This program is being rolled out new in Kalamazoo.  You can read the article here: Kalamazoo Pace Program

To qualify, an Michigan senior must be at least 55, live in Kalamazoo county and be certified as eligible for nursing-home care and deemed safe to live at home with the help of PACE’s services.  PACE does an assessment before enrolling any Michigan patients.  A senior can have just over $2,00 a month in income to qualify.  If a senior’s income ends up being too high to qualify for dual eligibility, they could choose to pay for the Medicaid portion of the program.

Because this is a group for individuals in the early stages, an in person pre-assessment is required for participation in order to make sure they meet the required guidelines. Deadline for registration for this group is January 18th!

If you know of anyone who may like to schedule a pre-assessment, have them call Alzheimer’s Association Helpline at (800) 272-3900. If they are unable to make this one but would like to be contacted regarding future social club dates, they may also call that number to be placed on the contact list.

For more information visit www.alz.org.gmc

For more information on Alzheimer’s Legal Planning.

Seniors who live longer generally have some sort of disability or need help at some level of living. Sandy Markwood, CEO of the National Association of Area Agencies on Aging, indicates that the focus needs to be on being able to help these seniors live at home as long as possible as nursing home cost could rise to average $72,000 a year.

Long Term Care at any level, in the home, assisted living or nursing home can add a tremendous cost to seniors and their families.

Government Programs Only Pay For About 16% Of Long Term Care

Government programs such as Medicare, Medicaid and the Veterans Administration will cover the cost of long-term care under certain conditions. Medicare will cover rehabilitation from a hospital stay or limited care at home if there is a skilled (medical) need. The Veterans Administration will cover the cost of nursing home care indefinitely if the veteran is at least 70% service-connected disabled. The VA will also cover other forms of home-based or community-based care if there is a medical need.

Medicaid will cover both medical and non-medical related long-term care but in order to qualify for Medicaid a person has to have less than $2,000 in assets and income that is insufficient to pay the cost of care.

Funding Long Term Care with your Life Insurance Policy

Drawing cash from life insurance or changing a life insurance policy should only be done after reviewing with an expert advisor.  Loss of the policy and death benefit could prove to be a detriment.  If, however you have accumulated cash in a life insurance policy and no longer need the coverage you may consider using the cash for long term care or purchasing a LTC rider to your current policy.

New insurance products are being developed to cover both life insurance and long term care insurance. ElderLawAnswers reports:

“A new law makes the purchase of products that combine annuities or insurancepolicies with long-term care insurance more attractive. These “hybrid” products are gaining in popularity due to a law that went into effect January 1, 2010, making distributions from life insurance and annuities tax-free when used to pay for long-term care. The same law also allows owners of annuities or life insurance policies to exchange their old policies for long-term care insurance or hybrid policies without being taxed.”

Combination sales which include life insurance, annuities and traditional long-term care coverage are becoming popular with insurance companies and may prove a method of financing long term care.  Investigate closely, however to find what exactly will be covered.  Some policies do not cover home care costs or complete costs of nursing homes.

Long Term Care Insurance Funding for All Long Term Care Needs

The first long-term care policies were offered about 40 years ago. These were primarily nursing home-only policies designed to take over when Medicare rehabilitation ran out. They were not the comprehensive benefit policies we see today.

Long Term Care Insurance policies today are greatly diversified in their coverage.  Home care, nursing home costs, adult day care, physical therapy, skilled and non-skilled nursing care are some of the services covered.  Policies vary in price and what they cover.  There is also a very restricted qualification of physical and mental heath to get a policy.  Purchasing a policy at a younger age makes it easier to qualify and also provides cheaper premiums. It is best to consult with a long term care insurance professional about the type of policy that fits your needs and budget.

Veterans Aid and Attendance Pension Benefit

Though not an insurance policy, the VA Pension Benefit should be mentioned as a way to pay for long term care needs.  A veteran or spouse of a veteran who served during a period of war can receive money, up to $2,019 a month, to pay for long term care medical expenses, home health care, and assisted living cost.  A qualified Veteran Consultant can help you determine if you qualify for this benefit.

Pre-Need Burial Insurance

One might ask what Pre-need burial insurance has to do with long term care. The purpose of preneed life insurance is to set aside funds for your funeral, before the need arises.
It is an insurance policy that covers the cost of the predetermined expenses of a funeral, cremation or burial.  It gives the purchaser the opportunity to preplan the services and peace of mind in having it paid for.  This is usually an insurance policy that pays at time of death for these expenses. There are many insurance companies that offer these packages as well as funeral homes.

