Today’s Q&A on ElderCareMatters.com is about the options available to pay for Long Term Care

Question:  What are the financial options that are available to us for paying for long-term care for our elderly parents?  For example, will Medicare and Medicaid pay for these elder care expenses?  Please advise.

Answer:  Medicare does not pay for “long term care”. The only time that Medicare will pay for a patient in a nursing facility is when that person is receiving rehabilitative therapy.  In that case, Medicare will pay fully for the first 20 days.  Thereafter, and assuming the person is still receiving therapy treatments, Medicare will pay a portion of the cost for UP TO the next 80 days. After a total of 100 days receiving therapy has elapsed, and assuming the person did not have a valid long term care insurance policy in place, the person must either go on private pay if they wish to remain in the facility or they must qualify for Medicaid.  

There are many issues to be addressed in determining whether a person is qualified for or can be qualified for Medicaid benefits and for that, it is advisable that the family seek the advice of an Elder Law attorney who is experienced in this area.

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.

Beverly J. White, Esq.
The Law Firm of Beverly J. White, P.A.
Tampa, Florida  33624
813-891-6610
Member of the national ElderCare Matters Alliance, Florida chapter

 


Today’s Q&A on ElderCareMatters.com is about the difference between a Will and a Living Will

Question:  What is the difference between a Will and a Living Will?

Answer:  A will deals with assets, whereas a living will deals with medical care. Many States have done away with the so-called living will and replaced it with the advance health-care directive (“AHCD”). An AHCD can accomplish a variety of objectives, from saying who will make health care decisions for you if you cannot communicate with your doctors, to saying under what circumstances conventional health care will be withheld from you so that nature will be allowed to take its course.

If you need additional help with your elder care matters, you can find competent, caring elder care professionals near YOU by searching on www.ElderCareMatters.com

Scott A. Makuakane, Esq., CFP
Est8Planning Counsel LLLC
Honolulu, Hawaii  96813
808-587-8227
State Coordinator of the national ElderCare Matters Alliance, Hawaii chapter


Georgia Elder Care Experts will answer your questions on ElderCareMatters.com

Question:  Any idea when you will be providing Georgia families with the opportunity to ask their elder care questions to the members of the Georgia chapter of the national ElderCare Matters Alliance?  My family and I have recently been faced with a host of elder care matters and we need some help, including finding competent elder care professionals.

Answer:  Later this week we will begin posting on the home page of ElderCareMatters.com answers to your elder care questions as provided by the experts of the Georgia chapter of the national ElderCare Matters Alliance.  

Please submit your elder care questions for our Georgia Elder Care Experts to answer.  And thank you for letting us help you find competent, caring Elder Care Experts, professionals whom you can easily locate on ElderCareMatters.com.

The national ElderCare Matters Alliance, which now has 2,100+ professional members, is committed to increasing the # of qualified Elder Care professionals who are members of our national Elder Care  Alliance and who are posted on ElderCareMatters.com so that we may help ALL families across America with their elder care matters.  To this end, we continue to encourage all competent, caring professionals across America who help families plan for and/or deal with elder care matters to JOIN the national ElderCare Matters Alliance.

Please  follow us on ElderCareMatters.com as we continue to provide ALL families across America with the opportunity to ask their elder care questions of the members of their state chapter of the national ElderCare Matters Alliance. 

Thank you for permitting us to help your family plan for and deal with Elder Care Matters.

With my best regards,

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO of ElderCare Matters, LLC
ElderCareMatters.com

 


Can Florida ALFs transfer elders without family approval?

Question:  Can an Assisted Living Facility (ALF) in Florida transfer my mother to another facility without my approval, her financial and health care Agent.  Apparently, Mom, who is 87 years old and has dementia, has been somewhat rowdy recently and apparently because of this behavior / acting out, the Assisted Living Facility has made a unilateral decision (without my input at all) to transfer her to another facility on the other side of town.  Can this be done and what is my recourse?

Answer:  In Florida, a resident in an assisted living facility has the right to at least 45 days’ notice of relocation or termination of residency unless a physician certifies that the resident requires an emergency relocation to a facility providing a more skilled level of care or the resident engages in a “pattern of conduct that is harmful or offensive to other residents”.  So, in your particular case, if the ALF has provided proper notice, they can transfer her for any reason or no reason.  If they have not provided proper notice and it is not an emergency transfer as described above, then you may have recourse.  I suggest that you contact the Long Term Care Ombudsman Program through the Department of Elder Affairs for more specific guidance in your mother’s case.   They can be reached at 1.888.831.04040 or at http://ombudsman.myflorida.com.   There is no charge for these services.

