by Bill Miller | Dec 12, 2019 | Aging Parents, Blog, Nursing Home
There is never a wrong time to visit a loved one who is in a nursing home. Simply seeing the visitor or family member may be more meaningful to the person confined to the long-term care facility than you know. With that said, each of us needs to be prepared as our loved one may find it difficult to effectively communicate due to his or her unique health concerns.
Despite there being little communication during the visit, oftentimes, just being present with a family member or friend can be satisfying to the patient. We know you may have questions on the ”right way” to visit with a loved one. We want you to know that there is no one “right way” but the following are some suggestions on how to make a visit to a person confined to a long-term nursing home meaningful.
As a visitor, you want to consider bringing with you items that can be of interest to the patient. For example, if the patient previously had a pet, it could be meaningful if the visitor brought his or her pet for a visit with the patient at the nursing home. Similarly, if the patient enjoyed music or played a musical instrument, the visitor could bring a cassette player and discs to play music that would be meaningful to the patient. Simply reading aloud can also be helpful.
Oftentimes, as nursing home residents decline, they lose the ability to communicate. Unfortunately, we see that this is a time when many families stop visiting as often because they do not know what to say or how to make the visits meaningful for the family, as well as their loved one. It can also be difficult to see a loved one when he or she cannot communicate. It is crucial to remember again that just being present can be rewarding for all involved.
Talk with your loved one about events going on in the community or family. Even if they are nonverbal, do not assume they cannot understand. Just hearing your voice could bring comfort and keep them connected with the outside world. It may also be helpful to prepare or purchase a special food or dessert they love or of an ethnic origin that is not offered at the nursing home. Before you do this, however, you will want to be sure that the dietitian and physician agree that the patient can tolerate this new food.
Looking at old family picture albums with a patient may be meaningful. This may cause the patient to reminisce about past life experiences. Bring in old family photographs and scrapbooks, if you have them. The patient may enjoy just listening to you explain the pictures and the memories.
We know this article may raise more questions than it answers. We are here to answer your questions on this or any elder care issue you may be facing. We guide and work to protect families throughout our community to ensure that they have the long-term care support they need. Do not wait to schedule a meeting with our team.
by Bill Miller | Sep 2, 2019 | Blog, Medicaid, Medicaid Qualification, Nursing Home
There is never a “right” time to enter a skilled nursing home. For most of us, we wish to live our lives in the comfort of our own homes and never have to contemplate a time when we would leave them because we need long-term care. Unfortunately, as we age, our needs, especially when it comes to our health, may not match what we want.
There may come a time when you or a loved one will need care outside the home. This could be due to a health care crisis, a cognitive decline, or for many other reasons. The question then changes to a more immediate issue: how will you be able to afford this care for your spouse in addition to your monthly bills?
Medicaid has a fixed amount of countable assets you are allowed to own and also receive Medicaid assistance.
What happens, then, should you have more than this amount? Did you know that in our state a Medicaid “spend down” of countable assets can be done to make sure the spouse entering into the skilled nursing facility is immediately eligible for Medicaid nursing home assistance? This is done because the spouse in a nursing home, often referred to as the “institutionalized spouse”, cannot own more than $2,000 in countable assets and the healthy or “community” spouse can only own countable assets that do not exceed $126,420.
A “spend down” scenario exists when the community spouse purchases assets that result in there being less cash or available assets that would otherwise disqualify the institutionalized spouse from Medicaid nursing home assistance. The “spend down” is accomplished by the community spouse paying for things that are allowed. For example, he or she could pay cash to improve his or her residence, pay off a credit card balance, or purchase a new automobile. There is no limitation on the ways in which a spend down can be accomplished. However, the spend down cannot result in a gift being made. This would constitute a penalty that would make the nursing home spouse ineligible for assistance.
The risk of a spend down is that the nursing home spouse may suddenly die. In such an event, the cash that could have available for the community spouse’s needs over the ensuing years of comfort may no longer be available for the community spouse’s medical or other emergency needs. There are alternatives to spending down. Rather than spending down the assets and subsequently not having the cash for emergencies, the community spouse should consider using the proceeds received through an allowed Medicaid strategy. For example, he or she could utilize a reverse mortgage on the residence to pay the nursing home costs rather than leaving the community spouse without sufficient funds for future expenses.
Another strategy could be creating a non-countable asset such as a Medicaid Qualifying Annuity.
This annuity can be owned by the community spouse, regardless of its value. This annuity must meet strict rules including being irrevocable, non-assignable, have no cash value, and payable over no more than the owner’s life expectancy. Since the community spouse may also eventually need long-term care, the community spouse’s purchasing a Medicaid Qualifying Annuity may be the best solution for protecting assets since the investment in the annuity, if not used for care, could be paid back to the community spouse and then be available for his or her subsequent long-term care.
