Archive for the ‘Long Term Care’ Category

Westchester to Receive $3.3 Million Grant for In-Home Senior Services

Tuesday, September 27th, 2016

Governor Andrew M. Cuomo recently announced that the Westchester County Department of Senior Programs and Services will receive a $3.3 million grant for in-home services for seniors.

Gov. Cuomo said that the funding would help older New Yorkers continue to live in their homes with dignity and would improve their quality of life.

New York State’s county-based Area Agencies on Aging will receive a total of $50 million through the Expanded In-Home Services for the Elderly Program to help seniors remain in their homes and communities. The program is intended to maximize independence, providing the assistance that seniors need in order maintain a high quality of life in their communities. This may prevent the need for more expensive care, the cost of which is often borne by Medicaid.

The services are designed to help lower income seniors who may have functional impairments and need help with activities of daily living. The in-home services program provides non-medical supports such as assistance with cooking, shopping and getting bills paid.Littman Krooks Elder Law

State Senator Sue Serino, chain of the Senate Standing Committee on Aging, said that both seniors and the community at large benefit when people are able to age in place. When seniors maintain their independence costly nursing home placement is prevented. The program is expected to benefit nearly 70,000 New York seniors.

To be eligible, seniors must not be eligible for similar services such as Medicaid, must be 60 years of age or older and must be able to reside safely in the community. It is not necessary to show that there is a medical need for the services.


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Medicaid Asset Transfers: What Are The Rules?

Tuesday, June 21st, 2016

For many families, paying for a loved one’s extended stay in a nursing home would be difficult without the help of Medicaid. However, in order to qualify for the program, a person’s income and assets must fall within certain limits.

Federal rules state that to qualify for Medicaid nursing home coverage, a person must have no more than $2,000 in “countable” assets. However, New York State has more generous rules, so for New York residents in 2016 the limit is $14,850 for a single person. If a married person needs nursing home care, there are protections for a spouse who remains outside. In this situation, the community spouse has a maximum threshold of &74,820 to $119,220 ($14,850 for the institutionalized person and $119,220 for that person’s spouse). Certain types of resources are exempt, such as up to $828,000 of equity in a home and one motor vehicle.

Littman Krooks Elder LawIf you have countable resources above the limits, you may be told that you need to “spend down” your assets, paying for nursing home care yourself, until you reach the resource limits, at which point Medicaid begins covering the cost. This is what happens in many cases. In other cases, a family may anticipate the need for long-term care and wish to transfer assets to the next generation ahead of time, in order to preserve the family’s resources while still qualifying for Medicaid. This is an excellent strategy, as long as the Medicaid rules are followed.

Medicaid has a five-year “look-back” period for transfers of assets. A person applying for Medicaid must disclose all financial transactions for the previous five years. During this time, any transfers of assets for less than fair market value may prevent the person from being eligible for Medicaid. (However, in New York State, the asset transfer rules do not apply for recipients of Medicaid for home care services.) In addition, invalid transfers may result in a costly penalty period during which ineligibility may continue even after assets are spent down.

To avoid ineligibility and penalties, it is important to plan ahead. Transfers made more than five years in advance are not affected by the rules. There are also important exceptions to the asset transfer rules as well as legal strategies including certain trusts that can help preserve assets while ensuring eligibility. As you can see, Medicaid planning is very complex and it is essential to have help from a qualified elder law attorney.


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Seniors & Mental Health: Is it Mental Illness or Aging?

Sunday, May 22nd, 2016

Seniors are more at risk for mental illness than the general population. According to the Centers for Disease Control and Prevention (CDC), about 20 percent of people age 55 and older experience some kind of mental health concern. Not only are more seniors affected by mental illness, nearly one in three affected older adults does not receive treatment. By learning more about this often-misunderstood problem and watching for warning signs, we may be able to help elders in need get treatment.

Littman Krooks Elder LawMost people are aware that seniors are more at risk for Alzheimer’s disease and other cognitive impairment. About 11 percent of seniors have Alzheimer’s disease, but it is crucial to understand that cognitive decline is not a normal part of aging. Therefore, changes such as increased forgetfulness, confusion or disorientation should be taken seriously. With a prompt diagnosis, seniors can benefit from treatment earlier, and any necessary changes to their living environment can be made in order to keep them safe.

