is $9,000 per month, then your family could be left with the responsibility of paying the remaining $4000 in care expenses, unless you have other assets to cover the shortfall.
Medicaid Spend Down: While Medicaid accounts for the largest percentage of payments to long term care facilities, most patients do not immediately qualify for Medicaid coverage. In order to qualify for Medicaid, recipients must pay for care and other qualifying expenses out-of-pocket until their assets reach below each state’s eligibility amount.  Factors to be considered include marital status, real estate, life insurance policies, business relationships, investments, etc. But once Medicaid is in place, you do not have to cover any shortfall between your income and the total cost of care.
Trusts: Whether you want to plan for the future, protect a disabled child or protect assets from long-term care costs – there are a number of legal ways to ensure that your family’s needs are provided for now and in the future. By transferring assets into a trust, families can maintain flexible control of assets on behalf of an older adult or someone with a disability. There are also specific kinds of trusts that can be established to help pay for the cost of long term care. Medicaid Pooled Trusts and Charitable Remainder Trusts are two examples of this.

What's the difference between Medicare and Medicaid?

by | Jun 24, 2016 | Elder Law, Life Care Planning, Medicaid Planning, Medicare

The world of health insurance is a complex one, even for those of us who work in it every day. So it’s no surprise that many seniors and their adult children struggle to make sense of all their insurance options. It can be overwhelming to try and determine what services are covered and what coverage you are eligible for. Two of the most frequently confused programs are Medicare and Medicaid. In fact, some people aren’t even sure which one they have!
The following information should clarify several major differences between the two programs and help you understand when/how/if you may be eligible for benefits.
Medicare is a national health insurance for Americans over the age of 65 and the disabled. This is intended to pay for standard medical care and short term nursing care or rehabilitation. This is a federally funded program and benefits are the same for everyone (based on which Medicare plan you are registered for) regardless of what state you live in.  Medicare DOES NOT cover the cost of long term, custodial, residential, extended nursing home or assisted living care.  The video below explains in more detail each type of Medicare coverage and you can review options here for how to select care based on each person’s needs and finances.
Medicaid is a cooperatively administered health insurance program supported by both federal and state funding. The guidelines and benefits for Medicaid will differ depending on where you live. In the state of Ohio, Medicaid insurance covers nursing home, assisted living and long term care for seniors and disabled adults or children. In order to be eligible for Medicaid in the state of Ohio, a senior has to demonstrate an ongoing need for medical care or health care services in which the costs exceed his/her income.
Medicaid is not a guaranteed benefit. You have to qualify and apply for coverage based on income and assets. In some situations, such as when one spouse stays in the community, you do not have to exhaust all of your financial resources in order to apply for Medicaid. Planning ahead with the assistance of a qualified Elder Care attorney can make completing a Medicaid application easier when the time comes.
For more information about Trusts and Estate Planning or for assistance with a Medicaid application. Please contact our offices. For more information about your Medicare options, please visit Medicare.gov or contact one of our Care Coordinators who can direct you to local resources.

Contact Us

Phone:

216-346-7002

Fax:

216-381-3865

Location:

5001 Mayfield Rd.
Suite 201
Lyndhurst, OH 44124
MAP AND DIRECTIONS

 



(By Appointment Only)

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

Power of Attorney: The Legal Basics and Why Everyone Needs One

by | Apr 27, 2016 | Aging, Cleveland, Elder Law, Life Care Planning, Medicaid Planning

What’s the difference between a POA, DPOA, and HCPOA?
And what about a Living Will – do I need one of those too?

