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Long-term care

Thursday, June 22, 2017

How Safe is My Mother from Financial Exploitation?


 

Jennifer’s 80-year-old mother seemed to be running low on funds every month.  By the end of the month, she had no money for groceries.  Jennifer had helped her mother with a budget, so she thought her mother had plenty of money to make it through each month.  When she asked her mother to allow her to look at her bank statements, though, Jennifer discovered a series of automatic debits to several companies she did not recognize.  It turns out, her mother had signed up for monthly book delivery clubs, as well as recurring magazine subscriptions for magazines Jennifer knew her mother did not read.
Read more . . .


Thursday, August 6, 2015

Five Questions to Ask Loved Ones About End of Life Treatment

How do we decide how we want to be treated at the end of life?

What would a good day look like if you were suffering from a terminal illness?

This is one of the questions Dr. Atul Gawande asks in Being Mortal, Medicine and What Matters in the End, New York: Metropolitan Books, Henry Holt and Company, 2014, his book exploring medical treatment at the end of life.

Dr. Gawande looks at how this one question, along with a series of questions most physicians are not asking their patients, might shape the course of medical treatment and care of those who are terminally ill, as well as those frail elderly who are in need of long term care.

In the book, one patient says that he is willing to have medical treatment for his terminal illness so long as the treatment will allow him to eat ice cream and watch football on television.  However, if at the end of the treatment he can’t have that ice cream and television, he does not want the treatment.

Another patient says a great day for her would be to take her grandchildren to Disneyworld.  Unfortunately, by the time she tells her doctor this she has undergone months of aggressive treatment that leaves her tired and weak and no longer able to go to Disneyworld.  The question then might be, if your idea of one good day is to go to Disneyworld, should physicians forgo treatment that will not cure you in order for you to have at least that one good day at Disneyworld with those people you love?

In our office, we spend lots of time helping clients fill out their Advance Directives for Healthcare, a document that allows a person to nominate an agent to make healthcare decisions for them if they are not able to make or communicate those decisions.  We talk about whether the client wants extraordinary medical treatment if they have a terminal illness that will likely end in death and they are not aware of their surroundings.  Most people say that they don’t want aggressive treatment under those circumstances.  However, we don’t have a good way for clients to really communicate their wishes to their loved ones when the question may be quality of life versus quantity of life.  What decisions should a healthcare agent make if treatment will prolong life but may leave that life not worth living for the person for whom the agent is deciding?

Dr. Gawande suggests a series of questions that should be asked while a person is still able to give answers. These questions would also be appropriate to ask someone who is aging and becoming frail :

  1. What is your understanding of where you are and your illness?
  2. What are your fears and worries for the future?
  3. What are your goals and priorities?
  4. What outcomes are unacceptable to you?  What are you willing to sacrifice and not willing to sacrifice?
  5. What does a good day look like for you?

Here is a link to an article about the author, along with a video discussing the five questions:

http://www.nextavenue.org/atul-gawandes-5-questions-ask-lifes-end/

Of course, the answers to these questions will change over time and as diseases progress.  For instance, a young mother facing terminal cancer will have very different goals, fears and worries from the frail 90-year old great-grandmother facing admission to a nursing home.

How would the answers to these questions help if you were the person who has to make or communicate these decisions for someone else?  If you knew a good day for your father was for him to be able to sit and eat ice cream while watching football on T.V., would you make decisions for his care that would allow him to do that?

I know how difficult conversations about end of life can be, but perhaps asking these five questions can at least open up a dialogue that will ultimately lead to better decisions about end of life care.

 

 

 

 

 

 

 

 

 

 

 

 


Thursday, July 23, 2015

Four Ways to Pay for Long-Term Care

Concerned about how your parents will pay for their long-term care?  Here are the four basic ways to pay for care.


Read more . . .


Thursday, July 16, 2015

The Zen of a Family Meeting: The Five Things You Must Cover When Planning for Your Aging Parents’ Care

 

 

July is Sandwich Generation Awareness Month.  The Sandwich Generation refers to those people, mostly in their mid-40’s to late 50’s, who are caring for aging parents as well as caring for young children or dependent young adult children.  If you are the meat or peanut butter in that sandwich, you might be looking for help from your siblings or other family members.  One of the best ways to plan the care for an aging or disabled family member is by holding a family meeting.  The meeting is designed to do many things:  get information from the aging or disabled person about their needs, figure out what kind of care is needed and brainstorm about ways to find that care, gauge the financial resources available for care, and assign duties to various family members so that one caregiver does not get burned out.

