Six years after starting Keystone Elder Law is a good milepost to be reflective as we observe Elder Law Month during May. Whether you are in your retirement years, or are helping a loved one who is, Keystone Elder Law’s experience and services are relevant. To avoid conflicts of interest and help families to focus on what should be most important, our priority is always the oldest person in the families we serve.
If you are managing the care of a loved one at home whose health is declining steadily, you are probably feeling as busy as if you were managing a house dominated by children’s activities. If you are doing both at the same time, you are a member of the “sandwich generation.” Hopefully, you are maintaining your sanity by learning how to juggle, and finding humor amid the challenges that you share with your closest friends, concluding that “you just can’t make this stuff up!”
Experienced guidance can help you to avoid caregiver burnout, and consider the things you would be wise to do now in advance of what could happen next. Even if you research and download directions from the internet before you leave home on a trip, it is wise to take a rest stop and ask for guidance from those who are experienced with the unfamiliar environment in which you find yourself along the way. A combination of good planning and experienced advice will make the most of your time and resources.
This week, an affluent family came to us for the first time, a few weeks after enrolling their parent in a nursing home following hospitalization. Their thrifty parent’s estate planning documents had been downloaded from the internet, and created as many questions as answers. Have you ever been a spectator at an outdoor event, equipped with only a cheap plastic poncho or broken umbrella, shivering as you notice others sitting comfortably in a rain suit? Planning for long-term care cannot cause the sun to appear on a stormy day, but it can reduce the exposure of a family to the natural elements of the aging process.
Unfortunately, our neighbors who stock up on milk and bread before a snowstorm often are not as well equipped when the stakes are much greater. We often hear, “I don’t have time to plan; my parents are not open to considering options;” or, “There is no way our family will either bring a strange caregiver into the home or use a care facility.” It is frustrating to hear this, when reaching out for help before a crisis is comparatively easy and affordable.
Perhaps you or a friend are now in the middle of a long-term care crisis. There is immediate concern for both the quality of care and the cost of care. Care should be your most important consideration. But when the care of a loved one costs more than $300 per day, and insurance and Medicare do not pay for it, panic sets in quickly. What can you do?
Let’s dispel some common misconceptions. All care facilities are not “nursing homes.” Different facilities offer different levels of care. Some rehabilitation facilities offer long term care and accept Medicaid for payment and others do not. The government offers assistance for some levels of care, but not others. What looks like the most expensive option might not be.
If you have long term care insurance, you will collect eventually; but your initial claim inquiry might be discouraged, and the amount paid can vary depending upon the facility and the way the claim is presented. If the well spouse wants to move along with the sick spouse and live independently nearby, that is possible at some facilities but not others. The best care option for your loved one depends upon the circumstances.
When a health crisis results in three days of admission to a hospital, then discharge to a rehabilitation facility is likely to be arranged by the hospital. Ideally, a hospital discharge planner would help a family to consider all of the facility options, and evaluate them with consideration to include the needs of the well spouse and asset preservation, but that rarely occurs due to a lack of time and experience. In contrast, an independent professional care coordinator can get the attention of various rehabilitation facilities on short notice, and help a family to make the best choice.
The celebrity who once hosted a morning TV show, and now promotes a free service to help you find a place for your parent, does not disclose that her associates are paid a referral fee by the facilities they arrange for you to visit. Those alleged expert advisors are not required to have any professional licensing; and often they have not even been to the facilities that they recommend. Contrast this with having access to the advice of a professional advocate who receives no compensation from any facility, and who knows most of the facilities’ professional staff on a first name basis because of having been in the facilities on a regular basis for follow up visits to a large number of clients over the years.
Another common misconception is that a nursing home will take the family home. That never happens. If a family has not implemented any asset preservation strategy, the family could lose the home after the loved one dies to an estate recovery lien to repay the state for the subsidized care. Although advance planning allows more options, under current law there are things that an experienced elder law attorney can do to soften the financial hardship of a crisis.
Whether you are in your retirement years, or are helping a loved one who is, pay attention to the weather forecast. It is wise to plan ahead and get the right equipment. But if you are suddenly caught in the elements of a long-term care crisis, you can find protection from the storm with the help of an experienced elder law attorney and care coordinator.
by Dave Nesbit, Attorney