Seniors are also at risk for depression and mood disorders. According to the CDC, in a 2006 survey, 10.5 percent of people age 65 and older said they had received a diagnosis of depression at some time in their lives, and 5 percent had current depression. Another 7.6 percent received a diagnosis of an anxiety disorder at some time in their lives. Anxiety disorders can include a variety of problems, such as phobias, post-traumatic stress disorder and obsessive-compulsive disorder, including hoarding syndrome. Many seniors fail to seek treatment, in part because some people mistakenly believe that depression is a condition natural to aging.

Mental health concerns can have consequences beyond the symptoms of the condition itself. Untreated mental illness can lead to social isolation, take away from seniors’ independence, and cause physical problems and additional medical concerns. That is why it is important for seniors to take preventive measures, and for their loved ones to be aware of warning signs.

Studies have shown that preventive measures can alleviate mental health problems. The risk of depression and anxiety can be lowered as a result of better physical health. Simple exercise three times a week can be even more effective than prescription medication. Research also indicates that keeping the mind active, through social activities, games and puzzles, and communication with friends and family, can decrease the risk of mental health disorders.

Loved ones and caregivers should watch for changes that may indicate mental health concerns for seniors.

Warning signs include:

  • social withdrawal,
  • a depressed mood that lasts longer than two weeks,
  • memory loss,
  • confusion,
  • feelings of worthlessness or guilt,
  • unexplained physical changes, such as in dress, weight or hygiene.

If any of these symptoms appear, discuss them with the family doctor. Treatment such as counseling or psychiatric care can help seniors get on the right track to healthy aging.


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NYC Restores Assistance For Seniors and People with Disabilities

Thursday, April 21st, 2016

The New York City Department of Finance has agreed to a settlement that will reinstate or recalculate the previously frozen rent rates of widowed seniors who had been surprised by steep rent increases after the death of their spouses.

senior couple planningA 2014 rule change by the New York City Department of Finance instituted a new requirement that a spouse or disabled adult wishing to take over a Disability Rent Increase Exemption (DRIE) or Senior Citizen Rent Increase Exemption (SCRIE) from a deceased head of household file an application within 60 days of the death. According to the lawsuit, households receiving the benefits were not given notice of the new rule. As a result, many recently widowed seniors were hit with alarming rent increases.

In March, a settlement was reached awarding damages and legal fees to the plaintiffs and putting an end to the 60-day deadline. The deadline for benefits takeovers is now six months after the death of the head of household or 90 days after receiving notice, whichever is later. The Finance Department also agreed to send information to tenants in seven languages. Read about SCRIE or DRIE.

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Proposed FINRA Rules Will Help Prevent Financial Elder Abuse

Monday, November 16th, 2015

Under new rule proposals soon to be released by the Financial Industry Regulatory Authority (FINRA), financial advisers would be able to delay disbursing funds from the accounts of senior investors if they believe financial elder abuse may be taking place.

Littman Krooks Elder LawOne of the proposed rules would allow financial advisers to wait up to 15 days to disburse funds from senior investors’ accounts if they reasonably believe that financial exploitation is occurring. The proposed rule defines a senior investor as a person who is age 65 or older, or an investor who may be vulnerable for other reasons. The rule would allow advisers to reach out to a person designated as a trusted contact.

A related proposal would require financial advisers to make a reasonable attempt to get contact information for a trusted person on senior investors’ accounts. Under the current proposal, if a senior investor declines to provide such information, the adviser is still permitted to open the account.

The proposed rules would require that if an adviser paused disbursements on a senior investor’s account because of suspected financial elder abuse, the adviser would be required to notify the trusted contact. However, if the trusted contact is the person suspected of committing the exploitation, then the adviser could notify another family member or other responsible party.

The proposed FINRA rules are similar to rules proposed by the North American Securities Administrators Association (NASAA) recently. The NASAA rules allow for a 10-day hold on disbursements when abuse is suspected, and provides for qualified immunity from civil or administrative liability for firms that report suspected financial exploitation of seniors.


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Making Decisions on Senior Housing

Tuesday, September 15th, 2015

When an older person needs care and can no longer live with full independence, the senior and his or her family are faced with a number of decisions to make. There is often a range of choices available such as assisted living, in-home care, or a skilled nursing facility, and the task of deciding what is right for the individual senior can seem overwhelming.Littman Krooks Elder Law

The decision may be difficult, but families do not have to face it alone. With Americans age 85 and older the fastest growing age group, millions of Americans are now struggling with this very issue, and there are a number of specialists that are available to assist them.

