Spotlight on Elder Law: How to Hire a Home Health Aide and Keep Future Medicaid Eligibility
As long term care needs increase, hiring home health aides often becomes necessary. Paying an aide, however, if not done correctly, can cause Medicaid ineligibility years later, after funds run out.
Qualifying for Medicaid requires spending down assets below $2000. Transferring assets may cause Medicaid ineligibility if you do not receive something of equal value back. Medicaid calls this a "penalty". However, and this is key, you must prove to Medicaid that assets transferred are not subject to a penalty. If you pay the aide cash (or check) but don't keep proper records Medicaid will assess a penalty. The aide may be reluctant to give you anything in writing, either because of immigration or income tax issues.
The penalty is calculated by dividing the transferred amount by the average cost of nursing home care. When one applies for Medicaid there is now a 5 year lookback period, meaning Medicaid will look back 5 years from the date of the application to find transfers. They will add together all the transfers made during that time. The penalty will begin when all other assets have been spent down and the individual enters a nursing home and applies for Medicaid.
Let's say Jane hires a home health aide at $700 per week cash, or $3000 per month. She keeps the aide 3 years until her funds run out and now needs round the clock care. A nursing home becomes the only option. She applies for Medicaid but is told, "Sorry, you're not eligible for 16.2 months. You'll have to private pay until then." Of course, Jane has no more money. She'll have to come up with the funds some other way, perhaps from family members. But at $8500 per month or more that may not be possible.
How did Jane get into this mess? Because Medicaid treated her payments to the aide ($108,000) as transfers subject to a penalty. How can you avoid Jane's problem? By keeping records to prove the payments were not gifts, which probably means paying withholding taxes and workers compensation insurance. Another, perhaps better, solution is to hire a home health agency that will supply the aide. Your contract with the agency will satisfy Medicaid that no gift is involved.
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Tune in to Yale Hauptman's monthly audio podcast on elder law issues at www.elderlawtodaypodcast.com.If you're not yet on our mailing list go to http://hauptmanlaw.com/requestinfo.asp to sign up.
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Spotlight on Elder Law is distributed for informational purposes only and does not constitute legal advice. For more information or to receive future mailings contact Yale S. Hauptman at Hauptman & Hauptman, P.C.
Tuesday, December 22, 2009
Wednesday, December 16, 2009
Time is Not on Your Caregiving Side
Time is not on your caregiving side
by Joy Loverde
If you don’t make good use of your time when you are gathered together as family during this holiday season, you will never ever get that kind of quality time to make plans for the future with your aging parents. In the eldercare world, change happens quickly. If you choose to say and do nothing this time of year, you lose. There is a reason why my book, The Complete Eldercare Planner is over 350 pages long. THERE’S A LOT OF STUFF TO PLAN FOR AND TALK ABOUT right now.
The possibility that your parents may need the family’s help down the road is real. And while it may be difficult to think about the day you hope will never come, doing nothing to plan for family caregiving responsibilities will leave the entire family in even worse shape — emotionally, financially and otherwise.
As a rule, family holiday gatherings are not the ideal time to discuss parent-care issues or to resolve them. Besides, who wants to spoil the festive atmosphere by talking about a potential hotbed of depressing emotional issues such as eldercare? Instead of trying to talk to your parents about their future well being during family holiday visits, try these three tips instead:
1. Before the holiday family visit – pick up the phone and call your siblings. Tell them of any present and future concerns you may have about your parents. Let them know how you feel about the importance of planning ahead should anything happen to Mom or Dad. Make a specific request that when everybody is together in person that they join you in looking and listening for clues that your parents may need help sooner rather than later.
2. During holiday family visits – the most efficient use of physically being together is watching for tell-tale signs that problems may exist. Are your parents walking slower or having difficulty climbing stairs? Are you sensing they are becoming more forgetful? Do you suspect they are having trouble making ends meet financially?
