Elder Law

HOW DOES THE DEATH OF A SPOUSE AFFECT MEDICAID ELIGIBILITY

Published on: April 14, 2016 | by Ettinger Law Firm

NEED FOR UPDATED ESTATE PLANNING WHEN ONE SPOUSE GOES INTO NURSING HOME

When one spouse goes into a nursing home, there is a good chance that he/she is using to pay for their care. That means that the community spouse will have to live survive on certain income thresholds determined by Medicaid. There are also asset limits that are allowed under Medicaid. Estate planning can allow for a middle class family to have one spouse qualify for Medicaid through such legal mechanisms as spousal refusal, which is only allowed in a few states, New York being one of them. These asset and income thresholds presuppose that there is one spouse in a nursing home and the other in the community.

If the spouse in the nursing home passes away, there may be some legal effect on the community spouse, depending on what means based programs he/she qualifies for. They may also receive Medicaid but only receive community based care or any number of other programs, such as the veterans aid and attendance program. On the other hand, if the community spouse passes away first, there will be a much greater chance that the spouse in the nursing home will risk losing their Medicaid benefits or have that additional income provide for the medical care of the spouse in the nursing home and the assets liquidated. The retirement account, the family home any life insurance proceeds from the community spouse’s passing as well as any investments or valuable personal property owned by the community spouse. All of this may be quite contrary to the estate plans that both spouses had. They would have rather left their nest egg to their children and grandchildren rather than have it pay for a Medicaid lien.

SOCIAL SECURITY SURVIVOR BENEFITS

Published on: April 5, 2016 | by Ettinger Law Firm

NEW RULES FOR SAME SEX COUPLES

Social security survivor benefits may seem like a relatively straightforward issues to understand. Indeed, it can be for the majority of people, but with the Supreme Court ruling in Obergefell v. Hodges that states must recognize the right of all couples, including same sex couples, to marry, the issue of social security survivor benefits for spouses and even for children should at least be touched upon. The opinion in Obergefell may be as monumental of an opinion as the Court ever penned. While only history will tell, the social consequences may be of the same magnitude as the Supreme Court’s opinion in Brown v. Little Rock Board of Education, requiring racial integration of schools across the country.

The implications ripple throughout the law, from tax law to social security benefits to family law, estate planning, bankruptcy and even elder law. Less than a year prior to the writing of this blog there was a patchwork of treatment for same sex couples, which was anything but similar in its treatment of two similarly situated couples, with the only difference being what jurisdiction the couple lived in. Social Security indeed denied some same sex life partners survivor benefits when a couple resided with each other as spouses for decades. Even before the Supreme Court heard oral arguments in Obergefell some who be widows/widowers (but for the state law denial of this right) sued the Social Security for this disparate treatment.

HOME CARE SERVICES IN NEW YORK STATE

Published on: March 29, 2016 | by Ettinger Law Firm

IN HOME PERSONAL ASSISTANTS

If you already have New York Medicaid you may be eligible for managed long term care or in home care by a licensed Managed Long Term Care Agency (often simply referred to as MLTC). The animating thought is to ensure that older adults can remain in their home and community rather than in a nursing home. The menu of options available to eligible New York state residents is actually quite extensive. In fact, there is even the option of hiring and training your own personal assistant, know as Consumer Directed Personal Assistance Program.

Traditionally, they could not live with you and you cannot hire your own spouse, parent, son-in-law, son, daughter-in-law or daughter, although they can be grandchildren, neices or nephews or any other relative for that matter. That requirement is changing in April, 2016. There is an exception that allows your personal assistant to live in your home if the amount of care required by the patient makes it necessary. That means that parents (usually of a disabled child), children, grandchildren or sons and daughters in law may reside in the home and care for the patient and get paid for it. You are also required to hire and train an alternate for when the primary care assistant is unable to come to your home because of vacation or need for sick time.

MEDICARE AND HOSPICE CARE

Published on: March 25, 2016 | by Ettinger Law Firm

FOCUS ON COMFORT

Hospice care is intended to ensure that those who are in the final stages of a terminal illness are cared for and comfortable. It is not to cure a current disease process. Instead it is to help provide a more holistic or all encompassing level of care. The patient’s medical, emotional, mental, social and religious needs are addressed. Prior to entry into a Medicare hospice program you and your family will meet with your hospice team to address the families needs, obviously with primary focus on the patient. Included within that plan, there could be social workers, dietary consultants, nurses, physicians, speech pathologists or any other medical professional that is Medicare eligible.

