Long-Term Care & Medicaid Planning

Activities of Daily Living are a series of basic activities performed by individuals on a daily basis necessary for independent living at home or in the community. Activities of Daily Living include:

1. Bathing: Includes grooming activities such as shaving, and brushing teeth and hair
2. Dressing: choosing appropriate garments and being able to dress and undress, having no trouble with buttons, zippers or other fasteners
3. Eating: being able to feed oneself
4. Transferring: being able to walk, or, if not ambulatory, being able to transfer oneself from bed to wheelchair and back
5. Continence: being able to control one’s bowels and bladder, or manage one’s incontinence independently
6. Toileting: being able to use the toilet

ADL's are further classified as requiring "Hands-on Assistance" or "Standby Assistance". Hands-on Assistance is the physical assistance of another person, without which the disabled individual would be unable to perform an ADL. Standby Assistance means the presence of another person within arm's reach of the individual that is necessary to prevent injury while the individual is performing an ADL. It is sometimes referred to as Supervisory Assistance. An example is being ready to catch an individual who may fall getting into or out of a bath or shower.

Long-Term Care Insurance Benefit Qualifications

In order to qualify for benefits under most tax qualified Long-Term Care Insurance Policies, you're required to be certified by a qualified health professional as having a chronic illness that will last for at least 90 days whereby the illness must result in you: being unable to perform at least two out of six activities of daily living ("ADL's"), or have a severe cognitive impairment that requires substantial supervision.

Additionally many long-term care insurance programs and other community/government programs require that a disabled policyholder must need "Substantial Assistance" in performing at least 2 ADL's in order to receive benefits. Substantial Assistance is defined as either Hands-on Assistance or Standby Assistance.

Another term often used is "Instrumental Activities of Daily Living". Instrumental Activities of Daily Living are actions that are important to being able to live independently but are not necessarily required activities on a daily basis. The Instrumental Activities of Daily Living include:

1. Using the telephone and other communication devices: being able to dial numbers, look up numbers, etc.
2. Managing medications: taking the appropriate medications and correct dosages on time
3. Preparing and cleaning up after meals: making appropriate food choices and preparing meals safely
4. Maintaining the home: doing or arranging for housekeeping and laundry
5. Managing money and finances: budgeting, paying mortgage/rent and bills on time, etc.
6. Shopping for groceries or clothes: being able to shop for groceries and other small necessities, and transport purchases from store to home
7. Using transportation: being able to drive or use public transportation for appointments, shopping, etc.
8. Caring for Pets: Walking, Feeding
9. Responding to Emergency Alerts such as Fire Alarms

The Keller Legal Group can help clients and their families assess options, review Long-Term Care Insurance Policies, and if necessary speak to the insurance company to make sure that their loved one is receiving the benefits and services they were promised. We also provide assistance with paperwork and claim forms and review and compare policy benefits. Please call us today for an appointment.

Custodial care refers to non-skilled, personal care, such as help with activities of daily living (“ADL”) like bathing, dressing, eating, getting in or out of a bed or chair, moving around, and using the bathroom. It may also include care that most people can do themselves, like using eye drops.

Medicare doesn't cover custodial care when it's the only kind of care you need.

Who helps with Custodial Care – Home Care Aides versus Home Health Aides

Home Care Aides provide custodial care; they help seniors with their activities of daily living such as bathing, dressing, housekeeping and transportation. This is also referred to as personal care, attendant care, non-medical care and companion care.

Home Health Aides offer skilled care such as checking patients’ pulses, temperature or respiration. They assist with medications, braces, ventilators and other medical equipment and can provide higher level skilled nursing as well as more basic personal care. Home health aides are also referred to as nurse aides, nursing assistants, certified nursing assistants and geriatric aides.

Both home care aides and home health aides bill on an hourly basis (with the exception of live in caregivers who sometime bill flat rates). Home care aides can be retained through a home care agency or by hiring private caregivers. Home health aides experience greater federal regulation and are almost always hired through an agency.

The Keller Legal Group will draft and review home agency contracts and upon request provide advice and resources. Please call our office today for an appointment.

Whether your search for senior housing is prompted by a serious medical condition or the desire for a lifestyle change, finding the right place to live can be challenging and stressful for both you and your family. The key to making the best choice is to match your housing with your lifestyle, health, and financial needs. This may mean modifying your own home to make it safer and more comfortable, or it could mean moving to a housing facility with more support and social options available on site.

It could involve enrolling in a network of like-minded people to share specialized services, or moving to a retirement community, an apartment building where the majority of tenants are over the age of 65, or even a nursing home.

We suggest you consider not only the needs you have now but also those you may have in the future. For example: (1) Physical and medical needs including activities of daily living and/or an increase in medical or physical therapy appointments; (2) Home maintenance like yard work or housework; (3) Social and emotional needs so that you do not become isolated and housebound; and (4) Financial needs should be considered so that you can live within your budget.

