Elder Law

Advocates Call for Tighter New York Medicaid Rule Enforcement

Published on: September 27, 2011 | by Ettinger Law Firm

Last week state legislators proposed New York Medicaid changes which would eliminate the financial involvement of local county governments–a state take-over of the program. However, this change would do nothing to curb the overall costs of the program. Lawmakers explain that reigning in Medicaid costs remains a top priority, and so additional alterations to the program are likely. Many observers are calling for tighter enforcement rules to root out fraud. Stricter enforcement of the program will likely target medical care providers who seek to collect money, but these changes may also affect individual residents who are working through the New York Medicaid application process.

An editorial in last Friday’s Albany Times Union called upon the legislature not to go “soft” on Medicaid users. Recent problems of fraud in institutions serving those with developmental disabilities were used to highlight the current problem with the program. Some observers believe that homes for those who are unable to live independently because of age or disability are the site of the clearest patterns of excessive Medicaid utilization. Several years ago the New York Commission on Quality of Care and Advocacy for the Mentally Disabled noted that Medicaid billing for these services were “costly, fragmented, sometimes unnecessary, and often appeared to be revenue-driven, rather than based on medical necessity.”

Senior care advocates believe that many disabled seniors find themselves in need of dental care, hearing aids, and similar basic services only to be shuffled to alternative medical appointments not of their choosing or tailored to their need. These advocates claim that Medicaid changes are necessary to correct the disconnect between needed services and the ones actually provided. On top of the programmatic problems, the state’s Long Term Care Coalition noted that the Health Department lacks the resources to oversee these adult homes properly. The state body struggles to ensure that nursing homes and senior living facilities are abiding by state rules and regulations. The quality of elder care suffers as a result.

Medicaid Asset Protection Trust Is Important Tool for New York Seniors

Published on: September 19, 2011 | by Ettinger Law Firm

A Medicaid Asset Protection Trust (MAPT) is one of the best tools available for seniors who do not have long-term care insurance to protect their assets from the staggering cost of nursing home care. This weekend our New York elder law attorney, Bonnie Kraham Esq., had a story published in the Times Herald-Record where she explained the value of this trust for local residents. The article highlighted the specific ways that a MAPT can help local seniors save assets for their family and dispelled misconceptions that some have about creating the trust.

A MAPT is a legal entity that a resident creates with the help of a professional to protect assets from being consumed in order to pay for long-term caregiving costs in the future–usually nursing home care. To create the trust, a resident transfers assets (such as the family home) into the separate legal entity and names someone other than themselves or their spouse as trustee to manage the assets in the trust. The senior may then be able to keep those assets down the road while still qualifying for Medicaid assistance if needed to pay for nursing home care.

Contrary to some misperceptions, local seniors who create a New York Medicaid Asset Protection Trust do not forever “lock up” all of their assets or lose the power to alter what happens to their property. The lifestyle of the senior who creates the trust is usually unaffected, because they still receive pension checks and Social Security checks directly, and they retain the exclusive right to use their home just as before while keeping their home tax exemptions. These trusts are irrevocable, but New York law actually allows the trust to be revoked with written consent of all involved parties. In addition, the individual who creates the trust can amend it to change the beneficiaries at any time.

Grandparents Day is Reminder of Importance of Long-term Care Planning

Published on: September 15, 2011 | by Ettinger Law Firm

While it slipped under the radar this year for many families, the first Sunday after Labor Day is Grandparents Day. As explained this week in the Daily Local, the holiday has been the topic of a presidential proclamation every year since 1978. More recently it has been used as a time to raise awareness of the continuing needs of many grandparents in nursing homes and the importance of helping our elders conduct long-term care planning. Considering that the majority of area seniors remain concerned about their future quality of life, our New York elder care attorneys know that all occasions are good ones to discuss these long-term care issues.

The non-profit association which champions Grandparents Day each year explained how the group has been working to help families take steps that will keep their elders in their own homes, instead of nursing homes. Efforts to transition away from nursing home care are growing in popularity nationwide. Our New York elder law estate planning lawyers have long recognized that most area seniors would prefer to “age in place,” receiving the additional care that they need without being forced to move into a nursing home or other long-term care facility.

However, the financial realities of these situations often mean that it is only those who have taken steps to prepare for this time in their lives that ultimately have the freedom to stay at home. For example, residents who visit a professional early enough to discuss these matters often decide to invest in long-term care insurance (LTCI). This insurance can ensure that the resources will be available when necessary to pay for at-home care when a senior is in need of extra assistance with day-to-day tasks. It is difficult to put a price tag on the peace of mind that comes with knowing one has done everything in their power to ensure that their quality of life will remain as high as possible no matter what the future holds.