Who should attend the meeting?  I recommend that all of the parents and siblings attend a meeting, preferably where they can meet face to face to talk about the issues facing the aging parent now, and those issues that may come up in the future.  If grandchildren, aunts and uncles or friends will be responsible for some of the care, invite them along.    The parent or person with a disability should be in attendance so long as they are physically able to be there. 

It is usually best to hold the meeting in a neutral place, such as a meeting room in a hotel or community center.  I also recommend there be a fairly impartial facilitator to keep the meeting on track, if possible.  And, there should be plenty of snacks and drinks so people won’t want to leave before you’ve discussed all the important points.

With so many families spread out over the world, it can be difficult to get everyone together.  If the family has a regular family reunion, perhaps the reunion time can be extended to allow the family to get together for this meeting.  If there is no regularly scheduled reunion, you can use scheduling programs such as www.doodle.com to find out when the most attendees will be available. If some family members absolutely cannot meet in person, you can use tools such as Skype www.skype.com or Google Hangouts www.google.com/hangouts‎ to bring those other family members in by video.

Once you have set the time and place, have everyone agree to an agenda.  Appoint someone to come up with a proposed agenda in advance of the meeting, and then circulate that proposed agenda for comments, additions and changes.

Here are the five basic items that should be covered in the meeting:

 

  1. The Health and Safety of the aging parent or person with a disability

     

    How do they feel about their own healthcare and safety and what are they concerned about?

    Are there any disease or illness diagnoses?

    Are they paying attention to personal hygiene?

    Have there been any instances where the safety of the parent has been compromised, such as falling, leaving the stove on, wandering, etc.?

    Who are their physicians, dentists, therapists, professional and volunteer caregivers?

    What medications are they taking and are they remembering to take them regularly? 

     

    What health insurance do they have?  If they are on Medicare, is there supplemental insurance or prescription medication coverage?

    How are the premiums paid and is there someone who will be informed if the premiums are not paid?

     

    How are their finances? 

    What financial resources do they have? 

    What are their regular bills and how do those bills get paid?  How will you know if they forget to pay the bills?

     

  2. The current living and care arrangements, whether those arrangements are working, and a plan for future living arrangements

 

 If the parent’s condition is changing, what living and care arrangements will be necessary in the future?

How will you find appropriate housing and care?

 

  1. The legal documents do they have and the legal documents they need

     

    Who is their lawyer and when was the last time they saw a lawyer?  Where are the legal documents stored?

    Who is named as Agent, Personal Representative, etc. in those documents?

    Who are their beneficiaries on their IRA’s, 401(k)’s, life insurance policies and annuities?

     

  2. A plan to pay for long-term care

    Is there long-term insurance available?  If so, what are the terms?  Where is the policy and how are the premiums paid for? 

    If there is no long-term care insurance, can the parent or person with disability afford to pay for care by him or herself?  Are there any government programs, such as Veterans benefits or Medicaid, that can help pay for long-term care?

     

  3. The family caregivers – who will do what and when

Sometimes family members volunteer to perform the tasks for which they have talent.  The brother who is a nurse may be the natural fit for the person to oversee the parent’s healthcare and the sister who is the CPA will take over the finances.  What if it isn’t so clear or if no one wants to take on the tasks?  Can people be hired to perform some of the tasks such as paying the bills? 

Can the family agree that it may not be fair to one of the children to take on all of the responsibility for care?

If one family member is taking on the bulk of the care, can the others agree to take a turn to provide relief to the primary caregiver? 

 

The topics may vary from family to family, and for those families who may find it especially hard to discuss these items you might consider having a professional or a mediator to assist in these discussions.

 

 

 

 


Wednesday, November 27, 2013

Nursing Home Care for Veterans

Nursing Home Care for Veterans

The VA provides “Community Living Centers”, or what used to be called Nursing Homes.  These are operated by the VA, and are usually in a Veterans Administration Hospital.  These Community Living Centers (CLC’s) provide rehabilitation for veterans recovering from injury and illness in the short-term, but also provide long-term skilled nursing care for veterans who need care for long periods of time for a service-connected injury.

For veterans rated at 70% service-connected or higher, or for those who need nursing home care for their service-connected injuries, the VA pays for their nursing home placement as part of their package of healthcare benefits.

