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…

A Brave New World - The Affordable Care Act

A BRAVE NEW WORLD: This week, President Obama signed into law the main part of the
contentious health care reform legislation. Although some parliamentary problems still need to
be resolved, the entire bill will likely become law prior to Congress’ scheduled recess at the end
of this month.

The president’s signature will put into effect the Affordable Care Act as amended by the Health
Care Reconciliation Act. The impending new law imposes responsibilities on both citizens and
employers. Here are some of the highlights:

Citizen Responsibilities:

Citizens and legal residents must have “qualifying health coverage”. Penalties will be imposed
on individuals without coverage and phased in over several years. The tax penalty is the greater
of $695 annually up to a maximum of three times that amount ($2,085) per family or 2.5% of
household income. Either way, the new law imposes hefty penalties on individuals who fail to
comply. However, persons with incomes falling below the federal tax filing threshold ($9,350
for singles and $18,700 for couples in 2009) and anyone whose lowest cost plan exceeds 8% of
that person’s income are exempt from penalties.

Employer Responsibilities:

Beginning in 2014, employers with more than 50 employees will be assessed a penalty depending on whether health plans are offered and whether certain employees receive premium tax credits. Penalties will not be assessed on employers with 50 or less employees. Employers with more than 200 employees must enroll employees in plans offered by the employer and opting out will not be option.

Private Insurance:

Within 90 days of the enactment of the new law, a temporary national “high-risk” pool will be
established to provide coverage to individuals with pre-existing medical conditions. Within six
months, all policies must provide dependent coverage for children through age 26.

Other Provisions:

The new law increases payments to physicians and Medicare payments to providers in certain
rural areas. Access to Medicaid and types of services will expand. Medicaid will now additional
preventive and long-term care services. Medicaid eligibility will also now cover low-income
nonelderly, non-pregnant individuals who are not otherwise eligible for Medicare. The new law
also contains additional provisions to attack fraud in the federal healthcare programs.

The Invoice:

The Congressional Budget Office estimates the cost of the mandatory coverage will be $940
billion over ten years. This expense will be financed through a combination of savings from
Medicare and Medicaid, new taxes and fees, which the CBO estimates will raise $32 billion over
those ten years. It also estimates the proposal will reduce the deficit by approximately $143
billion during that period.

Is the new law a step closer to forced socialism or does it reflect a nation’s collective decision to
expand the benefits of its “social compact”? Whatever one’s political stance, health care reform,
for better or worse, is a new pillar in the structure of our government.

Brought to you by Cohen & Oalican, LLP

Durable Power of Attorney and Health Care Proxy - FAQ Part 1

Durable Power of Attorney and Health Care Proxy

1. Does everyone need a power of attorney and health care proxy?

Absolutely.

These documents allow you to designate who will make decisions for you should you become incapacitated. Without them, it may be necessary for your family to become your legal guardian to the probate court which can be time consuming and expensive.

2. Could I be held liable for my actions as attorney-in-fact?

Yes, but only if you act with willful misconduct or gross negligence such as stealing money from your principal. If you do your best and keep your principal’s interest in mind as the basis of all your actions, you will not incur any liability.

3. When does the power of attorney take effect?

Unless the power of attorney is “springing”, it takes effect as soon as it is signed by the principal. A “springing” power of attorney takes effect only when the event described in the instrument itself takes place. Typically, this is the incapacity of the principal as certified by one or more physicians. Section III of your power of attorney indicates whether it is effective immediately or is springing. In most cases, even when the power of attorney is immediately effective, the principal does not intend for it to be used until he or she becomes incapacitated. You should discuss this with the principal so that you know his or her wishes.

4. What if there is more than one attorney-in-fact?

Depending on the wording of the power of attorney, you may or may not have to act together on all transactions. In most cases, when there are multiple attorneys-in-fact they are appointed “severally”, meaning that they can each act independently of one another. Nevertheless, it is important for them to communicate with one another to make certain that their actions are consistent.

5. Can I be fired?

Certainly. The principal may revoke the power of attorney at any time. All he or she needs to do is send you a letter to this effect. The appointment of a conservator or guardian does not immediately revoke the power of attorney. But the conservator or guardian, like the principal, has the power to revoke the power of attorney.

Contact an attorney at Cohen & Oalican, LLP who is skilled and experienced in this area.