Question of the Day on ElderCareMatters.com: “My mother just moved into an assisted living community in Illinois. We were told that once all her assets have been depleted that they will start taking her social security. They said that she would never be kicked out and that Medicaid will kick in. How do we know if Medicaid will approve her? And what if they don't? They are really pushing for us to sell her house ASAP! I'm just so scared that once they've sucked up all her assets that somehow she might have to leave. Is there a way Medicaid will pay without selling her house?”

Answer:  Wow, I would be worried also, without any assurances in writing.  Please understand that there are a number of issues in your question, all rolled into one.  First, when your mother entered the assisted living facility, she or, perhaps a family member acting on her behalf, probably signed a contract.  It is important to know what provisions are contained in the contract to see if, in fact, what you have been told verbally is in the written agreement.  Second, you said your mother moved into assisted living.  However, unless it is a continung care community or one of the few supportive living facilities in Illinois that take Medicaid, most assisted living facilities do not accept Medicaid, so more information is needed. Third, you don’t mention how your mother is paying for the assisted living facility and what other assets she may have, so it’s difficult to asses how soon she may need assistance paying for care.  The house presents a trickier issue.  Is there a possibility your mother intends to return to her home?  If so, the home may not be considered an available asset for purposes of qualifying for Medicaid.  The home may also be exempt if a “qualifying family member” is living in the home.  She may be allowed to transfer the home to a qualifying family member.  However, if she does not intend to return home, if there is no qualifying family member living in the home, and the home is sold, there may be planning strategies that could preserve some of the funds for her use, rather than to spend them all down before qualifying.  Bottom, line, it is not a simple question, and you would be well served by seeking the advice of an experienced elder law attorney in your area who could sort out all the issues and recommend planning strategies rather than rely on verbal assurances of the facility representative.

Teresa Nuccio, Esq.
Teresa Nuccio & Associates, P.C.
Park Ridge, Illinois  60068
847-823-9576
www.teresanuccio.com
Member of the national ElderCare Matters Alliance, Illinois chapter


Question of the Day on ElderCareMatters.com: “We are applying for Georgia Medicaid benefits for my mother who is 81 years old and has Alzheimer’s disease. Mom has very few assets but does have an IRA account that the Medicaid case worker says has to be annuitized so that monthly payments are received. Why is this necessary, who receives the monthly payments, and upon Mom’s death, will we the family – rather than the state – receive the remainder of Mom’s IRA?”

Answer:  Georgia Medicaid policy, found at Section 2332 et seq. of VOLUME II/MA, MT 39-08/10 titled “Retirement Funds”, expressly exempt retirement funds, including, Individual Retirement Accounts (IRAs) Keogh plans, and some retirement profit sharing plans are “exempt” or non-countable resources for Aged, Blind, or Disabled classes of Medicaid, including Long-Term Care (Nursing Home) Medicaid if owned by the applicant/recipient if the applicant/recipient applies for “periodic” distributions.  To be eligible for ABD Medicaid, the individual must apply for periodic benefits.  If s/he has the choice between periodic payments and a lump sum, the individual must apply for periodic payments. 

A “lump” sum is a liquidation of the retirement fund.  There’s no requirement in the Medicaid plan that payments be taken monthly; payments can be made annually.  The Medicaid policy states “[p]eriodic retirement benefits are payments made to an individual at some regular interval (e.g. monthly).  The signal, “e.g.” means “for example”.  As a result, the use of “monthly” in the policy is intended only as an example of what “periodic payments” means.  

The caseworker is directed to determine if the applicant for Nursing Home Medicaid is eligible for periodic payments from the IRA.  If not, can the individual make a lump sum withdrawal.  If the individual is eligible and receiving periodic payments, the payments are treated as “income” only; the fund is disregarded as an asset. 

A retirement fund belonging to an applicant/recipient’s spouse is disregarded, regardless as to whether periodic payments are made. 

The income is budgeted with other sources of income the applicant receives.  For example, if she has Social Security retirement and the IRA distributions, these amounts make up her income.  Once Medicaid eligibility is established, Medicaid calculates a “patient liability” or cost-share which is her contribution toward the costs of her long-term care.  Patient liability is paid over to the nursing home each month.  