The saddest cases of long term care needs we hear are:

“Mother can no longer live alone and she has no money to go live in a care facility.”

“ Is there someone that can come help me take care of my wife?  We live on our Social Security and I can not pay what home care costs.”

“Father died last night and we have no money to bury him, what do we do?”

It is important to make the necessary arrangements to cover long term care and end of life costs.  There is no government program that will cover all those needs. The National Care Planning Council at www.longtermcarelink.net strives to educate people about long term care services and encourages the planning that needs to be done to prepare for future costs and needs.

Arm’s Length Transaction.  Definition of arm’s length transaction was added to help workers determine whether fair market value was received for a resource.  The reason for the proposed change was recent court decisions.

Fair Market Value.  Clarified the definition of Fair Market Value when determining the amount of divestment.  This broader definition is based on recent court decisions.

Homestead. Update definition of Homestead to eliminate more than one domicile on the property from the homestead exclusion.  DHS is making this changed because of the abuse of homestead exemption becoming widespread.

Resource. The definition of Resource was added to the glossary to ease of use for workers.

Many of our elder law and Veterans Benefits cases involve assisting loved ones who have Alzheimer’s disease.  Alzheimer’s is a brain disease that causes a loss in memory, thinking and reasoning skills.  Many people may experiance some of these signs throughout their lives.  Some are due to age and may not be dementia or Alzheimer’s disease.  If you notice the signs of Azlheimer’s or worried your loved one may be suffering from some of the warning signs, don’t hesitate to set up an appointment with your family phsician.  An early diagnosis gives an Alzheimer’s patient a chance for treatment and gives the family a chance to plan for the future.

If your loved one is suffering from Alzheimer’s, please search around our site, visit our Alzheimer’s Resource Page or our Alzheimer’s Legal Planning Page.

Here is a short video on Alzheimer’s disease.

The Michigan governement has been busy working on a new way to fund Medicaid.  Medicaid is a governmental health insurance that is used by almost 20% of Michigan’s resideents.  That is about 2 million people including children, adults, and seniors.  The new Medicaid tax started on January 1st, 2012.

In September, Michigan law makers passed the Health Insurance Claims Act, known as “HICCA”.  Michigan is making a 1%tax  to be colelcted for all insurance claims for those who live in Michigan that are due to medical services.  The insurance company must pay this tax for every claim that is made.  This tax applies to all private, 3rd party self insured administrators and stop-loss insurance companies.

There are some entites that are excluded, including the Department of Veterans Affairs, Medicare, and Federal employees.

This tax is not going to charged on your deductibles or co-pay, but instead charged on your premium.  For example, you will see this as a line item on your premium invoice.

The major changes that may occur are with regard to how the VA treats the homestead and how the VA treats asset transfers.

Currently, the consensus is that the VA treats the homestead as an exempt asset for qualification.  What this means is that a Veterans is able to be under the asset limits of the non-service connected benefit, yet still keep the family home.  If the VA changes how the home is treated, it could have drastic consequences on families looking to protect the family home from long-term care costs.  You may run in to the same type of issues you face with Medicaid estate recovery.

The second huge proposed change would be to asset transfers.  Currently the VA allows for immediate transfers with no look back to the transfer.  What this means for current clients is that if they are over assets, they can fund a Veterans Asset Protection Trust and seek VA qualification within the short term, while protecting their assets from long-term care costs of nursing home stays.  The proposed change could create a “look back period” similar to what we have in Michigan.

The moral of the story is that the laws keep changing.  It’s important to work with a Michigan elder law attorney to guide your family through the long-term care legal maze.

The client had a husband, who was a veteran, living in an assisted living facility with pretty severe Alzheimer’s, which is the type of client I am helping more and more with their Alzheimer’s legal planning.  The typical planning would be to qualify for the VA benefit in the short term to bring in an additional $2,000 per month tax free to help pay the cost of long-term care, while also starting the proverbial “five-year clock” ticking if a nursing home stay would be needed down the line.  This would be accomplished with a Veterans Asset Protection Trust.  However, in this case, due to the high income from pensions for the clients, they would not currently qualify for the VA benefit, so the only benefit from the VAPT would be to start the five year clock ticking.

Well, for some reason this Macomb County Elder Law attorney prepared what we call a “SBO Trust” or “Spousal Annuity Trust”.  What this trust typically accomplishes is protect the assets of a community spouse if the other spouse is already in a nursing home.  I was shocked.  Shocked that the Macomb County Elder Law attorney a) charged thousands of dollars for planning that at the end of the day wouldn’t secure the VA benefit because the family didn’t’ qualify, but even more shocked that b) the type of trust prepared had absolutely no beneficial purpose to the family and did not meet either goal of VA qualification or Medicaid qualificaiton.  As a colleague of mine put it when I ran it by him, “it’s like comparing apples to oranges and then trying to make meatloaf.”

