216-346-7002 BG@BradleyGreene.com

No more Medicaid spend down: What does this mean for me?

by | Jul 1, 2016 | Cleveland, Elder Law, Medicaid Planning

As of August 1st 2016 there are several changes taking place in the state of Ohio’s Medicaid application and eligibility procedures. These changes are intended to simplify the Medicaid administration process, but according to the Ohio Association of Area Agencies on Aging there may be complications and even loss of benefits for some individuals. One of the biggest changes is the elimination of a “spend down” provision that has allowed many Ohioans to deduct health care expenses from their income in order to qualify for benefits.
For example, Jane Smith has a monthly income of $2,699 which is $500 above the 2016 Ohio income limit for Medicaid health coverage. Jane currently provides receipts for $500 a month of medication and medical supplies – which are deducted from her income, placing her below the State of Ohio’s $2,199 income limit.  After her “spend down” Jane is eligible for Medicaid coverage and then has 100% coverage for a home health aide through Medicaid’s PASSPORT program (also applies to waiver Ohio Home Care services, nursing home care and Medicaid assisted living coverage).
As of August 1st, with the elimination of the “spend down” criteria Jane will have to set up a Qualified Income Trust (QIT) in order to continue receiving Medicaid PASSPORT services. Her $500 of excess income must be placed in a QIT (sometimes called a “Miller Trust”) to be used only for health care expenses.
According to the Ohio Benefits government website, “Individuals may apply certain deductions to [QIT] funds, and the remaining amount in the trust is paid to the institution or health care providers. On a monthly basis, QIT funds pay for the cost of care, and Medicaid pays for the care not funded by the trust. Upon the recipient’s death, any and all funds remaining in the QIT, up to the total cost of care, are paid to Medicaid.”
The state of Ohio estimates that almost 9,000 nursing home and community residents who are currently on Medicaid will need to establish a QIT in order to continue receiving benefits. This simple online quiz can help you determine if you or a family member fall into this group. Each situation is unique, so if you are unsure about how your current or future benefits will be impacted by these upcoming changes, please call our offices. We are happy to answer general questions and can also help set up a simple QIT trust if necessary.
Please continue to follow us online for more updates on the impending Medicaid changes, and thank you for sharing this information with anyone who might be helped by it.

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Phone:

216-346-7002

Fax:

216-381-3865

Location:

5001 Mayfield Rd.
Suite 201
Lyndhurst, OH 44124
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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.
 

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.

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.
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