Florida Elder Law Blog - ElderLawAssociates.com

Millions of American families are caring for a loved one with Alzheimer's. The Alzheimer's Association, the world leader in Alzheimer's research, care and support, is dedicated to finding prevention methods, treatments and an eventual cure for the disease.

FALC member Elder Law Associates PA is gearing up for the Alzheimer's Association Southeast Florida Chapter Memory Walk on April 4th in West Palm Beach. Please show your support! Click here to visit Team Elder Law Associates' web page and help their efforts to support this worthy cause by making a donation.

Labels: Alzheimer's

We found this article about pre-paid funeral arrangements in the Chicago Tribune enlightening, and think that you may, too:

The funeral industry is reconsidering one of the biggest selling points of prepaid funeral contracts—locking in the price prior to death.

Of course, it just highlights some of the many reasons it pays to consult with an up-to-date Florida Elder Law Attorney when planning your estate.

Labels: Florida Elder Law Attorney, Florida Estate Planning

WHAT IF 33% OF ALL SENIORS IN THIS COUNTRY could receive up to $1,949 a month in additional income from the government to help cover their elder care costs? THEY CAN! Talk to a Florida elder law attorney today!

Under the right circumstances, a little-known federal program will pay additional income to cover long term care costs for at least 1/3 of all US senior households -- that's how many war veterans or their surviving spouses there are in this country. But the provisions of this program are such a well-kept secret that only 4.7% of US seniors are actually receiving the benefit. The great news about this program is the Department of Veterans Affairs will pay you to hire your family, friends or just about anyone to take care of you (Caregiving spouses can't be paid under this program). The program is called "Veterans Pension."

Most people who have heard about Pension know that it will cover the costs of assisted living and, in some cases, cover nursing home costs as well. But the majority of those receiving long term care in this country are in their homes. Estimates are that approximately 70% to 80% of all long term care is being provided in the home. All of the information available about Pension overlooks the fact that this benefit can also be used to pay for home care.

It also comes as a surprise to most people that the Department of Veterans Affairs will allow veterans' households to include the annual cost of paying any person such as family members, friends or hired help for care when calculating the Pension benefit. This annual cost is deducted from household income and used to calculate a lower "countable income" which in turn enables families to receive this disability income from VA. Even though VA claims the benefit is for low income families, because of the special provision in the regulations -- allowing for deduction for care costs -- households earning between $3,000 to $6,000 a month or more can still qualify for Pension under the right conditions.

This extra income can be a welcome benefit for families struggling to provide eldercare for loved ones at home. Under the right circumstances, this annualized medical expense for the cost of family members, friends or any other person providing care, could create an additional household income of up to $1,056 a month for a single surviving spouse of a veteran, up to $1,644 a month for a single veteran or up to $1,949 a month for a couple.

If the disabled care recipient has been rated "housebound" or in need of "aid and attendance" by VA, all fees paid to an in-home attendant will be allowed as long as the attendant provides some medical or nursing services for the disabled person. The attendant does not have to be a licensed health professional. There is also no need to distinguish between medical and nonmedical services -- all are deductible.

For a disabled person who has been rated "in need of aid and attendance" or "housebound", a family member will be considered an in-home attendant, but that family member has to be paid for services duly rendered. There is potential for fraud here where a family member may move into the home and ostensibly receive payment as a caregiver but not actually provide the level of care paid for. Documentation for this care must be provided to VA, and it is reasonable for VA to question whether the services being purchased from a family member living in the household are legitimate. Such arrangements should be extensively documented and completely arm's-length.

The care arrangements and payment for home care must be made prior to application and there must be evidence that this care is needed on an ongoing and regular basis. We recommend a formal care contract and weekly invoice billing for services. Money must exchange hands and federal law requires employment taxes must be withheld and there must be evidence of this. All of this documentation must be provided as proof to VA when making application for the pension benefit. Costs for these services must be unreimbursed; meaning these costs are not paid by insurance, by contributions from the family or from other sources. VA will allow, however, family caregivers being paid by their loved ones, to turn around and pay the household bills for their loved ones to help defray the cost of the care.