I felt bad for the client, she was taken advantage of by the prominent Macomb County Elder Law attorney.  I offered to help the client at severely discounted rates because I thought the previous attorney did a disservice to the profession and to other Michigan elder law attorneys.

As Michigan elder law attorneys, one of the ways I help families is finding sources to pay for the exceedingly high costs of long-term care.  In Michigan, I regularly meet with seniors, veterans and family who are paying between $5,000 to $12,000 per month in long-term care costs and one of their concerns is whether they will be able to continue to pay for the care their loved one needs.  Generally families have a few options for paying for long-term care.

Private Pay.  Some families who are well to do enough can continue to pay the $5,000 -$12,000 per month in long-term care costs right out of their checkbook. However, most of the families I meet with understand that if paying that per month will bankrupt mom or dad.  Then what?  Who’s going to take care of them when there is no money left?

Medicare or Medicare Supplemental Insurance.  Medicare and Medicare insurance plays an important role in our health care system, however, their assistance in paying for long-term care is minimal.  Generally, Medicare covers 100% of the first 20 days of a stay in a nursing home for short term rehabilitation.  Potentially the next 80 days may be covered as well as long as the patient continues to rehabilitate.  However, what happens after that?

Long-term Care Insurance.  Long-term care insurance is a form of private paying for long-term care.  Long-term care insurance is sold by a number of insurance companies and must be purchased prior to the need of long-term care.  Obtaining coverage can be difficult if there are any pre-existing conditions.  Additionally, many seniors are experience huge price increases in their policies and are unable to maintain the cost of the policies on their fixed incomes.  Now there are hybrid policies coming out that are a combination of life insurance and long-term care insurance, however you’ll need a lump sum, generally, to fund these hybrid policies.

VA Benefits- Aid & Attendance.  For veterans in Michigan, there is a great program available that will pay up to $2,200 per month in long-term care costs to veterans, married veterans, and surviving spouses who may qualify.  We have a free report available if you would like to learn more about the program that is available to any veteran (or surviving spouse) who ser

Medicad.  When a senior or veteran is needing 24/7 skilled nursing care, there is another governmental program that can help pay the cost of care and that is the Michigan Medicaid program.  Medicaid can pay nearly the entire $7,000 to $10,000 nursing home bill, if the you qualify.  Qualification is difficult and there are asset requirements for qualification, as well as a look back period.  Speaking with a qualified elder law attorney is important to avoid making any missteps in qualification.

One such way to help lower the cost of long-term care is through Veteran’s Benefits planning.

As a Michigan Elder Law and VA Accredited Attorney I focus in a niche of VA benefits called the non-service connected pension, or Aid & Attendance.   This program is for Veterans who need assistance with daily living activities, such as getting dressed eating and bathing.  What is nice about Aid & Attendance VA benefit is it can be used to pay for either a family caregiver or a caregiver outside of the family.  Aid & Attendance can also be used for the surviving spouse of a veteran as well.  The only downfall is not everyone can or will qualify for Aid & Attendance Veterans Benefits.  For this benefit the monthly payment can reach up to $1,949 in 2011 going up by 3.6% in 2012.

I am sure you are wondering how you can qualify for this…

Here are the qualifications that may help you through this process.  To start off you must have served at least 90 days active duty, 1 day during a period of war and cannot be dishonorably discharged.  You also have to be at least 65 years old or totally disabled.  Periods of war would include WWII Dec. 7^th, 1941- July 25^th, 1947, Korean War June 27^th, 1950- January 31^st, 1955, and Vietnam August 5^th,1964- May 7^th, 1975.

The next step in qualifying for VA Benefits are figuring out if you have Unreimbursed Medical Expense that meet or exceed your income.  Unreimbursed Medical expenses could be family care givers with a care contract, home care companies, assisted living facilities or skilled nursing facilities. These Unreimbursed Medical Expenses must meet or exceed income to maximize the available benefit.  Income is typically viewed as Social Security or pensions.

One of the final qualifications would be an analysis of available assets and resources.    This is to check and see if the veterans have a 401k’s IRA’s, checking or savings accounts.  If you are a multi millionaire these benefits aren’t really for you.   But, if you’re an everyday Joe who save a bit, you may qualify for the VA Benefit.

We are here to help through this tough process.  Please call our office if you have any questions about these qualifications or would like to set up a consultation.