Question: My mom is 85. I am 62 and blind. Is it true that elderly parents can transfer all assets to blind children, of any age, and immediately qualify for Medicaid? My mom does not need Medicaid now. I am just thinking ahead. There might be a time when she needs to enter a nursing home or needs nursing assistance. I want her to be able to protect her assets. She lives in a co-op type apartment now. Is there a way to set up something legally so that her apartment and meager savings are protected?
Answer: The rules for Medicaid qualification vary from State to State, so you will need to consult an elder law attorney in your jurisdiction for a definitive answer on how assets may be transferred by a parent to a child without affecting eligibility. However, as a general proposition, the answer to your question is that there are certain “exempt transfers” allowed by law whereby a parent can transfer a residence to a “caretaker child” (one who has resided in the home with the parent for at least two years and has provided actual assistance to the parent with such things as meal preparation and taking the parent to doctor’s appointments), and the law also allows special transfers using trusts for the benefit of blind, disabled, or minor children. If done correctly, these kinds of transfers do not impact the parent’s Medicaid eligibility. If a transfer does not satisfy all of the applicable rules, however, the transferor may be ineligible for Medicaid benefits for roughly the amount of time that the value of the transferred assets could have paid for nursing home care. In any event, a transfer made more than five years before a Medicaid application is filed by or on behalf of the transferor will not impact the transferor’s Medicaid eligibility. An additional complicating factor that your question raises is how assets may be transferred for your benefit without affecting your current or future eligibility for means-based programs. That is where “special needs” or “supplemental needs” trusts may come into play. The best time to begin planning for Medicaid qualification is well before there is a need for nursing home services, so your question is timely. Your best move right now would be to consult an elder law attorney in your State for help in navigating the complex rules of Medicaid qualification as well as the rules pertaining to special needs trusts.
ElderCareMatters.com can help you find an Elder Law Attorney near you who can help you plan for and/or deal with your family’s elder care matters.
Scott A. Makuakane, Esq., CFP
Est8Planning Counsel LLLC
Honolulu, Hawaii 96813
Member of the national ElderCare Matters Alliance, Hawaii chapter
Question: I have been taking care of my Mother since 2004. She has Alzheimer’s Disease. I do not currently have a job because I am with her 24 hours a day. Is there any compensation that I could receive for all my time and effort?
Answer: We certainly recognize the value of the time you have put in to taking care of your mother in the years since 2004. While your devotion to your mother is admirable, there unfortunately is no way for you to receive compensation for the time and effort you put in the past. In the elder care context, there are two (2) scenarios that come to mind where is it wise for the senior to make ongoing payments to the caregiving family member and for those payments to be thoroughly documented.
One situation is in the context of an application for Medicaid benefits under Title IX. Under current Medicaid law, when an application is made to the state benefit that agency is obligated to scrutinize the applicant’s financial history over the previous five (5) years. When money has been transferred from the senior to a family member, the benefit agencies will have a default assumption that the transfers were uncompensated, meaning the senior did not receive fair market value in return. If that was the case, there may be a Medicaid denial or a burdensome “penalty period” during which the agency will not pay for the urgently needed benefits. In contrast, if it can be demonstrated the senior was in fact paying the family member for providing urgently needed care, then the payments were not gifts and there is no problem with Medicaid eligibility. That can be a way for the caregiver to be paid for their time and efforts in providing for their senior loved one. In this context, payments to the family member can partially be thought of as a “defensive” tactic, to ensure that payments to the family member do not create Medicaid eligibility problems down the road.
When the senior is to make payments to the family member caregiver for care to be provided, it is crucial that the arrangement be formally documented. A document commonly referred to as a “Care Contract” should be prepared and it should spell out all the duties and responsibilities of the caregiver and the amount and terms of the compensation by the senior. While the senior and family members quite understandably are used to dealing with each other in a thoroughly informal manner, it is crucial for them to keep in mind a central goal to document the caregiver / care recipient relationship in a manner that will withstand third party scrutiny by the state’s Medicaid agency or other similar third parties. Thus, it is well worth the investment for the family to consult a competent elder law attorney to work with the family to draft the document.
The other situation is when the senior is eligible and applies for benefits through the United States Department of Veterans Affairs (VA). When the VA pays non-service connected benefits to a living veteran or to the living widow or widower of a deceased veteran, that benefit is structured as a reimbursement for recurring medical expenses. When properly documented, payments to a family caregiver will be accepted as recurring medical expense for which a reimbursement may be paid, just like reimbursement for health insurance premiums or similar. So, in that situation the benefit recipient can receive a greater benefit amount and effectively the caregiver is compensated for his or her time.
