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Steps to Take When Discharged from a Hospital to a Nursing Home

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April 20, 2015

- Chicago, Chicago Elder Law, Chicago Elder law attorney, Chicago Illinois Hospice Care, Chicago Suburban Elder Law Attormey, Chicago Suburbs, Chicagoland Elder Law, Elder Law Articles, Eldercare Attorney, Estate Planning, Estate Planning Attorney, Medicaid and Paying for Nursing Home Care, Medicaid spend down planning, senior estate planning

During your stay in a hospital, your doctor and the staff must work with you to help plan for discharge from the hospital.  Your input is an important part of creating a comprehensive plan for what happens after you leave the hospital setting and enter long term care.  The following questions come from a document called “Your Discharge Planning Checklist” from the Centers for Medicare and Medicaid Services.  We recommend using this and other checklists in working with the hospital’s staff before discharge. During your stay in a hospital, your doctor and the staff must work with you to help plan for discharge from the hospital. Your input is an important part of creating a comprehensive plan for what happens to you after you leave the hospital setting and enter long term care. The following questions come from a document called “Your Discharge Planning Checklist” from the Centers for Medicare and Medicaid Services. We recommend using this and other checklists in working with the hospital’s staff before discharge. The following questions are important considerations as you prepare to leave the hospital:
  •  Where will you receive care after discharge?
  •  Who will be helping you in the transition from the hospital to long-term care?
  •  What is the current status of your health? What can you do to improve it?
  •  What potential problems should you be aware of with regards to your health? Is there someone you could call if these problems do arise?
  •  Do you need medical equipment (like a walker)?
In addition, we strongly recommend doing the following in preparation for discharge from the hospital:
  •   Create “My Drug List” to write down any prescription drugs, over the counter drugs, vitamins, and herbal supplements that you need to take, along with the dosage and other pertinent information.
  •  Ask for written discharge instructions and a summary of your current health status. Bring this information, along with your complete “My Drug List” to follow up appointments.
  •  Talk to a social worker or a representative from your health plan to determine what your insurance will cover and how much you will have to pay.
  •  Talk to an elder law attorney if you do not know how your long term care will be covered:
        -Long Term Care Insurance? Not many people have it.
        -Private Pay? This can cost over $8,000 a month!
        -Medicare? Does not cover long term care in a nursing home or assisted living facility.
        -Medicaid? This covers long term care, but you must take planning steps to qualify based on your assets and income.
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For your information, Anthony B. Ferraro was elected President of the Illinois Chapter of NAELA, the National Association of Elder Law Attorneys. Congratulations to him.
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“I Love you Wills & Trusts” for Seniors? Bad Idea!

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March 9, 2015

- Blog, Chicago, Chicago Elder Law, Chicago Elder law attorney, Chicago Suburban Elder Law Attormey, Chicagoland Elder Law, Elder Law Articles, Estate Planning, Estate Planning Attorney, Medicaid and Paying for Nursing Home Care, Medicaid spend down planning, senior estate planning

You know the kinds of wills I’m talking about. The husband leaves everything to the wife, the wife leaves everything to the husband, and after they both die, everything goes to the children. This works well for situations in which the spouses are healthy one day and deceased the next. However, as most of us know, life doesn’t usually happen that way anymore. Some research indicates that 69% of individuals over 65 will require some kind of long-term care in their lifetimes. Thus, many spouses worry that if they predecease a disabled spouse who is currently in a nursing home or will require long-term care at some point in the near future, there will be insufficient funds available to provide for the institutionalized spouses’ needs. This is an especially relevant concern for expenses that are not covered under Medicaid, like a care manager, private nurse, single room, and certain therapies or drugs. Another concern is that the availability of funds from “I love you” wills and trusts will disqualify the surviving ill spouse from eligibility for Medicaid benefits. As you know from prior articles, Medicaid is the only long-term-care governmental program in the United States. Medicare does not cover long-term custodial care. To solve this problem many of our clients rely on a “testamentary trust:” a trust built into the will of each spouse. For many estate planners, this is counterintuitive because much estate planning occurs within the context of a revocable living trust. In order to preserve access to Medicaid eligibility without requiring that the surviving spouse spend down the assets and lose the chance to maintain a “rainy day fund,” creating a testamentary trust in the will of the pre-deceasing spouse is essential. What this means is that around age 55, you have to completely revise your wills and trusts to accommodate a different paradigm of thought. The thinking process is no longer what happens if I die? Rather, the question is what happens if I don’t die and live a long time with expensive long-term care. The new paradigm requires a new estate plan. If you consider yourself middle-class (meaning that your net worth will be significantly impacted by the cost of long-term care for you and/or your spouse) and are over age 55, I suggest that you revise your estate plan to reflect this newer paradigm as soon as possible.
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How to Get Answers NOW | Chicago Elder Law Attorney