Sheri Samotin, President
LifeBridge Solutions, LLC
Naples, Florida  34108
239-325-1880
Member of the national ElderCare Matters Alliance, Florida chapter


"Can two states claim me as a resident for tax purposes if I live in one state part of the year and another state the rest of the year?"

Answer:  You should take all steps possible to avoid a claim of dual domicile upon death.  You should analyze the tax structure of both states and decide where you want to live.  You may wish to consider changing the situs of assets by changing their character.

 Real estate, tangible personal property, and mineral interests are generally governed and taxed upon death only in the state where the property is located.  Intangible property, e.g. securities and partnership interest, are usually subject to taxation, if any, in the state of the owner’s domicile.  Transferring real estate into a corporation, partnership, or certain types of trusts may change the nature of the property from real property to tangible property.

Usually real property can only be taxed at its situs, whereas cash, bank accounts and securities (intangible property) are taxed where the decedent was domiciled at the time of death.

The United States Supreme Court has ruled that the question of domicile is for the states to decide, and it is not unconstitutional for more than one state to claim a decedent of that state for the purpose of imposing an inheritance tax.  Because domicile is determined under each state’s law, two or more states can constitutionally tax a person’s intangible property.

To constitute a domicile, or to effect a change of domicile, there must appear both an actual residence and an intention to remain there or make it one’s home.  The intention to establish a residence must be bona fide and unequivocal.  If one were to live in Florida for five to seven months and live in another state for the remainder of the year, the determination of where he or she was domiciled would depend on some or all of the following factors:

1.      Whether residence was declared homestead;

2.      Location of personal property;

3.      Location of voter registration;

4.      Location of banking accounts;

5.      Membership in clubs, churches, etc.;

6.      Location of charge accounts;

7.      Location of securities;

8.      Place where will or trust was signed;

9.      Address on tax returns;

10.  Address of automobile license;

11.  Subscriptions;

12.  Telephone listings;

13.  Location of contributions.

Assets in multiple states may also have to go through multiple probate proceedings.  Your attorney may advise you how these assets can avoid probate.

For additional information about a wide range of elder care matters, visit ElderCareMatters.com – America’s #1 source to find Elder Care Experts, Information and Answers about elder care matters.

Joseph F. Pippen, Jr., Esq.
Law Office of Joseph F. Pippen, Jr. & Associates
Largo, Florida  33771
727-586-3306
Member of the national ElderCare Matters Alliance, Florida chapter


Today’s Q&A on ElderCareMatters.com is about Florida Guardianship

Question:  Is it really true that Florida will not permit a newly appointed Guardian (of the person and property) to move a Ward to another state?

Answer:  You need permission from the Court for a Guardian to move a Ward to another county in Florida or out of state and you need acceptable grounds like facilities better serve the need of the Ward or Ward will live with the Guardian etc.,

If the Court approves the move and it is intended to be a permanent move, the existing guardianship is transferred to the new jurisdiction and the existing guardianship closed.  A Final accounting must be done before the guardianship is closed.

Anne Desormier-Cartwright, Esq.
Anne Desormier-Cartwright, PA
Jupiter, Florida  33458
561-694-7827
Member of the national ElderCare Matters Alliance, Florida chapter 


Florida Attorney answers question about live-in caregivers

Question:  My 95-year old Aunt who lives in Florida has a private, live in – caregiver.  The caregiver insists that Florida Law requires 2 hours off for every 12 hours worked.  She says if she doesn’t actually take time off, she’s entitled to pay.  She’s basically charging my Aunt for 28 hours a day!

Does Florida Law require this?  What are rules / standards for live-in caregivers who work 24/7?

Answer:  Although this is more of a Labor Law question (not my field of expertise) than an Elder Law question, I will offer what I do know.  Federal Labor laws generally govern wage and overtime requirements.  Presently, however, in-home health care “professionals” are exempt from those laws meaning that the employer is not required to comply with those minimum wage and overtime regulations.  I can tell you that the industry standard for in-home health professionals is that they are to have at least 8 hours of uninterrupted sleep per night.  Your fact scenario then raises an interesting question, if your aunt’s caregiver is not getting 8 hours of sleep at night, the quality of care and attention your aunt is receiving from this person could be compromised.

