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Re: Caregiving Expert Series: Legal and Financial Affairs 3/4-3/29/19

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Message 1 of 22

Thank you Amanda for the wealth of information. I found Office of the Aging and New York Connects very helpful. The nursing home business office actually got me the correct answers I needed.

My stepfather did pass away on March 6th, but it was wonderful that he had the time together with mom in the nursing home before he passed. My brothers and I are helping mom adjust and she is doing well.  Thank you again. This forum had excellent follow through.

Jeri

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Message 2 of 22

Hello @DawnJ143943 , and thank you for your question.  Your mother is unbelievably fortunate to have you as her caregiver and it seems that you have been incredibly devoted to her over the last few years (and surely before).  

 

Answers to your questions are going to largely depend on the state in which you live and its specific laws and regulations.  Also, your circumstances are going to dictate the recommended answers for you.  Have you consulted with a qualified elder law practitioner?  I would start there;  there are nuances to how you can structure the type of contracts you're contemplating, how you can draw compensation, and how to plan to not compromise a recipient's public benefits.    An elder law attorney licensed in your state is going to be able to help you sift through this and structure a plan that suits your family.  Your State Bar Association's or the National Association of Elder Law Attorney's websites will help you to find a lawyer.  

 

Wishing you the very best of luck as you move forward.  

Amanda Singleton
All posts are intended to convey general information only and not to provide legal advice or opinions. The posting and viewing of the information in this community should not be construed as, and should not be relied upon for, legal or tax advice in any particular circumstance or fact situation. The information presented may not reflect the most current legal developments. An attorney should be contacted for advice on specific legal issues. Nothing written in this community is intended to create an attorney‑client relationship. An attorney-client relationship may only be established through direct attorney‑to‑client communication that is confirmed by the execution of an engagement agreement.
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Re: Caregiving Expert Series: Legal and Financial Affairs 3/4-3/29/19

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Message 3 of 22

Hi @RozelleA93580 !  I wanted to touch base with you on your question.  The topic we were addressing was related to legal documents for caregivers, and I see you have some Medicaid-related questions that you were posting about.  This is an important topic that affects so, so many of us.   Medicaid covers 45% to 65% of the total nursing home costs in America.  And the issues related to Medicaid can be very complex and confusing.  

 

Answers to your questions are going to depend on what state you live in.  I recommend you look to your state's department of aging, regional area agency on aging, local AARP programming, or seek out a qualified elder law attorney who can advise you on your rights and help you make a short- and long-term plan to protect your assets and plan for your residence.  

 

Please check back in with us on the caregiver forums to let us know how things are going.  I'm wishing you and yours all the best.

Amanda Singleton
All posts are intended to convey general information only and not to provide legal advice or opinions. The posting and viewing of the information in this community should not be construed as, and should not be relied upon for, legal or tax advice in any particular circumstance or fact situation. The information presented may not reflect the most current legal developments. An attorney should be contacted for advice on specific legal issues. Nothing written in this community is intended to create an attorney‑client relationship. An attorney-client relationship may only be established through direct attorney‑to‑client communication that is confirmed by the execution of an engagement agreement.
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Re: Caregiving Expert Series: Legal and Financial Affairs 3/4-3/29/19

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Message 4 of 22

Hi @jerih879875 , and thank you for your question.  While I am not licensed in New York and cannot give you specific advice without an attorney-client relationship, I'd like to direct you to some resources that may be helpful for you.  

 

Look into the New York State Office of Aging.  Its website has a wealth of information that may help get you the answers you're seeking, including resources like Livanta, HIICAP, and New York Connects.  I am copying information directly from the NYSOA resource guide for you below: 


Medicare Prevention and Screening Services – Your Guide
www.medicare.gov/Pubs/pdf/10110.pdf
This federal government booklet contains important information about what disease prevention
is and why it’s important; which preventive services Medicare covers and how often, who can
get services; and what you pay. Many services are low or no cost.


