He looked into his wife’s eyes and flatly stated, “I’ll put a gun to my head before I ever go to a nursing home.” But the sad truth is this: His wife will be the one to bear the burden caused by his long term care needs and her own aging challenges.
This couple are frugal people who worked hard all their lives. They lived on two Social Security checks, his modest pension, and minimal investments. They were able to pay their bills and enjoy simple luxuries—until the out-of-pocket expenses of long term care begin to drain what they worked a lifetime to save.
His wife selflessly provides in-home care for her beloved husband, until eventually the day comes when her strength is not enough to pick him up or keep him from wandering away from home. On that day, it might be a doctor, a discharge planner, or a policeman who looks into her eyes and speaks the harsh truth to her: “I’m sorry, ma’am. You can’t take care of him by yourself any more.”
This poor woman now faces a nightmare as she walks the elder care journey with a frail and declining husband. First she learns that neither Medicare nor their health insurance provide any payment for home health care costs. Later, when her husband must be relocated to a long term care facility, she discovers that neither Medicare nor Medicare supplemental insurance will pay the facility’s $3,000 to $8,000 monthly cost.
Quickly, she also learns that Medicaid is not available because she has “too much money.” Her husband’s care will be offset by Medicaid only if she and her husband meet stringent income and asset limitations. If they have assets over approximately $101,000, they must “spend down” their life savings, which Medicaid defines as “excess assets.” When all excess assets have been spent on her husband’s medical care, then Medicaid will also control her monthly income. She is restricted to $2,500 per month; any income above that must be used to pay for her husband’s care.
Later, when her husband dies, she receives more bad news. She loses his pension, and as the “survivor spouse” she loses one of their two Social Security checks. She has spent nearly all of their assets to provide for her husband’s care, and now she can’t even afford to live in her own home. The nightmare of long-term care has left her impoverished and stolen her independence.
She will now face her own elder care journey alone. She will not have the luxury of a spouse who will serve her as she served him. No one will be there to dutifully care for her at home and to delay the day that she must move to a long term care facility. She will not have the financial resources that he had, because Medicaid called them “excess liquid assets” and she spent those assets on his care. As a single person, she will not be provided with assistance by the State of Illinois or the federal government until she has become impoverished to the point of a paltry $2,000 or less in total assets. The indignity committed against her does not stop there, for now she must sign over all her income to the nursing home as well, except for a miserly “personal needs allowance” of $30 per month.
The loving wife who faithfully cared for her husband is now out of money and out of options. $30 per month will not even give her the privilege of having her hair done. She is alone—and living the nightmare of long term care in America.
Illinois senior citizens may soon be punished by the State of Illinois when they announce new Medicaid eligibility rules for nursing home (NH) and Supportive Living Facility (SLF) benefits. The goal is to save the state big money by creating new ways to deny fragile senior citizens assistive living or nursing home help. The state wants to impose harsh penalty periods of ineligibility for NH and SLF services for any Illinois senior has given away money or assets during the five years (60 months) prior to a Medicaid application. Can you imagine being punished for helping your children and grandchildren?
Due to recent unemployment in the younger generations, Illinois seniors have paid loved ones’ medical bills, mortgage payments, tuition, and grocery bills. Illinois Healthcare and Family Services (HFS) is about to implement rules which will punish seniors whose only “crime” is helping those they love.
The current Illinois Medicaid eligibility rules are fair and include a “forgiveness factor.” Seniors who give away money or other assets create an immediate Medicaid penalty period of eligibility. When a senior is still healthy and/or wealthy enough to cover their own healthcare expenses the ‘penalty’ quickly goes away. For example, if a senior gives away $10,000 to a loved one, within about three months the senior is “forgiven” for that gift. BUT—
The new rules have no forgiveness factor. They will impose penalty periods of ineligibility that will hang over a senior’s head for five years. If you apply for Medicaid within five years after a gift, you will be punished with non-payment of Medicaid nursing home costs. This will happen even when the senior is ill and impoverished. Both the senior and the long term care industry will be denied payments. Can you predict what your health will be in five years?
Illinois must provide law-abiding seniors with fairness and a Medicaid forgiveness factor!
Illinois elder law attorneys have organized a DRA Task Force for Senior Fairness. Ask Governor Pat Quinn and HFS Director Julie Hamos to be fair to Illinois’ frail senior citizens and long term care providers. Contact Jessica Bannister at email@example.com to become involved!
I had just checked into the Crawford Country Store and Motel—a combination convenience store and motel in Crawford, Colorado. I had chosen to live at this clean and basic lodging during a five-day horse training clinic on the western slope of the Rockies. After I found and entered my room, I dropped my bags and headed for the bathroom. I walked in, turned to my right, and flipped the light switch—nothing happened. “The light bulb must be burned out,” I thought. I tried again—and nothing. Well, I hustled back downstairs to the country store area and told the folks behind the counter that my bathroom light did not work. A young man looked at me, chuckled, and said, “You need to flip the switch behind the towel.” My jaw dropped and I asked, “There’s a switch behind the towel?” He assured me that there was, as he had just used it that morning when he cleaned the room. Shaking my head and wondering about whomever had decided to install a towel rack over a light switch, I went back upstairs to see if this was really true. I put my hand behind the towel and felt a switch. Bingo, the light turned on!
