EAEDC Financial Planning for Rest Home Care in Massachusetts

The limited number of subsidized Assisted Living slots has made Rest Homes a viable alternative for many physically and mentally impaired elders in Massachusetts. The care in a Rest Home is greater than that of an Assisted Living facility, but not as encompassing as traditional Nursing Home care. Although Rest Homes are less expensive than Nursing Home care, they are not a long term solution for many families. If financial planning begins early, Emergency Aid to Elders, Disabled and Children (EAEDC) may be an alternative to help you or a loved one cover the costs of continued Rest Home care.

After he experienced frequent debilitating strokes, Maura decided to move her father, Joe, from his condominium in Newton to a local Rest Home less than ten minutes away from her house in Worcester. At a cost of $7,500 per month, Maura figures that Joe’s assets of $275,000 will finance just three years of Rest Home care. She knows that Rest Homes do not accept MassHealth for payment, like her mother-in-law is currently taking advantage of in a Nursing Home. Joe doesn’t need that type of care yet and Maura would like to keep him as active and independent as possible. The director of the Rest Home mentioned the EAEDC program and how it may assist Maura and Joe in financing his care in the long run. He recommend that they speak with an Elder Law attorney familiar with the program. Maura learned with the right financial planning Joe can be approved for EAEDC payments to the Rest Home and some of his hard-earned assets can be kept within the family.

A state-funded welfare program administered by the Massachusetts Department of Transitional Assistance, to qualify for EAEDC, you must be a senior aged sixty-five or older, with very little resources, not qualifying for other cash assistance programs such as Supplemental Security Income (SSI) or Veteran’s Services Benefits (VSB). The maximum value of your money and property cannot exceed $250, including bank accounts, IRAs, stocks, bonds, cash, and surrender value of life insurance policies and cars. To reach this miniscule amount, like Joe, one often has the choice of either exhausting available resources in effort to apply for EAEDC and similar state-funded programs, or transferring assets to his or her family members to render eligibility for state funding.

One significant advantage of the EAEDC program concerns its “look-back” period on the transfer of assets. If Joe were to transfer his assets to Maura for less than fair market value within the twelve months prior to the date of application for EAEDC, he would be subject to a period of ineligibility. In comparison with MassHealth’s five year “look-back” period, EAEDC appears much more generous. Additionally, applicants for EAEDC lose the right to retain individual health insurance coverage, but become eligible for MassHealth coverage (even if a person’s income exceeds the limits normally established for MassHealth).

However, one must be careful not to disqualify themselves for future MassHealth coverage of the Nursing Home stay due to sloppy EAEDC planning. Sometimes a person can deteriorate and no longer be appropriate to continue in a Rest Home. Both programs qualifications vary and are very specific. If you or a loved one plans on entering a Rest Home in the near future but want to keep hard-earned assets within the family, your best bet would be to undertake advanced financial planning with an Elder Law attorney, like Kristina Vickstrom, who is experienced in both the MassHealth and the EAEDC programs.

Applying for MassHealth: Is the No-Cost Solution Really “No-Cost”?

Medicaid, or MassHealth as it is referred to in Massachusetts, is an avenue available for funding long-term nursing home care. To qualify, you must meet asset thresholds that many elders exceed. Additionally there are income requirements for MassHealth/Mediciad. Adequate understanding of MassHealth/Medicaid law and proper strategizing is a critical component of any plan for the future. With the proper planning of an elder-law attorney, you can protect your property, spouse, and assets.

After attempting to cope with his mother’s diagnosis of dementia for several months, Joe has finally decided to research local nursing homes for his mother. However, he is concerned about the cost while protecting his mother’s multiple properties, which have been in the family for generations. During a vist, Lindsay, a social worker from the facility, reached out to Joe, offering to complete a MassHealth application for his mother at no-cost. While Joe likes the concept of this free service, he can’t help but wonder if there is a catch involved.