3. After the holidays – Arrange a family meeting – over the phone or in-person, and discuss your observations with your siblings; then make a date to talk with your parents about your concerns.
by Joy Loverde
If you don’t make good use of your time when you are gathered together as family during this holiday season, you will never ever get that kind of quality time to make plans for the future with your aging parents. In the eldercare world, change happens quickly. If you choose to say and do nothing this time of year, you lose. There is a reason why my book, The Complete Eldercare Planner is over 350 pages long. THERE’S A LOT OF STUFF TO PLAN FOR AND TALK ABOUT right now.
The possibility that your parents may need the family’s help down the road is real. And while it may be difficult to think about the day you hope will never come, doing nothing to plan for family caregiving responsibilities will leave the entire family in even worse shape — emotionally, financially and otherwise.
As a rule, family holiday gatherings are not the ideal time to discuss parent-care issues or to resolve them. Besides, who wants to spoil the festive atmosphere by talking about a potential hotbed of depressing emotional issues such as eldercare? Instead of trying to talk to your parents about their future well being during family holiday visits, try these three tips instead:
1. Before the holiday family visit – pick up the phone and call your siblings. Tell them of any present and future concerns you may have about your parents. Let them know how you feel about the importance of planning ahead should anything happen to Mom or Dad. Make a specific request that when everybody is together in person that they join you in looking and listening for clues that your parents may need help sooner rather than later.
2. During holiday family visits – the most efficient use of physically being together is watching for tell-tale signs that problems may exist. Are your parents walking slower or having difficulty climbing stairs? Are you sensing they are becoming more forgetful? Do you suspect they are having trouble making ends meet financially?
3. After the holidays – Arrange a family meeting – over the phone or in-person, and discuss your observations with your siblings; then make a date to talk with your parents about your concerns.
Thursday, December 10, 2009
Elderly and Depression: How to Understand Depression in the Elderly
11/30/2009 - Articles
Elderly and depression: How to understand Depression in the elderly 1/4
By: Heinz Redwood
Depression in the elderly is very common. It can be triggered by social isolation and the emotional reaction to the loss of loved family members or friends. Depression in the elderly can make them withdraw from all social contact. ‘Depression is perhaps the most frequent cause of emotional suffering in later life’ said Dan G Blazer, Professor of Psychiatry at DukeUniversity. Being socially isolated, particularly after the death of a partner, and co-existing illness may contribute towards depression in elderly. Depression often goes undiagnosed or untreated so it becomes an increasing public health issue in our ageing society. The challenge, then, is more one of managing depression effectively in later life rather than understanding the condition.
How widespread is depression among older people? Recent surveys suggest a prevalence between 1.8% in the over 55s to 15% in those over 85. While depression is actually less prevalent among the old, compared to the young, major depression may be more common. There is also a clear link between chronic disease and depression, with those in nursing homes showing higher rates than those living in the community. But is the link a causal one? We know that illness can cause depression (and vice versa), but we cannot be sure residents of nursing homes are depressed because they are ill or because their care is not sufficiently ‘caring’.
And when it comes to the gender gap, it’s well known that women are more prone to depression in Europe and North America. But a new study from China, covering 2,633 adults, showed that the gender difference is insignificant, save in the 35-49 age group where lifetime prevalence for major depression for men was 3.6% compared to 2.3% for women.
There is also a cultural dimension to elderly depression. A meta-analysis of nine European centres revealed a prevalence of 8.8% in Iceland in the 88-89 age group compared to 23.6% in Munich in the over 85s. And, among the ‘oldest old’ 2% declared ‘life not worth living’ and 3% ‘wish to be dead’ in Iceland, compared to 16% and 25% in Berlin and 30% and 29% in Munich. The researchers wondered if some lingering distress from the Second World War could account for high rates of depression among very elderly Germans.
Causes of depression in the elderly:
Pain, functional limitations, visual impairment, stroke, loneliness, lack of social support, negative life events, and perceived inadequacy of care have all been linked to depression in the elderly. Living alone or being socially isolated is also a risk factor for depression. It is certainly possible that, if personal privacy were very important to the resident, a perceived lack of privacy could contribute to feelings of depression. Browse through HealthandAge's Information for Caregivers for tips on choosing nursing homes/care facilities and recognizing depression in the elderly.