Bankruptcy Filings Among the Elderly Are Rising

Published on: September 9, 2011 | by Ettinger Law Firm

The economic conditions of the past few years have placed many families in difficult financial circumstances. Few demographic groups have been spared, and our New York elder law attorneys know that the situation has affected many seniors in our area. Echoing that trend, a forthcoming article in The Elder Law Journal explains how there has been a sharp increase in the number of elderly community members filing for bankruptcy.

According to the latest data available, those over sixty five years old account for seven percent of all bankruptcy filings. This is a marked increase from rates over the past two decades. For example, senior citizen bankruptcies represented only four and half percent of the total in 2001 and roughly two percent in 1991. The new research on the topic found that medical debt was one of the most commonly cited reasons for the filings by these community members. The often staggering cost of care required by seniors makes it a virtual necessity for all local residents to conduct proper New York long-term care planning to ensure that they are not financially devastated by these medical and caregiving bills.

The new research on elderly bankruptcies found that one of the main reasons why seniors find themselves facing financial struggles is an unwillingness to ask others for aid with fiscal questions. All local seniors who are worried about their financial well-being should remember that assistance is available. An experienced New York elder care lawyer is able to help local families plan ahead for long-term medical care. This preparation provides the peace of mind that comes with knowing that one’s finances will be protected regardless of what the future holds.

Proper Senior Care Planning Needed to Prevent Elder Financial Abuse

Published on: September 2, 2011 | by Ettinger Law Firm

Earlier this year Congressional hearings were held on the often forgotten problem of elder financial exploitation. Federal officials are still considering a variety of legislative options to protect victims of these crimes and hold wrongdoers properly accountable. Our New York elder law attorneys know that many residents in our area fall victim to predatory actions that often deplete resources built up over a lifetime. The problem takes many forms, from identity theft and scams to manipulation by trusted caregivers. Surprisingly, much financial abuse is perpetrated by friends and family members who exploit the senior’s vulnerability for personal enrichment.

While legislative actions may be helpful to better protect seniors from this exploitation, the first line of defense is proper individual financial preparation. Taking proactive steps to minimize the risk of being taken advantage of is the best way each individual resident can protect themselves. For example, a comprehensive story at TBO News explained this week that identity theft can usually be prevented if simple steps are followed. This includes refusing to give personal information over the telephone, deleting unsolicited emails that ask for personal information, and not carrying Social Security cards and multiple credits cards at the same time. Additionally, seniors should be sure to shred personal mail, stop mail before going on vacation, be cautious with online shopping, and frequently review financial statements.

While identity theft is a common fear, most seniors are much more likely to be financially exploited by family and friends. To guard against this mistreatment, local advocates agree that it is important to have a New York elder care plan in place so that trained eyes are aware of your financial situation. Beyond that, simple steps can help to limit one’s risk of being victimized. It remains important never to give blank checks for others to fill in the amount, sign complicated papers that you don’t understand, or give others unlimited access to financial information. In addition, seniors should always work with their banks to control who has access to funds.

Tips for Choosing the Best Elder Care for Loved Ones

Published on: August 17, 2011 | by Ettinger Law Firm

It is often emotionally wrenching to come to the realization that your aging loved one is in need of extra day-to-day care. For local residents, if a proper New York elder care plan is in place there should be options available to provide the necessary assistance. In many cases aid can be provided to the senior while they remain in their own home with care workers traveling to them to assist with basic living chores and some medical needs.

However, there may come a time when moving the relative into a long-term care facility is unavoidable. When that time comes there are often two major questions to answer: how will we pay for nursing home care and how do we know what facility is best? Local community members can receive guidance on the first question by visiting a New York elder care attorney. Even if no prior planning has been conducted to save assets from these costs–such as the creation of a Medicaid Asset Protection Trust–there may be options to protect part of one’s assets while on the nursing home doorstep. This is known as the “gift and loan” strategy; it is an advanced elder law technique that can save some of your relative’s nest egg from being spent down to pay for an extended nursing home stay.

This week Penn Live shared some tips to help families decide on the appropriate facility for their loved one once the financial issues have been resolved. Some assisted-living facilities are geared toward seniors who can do some things on their own (like bathing and dressing), while many other nursing homes provide assistance in virtually all tasks. In our area, the New York State Office for the Aging provides helpful information on various housing options for seniors and the specific services that they usually provide.

Power of Attorney & Health Care Proxy Are Crucial Components of New York Elder Care Plan

Published on: August 15, 2011 | by Ettinger Law Firm

Every New York elder law estate plan should likely include a Power of Attorney and Health Care Proxy. These documents allow another person to handle a variety of legal, financial, and medical affairs on your behalf in the event of disability. Our New York elder law attorneys know that preparing for all possible contingencies is the main purpose of this planning, and so inclusion of these documents remains essential.

