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The Holidays - A Time to Consider Elderly Loved Ones

Once again the holiday season is upon us, a time of joy but also stress.  We often visit family members we haven’t seen in some time and that’s when changes in older loved ones become more noticeable.  Some of the changes that may indicate your loved one needs some extra help:

1. Weight loss
2. Deterioration in personal hygiene
3. Unusually dirty or messy home
4. Unusually loud or quiet, paranoid or agitated behavior
5. Local friends and relatives noticing changes in behavior
6. Self-imposed isolation, stops attending activities
7. Signs of forgetfulness such as unopened mail, piling newspapers, missed appointments, unfilled prescriptions
8. Signs of poorly managed finances, such as not paying bills, losing money, paying bills twice
9. Unusual purchases

So what should you be doing if you see any of the above? A physical and neurological exam should identify any medical issues.  A Geriatric Care Manager (GCM) can help assess the options available that will allow your loved one to continue to live a full, fruitful and safe life.  Suggestions may include a home health aide, adult day care, and personal organizer to help with money management.

If your loved one can no longer live alone, possible alternative living arrangements include another family member’s home, assisted living, senior housing or nursing home.  Each choice has pros and cons and expense is often an issue.  Planning should be done as early as possible to determine what government benefits can be tapped to help pay the cost, such as Medicare, Medicaid and Veteran’s benefits. 

 Because the family is together once again, the holidays  are a good time to begin discussing these difficult decisions.  For example, if one child lives nearby an aging parent and sees the decline on a daily or weekly basis, and the other child does not, there is often a tendency for that second child to downplay or minimize the decline, often basing his/her opinion on phone calls with the parent.  But seeing the parent and visiting their home can alter that perception. 

Remember, there are resources available to you.  All you need to do is find them or consult with someone knowledgeable, such as an elder care attorney, who can help point you in the right direction.  But, don’t put it off till next year.  By that time you may be dealing with a full blown crisis.

A Pension Crisis Brewing?

Much has been written in recent years about the health of Social Security.   As the population ages two things are happening.  Fewer people are paying into the system, while at the same time more people are receiving benefits, raising concern that the program will run out of money.   But there is another, perhaps, more serious crisis developing within state employee pension programs that hasn’t, until now, received as much attention.  We are seeing it here in New Jersey, as are other states across the country.  And it may hit some folks harder than the Social Security problem because so much more of their retirement income may be derived from a state pension than from Social Security.

As the economy remains in a funk and financial markets still struggle to recover from huge losses over the past couple of years, many pension systems have seen their investments take a big hit.  Since the beginning of 2009, for example, New Jersey ‘s pension fund has lost almost 13% in value,  $10 billion to be exact.  It hasn’t helped that the government has taken money from the pension system to plug budget gaps in other areas in past years.

Now, our new governor, Chris Christie, is assessing the situation.  Will he be the one to make some hard decisions?  Our outgoing governor already has signed legislation raising the retirement age and barring retirement payouts for part time employees paid less than $7500 per year.  You can be sure other changes are coming from the new governor.  There have to be.  There isn’t enough money to pay everyone who will be entering the pension system in the next 30 years.  The state has to close the gap somehow.

Now, ask yourself what you would do if the State cut your pension by 10%, 20% or more.  What would you do to replace that income?  And what would you do if you were then faced with rising long term care costs?  The government is dealing with a fiscal crisis.  It is doing the same things we all do when we are faced with a financial crisis – tighten our belts and cut costs.

The signs are there.  You just have to pay attention – and take the opportunity to protect yourself and our families.  Don’t assume the government will be there to protect you.  It’s busy trying to fix it’s own problems.  You’ve got to take care of your own.  And the time to do it is now.

Another VA Benefit You Never Heard Of

Understanding the maze of laws and benefits that form our long term care system is a full time job.  That’s why I devoted my practice exclusively to elder and disability planning.  A few weeks ago I was reminded of that fact when I was asked what I know about a particular VA program that provides adult day care services for a small co-pay.  This clearly didn’t sound like the Aid and Attendance program that in the past two years we have incorporated into our planning arsenal.(see my 2/25/08 post).  So I decided to investigate and here’s what I learned.

 The VA doesn’t do a good job of publicizing its benefits and services so getting accurate information is never easy.  There is a program of services under what the VA calls the Geriatric and Extended Care Program.  These include programs that provide care in a veteran’s home or in a community setting such as adult day care, specialized services for rehabilitation following, amputation, stroke, traumatic brain injury and spinal cord injury, physical therapy and home hospice care.  Keep in mind that the range of services can vary greatly depending on where you live and which health care network the VA has charged with providing those services.

 Uncovering and understanding the eligibility requirements is the harder part.   Unlike the Aid and Attendance program which is available to veterans and their spouses, the Extended Care Program is only available to veterans who received a discharge under honorable conditions.  It is, however, not limited to veterans who served during wartime (again, unlike Aid and Attendance).  There is no length of service requirement for vets who enlisted before 1980. 

