Notes to Pretty Much Everyone To Consult with Attorneys to Make Legal Plans (now's as good a time as any and to clarify more about medicare, medicaid coverage options too)

Hello to Everyone... This was a letter I sent to some personal friends but wanted to share the topics with more people. None of this is to be taken as legal advice or my recommendation...just a lot of info to research further with professionals and points to clarify in one's state. Some legal firms are offering consults by phone or online zoom.com type meetings. One such place may be CTSeniorLaw.com folks who also have a blog with a lot of helpful information. So think about the ways  learning about this with family and friends and others in your community may prove helpful now and in the future. 

 

Here in 2020 we are in the midst of March (madness which really has taken on a new definition...not just shopping sales...or the Ides of March.) I am sharing this info so people can see a good alternative to 'doing business as usual' even for pressing matters like gaining legal information.

 

This situation should include a primer in 'having some safety and emergency paperwork plans in place' such as the booklets from AARP regarding one's personal information (medical, health care representative, financial, legal,will,estate plan, insurance, household and so on) in a notebook and folder that one can readily find at home (and with a copy with a trusted person as well at least of certain info such as medical and health care rep info with one's doctor which one would benefit from being in touch with likely to go over things to make sure things are updated.)

 

I summarized a lot of what these legal consultants would want to know in advance on my blog livfully.org in another post , taking the info off of forms they sent me when I thought we'd have an appointment that was going to have to be in person.

 

This new option would be ideal since a few people could be on the call, someone take notes and share with others as may be appropriate in terms of the questions they ask or info they share. They have an extensive blog so that's worth looking at. 

 

The kinds of precautions people are taking for the COVID19 to stay safe and keep living well are similar to the 'realities' we could face regarding how people may fare financially and medically (with care options with aides in one's home or going to an assisted living or nursing home, funds to pay for that if need be, and many other matters such as how to legally spend down one's assets with a good record log (receipts, notebook, and other pre-approved plans that fit in the legal medicaid guidelines whether buying a car (and one can only have one car for the person with medicaid potential, not sure about if married or if one has a business use vehicle) or improving one's home.

 

Likely basics like plumbing and such are covered but not necessarily landscaping etc unless it's for wheelchair access. I don't know the details and maybe those are online.

 

The 'new info' I learned a few months ago at a public talk in MA is that if someone is single but has a sibling living with them for a year who has made a financial investment in the home (but I don't know the amount or type...and any real details about the terms) then that can keep the home from being put in medicaid spend-down.

 

 A person needing medicaid can only reside in one place who is applying for medicaid as the home they live in  so owning another residence is not a way to have 'savings' that would not be earmarked for medicaid spend down. 

 

There is a five year (and some say it will be a 7-year) look back period from the time a person is 65, so  plans likely should be in place well before someone turns that age or older in terms of not running into needing to use one's home to pay for medical bills incurred for nursing home care (generally after 100 days but even that first free 100 days depends on one's 'medicare vs medicaid' medical status.)

 

 One needs to be viewed as improving (healing from a minor set back like low sodium levels or short term physical therapy after a knee replacement etc and meet minimal standards for being able to walk with assistance or not need a Hoyer lift long term even if one is in a wheelchair. )

 

 What is very difficult to come to terms with is the more compromised one is with mobility and health, the more readily one will be 'put on a medicaid spend down plan', sometimes one day to the next...with a 'snapshot' taken as of a given date (an accounting) of one's income, assets, legitimate debits and so on as well as a review of what happened to assets expended on daily living and maybe also withdrawal of stocks etc or sales of items (income from any resources, though I don't know all the details) for the past 5-or possibly 7-- years.

 

This law firm has extensive experience with medicare, medicaid, financial and legal matters to advise people of their options to help them get the most out of the value and use of their primary home, connections with others who are able to help in various ways and ways to manage other resources (investing in one's primary residence, a vehicle and setting up in advance Legal Caregiver Agreement terms for instance so a person would be legitimately recognized and paid (even if in the future, but some fees such as workman's comp and some taxes maybe would be needed to be paid in a timely fashion even before work begins.... something to inquire about.)

 

Without such a formalized  LCA, Legal Caregiver Agreement detailing hours of work, job description, wages and records of work done in advance of doing the work, a person can be determined to have 'done the work as a gift so therefore cannot be compensated in the future even in a patient or client's health declines and merits more intense care.' That all needs clarification, but again is something important to study in advance. That may be a federal set of terms since it relates to medicaid, but every state may have its own guidelines.

