Today’s Elder Care Question on ElderCareMatters.com is: “What is the purpose of a Special Needs Trust?”

Question: What is the purpose of a Special Needs Trust?

Answer: While you can certainly bequest money and assets to those with special needs, such a bequest may prevent them from qualifying for essential benefits under the Supplemental Security Income (SSI) and Medicaid programs. However, public monetary benefits provide only for the bare necessities such as food, housing and clothing. As you can imagine, these limited benefits will not provide your loved ones with the resources that would allow them to enjoy a richer quality of life. Fortunately, the government has established rules allowing assets to be held in trust, called a Special Needs or Supplemental Needs Trust for the benefit of a recipient of SSI and Medicaid, as long as certain requirements are met.

To find additional information about a wide range of Elder Care Matters, go to: www.ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Professionals.

James J. Ruggiero, Jr., Esq., An ElderCare Matters Partner
James J. Ruggiero, Jr., Esq.
Ruggiero Law Offices, LLC
An ElderCare Matters Partner


Today’s Question of the Day on ElderCareMatters.com is “What long term care benefits does the VA pay for?”

Question:  What long term care benefits does the VA pay for?

Answer:  The VA has a benefit called the Veteran’s Improved Pension, commonly known as the VA Aid & Attendance Benefit.  In order to qualify for the Veteran’s Pension Benefit, the veteran must not have been dishonorably discharged, must have served at least 90 days active duty with at least one day served during a declared state of war, and must be either disabled or over age 65.  Widows of veterans may also qualify.  Applicants must meet certain income and asset limitations to qualify, and they must need assistance with Activities of Daily Living (ADLs) such as eating, bathing, and dressing.  This benefit can help married veterans may qualify for up to $24,239 of tax free assistance annually.  This money can be used to cover the costs of care in the home, in an assisted living community, or in a nursing home. 

If you think that you or a loved one might qualify for benefits, the next step would be to enlist the service and advice of an experienced Veterans Administration Accredited attorney who understands the Pension Benefit, as well as Medicaid planning rules and other estate planning issues.  Advisors such as a VA accredited attorney and a knowledgeable, experienced financial planner can help veteran households rearrange assets, make legally effective transfers, and assist with other estate planning needs in order to qualify a veteran household for a pension benefit.  It is extremely important that you involve an attorney who has experience with Medicaid planning if you plan on moving or otherwise rearranging assets in order to qualify for the Veteran’s Pension Benefit.  There is a high probability that the veteran, the spouse, or the surviving spouse of a veteran household may need nursing home care in the future.  Such care is very expensive and the individual’s income plus the veterans benefit rarely pay for the cost of a nursing home.  This means the veteran may have to rely on Medicaid to cover the deficit.  Assets reallocated to qualify for VA benefits could create penalties for Medicaid eligibility, underscoring the importance of planning for the possibility of having to apply for Medicaid in the future. 

In addition to the Aid and Attendance Benefit, the VA in its various facilities around the country will provide nursing home care the qualifying veterans.  However, the number of beds are very limited.  The VA provides service-connected disability ratings that range from 10% to 100%. Those veterans who are 100% disabled because of the service-connected injury or illness will receive priority for admission with priority moving down the rating scale.  In addition to the beds available in VA operated facilities in some states the VA has contracted with other nursing homes to make beds available to qualifying veterans.

To find Elder Care Professionals near you who can help you with these elder care matters, go to:  ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Professionals and Resources for Families.

hweatherby
Henry C. Weatherby, Esq., CLU, ChFC, CEBS
Weatherby & Associates, PC
Connecticut State Coordinator – ElderCareMatters.com

 

 


Today’s Q&A on ElderCareMatters.com is from a family who is “Scared about getting old!”

Question:  We are scared about getting Old!  How would we go about planning for the cost of our future elder care needs?

Answer:  I advocate the compilation of a Life Transition Plan (with at least annual updates). This plan documents not only the usual things, like income, expenses, assets and liabilities but also contemplates various scenarios for lifestyle changes (e.g. what will happen if I can’t take care of myself and my spouse can’t/won’t care for me or I don’t have a spouse?) and creates long range budgets around these scenarios. This will then show the gap between possible future needs and likely available resources. At that point, depending upon the particular circumstances, it might be prudent to explore purchasing long term care insurance and/or consulting with and elder law attorney regarding structuring to provide for the availability of public benefits (Medicaid, VA, etc.) should the need arise. This is a highly individualized process with many nuances.

