COVID-19 caught many of us by surprise in March. Who honestly imagined that COVID-19 restrictions would remain in effect for more than four months?
After months of optimism that the United States was on the verge of reopening what had been a robust economy, recently President Trump acknowledged that “it (the COVID-19 pandemic) will probably unfortunately get worse before it gets better.” This is a dramatic shift in expectations. How should we process that with respect to long-term care planning and preparation?
Currently, we are able to present an opportunity for you to meet to learn what you can do now in preparation for whatever the future might bring. Having “foundational” estate planning documents in place better enables us to help a family to respond to a long-term care crisis which results in a need for nursing care. Foundational documents include a durable financial power of attorney, an advance care directive which appoints a health care agent, and a last will and testament.
We have been able to help several clients who were prepared with foundational documents to preserve the family home and accelerate the ability to obtain Medicaid for their loved one. As an Eagle Scout, the need to “Be Prepared” was imbedded in me from a young age. Preparation pays off.
It can be very difficult for a family member who is not named as an agent by a power of attorney document to gather the papers needed to apply for Medical Assistance to help to pay for the cost of nursing care, which is more than $350 per day on average. Pre-COVID, we routinely visited nursing homes and personal care facilities to meet with clients to counsel them about their options, and then again to execute legal documents. It has been more than four months since such visits were permitted.
While we have the technology to meet virtually with new clients by the use of Zoom and other similar technology, such visits often require that a facility’s care aide be present to facilitate the communication. It can feel awkward to discuss sensitive family issues is this manner, when confidentiality is not possible. Although the COVID-19 restrictions have required us to become able to serve clients remotely, the use of technology is at best a marginally adequate substitute to the opportunity to meet with a client in person.
Proper counseling in relation to the appointment of a healthcare agent to speak for a loved one’s preferences at a future time when they are no longer able to do so necessarily involves open discussion about unpleasant possibilities. Sometimes what a client suggests with body language, for example with respect to organ donation, is different than a yes or no answer to a routine question.
Most of our new clients have previously prepared a last will and testament. However, few new clients have been previously counseled about what considerations should be discussed about a desire to leave an inheritance for a loved one who is at risk of losing important government benefits due to receiving an inheritance. These discussions, which can involve intimate family details, are better held in person than with a Zoom meeting.
In addition to having foundational documents in place it is helpful if, prior to experiencing an event which triggers a need for long-term care, a family has visited a couple of facilities to better understand what care options are available. At the present time, due to COVID restrictions, no facility is able to permit a prospective resident to tour. When the facilities begin to again offer tours, explore their options with on-site visits.
Imagine how you would feel if you or your loved one would sudden require hospitalization, after which discharge to home would not be a safe option. In pre-COVID times, it is probable that you would have at least one day to visit a couple of facilities so that you could feel less in the dark and out of control with the discharge process. Over the last four months, we have met several families who have never been able to visit their loved one at the care facility. Not only are they separated from their isolated family member, but they have no visual impression of the facility since they have only been able to see it from the outside.
We have had new clients who have been shocked when a rehabilitation facility that does not accept Medicaid has admitted their loved one, then later offered an abrupt option to the family that they either drop off a large check or come to take their loved one home, sometimes even when that is not a safe option. Because the transfer from one facility to another is more difficult during this time of COVID restrictions, it is more important than ever to consider whether it would be best to advocate a discharge from a hospital to a rehabilitation facility that also takes Medicaid when the Medicare payments are exhausted, which is always not longer than within one hundred days from hospital discharge.
Planning ahead for potential bumps in the road of older adulthood is advantageous during normal times. During this pandemic, the effects of a lack of preparation are more pronounced and difficult to circumvent. For more information about estate planning and preparation, visit https://keystoneelderlaw.com/estate-planning/.
Dave Nesbit, Attorney