Christopher B. Kroll & Associates – Elder Law Solutions

Medicare and Medicaid sound the same, but they are very different.

Few people realize the limitations of Medicare—which winds up costing them a substantial loss of dignity if or when they get hit with long term care expenses.  Medicare is the federal health insurance program provided on behalf of persons who are over the age of 65, blind, and/or disabled.  Medicare does not provide long term care benefits (nursing home care, for instance).  Medicaid, which is a poverty health care program, pays for 50% of the nursing home care in America today.

Medicare only cares about short-term or “acute care” health care.  Medicare only cares about your health care expenses if you can get well! Medicare does NOT provide care when a person is diagnosed with a long-term illness and needs nursing home care.  Essentially, our senior citizen health care is based on a “diagnosis lottery.”  If you are “lucky enough” to have a heart attack or diabetes, then you are covered by Medicare.  You are out of luck if you are diagnosed with  Alzheimer’s, Parkinson’s, Huntington’s disease, or anything else that lands you in a nursing home.  If  you need a nursing home and you are not impoverished, you are on your own dime!

Medicaid is the safety net for the impoverished.  Once you become sufficiently impoverished, then Medicaid is designed to provide care for you.  To qualify for Medicaid nursing home benefits you must be very ill and have no more than $2,000 total assets.

An elder law attorney knows the ins and outs of the public benefit system and can provide the client with solutions that help to fulfill the requirements of the law and still provide a better future for themselves or their loved ones.  .  If you want more information regarding a specific client situation, please contact us.

 Anytime that you place a loved one in the care of others, there is always room for disagreement.  Some disagreements are not much more than a difference in opinion or a misunderstanding, others are relatively severe and cause for demanding immediate action and turning to authorities for resolution.   No matter how sensitive and caring the staff of a nursing home, nursing home staff and the senior or the senior’s family can develop a misunderstanding or a disagreement.

When significant problems arise, it’s often best to involve a geriatric care manager (GCM).  A GCM will act as independent expert who can evaluate the conditions and disagreements in light of state and Federal laws, industry norms, and the specific needs of the senior.  The GCM can also often act as a mediator to talk to the administrator of the facility in terms that they understand, with less emotion because they are not personally involved.  Administrators know that the opinion of a GCM is important as an independent person, should the case ever have to be resolved in court.  In short, nursing home administrators often attempt to work with a GCM when they would not with an irate family member. 

     A good way to reduce a parent’s countable assets when trying to qualify for Medicaid nursing home benefits is by having the child charge the parent for caregiving services provided.  A child or other family member is permitted to contract with the parent to provide personal care to the parent.  Such payments will help to deplete the parent’s countable assets without causing the imposition of a penalty.  The payments must be considered reasonable and in line with the going rate for similar services provided by outside companies in the same area.  The following guidelines should be followed for personal care contracts:

• Prepare a written contract prior to the delivery of the personal care services.

• Detail what types of services are  included.

• Both parties to the contract should sign in front of witnesses and a notary

• A doctor’s note should be obtained indicating that the parent needs the services being provided in the contract.

It is best to contact an Elder Law attorney for assistance when considering a personal care contract. 

     It should come as no surprise that falls are the leading cause of serious injuries in older patients. According to the American Geriatrics Society, each year about one third of Americans aged 65 and older fall, leading to hospitalizations, admissions into long-term care facilities, and even death.

     And while many health problems, including arthritis, poor balance, muscle weakness, poor vision, dementia, and certain medications may increase fall risk, vitamin D deficiency plays a surprising role in older adults’ falls.

     Vitamin D appears to reduce the risk of falls in older adults by improving muscle function and strength. How does Vitamin D help? Vitamin D regulates calcium transport into muscle cells, which is necessary for muscle contraction. Vitamin D also plays a role in regulating protein synthesis within muscle cells, which is necessary for building and repairing muscle fibers. Studies show that individuals with low vitamin D levels are more likely to have worse physical function, such as, slower gait and worse physical performance and balance, as well as lower strength. Older adults with vitamin D deficiency also have an increased risk of muscle weakness and bone diseases.

A “CCRC” is a Continuing Care Retirement Community, the most comprehensive retirement living option available to seniors in America today.

A CCRC combines the services of an independent living retirement community with an assisted-living facility and a nursing home at a single location.

In exchange for an entrance fee and ongoing monthly service fees, the resident receives the immediate benefit of all of the independent living services, together with the assurance of high quality assisted-living or nursing home services if the need should arise, for the rest of the resident’s life.

Most CCRCs are operated by charitable or religious organizations on a not-for-profit basis. Financial surpluses generated in these CCRCs are reinvested in the community for the benefit of its residents, rather than distributed to investors as dividends.  This reinvestment enables most CCRCs to continue to care for their residents who outlive their assets.  Virtually all for-profit long-term care facilities require such residents to move out and/or receive government assistance.

     Many seniors mistakenly believe that Medicare covers nursing home stays. In fact, Medicare’s coverage for nursing home care is quite limited. Medicare only provides up to 100 days of “skilled nursing care” per illness, and there are a number of requirements that must be met before the nursing home stay will be covered.

     In order for a nursing home stay to be covered by Medicare, the individual must enter a Medicare approved “skilled nursing facility” or nursing home within 30 days of a hospital stay.  The hospital stay must have lasted at least three days, not including the date of discharge. The care in the nursing home must be for the same condition as the hospital stay. In addition, the individual must need “skilled care.” This means a physician must order the treatment, and the treatment must be provided daily by a registered nurse, physical therapist, or licensed practical nurse. Finally, Medicare only covers “acute” care as opposed to custodial care. This means that Medicare only covers care for individuals who are likely to recover from their medical conditions, not care for individuals who only need assistance with activities of daily living, including: eating, bathing, continence, dressing, toileting, and transferring.

     Once the individual is in a nursing facility, Medicare will cover the cost of a semi-private room, meals, skilled nursing and rehabilitative services, and medically necessary supplies.  For the first 20 days, Medicare covers 100 percent of the costs.  Beginning on day 21, the individual is responsible for a daily co-payment amount.  This daily copayment amount may be covered by the individual’s Medicare supplemental insurance policy, assuming he or she already has one.  After the 100 days are up, Medicare nursing home benefits end, and the individual is then responsible for all costs moving forward.  At that point, many individuals will turn to Medicaid for assistance.