To find elder care professionals near you who can help you with these types of issues, go to ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Resources for Families.

Hope this helps.

ssamotin
Sheri Samotin
LifeBridge Solutions, LLC
Playa Vista, California  90094
An ElderCare Matters Partner


Today’s Q&A on ElderCareMatters.com is about Paying Family Caregivers

Question:  How much can an elder pay their family members to provide them with long term care?  I am assuming this is permitted.  I would prefer to pay my family than to pay a home care company for this type of personal care.

Answer: What you are referring to is what is called a “Personal Services Contract” that changes what would normally be treated as a “gift” into a bargained-for exchange of your property for the return of services by your children, grandchildren, brothers, sisters, and others.  Most of the services include many things that those caregivers are already doing for you.  They include the following: cooking, cleaning, laundry and taking you to the doctor, taking you for medical tests, health monitoring, meeting with doctors about the medical care that will be needed, etc.  Taking the ill parent on trips, providing entertainment, visiting with you.  They may also include bathing you and dressing you and assisting in your toiletries.  If in the hospital, then visiting with you in the hospital and making arrangements for others to visit you.  Answering letters that you receive, paying bills (under the authority of a current durable power of attorney) and writing letters for you.  These are the normal activities that are included in the “Personal Services Contract”, but there may be additional items based upon your individual needs.

The next thing is to determine your life expectancy based upon the SSI Life Expectancy Tables.  This will indicate statistically how many years and months someone of your current age is expected to live (you may be live that long or you may live even longer).  Next, you need to determine how many hours will be necessary to carry out the various duties under the contract on a weekly basis.  Normally, we would expect 4 or 5 hours per day seven days a week.  Of course, this may vary depending on the circumstances.  If it varies too much, then Medicaid may question the hours so you had better keep some kind of journal or calendar where you routinely write down the expended each day and what activities are undertaken on that day.

Lastly, you need to have an idea of what homecare workers charge in your area.  The best way to do this is to discuss it with an experienced elder law attorney in your area, but, if you cannot find one then you will have to make some calls to find out this information.  It is much easier to go to a qualified elder law attorney as he will already have this information and it would, of course, have the attorney draw up the agreement to meet with your state’s requirements.

The amount of money that can be protected is figured out this way. 1) The number of hours each week, 2) times the average hourly rate, 3) times 4.3 weeks to give you the monthly total for services rendered, 4) times 12 months to give you the annual total for services rendered, 5) times the life expectancy of the elderly person.  In most instances, I have found that there is usually not enough money to cover the full funding of the contract.  This is a good sign as it will show that the elderly person is receiving more services than he or she is actually paying for.  In other instances, the hours per week might have to be increased or the average hourly rate must be increased or both.

As always, you can use the ElderCare Matters website – ElderCareMatters.com –  to find a list of attorneys and other types of caregivers in your area.

mtucker
Ivan Michael Tucker, Esq.
Altamonte Springs, Florida
“Partner” Member of the national ElderCare Matters Alliance


Illinois Elder Law Attorney Answers Today’s Elder Care Question on ElderCareMatters.com

I desperately need some advice. My wife is 79 years old and has progressively gotten so debilitative that I (82 years old) can no longer care for her at home. We have lived in our paid off home for more than 30 years and we receive every month about $2,800 in total benefits, including our Social Security checks. Other than the value of our home (which is about $125,000), we have a modest amount of savings and no other assets to speak of. How can I afford to place my wife in a nursing facility, which I understand may cost $5,000 – $6,000 per month? What are my options? Please help!

