Alternatives to Nursing Homes as Nursing Home Populations Swell With Younger Patients - Part 2

 

One of the main reasons cited for this movement of younger people into nursing homes are the budget cuts most states face in Medicare and Medicaid.  In the long term, it is more cost efficient to care for a younger person in their home with part time caretakers.  However, in the short term, this is a more expensive way of treating patients, as the caregivers need to be hired and trained.  In the budget crunch most states are experiencing, short term funding takes priority over long term spending.   Younger people are being moved into nursing homes earlier, as in the short term, this is a more economically viable way of treating them.

According to a study by the AARP Public Policy Institute, the cost of at home care is about a third the cost of providing care in a nursing home or institution.  Many states, however, simply do not have the funding for at home care in their Medicaid programs.

One of the most telling quotes about the movement of younger people to nursing homes is:

“Over the past 20 years, federal laws and policies have established a civil right to get long-term care at home. But NPR's investigation found that is only sporadically enforced.

More than 60 percent of what states spend on long-term care for the elderly and disabled goes to pay for people — like Michelle Fridley — to live in a nursing home. The amount spent on home-based care has grown steadily, but not nearly enough to meet the need. Nationwide, there are some 400,000 people on state waiting lists for home-based care, double the number 10 years ago.”

Frequently attorney’s like our firm, that specialize in caring for the elderly, and those that have long term care needs, must be engaged to support a patient’s right to at home care.  In 1999, the right to at home care was clearly established in the Supreme Court, in the “Olmstead Case”.   In that decision, the Supreme Court stated that the unnecessary institutionalization of people with disabilities is  a form of discrimination.

 

To be continued…

Alternatives to Nursing Homes as Nursing Home Populations Swell With Younger Patients - Part 1

We heard the other day on National Public Radio, that one of the fastest growing populations in Nursing Homes is not the elderly, but rather adults   aged 31 TO 64.

These patients that are victims of disease, accident, health failure, or mental health problems.  Many of these new patients could be cared for at home, or assisted living facilities, but are instead finding themselves in the Nursing Home System.  Young people aged 31 to 64 are the single fastest growing population of nursing homes.  This population has grown roughly 40% since 2000.

This report underscores the fundamental need for legal advocacy when considering nursing home care, or alternatives to nursing home care.

You can see the full report here.

http://www.npr.org/2010/12/09/131912529/a-new-nursing-home-population-the-young

 

All too often, people think of nursing homes as a repository for the elderly, and disability attorneys like Cohen and Oalican as being entirely elder law.  There is a huge sense of accomplishment for us, however, when  we can use our skills and help young people, and their families, to live a fulfilling life, perhaps outside of institutional care, and despite their disadvantages.  We have long been involved in special needs trusts to help protect family’s finances when there is a young (or younger) family member with special needs.

 

To be continued….

Preview of the Proposed New Tax Relief Act of 2010 - Part 2

 

Once again.. this is a preview of what is currently under discussion.  It is NOT law, and should not be looked at as political, legal, or financial advice.  This is only  a brief look at some of the currently debated act, as it impacts our senior clientele.

 

 

Capital Gains and Dividends.
Many of our clients are reliant on their investments.  Here is what is under contemplation regarding Capital Gains and Dividends.

Under discussion it to temporarily extend the current capital gains and dividend rates. Currently  capital gains and dividend rates for individuals below the 25% bracket is equal to zero percent. For those in the 25% bracket and above, the capital gains and dividend rates are 15%. If this portion of the act does not happen, capital gains taxes become 10% and 20% respectively.  Dividends will be subject to the ordinary income rates. This proposal extends the current capital gains and dividends rates for all taxpayers for an additional two years, through 2012.

 

 

Dependent Care Credit
Many of our clients have adult dependent children, or are themselves dependents of their children.  The impact of the dependent care credit is of a direct concern to our elder and disabled clients.   Under discussion is to (temporarily) extend the expanded dependent care credit.  The dependent care credit allows a taxpayer a credit for an applicable percentage of child care expenses for children under 13 and disabled dependents.   The current eligible expenses are $3,000 for one dependent, and $6,000 for two or more dependents.  These are proposed to be extended through 2012.   If the credit falls back to previous rates, it will be only $2,400 for one dependent and $4,800 for two or more dependents.

 

 

Your friends at…

Cohen & Oalican, LLP

Boston ElderLaw Attorneys
Raynham ElderLaw Attorneys
Andover ElderLaw Attorneys

Supplemental Needs Trust - Questions Answered Part 1

SUPPLEMENTAL NEEDS TRUSTS





• What is a supplemental needs trust?

Supplemental needs trusts (also known as "special needs" trusts) are drafted so that the funds will not be considered to belong to the beneficiary in determining his or her eligibility for public benefits, such as Medicaid, Supplemental Security Income (SSI), or public housing. These trusts are designed not to provide basic support, but instead to pay for comforts and luxuries that could not be paid for by public assistance funds, such as education, recreation, counseling, and medical attention beyond what is required simply to maintain an individual.

• Who can create a supplemental needs trust?

Very often supplemental needs trusts are created by a parent or other family member for a disabled child (even though the child may be an adult by the time the trust is created or funded). But the disabled individual can often create the trust himself or herself, depending on the program for which he or she seeks benefits. Medicaid is the most restrictive program in this regard, making it difficult for a beneficiary to create a trust for his or her own benefit. But even Medicaid has a "safe harbor" allowing for the creation of a supplemental needs trust with a beneficiary's own money if the trust meets certain requirements. This is sometimes called a "(d)(4)(A)" trust, referring the authorizing statute.

• Must the supplemental trust be irrevocable?

Yes, if it is created and funded by the person seeking public benefits himself or herself. No, if it is created and funded by someone else for the benefit of person receiving or seeking public benefits.


• Who can serve as trustee?

Choosing a trustee can be a difficult decision. The basic question to consider is whether to choose a professional trustee (such as a bank orhttp://www.cohenoalican.com/) or to use family. Family and friends can serve as trustee, but it is important to consider whether they have the experience and qualifications to serve in this role. The only person who cannot serve as trustee is the beneficiary themselves as this could disqualify them for public benefits.

When choosing a trustee, the factors to be considered include the cost of the available parties, relative investment experience, and flexibility and bureaucracy. Additionally, the trustee’s knowledge of public benefits programs and their regulations, as well as the beneficiary’s special needs and circumstances, should be considered. Often it can make sense to split the necessary trustee roles, with a bank or trust company handling investments and accounting, a family member or social worker taking care of planning for the beneficiary and disbursements, and an elder law attorney advising on public benefits issues. This can be done through multiple trustees, or a single trustee advised by individuals with the necessary knowledge and experience.

Cohen & Oalican provide a full spectrum of services for the elderly, for disabled adults, and for the families.