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.

Most people that have long-term care needs want to stay in their homes.   Services to keep and individual in their home are available from for-profit companies, local non-profits, churches, friends, and family members.   Individuals that can privately pay for these services often have more choices than those who can’t.  The local Area Agency on Aging is a good starting point when searching for services available from the community.  In addition, professional care managers (geriatric care managers) are available to develop a plan of care based upon an individual’s ability to pay.  The MI Choice program is designed exclusively for individuals who require nursing home level care but wish to remain in their own homes.  The vast majority of those individuals that qualify for  MI Choice reside in their own homes, in the home of a relative, or in assisted living facilities.  To qualify for MI Choice, applicants must pass the same eligibility screen that is used for nursing home residents.  Unfortunately, this program currently has a long waiting list.

Understanding the long-term care needs of individuals and the options designed to serve them requires familiarity with the concept of activities of daily living. Activities of daily living include activities such as toileting, eating, bathing, dressing, and transferring.  Assessing an individuals’ ability to perform the activities of daily living is generally done by health care and social service providers.  A sliding scale is used and a score is assigned based upon whether or not the individual can perform the task independently, with suggestion or supervision, with some assistance, or is totally dependent on caregivers to perform the task.

An evaluation of an individual’s abilities is often required for a claim for benefits under a long-term care insurance policy.  In addition, to qualify for Medicaid nursing home benefits, an individual must be assessed on how well he/she can perform the activities of daily living.  An individual who can independently perform the all the activities of daily living is not likely to be eligible for publicly funded long-term care services.

 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 national Medicaid estate recovery program has been in effect for many years.  Just recently, Michigan became the last state to adopt an estate recovery law.  The law seeks to recover from the  probate estate of those individuals that have received Medicaid benefits.  Certain probate estate property is exempt.  This includes property to which a hardship waiver applies, that portion of the property that is the primary income-producing asset of the survivors, and only a portion of the Medicaid recipient’s homestead.

To learn more about estate recovery,  contact a competent elder law attorney.

     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. 

Long-term care costs are not covered by private health insurance or any of the Medicare plans. Under traditional Medicare Part A, a three-night hospital stay triggers up to 100 days of skilled care in a nursing home. The majority of long-term care costs are either paid privately by the resident and the resident’s family, long-term care insurance, or paid by Medicaid.
Eligibility for Medicaid is determined based on strict income and asset rules. However, typically a single person can only have a maximum of $2,000 in countable assets plus certain excluded assets such as the individual’s personal residence, one car, personal effects and a pre-paid funeral contract. There are various planning techniques that may allow an individual to protect more assets. However, the Medicaid rules frequently change. Therefore, it is wise to seek the advice of an experienced elder law attorney when considering any type of asset preservation planning.

     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.

     When older adults suffer from Alzheimer’s disease, it can often be challenging to find ways to stimulate their memory—or even to help them communicate. But creative forces such as music and art have been shown to make a dramatic difference for many with the disease.  Music and art may give a “voice”—or at least some form of communication—back to older adults who had previously been uncommunicative.  As Alzheimer’s disease progresses, elders gradually lose verbal skills. But researchers have found that art may allow these patients to express themselves even when their verbal skills have failed.  In addition, music therapy may assist in socialization, may enhance and recall language skills, may enhance movement, and may even decrease agitation.  These activities may also promote communication between people with Alzheimer’s and their caregivers.

     Experts believe both art and music can tap into areas of the brain that were previously dormant as a result of Alzheimer’s disease.   And music may be rooted in the brain even deeper than language.  Music is processed by many different parts of the brain rather than just one center, as in language. The elements of music, such as rhythm, pitch, and melody, are all processed differently.

     Everyday caregivers and practitioners working with elders can successfully incorporate elements of music therapy into their patients’ daily lives. The key to using music with Alzheimer’s patients is finding what kind of music the person enjoys.