We know this article may raise more questions than it answers. There is never a wrong time to plan for the potential need for long-term care in a skilled nursing facility and, often, pre-planning can help you achieve the strategies you need early on. Whether you are in a crisis or pre-planning today, know that we have solutions available for you. Do not wait to contact our firm and schedule a meeting to discuss your needs.
by Bill Miller | Aug 20, 2019 | Blog, Medicaid, Nursing Home
Everything seemed to happen in a split second. One minute, 88-year old Mary Elizabeth was living at home and appeared able to care for herself. Then her son, Jason, received a call from the emergency room. Mary Elizabeth had suffered a devastating stroke and needed the kind of 24/7 nursing care best offered in a nursing home. She moved immediately from the hospital to a nursing facility, but financing her stay was a problem. Jason quickly learned how fast he could get Medicaid for a nursing home resident.
The Basics of Medicaid for a Nursing Home Resident
We’ve all heard of Medicaid, but may not understand the finer points of applying, qualifying, and finding the services we need.
Medicaid is federally funded, but state managed. Programs and eligibility requirements may vary from state to state. Alabama Medicaid offers a program for Institutional Medicaid – or Medicaid for nursing home residents.
Qualifying as a Nursing Home Resident
For Jason to get Medicaid for Mary Elizabeth, she has to meet the following criteria:
- Mary Elizabeth must be a U.S. citizen residing in Alabama.
- She must prove that her nursing care is needed for a medical condition.
- Mary Elizabeth must live in the nursing facility for at least 30 continuous days.
- She must have a monthly income below the current limit of $2,205 per month, although this amount may be adjusted in January of each year.
- Mary Elizabeth’s resources must be worth less than the limit Medicaid sets. At this time, the limit for an individual is $2,000. However, there are exceptions to this, particularly if the applicant is married.
But applying for government benefits can take months. Mary Elizabeth and Jason urgently need Medicaid coverage now.
Emergency Medicaid
It make take 45 to 90 days for a Medicaid application to be approved. However, Medicaid coverage may be granted to cover up to three months before the month in which the application was submitted. This applies if the applicant received medical case and if the applicant meets all other eligibility requirements.
One of the best ways to quickly receive Medicaid is to submit an incomplete or inaccurate application. We can help.
Get a Decision on Medicaid as soon as Possible.
The attorneys at Miller Estate and Elder Law understand the estate planning needs of their clients. Contact Bill Miller at 256-472-1900 to schedule an appointment. Though our office is now located at 818 Leighton Avenue in Anniston, we serve clients in Gadsden, Hoover, Talladega, Vestavia Hills, and surrounding areas.
by Bill Miller | Aug 31, 2018 | Elder Law, Medicaid, Medicaid Planning, Medicaid Qualification, Nursing Home
It’s a cold, hard fact. Many people in the United States need long-term care at some point in their lives. It’s also true that this care is expensive.
How many people really need long-term care?
As our population ages, the number of people in need of skilled nursing care will skyrocket. Today, roughly 70% of people who are age 65 will need some form of long-term care in their lifetimes.
Also, age is not the only reason people need long-term care. About 8% of people age 40-50 year age group need long-term care due to a disability. And 69% of people age 90 and up are likely to suffer from one or more disabilities.
Long-term care is expensive. How do people pay for it?
There are basically three ways to pay for this type of care:
- Self-pay, which may use up all your savings and resources.
- Long-term care insurance, which can be difficult to get as you get older.
- Public benefit programs like Medicaid.
So, it’s important that you be able to qualify for Medicaid.
That requires planning.
And Medicaid planning should take place years before you need care.
If I won’t need long-term care until I’m 65 or older, why plan now?
Medicaid programs pay more long-term care expenses than any other group. This means it’s critical that you be able to qualify for Medicaid. The whole application process is complicated and frustrating. Not everyone qualifies for Medicaid, leaving their families struggling to find other ways to pay.
The reason to start planning now is because Medicaid doesn’t just look at your current financial picture when considering your application. They actually look at financial records starting from 60 months prior to the application date. During that time, you may have transferred money or property to family as an early inheritance or just a gift. That kind gesture could reduce or eliminate your eligibility for Medicaid.
The Good News.
There are ways to prepare for Medicaid, well in advance of the time you need it. It’s complicated, but we can help.
The attorneys at Miller Estate and Elder Law assist clients just like you apply for Medicaid benefits. We also help with Medicaid planning and estate planning. For a free consultation with an experienced Alabama attorney, contact us at 256-251-2137 or use our convenient Contact Form.