Medicare Quality of Care – Livanta
www.livanta.com/bfccqio.html
1-866-815-5440
Livanta is the federal contractor to ensure Medicare beneficiaries are receiving high quality care.
They help with Medicare questions, appeals, hospital patients’ rights, billing issues, and
complaints.


New York State Long Term Care Ombudsman Program (LTCOP)
www.ltcombudsman.ny.gov
1-855-582-6769
This program investigates and resolves complaints and concerns about long term care facilities
such as adult homes, skilled nursing facilities, nursing homes, and assisted living residences.
Trained volunteers serve as certified ombudsmen who advocate for residents, assisting them,
their families and the facilities in resolving problems. Technical assistance is provided by
LTCOP staff, who work side by side with more than 1,600 certified ombudsmen. These
ombudsmen serve more than 180,000 long-term care residents across the state.


Health Insurance / Prescriptions
Elderly Pharmaceutical Insurance Coverage (EPIC)
www.health.ny.gov/health_care/epic
1-800-332-3742
EPIC, administered by the New York State Department of Health, helps many older New
Yorkers pay for prescription drugs. It covers those who do not have adequate insurance
coverage for prescription drugs and who are not eligible for Medicaid. EPIC is coordinated with
Medicare Part D prescription coverage to provide services with additional coverage for
prescription medication.

Health Insurance Information, Counseling and Assistance Program (HIICAP)
www.aging.ny.gov/healthbenefits
1-800-701-0501
More than 500 trained HIICAP counselors located in local offices for the aging across the state
are available to answer questions about Medicare, Medicare Advantage programs (managed
care), Medicare prescription drug coverage, Medigap, and other health and long-term care
insurance issues. Counseling is also available through the toll-free HIICAP helpline. Callers will
be prompted to enter their zip code and will be routed to their local offices for the aging to talk
with a trained counselor.


Medicaid
www.health.ny.gov/health_care/medicaid
1-877-267-2323


www.nyconnects.ny.gov
1-800-342-9871
This program provides medical assistance for people 65 or older or those who are blind or who
have a disability who are eligible for SSI, or for those who have too little income and resources
to meet their medical needs. Medicaid also pays for long-term care services for people after
they “spend down” their assets to qualify for many benefits. For more information, contact NY
Connects or your local department of social services.


Medicare
www.medicare.gov
Medicare provides health
insurance for people age 65+,
certain people with
disabilities, and those in final
stages of renal (kidney)
disease. The Social Security
Administration takes
applications for Medicare and
provides information regarding eligibility. To avoid penalties, apply during the period from three
months before your 65th birthday month through three months after your birthday month.
Medicare has four programs:
• Hospital Insurance (Part A): Part A helps pay for inpatient hospital care, limited inpatient
care in a skilled nursing facility, home health care, and hospice care. Part A has deductibles
and co-insurance, but most people do not have premiums for Part A.
• Medical Insurance (Part B): Part B helps pay for doctor’s services, outpatient hospital
services, durable medical equipment, and a number of other medical services and supplies
that are not covered by Part A. Part B has premiums, deductibles, and co-insurance that you
must pay yourself or through coverage by another insurance plan. If choosing a fee for
service plan, you must also arrange for separate prescription coverage.
o Preventive Health Benefits Medicare provides coverage under Part B for many
health screening and preventative health tests including colorectal and breast cancer
screening, diabetes screening, flu and pneumococcal vaccinations, and smoking
cessation, among others (see your annual “Medicare and You” book).
• Medicare Advantage Plans (Part C) are health plan options that are approved by Medicare
and run by private companies. Some of these plans require referrals to see specialists. In
many cases, the costs of services (co-pays) can be lower in a Medicare Advantage Plan
than they are in the original Medicare plan with a Medigap policy. Medicare Advantage
Plans provide all of your Part A (hospital) and Part B (medical) coverage and must cover
medically necessary services. They generally offer extra benefits, and many include Part D
drug coverage. These plans often have networks, meaning you may have to see doctors
who belong to the plan or go to certain hospitals to receive services.
• Medicare Prescription (Part D) is prescription drug coverage for everyone with Medicare.
This coverage may help lower prescription drug costs and help protect against higher costs
in the future. It can give you greater access to prescription drugs that you can use to prevent
complications of diseases and stay well. If you join a Medicare drug plan, you usually pay a
monthly premium. These plans are administered by private companies approved by
Medicare.


