Healthcare

If you or a loved one has been turned down for long-term care insurance, cannot afford the premiums for the long-term care insurance, or believe that you will apply for Medicaid in the future, then you should consider Medicaid Planning.

When you apply for Medicaid, any gifts or transfers of assets made within five years of the date of application are scrutinized and subject to a penalty. This is referred to as the “lookback” period. That penalty is based on the dollar amount of the transferred assets divided by the average monthly private patient care rate, the resulting number translating to the amount of days or months that the applicant is ineligible for Medicaid.

In the United States, six out of ten adults in the United States have a chronic disease, and chronic disease is the leading cause of disability and death. While many healthy adults view estate planning as a contingency plan, adults with a chronic illness approach estate planning with higher urgency. While preparing their plan, adults with chronic illnesses should assemble a “team” of advisors.

An attorney can draft important financial and health documents, such as your:

• Will or Revocable Living Trust: Expresses your wishes regarding your property after you pass away;
• Durable Power of Attorney: Appoints an agent to make your financial decisions if you cannot do so;
• Medical power of attorney: Appoints an agent to make your medical decisions if you cannot do so;
• Living Will: Expresses your preferences for life support;
• HIPAA Authorization: Allows family members to know your protected healthcare information;
• Out of Hospital Do-Not-Resuscitate Order: Informs paramedics not to use a cardiac defibrillator if your heart stops.

These documents will enable you to empower a trusted person or group of people to care for you when you are unable to do so.

Do I Really Need Advance Directives for Health Care?

Many people are confused by advance directives for health care.  They are unsure what type of directives are available and whether or not they need directives at all, especially if they are young.  There are several types of advance directives.  One is a living will, which communicates what type of life support and medical treatments, such as ventilators or a feeding tube, you wish to receive.  Another type is called a medical power of attorney.  In a medical power of attorney, you name another person to make health care decisions for you in the event are unable to do so for yourself.  A third type of advance directive for health care is a do not resuscitate order or a DNR.  A DNR is a request that you not receive CPR if your heart stops beating or you stop breathing. 

If you are 18 or over, it is time to establish your health care directives.  Although no one thinks they will be in a medical situation requiring a directive at such a young age, it happens every day in the United States.  People of all ages are involved in tragic accidents that could not be foreseen which result in the use of life support.  If you plan in advance, you can make sure you receive the type of medical care you wish, and you can avoid a lot of heartache for your family, who may be forced to guess what you would want done.

Many people do not want to execute health care directives because of some common misperceptions about them.  People are often frightened to name someone to make health care decisions for them, because they fear they will give up the right to make decisions for themselves.  However, an individual always has the right, if he or she is competent, to revoke the directive or make his or her own decisions.  Some also fear they will not be treated if they have health care directives. This is also a common myth – the directives and medical power of attorney simply inform caregivers of the type of treatment you would like to receive in various situations and the person you designate to make health care decisions if you cannot.  Planning ahead can ensure that your treatment preferences are carried out while providing some peace of mind to your loved ones who are in a position to direct them.

The high cost of long-term care has made planning a critically important issue for most middle class seniors and their families.  In fact, most seniors will likely require some form of long-term care.  Sadly, many of them are unprepared for the significant financial burdens it places on their family’s hard earned savings.

While some seniors are able to afford private pay care, the cost of long-term care will wipe out savings of all but the wealthiest families in a matter of years.  Those who have planned ahead by purchasing long-term care insurance have a degree of certainty and peace of mind, knowing that they have a lesser need to rely on other sources in the future.  Unfortunately, many can’t afford the high cost of long term care insurance or worse, because of age or medical condition cannot qualify for long term care insurance altogether.  If you do have long-term care insurance, you should be aware of what your policy covers.  Many policies have high deductibles or provide for only a short period of care in facility.  In fact, many who have long-term care insurance still have to resort to Medicaid to pay for their care.

The other option to pay for care is Medicaid.  A joint federal-state program, Medicaid provides medical assistance to low-income individuals, including those who are 65 or older, disabled or blind.  Medicaid is the single largest payer of nursing home bills in America and serves as the option of last resort for people who have no other way to finance their long-term care. 

While Medicaid eligibility with respect to long-term care was not difficult in the past, there has been a steady drift towards more complex and restrictive rules.  It’s no longer as easy as reviewing one’s bank statements.  There are a myriad of regulations involving look-back periods, income caps, transfer penalties and waiting periods to plan around.  Unfortunately, the advice given by well-meaning friends is often faulty, placing you or your loved one in a worse situation.

Pre-planning can help avoid the financial ruin associated with the high cost of long-term care. 

