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Sentinel : Secrets of Government Benefits | Keystone Elder Law – Mechanicsburg, PA

The government has proposed no innovative solution to respond to the growing need for extended care for older persons. It’s not because we haven’t been warned by insurance companies and care providers. A consensus of published studies concludes that, if a husband and wife survive to age 65, one of them is likely to need nursing care when the other spouse is still reasonably healthy and able to be at home.

Taking care of one’s spouse at home is an exercise of love and endurance. Sometimes, even with the support of family or a home care agency, it becomes unmanageable for the well spouse. Frequently, when concerned family or friends encourage the well spouse to consider placing the ill spouse in a care facility, the well spouse says: “but I promised I’d never place him in ‘a home’.”

Rarely does the spouse who made such a promise plan for the cost of implementing it, such as by obtaining long-term care insurance to pay for the hiring of the necessary support. If a home care service is needed for more than 40 hours a week over an extended term, placement in a personal care home becomes a more affordable alternative than home care. This is especially true for wartime veterans who are entitled to a special pension.

Entry into a skilled nursing facility is almost never planned as a voluntary choice, as is admission to a personal care home or assisted living. Most who are admitted to a skilled nursing facility get there after hospitalization because of a stroke, chronic disease, or serious orthopedic injury. Persons who qualify medically to live in a skilled nursing facility after rehabilitation has ended can benefit from the level of nursing attention that is available there.

Financial stress in reaction to the cost of nursing care, and the loneliness of living at home alone, can fuel an unrealistic desire of a spouse to bring a partner home from a nursing facility, especially if a promise has been made. It rarely is a good idea to attempt home care when the ill spouse cannot get out of bed and to the toilet independently after rehabilitation has run its course. Skilled nursing facilities have a higher level of nursing attention than is provided in a personal care home, or than anyone but the very wealthy can afford to provide in their home.

The admissions staff and social workers at a nursing home are busy and caring people whose role is to help the patient and family members to adjust to the nursing facility. Their responsibilities range from administrative paperwork to communicating about care plans and expectations. Nursing homes have no duty to explain how government programs can be used to pay for care; and a few facilities resist admitting patients who are likely to pay with Medical Assistance, since it pays less than the private rates.

An elder law attorney can help older adults and their families understand financial options and strategies to manage the cost of skilled nursing care with long-term care insurance, Veterans special pension benefits, and Medical Assistance. Many clients are surprised that, after Medicare pays for a maximum of 100 days, it will not contribute towards the more than $9,000 per month cost of nursing care.

Every situation is different, but an elder law firm can often help a family save thousands of dollars that would otherwise be depleted quickly. Usually, this involves knowing the ins and outs of government programs, and how these can be used together most effectively. Decisions made without proper guidance at the beginning of a nursing home stay risk overlooking opportunities for government assistance, creating penalties, and/or personal liability for the family.

The most significant government program to help pay for skilled nursing care is Medical Assistance. When Medical Assistance eligibility is obtained, a family’s financial liability for nursing care is ended. Generally, it is not possible within a nursing home to distinguish the difference between the care received by a private pay patient or a patient on Medical Assistance.

Medical Assistance has a penalty and ineligibility provision which people might not discover until they are out of money and expecting to receive benefits. The penalty and ineligibility period is caused if a Medical Assistance applicant has made a gift(s) which totals more than $500 in any single month during the five years before the nursing home admission.

Sometimes a family will overlook the gifts a nursing home resident has made in the past. Putting an adult child’s name on the deed to the family home or bank account is considered by the government to be a gift that will result in ineligibility for Medical Assistance. Paying for college tuition, weddings, and new cars is not viewed as “what grandparents are expected to do,” but is penalized as gifting.

Gifting is not a crime; and if an elder law attorney is consulted as soon as a family member enters a skilled nursing facility, in most cases a good solution can be created. Sometimes, if other assets remain, recovery of the gifted assets is not required. The key is to recognize the existence of a prior gift immediately so that a corrective strategy can be devised by an elder law attorney.

In 2012, the Pennsylvania Superior Court ordered John Pittas to pay $93,000 to a nursing facility for the cost of his mother’s care. It is doubtful that this collection action against Mr. Pittas would have occurred if Medical Assistance could have been obtained. Gifting not only results in a lack of Medical Assistance payments for the nursing home resident, but can result in personal liability for the family.

While ending up in a skilled nursing facility is not what anyone hopes for, if your family or friends are facing that situation, an elder law attorney should be consulted immediately to make sure that gifting problems are corrected, government benefits are obtained as soon as possible, and family financial liability is avoided.

To learn more about government benefits, you can attend our free seminar on Thursday, April 18th, or visit our website at

This article was written by Dave Nesbit, Esq.