Medicare Savings Program
www.nyconnects.ny.gov (NY Connects)
1-800-342-9871


www.aging.ny.gov/healthbenefits (HIICAP)
1-800-701-0501
New York State and the federal government help low-income Medicare beneficiaries with out-ofpocket expenses. Contact NY Connects or the Health Insurance Information, Counseling and
Assistance Program (HIICAP) to learn about Medicare Savings Programs. New plan choices
are announced in October of each year.


New York State Partnerships for Long-Term Care
www.nyspltc.org
1-866-950-7526
The New York State Partnership for Long-Term Care combines private long-term care
insurance with Medicaid to help people prepare financially for possible nursing home care,
home care or other long-term care services as specified under the policy. It allows New Yorkers
to protect assets while remaining eligible for Medicaid extended coverage if their long-term care
needs exceed the period covered by their private partnership insurance policy. For an
application, contact your local office for the aging.

 

An elder law attorney can help you on issues that come up related to Medicare, Medicaid, and helping you and your parents plan for their advancing years.  The National Academy of Elder Law Attorneys site has an attorney guide to help you find a qualified practitioner.   

 

On a personal note, I hope that your parents are doing well after their transition into the nursing home!  Please check back in here to let us know how you're all faring.  

Amanda Singleton
All posts are intended to convey general information only and not to provide legal advice or opinions. The posting and viewing of the information in this community should not be construed as, and should not be relied upon for, legal or tax advice in any particular circumstance or fact situation. The information presented may not reflect the most current legal developments. An attorney should be contacted for advice on specific legal issues. Nothing written in this community is intended to create an attorney‑client relationship. An attorney-client relationship may only be established through direct attorney‑to‑client communication that is confirmed by the execution of an engagement agreement.
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Re: Do you have a question about legal documents as a caregiver? Ask our expert.

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Message 5 of 22

Hi @r134025w and thank you for your question!  There are a few factors here that need to be considered to help you reach your decision.  First, you need to know what the POA authorizes you to do.  Second, I would wonder about the principal (the person who made the POA) and their competence/capacity.  Can they decide to make a charitable donation now?  Is it in their financial best interests.  I understand you have a letter, but remember that this is not as binding/formal as a Power of Attorney.

 

When we act as someone's agent or attorney-in-fact, we become a fiduciary.  This means we must manage their money and property carefully, and in their best interests.  The agent/attorney-in-fact can face penalties (both criminal and civil) if they breach their duties.  If there is ever a question about what you can/should do, you may want to consult an attorney to help you decipher the POA and/or ask the principal's medical providers about her competence. 

 

Wishing you the best of luck!  

Amanda Singleton
All posts are intended to convey general information only and not to provide legal advice or opinions. The posting and viewing of the information in this community should not be construed as, and should not be relied upon for, legal or tax advice in any particular circumstance or fact situation. The information presented may not reflect the most current legal developments. An attorney should be contacted for advice on specific legal issues. Nothing written in this community is intended to create an attorney‑client relationship. An attorney-client relationship may only be established through direct attorney‑to‑client communication that is confirmed by the execution of an engagement agreement.
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Re: Living wills/Power of Attorney/medical proxy

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Message 6 of 22

Hi @k920929b and thank you for your question!  There is no set age to begin planning for caregiving or to be cared for.  Ideally, I would like to see every person over the age of eighteen prepare their advance directives!  Thinking about all of this and formalizing a plan while you are healthy and not under pressure to plan is the best case scenario.  

 

You're contemplating what happens and how to plan for when you may need public benefits.  It's wonderful that you're considering this while you're young and not facing a medical crisis.  The reality is that 5 out of 8 nursing home residents in New York are covered by Medicaid.  Should the need arise for you to use long term care services or for admission to a nursing facility, there is a strong likelihood that public benefits may be needed.  

