Aging Options Blog : Washington Estate Planning Lawyer & Attorney : Rajiv Nagaich : Aging Options Law Firm : WA Elder Law, Wills & Trusts

We are having a difficult time dealing with our parents whose health is rapidly failing. They refuse to discuss moving and are shutting us out. How should we approach them about these issues?

Why is anyone surprised that when a person refuses to consider moving out of their home. Especially when the move is to a nursing home – a term that my well be synonymous with the notion of end of life. Most children who are concerned about their parents make the mistake of thinking that they can rationally debate the issue and have parents to see the errors of their ways.   Some parents are able to deal with it, though most are not. Put yourself in their shoes. A home represents everything in life – a lifetime of hard work; independence, symbolic and actual; and pride of being in control of their own lives. Further, the process of aging is slow. Changes that outsiders can spot quickly are something that the aging elderly will not feel or notice. It is like watching your own children grow. Each day they grow, but those who see the children from time to time will notice the growth while the parents may not. Similarly, those who are aging may not see the deficits the same way others do and when the deficits are pointed out they may dismiss it as being worries not based in reality. Further, remember, as a child your parents raised you and always have had the advantage of experience over you. So, when they guided you all their lives why do you think they will view you any different than the snotty nosed kid who knew little when you were young any differently today? The better way is to encourage your parents to seek advise on how to protect their assets and learn how to avoid nursing home stay. Keeping mom and Dad safe at home.This is likely their goal. And they are likely to listen to outsiders more than someone from their children with whom they have many contacts in many different contexts, most of them being in the context of a wise parent guiding a child through life. Don’t play the role of a teacher or someone who knows more than mom or dad, be the child the parent loves and cherishes – and encourage the parent to seek assistance to address concerns they can and likely do identify with. Have them speak to their physician or a qualified professional, including an elder law attorney. 

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The emotional trauma brought on by the death of a close family member often is accompanied by bewilderment about the financial and legal steps the survivors must take. The spouse who passed away may have handled all the couple's finances. Or perhaps a child must begin taking care of administering an estate about which he or she knows little. And this task may come on top of commitments to family and work that can't be set aside. Finally, the estate itself may be in a disarray or scattered among many accountants, which is not unusual with a generation that saw banks collapse during the Depression.

Here we set out the steps the surviving family members should take. These responsibilities ultimately fall on whoever was appointed executor or personal representative in the deceased  family member's will. Matters can be a bit more complicated in the absence of a will, because it may not be clear who has the responsibility of carrying out these steps.

First, secure the tangible property. This means anything you can touch, such as silverware, dishes, furniture or artwork. You will need to determine accurate values of each piece of property, which may require appraisals. Later, you will distribute the property as the deceased directed. If property is passed around to family members before you have the opportunity to take an inventory, this will become a difficult, if not impossible, task. Of course, this does not apply to gifts the deceased may have made during life, which will not be part of his or her estate.

Second, take your time. You do not need to take any other steps immediately. While bills do need to be paid, they can wait a month or two without adverse repercussions. It 's more important that you and your family  have time to grieve. Financial matters can wait.

When you are ready, but not a day sooner, meet with an attorney to review the steps necessary to administer the deceased's estate. Bring as much information as possible about finances, taxes and debts. Don't worry about putting the papers in order first; the lawyer will have experience in organizing and understanding confusing financial statements. Just bring all the information and papers you have to the meeting  and go from there .................

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Medicaid is a federal program that provides payment for medical care for persons who are unable to pay for medical care. It covers physicians' services, hospital care, medications, supplies, and other necessary services. It also pays for the expenses of long-term care in a nursing home or an adult care home. The Medicaid program is administered independently in each state, but the basics are the same throughout the United States. Eligibility is based upon the amount of assets a person has, along with the income that the person receives.

It is important to distinguish between Medicare and Medicaid. Medicare is an insurance program providing payment for medical needs for persons 65 and over and for certain disabled persons. All persons 65 and over, regardless of financial resources or income, are eligible for Medicare. Medicare, however, provides only limited coverage in the case of an illness, excluding payment for prescription medications and not covering any of the cost of long-term custodial care in nursing homes or adult care homes. These non-covered items must be paid privately by Medicare beneficiaries, unless coverage is provided under some type of supplemental policy the person has purchased independently. Medicaid, on the other hand, pays for all medical needs for those of any age who have been determined to be eligible. In fact, a person with limited income and resources who has Medicare coverage may also qualify for Medicaid benefits.

Medicaid is most often of importance to middle-income Americans because the cost of long-term care for such illnesses as Alzheimer's Disease or paralysis caused by a stroke is not covered by Medicare. Most people who need such care for extended periods will eventually deplete their assets and be unable to pay the costs of their care. At such a time, Medicaid is available to pay the difference between their actual income and the actual costs of care, including not only room and board, but also physicians' care, medications, hospital care, and all other reasonable necessary medical expenses. Medicaid covers the costs of such care in nursing homes, adult care homes, hospices, and, in appropriate cases, in the patient's own home. If faced with the possibility of such long-term care expenses, there are certain facts one should be aware of:

• In determining eligibility for Medicaid payment for long-term care expenses, a team, comprised of a social worker and financial worker, will review the individual's actual need for care, the person's available resources (including life insurance and retirement plans), and income received from any source.
• In determining the eligibility for one spouse, the resources and income for both spouses is considered, regardless of community property laws or the nature of the ownership of the asset.
• Any assets transferred within 60 months prior to application may be considered available if they were transferred for less than value, whether they were transferred to a person or to a trust.
• Assets of married couples, however, receive special treatment so that the spouse who remains living at home will not be unduly impoverished. Such a non-institutionalized spouse is permitted to keep up to a federally-established maximum of $47,104 to $111,560 and is allowed to keep a substantial portion of the income of the couple in order to provide for support expenses at home.
• In addition, there are certain resources that are not counted for eligibility purposes; these may include the family residence, household contents, a vehicle, an irrevocable prepaid burial fund, and other necessary items.
• It is important to be aware of the specific eligibility provisions and exemptions so that assets will not be wasted before applying for Medicaid.
• There are appeals processes built into the Medicaid system. If a person is unhappy with eligibility determinations, care decisions, or placements made under Medicaid, there is a process for administrative review, an administrative hearing, and even court proceedings to help enforce one's rights.

It is important for you to understand certain aspects of the risks associated with legal and financial planning for institutionalization in a skilled nursing facility. As we have previously discussed, planning for Medicaid eligibility can be very time-consuming and financially risky and at times overwhelming. I will advice you to have a guide, who has walked this walk & who can make your journey through this maze comfortable, pleasant and enjoyable.....
 

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