There are times when a hospice care plan will include bereavement counselors and priests or chaplains. Care can even be provided in home, unless your hospice team determines that the level of needed care can only be provided in an inpatient facility. If the care is in home and one of the primary caretakers needs a break, Medicare authorizes respite care for up to five days each time respite care is authorized. Respite care may be available more than once it is not authorized more than once very often.

PARENTAL VISITATION LAWS – RIGHT TO VISIT PARENT OF ADULT CHILDREN

Published on: March 22, 2016 | by Ettinger Law Firm

ANOTHER CELEBRITY CASE MAKING CHANGES

In the last few months that Casey Kasem had on this earth, he was the center of a brouhaha between his daughter, Kerri Kasem, and her stepmother, Jean Kasem, Mr. Kasem’s second wife. More specifically, Kerri Kasem alleged that at the end of the Mr. Kasem’s life she tried to visit with him but was not allowed until she forced the issue via a court Order. Kerri obviously cared deeply for her father and was clearly distraught over how everything played out during Ms. Kasem’s last few months as almost anyone would. She decided to do something about it and created the Kasem Cares Foundation to advocate for parental visitation laws.

It is not surprising that Kerri Kasem sound to advocate for change, as Mr. Kasem was well known for his advocacy against things such as factory farming and his refusal to engage in movies as a voice actor that portrayed Arabs in a negative light; the Kasem’s are of Lebanese heritage. Kerri Kasem also followed her father into the radio industry. Mr. Kasem passed away on June 15, 2014 and in the last two years, the foundation can justifiably claim some modest success.

NURSING HOME EVICTIONS

Published on: March 17, 2016 | by Ettinger Law Firm

LEADING COMPLAINT ABOUT NURSING HOME IS EVICTIONS

On February 25, 2016 National Public Radio (NPR) ran a story about what is looking to become like a national epidemic: nursing home evictions. According to statistics between 8,000 and 9,000 nursing home residents complain each year about nursing home evictions. The problem with this statistic is that it only measures the complaints, not the actual evictions. As if not being able to measure the full extent of the actual problem is not enough, there is a larger, more grievous issue wrapped up in the issue of nursing home evictions. According to the ombudsman to the Federal Department of Health and Human Services, Administration on Aging, it is the number one complaint regarding nursing facilities. In many cases the nursing home wrongfully evicted the resident(s) but will not honor rulings that find that the nursing home wrongfully evicted the resident. The entity that decides if a facility wrongfully evicts a resident is not the same entity to enforce its own decision. Without a sister state agency to enforce its decision (much like one state honoring a sister state’s money judgment on full faith and credit), such legal endeavors by residents are simply an exercise in futility. The rulings are not worth the paper they are printed on. It is a prime example of a bureaucracy run amok; without teeth to enforce its own ruling. One can and should rightfully ask, why do the agencies even bother to engage in a hearing to only allow the offending party to blithely ignore its ruling?

FEDERAL CASE TO FORCE CALIFORNIA TO ACT

MAJOR NURSING HOME CASE TESTING MANDATORY ARBITRATION CLAUSE

Published on: March 15, 2016 | by Ettinger Law Firm

CASE OF POTENTIALLY NATIONAL IMPORTANCE REPORTED IN NEW YORK TIMES

On August 21, 2009 a tragic event occurred at a nursing home in the quaint coastal town of South Dartmouth, Massachusetts. Elizabeth Barrow was over 100 years old at the time of the tragedy, but told her son on her birthday when she turned 100 that she wanted to live to be 104. The New York Times article describes her as a sweet, compassionate woman full of verve and love even in her advanced age. She was known around the nursing home as offering people hugs. It is no surprise that she made friends quickly and was quite popular amongst the fellow residents. Mrs. Barrow entered the nursing him in 2006 with her husband, with whom she shared a room. She felt fortunate just the same because her room gave her a terrific southern exposure, which helped her grow her beloved african violets. Then in 2008 Ms. Barrow’s new roommate moved in with her, after the new roommate had an argument with her previous roommate.

The exact nature of the relationship between Ms. Barrow and her roommate and very much in dispute. What is known is that soon after Ms. Barrow’s death the local District Attorney filed second degree murder charges against the 98 year old roommate. Soon after the charges were filed, the Defendant was found incompetent to stand trial. As of the time of the writing of the New York Times article, the Defendant was still alive at 104 in a local state hospital. Given her advanced age it is unlikely she will ever stand trial.