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February 21, 2014

- Chicagoland Elder Law, Estate Planning, Medicaid and Paying for Nursing Home Care

Medicaid certainly is an intimidating process; and many of you want to get answers immediately. If this sounds like you, the following link is a special offer that will give you some relief for the time being. http://www.learnmedicaid.com/ferraro/get-answers-now/index.html The above link will help you understand the first steps that you will need to take in order to reduce the cost of care for your loved one while protecting your family and your home. Better yet, call our office to see if we can determine that we can help you with a free 15 minute telephone consultation because your concern lies in one the areas of our law practice Best of luck. -Anthony B. Ferraro
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7 Secrets to Surviving The Medicaid Spend-Down | Chicago Estate & Trust & Elder Law Attorney-CPA, Anthony B. Ferraro

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January 10, 2014

- Chicago Elder Law, Chicago Elder law attorney, Medicaid and Paying for Nursing Home Care

The key to figuring out how to save money by turning to Medicaid is understanding what exactly Medicaid benefits entail and how they may relate to you. These 7 secrets to surviving the Medicaid spend-down will help you be in a better position to protect your hard-earned savings. 1) Many couples end up spending too much money on the first spouse’s long-term care costs because they do not know the rules.  An Elder Law attorney can show you the rules and make the healthy spouse’s life better. 2) People give their assets to their children using the wrong method.  If you choose to go this route, you must do this right, or it could have terrible consequences. 3) Save money by transforming your assets.  Medicaid categorizes your assets as either available or exempt, and an Elder Law attorney can help you convert your available assets into exempt assets so that you keep them. 4) Medicaid application timing is crucial.  If your timing is off, you could lose thousands of dollars, and create a Medicaid penalty because you applied too early or too late. 5) Avoid going broke due to giving your assets away in the wrong way.  There is a Medicaid ineligibility penalty for seniors who give away their assets in the wrong way to children, churches, or charities within 5 years of applying to Medicaid. 6) Annuities are not always “Medicaid-proof”.  Don’t assume just because an annuity is touted as “Medicaid-proof” that it actually is.  Instead consult an elder law attorney, to ensure it actually is. Learn all about VA benefits – A wartime veteran and a spouse could potentially receive $2,000 or more for in-home or assisted living medical care. Stay tuned for further elaboration on the 7 Secrets to Surviving the Medicaid Spend-Down. -Anthony B. Ferraro
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An Intro to Medicaid | Illinois Estate Planning & Elderlaw Attorney-CPA Anthony B. Ferraro

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January 6, 2014

- Eldercare Attorney, Medicaid and Paying for Nursing Home Care

Thinking about how you are going to cover the expensive cost of nursing home care is certainly a scary thought.  However, you have options.  Medicaid can help. Unfortunately, Medicaid assistance is not available to everyone.  Medicaid will cover the nursing homes costs for individuals who have run out of money and other resources.  For those who qualify, Medicaid covers nursing home expenses.  Medicare does not cover most nursing home expenses, so Medicaid fills that void. In truth, Medicaid is a very complex process.  So, before you begin to look into it, it is very important to consult an Elder Law attorney to avoid some very common mistakes. The biggest mistakes people makes include:
      1. Letting a nursing home, social worker, or the state Medicaid department complete your Medicaid application.
      2. Assuming there is nothing you can do because it is “too late” and there is nothing you can do to help your or your family save money because you are within five years of applying for Medicaid.
      3. Not letting an elder law attorney deal with the State Medicaid department for you.
These common mistakes can cost you large amounts money.  It’s important to consult with an Elder Law attorney to guide you through the minefield of public benefits, especially Medicaid. More to follow. -Anthony B. Ferraro
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What do they mean by “division of assets” when my mother is applying for Medicaid to pay for a nursing home? | Chicago Elder Law Attorney Anthony B. Ferraro

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August 13, 2012

- Alzheimer's Care, Blog, Elder Law Articles, Medicaid and Paying for Nursing Home Care