The exact type of assistance that is required depends on the needs of the individual senior and the family’s situation. Families may need to seek guidance from their family doctor, a financial planner, or an elder care specialist. Crucial assistance can be provided by an elder law attorney, who can provide services such as drafting documents that give power of attorney to a trusted family member so that medical and financial decisions can be made if the senior loses the capacity to make them.

A key factor in making a good decision on senior housing is advance planning. Too often families end up making a decision because of a crisis such as a health issue that has taken a turn for the worse. However, in many cases, the need for care can be predicted and planned for. If the family waits for a crisis to develop, they may not have time to consider all the options.

Ideally, the choice of a housing situation for a senior will come out of a series of family discussions that incorporate the senior’s needs and desires, the available options, and the family’s financial situation. Taking the time to consider the options, and seek expert counsel, can allow a family to craft a unique solution for the individual’s unique needs.


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Learn the Facts About Medicare, Medicaid and Long-term Care

Tuesday, July 14th, 2015

More than 40 million seniors rely on Medicare for their everyday health insurance needs, and many mistakenly assume that Medicare will also cover long-term care if it is needed. In fact, there are specific limitations to Medicare coverage for long-term care, and such care is often covered instead by Medicaid, which has eligibility requirements. Therefore, it is important to understand how these two public benefit programs affect long-term care expenses.

Littman Krooks Elder Law

Medicare pays for health care for people age 65 years and older or with certain disabilities. Under certain conditions, Medicare will pay for short-term stays in skilled nursing facilities, hospice care, or home health care. Generally, Medicare focuses on medically necessary care such as doctor’s visits and hospital stays, rather than personal care services associated with long-term care.

Until recently, there was an unevenly enforced “improvement standard,” by which Medicare beneficiaries were denied coverage if their condition was no longer improving. However, the settlement of Jimmo v. Sebelius, a 2013 lawsuit, clarified that no such “improvement standard” can be enforced, and people with chronic conditions can continue to be eligible for Medicare to pay for their medical treatment.

Nevertheless, Medicare generally does not provide for room, board and custodial care such as that offered in a skilled nursing facility. Therefore, people needing such care usually use personal resources, long-term care insurance, and Medicaid. Medicaid has income and asset eligibility requirements, and many seniors will have to spend down some assets to qualify. The financial requirements for Medicaid can be complicated, and the advice of an experienced elder law attorney can be invaluable in planning for long-term care.


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Comparing Different Options in Life Insurance

Wednesday, March 18th, 2015

Certain forms of life insurance can be used as an investment and estate planning tool as well. Understanding the different options, term life insurance and permanent life insurance, can help to protect your family’s economic security in the event of an unexpected death.

Term life insurance
Term life insurance is pure risk protection, and it is what many families consider to be essential. The premium is paid for a certain term, or number of years, and the death benefit is paid out only if the insured person dies before the term ends. Term life insurance is much less costly than permanent life insurance, for the simple reason that the insurance company expects to only have to pay out the death benefit for about five percent of policies.

Within term life insurance, a common type is guaranteed level premium term life insurance, in which the annual premium remains the same for the entire term of 10, 15, 20 or 30 years. Insurance companies may also offer return premium term life insurance. With this type, some of the premiums paid are returned if the policyholder outlives the term, minus fees that the insurance company retains. This type of term life insurance is more expensive.

Permanent life insurance
With permanent life insurance, there is no fixed term, and the policy is in place for the insured person’s entire life. As long as the premiums are paid, then a death benefit will be paid when the person dies. Because the insurance company knows it must pay out a benefit, the premiums it charges are much higher than for term life insurance.

Permanent life insurance is typically comprised of an insurance portion and a savings or investment portion. The insurance company invests part of the premiums paid, and the policy builds up a cash value on a tax-deferred basis. The policyholder can usually borrow against the cash value.

The basic form of permanent life insurance is known as whole life insurance. A more flexible form is known as universal or adjustable life insurance. With a universal life insurance policy, one may choose to pay premiums at different times and increase the death benefit. One may also select a fixed death benefit, or an increasing amount equal to the face value of the policy plus the cash value amount.