Finally, a number of risk factors for elderly depression have been identified, including medical burden, bereavement, chronic insomnia, cerebrovascular disease, Alzheimer’s disease and Parkinson’s disease.
If you are concerned about Depression in the elderly, you might want to read the following articles:
Menopause and Depression: Myth versus RealityAlcohol and Depression: Is There a Relationship?Depression and Sexual ActivityWhen the Problem is 'Depression'
Source:
adapted from ‘Elderly depression. 1. Its prevalence, causes and implications for society’ Heinz Redwood, August 2009.
Elderly and depression: How to understand Depression in the elderly 1/4
By: Heinz Redwood
Depression in the elderly is very common. It can be triggered by social isolation and the emotional reaction to the loss of loved family members or friends. Depression in the elderly can make them withdraw from all social contact. ‘Depression is perhaps the most frequent cause of emotional suffering in later life’ said Dan G Blazer, Professor of Psychiatry at DukeUniversity. Being socially isolated, particularly after the death of a partner, and co-existing illness may contribute towards depression in elderly. Depression often goes undiagnosed or untreated so it becomes an increasing public health issue in our ageing society. The challenge, then, is more one of managing depression effectively in later life rather than understanding the condition.
How widespread is depression among older people? Recent surveys suggest a prevalence between 1.8% in the over 55s to 15% in those over 85. While depression is actually less prevalent among the old, compared to the young, major depression may be more common. There is also a clear link between chronic disease and depression, with those in nursing homes showing higher rates than those living in the community. But is the link a causal one? We know that illness can cause depression (and vice versa), but we cannot be sure residents of nursing homes are depressed because they are ill or because their care is not sufficiently ‘caring’.
And when it comes to the gender gap, it’s well known that women are more prone to depression in Europe and North America. But a new study from China, covering 2,633 adults, showed that the gender difference is insignificant, save in the 35-49 age group where lifetime prevalence for major depression for men was 3.6% compared to 2.3% for women.
There is also a cultural dimension to elderly depression. A meta-analysis of nine European centres revealed a prevalence of 8.8% in Iceland in the 88-89 age group compared to 23.6% in Munich in the over 85s. And, among the ‘oldest old’ 2% declared ‘life not worth living’ and 3% ‘wish to be dead’ in Iceland, compared to 16% and 25% in Berlin and 30% and 29% in Munich. The researchers wondered if some lingering distress from the Second World War could account for high rates of depression among very elderly Germans.
Causes of depression in the elderly:
Pain, functional limitations, visual impairment, stroke, loneliness, lack of social support, negative life events, and perceived inadequacy of care have all been linked to depression in the elderly. Living alone or being socially isolated is also a risk factor for depression. It is certainly possible that, if personal privacy were very important to the resident, a perceived lack of privacy could contribute to feelings of depression. Browse through HealthandAge's Information for Caregivers for tips on choosing nursing homes/care facilities and recognizing depression in the elderly.
Finally, a number of risk factors for elderly depression have been identified, including medical burden, bereavement, chronic insomnia, cerebrovascular disease, Alzheimer’s disease and Parkinson’s disease.
If you are concerned about Depression in the elderly, you might want to read the following articles:
Menopause and Depression: Myth versus RealityAlcohol and Depression: Is There a Relationship?Depression and Sexual ActivityWhen the Problem is 'Depression'
Source:
adapted from ‘Elderly depression. 1. Its prevalence, causes and implications for society’ Heinz Redwood, August 2009.
Monday, December 7, 2009
Holidays with Alzheimer's Disease
Posted on Dec. 6th, 2009
By Jo Nelson
Holiday time is coming up, and for caregivers of loved ones with Alzheimer’s disease, it can be a very challenging time of the year. Here are some suggestions to help you and your loved one to have a safe and happy season together in spite of the obstacles.