I thought about this for a moment… I had a low opinion of the decision to place a light switch “behind the towel”—but then it reminded me of how often in life the real answer to something is hidden from us. The obvious answer is often not the right answer—this is why we need to find those professional counselors, health care providers, and lawyers who know where to find the light switch we need.
Imagine for a moment that you suddenly have a diagnosis of some grave physical ailment. You would most likely consider immediately hustling off to see experts places such as the Mayo Clinic or the Cleveland Clinic. Another example: even though we are lawyers ourselves, we often hire other lawyers to give us advice in specific legal problem areas. When we need to hire a lawyer, we seek out an experienced practitioner with a proven record. You see, when I need an attorney, I want the best! We don’t just hire the first person who says, “I’m sure I can take care of you, but I’m going to have to do some research in the area first.” We hire legal counselors and refer our clients only to attorneys who can readily say, “Oh yes, we handle situations like yours every day.” Those legal advocates know where the hidden light switches have been placed.
When it comes to dealing with the issues of the frail, elderly, and disabled, Law Elder Law knows where those hidden light switches are. Our areas of concentration are elder law estate planning, disability, Medicaid, and V.A. long term care benefits. Our outstanding Law Elder Law team turns on the lights for our clients every day!
He looked directly at me and softly said, “Every day I pray ‘the parent’s prayer’—that Mitchell has a long, healthy life, but that Linda and I live just one moment longer, so that no one else ever has to take on the enormous responsibility of caring for our special needs child.”
I was interviewing attorney Brian Rubin of Buffalo Grove, Illinois, who focuses on estate planning and advocacy for clients and families who struggle to find the right answers for their child with special needs.
I recently met Brian when I was invited to join the Special Needs Alliance (SNA). My own law practice is focused on serving seniors who have either a long-term illness or an adult child with a disability.
He went on to tell me, “My adult life started out fairly normally. After college, I worked for a large CPA firm, then went to law school at night, and worked for the IRS by day. I have always had to wear more than one hat.”
Brian, and his wife Linda, never planned to have a law firm which focuses on Special Needs Future Planning—but life often takes an unexpected turn. In January of 1981, their son Mitchell was born. When Mitch was five months old, Linda told Brian, “There is a problem.” Brian says the truth of that statement was the beginning of his going through “the stages of special needs grief”: denial, self-blame, and doctor-hopping. Mitch has autism, among other diagnosed special needs. It soon became apparent that Brian needed to quit his downtown Chicago law practice and stay closer to home. He also wanted to provide appropriate legal guidance and advocacy for his family and others who faced the same issues. “In those days, almost no one was doing any special needs trusts and benefits planning. I was one of the pioneers in Illinois.”
Brian struggled to balance the demands of a law firm and his passion to serve the community of the disabled from 1987-2001.
When Mitch reached 18 years of age in 1999 and became eligible for health care through Medicaid, Brian began thinking about opening a law firm which would be 100% devoted to the laws, regulations, and benefits that both frustrate and support clients with disabilities and their families. Brian opened the doors of The Law Offices of Brian Rubin and Associates in 2001. The firm provides more than just estate planning and special needs trusts. Brian says, “Illinois has a very splintered benefit system. There is no single door of entry, so families are constantly hitting roadblocks. For example, our son Mitchell’s area of autism does not specifically fit in any one legally defined area. He needs a variety of services, but no one agency supplies them as one package. It’s my job as attorney and dad to discover how to get Mitchell the benefits that he needs. We provide that same type of advocacy for our clients.”
He further explained, “We have found that the government does not tell people the whole story. Our job as legal advocates is to tell the whole story and to help get appropriate services and residential environments. We cannot do everything—but we act as the quarterback to get the financial advisor, psychiatrist, health care professionals, education providers, and caseworkers to collaborate to achieve the needed results.”
In closing, Brian shared this: “Mitchell has allowed me, Linda, “big sister/assistant mom” Nicole, and “little/big brother” Benjamin to better appreciate what’s truly important in life… and what is not so important.”
Brian Rubin has created a website (www.brianrubin.com) which is filled with helpful information. In addition, he makes public presentations frequently throughout the Chicago metropolitan area and Illinois.
He is 80 years old but looks like mid-60s. When I told him that, he remarked, “Thanks, but the old noodle is giving out. Doctor says I’ve got dementia.” His wife nodded in vigorous affirmation. She added, “He goes to the store with a list, but always messes it up.” She was not trying to be hurtful—rather, she just wanted me to know how things really sit. This time, he nodded in animated agreement.