The IRA does not designate the State as the beneficiary upon death; she can designate whomsoever she wishes. 

It sounds like the Medicaid caseworker communicating with this family is confusing the treatment of an “annuity” with the treatment of “retirement funds” for Nursing Home Medicaid eligibility purposes.

David Paul Pollan, Esq.
The Pollan Law Firm
Atlanta, Georgia  30309
678-510-1358
www.PollanLawFirm.com
Member of the national ElderCare Matters Alliance, Georgia chapter


Question of the Day on ElderCareMatters.com: What are the most common signs of nursing home abuse or neglect?

Answer:  If you have a loved one living in a nursing home, it is important for you to understand what constitutes abuse and neglect, and how to recognize the warning signs.  Abuse and neglect comes in many different forms and may affect a resident physically, mentally and emotionally.  The most important things to look for if you suspect abuse or worry about the welfare of your loved one include: falls, cuts and bruises, the development of bed sores, sudden weight loss, anxiety or agitate behavior, overmedication, poor hygiene, unsanitary conditions, or a sudden change in the resident’s disposition or behaviors. Residents and their families have a right to question a nursing home’s care decisions. If you believe a loved one is receiving substandard care in a nursing home, you should discuss their care plan with staff.  If you suspect that your loved one has been seriously injured as a result of nursing home abuse or neglect, you should contact a nursing home lawyer who can help you determine if you have a case against the facility.

Steven M. Levin, Esq., Co-Founder & Senior Partner
Levin & Perconti
Chicago, Illinois  60654
312-332-2872
www.LevinPerconti.com
Member of the national ElderCare Matters Alliance, Illinois chapter


Question of the Day on ElderCareMatters.com: “For some reason, my aging parents are stonewalled about signing a healthcare power of attorney. They seem to think that one of them will always be available to take care of the other. As they age, it is becoming more and more apparent that this issue needs to be discussed, but they refuse any attempt on any family member's part to do this. I believe they view it as a means for someone to take control, thus losing their independence. What would you suggest?”

Answer:  In Massachusetts and probably other states, if  married couples do not have  a health care proxy (HCP) in place and one of them needs hospital care the other will have no rights with respect to his or her spouse’s health care needs.
 
In circumstances where the hospitalized spouse loses competency to decide an emergency, guardianship will be required. The cost will then become large because court action will be required. If these people are hesitant they can name each other as health care agent followed by a trusted child as an alternate. Also they should think about a durable financial power of attorney  because a health care proxy only addresses health issues, and if one of them becomes incompetent the other can take over with the financials. Without that document financial institutions would require a Conservatorship– again an expensive proposition. Every person needs to have these 2 documents in place. The fiscal and emotional costs to the family would be far greater than the actual legal costs to retain an attorney to draft them.

Susana Lannik, Attorney at Law
Law Office of Susana Lannik, LLC
Newton, Massachusetts  02458
617-658-2980
www.LannikLaw.com
Member of the national ElderCare Matters Alliance, Massachusetts chapter


Question of the Day on ElderCareMatters.com: "Would payable on death accounts need to be included in a revocable living trust?"

Heather R. Chubb, Attorney at Law
The Chubb Law Firm
Gold River, CA  95670
916-635-6800
www.ChubbLawFirm.com
Member of the national ElderCare Matters Alliance, California chapter

Answer:  If you have an account that is set up with a beneficiary, that is payable on death to a particular person, it is not necessary for this account to be included in your revocable living trust.  The premise behind the payable on death account is that when the account holder dies the account will legally belong to the beneficiary.  This is one way to avoid the probate process for an individually owned account.  Presumably, one of the reasons you would create a trust is also to avoid probate of your assets upon your death. 

If the account is owned by your revocable living trust, because the trust does not “die,” the pay on death feature will never be triggered.  In any event, I’m not certain that bank would allow an account owned by a trust to also carry a payable on death designation. 

Although not absolutely necessary, including this account in your trust is a good idea and will help centralize the management of all your assets in the event of your incapacity or death and make life easier for your family.  If the account is in your trust you can use your trust distribution instructions to indicate that this account go to a specific person.  This is called a specific distribution.


