The Elder Firm, LLC - Nathan J. Forck, Attorney

Wednesday, September 5, 2012

Heartwarming Story of Two Princesses


6-year-old Diamond Marshall, who was diagnosed with stage 4 cancer last year and lost her mother to the disease when she was 18-months-old, met Kate Middleton in Calgary with help from the Children’s Wish Foundation after she wrote this letter: 

NY Times Article: "For Veterans, an Alternative to the Nursing Home"

Paulia and Bienne Bastia set two dinner tables in their house in Mount Airy, Pa., each night, one for their three children, and another for themselves and the two older men the children call “Grampa.”
The Army veterans Booker Lovett, 79, and Wesley Ottis Furr, 95, are not related to the Bastias or to each other, but this has been their home since late winter. They’re participants in the Department of Veterans Affairs Medical Foster Home program, which places veterans who need round-the-clock care in private homes.
Mr. Lovett, who previously lived with his sister in Philadelphia, had a stroke — he still has trouble speaking — and has glaucoma. Mr. Furr, who maintained his own Philadelphia home, remains talkative and agile despite his age.
The Bastia children, ages 5, 6, and 7, consider the veterans family. Mr. Bastia thinks of them as father figures — he calls each “my king.”
“I felt at home as soon as I come here,” Mr. Furr said.
Mrs. Bastia, 36, a certified nursing assistant, and Mr. Bastia, 45, owner of a tax preparation business, drive the men to appointments, serve meals tailored to their dietary needs and administer medications. The Bastias can communicate with a nurse through a V.A.-provided telehealth monitor equipped with a video camera, blood pressure cuff and other equipment.
On a recent afternoon, Mrs. Bastia fastened the cuff on Mr. Furr’s thin arm while a nurse at the Philadelphia V.A. Medical Center 13 miles away observed. “Thank you, your blood pressure reading has been accepted,” said an automated voice from the monitor.
Medical foster homes provide an alternative to nursing homes for veterans who are unable to live safely and independently at home or lack a strong family caregiver. Conceived in 2000 by V.A. social workers in Little Rock, Ark., the program currently serves 535 veterans; it has cared for 1,468 since it began.
Though the veterans range in age from 23 to 101, their average age is 70. About half have some form of dementia. They often stay until they die, an average of 459 days.
“I know a lot of people suffering,” Mrs. Bastia said, explaining why she decided to participate. “I used to work in nursing homes. I know how it’s like when you get 14, 16 people to take care of. You don’t have time to do what you’re supposed to do. I figure out, if I take them to my house they can get more care.”
Now operating through 73 V.A. sites in 36 states, the medical foster homes program is scheduled to expand to 10 more states within two years. Eventually, the V.A. hopes to introduce the program to all 153 of the agency’s medical centers, said Dan Goedken, national program analyst.
It costs a site about $260,000 a year to introduce the program; each site can serve up to 30 vets. The V.A. finances each place for two years, after which the program is expected to be self-sustaining, said Dr. Thomas Edes, national director of geriatrics and extended care operations at the V.A.
Though medical foster homes are intended to provide better care, not to reduce costs, they operate for half the cost of nursing homes. “It is quite likely that it will save V.A. money and taxpayer money and veterans’ money,” Dr. Edes said.
The Bastias, who met in Florida after emigrating from Haiti, went through months of interviews and background checks to qualify as caregivers. A social worker, a nurse, a dietitian and a fire-safety expert inspected their two-story home on a quiet suburban street, and it will be reinspected annually.
Given the vulnerability of the older veteran population, the V.A. approval process is rigorous. Only one in 10 to 15 applicants are selected. People with no formal training can apply, however, and many with family caregiving experience do. Once a veteran is placed in a home, the V.A. provides training for tasks like cleaning wounds, managing incontinence and safely transporting the new residents.
And it provides periodic respite for caregivers. “It really is 24/7 care,” Mr. Goedken said. “This is a fairly intensive expectation on our part on what they’re going to do. Some willingly back away.”
Veterans pay $1,800 to $3,000 a month for care, depending on their medical needs, often using their combined V.A. and Social Security benefits. Mr. Furr and Mr. Lovett each pay the Bastias $2,000 a month for their shared bedroom and their care. The couple has another room available and is awaiting a third veteran, the maximum allowed.
A national V.A. study measuring veterans’ satisfaction and costs won’t be completed until 2013 and 2015. But 30 percent of veterans who would qualify for V.A.-paid nursing homes choose instead to pay out of pocket for medical foster homes — evidence, Dr. Edes said, that they prefer a home setting.
Even with dementia or mental illness, “they recognize this as their home. It’s very familiar,” he said. “They’re given a lot of autonomy. And it’s very one-on-one attention.”
Mr. Furr and Mr. Lovett get along well in their dorm-style room, with its twin beds and flat screen television. They take turns — Mr. Furr watches the news, while Mr. Lovett prefers football. One is a Democrat and the other a Republican, so they keep political talk to a minimum. Members of Mr. Furr’s congregation drive him to and from his Methodist church twice a week, and he often takes walks. He recently surprised his roommate, who prefers napping and relaxing at home, with a box of Lorna Doone cookies.
“I don’t expect him to be like me, and I can’t be like him,” Mr. Furr said. “So, I accept him as he is and he accepts me as I am. It’s a good deal.”


