A Long Term Care Mess (Part 2)
In last week’s post I started telling you about Mary’s call concerning her stepmom, June. Mary’s dad had recently died leaving her with the responsibility of caring for June. He also left June with ¼ of his estate per his will which she knew would not last very long, approximately 6 months. As I related last week, under the law June is entitled to a minimum amount from Mary’s dad’s estate to satisfy her right to an elective share. In New Jersey that is 1/3 of the deceased spouse’s estate less what the surviving spouse already has. June had nothing so it made it easy in the sense that I knew the ¼ share in the will would not be enough. Mary objected that her sisters would not understand why their dad’s will wouldn’t control here. I explained that if June does not assert her right to the full amount of the elective share then Medicaid will assess a penalty – a period of ineligibility for benefits - for any amount she does not receive to which she was entitled. Mary asked me how we could accomplish this since June didn’t have a power of attorney. I explained that all this needed to
A Long Term Care Mess (Part 1)
Most people don’t prepare well for the possibility of needing long term care. This story is no different but with the right steps, guidance and a lot of work this story shows what can be accomplished. Mary called us after her dad died. She wasn’t calling because she needed help with the probate of his will. Mary wasn’t sure what to do about her stepmom, June. Dad and June had been living together in an assisted living facility when he died. Dad’s will left 1/4 of his estate to June and the rest to Mary and her 2 sisters. Mary also told me that June had no power of attorney. When I asked about her health, Mary told me that June had advanced dementia and no longer recognized anyone or had an ability to communicate any longer. She added that while Dad was alive, he helped provide her care but now that he is gone the assisted living facility said June needed an aide to be able to stay there. Mary told me that there isn’t enough money to cover the cost for very long and she’ll need to apply for Medicaid. I anticipated that Medicaid would be needed within 6 months. Mary’s
Medicare Decision – 6 Years Later
I wrote about this decision here six and a half years ago. (Blog posts 3-25-13 and 4-1-13) The case is Jimmo vs. Sebelius and it corrected the misapplication of Medicare rules concerning coverage for rehabilitation services and therapy. The standard that had been applied for many years was whether the patient was improving as a result of the treatment, called the “Improvement Standard’. If not, then Medicare coverage would be terminated. This termination was often well short of the 100 days of coverage allowed under Medicare. It is certainly easy to understand why this became the standard. With elderly patients suffering from dementia, Alzheimer’s, Parkinson’s and other noncurable illnesses, they often could not show sufficient improvement to avoid Medicare’s cutoff. Medical treatment is focused on curing a condition. The problem, however, was that this was never the standard as written. Instead, what determines whether Medicare Part A coverage for skilled nursing home stays, home health care and outpatient services will continue is whether those services are needed to maintain the patient’s current condition or prevent or slow further deterioration. This is what is termed the “Maintenance Coverage Standard”. That was the issue at hand in the class action suit filed. The outcome
More Numbers for 2020
In my 11/4/19 post, I disclosed some of the important numbers that change year to year with respect to the Medicaid and VA Aid and Attendance programs that we work to obtain for many of our clients. Here are the rest of the important numbers as well as 2020 Medicare and estate and gift tax numbers. In the case of a married couple where one spouse is applying for Medicaid, the healthy spouse is entitled to keep a certain level of assets, referred to as the Community Spouse Resource Allowance (CSRA). The maximum CSRA is $126,420 (if the couple has $252,840 in countable assets or more). The minimum CSRA is $25,284. This means that the healthy spouse can keep at least the first $25,284 of countable assets. The primary residence is an exempt asset for Medicaid purposes no matter the value if the non-Medicaid spouse is living in it. In the case of a single applicant with no spouse, in New Jersey the first $878,000 of equity is exempt and does not have to be spent down. Any equity above this amount is a countable asset and subject to the spend down requirements. Let’s look at some of the relevant Medicare numbers. Under
Alternate Care Facilities (Part 2)
In last week’s post I discussed lesser known facilities that provide some level of long term care. One is a residential health care facility and another is a dementia care facility. They are categorized differently by the State of New Jersey for licensing purposes. But paying for them can also be very different than covering the cost of a nursing home or assisted living facility. One way, however, does remain the same. Private paying – using your own savings – always works as long as you don’t run out of money. If you have a long term care policy it can be a little more tricky. A residential health care facility such as the Society House which I talked about last week probably would not be covered under a long term care insurance policy for one of two reasons. Policies that cover the cost of a nursing home or assisted living facility will define those facilities within the insurance contract. Boarding homes, individual residences and independent living units won’t qualify for coverage. Whether a residential health care facility will be covered will also depend on what services it provides to residences and the frequency. A second reason the insurance may not cover the
Alternative Care Facilities (Part 1)
I recently made a visit to see a new facility opening in Livingston. The Society House is a single family home built to house 15 seniors in a group home type setting. The owners have applied but not yet received approval for licensing as a residential health care facility. When considering options for long term care care in a facility setting, most people know about assisted living facilities and nursing homes. There are many such options in our area. There are, however, lesser known categories of facilities licensed by the State of New Jersey. One type is the residential health care facility defined as a homelike setting that provides shelter, food, supervised health care and related services. There are only a handful of licensed residential health care facilities in New Jersey. Meals are provided in a common dining area similar to an assisted living facility. Staff is present to provide some assistance as needed and in some cases to administer medication. Society House’s price point is $3900 per month so it would appear that they will be focusing on higher functioning residents for whom living alone is no longer safe, although that is