Answer:  I believe you need to consult with an Elder Law Attorney immediately. An experienced Elder law Attorney can advise you as to the Medicaid requirements in your State.  Medicaid is a combined federal and State program, which among other benefits, pays for the nursing home costs of those we meet the program’s requirements, which include limits as to the amount of assets the applicant can possess. The program also has provisions for circumstances such as yours, which allows the community spouse to keep a certain amount of income and assets in order to prevent spousal impoverishment. The actual financial amounts vary from State to State, so it is essential that you speak to an Elder Law Attorney in your State to determine what limitations would apply to you. I can tell you that based upon the limited facts that you provided – in Illinois, you would be entitled to keep your home, up to $109,560.00 in assets and up to $ 2,739.00 of your joint income.  Depending upon your actual figures an Elder Law Attorney may also be able to assist you in preserving other assets or avoid certain debts.  It is certainly worth an initial consultation. An experienced Elder Law Attorney can also act as a vital source of local resources, which along with those listed on ElderCareMatters.com, could provide you with the assistance necessary to make this difficult transition a little easier.

jsiebert
James C. Siebert, Esq.
Arlington Heights, Illinois
“Partner” Member of the national ElderCare Matters Alliance


Elder Law Attorney Answers Family’s Question About ElderCare Options

Question:  I desperately need some advice. My wife is 79 years old and has progressively gotten so debilitative that I (82 years old) can no longer care for her at home. We have lived in our paid off home for more than 30 years and we receive every month about $2,800 in total benefits, including our Social Security checks. Other than the value of our home (which is about $125,000), we have a modest amount of savings and no other assets to speak of. How can I afford to place my wife in a nursing facility, which I understand may cost $5,000 – $6,000 per month? What are my options? Please help!

Answer:  Surprisingly, you may be able to qualify your spouse for Medicaid for nursing home benefits without doing anything further.  The rules vary widely state to state, so it is essential that you talk to an elder law attorney who has extensive experience in Medicaid planning (called Medi-Cal in California) in your state before you do anything.  There are many rules.  In California, you can own a home of any value and still qualify a spouse for Medi-Cal.  Also, in California, the retirement accounts will not keep you from getting Medi-Cal.  In fact, in California, you can own up to $117,920 in countable assets and still qualify the ill spouse for Medi-Cal for a skilled nursing facility.  Countable assets exclude the primary home of any value, one car, and the retirement accounts.  Further, in many states, a court order can increase the amount of assets that you can keep and still qualify the ill spouse for nursing home Medicaid, and a court order can increase the amount of income that you can keep.   There are also legal means to protect a home from an estate recovery claim after death if the legal steps are properly taken before the death of the nursing home spouse.  Lastly, if you or your spouse served in the US military for at least 90 consecutive days, at least one of which was during a war time (combat zone or injury are NOT required), then you may qualify for up to $2,054 per month in a tax-free pension from the VA (known as Aid and Attendance Pension, or Non-Service Connected Pension) depending on your assets and your income and how much you are paying out of pocket for elder care or medical care.  See an experienced elder law attorney in your state for advice on these two programs:  Medicaid for nursing homes, and VA Aid and Attendance.

To find an Elder Law Attorney near you who can help you with your elder care matters, go to:  ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Resources for Families.

datkins
Dallas Leigh Atkins, Esq.
Santa Barbara, California
“Partner” Member of the national ElderCare Matters Alliance


Answer to Today’s Elder Care Question about VA “Countable” Resources

Question:  Can you tell us what resources are “countable” by the VA during the application process for Spousal Aid & Attendance benefits?

Answer: This is a one of the most confusing terms in the VA benefit area.  There are numerous sources that give varying degrees of upper limits.  In reality, the lesser the better.  The house (including a reasonable amount of land that it sits on) does not count if the home is occupied by the applicant.  If it is not occupied by the applicant, then the house does count.  In addition, the personal cars are exempt from consideration if they can reasonably used for the transportation of the applicant.  I would not take this to necessarily mean more than one vehicle.  Personal property is also excluded. 

If you want to estimate the upper limit, then I would suggest around $20,000.00 for a single person.  Since the figure is actually different from one claims examiner to another, I would suggest that the figure should be one that could reasonably expected to run out in one year.  This $20,000.00 would be in the form of cash (checking, saving, money market, CDs), stocks and bonds.  Because of the different cost of living figures around the country, it is wise to specifically discuss your situation with a local attorney or other recognized VA authorized agent.

To locate professionals near you who can help you with this elder care matter, go to:  www.ElderCareMatters.comAmerica’s National Directory of Elder Care / Senior Care Resources for Families.

mtucker
Ivan Michael Tucker, Esq.
Altamonte Springs, Florida
“Partner” Member of the national ElderCare Matters Alliance, Florida chapter

 


What are the eligibility requirements for Medicaid?