Question of the Day on ElderCareMatters.com: "Do I need a Trust or a Will?"

Michael A. Jensen, Attorney at Law
P.O. Box 571708
Salt Lake City, Utah  84107
801-519-9040
www.UtahAttorney.com
Member of the national ElderCare Matters Alliance, Utah chapter
 
Answer:  Everyone should have a will, but not everyone needs a trust.  Even if you have a trust, you should have a will in order to transfer assets from your personal estate upon death to your trust.  This happens when an asset is purposely or unintentionally left out of the trust and is discovered after the death of a grantor of the trust.  When that happens, the will needs to be probated so that the asset can be transferred to the trust.  When a person has a trust, the associated will is often referred to as a “pour over will” since the will is intended to pour any assets outside of the trust into the trust.


Question of the Day on ElderCareMatters.com: "Would you please provide us with information about the NEW service that ElderCareMatters.com and its 1,686 elder care experts will be starting in October to provide families across America with more information and more answers about a wide range of elder care matters?"

Answer:  Starting in October, ElderCareMatters.com will feature each week 1 of the 81 different elder care services that are provided by the members of the national ElderCare Matters Alliance, experts who help families across America plan for and deal with their elder care matters. 

For example, during week 1 we will showcase members of the national ElderCare Matter Alliance who provide “Aging in Place Services”

During this week our “Premium” and “Lifetime” members who are experts in helping families “Age in Place” will provide us with:

1) Actual Q&As taken from their practices,
2) Original articles written by them about this important elder care service,
3) Answers to your questions about Aging in Place.

So if you would like to ask one of our elder care experts a question about “Aging in Place”,  just send a short email (a few sentences only please) to: questions@ElderCareMatters. com.

And remember to bookmark ElderCareMatters.com and check back often to see if your question is our Elder Care Question of the Day.

Thank you for your support of ElderCareMatters.com – America’s #1 online source for Elder Care Experts, Information & Answers About a Wide Range of Elder Care Matters.

Phillip G. Sanders, MBA, MSHA, CPA
Founder of ElderCareMatters.com
1-877-379-4500


Question of the Day on ElderCareMatters.com: "Inasmuch as ElderCareMatters.com now includes 80 different elder care / senior care services, would you consider featuring on this website a different service every week so that families like mind could get answers about a specific elder care matter from one of your elder care experts? For example, it would be helpful if we could have one week to ask questions exclusively about a specific elder care service, i.e., elder abuse litigation services or perhaps elder law, and then one of the members of the national ElderCare Matters Alliance with expertise in this specific elder care service could answer the questions in the Question of the Day section of ElderCareMatters.com. Also, is there any possibility of providing families across America with an easy way of locating your elder care experts in each of these different 87 services, by state? For example, I would like to easily locate your experts in Geriatric Care Management by state."

Answer:  What a great idea!  Yes, we can make this happen.

In fact, I am pleased to announce that starting Monday, October 3rd, ElderCareMatters.com will “Feature” every week one of our 80 different elder care services.  For example, during one week we may showcase Elder Law or Geriatric Care Management or perhaps Elder Abuse Litigation Services.  And during this week, families are encouraged to send us their questions about this specific elder care service.  Then every day we will post an answer to one of your questions in the Question of the Day section of  ElderCareMatters.com, an answer provided by one of our Elder Care Experts who practices in this specific elder care service area.  Additionally, we will post during this week one or several original articles about this service, written by members of the national ElderCare Matters Alliance who practice in this specific service area.

And, yes, ElderCareMatters.com would be pleased to provide a link each week to ALL of our elder care experts, by state, who provide this “Featured” Elder Care Service. 

Thank you again for this great idea.

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO, ElderCareMatters.com
1-877-379-4500


Question of the Day on ElderCareMatters.com: "Congratulations on having 1,650 professionals now in the national ElderCare Matters Alliance to help families across America plan for and deal with their elder care matters. My question is: Is there a limit to the # of elder care professionals that you will include on ElderCareMatters.com – America's #1 source for Elder Care Experts plus information & answers about a wide range of elder care matters?"