Upcoming Educational Symposium

FREE for Preferred Client Maintenance Program Members

Fort Bend Senior Trust Alliance is hosting “Empowering Caregivers for Today and Tomorrow,” a Symposium sure to benefit present and future caregivers. Each of us will one day be in the position of caregiver for our loved ones and this Symposium will give you the tools necessary to successfully handle the challenges that arise during this time. If you are part of our Preferred Client Maintenance Program, The Dean Law Firm is offering FREE registration for this Symposium as one of your educational benefits.

Julia Dean will be speaking along with other notable professionals related to senior care. Keynote speakers for the event are Dr. Knox and Dr. Jang from The University of Texas MD Anderson Cancer Center. Dr. Knox will be addressing “End of Life Issues in the Emergency Department,” and Dr Jang will be presenting “Exciting New Initiatives and Directives in Alzheimer’s Research.” Breakfast, lunch and snacks will be provided for this event at Houston Methodist Sugar Land Hospital on Saturday, November 16th. Please see the attached brochure for more details.

Space is limited, so register today! You can register online at www.seniortrustalliance.org. 

Medicare vs. Medicaid: Similarities and Differences

With such similar sounding names, many Americans mistake Medicare and Medicaid programs for one another, or presume the programs are as similar as their names. While both are government-run programs, there are many important differences. Medicare provides senior citizens, the disabled and the blind with medical benefits. Medicaid, on the other hand, provides healthcare benefits for those with little to no income.

Overview of Medicare
Medicare is a public health insurance program for Americans who are 65 or older. The program does not cover long-term care, but can cover payments for certain rehabilitation treatments. For example, if a Medicare patient is admitted to a hospital for at least three days and is subsequently admitted to a skilled nursing facility, Medicare may cover some of those payments. However, Medicare payments for such care and treatment will cease after 100 days or if the patient stops improving.

Nursing home patients often find their Medicare payments are terminated much sooner than 100 days. If a patient’s condition stops improving, Medicare coverage will be discontinued. For example, many older Americans are suffering from diseases with no known cure, such as Parkinson’s or Alzheimer’s Disease. Accordingly, it is simply impossible to “rehabilitate” these patients so Medicare typically denies skilled nursing facility coverage in these types of situations.

In summary:

• Medicare provides health insurance for those aged 65 and older
• Medicare is regulated under federal law, and is applied uniformly throughout the United States
• Medicare pays for up to 100 days of care in a skilled nursing facility
• Medicare pays for hospital care and medically necessary treatments and services
• Medicare does not pay for long-term care
• To be eligible for Medicare, you generally must have paid into the system

Overview of Medicaid
Medicaid is a state-run program, funded by both the federal and state governments. Because Medicaid is administered by the state, the requirements and procedures vary across state lines and you must look to the law in your area for specific eligibility rules. The federal government issues Medicaid guidelines, but each state gets to determine how the guidelines will be implemented.

In summary:

• Medicaid is a health care program based on financial need
• Medicaid is regulated under state law, which varies from state to state
• Medicaid will cover long-term care
   

You’ve Finally Done Your Healthcare Directives – Now What?

Healthcare directives can be vitally important, as recent cases, like that of Terry Schiavo, clearly brought to light. These important documents can mean the difference between your health care wishes being carried out or family members fighting over whether a loved one should be placed in a nursing home or removed from life support. Healthcare directives usually include both a healthcare power of attorney and a living will. In a healthcare power of attorney, an individual authorizes another individual to make healthcare decisions for him or her if the individual becomes unable to do so. A living will expresses an individual’s preferences about life support.

Once you have executed your healthcare directives, you may be uncertain as to what to do with them. First, you should make copies of the documents and inform others of their existence. In addition to your health care agent, persons you should consider notifying of the directives include family members and your health care providers. Ideally, the originals should be kept in a place that is both safe and easily accessible.

You may wish to consider using a secure registry service to store your healthcare directives. Such services allow you to access healthcare directives any time and in any location with access to the Internet. Some also allow the documents to be accessed via an automated fax-back service. In addition to providing the healthcare directives, many registries also allow caregivers to access information like emergency contacts, allergies, and other pertinent medical information. If you are a part of our Preferred Client Maintenance Program, this service is provided by Legal Vault beginning January 1, 2013. For all our other clients, you may call to become part of our Preferred Client Maintenance Program and receive this valuable benefit.

You should review your healthcare directives regularly. As individuals get older, their preferences about health care and life support change, and it’s important that your directives reflect your current health care wishes. Of course, life changing events such as marriage, divorce, or the death of a loved one typically require changes in those documents to ensure that the people named in them are still those you wish to make decisions on your behalf.

Moving to another state? It is best to update your healthcare directives to ensure they are valid so your wishes will be carried out in the manner you desire.

Establishing your healthcare directives can spare your family a great deal of anguish if they need to make decisions at a time that is already very emotionally-charged. By keeping the documents in a secure place, providing copies to loved ones, and reviewing them regularly, you can be more certain that your healthcare wishes will be carried out.