Below is a summary describing some of the current options:

1. Aging in Place – staying at home. Staying at home as you age has the advantage of keeping you in a familiar place where you know your neighbors and the community. There is a wide range of home care services that can help you maintain your independence within the comfort of your own home, from in-home care to day care. Aging in place is a less effective senior housing option once your mobility is limited. Being unable to leave your home frequently and socialize with others can lead to isolation, loneliness, and depression. So, even if you select to age in place today, it’s important to have a plan for the future when your needs may change and staying at home may no longer be the best option.

   1a. The Village Solution. This is a relatively new concept. The Village Solution entails joining a privately run network where people pay for and share certain private services and organize the use of certain public services. For example members of a “village” can access transportation to the grocery store, home health care, or help with household chores, as well as a network of social activities with other village members.

   1b. Naturally Occurring Retirement Communities (NORC). A NORC enable seniors to stay in their own homes and access local services, volunteer programs, and social activities, but tend to exist in lower income areas. A NORC may be as small as a single urban high rise, or it may spread out over a larger suburban area. Click here for information about NORCs in NYC.

2. Assisted Living – In general, assisted living is a housing option for those who need help with some activities of daily living, including minor help with medications. Costs tend to vary according to the level of daily help required, although staff is available 24 hours a day.
3. Nursing Home - is normally the highest level of care for older adults outside of a hospital. While they do provide assistance in activities of daily living, they differ from other senior housing in that they also provide a high level of medical care. A licensed physician supervises each resident’s care and a nurse or other medical professional is almost always on the premises. Skilled nursing care and medical professionals such as occupational or physical therapists are also available.
4. Continuing Care Retirement Community- (CCRCs) are facilities that include independent living, assisted living, and nursing home care in one location, so seniors can stay in the same general area as their housing needs change over time. There is normally the cost of buying a unit in the community as well as monthly fees that increase as you require higher levels of care. It also can mean spouses can still be very close to one another even if one requires a higher level of care.
5. Independent Living is any housing arrangement designed exclusively for seniors, generally those aged 55 and over. Housing varies widely, from apartment-style living to freestanding homes. In general, the housing is friendlier to older adults, often being more compact, with easier navigation and no maintenance or yard work to worry about. While residents live independently, most communities offer amenities, activities, and services. Often, recreational centers or clubhouses are available on site to give seniors the opportunity to connect with peers and participate in community activities, such as arts and crafts, holiday gatherings, continuing education classes, or movie nights. Independent living facilities may also offer facilities such as a swimming pool, fitness center, tennis courts, even a golf course or other clubs and interest groups. Other services offered in independent living may include onsite spas, beauty and barber salons, daily meals, and basic housekeeping and laundry services.

Differences between independent living and other senior housing

The key difference between independent living and other housing options is the level of assistance offered for daily living activities. If you require round-the-clock help with eating, dressing, and using the toilet, or require regular medical assistance, assisted living facilities or nursing homes may be a better fit.

The Keller Legal Group can provide more information regarding long-term care alternatives. Call us today for an appointment.

Long-term care is a range of services and supports you may need to meet your personal care needs. Most long-term care is not medical care, but rather assistance with the basic personal tasks of everyday life, sometimes called Activities of Daily Living (ADLs).

Long-term care can be provided at home, in an assisted living facility, or in a nursing home, and is generally paid for in one of four ways: (1) personal income and savings; (2) reverse mortgages and annuities; (3) Long-Term care insurance; and (4) qualify for Medicaid.

The Keller Legal Group can provide for more information regarding long-term care alternatives. Call us today for an appointment.

Long-Term Care Insurance is a special kind of insurance designed to cover personal care. It can cover both home and nursing home care. (Many people are not aware that there is little coverage available from Medicare for long-term care.)

Depending on your policy, Long-Term Care Insurance will pay for Home Care (care in your home), or Facility Care (care in a facility such as assisted living, adult day center, CCCR or a nursing home).

Typically there are four alternatives for financing long-term care: Private payments from personal assets and income, Medicaid, Long-Term Care Insurance; and Long-Term Care Insurance and Medicaid (The New York State Partnership for Long-Term Care).

The Keller Legal Group can provide for more information regarding long-term care alternatives. Call us today for an appointment.

The Medical Assistance Program, commonly known, as “Medicaid” is a health insurance program for the poor, providing benefits to persons of limited financial means. Medicaid is a joint program with New York State and the federal government for New Yorkers who cannot afford to pay for medical care, home care, or nursing home care. There are two main types of Medicaid benefits, generally classified as Community Medicaid and Institutional Medicaid.

Community Medicaid covers things such as doctors’ visits, medications, hospital inpatient and outpatient services, and care through home health agencies. Institutional Medicaid covers nursing home care. In order for a person to qualify for Medicaid, they have to be a resident of New York and meet certain financial guidelines.