The CLC’s are available for non-service connected veterans who are enrolled in VHA healthcare, and need short term services such as rehabilitation, hospice, respite, and for those waiting for placement in the community.

VA provides care to veterans based on a priority system.  There are currently 8 categories of veterans based on service- connection and financial need.  For example, a veteran who is 50% service-connected or higher is in category 1.  A non-service connected veteran with significant assets and income is most likely going to be enrolled in category 8.

Veterans in category 1 will be eligible for placement in a CLC, and will not have a co-pay, but those in category 8 will be placed in a CLC only if there is availability and no one in a higher category needs the bed.  The veteran in category 8 will pay a daily co-pay for services in the CLC.

In Atlanta, the CLC is located in the VA hospital on Clairmont Road, and is almost always full to capacity with a waiting list.  For those veterans for whom nursing home care is not part of the package of medical benefits, they may be able to find placement in one of the two Georgia War Veterans Homes.

The two Georgia War Veterans Homes in Georgia are not run by the national VA, but are available to veterans.  The Georgia Department of Veterans Services and the Georgia Health Sciences University operate the Georgia War Veterans Nursing Home in Augusta.   The Georgia War Veterans Home in Milledgeville is operated by United Veteran Services of Georgia, Inc., which operates the home for the Georgia Department of Veterans Services. 

In order to be eligible for admission to a Georgia War Veterans Home, the person must be domiciled in Georgia, and must have resided in Georgia for the five years immediately preceding admission.  He or she must have been a “war veteran”, defined as any veteran who served on active duty in the Armed Forces of the U.S. during wartime or during the period between January 31, 1955 and May 7, 1975.  In addition, the U.S. Department of Veterans Affairs must approve them as “eligible for care and treatment”.  Veterans accepted into the Georgia War Veterans Homes will be required to pay some expenses such as Medicare or health-care insurance deductibles and co-pays.  The forms to apply for admission to the Georgia War Veterans Homes are found at veterans.georgia.gov/gwvh-forms.


Monday, March 18, 2013

Come hear Patti speak Tuesday, March 26th!

Come join us at the Tapestry House of Alpharetta Tuesday, March 26th at 6:30pm.

Patti will be speaking about the difference between being housebound with a  caregiver vs moving into an Assisted Living Facility. 

All are welcome!

 

 

 

 

 


Tuesday, March 12, 2013

March is Social Work Month!

Featured Article by Thom Corrigan, MSW, CMC

Each March we are asked to celebrate Social Work month. For some, this means sending a note or an e-mail to a social worker we may know. For others, it may be treating a social work colleague to lunch or bringing them a plant or some flowers to show our appreciation for them.

But this year, I invite you all to celebrate what social workers do, in addition to who they are. Social workers possess many traits and skills. These include being trained to serve as advocates and brokers for our clients. Social workers have developed skills in the areas of empowerment, resourcefulness, problem solving and helping people with transition. They help people to learn new skills while at the same time, helping them to regain confidence, self-esteem, self-determination and resilience. Social workers do this in part by modeling, teaching, empowering, counseling and developing in a person the traits and characteristics that will lead to better outcomes and create a heightened sense of accomplishment and independence.

Each year, the National Association of Social Workers (NASW) creates a theme as part of its celebration for social work. This year's theme is "Weaving Threads of Resilience and Advocacy: The Power of Social Work."   Lastly, did you know that Social Work is the only profession that has the word "WORK" in its name? I find that interesting-

Happy Social Work Month to all my professional peers and colleagues and thanks for all that you do to help people with their everyday needs and challenges!

Thom Corrigan, MSW, CMC
Certified Care Manager


Wednesday, February 20, 2013

Caregiver Appreciation

Expressing appreciation for the assistance received from caregivers is something that not many think about, but is certainly needed. Now some may say, “Why should I be grateful for help from someone I am paying?” Or in the case of family caregivers, “Aren’t family members supposed to take care of each other?” Research shows, however, that not only does expressing appreciation make the caregiver feel better about what they do, but also that the people expressing gratitude have a greater sense of well-being.

Expressing appreciation for something your caregiver has done for you does not require the eloquence of a public speaker, only a few words are all that it takes. Examples of some things to say thank you for are : “Your gentleness when helping me change positions really minimizes my pain. Thank you.” “The way you talk to me as a person, rather than a patient, really makes me feel good.”  By giving sincere words of affirmation  will not only allow the caregiver to feel appreciated, but will help them to have a know how you liked to be cared for.