Answer:  No, we have not designated a maximum # of elder care professionals that we will include on ElderCareMatters.com.  Our criterion for including professionals on this wonderful online elder care resource is:

  1. All elder care professionals included on this site must complete an Application for Membership to the national ElderCare Matters Alliance and must demonstrate that they are actively involved in helping families plan for and/or deal with the issues of aging.

The bottom line is that we want ElderCareMatters.com to be a resource that families across America can use that will help them plan for and/or deal with their elder care matters.  Soon this website should include most (if not all) of the competent, caring elder care professionals across America.

So if you know of some competent, caring elder care professionals who are not yet listed on ElderCareMatters.com, encourage them to become a part of this wonderful online elder care resource for families  across America.

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO, ElderCareMatters.com
1-877-379-4500

 


Question of the Day on ElderCareMatters.com: "Would you please provide me with a list of all the 87 different elder care services that the members of the national ElderCare Matters Alliance provide on ElderCareMatters.com?"

Answer:  It is my pleasure to provide you with the following list of the 87 different elder care services that are currently provided by the members of the national ElderCare Matters Alliance on ElderCareMatters.com:

  1. Accounting Services
  2. Adult Day Care
  3. Advance Medical Directives
  4. Aging in Place Services
  5. Alzheimer’s / Memory Care Communities
  6. Annuities
  7. Arbitration
  8. Asset Protection Planning
  9. Assisted Living Communities
  10. Assisted Living Referral Services
  11. Bankruptcy
  12. Bill Paying
  13. Budgeting
  14. Caregiving Education
  15. Companion Care
  16. Conservatorship
  17. Consumer Law
  18. Continuing Care Retirement Communities
  19. Cremation Services
  20. Crisis Intervention
  21. Daily Money Management
  22. Dementia Care
  23. Disability Income Insurance
  24. Disability Planning
  25. Elder Abuse Litigation Services
  26. Elder Law
  27. ElderCare Planning
  28. Estate Administration
  29. Estate Liquidation
  30. Estate Planning
  31. Family Law
  32. Financial Planning
  33. Funeral Services
  34. Geriatric Care Management
  35. Guardianship
  36. Health Insurance
  37. Hoarding Clean Up and Coaching Services
  38. Home Care
  39. Home Downsizing Services
  40. Home Health Care
  41. Home Modifications
  42. Hospice Care
  43. Independent Living Communities
  44. Investment Services
  45. Life Care Planning
  46. Life Insurance
  47. Litigation
  48. Long Term Care Insurance
  49. Long Term Care Planning
  50. Medicaid Planning
  51. Medical Services
  52. Medical Alert Systems
  53. Medical Claims Processing
  54. Medical Equipment & Supplies
  55. Medical Malpractice Litigation
  56. Medicare Consulting
  57. Medicare Supplemental Insurance
  58. Medication Management Services
  59. Moving Services
  60. Nursing Homes
  61. Personal Finance
  62. Powers of Attorney
  63. Probate
  64. Professional Organizing
  65. Public / Non-Profit Resources
  66. Real Estate Services
  67. Rehabilitation Services
  68. Residential Psychiatric Care
  69. Respite Care
  70. Retirement Planning
  71. Reverse Mortgages
  72. Securities Arbitration & Litigation Services
  73. Senior Housing
  74. Senior Move Management
  75. Senior Move Planning
  76. Senior Relocation Services
  77. Social Security Disability Services
  78. Special Needs Planning
  79. Tax Law
  80. Tax Planning
  81. Tax Preparation
  82. Transportation Services
  83. Trustee / Fiduciary Services
  84. Trusts
  85. VA Benefits
  86. Wills
  87. Wound Care

The goal of ElderCareMatters.com is to provide families across America with the help they need to plan for and deal with their elder care matters.  Let us know if there are other elder care services that you would like to have us list on ElderCareMatters.com – America’s #1 source for Elder Care Experts plus information & answers about a wide range of elder care matters.

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO, ElderCare Matters, LLC
ElderCareMatters.com
1-877-379-4500


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