Question: My family is considering hiring someone to help us monitor the care provided to our elderly parents. Should we be looking for a Care Manager or a Case Manager? We are a little confused as to the difference between these 2 types of professionals…or are they the same?
Answer: Whether or not you want a Case Manager or a Care Manager depends on the situation of your parents. If they are living in their own home and not an assisted living facility, you would hire a Care Manager. Assisted Living Facilities will have a Case Manager available for you to hire; however, you still would want to hire an independent Geriatric Care Manager. The Care Manager will be more considerate to what is best for you rather than what is best for the facility.
Before making the effort, step back a moment and try to determine whether your parents actually have a problem that a professional geriatric care manager needs to be involved. Do you or your parents have time, inclination, and skills to manage the problems themselves? If you are not sure, ask your clergy, your parent’s doctor, a social worker, your parents financial advisor, or a trusted friend of your parents to help you decided if an elder care expert may be helpful in this situation. Enlisting the support of other family members to consult a professional is a good way to build a consensus on the solutions.
There are many places to find a care manager in your parent’s city or state. In addition, our website www.ElderCareMatters.com includes a host of professional geriatric care managers. You may also want to check with local agencies or hospitals to obtain a list of local referrals. Health professionals and elder law attorneys are other excellent referral sources.
Hope this helps your family.
Question: “My step-Dad, who is in a convalescent home, is having to pay off some medical bills. He has a long-term care (LTC) policy that we’re hoping will pay; it is currently in claims review. If he receives the LTC benefit from the policy, will that benefit he receives from the policy be included in the VA’s calculation as income?“
Answer: I presume that when you refer to VA benefits you are referring to the Aid & Attendance benefit. In that case, the VA does not consider the Long-Tern Care insurance payments as income.
However, the payments will reduce the reimbursed medical expenses and depending on your father’s income, may impact his eligibility for VA benefits.
For example, if dad’s income is $2,000 /month and his care costs (unreimbursed medical expenses) are $4,000, then he will be entitled to the full A&A benefit (presuming he is single) of $1,703 /month because his income for VA purposes will be negative $2,000/month.
If the Long-term care insurance pays $2,000/month, then his care costs (unreimbursed medical expenses) will be reduced to $2,000/month. In this case dad will still receive the full benefit, because his income for VA purposes is now zero. BUT if his care costs total $3,000 and the insurance pays $2,000 his income for VA purposes will be $1,000 and his benefit will drop to $703.
As you can see this can be a complicated issue. The VA will want to know about any changes to dad’s income or medical expenses. A consultation with an elder law attorney who is well versed in VA benefits would be useful in this situation.
Heather R. Chubb, Esq.
Life Transitions Lawyer
The Chubb Law Firm
Fair Oaks, California
Member of the national ElderCare Matters Alliance, California chapter
Question: How would we go about getting custody over our elderly aunt, who is physically disabled but mentally competent and has no one else to look after her and her resources?
Answer: If your elderly Aunt is mentally competent and is willing to have you look after her, she can execute a General Durable Power of Attorney which names you as her agent. She can also execute an advance directive for her health care. Her physical incapacity does not equate to a mental incapacity. The power of attorney would help you assist with her finances and to look after her and her resources. The key here is that she must be willing to let you assist her with her needs. If she is not willing and is physically unable to take care of herself you may petition the court to become guardian of the person if she is unable to physically take care of herself. Someone who has capacity is presumed to have the ability to take care of their own finances.
James J. Ruggiero, Jr., Esq., AEP
Ruggiero Law Offices, LLC
Member of the national Panel of Elder Care Experts on ElderCareMatters.com
Question: My family and friends in Dallas, Texas love the ElderCareMatters.com website, and we are looking forward to the day (hopefully soon) when we will be able to find on this wonderful site a comprehensive list of ALL professionals across America who help families plan for and/or deal with their elder care matters. Thank you very much for making it easy for families across America such as ours to find the help we need for our elder care matters.
Answer: It is our pleasure to be able to compile this national online Elder Care Resource Directory, and we will continue to encourage ALL competent professionals across America who help families plan for and/or deal with elder care matters to be listed on ElderCareMatters.com. Our goal is to make it easy for ALL families across America to find the help they need to plan for and/or deal with their elder care matters.
Thank you for your support of ElderCareMatters.com.
With my best regards,
Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO
ElderCare Matters, LLC
Question: I am a senior and a disabled veteran. I receive some Veterans benefits and Social Security. Due to circumstances beyond my control, I can no longer pay my credit card debts. Is bankruptcy my only choice?
Answer: No, bankruptcy is not your only choice. Here is why.