The 13 Most Frequent Medicaid Mistakes for Nursing Home Care

I wish I had written this!  What a great article that exposes many of the myths surrounding Medicaid planning and Medicaid eligibility.  Although it is written by a Florida Elder Law attorney (C. Randolph Coleman), almost everything that is mentioned in the article could apply to Missouri (or other state's) residents as well.  

As our population grows older, more and more families will face the need for long term care for their loved ones.  The cost of a skilled nursing home care in Florida averages about $7,000 to $8,000 per month.  That number increases each year. 
Medicare does not cover the cost of skilled nursing home care (except for rehabilitation usually with a limit of 100 days of coverage).  Beyond that limited coverage, the family must pay the full cost of skilled nursing home care.
Most studies suggest that the average family will exhaust the family's life savings within the first year of skilled nursing home care!  Without long term care insurance, practically all nursing home residents will eventually end up needing Medicaid to pay for the nursing home care.
When faced with the reality of the cost of nursing home care, and the almost certain eventual need for Medicaid eligibility to pay for the nursing home, most families engage in actions that can result in loss of eligibility for Medicaid benefits, or a long penalty period in which Medicaid benefits are not available to cover the costs of the nursing home care.
In an effort to help families avoid costly mistakes, that can cause them to lose their life savings unnecessarily, we have compiled this list of 13 most frequest mistakes that families make when a loved one enters a nursing home.

1. Failure to Take Advantage of the Avalable Spend-Down Options.
Many families assume when they are told the family must "spend-down" the family's assets to qualify for Medicaid benefits to pay for nursing home care, that the spend-down must be paid to the nursing home. The fact is, there are more than a dozen strategies that can be used to meet the Medicaid requirement for spend-down, without spending the money on nursing home care.  These strategies allow you to protect your assets from Medicaid and the cost of nursing home care.

2.  Transferring Assets to Other Family Members or Friends Without a Plan.
Probably the most common reaction to the realization that you must spend-down your assets to qualify for Medicaid nursing home benefits is to gift the assets to other family members or friends. There are Medicaid rules and regulations that create negative consequences, sometimes severe, when gifts of assets are made in contemplation of applying for Medicaid benefits for nursing home care.  These same Medicaid rules, however, when used properly, can result in the protection of substantial assets for the family.  You must understand how to use those rules and regulations to make them work in your favor.

3.    Assuming Your Existing Annuity Provides Asset Protection from Medicaid Spend-down.
Prior to the passage of the Deficit Reduction Act of 2005 (which became effective in 2006, "DRA"), annuities were widely used as effective planning to preserve assets from Medicaid spend-down.  The rules changed dramatically with the DRA.  Most all of the annuities that were effective prior to the DRA no longer provide asset protection.  There are a few annuities that are "DRA Compliant" that can be purchased in today's market.  These DRA compliant annuities can provide significant asset protection.  If an annuity is not DRA compliant, it is not likely to provide any meaningful protection.

4.    Having No Plan or Procrastinating Too Long to Take Action.
This year hundreds of millions of dollars will be lost to nursing homes or other long term care providers because families failed to take any action. Often this is a result of the family assuming, wrongly, that after the loved one is in the nursing home there is nothing that can be done.  In almost all cases, most of the family's assets could have been saved for the spouse living at home, or other family members, if action had been taken immediately after the family member enters the nursing home.  The reality is, the longer you wait to take action, the more money will be lost to the nursing home that could have been protected from the Medicaid spend-down.

5.    Trying to Hide Assets from Medicaid.
Sometimes families try to hide assets from Medicaid.  Sometimes they conveniently "forget" about some assets.  How will Medicaid know about the family farm or vacation home in another state?  Or, the coin collection in the safe deposit box?  The reality is that Medicaid has access to all the real property records in the US, as well as access to the most sophisticated asset databases.  Be aware that failure to disclose known assets is a federal crime (Medicaid fraud), conviction of which can result in signficant monetary fines and prison terms.  Medicaid can also pursue legal action to recover the cost of the benefits paid to someone who procures Medicaid benefits through fraud.  Do not ever seek to hide or otherwise perpetuate Medicaid fraud.  There are legitimate and legal options that allow protection of signfiicant assets without violating the law.

