Selecting A Nursing Home
One of the hardest decisions families make for loved ones is selecting a nursing home. There are so many factors to be considered that the process can be overwhelming. The following is a list of ideas and resources that may help make the process easier. If you are a client of Keystone Elder Law, the Elder Care Coordinator can assist you in evaluating and selecting a nursing home.
Decisions are reversible. Just because you could not get into your first or second choice of a facility when needed does not mean you can never get in. It is possible to transfer from one facility to another as long as the receiving facility is willing to accept your loved one when an opening becomes available.
Check any insurance restrictions. Some insurance plans restrict coverage to “in-network” facilities. If you use an out-of-network facility, the insurance may not pay or you may have higher co-pays.
Look for a good fit. Just as people are all different, facilities are different, even when the care is comparable. Look at size, location, activity programming, staffing, and any church or lodge affiliations that match your loved one. The goal is to get the best fit between the facility’s characteristics and your loved one’s unique preferences.
Use available resources. Medicare’s web site (www.medicare.gov) offers comparisons of nursing homes. It also has a link to a “Guide to Choosing a Nursing Home.” The Pennsylvania Department of Health’s web site (www.health.state.pa.us) provides their “Patient Care Survey” and “Building Safety” information on every nursing home in Pennsylvania. If your loved one is in a medical facility, be sure to contact the person doing discharge planning (usually a social worker or a case manager) to help coordinate plans.
Medicare requires a three day hospital stay before it will pay for nursing home care. Please note that if the your loved one is in the hospital under “Observation,” the observation days do not count toward the three day stay requirement. In the nursing home Medicare covers “skilled care” but not “custodial care.” As long as your loved one qualifies for “skilled care,” Medicare covers up to twenty days in full and up to eighty additional days with a co-pay. Many Medicare Supplement and Medicare Advantage policies cover these co-pay days and will cover for up to a year after Medicare benefits are exhausted. However, your loved one must qualify for “skilled care” the entire time . The reality is that most patients move from “skilled” status to “custodial” status within a few days to a few weeks of admission.
Long-Term Care Insurance policies generally cover either “skilled” or “custodial” care. Be sure you understand any waiting periods, the benefit amounts, and how long benefits continue. Your loved one will likely be financially responsible for the difference between what his or her insurance pays and the total cost of the nursing home.
Financial planning – Once insurance stops paying for nursing home care, your loved one will need to use his or her financial resources to pay for care until he or she spends down to the point where he or she is eligible for Medicaid (Pennsylvania calls this Medical Assistance). If your loved one will need long-term care, the attorneys at Keystone Elder Law can help you understand all of the options available to conserve and preserve your loved one’s assets. For maximum protection it is wise to obtain this counsel before the loved one is in the nursing home, but as long as there are assets to protect it is never too late to contact an elder law attorney.
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REGISTER HERE for LONG-TERM CARE PLANNINGPower 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.
For Medicaid
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.
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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.
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