Although there is some movement in the Department of Labor in Washington to remove the exemption as it applies to professional home health care providers, I know of no one in the home care provider field who recognizes the “two hours off of or two hours of pay” you speak of.  If this is an independent provider she may either have misconstrued something she heard or is making up her own employment requirements.   You can visit the website for Labor and investigate the status of the pending work on the revising the exemption statute at www.dol.gov.

Beverly J. White, Esq.
The Law Firm of Beverly J. White, P.A.
Tampa, Florida  33624
813-891-6610
Member of the national ElderCare Matters Alliance, Florida chapter 


Florida Attorney Kantner answers Elder Care Question on ElderCareMatters.com

Question:  “My parents live in Melbourne Florida. My Dad has dementia and my mom is the primary caregiver. They live in their home. The house they live in is in a trust. They do not have a lot of money. My Dad is a vet with a 15% Hearing Disability. 

I have a 3 part question:  

  1. What are their options for care – Especially for my Dad.
  2. Being a vet is my Dad able to get Veterans Aid and Assistance?
  3. Should they move to Assisted Living Facility or Retirement Community? 

We just don’t know which way to go – Thank You.”

Answer:  There are various options available to your family for the future care of your father.  Your father can inquire into a home health care agency to help him stay at home by providing various functions and services to him depending upon his individual needs after being medically assessed.  The next level if that option is not available is an assisted living facility (ALF) where he may get assistance with some of his living activities but generally retains some level of independence.  Finally, a nursing home will provide comprehensive, full-time residential care services for those that require more advanced medical and physical assistance.     

Because you note that your father is a Veteran, it would be advisable and worthwhile for you to explore VA Pension Benefits with an Elder Law attorney who is also a VA accredited attorney.  Most Veterans and their families know about the disability pension available through the VA, however very few Veterans know about The VA Improved Pension, which is not dependent upon any service connected injuries or disabilities.  This benefit was established to help Veterans and their spouses live out their lives with dignity by assisting them with their financial needs.  There are different programs, so by meeting with an accredited VA attorney you will be able to determine which programs for which you father may be eligible.  There are three types of Special Monthly Pensions (SMP) to offset the cost of necessary health care.  The three SMPs are “Low Income Pension,” “Housebound” benefits, and “Aid and Attendance” benefits. 

There are qualification standards in order to be eligible for any of the three pension benefits, so it is not available to every Veteran.  In order to qualify, the Veteran must be disabled or over the age of 65 and in financial need, and has been discharged honorably, serving a minimum of 90 days, at least 1 day of which was during a period of war.  Financial need is determined by evaluating the net worth of the Veteran or surviving spouse, as well as the gross annual income.  The income limits noted below are 2012 figures and are subject to change annually. 

To be eligible for the Low Income Pension, in addition to the above requirements, the Veteran and one dependent, for example, may have income of about $1,300.00 a month.  The Low Income Pension is similar to SSI benefits. 

Eligibility for the Housebound benefits program limits the Veteran and his/her dependent to monthly income of about $1,560.00.  This program is suited for the Veteran who is determined to be disabled and confined to home.  If the Veteran is over the age of 65, a disability rating is not required but a physician’s affidavit substantiating the Veteran’s condition will be required. 

The third program that is available, called Aid and Attendance, assists veterans and their surviving spouse who requires the aid and attendance of another person in order to avoid the daily hazards of their living environment.  The monthly income limit for this program is about $2,020.00.  Typically, the Veteran is living at home or in an assisted living environment. 

You should inquire whether or not your father is receiving VA Disability Compensation if the 15% hearing disability you note stemmed from an injury received while on active duty and have been administratively approved by Department of Veterans Affairs officials, commonly referred to as a Disability Rating. 

If Veterans benefits are not available or appropriate for your father’s situation, other benefits, such as the Medicaid Institutional Care Program (also a needs-based program), should also be explored to help them afford his long term care needs.

I hope that I have answered your questions and reiterate the importance of consulting with a qualified and experienced attorney to direct you and your family through this complicated set of rules and regulations.

Richard I. Kantner, Jr., Esq.
The Kantner Law Firm, PL
St. Petersburg, FL  33701
727-781-8201
Member of the national ElderCare Matters Alliance, Florida chapter


Florida Elder Care Experts to answer your questions next week on ElderCareMatters.com

Question:  My family and I have been following for some time now the Q&As provided on this wonderful site.  We were wondering when you will provide Florida families with the opportunity to ask questions of the members of the Florida chapter of the national ElderCare Matters Alliance.  We would appreciate having the opportunity to have our questions about elder care matters answered by Florida Elder Care Experts.

