Wills and Powers of Attorney
Rehabilitation Hospitals and Nursing Homes As Rehab
Rehab hospitals provide comprehensive, intensive rehabilitation to help patients restore lost function. At a rehab hospital you can expect to have therapy sessions twice per day for a minimum total of three hours per day. Because these facilities are hospitals, they are covered under “hospital benefits” for Medicare and most other insurances. The Center for Medicare and Medicaid Services (CMS) presently requires that 60% of rehab hospital admissions come from 13 different diagnostic categories. Because of this CMS requirement, some patients, who would have gone to a rehab hospital in past years, are now going to nursing homes for their rehabilitation.
Nursing Homes as Rehabs
At one time nursing homes were looked upon as places where old people, who had no family support, went for care until they died. In our lifetime this has changed radically. Due to changes in Medicare regulations, known as the CMS 13, many people find that their insurance will no longer pay for rehabilitation in a Rehab Hospital, but requires them to go to a nursing home for needed inpatient rehabilitation. As a result, nursing homes have been changing to meet this rehab need. Some nursing homes are setting up specific areas within their facilities just for short-term rehab cases. If you are planning for surgery, it is good to ask your surgeon if you are likely to require inpatient rehab post operatively. Since some insurance companies contract with a limited number of nursing homes, it is helpful to contact your insurance company to find out what choice of facilities you have. It is wise to plan ahead and to prioritize your preferences. In the case of a planned surgery, you may be able to schedule an admission to the facility you prefer.
Some helpful questions to ask as you check on nursing homes are:
- Are you “in network” with my insurance?
- How much of my care will be paid for by my insurance? Will I have to pay part of the cost? If so, how much?
- Do you have a separate area for short-term rehab patients?
- How many days of the week do you provide therapy?
- How much therapy can I expect to receive each day?
- What percentage of your short-term rehab cases are discharged to home?
- Will you provide transportation to follow-up visits at my surgeon’s office? Is there a charge for this?
- What discharge planning services are provided?
While hospitals have discharge planners to help you, by being informed and prepared you can help to ensure you receive the best possible rehabilitative care.
Some individuals at home need rehab services. If you can travel to and from the outpatient center, your physician can give you a prescription for outpatient therapy. These centers are normally open five days per week, but not everyone needs to go five days per week. Most insurance will cover a certain number of outpatient therapy visits each year. Outpatient rehab centers can be found by looking under “Rehabilitation Services” or “Physical Therapists” in the yellow pages of your phone book. If you have a Medicare Advantage insurance, or another type of managed care insurance plan, check with your company to see if you need a referral from your primary care physician and if you need to use an in-network therapy provider.
Home Based Rehabilitation
Some individuals at home in need of rehabilitation cannot travel to an outpatient center, and they are what insurance companies call, “homebound.” Home Health agencies have physical, occupational, and speech therapists that can come to your home several times a week. A physician must order the therapy. If you have a Medicare Advantage or managed care insurance, be sure to check if you need a referral from your primary care physician and if you need to use an in-network provider.
Power of Attorney
A Power of Attorney can be used to give another person the right to sell a car, home, or other property in the place of the maker of the Power of Attorney. A Power of Attorney might be used to allow another person to sign a contract for the maker of the Power of Attorney (the person who makes a power of attorney is called the “principal”). It can be used to give another person the authority to make health care decisions, do financial transactions, or sign legal documents that the principal cannot do for one reason or another. With few exceptions, Powers of Attorney can give others the right to do any legal acts that the makers of the Powers of Attorney could do them themselves. A General Power of Attorney gives the “power of attorney Agent” or simply “Agent” (the legal name of the person who is authorized to act for the principal) very broad powers to do almost every legal act that the principal can do. When Elder Law Attorneys draft general Powers of Attorney, they still list the types of things the Agent can do but these powers are very broad. People often do general Powers of Attorney to plan ahead for the day when they may not be able to take care of things themselves. By doing the General Power of Attorney, they designate someone who can do these things for them.
Normal Powers of Attorney terminate if and when the principal becomes incompetent. Yet many people do Powers of Attorney for the sole purpose of designating someone else to act for them if they cannot act for themselves. It is precisely when persons can no longer do for themselves that a Power of Attorney is most valuable. To remedy this inconsistency, the law created a Durable Power of Attorney that remains effective even if a person becomes incompetent. The only thing that distinguishes a Durable Power of Attorney from a regular Power of Attorney is special wording that states that the power survives the principal’s incapacity. Even a Durable Power of Attorney, however, may be terminated under certain circumstances if court proceedings are filed. Most Powers of Attorney done today are durable.
Yes. At the time the Power of Attorney is signed, the principal must be capable of understanding the document. Although a Power of Attorney is still valid if and when a person becomes incompetent, the principal must understand what he or she is signing at the moment of execution. That means a person can be suffering from dementia or Alzheimer’s Disease or be otherwise incompetent sometimes but as long as they have a lucid moment and are competent at the moment they sign the Power of Attorney, it is valid even if they do not remember signing it at a later date. At the time it is signed, the principal must know what the Power of Attorney does, whom they are giving the Power of Attorney to, and what property may be affected by the Power of Attorney.
Any competent person eighteen years of age and older can serve as an agent. Certain financial institutions can also serve. There is no course of education that agent must complete or any test that Agent must pass. Because a Power of Attorney is such a potentially powerful document, agents should be chosen for reliability and trustworthiness. In the wrong hands, a Power of Attorney can be a license to steal. It can be a big responsibility to serve as an agent.
Medicare is health insurance and covers medical services such as physician appointments, therapy, blood tests, x rays, medical procedures and hospitalization. Medicare will sometime pay for rehabilitation in a long-term care facility for a period of 20 to 100 days, but not longer. In long-term care, Medicaid covers the cost of ongoing support services for daily functioning, such as room and board in a nursing home.
Medicaid is a federal program that is overseen by the Center for Medicare and Medicaid Services (CMS). In Pennsylvania, Medicaid is called Medical Assistance and is administered by the Department of Human Services (DHS).
In Pennsylvania, Medicaid funds are not available to pay for assisted living or personal care.
For Medicaid to pay for care in a nursing home, an individual recipient must be determined to need a nursing home level of care by a physician and the local Office of Aging. An individual whose income is not greater than three times the poverty level may keep up to $8,000 of total resources, but may otherwise keep only $2,400. The cash value of life insurance counts as a resource, but one car and a residential home does not count as a resource.
Empowering Clients with Holistic Planning at
Keystone Elder Law
At Keystone Elder Law, we believe that the physical, social, legal, and financial considerations of our clients all intertwine. We utilize an interdisciplinary approach to evaluate each area, which allows for the creation of a plan that addresses the concerns of the individual as a whole as well as the family. To this end, our model of practice includes a Care Coordinator (usually a nurse or social worker), whose expertise complements our team of attorneys.
When the road of life is smooth, decisions about legal and financial matters are easy to push aside for “a rainy day.” Planning ahead, however, will allow for more options as you view the map of where you’ve been and where you want to go. Don’t let a crisis limit your choices or derail your plans.(717) 697-3223