There is a co-pay requirement applicable to the nonservice connected veteran, that is, a veteran who’s injury or illness is not linked to his military service (which is the case with most of our elderly clients).  In order to be eligible the veteran’s income must not exceed  the maximum annual pension rate for the Aid and Attendance program.  The co-pay generally ranges from $5 to $97 per day, depending on the particular service received.

What I concluded from my research so far is that  the Extended Care Program is another option, another piece of the long term care puzzle.  And with proper guidance our clients may be able to tap into a valuable source which will help lessen the risk that they will run out of money and options when they reach the next step in the long term care journey.

How Do You Know if You are Getting Accurate Medicaid Information?

How many times have you contacted a government office to inquire about some benefit or program and told you are not eligible?  Have you then left the office or hung up the phone accepting that what you have been told is true?  What if that is just flat out wrong?  As an elder law attorney I see that happen all the time, especially when it comes to the Medicaid program.  A recent court case last week corrected at least one of those untruths.

A federal court last week finally weighed in on a particular exception to the Medicaid transfer rules that the State of New Jersey has, for some time, misinterpreted.  A transfer of assets from parent to child, if made within 5 years of the date of application for Medicaid benefits, carries a Medicaid penalty, but there are some exceptions to that general rule.  If the transfer is made to a child, or to a trust for the benefit of the disabled child, then that transfer is not subject to a Medicaid penalty.  The State has for as long as I can remember, insisted that this exception applies only if the transfer is to a trust for the sole benefit of the disabled child. 

Now, if you are not familiar with the ins and outs of the Medicaid laws, and were told that your mother is ineligible for this reason, what would you do?  Probably go home and wait till the Medicaid penalty expires, not knowing any better.  My staff has reported back to me on some of our cases the same thing.  I then have to go back to the federal law and state regulations interpreting that law to find the exact sections that support our claim.  Sometimes that is enough to resolve the issue, but other times, such as in the case of Sorber v. Velez, the case decided last week, the State doesn’t budge and we, as elder law attorneys, have to resort to the court system to settle the dispute.  In the Sorber case, the issue came down, in part, to the type of grammar lesson you might remember from elementary school about the proper placement of a comma. The State’s interpretation didn’t seem logical and the court agreed.

One of my staff asked me the other day why the State would take a position that seems so farfetched.  The answer, I think, can be found by looking at the bigger picture of what is playing out in this country.  The government doesn’t have enough money to fund the programs and services it currently has.  Looking at what’s coming, the number of people facing a long term care crisis will continue to increase in the next 20 years as 77 million baby boomers reach senior status.  So, you can expect the State to continue to interpret eligibility standards very strictly.  And sometimes they’ll get it completely wrong.  That’s why the “do it yourself” approach is dangerous.  You could be losing valuable benefits and without the assistance of someone with knowledge of the laws you wouldn’t even know it.   The government wants to push you to the back of the line.   Make sure you protect yourself and fight to maintain your spot at the front .

Mary's Worst Home Care Nightmare

For many families, keeping their elderly loved one at home will require in home assistance.  There are many quality home health care companies in the area so finding one isn’t a problem.  But I find so often that clients don’t go through a licensed agency  because of the cost.  While I have written in the past about the Medicaid problem of hiring aides directly and paying cash (7/20/09 post), there is another very real risk, safety.  The following story is one, unfortunately, I have heard more than once.

Mary found an aide to care for Dad through an agency she had learned of from a friend.  I know many of the quality licensed agencies in the area but had never heard of this one.  Mary paid a fee to the agency, who sent an aide to her dad’s home but her financial dealings with the agency ended there. She paid the aide directly in cash.  I cautioned Mary that she didn’t really know anything about the agency or the person they were sending but she said she interviewed the woman, who seemed pleasant enough.  And Mary was in a bind because Dad had run out of money so she was paying out of her own pocked.  Now the aide she had found herself and whom had stayed with Dad for 3 years was going back to her native country.  Mary needed to find someone quickly and cost was a real issue.

What happened after one month was Mary’s worst nightmare.  On one of her daily visits to Dad’s home she found him bruised and battered, in a semiconscious state.  He had been beaten by the aide, who claimed not to know what happened.  Mary called the police. They immediately arrested the aide and Dad was transported to the hospital.

Upon further investigation, Mary discovered that the agency was neither licensed nor insured.  The owner disappeared, probably to reappear under another agency name.   And unfortunately Dad’s injuries were of a severity that he could no longer stay at home, but needed nursing home care.  Mary felt terrible, but her predicament is hardly uncommon.  When trying to make ends meet safety was compromised.  Bringing a complete stranger into a home to care for a defenseless senior should not be taken lightly.  Background checks must be done.  Training is important.  There is a reason going through a reputable agency is more expensive. 

However, if a long term care plan had been put in place, well before Dad needed care, perhaps Mary would not have been strapped for cash.  Dad would have the money to pay for his own care, maybe government benefits could have been tapped to help out. Mary would then have hired the licensed agency, safety precautions would have been taken, and a tragedy could have been avoided.