We also offer free guides, videos, and workshops.
We have offices in Anniston and Birmingham and serve clients in Gadsden, Hoover, Talladega, Vestavia Hills, and surrounding areas.
by Bill Miller | Aug 22, 2018 | Medicaid, Medicaid Planning, Medicaid Qualification, Nursing Home
Medicaid, though funded by the federal government, is managed by state agencies. Each agency has the power to customize their program, and this can include imposing co-payments, deductibles, and so on. If you or a loved one receives Medicaid benefits, you need to know how Medicaid handles out-of-pocket costs.
Do I have to pay out-of-pocket expenses?
Many patients are expected to pay co-payments on expenses like:
- Office visits to doctors, optometrists, nurse practitioners, and other healthcare providers).
- Hospital care, including those provided at federally qualified health centers, rural health clinics, inpatient, outpatient, and ambulatory surgical centers.
- Durable medical equipment,
- Medical supplies and appliances, and
- Prescription drugs.
The co-payments are small. However, health care providers cannot deny services if a Medicaid recipient cannot pay the co-payment.
Are any services exempt from out-of-pocket charges?
Yes. Out-of-pocket fees by law cannot be charged for:
- Emergency services,
- Family planning services,
- Pregnancy-related services, or
- Preventive services for children.
Are any groups exempted from paying out-of-pocket fees and co-payments?
Yes, some Medicaid recipients are not expected to pay such fees:
- Children,
- Terminally ill people,
- Nursing home residents,
- Native American Indians with an active user letter from Indian Health Services,
- People receiving emergency treatments, and
- People receiving family planning services.
Check with your Medicaid caseworker to make sure you are not charged for co-payments and out-of-pocket expenses if you are included in one of these groups.
Will Medicaid repay my out-of-pocket expenses?
Not exactly.
Sometimes Medicaid will be awarded retroactively. This means that earlier costs that are eligible for Medicaid coverage may be paid. However, the patient is responsible for contacting the health care provider responsible for anything they paid for themselves. The provider will submit the services to Medicaid and typically reimburse the patient after receiving the payment from Medicaid.
First, You Have to Get Through the Medicaid Application Process.
It’s complicated and difficult, but we can help. We have helped many clients navigate federal and state guidelines to get the benefits they deserve.
The attorneys at Miller Estate and Elder Law assist their clients with all phases of estate planning and incapacity planning. For a free consultation, contact us at 256-251-2137 or use our convenient Contact Form. Although we’re located in Anniston, we also help clients in the Birmingham, Gadsden, Hoover, Talladega, Vestavia Hills, and surrounding areas.
by Bill Miller | Aug 13, 2018 | Elder Care Planning, Elder Law, Estate Planning, Medicaid Planning, Medicaid Qualification, Nursing Home
Jackie wanted her mother to have the best care possible. At age 82, Mom needed more assistance than she could get at home, even considering the great in-home nursing options available. As Jackie looked for a nursing home for her mom, she wondered how much her mom’s long-term care would cost? She came face to face with reality: long-term care is expensive!
What are the chances someone will need long-term care?
According to federal government statistics, 20% of people age 65 will need long-term care for more than five years. And if you are 65 right now, you have an almost 70% chance of needing some form of long-term care.
The families of people needing long-term care are affected also. In addition to the stress of caring for another person, they must also find the right type of care. Family members also usually have to struggle to find a way to pay for that care.
What type of care is considered long-term care?
It’s not just residential care at your local nursing home. There are other options.
- In-Home Care. Most older people want to stay in their homes as long as possible. When they need extra nursing assistance, they can often hire skilled in-home care providers.
- Assisted Living Facilities. While this is residential care, as is a nursing home, the resident has greater flexibility and privacy. Assistance, often from a trained nurse, is available if needed.
- Residential Care. Sometimes this type of care if unavoidable. Residents of nursing homes may lose some privacy but make up for it with greater skilled nursing care.
So, how much does long-term care cost?
It depends on where you live and what type of long-term care is needed.
The following figures reflect the 2017 cost for long-term care in Alabama:
- $42,900 – In-home care
- $41,688 – Assisted Living Facility
- $73,000 – Nursing Home (semi-private room)
- $76,650 – Nursing Home (private room)
These costs, of course, are averages and the actual cost may vary. Costs are expected to increase over time.
Start Planning Now.
At Adams & Miller, P.C., we make it our business to put our client’s needs first. We assist our clients in making thoughtful decisions regarding incapacity planning. For a free consultation, contact us at 256-251-2137 or use our convenient Contact Form. We have offices in Anniston and Birmingham and we assist clients in the Leeds, Gadsden, Hoover, Talladega, Vestavia Hills, and surrounding areas.