Expressing gratitude is a choice. This month, show some appreciation to someone who helps care for those in need.


Monday, February 11, 2013

Helpful News for Trustees and Beneficiaries for Special Needs Trusts

Last fall the Social Security Administration quietly released the text of changes to the Program Operations Manual System -- the POMS. Though described as "clarifications" by Social Security, they were actually far-reaching changes that would have driven up the cost of trust administration, complicated the lives of beneficiaries and provided no additional protection for anyone involved.

Lawyers, trustees and advocates raised objections, and thankfully Social Security listened. Last week another set of changes were announced and the news is entirely good for everyone.

First, a word about POMS. This not very well known set of rules has far-reaching effect. It is a manual of instructions for Social Security eligibility workers, explaining how to treat all manner of documents, transactions and information obtained in the course of eligibility applications and reviews. You can look at the POMS online, but you will quickly see that it is a complicated, detailed and tightly-written set of rules.

The POMS is not law. It is not even a set of regulations governing Social Security eligibility. It has no legal force, and so one might think it is not important. Actually, it is more important than the law, at least in day-to-day decision-making. It is the document Social Security eligibility workers look to when faced with any wrinkle, confusion or question.

The changes last fall addressed several sections of the POMS dealing with how to treat expenditures from special needs trusts. Some of the changes focused on just "self-settled" special needs trusts, others included expenditures by "third-party" special needs trusts and perhaps even payments by family members or others who try to help recipients of Supplemental Security Income (SSI).

Among the changes posted last fall:

  • When family members paid for items for a trust beneficiary -- like medical supplies, clothing, transportation or pretty much anything else -- reimbursement from a trust would be treated as income to the beneficiary, even though nothing ever went through the beneficiary's hands or account. The same would have been true for trust payments to the family member's credit card.
  • Payments for caregiving could not be made to a family member unless the family member was certified in some way. (This change actually wouldn't have made much difference in Arizona, since a variation of this rule is already in place for Arizona Medicaid -- AHCCCS/ALTCS -- recipients.)
  • Travel expenditures for third persons to visit a trust beneficiary would have been prohibited in pretty much all circumstances.

What changed? Social Security initially removed the change governing travel, and then indicated that the others were under review. Reportedly the high-level reconsideration included senior staff and even out-going Social Security Commissioner Michael J. Astrue (who had already submitted his resignation from that post, to be effective February 13, 2013). Commissioner Astrue wanted the reconsideration completed before the end of his tenure, so Social Security moved very quickly to make changes.

Last week one of the reviews got completed, and the reimbursement policy changed. Not only did it change -- it actually changed to make good sense. Now POMS section SI 01120.200 E.1.d, "Reimbursements to a third party," reads:

"Reimbursements made from the trust to a third party for funds expended on behalf of the trust beneficiary are not income.

"Existing income and resource rules apply to items a trust beneficiary receives from a third party. If a trust beneficiary receives a non-cash item (other than food or shelter), it is in-kind income if the item would not be a partially or totally excluded non-liquid resource if retained into the month after the month of receipt. If a trust beneficiary receives food or shelter, it is income in the form of in-kind support and maintenance (ISM)."

Similar changes have been made in another, related section, SI 01120.201 I.1.f.

What does it mean?

  •  It means that an arrangement used by trustees all over the country, though without any specific authorization, has now been formally blessed by Social Security.
  • It means that the trustees of special needs trusts can reimburse family members who buy clothing, bedding, diapers, supplements, medical devices, transportation services, furniture -- all manner of items -- without risking loss of benefits from Social Security.
  • It means that all of those things can be done without limiting or losing benefits from AHCCCS and ALTCS (Arizona's version of Medicaid). It means that a system that worked well, was responsible and cost-effective, is now available again to trustees, beneficiaries and family members.

Word is that the other changes are in the works for release this week. Here's hoping all the changes will be as thoughtful and responsive to practical realities.


Wednesday, January 23, 2013

The Importance in making the right choice in Assisted Living

When families and seniors are looking at assisted living communities, it’s a momentous, life changing time. With so many options out there, it is important to get it right the first time.

It can be such an intimidating choice that many families come down with “analysis paralysis” and indefinitely postpone a decision out of fear of making the wrong choice.

Fortunately, the decision becomes easier as you expand your knowledge and visit several places. A Place for Mom has a video, How to Find the Best Assisted Living, that outlines the things to look for when researching assisted living, but it can be equally helpful to know exactly what not to do when searching for assisted living.