6.    Taking the Advice of the Medicaid Case Worker.
The Medicaid case worker, employed by the Department of Children and Families in Florida, has no interest in helping you preserve your family's assets from spending down those assets on long term care.  In fact, the Medicaid case worker's responsibility is to process and evaluate whether you are eligible for Medicaid benefits to pay for nursing home care.  The Medicaid case worker is not allowed to give financial or legal advice. To protect your family's assets as much as you legally can you need your own advocate - one who is looking after your best interests.  The Medicaid case worker is not that person.
7.    Relying on Advice from Friends and Neighbors.
It is appalling how many people rely on their neighbors, hair stylist, insurance agent, or others who are not Medicaid professionals for Medicaid advice.  Even more appalling is relying on information from friends and relatives who live in other states.  The Medicaid rules and regulations have been referred to as the most complex laws in the country, second only to the Internal Revenue Code (tax law). To further complicate this area of the law, Medicaid is a federal program that is administered by the various states.  Each state is free to establish its own rules and regulations, within certain parameters.  The law is implemented differently by each state.  What applies in New York, or Pennsylvania, or New Jersey or Ohio, does not apply in Florida.  So not only do you want to restrict your source of advice to a qualified Medicaid professional, but you want to restrict your counsel to those within the state in which you reside.  For those who are familiar and experienced with the particular state's rules and regulations, Medicaid asset protection can be quite effective.

8.    Choosing the Wrong Attorney
In most cases, the family is going to need an attorney to achieve the most favorable outcome for preserving the family's assets.  There are legal documents that are often required, such as a qualified income trust.  Attorneys, like all professionals in other disciplines, usually have a specific area of the law in which they are knowledgeable and experienced.  To obtain the proper counsel and advice you will want to work with an experienced elder law attorney to deal with Medicaid spend-down planning for asset protection.  You do not want to rely on the advice of a divorce attorney, personal injury attorney, real estate attorney, corporate attorney, or attorneys who practice in other disciplines.  Probably less than 10 lawyers out of a 100 have experience in elder law and Medicaid asset protection planning.  Of those 10, probably only 2 or 3 of them have substantial experience over a number of years.  Your most effective Medicaid spend-down plan for nursing home care will likely come from one of the elder law attorneys with substantial experience.

9.    Making Transfers Without Authority
Some families, in a desperate attempt to protect the assets of a family member who is no longer legally competent, will transfer assets without the property authority.  For instance, we sometimes find that deeds have been signed by the legally incompetent senior, or assets have been transferred un the authority of a power of attorney that does not include the authority to make the kinds of transfers involved. Such actions may be viewed as harmless (that's what Dad would have wanted) or convenient.  However, those actions may actually be fraudulent, create title problems for future transfers of real property, or may be considered "financial abuse of the elderly" (which is a criminal act in Florida).  Furthermore, such transfers may ultimately be challenged by Medicaid as uncompensated transfers that result in signficant penalty periods during which no Medicaid benefits can be received.

10.    Mistakenly Giving $13,000 (or $10,000) Won't Impact Medicaid Eligibility.
The Internal Revenue Code (tax code) currently allows an individual to transfer $13,000 (up from the original $10,000) to another person as a gift, without incurring any gift tax liability.  For Medicaid eligibility purposes, the tax code doesn't matter.  ANY gift or transfer of property, including cash, to another person within five years of the date your loved one applies for Medicaid benefits to pay for nursing home care, will result in a penalty period during which the nursing home resident will not be eligible to receive Medicaid benefits.  In Medicaid planning, if you are going to make any gifts, make sure it is according to a specific plan and that you have properly evaluated the potential consequences of the gfit.

11.    Relying on a Revocable Living Trust to Protect Assets from Medicaid Spend-down.
Many people have used revocable living trusts as their primary estate planning tool, in an effort to avoid probate.  Many believe that the revocable living trust provides some asset protection value for Medicaid spend-down plan purposes.  Notwithstanding the benefits provided by revocable living trusts from the perspective of estate planning and probate avoidance, such a trust provides no asset protection - either from Medicaid spend-down planning, nor for any other purpose.  Any and all assets titled to the revocable living trust will be considered available resources for purposes of Medicaid eligibility.

12.    Applying for Medicaid Too Early.
Some families file the application for Medicaid eligibility for nursing home benefits for the sole purpose of determining whether they qualify for benefits.  The belief is the worst thing that can happen is that the application is declined.  However, the Medicaid rules and regulations have many issues that could result in an application that is filed too early to cause substantial penalty periods during which Medicaid benefits cannot be received by the applicant.  These penalty period can be for a longer time than the 5 year look back period.  You should never file a Medicaid application unless you fully understand the possible consequences of the application being denied.

13.    Failure to Avoid Estate Recovery.
Often someone can qualify for Medicaid benefits to pay for nursing home care and retain the ownership of some assets.  Each state has the right to "Medicaid Recovery."  Medicaid recovery is a procedure where the state can recover from the estate of the person receiving Medicaid benefits, after the person has died.  The State can recover the value of the benefits paid on behalf of the deceased person.  Most states can recover only from the "probate estate."  Other states have defined the "estate" to include assets that are not included in the deceased person's probate estate.  To effectively protect assets from Medicaid estate recovery, you must first understand what constitutes the "estate" for a particular estate, and then understand how you can title assets to avoid estate recovery for the specific state that is involved.

These 13 mistakes cost families millions upon millions of assets every year that are paid to nursing homes when those assets could be preserved for the spouse or other family members.  If you have a loved one in a nursing home, or about to enter a nursing home, there are many actions you can legally take to avoid spending down the family's assets for nursing home care.
Our attorneys can help you protect your family's assets from the costs of nursing home care.