Question: How would I know whether my elderly father is eligible to receive help from the government in order to live in a nursing home?  He has no income, to speak of, other than his monthly Social Security check, has a very small checking account, owns his small home, and desperately needs nursing home assistance.

Answer:  The Medicaid program bases eligibility on the applicant’s medical condition and on the person’s assets and income. To apply for Medicaid to cover residential long-term care costs, the applicant must live in a nursing home or have a medical need that requires nursing home care. To establish medical eligibility, the applicant must undergo a medical assessment to identify what the person’s long term care needs will be. In addition, applicants must be citizens of the United States or fall within certain categories of aliens who have been lawfully admitted for permanent residence in the United States. Applicants must also live in the state where they apply for Medicaid. 

Medicaid places strict limits on the assets you can own. Each state has its own limit on this amount and its own guidelines for which assets count toward the total. In general, the following assets are considered “exempt” and will not count towards your asset total:

  • Your home– your principal place of residence is usually an exempt asset, regardless of value.  In some cases, the nursing home resident may be required to show some intent to return home, even if that never happens.
  • Household and personal belongings– Furniture, appliances, jewelry, and clothing
  • One car– Some states may limit the car’s value
  • Burial plot/prepaid funeral plan– some states may limit the value of the plot or plan.
  • Cash value of permanent life insurance policies up to $1,500– In most states this asset is exempt only if the face value of all policies added together does not exceed $1,500.  Term life insurance is not counted.
  • Cash– A small checking or savings account not to exceed the limit imposed by the state.

All other assets not include in the above list are considered countable assets, including checking accounts, savings accounts, certificates of deposit, money market accounts, stocks, mutual funds, bonds, individual retirement accounts (IRAs), pensions, 401(k) accounts, 403(b) accounts, second cars, vacation homes, and any other items that can be valued and turned into cash. Once you become eligible for Medicaid, you can generally keep around $30 to $60 in income per month as a personal needs allowance.  A veteran receiving veterans benefits is allowed to retain a slightly higher personal needs allowance.  

As you begin considering Medicaid as a long-term care funding option you may encounter terms and concepts you are unfamiliar with.  The term “look-back” period refers to the period of time prior to applying for Medicaid for which you will have to provide financial records.  Transfers and gifts made during the “look-back” period must comply with certain requirements and failure to comply with these requirements may jeopardize an applicant’s Medicaid eligibility.  Also important is the penalty period, which refers to a period of ineligibility imposed because of an uncompensated transfer of assets during the “look-back” period.  There is no cap on the length of a penalty period, which is calculated by dividing the value of the transfer in question by the “regional rate.”  For this reason, applicants should either wait the full 5 years from the date after such transfers to file a Medicaid application so that they do not have to disclose these transfers or retain sufficient resources to pay privately during the penalty period if it is possible for them to do so.  Due to the numerous and complex rules and regulations, Medicaid planning can be challenging and it is best to consult a specialist who can assist with your application and help ensure that you don’t encounter problems.

To find Elder Care Professionals near you who can help you plan for and deal with this elder care matter – go to: ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Resources for Families.

hweatherby
Henry C. Weatherby, Esq., CLU, ChFC, CEBS
Connecticut State Coordinator, ElderCareMatters.com

 


Veterans Administration Spousal Aid & Attendance Benefits

Question:  Can you tell us what resources are “countable” by the Veterans Administration during the application process for Spousal Aid & Attendance benefits?

Answer: This is a one of the most confusing terms in the VA benefit area.  There are numerous sources that give varying degrees of upper limits.  In reality, the lesser the better.  The house (including a reasonable amount of land that it sits on) does not count if the home is occupied by the applicant.  If it is not occupied by the applicant, then the house does count.  In addition, the personal cars are exempt from consideration if they can reasonably used for the transportation of the applicant.  I would not take this to necessarily mean more than one vehicle.  Personal property is also excluded.