LONG TERM CARE THROUGH LIFE INSURANCE POLICY

Published on: March 10, 2016 | by Ettinger Law Firm

CONVERSION OF LIFE INSURANCE DURING LIFE OF COVERED INDIVIDUAL

As this blog discussed in the past, long term planning insurance is something that many consumers are reluctant to purchase for a number of reasons One of the main reasons for this reluctance is the long term cost may not financially justify its utilization. Life insurance companies recognized this problem and started to allow for a hybrid financial product in their life insurance policies. The life insurance company allows for the conversion of a life insurance policy to pay for the long term care services.

The animating philosophy is that there will be a pay out regardless of whether or not it happens during the insured’s lifetime, so the life insurance company could just as easily pay out on the policy during the insured’s life. Every day over 10,000 baby boomers turn 65, so the population base that could potentially utilize such as a product is growing larger every day. It is estimated that at least 70 percent of the baby boomer population will need some sort of long term care during their lifetime, with 40 percent in need of nursing home treatment.

TOOLKIT TO HELP PREVENT SENIORS FROM FALLING

Published on: March 8, 2016 | by Ettinger Law Firm

SIMPLE GUIDELINES, EASY TO UNDERSTAND AND FOLLOW

The Center for Disease Control (CDC) released guidelines to help prevent and mitigate falls among senior citizens in 2012. The CDC program is called STEADI, an acronym coming from the full title Stopping Elderly Accidents, Deaths and Injuries. Research shows that falls are the leading cause of injuries, death and emergency room visits for trauma. If a senior citizen falls it can literally be a traumatic, life altering event or even a deadly one. The silver lining is that many falls are preventable. Last year the Obama Administration announced that that the White House Conference on Aging, the Administration on Aging awarded $4 million in various grants to help expand STEADI. It is estimated that the increased funding will help reach an additional 18,000 at risk senior citizens. It is further hoped that the funding will increase participation in evidence based community programs and improve the overall programs long term viability. The CDC developed these guidelines in conjunction with British and American Geriatric Societies.

The American and British Geriatric Societies already had clinical practice guidelines in place to better define the various risk factors in falls by senior citizens. The CDC guidelines contain basic information about falls, methods to begin conversations with seniors, balance assessment tests, gait assessment tests along with instructional videos for the gait and balance tests and even case studies of the the fall risks for different senior citizens. The program and recommendations are all inclusive in that the STEADI program at the CDC website has a testing protocol for professional medical care providers, to information about webinars and other instructional videos, material for senior citizens themselves, important facts about falls, referral forms, posters for professional establishments, with posters also available in Spanish and Chinese and most importantly, it has a toolkit for medical professionals.

OPERATION COCOON: FEDERAL EFFORT TO CURB UNWITTING SENIORS FROM ACTING AS DRUG MULES

Published on: March 4, 2016 | by Ettinger Law Firm

On February 10, 2016 the United States Immigration and Customs Enforcement (‘ICE’) announced in a policy document that appears to coincide with ranking ICE officials testimony before the United States Senate Special Committee on Aging that it recently launched ‘Operation Cocoon‘ to help curtail the use of “elderly citizens” unknowingly acting as drug couriers, or drug mules as couriers are sometimes referred to as, from foreign countries to the United States or to other foreign countries. While not part of the policy document released, typical of the victims of such scams is J. Byron Martin a 77 year old retired minister from Maine, who thought he was helping a fellow soul by transporting what he believed to be books from Peru to London via Spain.

It turned out that the books in issue had drugs secreted away in them. Mr. Martin’s son, Andy Martin of Henderson, Nevada testified that his father was never arrested in his 70 plus years on this planet prior to this episode. Mr. Martin is now serving a seven year sentence of incarceration in Spain. Senator Susan Collins presided over the hearing and indicated that the ensnared seniors are duped into transporting the drugs, those with the requisite criminal intent secret the drugs away in “chocolates, picture frames, tea, markers, canned goods, shampoo bootles, soap and wooden hangers.” The hearings were an effort to get the word out about this very serious danger. Both the Senate Committee on Aging and ICE operate a toll free number to report suspected scams. That number for ICE is (866) DHS-2-ICE; (866) 347-2423. The phone number for the Senate Committee on aging is (855) 303-9470.

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