Medicaid has different financial requirements based on an individual’s living situation, familial status, and health. All Medicaid recipients have to meet a certain income and resource requirement.

Although Medicaid is generally a program for people of limited assets and income, under New York law, with proper elder law planning, people who have assets and incomes above the level needed to qualify for public assistance can still qualify for Medicaid. Elder law lawyers can help you to navigate this complex qualifying system through proper Medicaid planning.

The Keller Legal Group can provide more information regarding Medicaid and whether or not you or our spouse may be eligible. Call us today for an appointment.

The Medicaid Application form is lengthy and complex, and mistakes can be made when you are not familiar with the process. If your application or claim has been denied, your remedy is to seek to have the decision reversed in a "Fair Hearing". At a Fair Hearing you will be able to tell an Administrative Law Judge (ALJ) who works for the New York State Office of Temporary and Disability Assistance (OTDA) why you think a decision about your case was wrong. A representative from the NYC Human Resources Administration (HRA) will also be there and will have a chance to explain why the HRA made that decision.

The Keller Legal Group can prepare and/or review your Medicaid Application and if requested represent you in a Fair Hearing. Please call our law office today for an appointment.

Medicaid planning is a method of advanced estate planning that can help you become eligible for Medicaid assistance and help save your money, even if your income and assets are too high to otherwise qualify. Because of certain rules allowing Medicaid to look at your assets years before you apply, it is important to do Medicaid planning early—at least 5 years before you may need a long-term care facility.

The Keller Legal Group may still be able to help you qualify for Medicaid even if planning was not done early.

Call our law office today to schedule an appointment.

A Medicaid Trust or Spend Down Trust is a form of trust designed to preserve the grantor’s assets in anticipation of a possible long-term disability. The Medicaid Trust involves transferring your home and other assets into an irrevocable trust which will then be managed by a trustee (or trustees) of your choice. The trustee can be a child, friend, sibling, or anyone you trust, excluding your spouse.

The Keller Legal Group can draft a trust to meet your needs. Please call our office to schedule an appointment.

Medicare is America’s health care program for persons over 65 and for young persons with disabilities who are not covered by an employer health insurance plan. Medicare pays for acute care and skilled care.

Medicare Part A covers hospital stays, home health services and hospice care. Part A is free if you or your spouse has worked and paid taxes to Medicare for at least 40 quarters (10 years). If you do not have enough working quarters, you will have to pay a premium for Part A.

Medicare Part B covers doctors’ services, outpatient care and medical equipment. Part B is not free and has a monthly premium. Whether you need Medicare Part A and Part B depends on whether Medicare will be your primary or secondary insurer. Part A is hospital insurance and Part B is medical insurance. If your current employer insurance is primary, you do not need either Part A or Part B. However, most people choose to take Part A because it is free for them. If your Medicare is primary because, for example, you have retiree insurance or COBRA coverage you need both Part A and Part B.

Medicare Part C (Medicare Advantage) covers private plans that provide Part A and B and (often) D services, as an alternative to traditional Medicare, usually through managed care. They are also called Medicare Health Plans.

Medicare Part D covers prescription drug coverage, offered through private “stand-alone” drug plans or Medicare Advantage Plans. Medigap Insurance is private supplemental insurance that covers many of traditional Medicare’s out of pocket expenses. What’s Not Covered by Part A and Part B: Medicare doesn't cover everything. If you need certain services that Medicare doesn't cover, you'll have to pay for them yourself unless you have other insurance or you're in a Medical Health Plan that covers these services.

Even if Medicare covers a service or item, you generally have to pay your deductible, coinsurance, and copayments.

Some of the things that are not covered include: Long-term care (also called custodial care, most dental care, eye examinations relating to prescribing glasses, denture, cosmetic surgery, acupuncture, hearing aids and exams, routine foot care.

The Keller Legal Group can assist you with your Medicare questions, reimbursements, and claims. Call for an appointment.

A Reverse Mortgage allows a person to tap into the equity in their home to pay for health care and other living expenses. You can borrow up to about half of the fair market value of the property, either in a lump sum or through several small amounts over time. Although interest accrues monthly, the loan is only paid back at the earlier of the person’s death or if the premises are permanently vacated.

Furthermore, the person’s estate would not be financially responsible to cover the deficiency if the bank did not recoup their balance after selling the home. (The home would only be sold if your estate could not repay the balance owed). If you execute a deed with a life estate then the remainder person(s) would need to agree before the Reverse Mortgage could be obtained.

Reverse Mortgages should be considered if you wish to stay in your house for as long as possible and have exhausted your savings. However, if you can qualify for a standard mortgage or home equity line of credit, the cost in terms of interest and fees will probably be less. Eligibility depends on your income. Reverse Mortgages are generally best for people who cannot qualify for traditional mortgages or equity lines of credit.

The Keller Legal Group can assist you with your questions regarding Reverse Mortgages. We will review and explain the legal agreement and advocate for best terms possible. Call for an appointment.