In general, the original creditors will try to collect their debts for the first three months. After that they send it to a collection agency, an attorney or sell it to a junk debt buyer. These collectors are far more aggressive than the original creditors. They will call daily and constantly send collection letters. Many law firms, including my firm, will act as a buffer to keep the debtors free from the creditors’ harassment techniques. We contact each collector and advise the collector that our client is represented by counsel. We also advise them that our client is a senior, disabled, and/or Veteran and we issue a Cease and Desist order to each of them. If the third party collector violates the notice of representation and the Cease and Desist order, we will file FDCPA (Fair Debt Collection Practices Act) violations against them.
In most states a creditor can garnish wages – but our clients are retired and their income is exempt from garnishment. A creditor can attempt to garnish a bank account, however, if our client is properly depositing Social Security and Veterans benefits into a bank account, these funds cannot be garnished. A creditor can put a lien on real property in the majority of states; however there may be ways to legally protect real property with estate planning tools. Finally, a creditor can only take personal property that you own that is not exempt. Each state has different exemption amounts; however, most of your personal items are exempt.
To locate Attorneys near YOU who can help you with these types of elder care matters, go to www.ElderCareMatters.com – America’s #1 online source to find Elder Care Experts, Information & Answers to your Questions about a wide range of elder care matters.
Hope this helps.
Question: I am an Elder Law Attorney who has helped hundreds of families within my state plan for and deal with their elder care matters. Would you please explain why you are offering a FREE membership option to ALL elder care professionals across America to be listed on your website, ElderCareMatters.com?
Answer: ElderCareMatters.com is a national online elder care resource that is committed to helping families across America plan for and deal with their elder care matters. To this end, we are encouraging ALL competent, caring elder care professionals across America to become members of the national ElderCare Matters Alliance, to be listed on ElderCareMatters.com, and moreover, to help us become the “BEST” national online elder care resource in America – helping families: 1) find Elder Care Experts near them 2) find useful elder care information and answers to their elder care questions.
We are now offering 2 membership options:
Choose the level of membership that best fits your individual needs and budget.
Regardless which membership option you select (Basic or Premium) – if you are a competent Elder Care Professional, YOU should be listed on this national online Elder Care / Senior Care Resource Directory.
Membership in the national ElderCare Matters Alliance and your Professional Listing on ElderCareMatters.com are “cost effective” ways for YOU to “get the word out” to tens of thousands of families across America.
The bottom line is: If you are a competent professional who helps families plan for and/or deal with their elder care matters, YOU NEED TO BE LISTED ON THIS NATIONAL ONLINE ELDER CARE / SENIOR CARE RESOURCE DIRECTORY.
Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO of ElderCare Matters, LLC
Question: “My sister and I have powers of attorney for our mother. Mom also has her assets in a trust and we are joint trustees in the trust. We need to take over bill paying and handle financial matters for her. Would you please answer the following four (4) short elder care financial questions for us?”
1. When we pay bills, can we sign our own names to the checks since we are joint trustees on her accounts, including her checking?
Answer: If the checking account is in the trust, depending on the terms of the trust agreement and your state trust code, either one or both trustees should sign the checks in their own name(s) as trustee(s).
2. When depositing her checks from her long term care insurance company, do we endorse the checks with our names or hers?
Answer: How checks are to be endorsed depends on to whom they are payable. Generally, LTC insurance benefit checks are payable to the insured, in which case they should be endorsed either in your name, followed by “agent under power of attorney”, or in some states and depending on the terms of the power of attorney, it may be proper for you to sign her name, then “by [your name], agent under power of attorney”.
Personally, I am uncomfortable with anyone signing someone else’s name, so I recommend that the agent sign his or her own name, followed by agent under power of attorney. (Agent is the more modern title, but many powers of attorney still use the title “attorney-in-fact” or even just “attorney” for the agent, so use the terminology preferred in your state and used in your mother’s document.)
3. Do the powers of attorney cover her trust assets or do we just use our rights as joint trustees in dealing with her banks?
Answer: In general, no. There may be exceptions, but in general, powers of attorney granted by an individual are ineffective at controlling transactions within a trust. The trustees are the fiduciaries responsible for transactions with trust assets and income.
4. Do we have to send copies of the powers of attorney to her utility and insurance companies in order to have her bills sent to us to pay?”
Answer: If utility and insurance accounts are in your mother’s personal name as an individual, you will deal with them by power of attorney. The companies will probably require a copy of your mother’s power of attorney in order to release information to you about her accounts and to enable you to make any changes in her accounts, such as to change the mailing address.
Martin C. Womer, Esq.