Answer:  Beginning next Tuesday, May 29th we will post for a couple of weeks on ElderCareMatters.com Questions about elder care matters that we receive from Florida families and Answers to these questions as provided by members of the Florida chapter of the national ElderCare Matters Alliance.

So if you have a question about a Florida elder care matter, send us an email (along with your name) to: Questions@ElderCareMatters.com and one or several of our Florida Elder Care Experts may answer your question on ElderCareMatters.com.

Thank you for your support of ElderCareMatters.com and for relying on us to help you and your family plan for and deal with your elder care matters.

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO
ElderCare Matters, LLC
ElderCareMatters.com

 


Today’s Q&A on ElderCareMatters.com is about moving an elderly parent

Question:  Mom currently lives in an assisted living community in Phoenix Arizona, but because of a change in my job (I am her only living relative), it is necessary for her to move to California. How do we go about getting mom moved from an assisted living facility in Arizona to an assisted living facility in California? Please provide me with a “road map” so to speak. Thank you.

Answer:   Helping a parent move can be stressful, especially if that move is long distance. The job can be made less overwhelming by good planning. The big decision to move will be made easier by turning the process into a series of smaller decisions and tasks. Teaming up with senior service providers will make the physical and emotional tasks easier.

PLANNING should be your first step.  Develop a timeline. Decide which parts of the move you will do,   and which parts you need help with.  Decide where she will move to.  If  you need help, a geriatric social worker or a Senior Placement Counselor can help you locate an assisted living facility that is appropriate for her needs and resources. Talk to the Move-In Coordinator to find out the rules and schedules for moving in. You may also want to obtain a floor plan of her new apartment to help you decide which furniture to move and where it will  be placed within her room.

Another aspect of planning is to decide how you will move your mom’s furniture and possessions. You can rent a van and drive it yourself. You can use a U-pak service like PODS who will transport your items after you pack them into a container (which they provide and deliver.) If you are moving a small amount you may choose to send it via a freight company or UPS. Finally, you can schedule a move with an interstate mover.  How you choose to move her things will be determined by what she is moving, your time availability, physical ability, and financial resources. Schedule your mover as soon as you are sure about the date and location. Sometimes it takes awhile to get on a schedule.

PACKING You didn’t say the degree to which you are able to be involved in the your mother’s relocation.  Are you planning to go there and help her organize, downsize, and pack?  If so, allow enough time that you and she are not rushed.  It is always a good idea to use new boxes and packing paper, not salvaged boxes. Boxes need to be of a uniform size,  taped closed, and strong enough to stack.  If you are not able to do the packing yourself, you may want to hire a professional move manager,  who specializes in working with older adults.  A move manager understands the  needs and limitations of elders. They will also know the local moving resources. Typically a move  manager will provide boxes.  Some will be able to help you load a van or pod if you choose that route.  A move manager knows how to downsize with sensitivity;  in all probability they have a working relationship with the facility where your mom is now living.  Another benefit of using a move manager is that she will know how to contact other move managers who service the residence where your mom is moving into.

It is a good idea to take with her valuables like jewelry, keys, eyeglasses, medicine, personal phone book, and anything she will need as soon as she arrives. In some cases there will be a difference in time between her arrival and the delivery of her things. Most assisted living communities have furnished rooms for short term occupancy.

Don’t forget to file a change of address with the Post Office, arrange to change her bank accounts and any automatic deposits. Notify her doctors, dentist, caregivers, and other service providers.

RELOCATING YOUR MOTHER Your mother may be able to travel alone, if not you will need to drive her or fly with her.  Consult her doctor for advice and any needed medications. If you are unable to travel with her, you can hire a travel companion. Some move managers provide that service. Caregivers services can drive her to the airport and, if you want, fly with her. Airlines offer limited companion services similar to those provided to unaccompanied minors.

UNPACKING will take the same amount of time as packing. Your mom will adjust to her new residence faster if her things are put away where she is used to finding them.  A move manager in your area can help you unpack, set-up her new apartment and remove the boxes.

ATTITUDE is as important as logistics to a successful move. Listen to your mom and let her express her   preferences about where she will live, what to take or leave, and how her new residence will be set up. Treat her with respect and tact. Recognize the difficulty of moving away from familiar surroundings and routines. Avoid becoming critical or impatient. Be realistic about the time needed to accomplish a move. Remember the most important thing is to accomplish her move with minimal disruption to your lives and your relationship.

Jamie Wasson, CRTS, Managing Partner
easyMove, LLC
Pleasant Hill, California
Member of the national ElderCare Matters Alliance, California chapter


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