If you want to estimate the upper limit, then I would suggest around $20,000.00 for a single person.  Since the figure is actually different from one claims examiner to another, I would suggest that the figure should be one that could reasonably expected to run out in one year.  This $20,000.00 would be in the form of cash (checking, saving, money market, CDs), stocks and bonds.  Because of the different cost of living figures around the country, it is wise to specifically discuss your situation with a local attorney or other recognized VA authorized agent.

To find professionals near you who can help you with your VA questions, go to ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Resources for Families.

mtucker
Ivan Michael Tucker, Esq.
Law Office of I. Michael Tucker, PLC
Altamonte Springs, FL  32701

 

 


Michigan Attorney & State Coordinator Answers Today’s Elder Care Question

Question: “My mother is 78 years old and has been diagnosed with Alzheimer’s Disease. She and my father (who is 79 years old) live in a small town, have a paid off home, and both receive small pensions and Social Security. My question is how I, the daughter and an only child, should start getting information about the elder care benefits to which my parents may be entitled. For example, I’m not very knowledgeable about Medicaid, Medicare, VA Benefits, etc. With whom should I talk to get this type of elder care information BEFORE I actually need it? By the way, I sincerely appreciate all ElderCareMatters.com does to help families like mine across America with Elder Care Matters. This is a wonderful online resource for families. Thank you.”

Answer: I assume the answer should be obvious. You need to consult with an experienced and skilled elder law attorney. An elder law attorney can help you navigate the most complicated and overwhelming area of the law. Elder Law is a specialty developed to serve the needs of seniors and those that will become seniors one day. In other words it is for anyone who wants to be old one day. Elder Law is much more that Estate Planning. An attorney specializing in Elder Law will help with the tough questions like:

1)  Who will make my medical decisions when I am no longer able to make them?
2)  If I unable to care for myself, how can I achieve the greatest quality of 
      care without bankrupting me or my family?
3)  Who will make my end of life decisions?
4)  What happens if I get sick and can’t stay in my home anymore?
5)  How am I going to pay for it?

Not many people look forward to giving up their independence and moving into a long term care facility, even if it is in their best interest. Fortunately, as our population has aged, care alternatives to the traditional nursing home have emerged, such as home care, assisted living, adult day care and senior apartments. These options can cost anywhere from $30,000 to $100,000 a year or more. Unfortunately, to pay for these services, many seniors will quickly go through their entire life savings and assets, when it is not necessary. There is a better way, that is to plan now! For example many people believe in the old notion that to protect their assets, they need to give away assets to family at least five years before entering a nursing home. First this is usually not true and further, while this may be a good idea for some, it is not for everybody. First, there is no guarantee that the nursing home is the best option. In fact no one ever wants to go into a nursing home. There may be other strategies available that will allow one to remain in their home, assist with the cost of home care or the expense of assisted living. Some of these options are exploring Veterans benefits for qualified Veterans and their spouses and using home based community care options. Second, if gifting is done improperly, it may cause you to lose Medicaid benefits you might otherwise be entitled to. Gifting your assets without the assistance of an experienced Elder Law attorney usually limits your choice and quality of care substantially.

Finally, there will be greater opportunities for better care at the least cost to those that become informed and seek the assistance of a experienced Elder Law attorney. For example, Who Can You Trust To Make Your Decisions When You Cannot Make Them Yourself? It is a common misunderstanding that your spouse or children can act for you during a disability. The truth is, if you cannot make your own medical and financial decisions, a court of law will. It is essential that everyone over 18 years of age creates a Durable Power of Attorney. A Durable Power of Attorney is a legal document allowing you to delegate your personal, health care and financial responsibilities to an agent. You decide who that agent is and how much power to give the agent. If you become incapacitated without a Durable Power of Attorney, no one can legally act on your behalf until the Court appoints a Conservator and/or Guardian. Court proceedings take time and money. There are no guarantees the Court will select the same person you would have chosen. But not all Durable Power of Attorneys are the same. You need an Elder Law Durable Power of Attorney. If you have a Durable Power of Attorney which has not been prepared by an Elder Law attorney, your planning options could be drastically limited without court intervention.

To locate Elder Law attorneys near you, search ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Resources for Families.

drosenberg1

Don L. Rosenberg, Attorney and Counselor
The Center for Elder Law
Troy, Michigan 48098
Michigan State Coordinator for ElderCareMatters.com


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