Looking at Continuing Care Retirement Communities? Look Closely.

December 3, 2010

There are a lot of benefits to Continuing Care Retirement Communities (CCRC’s), also called “Buy-In’s.” These are the places where you put down a substantial sum (maybe $250,000 or more) as an entrance fee, and you plan to stay there for life – they have independent apartments, various levels of assisted living, and skilled nursing (nursing home), all on campus. There is definitely something appealing about the promise of being cared for for life.

But will they really care for you for life? There are some big questions right now about the nursing home units at CCRC’s. For example, when describing the nursing home to you, a potential customer, the sales staff will explain that if you run out of money, they will help you apply for Medicaid. Well, as it turns out, sometimes the CCRC makes you spend down even further than the Medicaid rules do.

For example, for a married couple, if one spouse needs nursing home but the other is still in the community (ex. in her own apartment or in the assisted living), MassHealth rules permit the community spouse to keep about $110,000 to live on. But guess what – before letting the husband move into a MassHealth nursing home bed, the CCRC might make the wife spend her own money down even further than the $110,000, maybe allowing her to keep only $50,000 for herself. And what did they have her spend it on? The husband’s private pay bed in the CCRC nursing home. And how much longer can she last in the community with only $50,000 to her name?

The sales team might also tell you that if a couple really runs out of money, there is a benevolent fund that will help you pay your monthly fees. I’d be a lot more comfortable moving into a CCRC if I saw the balance sheet for that benevolent fund – is there really enough in it for all the residents who might need help? And do they ever really expend from the benevolent fund?

Before committing to a CCRC, do your research. Dig around to make sure that what the sales staff is telling you is true. Two sources of hands-on experience with the nursing home units are going to be (1) local families who have been through the nursing home, and (2) local elder law attorneys who have helped clients navigate the CCRC nursing home experience.

Single Elders Who Will Soon Need MassHealth Nursing Home: Act Fast to Set Aside a Cushion

December 4, 2009

Filed under: Medicaid (MassHealth) — Tags: — Alexis @ 9:38 AM

To qualify for MassHealth to pay for nursing home care, a single elder can have only $2,000 in his name. A big problem with allowing such a small reserve fund is that MassHealth doesn’t cover many needed services and medical items – like hearing aids, routine dental care, and eye glasses – and the elder is left with no way to pay for those items himself.

For anyone who will need MassHealth to pay for nursing home care, it is usually a good idea to try to set aside some funds to serve as a cushion to provide those necessary items that MassHealth won’t cover. For single elders,  the way to set aside a reserve fund is usually to deposit some amount of money with a “pooled trust.” A pooled trust is a trust fund, operated by a nonprofit organization, that pools together the deposits of its many elder and disabled members in order to streamline costs and maximize interest earned. The staff at the pooled trust keeps a separate running balance of each individual’s deposits. We have four pooled trusts in Massachusetts.

Until now, MassHealth has allowed elders to set aside some funds in a pooled trust to serve as a cushion for those uncovered “extras” that will inevitably be needed during a nursing home stay. MassHealth has permitted this transfer without imposing the usual transfer penalty.

But we just learned that this month, MassHealth plans to close this door and will no longer allow elders to set aside reserve funds in this manner. Therefore, if you are an elder or are caring for an elder who you think will need MassHealth nursing home care soon – whether that be in the next few months or the next year – you should speak with an elder law attorney this week about setting up a pooled trust account. In order to preserve a cushion to sustain a person through a nursing home stay, all of the paperwork for enrolling in the pooled trust must be completed before MassHealth changes the regulation, and they intend to make the change some time this month.

If someone you love will need MassHealth to pay for nursing home care soon, and they would like to set aside a reserve fund to pay for those items and services that MassHealth doesn’t cover, then you need to speak with an elder law attorney now. Time is of the essence.  

More Reasons to Write up a Caregiver Contract

November 13, 2009

I’ve been writing a lot about caregiver contracts lately. That’s because they represent the ideal solution for so many families.

Many children become part-time or even full-time caregivers for their aging parents. Sometimes a child needs to be paid for this – usually that is the only way she can afford to leave her job in order to stay home and care for Mom. And in some families, the parent insists on paying the child, or at least contributing to groceries and utilities – because she doesn’t want to feel she is taking advantage of anyone or being a burden.

Earlier posts describe why a written caregiver contract is important to prepare for the possibility of a future MassHealth nursing home application, but here is something that would apply more immediately:  in addition to drafting a good contract, an elder law attorney will also set the family up with a payroll service that will make sure the child receives the benefits of an employee. Namely, the child will have two special protections.

The first is worker’s compensation coverage. Have you ever helped a frail elder with a shower? How easy is it to hurt your back? Very. With a proper caregiver contract arrangement, that child can collect worker’s comp from her injury.

The second protection is the unemployment benefit. Sometimes, no matter how good a job a child does of keeping Mom at home, there comes a time where the care Mom needs exceeds what the child can provide, and she must move to a nursing home. Now the child is unemployed.