They have been clients for years, and they had urgently called to “get their affairs in order.” He has his brain scan results, and she has emphysema and COPD. She has already signed a DNR for herself.
As I listened to the facts, she threw me a bombshell. “I heard about the five-year Medicaid look-back rules, so I cashed in my IRA and gave $10,000 to each of our four adult children.” I gulped and said, “That was a mistake. Based on what you have told me about your health and your assets, it is highly likely that one of you will need nursing home care before 2015. Your gifts to your children will create a six- to eight-month penalty period of ineligibility for Medicaid nursing home benefits.
She asked, “What should we do?”
I answered, “You should call your family members and tell them that you made a mistake and to please give you back the money.”
Her look told me that she would never do that.
Her husband said, “We screwed up, huh? We should have called you first.”
Most elderly clients who give away money due to a medical crisis will need long-term care within a short period of time. If you know a client or a client family member who is thinking about giving away assets “to protect them from being lost to nursing home expenses,” please tell them to call an elder law attorney first. Our firm can be reached at 630-585-5200 or firstname.lastname@example.org
Medicare and Medicaid sound the same, but they are as different as the two beauty queens you see here. Frankly, it’s surprising how many people don’t recognize the difference between the two.
Few people realize the limitations of Medicare—which winds up costing them a substantial loss of dignity if or when they get hit with long term care expenses. Medicare is the federal health insurance program provided on behalf of persons who are over the age of 65, blind, and/or disabled. Medicare does not provide long term care benefits (nursing home care, for instance). Medicaid, which is a poverty health care program, pays for 50% of the nursing home care in America today.
Medicare only cares about short-term or “acute care” health care. Medicare only cares about your health care expenses if you can get well! Medicare does NOT provide care when a person is diagnosed with a long-term illness and needs nursing home care. Essentially, our senior citizen health care is based on a “diagnosis lottery.” If you are “lucky enough” to have a heart attack or diabetes, then you are covered by Medicare. You are out of luck if you are diagnosed with Alzheimer’s, Parkinson’s, Huntington’s disease, or anything else that lands you in a nursing home. If you need a nursing home and you are not impoverished, you are on your own dime!
So, unfortunately for seniors, the blind, and disabled persons living in 2010, the acute care model does not help them when they are afflicted with long term care costs. Medicaid is the safety net for the impoverished. Once you become sufficiently impoverished, then Medicaid is designed to provide care for you. To qualify for Medicaid nursing home benefits you must be very ill and have no more than $2,000 total assets.
An elder law attorney knows the ins and outs of the public benefit system and can provide the client with solutions that help to fulfill the requirements of the law and still provide a better future for themselves or their loved ones. We help clients fulfill their legal obligations and avoid unnecessary impoverishment due to long term care expenses. If you want more information regarding a specific client situation, please contact us.
This blog is not about strangers lurking in an alley. Nonetheless, nursing homes are routinely “invaded” in the wee hours and weekends, because they are subject to unannounced night and weekend visits by trained teams of Medicare inspectors.
These snoopy night stalkers show up and “camp out” in the facility for days. These teams have full authority to review and audit over 180 different items covering all major aspects of care in a skilled nursing facility. They inspect the buildings, the medical records, the residents, the cleanliness, the staffing hours per resident, and much, much more. These investigators are there to find deficiencies, note them, and report them to the Center of Medicare and Medicaid Services (CMS). The report is used to provide a rating which is available to the public at the Nursing Home Compare website.
The website lists each nursing home and assigns a quality rating between 1 and 5 stars. A 5-star nursing home is heavenly! Unfortunately, a 1-star nursing home is a probably a living hell.
CMS has created this rating system to help seniors and their loved ones see behind the scenes and beyond the nice décor to find a safe and nurturing care facility for a frail senior.
The most coveted score is a 5-star Medicare quality rating. That score is received by only 10% of all skilled nursing home facilities. There are very few facilities who receive such an award even when they are in the luxury market. It is even more impressive when a facility which accepts Medicaid residents qualifies as a 5-star-rated Medicare facility. Recently Tower Hill Healthcare of South Elgin, Illinois announced in their newsletter that they had received a 5-star award. I was impressed! Tower Hill is a 206-bed Medicaid-certified skilled care facility with a 31-bed Alzheimer’s wing.
In my next blog, you will be introduced to a 33-year-old orthodox Jewish synagogue cantor and wedding singer, Jeremy Amster, whose leadership skills have earned the 5-star rating.
“Like millions of boomers, I chose not to marry or have children. But I don’t think that we unmarried boomers fully realize that there’s a lot more to worry about now than just long term care for our geriatric parents.”
We find that clients rely upon us for more than traditional legal advice. We help clients and families put together the “aging puzzle” with its many ill-fitting pieces. . . In fact, the legal advice we provide may be the least complicated piece of the client’s aging puzzle.