Due to the need for a rating, documentation for annualizing care costs and the extensive proof needed to show the caregiver is indeed an employee of the care recipient, most people should not try this on their own. An expert in this area should be sought to help with the application in order to avoid lengthy delays in awarding a benefit or a possible denial of benefits.

Labels: Florida Elder Care, Florida Elder Law Attorney

One very useful Medicaid planning technique in the arsenal of a Florida Elder Law Attorney involves the creation of an irrevocable Medicaid Asset Protection Trust. With a Medicaid Asset Protection Trust a person or couple can transfer some of their property to the trust to hold and manage for their benefit during their live with the remainder paid to their family after their death.

Example: Joe and Joan have assets in their savings and stock accounts of $250,000. They currently live off income from their investments, social security, and other retirement benefits. They are concerned that if they need nursing home care they will not have enough money to support their lifestyle and pay for the medical expenses for the remainder of their life.

Solution: Joe and Joan decide to transfer $150,000 to a Medicaid Asset Protection Trust. The trust provides that all income is paid to them while alive and in the even one need nursing home coverage under Medicaid the income is paid to the other. Upon the death of the surviving spouse, the trust will terminate and distribute the remainder to their children. By using this type of irrevocable trust their assets are protected and they receive an income stream for their lives.

Potential Problems: The gift to the Medicaid Asset Protection Trust can cause the a period of ineligibility for Medicaid benefits. The length of the ineligibility period depends upon the value of the assets given away as well as how long before the care is needed they are disbursed. After the ineligibility period, the assets in the Medicaid Asset Protection Trust should be protected and not counted as a disqualifying asset for Medicaid planning purposes. In addition, this removes the assets from the reach of the spouses.

A Medicaid Asset Protection Trust is not for everyone, but it can be a means of protecting a family's financial security. These trusts can be complicated and must be tailored to the families resources and needs. It is important that you use a Florida Elder law attorney who is familiar with the Florida Medicaid laws and who has experience in creating this type of trust.

Please note: The Irrevocable Medicaid Asset Protection Trust is not the same as a "revocable trust", "revocable living trust" or "living trust" that is currently being sold through Trust Seminars. As always, when considering these types of instruments, please consult a Florida Elder Law Attorney.

Labels: Florida Elder Law Attorney, medicaid, Medicaid Planning

Elder Law Associates just learned about this great product called QuietCare, which helps seniors maintain their independence safely, without intruding on their privacy. By observing a senior's normal patterns of daily living key to their well being, the system will alert an emergency response operator in case of emergency to call the senior and, if needed, their designated family members, caregivers or local emergency services. No cameras or microphones are used and no action by the senior is required.

Click here to find out more.

Labels: Florida Elder Care

Nursing home coverage for veterans is available from two sources within the Department of Veterans Affairs -- the veterans health care system and the state veterans homes system. As always, if you are making elder care plans for a veteran, consult with a Florida elder law attorney.

Nursing Home Coverage through the VA Health Care System
Nursing home coverage along with other long term care services such as home care and assisted living as well as geriatric care management are available through the Veterans Health Administration for qualifying veterans.

In order to get into the veterans health care program, the veteran must have service-connected disabilities, or be below a qualifying income level or be receiving Veterans Pension income. Once in the system, veterans are not guaranteed long term care services, including nursing home care, unless they meet specific requirements. Here is a list of these requirements for nursing home coverage.

Who is Eligible for Nursing Home Care

• Any veteran who has a service-connected disability rating of 70 percent or more;
• A veteran who is rated 60 percent service-connected and is unemployable or has an official rating of "permanent and total disabled;"
• A veteran with combined disability ratings of 70 percent or more;
• A veteran whose service-connected disability is clinically determined to require nursing home care;
• Nonservice-connected veterans and those officially referred to as "zero percent, noncompensable, service-connected" veterans who require nursing home care for any nonservice-connected disability and who meet income and asset criteria; or
• If space and resources are available, other veterans on a case-by-case basis with priority given to service-connected veterans and those who need care for post-acute rehabilitation, respite, hospice, geriatric evaluation and management, or spinal cord injury.