It applies only to married couples and is a phrase commonly used for the Spousal Impoverishment provisions of the Medicare Catastrophic Act of 1988. It changed the eligibility requirement for Medicaid in situations where one spouse needs nursing home care and the other doesn’t. Basically, the law says that it makes no sense to impoverish both people when only one needs to qualify for Medicaid coverage for nursing home care. Because of this distinction, “division of assets” was created. This is basically how it works: The couple gathers all of their non-exempt (countable) assets in a review. Depending upon the rules of your particular state, exempt assets are usually: the home, personal and household belongings, a single vehicle, burial plots and irrevocable funeral plans, the cash value of life insurance (for cash surrender values up to $1,500 only) and cash (the amount varies from state to state). These non-exempt assets are then divided into two, with the at-home (“community”) spouse allowed to retain one-half of the assets, up to a maximum of about $110,000. The other half of the countable assets must be “spent down” until a certain amount remains. The amount varies from state to state. This amount of countable assets that the at-home spouse gets to keep is called the Community Spousal Resource Allowance (CSRA). The at-home spouse is given a monthly income floor, which is established by states individually. This is called the Minimum Monthly Maintenance Needs Allowance (MMMNA). The community spouse is allowed to keep a minimum monthly income ranging from about $1,750 to about $2,650. In the case the community spouse doesn’t have an income of at least $1,750, she or he may take income from the nursing home spouse in an amount large enough to reach the MMMNA bottom threshold. The nursing home spouse’s remaining income (minus a persona-needs allowance) goes to the nursing home. This can help the community (at-home) spouse avoid having to dip into savings each month, which would gradually bring impoverishment. If you’re in this situation, you should seek advice from someone who knows Medicaid law intimately well. You can find elder law attorneys in your area by visiting www.NAELA.org, the website for the National Academy of Elder Law Attorneys.  You can also find more information about Medicaid by clicking here.
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How will we know when it’s appropriate to move my dad from adult day care to a nursing home, or an assisted living facility? . | Chicago Long-Term Care Planning Attorney Anthony B. Ferraro

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July 26, 2012

- Alzheimer's Care, Blog, Elder Law Articles, Estate Planning, Medicaid and Paying for Nursing Home Care

The answer is simple: When you no longer can care for him at home. Adult day care is just a day service, so it occupies only part of the time. Care at home is still needed for nights and weekends. There are some adult care centers that offer evening and weekend services, but often it is not enough. Some people “package” services from a home care agency with the time spent at adult day care. In addition, a home care agency can assist with evening and weekend care to reduce the strain on you, and keep your father at home longer. But as you can see, that takes quite a bit of coordination, and still a fair amount of resources, to do properly. Everyone’s situation is different and everyone has a different threshold, so you have to figure out what is appropriate for you and your loved one. It is time to consider a nursing home or assisted living facility if you are feeling overwhelmed and the quality of life at home has fallen. You need to remember that it isn’t fair to either of you if your time with your father is so strained it diminishes your quality of life. If he were to go to an eldercare facility, your time together would likely be decreased, but then your time together could be that much more focused on doing things you like together, and in a lower stress environment. Some assisted living facilities have staff members who are trained and equipped to work with Alzheimer’s residents. But many do not. You must research any long-term care operator’s limitations before making a decision. Some will accept Alzheimer’s residents until they become incontinent or require some other type of skilled care. In that case, you must consider what an extra move might mean to your father’s well being and sense of orientation. This is a decision that you, as primary caregiver, must make. Everyone has different limitations and goals. When you know you have reached your limit, make the most appropriate, effective decision for everyone involved.  Realize you have done your best and that that is good enough. Let go of any guilt, for it can only destroy you.  For more information about Alzheimer`s, click here for our Resource Kit.  
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I’m scouting nursing homes for my mother, who has Alzheimer’s. Can they ever kick her out if she runs out of money? ? | Chicago, Illinois Elder Law Attorney Anthony B. Ferraro

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July 25, 2012

- Alzheimer's Care, Blog, Elder Law Articles, Medicaid and Paying for Nursing Home Care

This is a good question that you need to sort out before making a final decision about specific living arrangements for your mother. Medicaid is for individuals who have little or no means to pay for their own care. Eldercare facilities must be certified by the appropriate government entities to serve Medicaid beneficiaries. Some nursing homes and other eldercare facilities simply are not certified to accept Medicaid funding once a resident runs out of his or her own money. And those facilities that do accept Medicaid could have a long waiting list for the beds designated for that type of care. That is why it is so important to figure out the lay of the land and your options before you initially settle your mother into a facility. Find out the monthly cost of a nursing home that interests you and project how much you think you will ultimately be needed. If you think your mother will outlast her funds, you can ensure you choose a provider that will accept Medicaid, when and if the need arises. Families of individuals with Alzheimer’s usually do not want to move their loved ones if they don’t have to, especially not after they have adjusted to their surroundings. Changing locations can be very stressful for a person with dementia.  To learn more about Medicaid, click here.
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Could my loved one actually be happier at a nursing home?