Maine Center for Elder Law, LLC
Kennebunk, Maine 04043
Member of the national ElderCare Matters Alliance, Maine chapter
Answer: There are three (3) main options for paying for long-term care – out of pocket (private pay), long-term care insurance, and government programs such as Medicare (very limited), Medicaid (income and asset dependent) and Veterans Administration (income and asset dependent). Which options are available to help your parents will depend on their situation.
Long-term care refers to medical and non-medical care for a person who has a chronic illness or disability. The need for long-term care, also known as custodial care, occurs when you need care but you are unlikely to get any better. For example, as we age our bodies simply start to wear out and fall apart. This may result in limited mobility, loss of independence and the need for assistance with every day activities such as dressing, bathing and eating. Or we may need help with everyday activities due to diminished cognitive abilities, neurological conditions, confusion or dementia. Things that used to come naturally, such as turning off the stove when you are done, or remembering that you turned the stove on to make lunch are suddenly gone. The need for long-term care may also arise due to a sudden medical incident such as a heart attack or stroke, which even after the patient reaches “full recovery,” they may still be left with a reduced ability to care for themselves.
Most often long-term care is non-medical in nature and assists with support services such as activities of daily living like dressing, bathing, and using the bathroom. Long-term care can be provided at home, in the community, in assisted living or in nursing homes.
Difference Between Medicare and Medicaid – There is a very large difference between Medicare and Medicaid and people confuse the two all the time.
Medicare is a federally funded entitlement program to provide health insurance primarily to Americans over the age of 65 and many individuals with disabilities. There are several parts to Medicare: Part A covers hospital bills, post-hospital nursing home stays and home health care, Part B covers medical insurance and pays most basic doctor and lab costs, and some out-patient medical services, including medical equipment and supplies, home health care, and physical therapy, Part C is called Medicare Advantage and is the Medicare HMO program, and Part D covers some of the costs of prescription medication.
Medicaid on the other hand is a federal program, administered by each State, that pays for certain health services and nursing home care for older people with low incomes and limited assets. It also pays for some long-term care services at home and in the community. Medicaid covers a broader range of services and people than Medicare, including children, pregnant women, parents of eligible children, seniors and individuals with disabilities. Its greatest difference from Medicare is that Medicaid is based on need and financial resources. In order to qualify a person must fall into a covered group and meet the financial needs test.
Medicare generally doesn’t pay for long-term care. Medicare also doesn’t pay for help with activities of daily living or other care that most people can do themselves or that can be provided by family or non-medical personnel. Medicare only covers a small amount of the nursing home care provided in the United States, and only under very limited circumstances, making the hope of Medicare paying the bill quite difficult.
Medicare pays for 20 days of full coverage if you discharged to a skilled nursing facility after being admitted for at least three days in the hospital, so long as you are receiving skilled care as opposed to custodial care. If you still need skilled care after the first 20 days, you can get up to 80 additional days of partial coverage from Medicare. When the Medicare coverage ceases, you will have to pay out-of-pocket unless you have private long-term care insurance or qualify for Medicaid (“Medi-Cal” in California) benefits.
If you need “custodial care,” rather than care associated with an injury or illness Medicare won’t pay a dime. Custodial care is defined by Medicare as help with activities of daily living, like dressing, bathing, going to the bathroom and eating. This is the kind of care that can be safely and reasonably provided by people without professional skills or training – like your family. Custodial care is also called “long-term care” and is the type of care that most people will need as they approach the end of their lives.
If you need custodial care there are a couple of alternatives to pay for it. First, you could purchase long-term care insurance – provided you are healthy enough and can afford the premiums. Many policies can also be used to pay for assisted living and in-home care, as well as skilled nursing care. Second, you can pay for everything directly out of your pocket. Third, if you qualify, Medicaid will pay for your care under certain circumstances. Finally, Veteran’s and widow(er)s of veterans may receive a Special Monthly Pension called “Aid & Attendance.” This benefit is based on a person’s assets and income. If approved for Aid & Attendance, the person will receive additional monthly income to help pay for the cost of health care.
Consulting with an experienced elder law attorney can help you determine the options available to help your parents get and pay for the care they need. It is important that you look at and evaluate all of the options. Assessing the options to pay for long-term care before the need for care arises or before a crisis occurs will ensure the greatest flexibility. Even with good advance planning, making long-term care decisions can be difficult.
To locate Elder Law Attorneys near YOU who can help you with your elder care matters, go to www.ElderCareMatters.com – America’s #1 online source to find Elder Care Experts, Information & Answers to your Questions about a wide range of elder care matters.
Heather R. Chubb, Attorney at Law
The Chubb Law Firm
Fair Oaks, California 95628
Member of the national ElderCare Matters Alliance, California chapter
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