Employed by the nursing home, social workers and other nursing home advocates focus on the rights of the nursing home and not the resident. The nursing home has a vested interest in keeping someone on “private-pay” for as long as possible because their private pay-rates are much higher than the amount received in MassHealth/Medicaid reimbursement. This means more out-of-pocket costs for residents than may be necessary.

Further, even if nursing home advocates do have the best of intentions, the MassHealth/Medicaid process is riddled with complex rules and regulations that are difficult to navigate for those not educated in the eligibility requirements and advantageous planning opportunities available under MassHealth/Medicaid. For instance, an individual encouraged to apply too soon might be ineligible for an extended time period and have to pay privately for a longer duration. Alternatively, the “advocate” may not inform the family that they can pre-pay for funeral expenses as part of a spend down, thereby reducing the burden on family members when the applicant passes.

Individuals that enlist family members to fill out their MassHealth applications or file themselves may face similar problems. Unfamiliar with eligibility requirements and liable to miss prime planning opportunities, these individuals are likely to encounter harsh penalties or confusion when faced with the application process, as well as income and asset verifications. Once they receive their denial notice in the mail, it will be much more expensive to get an Elder Law attorney involved at that point. Additionally there are strict time periods that must be adhered to in order to have any change at being sucessful in a MassHealth/Medicaid appeal.

Nursing home advocates and family members, although the cheapest solution up front, do not have the requisite knowledge, skills, or ability to compose trusts, devise appropriate estate plans, and represent you in an appeal setting if the need should arise. Rectifying the mistakes of an advocate or self-handled application may be more costly than a properly executed plan formulated a skilled elder law attorney. By hiring an elder law attorney to guide the MassHealth application process, you will ensure that your savings, your spousal support, and your family’s inheritance will not be jeopardized by lost opportunities in a last minute planning strategy.

Hiring a lawyer to handle your MassHealth application is a necessary investment. Elder law attorneys can save clients and their family members an amount greater than the cost of their legal services. If you are interested in learning more about the MassHealth application process or long-term care planning, contact Vickstrom Law today!

What Do You Mean Medicare Won’t Pay for Dad’s Nursing Home Stay?!

A three-day hospitalization often serves as a gateway for a senior citizen’s transition into a skilled care facility. When the patient is discharged to a skilled care facility for occupational, physical, or speech therapy, the patient’s health insurance (Medicare) will continue to finance treatment for up to 100 days per stay (as long as the person continues to benefit from rehab). Medicare coverage ultimately ends, and when it does, the patient must pay from income, savings, long-term care insurance, Medicaid, or a combination of these resources.

Jo-Ann’s ninety year-old father, Ed, recently suffered a massive stroke. After spending four days in the hospital, Ed was transferred to the Odd Fellows Home in Worcester, Massachusetts for round the clock skilled care. Medicare covered the entirety of Ed’s expenses for the first 20 days of his stay, and Ed fronted a $95 copayment for days 21-100. It is now day 101. Medicare refuses to pay for Ed’s care because the program contends coverage has ended and that Ed now must meet his skilled care expenses from another source.  Ed has been primarily dependent on monthly Social Security checks after running through his savings a few years ago. Jo-Ann is a single mother of four children who fears that she won’t be able to keep her father in a nursing home due to her financial inabilities and his exhausted savings. She thought that since Ed paid taxes his whole life it would have guaranteed him government-funded nursing home care. What are Ed’s options?

It is easy to confuse Medicare with Medicaid. Medicare is a federal health insurance program. Anyone who has paid their taxes and meets specific qualifications (is over the age of 65, or who has been blind or disabled for the past two years) is entitled to Medicare coverage. Hospitalization, immunizations, medical equipment, and physician visits are covered by Medicare, while deductibles and co-pays are often covered by a form of supplemental policy. Medicare applies regardless of financial need but will not pay for nursing home care except in extremely limited circumstances, and then only for small durations.