Many people assume that determining how your assets will be managed after death is the most important legal decision you need to make. But at BLG, we believe that identifying who you trust to handle financial and health care decision-making on your behalf in the event of illness or injury is equally if not more important.
Technically, the state you live in already has a plan in place for the distribution of assets in the event of your death. But if you become sick or incapacitated, even temporarily, your family may not be able to access the information they need to make health care decisions, pay your bills or apply for public benefits.
Having a Durable Power of Attorney (DPOA) and Health Care Power of Attorney (HCPOA) ensures that your values and best interest are supported by the person (or agent) you have designated to handle specific legal, health and financial responsibilities.
The following guidelines offer a brief overview of each document, along with the answers to frequently asked questions:
Power of Attorney or POA – A legal document, signed by a competent adult, giving authority and permission for a trusted family member or other agent to manage specific decision making on their behalf. Health care and legal/financial are the two primary types of POAs. You can also designate secondary agents, who can assume responsibility if the primary agent is unable to fulfill his/her duties.
Durable Power of Attorney or DPOA – The word Durable means that the authority granted to a POA agent will continue in the event of incapacity or incompetence. This is especially important for children who want to help with an aging parent’s finances and is required for the Medicaid application process. Many POAs are drafted with limited powers, which can make the planning process difficult or impossible. A Financial POA should give your agent broad authority to do all the things that you can do.
Health Care Power of Attorney or HCPOA – This document outlines who can have access to health care information about you and who you trust to make decisions if you are unable to for any reason.  Your HCPOA should also include a HIPPA release clause. This authorizes providers to release protected health information such as test results, medical records, etc.  Facilities often ask to keep a copy of the HCPOA on file, and they may also ask for a Living Will.
Living Will – This is a signed legal document outlining what your wishes are regarding medical care if you are no longer able to give informed consent.  Our HCPOA document includes this language in it, outlining what each client’s wishes are regarding life sustaining measures and end of life care. This can ensure that your family and care providers have a clear sense of what your values and priorities are.
Once you have these important legal documents in place, we encourage you to talk with each person who might be involved in future decision making and, if you trust them implicitly, provide them with a copy of the documents. It’s especially important for family members to be aware of any Advanced Directives and know where to locate them, so that if an emergency occurs they feel confident making decisions.
Our professionally licensed counselors are available to help guide you through these discussions. And for additional peace of mind, ask about creating a Life Care Plan to receive ongoing support and guidance throughout all of life’s transitions. This includes helping you decide which benefits and providers are best for your needs and planning ahead whenever possible. For more information, please email BG@bradleygreene.com or call 216-575-5200.
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.

4 Essential Questions to Ask Your Aging Parent

by | Apr 15, 2016 | Aging, Cleveland, Elder Law, Life Care Planning, Medicaid Planning

Many people put off asking about their parents’ financial and legal affairs until faced with crisis – such as an unexpected illness or the death of a loved one. Too often, children find themselves sitting in a hospital room with a busy social worker, forced to make important, life-changing decisions without having all the information they need. Do they have Long-Term Care Insurance? A Living Will? Who is Power of Attorney? Where can they afford to go for rehabilitation if home is not an option? Where do they keep their checkbook and is anyone else listed on the account?
Whether you are an aging parent or the child of one, the 4 questions below will help you prepare ahead of time for inevitable life-changes and the decisions that come with them.  Having the conversation early, before you need it, will alleviate stress and empower your family with information. Then, if something happens, they can focus on more important things, like spending time with you and supporting each other.

  1. Do you have advanced directives? This includes Power of Attorney forms, a Health Care Proxy, Living Will, a Life Care Plan, etc. These documents are the first thing medical professionals will ask for when sharing health care information or if any medical decisions need to be made. Whether it’s as simple as sharing test results or as complex as making a decision about heroic measures, having these documents allows family members and care providers to act with confidence, knowing they are following Mom or Dad’s wishes.
  1. Do you have a financial advisor or attorney? Knowing who manages accounts and where documents are filed can make things much simpler if/when your family needs to access information. Even just having the contact information on file can save time and energy during stressful moments. This is also important so  you can feel confident that the person who is offering legal and financial advice is a reputable provider.
  1. Where do you keep important papers? Now, I know that we don’t all keep everything neatly filed in fire-safe boxes, alphabetized and cross-referenced by date. Most people have a specific file-folder, drawer or filing cabinet where this information is kept. And if not, then asking this question will help you realize how scattered the details are and something can be done to change that. This should include all of the following documents: birth certificate, marriage license, divorce paperwork, copy of driver’s license, social security card and military records, insurance paperwork. You can also download a copy of our BLG Essential Documents Checklist, to help you get started.
  1. If there ever comes a time when you can’t live safely at home, have you thought about where you would choose to live? One of the hardest decisions for families to make occurs when a loved one needs rehabilitation or long-term care. Some parents are willing to explore options ahead of time and can let you know what their wishes are. You can even reserve space prior to need, or get on a waiting list (sometimes up to five years) at a desirable senior apartment complex or assisted living facility. Parents: Sometimes just telling your adult children, “I don’t expect you to take care of me at home” can provide tremendous relief from guilt, if they ever need to choose an assisted living or nursing home on your behalf. And if you can’t say that your loved (or you) would be willing to move out of your own home, then it’s even more important to have your financial affairs in order. There are a variety of supportive services available to help seniors stay at home and independent for as long as possible, and there may even be benefits available to help pay for them.  By planning ahead and sharing financial/legal information with family and caregivers, you can minimize future stress and ensure that you will have the most options for care if/when the time comes.

CLICK HERE to DOWNLOAD a copy of the BLG Essential Documents Checklist to get started today.
#TipForToughTalks