VA's nursing home health system programs include VA-operated nursing home care units and contract community nursing homes. Many VA hospitals operate nursing home care units located in or near the hospital. Other hospitals, without adequate nursing home beds, contract with approximately 2,500 community private nursing homes nationwide to provide services.

State Veterans Homes
State veterans homes fill an important need for veterans with low income and veterans who desire to spend their last years with "comrades" from former active-duty. The predominant service offered is nursing home care. VA nursing homes must be licensed for their particular state and conform with skilled or intermediate nursing services offered in private sector nursing homes in that state. State homes may also offer assisted living or domiciliary care which is a form of supported independent living.

Every state has at least one veterans home and some states like Oklahoma have a number of them. There is great demand for the services of these homes, but lack of federal and state funding has created a backlog of well over 130 homes that are waiting to be built.

Unlike private sector nursing homes where the family can walk in the front door and possibly that same day make arrangements for a bed for their loved one, state veterans homes have an application process that could take a number of weeks or months. Many state homes have waiting lists especially for their Alzheimer's long term care units.

No facilities are entirely free to any veteran with an income. The veteran must pay his or her share of the cost. In some states the veterans contribution rates are set at a certain level and if there's not enough income the family may have to make up the difference. Federal legislation, effective 2007, also allows the federal government to substantially subsidize the cost of veterans with service-connected disabilities in state veterans homes.

State Veterans Homes Per Diem Program
The Veterans Administration pays the state veterans homes an annually adjusted rate per day for each veteran in the home. This is called the per diem. The 2008 nursing per diem amount is $74.42 and for domiciliary care it is $34.40. Adult Day Health Care – up to one-half of the cost of care -- cannot exceed $66.82 per day. The goal of state veterans homes is to get Congress to increase the per diem rate for nursing care to 75% of the state private nursing rates. In most states the per diem falls well short of this goal.

The per diem program and construction subsidies mean that State veterans homes can charge less money for their services than private facilities. Some states have a set rate, as an example $1,400 a month, and they may also be relying on qualified veterans receiving the Pension benefit with aid and attendance plus the per diem to cover their actual costs. Other states may charge a percentage of the veteran's income but be relying on other subsidies to cover the rest of the cost. Some state homes can receive Medicaid support as well.

Most of the states with income-determined rates are selective about the veterans they accept. These states may rely on a variety of private and public sources to help fund the cost of care.

Eligibility and Application Requirements for State Veterans Homes
From state to state, facilities vary in their rules for eligible veterans. And even in the same state it is common, where there is more than one state home, for some homes to have very stringent eligibility rules and others to be more lenient. These differing rules are probably based on the demand for care and the available beds in that particular geographic area.

Some homes require the veteran to be totally disabled and unable to earn an income. Some evaluate on the basis of medical need or age. Some evaluate entirely on income -- meaning applicants above a certain level will not be accepted. Some accept only former active-duty veterans, while others accept all who were in the military whether active duty or reserve. Still others accept only veterans who served during a period of war. Some homes accept the spouses or surviving spouses of veterans and some will accept the parents of veterans but restrict that to the parents of veterans who died while in service (Goldstar parents).

Federal regulations allow that 25% of the bed occupants at any one time may be veteran-related family members, i.e., spouses, surviving spouses, and/or gold star parents who are not entitled to payment of VA aid. When a State Home accepts grant assistance for a construction project, 75% of the bed occupants at the facility must be veterans.

Domicile residency requirements vary from state to state. The most stringent seems to be a three-year prior residency in the state whereas other homes may only require 90 days of residency.

All states require an application process to get into a home. Typically a committee or board will approve or disapprove each application. Many states have waiting lists for available beds.

Labels: elder care, Florida Elder Law Attorney