Ed might benefit from applying for Medicaid, or MassHealth in Massachusetts. A joint federal and state program for individuals with certain medical needs who are financially needy, Medicaid/MassHealth is often the chief financier for nursing home care. An applicant may have no more than $2000 in countable assets (cash, savings, mutual funds, retirement accounts, houses) before requesting Medicaid/MassHealth. To achieve Medicaid/MassHealth payouts, many individuals will seek to transfer their assets to loved ones to demonstrate financial need. It is important to note that the transfer of assets for less than their fair market value will result in a corresponding ineligibility period for Medicaid/MassHealth coverage of nursing home care.

The average cost of a nursing home in Massachusetts is an astounding $11,000 per month. If you or a loved one has exhausted all means of paying for skilled care, it is important to contact an Elder Law attorney to discuss your options. After recommending Medicaid/MassHealth, an Elder Law attorney may suggest ways to set aside funds and assets for your family without jeopardizing the patient’s medical care and “spend down” ideas which benefit the patient.

Medicaid/MassHealth rules are complex and confusing. Further, nothing in this area is concrete or insulated from legal or policy change. Vickstrom Law can help explain the interrelationship between Medicaid/MassHealth and nursing homes and can assist with protecting and preserving assets for a spouse or other family members.

Antipsychotic Drug Use for Dementia Should be Closely Monitored by Doctors & Family Members

Are you a family member or guardian of someone that suffers from dementia? Is s/he living in a nursing home? Do you know what medications s/he is taking? Do you know what the dosages are? When was the last time those medications were reevaluated to determine if they are helping in any way, or if they are even necessary? These are all important questions to keep in mind and to continue asking the administrators of the nursing home and the physicians who care for your loved one.

On March 10, 2010, Massachusetts joined a federal suit against Johnson & Johnson for paying millions of dollars in kickbacks to Omnicare, Inc., the largest pharmacy in the US that specializes in providing drugs to nursing home facilities. United States Attorney Carmen Ortiz argues in the complaint that substantial monetary kickbacks can be especially harmful in the nursing home context because nursing home patients have little to no control over the medical care they receive. He states: “Nursing home doctors should be able to rely on the integrity of the recommendations they receive from pharmacists, and those recommendations should not be a product of money that a drug company is paying to the pharmacy.”

The primary drug at issue in this case is Risperdal, an antipsychotic drug that is usually prescribed for patients with severe mental illnesses, such as schizophrenia. It is legal to prescribe antipsychotics for “off label” uses to treat people with dementia, but these drugs may also raise the risk of death among such patients. At the same time, antipsychotics can help patients with dementia suffering from extreme agitation and sleeplessness. When prescribed in small doses, these drugs can actually have amazing effects on making the lives of patients with dementia more bearable. However, it is important that the prescriptions and dosages be reevaluated regularly to determine their effectiveness and potential harm to the patient.

On March 8, 2010, the Boston Globe reported that 2,483 nursing home residents in Massachusetts were treated with powerful antipsychotic drugs in 2009. This data was collected by the federal Centers for Medicare and Medical Services, and Massachusetts has the 12^th highest rate in the nation for nursing home patients on antipsychotic drugs. While these statistics may appear alarming at first glance, any good researcher knows they don’t paint the whole picture. Many patients with dementia are only put on small doses that do not harm them in order to lower their agitation and improve their sleeping habits, but it is also critical not to simply overlook these statistics. As noted earlier, two after the data was published in the Boston Globe, Massachusetts joined an important federal suit against one of the drug companies that promotes these potentially harmful practices.

It is extremely important to be educated and informed regularly about the drugs your loved one is taking, especially if s/he is in a nursing home. While issues concerning antipsychotic drugs are currently making headlines, it will take individual conversations to ensure that your loved ones are being treated appropriately. Sometimes antipsychotic drugs are extremely beneficial for a patient with dementia, but if not administered properly, they can also be very damaging. Open communications between you, the patient, the patient’s guardian (if that is not you), the patient’s primary care physician, and the administrators at the nursing home s/he lives at, will make it possible to ensure that your loved one is on the right medication so that s/he is safe and comfortable.