In the midst of putting up decorations, rearranging furniture and putting up Christmas trees, the person with Alzheimer’s will do better in an environment that is as consistent as possible. Try not to move the furniture more than absolutely necessary, and watch for danger spots, like electrical cords or throw rugs that could cause a fall. Don’t have candles burning in places that could easily be brushed up against with clothing. Avoid using blinking lights or decorations that look edible. Use your loved one’s best-loved decorations to spark memories and increase their ability to enjoy the festivities. Play familiar Christmas songs, and fix traditional foods that they will enjoy.
Have young children play in a separate room to keep noise levels down and avoid causing your loved one to feel panicked or agitated. Alzheimer’s patients pick up on the moods of others around them, and the atmosphere needs to feel serene and peaceful for them to enjoy visitors. Have just a few guests at one time, and avoid large crowds of people. Name tags are very helpful and will keep your loved one from feeling frustrated and embarrassed when they can’t remember people they should know. Have a quiet room that the Alzheimer patient is accustomed to in case they feel overwhelmed by too much noisy activity. If you notice signs of increased confusion or agitation, assist them to their quiet place to rest for a while.
Christmas stories from years gone by will help draw your loved one in and keep them involved in the celebration. It’s much easier for people with Alzheimer’s Disease to remember things that happened long ago than something that happened yesterday, so reminisce!
Try simple tasks to occupy the time, like frosting cookies, stamping envelopes for cards, or making simple ornaments. Look at catalogs together and help your special one to order gifts for people they care about. Take time to look at photo albums and talk about happy holiday times together. This could be just what they need to reconnect and appreciate the holidays, creating more memories that you will hold dear for years to come.
Jo Nelson, RN is the owner of Servant’s Heart Homemaker Services, a personal care assistance company located in North Central Indiana.
Article Source: http://EzineArticles.com/?expert=Jo_Nelson
By Jo Nelson
Holiday time is coming up, and for caregivers of loved ones with Alzheimer’s disease, it can be a very challenging time of the year. Here are some suggestions to help you and your loved one to have a safe and happy season together in spite of the obstacles.
In the midst of putting up decorations, rearranging furniture and putting up Christmas trees, the person with Alzheimer’s will do better in an environment that is as consistent as possible. Try not to move the furniture more than absolutely necessary, and watch for danger spots, like electrical cords or throw rugs that could cause a fall. Don’t have candles burning in places that could easily be brushed up against with clothing. Avoid using blinking lights or decorations that look edible. Use your loved one’s best-loved decorations to spark memories and increase their ability to enjoy the festivities. Play familiar Christmas songs, and fix traditional foods that they will enjoy.
Have young children play in a separate room to keep noise levels down and avoid causing your loved one to feel panicked or agitated. Alzheimer’s patients pick up on the moods of others around them, and the atmosphere needs to feel serene and peaceful for them to enjoy visitors. Have just a few guests at one time, and avoid large crowds of people. Name tags are very helpful and will keep your loved one from feeling frustrated and embarrassed when they can’t remember people they should know. Have a quiet room that the Alzheimer patient is accustomed to in case they feel overwhelmed by too much noisy activity. If you notice signs of increased confusion or agitation, assist them to their quiet place to rest for a while.
Christmas stories from years gone by will help draw your loved one in and keep them involved in the celebration. It’s much easier for people with Alzheimer’s Disease to remember things that happened long ago than something that happened yesterday, so reminisce!
Try simple tasks to occupy the time, like frosting cookies, stamping envelopes for cards, or making simple ornaments. Look at catalogs together and help your special one to order gifts for people they care about. Take time to look at photo albums and talk about happy holiday times together. This could be just what they need to reconnect and appreciate the holidays, creating more memories that you will hold dear for years to come.
Jo Nelson, RN is the owner of Servant’s Heart Homemaker Services, a personal care assistance company located in North Central Indiana.
Article Source: http://EzineArticles.com/?expert=Jo_Nelson
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