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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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The 35%Estate Tax is Peanuts! How About the 100% “Medicaid Tax”?|Chicagoland Elder Law Attorney Anthony B. Ferraro

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February 18, 2013

- Chicagoland Elder Law, Medicaid spend down planning, senior estate planning

Why has everybody been so concerned about the Estate tax? For years,  clients of our office have  been very concerned about the Estate tax. I have reassured many clients over the last couple of  years that the Estate tax will not impact you unless you have more than $5,000,000 ($10,000,000 if you are married). Now contrast that to the cost of what I call the “Medicaid tax”. The “Medicaid tax” is  the government’s  requirement that you  spend your assets down to $2,000 (as a single person) before you get any Medicaid  help for your  custodial care or long- term care, either in a Supportive Living Facility (similar to an assisted living facility) or an Intermediate or Skilled Nursing Facility. This terrible governmental  requirement to spend down to $2000 is what I refer to as a 100% Medicaid tax. Because, effectively you have to be down to zero assets before you get any assistance with maladies that require custodial care, such as dementia, Alzheimer’s, Parkinson’s, MS, ALS, COPD,  muscular dystrophy, etc. Therefore, I politely ask my clients to “wake up and smell the coffee”. Quit obsessing over the effect of the Estate tax. It will not affect most of us. On the other hand, consider the government-mandated Medicaid spend down of your assets to paltry $2,000 –  this will affect most of us. Why will this affect most of us? Because, due to the advances of medical science,  most of us are living much longer (thankfully).  However, while we are living much longer, we also need more care as we age. Couple this with the fact that the average cost of a Supportive Living Facility (SLF) is somewhere around $4,000 a month and the average cost of an Intermediate or Skilled Nursing Facility is $6,000 to $10,000 a month, and you have a “perfect storm” scenario that can lead to a Medicaid spend down of your assets to a measley $2,000. And that $2000 has to last you for the rest of your life. This is, in my view, the equivalent of a 100% “Medicaid tax“. How treacherous is it to be spent down to $2000? Let me give you an example. We recently had a client at our office that needed  abscessed teeth to be removed. Our client was 85 years of age and spent down to $2000. She was told that the only available Medicaid dentist  in Cook County would take her, but it would require her to wait 6 to 8 hours in the waiting room. My client had moderate to severe dementia and could not last 6 to 8 hours in a waiting room. It would have been nice if she had come to me earlier so I could set aside a rainy day fund for her. A Solution: This would be a legal and ethical  re-allocation of her assets so that she could have funds for things like teeth extraction,  but still qualify for Medicaid benefits. We had  another client that required hearing aids. Hearing aids cost $6,000.How do you buy them when you’re spent down to $2,000? So we inform our clients that they should not be concerned about the Estate tax unless they are very, very wealthy. The more likely severe financial impact that will hit most of our clients comes from the devastating cost of long-term care. Clients have to understand that they must  plan while they still can. Unfortunately, this window can sometimes close very quickly due to the onset of a stroke, heart attack, accident, or some other catastrophic disability. At The Law Offices of Anthony B. Ferraro, LLC, we are Attorneys and CPAs. We have been serving clients in matters of Medicaid asset protection, long-term care planning, traditional estate planning, senior estate planning, estate tax planning, and estate and trust administration for a combined 45 years. Today’s environment in which our seniors are asked to fend for themselves and protect themselves and loved ones from Medicaid spend down, taxes, the cost of home care, healthcare, long-term care,  creditors, predators, divorcing spouses, and illness, is very complicated to most of our clients. But we deal with this every day. And we are just a phone call away. Consider making the call to our office while you are still are able to plan. Let us provided you with service and guidance that will be essential for your well-being and that of your loved ones. Let us give you options… So you don’t go broke the aging process.     Anthony B. Ferraro Attorney-MSTax-CPA The Law Offices of Anthony B. Ferraro, LLC Attorneys & CPAs The Elder Law, Estate & Trust and Asset Protection Law Firm 5600 North River Rd. Rosemont, Illinois 60018  847-292-1220 www.ABFerraroLaw.com
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