Alternatives to Nursing Homes as Nursing Home Populations Swell With Younger Patients – Conclusion

Our current health care reform has several provisions to incentivize states to expand at home care, but there is still a strong “institutional bias” that requires states to fund nursing homes, but makes the payment of nurses for at home care optional.   Despite the savings, participation in  a new Federal pilot program that promotes at home health care is optional for states.

Another trend that has been found is that the population in nursing homes is changing to those who are either sicker, or more economically disadvantaged.   Those with the ability to pay, are moving to assisted living facilities.  Those who do not have as great a medical need (i.e. Healthier, but still in need of assistance) are also better served in more independent living facilities.  This new movement creates a nursing home population that is more disadvantaged both from a medical and a financial perspective.

NPR reports that “By federal law, people who face going into a nursing home must be told about alternatives. But in Miller's study in one state, nearly 30 percent of younger people in nursing homes said they weren't told about options. Often doctors and other health care providers just don't know what's available — and recommend a nursing home instead.”

Many times, when younger people chose to not to into a nursing home, it is at the expense of family members.  These family members provide care at no cost to the state.  While the state gets a free pass, the care giver family members can bear a huge burden in terms of  health, time and stress.

There are alternatives for many younger people to nursing home care.  With an experienced legal advocate by your side, you can also consider independent living facilities.  Many severely disabled people still live full and rich lives, not even in a facility, but with at home care.  It will frequently take an experienced attorney to protect your rights, and to help you determine what care is most appropriate for your situation.

 

We welcome hearing from you if you or a family member has special needs, and is looking for alternatives to nursing homes, or looking for ways to protect your family financially from the costs of long term care.

Call one of elder law attorneys at Cohen & Oalican, LLP Boston, Andover and Raynham.

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…

Home Care as An Alternative to Nursing Home Care

Home Care as An Alternative to Nursing Home Care Part 1

By Denise Leydon Harvey

If you or an elder or disabled person you know are living at home but need more care than you or your loved ones can provide, you should consider the services of a (PCA). A PCA is someone who can assist you with daily living needs in your own home, or in your assisted living facility. PCA services are specifically intended to allow elders or disabled people to remain at home when the alterative is a nursing home or other in-patient facility. PCA services are available to anyone covered by MassHealth who meets certain eligibility requirements.

The types of services offered by the MassHealth PCA Program include assistance with personal care needs, such as bathing, grooming, eating, getting dressed, and helping with medicines as well as housekeeping needs that include laundry, meal preparation and the like. To benefit from PCA services because of a disability, you should do the following:

1. If you are applying for MassHealth, include the Senior Medical Benefit Request form with your application
2. If you are already a MassHealth member, submit the MassHealth Eligibility Review Form.

If MassHealth determines that you are eligible for PCA services, you will be advised to contact a MassHealth PCA agency in your area to set up services. The Council has established a directory for consumers to use in searching for qualified PCAs. The directory can identify PCA candidates from its database based on several different criteria, including proximity to the consumer, language, skills, transportation, preferred hours and so forth. MassHealth does not screen PCAs, so the directory does not represent a screened or qualified list of potential providers. However, the consumer may call references and request a CORI background check for any potential PCA before hiring. The directory is accessible and free to anyone who is eligible for PCA services by registering online using your MassHealth number.

This series brought to you by Boston Attorneys Cohen & Oalican,LLP, specializing in Guardianship and Conservatorship.

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




Part 2 to follow

Superior Court Upholds MassHealth Applicant's Sale of Property to Daughter: A Summary of Clark v. Dehner

Overview

The implementation of the Deficit Reduction Act (DRA) has made it increasingly complicated for families to protect their assets from the high costs of long-term nursing home care. Many planning options were curtailed by the DRA, and state Medicaid agencies are implementing the revised rules at a disadvantage to families seeking government benefits. However, a 2009 Massachusetts Superior Court decision has validated a planning option involving the fair market value sale of assets to family members.



Background

In May of 2005, George and Susan Clark established the George E. & Susan Clark
Irrevocable Trust. They were named as grantors and trustees of the trust. George and Susan transferred title to their home located in Marshfield into the trust on the date the trust was executed. The home's value at that time was approximately $412,000. The trustees of the trust were to hold the property for the benefit of George and Susan's children, Michelle Dionne and Kerri Poole. This transfer disqualified George from MassHealth benefits for a period of fifty-two months beginning on the date of the transfer.



In August of 2006, George entered the Walden Nursing Home, a long-term care facility. He suffers from a degenerative condition called Pick's Disease. As George's date of admission was during the aforementioned fifty-two month ineligibility period, an alternative planning strategy was implemented. This strategy involved curing the original transfer through the sale of a partial interest in the home using a promissory note and mortgage executed between Susan and Michelle.



Promissory Note

The MassHealth regulations allow applicants for long-term care to sell assets through the use of a promissory note and mortgage if the following conditions are met: 1) the repayment of the note is actuarially sound, 2) the promissory note provides for equal payments during the life of the loan, 3) the promissory note prohibits cancellation of the balance on the death of the lender. See 130 C.M.R. 520.007(G)(3). The regulations do not specifically prohibit such transactions from occurring between family members, as long as the sales are for fair market value and meet the above requirements. However, in recent years, MassHealth has taken the position that such transactions between family members are not reasonably enforceable, and therefore should be treated as disqualifying transfers.


George submitted an application for Medicaid benefits on October 31, 2007. Although the promissory note executed between Susan and Michelle satisfied all of MassHealth's regulatory conditions, as described above, George's application for benefits was denied. The hearing officer determined that Michelle's purchase of the property interest was a disqualifying transfer of assets, due in large part to the fact that it occurred between family members.

Tomorrow we will share the supreme court decision.

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