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Age-Related Financial and Planning Milestones that People Will Encounter in their Sixties

Friday, March 28th, 2014

As one nears retirement age, a number of important financial planning milestones begin to approach. It can be difficult to keep them all straight. Here is a timeline of what happens when:

  • At age 59 1/2, people can begin to make withdrawals from 401(k)s, traditional IRAs and similar retirement savings accounts, without an additional tax penalty of 10 percent. (Withdrawals are still taxed as income in any case.) Of course, just because one can begin to make withdrawals at this age does not mean one necessarily should.
  • At age 60, if one’s spouse has died, then one can begin to collect a Social Security survivor benefit. This is also true if an ex-spouse has died, if the marriage lasted at least 10 years and the survivor did not remarry.
  • Upon reaching age 62, people can take the option of early Social Security retirement benefits. Keep in mind that starting one’s benefits early results in lower payments, and it is usually better to wait a few years to receive a larger benefit. If one is eligible for a pension, these benefits also often kick in at this age.
  • At age 65, one becomes eligible for Medicare. There is a seven-month window around one’s 65th birthday to sign up for Medicare benefits and avoid a surcharge.
  •  Age 66, for most baby boomers, is full retirement age for the purposes of Social Security retirement benefits. Additionally, at this age, someone who chose early benefits can now suspend benefits in order to build up delayed retirement credits.
  •  Upon reaching age 70, there is no further advantage to delaying taking Social Security retirement benefits. People who wait until this age to begin receiving benefits maximize their monthly payments.
  • At age 70 1/2, required minimum distributions begin for 401(k)s and IRAs. A certain amount must be withdrawn from these accounts each year, based on the total value of all such accounts.

By paying close attention to these milestones, one can complete a more precise budget, an important part of retirement planning.


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Further Thoughts on Long-Term Care Insurance

Monday, March 17th, 2014

Our recent post (see below) entitled, “Is Long-Term Care Insurance Worth the Cost?” has generated a lot of discussion.

We’d like to clarify a few points:

  • Long Term Care (LTC) insurance pays for expenses associated with chronic illnesses, such as home care, assisted living and nursing homes. On a long-term basis, these expenses are not covered by Medicare, which covers mainly short term rehabilitation.
  • In many cases, long-term care insurance enables policy holders to protect their financial assets.
  • Premiums for LTC insurance are based on a variety of factors, including the person’s age, health, medical history and policy benefits.  The earlier you buy, the less expensive the policy will be.

Whether and when a particular individual should purchase a LTC policy is a complex issue and the answer to the question posed in the original post can differ by individual, age, family situation, income and assets.  There really is no bright line test. LTC insurance should be considered by all as part of the estate planning process.

Before purchasing a LTC  policy:

  • Familiarize yourself with the benefits as well as the limitations
  • Have a thorough understanding of your financial situation and goals

Work with a reputable agent who specializes in LTC insurance.  In addition, speak to an elder law attorney and discuss the terms of the policy, the costs, the associated benefits as well as the financial strength of the insurer.


Is Long-Term Care Insurance Worth the Cost?

As the cost of a nursing home stay has increased, so has the cost of long-term care insurance, causing many seniors to reassess the value of such insurance.

Many people’s financial planning for retirement includes a combination of Social Security retirement benefits, other sources of income such as a pension, and savings and investments. On the expenses side, many costs are stable and predictable, with one serious risk being the need for nursing care for a long period of time. Since the annual cost of care in an Alzheimer’s unit can reach $100,000 or more, it is no wonder that many consider long-term care insurance. However, it is important to think about whether such protection is right for you.

First, keep in mind that many nursing home stays are not covered by such policies. Most long-term care policies do not cover the first 90 days, and two-thirds of nursing home stays are for less than 90 days, so insurance will not help at all in these cases. In the case of an extended stay, many policies will cover only a certain dollar amount and only for the period of time covered, often three years.

For many seniors entering a nursing home for an indefinite stay, Medicare will provide for the cost, with assets being used to offset the cost until they are exhausted, when Medicaid will kick in. Therefore, for a single person with no heirs, long-term care insurance may not be necessary. For a married couple, if one spouse requires an extended stay in a nursing home, the healthy spouse may keep the house, one vehicle, and assets of about $116,000 (the amount varies by state), and still qualify for Medicaid for the nursing home expenses.

One view is that long-term care insurance may be unnecessary either if a couple’s assets are less than $116,000 exclusive of the home and one vehicle, such that they will be eligible for Medicaid, or if assets are above about $700,000, in which case the couple can probably self-fund a nursing home stay. Within that window between roughly $116,000 and $700,000, long-term care insurance may be useful.


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