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June 20, 2012

- Alzheimer's Care, Blog, Elder Law Articles, Medicaid and Paying for Nursing Home Care

Yes. Many people are happier at a nursing facility, for a variety of reasons. First of all, nursing home residents have decreased feelings of intimidation because they are surrounded by others who similarly have decreasing abilities. Also, the intimidation of being in one’s own home but being far less able is taken away. Some view a nursing home like a specialized college dormitory. Each resident has his or her own living space, plus access to common living areas. There are good opportunities for social interaction in places such as the dining room or TV lounge. Even individuals who were not particularly social earlier in life usually enjoy socialization at this point. A good eldercare facility also offers daily activities. There typically is enough variety to have something that meets the needs of almost everyone. There can be group activities such as bingo or book clubs. There might be reading or jigsaw puzzles that can be made. If a favorite activity is not offered, a facility often will make an attempt to add it, as long as staff members know there is interest in it. Throughout, residents are monitored by nurses and nurse aides. Another plus is that a facility doctor is available, at least by phone, to answer questions and write orders as needed on a personalized basis. Realize that once someone enters a nursing home, he or she may still leave for short trips or overnight stays with family or friends. If there is dissatisfaction with a certain facility, a transfer to another facility is always a possibility. It’s you and your loved one’s choice — always. Being in a nursing home also can increase feelings of independence for an individual. How? A nursing home is a safe, secure place with care around the clock, good hot meals, socialization aspects usually not found at home, and activities available all day. Residents who might have felt they were a burden to their families can find some sense of comfort and satisfaction that they can live “on their own” and not be such a strain on their loved ones.  
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How do I pick the ‘right’ nursing home or assisted living facility for my loved one?

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June 18, 2012

- Alzheimer's Care, Blog, Elder Law Articles, Medicaid and Paying for Nursing Home Care

Be aware that you can narrow your choices by location and by whether they offer specialties such as Alzheimer’s and dementia care — at both assisted living and skilled nursing facilities. You can get a list of facilities from the Alzheimer’s Resource Center, Alzheimer’s Association, Area Agency on Aging or various telephone directories. Check out facilities that interested you in your area before your family needs one so you can make a decision under less stress. Take notes on several facilities so you can comparison shop because that is exactly what you’re doing: scouting out some of the most important services you may ever need. Make a few visits, and make them at different times of the day. Take someone you trust with, preferably not a family member, as this type of person will be more objective and see things in a different light. Gauge the atmosphere of the facility. Is it warm and inviting? Does it pass the “smell test”? How do staff members interact with residents? Are they treated with respect? Are they attended to promptly? Is the facility clean, both inside and out? Are there secure outdoor areas intended for resident use? Is administrative staff available? Does it seem like a friendly facility? Ask for at least three names and phone numbers of families you can talk to who currently have a resident at the facility. Ask around in the community about the reputation of the facility. Any nursing home you visit must have readily available the results of its last state survey (inspection) so don’t be afraid to ask to see them. Or check out the Nursing Home Compare website that the government publishes precisely for this use. Once your loved one is admitted, your responsibility for checking out a facility is not over. You can stay as involved as you want, and you should keep as prominent of a presence as you wish. Research has shown that proximity is the top reason most families choose a certain facility. This means visits should be convenient, and possible for other family members and friends. Use visits — by any others — to serve as check-ups on living conditions for your loved one. Although there are more and more Alzheimer’s-specific facilities opening, it is not uncommon for them to have waiting lists. It can be months before a spot opens up, so if you’re at all inclined, go ahead and put your loved one’s name on a waiting list. If you are called about a vacancy and aren’t ready for the move yet, tell them. They are usually more than willing to put you back on the list, farther down, and they will call again. For more information regarding Alzheimer’s, you can click here to view the Alzheimer’s Resource Kit.
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