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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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A Quick Lesson in Estate Planning | Chicago Estate Planning & Eldercare Attorney-CPA Anthony B. Ferraro

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January 3, 2014

- Chicago Elder law attorney, Estate Planning Attorney

It’s time to face the facts.  Most people wait until it’s too late to implement a great estate plan. According to PBS.com, the typical American over the age of 65 has a 75% chance of needing extra assistance with daily activities.  If your loved ones can’t be there to help you in this situation, you will, unfortunately, have to spend your savings in order to get the in-home care that you need For those who end up in nursing home care, they will have to pay as much as $7,000 to $8,000 a month!  That works out to about $100,000 per year!  With cutbacks in funding for government-run programs, you can’t afford to rely on anybody but yourself in these particular situations.  So, it is imperative that you have the proper estate planning. How do you know if you are getting the proper estate planning? For starters, everyone should have a living will and powers of attorney for health care and property – these documents state one’s wishes on what they feel would be appropriate to do in the event that they have an incapacitating terminal illness that would require life-prolonging treatment. In order to have a proper estate plan, you will need the help of a qualified Estate Planning/ Elder Law attorney.  You will be assisted in order to explain to the attorney how you would like to be protected in the event that you become incapacitated or pass away. The number one thing to remember in estate planning is that it is absolutely imperative that you consider the “what-ifs.”  This way, you and an attorney can work towards a solution that will be the most beneficial to you and your loved ones. -Anthony B. Ferraro Attorney-CPA
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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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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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Are group homes appropriate for individuals with Alzheimer’s disease?

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June 25, 2012

- Alzheimer's Care, Blog, Elder Law Articles

States use different names for residences like these, which may have four or five people each. In some states, they are referred to as boarding-care homes. Some states license them and some do not. You should call your state’s facility licensing agency and ask. You also can inquire about getting a list of them. Look for homes like this, which are specifically designed to help people with Alzheimer’s or other dementia. Typically, staff there will be specially trained to work with such individuals, and keep everyone safe. If there isn’t a facility like this near your home, you might want to reconsider pursuing such living arrangements. One of the considerations for this type of living arrangement is whether your loved one can live out the rest of his or her life there. What happens if he or she runs out of money? Does the place accept Medicaid? Can he or she stay if she becomes bedridden, needs incontinence care or needs a wheelchair? With regard to dementia care, sometimes the smaller homes are ideal because they feel more like home, not an institution. The facility manager can keep a closer eye on things, though the appropriate employees still need to be hired and trained. Smaller homes like these typically have staff members cross-trained; they might be personal care assistants, as well as cooks and cleaners. You’ll want to observe at any home like this you may be considering whether residents have a daily schedule and routine. Some tasks might need to be modified to take an individual’s level of functioning into consideration. But by and large, residents can assist with things such as preparing meals, setting the table, folding clothes and towels, sweeping the floor, watering plants, helping in the yard, taking out the trash, and numerous other tasks. Allowing residents to help with daily chores makes it feel more like a family environment for everyone. This will be a community of its own for your loved one. It should be a place where he or she will make friends and have other caring individuals around.  For more information about Alzheimer’s click here.
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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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How do you know when it’s time to start nursing home care?

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June 14, 2012

- Alzheimer's Care, Blog, Elder Law Articles

The top desire of most people — Alzheimer’s patients or not — is to keep a loved one at home for as long as possible. Each caregiver and each person has a different threshold for what he or she can deal with (and survive with) at home. For example, if incontinence is involved and a person can’t go to the bathroom on his or her own, a caregiver might think it is almost automatic that nursing home placement is necessary. Other issues involving “activities of daily living,” such as eating, dressing and wandering, or behavior or wandering issues, might worry caregivers, too. Sometimes caregivers think they have reached their limit but then realize things aren’t as bad as they first think. This is often the case if they have taken steps beforehand to pre-arrange help. Being prepared and pro-active will lower stress and worry, and likely put off facility placement, for at least a while. Whether to keep a loved one at home or in a nursing home is a very personal choice. Most caregivers want to keep their loved one at home as long as possible; most individuals agree with this philosophy. But keeping a person at home isn’t always the best choice. Nursing homes are a needs-based service and there are very real reasons people need to be there. Moreover, nursing home placement may be necessary for the caregiver’s health. If you are the primary caregiver and someone you respect voices concerns about your health, you should listen with an open mind. Many caregivers are too close to a situation and do not view things rationally or objectively. It could damage their health. There are numerous senior service agencies around to help with the decision about nursing home placement. Get a list of options soon after you receive the Alzheimer’s diagnosis. This will help you be more comfortable, by planning and being more proactive, rather than being unprepared and uncertain during what could become a crisis situation. Dealing with a loved one with Alzheimer’s is a daunting task. There’s no need to tackle it alone, however. An excellent resource is “The Indispensable Alzheimer’s Resource Kit.” It can be downloaded at no cost by clicking here.
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When should I start looking for a nursing home if my father has Alzheimer’s?

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June 13, 2012

- Alzheimer's Care, Blog, Elder Law Articles

You should start looking as soon as you are comfortable — realizing that it will almost always be difficult. Proper advance planning will help prevent or lessen a crisis situation later. Maybe you’ll never need the services of a nursing home, but it pays to be proactive and check them out anyway. Making decisions in crisis mode is much different than being able to plan ahead more calmly and thoughtfully. Local elder law firms, the Alzheimer’s Association, hospitals and other healthcare providers, the Area Agency on Aging and stage regulatory departments can be good sources for lists of facilities. When you visit a facility, take someone with you so you get more than one perspective. It also helps to have someone removed from the situation who can be more objective and might notice things that you don’t. Ask facility operators if they offer short-term respite care. That might be what you need to start with — or it might be the only thing you ever need. This can allow you a break if you get sick or need to go out of town, for example. If you have an unexpected situation that takes you out of the picture, you will have plans, and lowered the stress levels for you and everyone around you. Dealing with a loved one with Alzheimer’s is a daunting task. There’s no need to tackle it alone, however. An excellent resource is “The Indispensable Alzheimer’s Resource Kit.” It can be downloaded at no cost by clicking here.
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Medicaid Reform Again, But WORSE!

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May 25, 2012

- Blog, Elder Law Articles, Estate Planning, Medicaid and Paying for Nursing Home Care, Probate, Estate, and Trust Administration

The SMART Act SB 2840 will reverse many of the DRA changes Elder Law attorneys fought for on behalf of our clients.  The changes include the following:
  • Legal fees are no longer exempt for 3-month backdating.
  • Abolishes spousal refusal entirely.
  • A homestead in Trust is no longer an exempt asset.
  • Except for the Community Spouse Resource Allowance ($109,560) and Minimum Monthly Needs Maintenance Allowance ($2,739, HFS is no longer limited in how much it can seek when pursuing a support order against a community spouse.
  • Reverts to the old limits on prepaid funeral contracts.
  • Reduces the home equity exemption to the minimum allowed under federal law (base figure of $500,000, adjusted annually for inflation, rather than the $750,000 adopted in the DRA rulemaking).
  • No exception for prepaid funerals for 3-month backdating.
More to come.
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