 

While I don't know your circumstances and can't give you specific advice, I would definitely encourage you to keep educating yourself on the laws of your state and how you may be eligible for coverage.  I am going to attach a few links here:

 

Here is a link that will take you to the AARP advance directive state-by-state guide; and 

 

Here is a link that will take you to the American Council on Aging's Medicaid planning page, which includes lots of information and resources.  

 

Thanks so much, and take care! 

Amanda Singleton
All posts are intended to convey general information only and not to provide legal advice or opinions. The posting and viewing of the information in this community should not be construed as, and should not be relied upon for, legal or tax advice in any particular circumstance or fact situation. The information presented may not reflect the most current legal developments. An attorney should be contacted for advice on specific legal issues. Nothing written in this community is intended to create an attorney‑client relationship. An attorney-client relationship may only be established through direct attorney‑to‑client communication that is confirmed by the execution of an engagement agreement.
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Re: Do you have a question about legal documents as a caregiver? Ask our expert.

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Message 7 of 22

Hi @rr205849 !  Thanks for your question.  Can you elaborate on what you mean? 

 

There is never a one-size-fits-all approach to planning.  What will be most helpful for your circumstances today may be very different in five years.    Let me know what you have in mind and we'll see if we can point you toward some resources.

 

Thank you, Amanda

Amanda Singleton
All posts are intended to convey general information only and not to provide legal advice or opinions. The posting and viewing of the information in this community should not be construed as, and should not be relied upon for, legal or tax advice in any particular circumstance or fact situation. The information presented may not reflect the most current legal developments. An attorney should be contacted for advice on specific legal issues. Nothing written in this community is intended to create an attorney‑client relationship. An attorney-client relationship may only be established through direct attorney‑to‑client communication that is confirmed by the execution of an engagement agreement.
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Re: Do you have questions about Living Wills or Advance Directives? Ask our Expert.

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Message 8 of 22

Hello @ct8926 :  Please accept my condolences on your husband's passing.    Thank you for reaching out here.    The answer to your question is: it depends.  Your documents may have fully addressed the contingency of a spouse passing away.  Or they may not have.  Or, circumstances may be different now than they were when you made your documents (you may own different property now, or a beneficiary or fiduciary you named in those documents are no longer appropriate, for example).  Take your documents out and give them a read over.  Consider calling the attorney who prepared them; they may be able to answer your questions very quickly and advise you about what best suits your unique needs and circumstances.  

 

Ideally, I'd like to see clients pull out their documents annually (perhaps around the new year or tax time) and take a look to see if they documents are in need of any updates.  If every year is not a possibility, at least keep in mind the 5 Ds.  If any of these events happen, it may be time to refresh your plans: 

 

1. Decade – Go over your documents at the beginning of a new decade of life
2. Death – Review your wishes after the death of a loved one.
3. Divorce – Revisit your plan following a divorce or other major family change.
4. Diagnosis – Be sure your wishes are formalized if you are diagnosed with a serious health condition.
5. Decline –  Consider whether your plan and documents address what will happen if you experience a significant decline or deterioration of an existing health condition, especially when it diminishes your ability to live independently.

 

Thank you, and I'm wishing you the best.

Amanda Singleton
All posts are intended to convey general information only and not to provide legal advice or opinions. The posting and viewing of the information in this community should not be construed as, and should not be relied upon for, legal or tax advice in any particular circumstance or fact situation. The information presented may not reflect the most current legal developments. An attorney should be contacted for advice on specific legal issues. Nothing written in this community is intended to create an attorney‑client relationship. An attorney-client relationship may only be established through direct attorney‑to‑client communication that is confirmed by the execution of an engagement agreement.
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Message 9 of 22

Is there a outline, or checklist for my state. So that I get everything I  need without wasting time?

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Message 10 of 22

Your Will can be amended with a Codicil, it need not be rewritten. Your Trust may need an amendment or revision depending on the terms of the Trust.

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