Some residents are less familiar with the importance of these decision-making tools and may assume them to be unnecessary in their particular case. They may believe that their friends or family members will step up and handle affairs appropriately without the need for formal legal documents. Unfortunately, that assessment is misguided because very often family disagreement arises among these individuals under the stress of dealing with the disability–setting the stage for conflict without prior delegation of decision-making power. The director of a local public aging services center explained that “the last thing you want is if you age and lose capacity, to become a pod in a power struggle between your kids or your grandkids.” On top that, even if one’s family members do not disagree on any financial or medical issue, the law will not automatically grant these powers to a certain friend or family member. In many cases, the disability requires court intervention to appoint a guardian which is a situation that should always be avoided.

Failure to provide this legal clarity ahead of time can have wide ranging effects. For example, KFBB News reported late last week on one man who is facing felony kidnapping charges after allegedly taking his 92-year old mother out of her long-term care facility and bringing her into another state without permission. The man was not his mother’s Power of Attorney. The family was confused about the local elder care laws, and the man assumed he had the right to move his mother. He didn’t. He is now awaiting extradition to face possible criminal sanctions for his conduct. It is likely that the man would not be facing any charges at all had a Power of Attorney been drafted.

Elderly Residents Can Keep Their Pets With Flexible Care Options

Published on: August 3, 2011 | by Ettinger Law Firm

Many seniors consider their pets to be part of their family. The companionship that an animal brings is often particularly important for those who have lost their spouse or who live alone. In fact, the Center for Disease Control and Prevention specifically credits pets with decreasing blood pressure, increasing socialization opportunities, and providing exercise for owners. New research out of Miami University of Ohio and St. Louis University found that pet owners were more physically fit and less fearful of basic daily stresses than those without animals.

The unique connection between owners and their animals is one of the key reasons that our state allows residents to create a New York pet trust as part of their estate plan to pass along resources for the care of their animals. In addition, senior pet owners can now receive varying degrees of assistance to help care for their animals in their golden years. Proper pet care is often daunting for seniors who struggle to get their animal to and from the vet, provide regular walks, and similar tasks. In the past, residents were often forced to give up their beloved animals when they were no longer able to provide them the care they needed on their own.

Fortunately, as Global Animal discussed in an article this morning, various services are now available to help senior pet owners keep their pets in their own home. For example, pet sitters are prevalent in most cities to help walk dogs, administer medication, and perform other aid. Many of these sitters double as veterinary technicians so they are often trained to catch animal illness that may not be noticed by the pet owner.

Primary Progressive Aphasia Remains Little-Known Form of Dementia

Published on: June 1, 2011 | by Ettinger Law Firm

The onset of medical conditions that affect brain function like dementia or Alzheimer’s often act as triggers for local residents and their families to visit a New York elder law attorney. As most are aware, these illnesses affect millions of individuals across the country. The brain conditions result in memory-loss, reduction in learning ability, and reasoning problems. Obviously these illnesses pose a serious threat to an individual’s ability to properly manage their affairs, and caregivers are often required to help with day-to-day activities.

While conditions like dementia are rarely found in anyone less than 65 years of age, there are a few lesser known illnesses that affect brain function and occur in younger individuals. Last month the New York Times profiled one of those forms of dementia, known as primary progressive aphasia (P.P.A.). The syndrome often strikes those in their 50s. Its rarity and the age at which it occurs often cause doctors to misdiagnose the condition as depression, anxiety, or even a stroke.

Unlike Alzheimer’s or dementia, P.P.A. does not initially affect memory but instead affects an individual’s communication abilities. An expert on the disease explains how P.P.A. damages the part of the brain that is used in word-finding, object naming, syntax, spelling, and word comprehension.

The wife of one 55-year old sufferer from P.P.A. explains her husband’s impairments, noting that “he can no longer punch in the numbers to operate the garage door or the microwave or the remote for the TV. He might open the car window, then not know how to close it.”

While communication impairment is the primary problem caused by P.P.A., eventually patients suffer other deficits, like memory-loss, various cognitive abnormalities, and even motor problems. It is for those reasons that the article concluded by recommending that those who may be suffering from P.P.A. visit an elder law attorney to ensure that their family’s financial affairs are in order.
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The Medicaid Asset Protection Trust (MAPT) – Do’s and Don’ts

Published on: April 13, 2010 | by Ettinger Law Firm

by Michael Ettinger, Attorney at Law The Medicaid Asset Protection Trust (MAPT) is a technique commonly used by elder law attorneys. It consists of an irrevocable trust, usually set up by a parent of parents sixty-five and older. One or more of the adult children are named as “trustees” to manage the trust for the benefit of the “beneficiaries” who remain the parents during their lifetimes. For example, the parents retain the right to the exclusive use and enjoyment of the home and the income from all of the trust assets. The establishment and “funding” of the trust, i.e. retitling the home and the investments in the name of the trust, starts the five year look-back period running. After five years, those assets become exempt and are protected from the costs of long-term care.

Once the MAPT is established, there are certain things the parties can and cannot do. Below are a list of the “Do’s and Don’ts” concerning the MAPT.

Do’s