For so many families, paying a child to care for the parent is the best solution. Having informal, unwritten understandings is typical, but leaves both the parent and child open to too many pitfalls. By working with an elder law attorney to craft a good caregiver contract and to set up a payroll service to take care of the deductions and taxes, both the parent and child will be much better protected in the long run.

Paying Your Children to Care for You? Put it in Writing.

August 30, 2009

As they need more help with daily tasks, many parents prefer to have their kids helping them rather than hiring an aide. And many children want to be helping their parents, if only they could afford to quit their job.

One solution is for the parent to hire the child. I discuss some of the nuts and bolts of how to draft a caregiver contract in another post. I also previously discussed the advantages of caregiver contract in a down economy.

The message for this post is that if you plan to hire your child, or if you plan to work for your parents, everything must be in writing. If the parent eventually needs to apply for MassHealth, your chances of having the application approved significantly increase if the agreement was in writing during all those years that the child provided care. If it is not in writing, MassHealth may well declare that any money passing from the parent to the child was a gift – and a gift disqualifies a person from receiving MassHealth assistance.

Working with an elder law attorney will improve your chances of having the agreement approved by MassHealth, because an elder law attorney understands what needs to be in the contract not only to satisfy MassHealth, but also to help you comply with Social Security laws, income tax regulations, and employment laws.

Always Keep Time & Expense Records When Helping Another

August 6, 2009

So many children, nieces and nephews, and good neighbors pitch in to do heavy lifting for an aging or disabled family member or friend. You may be running errands, cleaning out a basement, doing weekly grocery trips. We do these things on a volunteer basis, usually receiving just reimbursement for purchases made. And when the hours pile up – like cleaning out a house or overseeing home remodeling – elders often insist on paying their helpers for their time.

If you are doing this sort of work for an elder or disabled person, it is imperative that the person you are helping (or you yourself, if she can’t), keep good records of expenses and time spent.

While this may feel wrong to you – afterall, you are doing this work out of kindness, it’s not a business arrangement – a lack of records can spell big trouble for the elder or disabled person later. If they will ever be turning to MassHealth (Medicaid) for care, whether at home, assisted living, or in a nursing home, MassHealth will examine the last 5 years of the applicant’s bank records. She will need to explain – and document – why she was paying you.

Without accurate records and receipts, MassHealth will likely reject the elder’s application. At that point, the only way for her to get the care she needs from MassHealth will be for you to return all the funds she paid you.

While it may feel awkward, do yourself and the person you are helping a favor and keep good time records and all receipts. And carry on with your good work.

What Happens to My Special Needs Child’s Health Care Coverage When She Turns 18?

February 6, 2009

The idea of a special needs kid turning 18 can be scary – that is when she is legally an adult and things start to change.  In another post I will address her legal decision-making power.  This post looks at health care coverage. 

If your child is on your private health insurance policy (i.e., the family plan you have through your employer), the good news is that she should be covered through age 25, so long as she is still your “dependent,” meaning that she receives over one half of her financial support from you.  After 25, if she is not employed, you will probably need to look at MassHealth. 

On the other hand, if your child has been on MassHealth as a minor, her current coverage will end somewhere between 18 – 22, depending on which program she has been enrolled in.  The good news here is that there are several MassHealth programs that she can switch over to as an adult.  

A word of warning – there are many different MassHealth programs, and they each of different enrollment criteria.  The enrollment process itself is long, tedious, and frustrating.  (If you’ve dealt with MassHealth in the past, you already know this.)  So if you are planning to enroll your child in MassHealth as an adult, get started on that process early.  Record-keeping is critical.  Keep all receipts related to medical care and medical purchases (doctor’s visits, prescriptions, equipment, even the little things from the pharmacy). 

The Boston Children’s Hospital and the Boston Bar Association wrote a good guide on this topic, see chapter 7 here

MassHealth (Medicaid) Programs for Kids

February 4, 2009

Some children don’t have private health insurance coverage through their parents, as a matter of fact, lots of kids – one in four Massachusetts children is on MassHealth (Medicaid). 

Applying for MassHealth is very confusing – there are several programs, they each have different enrollment criteria, and they provide different levels of coverage.  Check out this guide, produced by Children’s Hospital and the Boston Bar Association – chapter 3.  Scroll down to page 10 for a good overview of several different MassHealth programs.  The guide is written for parents of kids with mental health issues, but the insurance chapter applies to all kids.  

Being Paid to Care for Your Parents

January 28, 2009

As their parents have needed increased hands-on care and errand-running, many “Boomers” have been squeezed trying to juggle caring for their parents and performing well at work.  Our current economy has produced a mixed blessing for some – lost jobs means time to address their parents’ needs, but without economic security.

One solution is a “caregiver contract.”  This is a written agreement between the parents and the adult children, laying out tasks the child will perform and a rate of pay.  Set up along with worker’s compensation and the usual payroll deductions, this provides an income stream to the caregiver while giving the parent what most elders want – being cared for by her own family.  Only an elder law attorney familiar with the ever-changing rules of Medicaid should draft a caregiver contract, so that it will protect the elder in the event she needs nursing home care in the future.  If not done correctly, a caregiving arrangement can result in a later denial of MassHealth nursing home benefits.