Along with the video, A Place For Mom has listed the top 8 mistakes people make when looking into assitied living. There are a lot of decisions you will have to make when it comes to choosing the perfect assisted living, so be sure to do your research and ask questions!!! Feel free to ask us for help! As an Elder Law attorney, we work closely with many assisted livings in the area and can provide some helpful information.

Click here for more information


Monday, January 21, 2013

Can A Special Needs Trust Pay for things such as Credit Card Bills or Security Deposits?

   Administering a "special needs" trust can be a challenge. The rules often seem vague, and they occasionally shift. What may seem like a simple question might actually involve layers of complexity. Sometimes expenditures might be permissible under the rules of, say, the Social Security Administration, but not acceptable to AHCCCS, the Arizona Medicaid agency -- or vice versa. Trustees work in an environment of many constantly-moving parts.

Take these two examples:

Example 1:  Being the trustee of a Self-Settled Special Needs Trust for a sister. Can you pay her credit card bills?

Maybe (don't you just love lawyers' answers?). Let's break the question down a little bit.

    First, identify the trust as "self-settled." That means the money once belonged to your sister (it might have been an inheritance, or a personal injury settlement, or her accumulated wealth before she became disabled). That also means the rules are somewhat more restrictive.

We will assume that the bills are for a credit card in her name alone. If the card belongs to someone else, the rules may be different. Not many special needs trust beneficiaries can qualify for a credit card; when they can, it can be a very useful way to get things paid for (as you will soon see).

The next question requires a look at the trust document itself. It might be that it prohibits payments like the one you would like to make. That would be uncommon, but not unheard of. We will assume that the trust does not expressly prohibit paying her credit card bills.

What benefits does your sister receive? Social Security Disability and Medicare: Not a problem.But if it is Supplemental Security Income (SSI) and AHCCCS (Medicaid) there could be a problem.

    Next, we need to know what was charged to the credit card. Was it food or shelter? If it was used for meals at restaurants, or grocery shopping, or for utility bills, you probably do not want to pay the credit card bill from the trust. If you do (and assuming the trust permits it) then you will face a reduction of any SSI she receives, and possible loss of AHCCCS benefits.

Were the credit card bills for clothes, medical supplies, gasoline for her vehicle, even car repairs? There is probably no problem with paying the credit card statement. Even home repairs should be OK in most cases (just not rent, mortgage, utilities, etc. -- and the rules might be different if anyone else lives with your sister).

As you can see, what started out as a simple question turns out to have a lot of complexity. You might want to talk with a lawyer about your sister could use the credit card. When it works, though, it can be quite beneficial.

Example 2: Can a special needs trust pay the security deposit on a new apartment?

What an interesting question. We think the answer is probably "yes."

Once again we need to look at the trust document itself. Was it funded with your own money (like a personal injury settlement), or was the trust set up by a relative or friend with their own money? Is there language prohibiting payment for anything related to your apartment?

Assuming no trust language prohibits the payment, we can turn to the effect such a payment would have on your benefits. Social Security Disability and Medicare? Once again, no problem. SSI and AHCCCS/Medicaid? Your benefits might be reduced, but the payment can probably be made.

The key question is whether a "security deposit" is "rent." Arguably, it is not, rather it is an advance payment for cleaning. A special needs trust, even a self-settled special needs trust ,can pay for cleaning. Social Security's rules treat payment of "rent" as what's called "In-Kind Support and Maintenance (ISM)." This payment, we think, should not be characterized as ISM.

If it is not ISM, then it should have no effect on your SSI or your AHCCCS benefits. If it does, it might simply reduce your SSI payment (by the amount of the deposit, but capped at about $250). So long as you still get SSI it should not have any effect on your AHCCCS benefits.

Are these rules unnecessarily complicated? Yes. Does it sometimes end up costing more in legal fees to figure out what to do than it would to just pay the bills? Yes. Welcome to the complex world of Special Needs Trust Administration. Would it be possible to write simplified rules that allowed limited use of special needs trust funds while saving a bundle on administrative expenses? Yes, but please don't hold your breath while waiting for them.

 


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The Elrod-Hill Law Firm,LLC assists clients with Estate Planning, Veterans Benefits, Medicaid, Elder Care Law, Probate, Special Needs Planning and Pet Trusts in the North Atlanta area including the counties of Dekalb, Gwinnett and Fulton.



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