 

Medicare may be able to cover some help for people with the appropriate safe housing to have help in their homes on a limited basis (to have a shower, dressing, help to appointments and so on.) If a person needs more involved or more hours daily then they may qualify for medicaid help but a full-time caregiver would be needed to be there in the home. 

 

That could be a family member and it an assistant came in for various times, the main caregiver would not be paid (I think that's how it goes...but basically these are both new programs to help people not have to go into a nursing home if they are mainly functional and have a home or place to reside with some community support.) The main caregiver is not paid for 24-7, but up to 10 hours a day depending on what needs are determined by the state as necessary. It may only be for 4-8 hours etc and is paid at minimum wage or 10/hr. 

 

That is also what is recognized as legitimate wages for hours paid 'out of pocket' in the medicaid spend down program...so ideally if someone is in that range of needing to qualify for medicaid, people would 'help that person on the books with good record keeping' for months if not years before to help manage the finances and have it work out reasonably and on the books.

 

If a person is forgetful or a fall risk, or told by their doctor after being in a nursing home for a short time (or maybe with other conditions) that they need to have someone living with them to stay in their home for safety reasons that may qualify as a legitimate reason to have paid help and meet medicaid guidelines. Another question would be is if that can be done voluntarily for people who would like a companion whether they have clear medical or mental health issues or are a certain age.

 

Whatever is paid out needs to be documented (even if being paid in the future out of the sale of the main home or as part of an estate....and the person receiving the funds may need to pay taxes as as self-employed person if taxes were not with held. That may have other rules to follow under 'domestic services' however.

 

If a caregiver is paid 1000/ year (or quarter I'm not sure) then there may be a need to have the employer pay workman's compensation Before the work begins (or face steep fines for each day not covered.) Social Security and medicare wages would also likely be paid in part by each party (the employer and employee) but it's good to explore the options.

 

If one is caring for someone in their home versus the client's home then that may change aspects of that, and it may be viewed more as a business. If the person one is caring for claims that home as their new primary residence that again would shift options. That's why it's helpful to have someone familiar with these options help people look into what would be reasonable and feasible to do.

 

Finding qualified, capable people can be another level of concern. Some insurances will only pay for people who have a certified nurses assistant license which needs to be updated with about 20 hours of paid work yearly (again states may vary.) Some people take the class but not the test so that is a gap that could preclude someone from being a candidate to be paid on the books by an insurance company.

 

It's about 1500 dollars to take the CNA, Home Health Aide class in CT. That involves classroom and practicum hours. (Some places offer free trainings but expect or possibly require one if they can legally to work at their facility for a certain period of time or hours if  competent to be licensed.)

 

 Some places like SNAP may offer trainings as well be the way for low or no cost but not sure about needing to do certain amounts of work.lThen there is a test, again with a practical skills section (usually making sure one knows to wash hands and address a patient by telling them who one is and what their role is are  part of the test...as well as knowing how to take a blood pressure reading manually even if they use machines in most places now...)

 

Okay so that's some of the basics. I will add that CNAs and nurses etc are viewed as an extension of the military and can be theoretically called in to help with national concerns (that's in fine print at the end of the program, just before taking the test...and that's part of why I didn't take the exam...so I'll have to see what it says now. Likely it's in even finer print after one takes the exam!) 

 

Hope this is helpful. It can take a few years or decades to get one's mind around all this and then again it's helpful to have a half dozen people at the ready to pitch in with all sorts of things if someone needs help...shopping, cleaning, transportation and of course meal prep and care for the person. 

 

There could be more coaching about how to 'bring all the pieces together' and prevent caregiver stress and burn out'...and that can be helpful whether caring for infants, kids, special needs people, elders and others...even oneself if having various challenges. Getting to a physical and dental appointments, other supportive programs (online as much as possible such as one via HumanitysTeam which I can send a link to that starts at noon today for free) are all good things to keep in mind...

 

While this is a lot of info, the overall hope is it gives an idea of what's needed so people could work in teams to explore things well in advance and appreciate what it takes for one and all to keep their show on the road (or in their home....or online.) I do have a product from a company I'll be trying (which I won) called Essensiac from Ambaya Gold. I may be able to help market their products. I met the folks in Sedona at a conference who have had this company for a couple of decades. They look healthy too!

 

Best to all, Catherine