Under our “system” of paying for long-term care, you may be able to qualify for Medicaid to pay for nursing home care, but in most states there’s little public assistance for home care. Most people want to stay at home as long as possible, but few can afford the high cost of home care for very long. One solution, which is growing in popularity, is to tap into the equity built up in your home. If you own a home and are at least 62 years old, you may be able to quickly get money to pay for home care (or for anything else) by taking out a reverse mortgage. Reverse mortgages, financial arrangements designed specifically for older homeowners, are a way of borrowing that transforms the equity in a home into liquid cash without having to either move or make regular loan repayments. They permit house-rich but cash-poor elders to use their housing equity to, for example, pay for home care while they remain in the home, or for nursing home care later on. The loans do not have to be repaid until the last surviving borrower dies, sells the home or permanently moves out.
In a reverse mortgage, the homeowner receives a sum of money from the lender, usually a bank, based largely on the value of the house, the age of the borrower, and current interest rates. For example, a 70-year-old borrower with a $200,000 house in County X, State Y, could receive a loan of $115,000. The lower the interest rate and the older the borrower, the more that can be borrowed. Homeowners can receive the money in one of three ways (or in any combination of the three): in a lump sum, as a line of credit that can be drawn on at the borrower’s option, or in a series of regular payments. The most popular choice is the line of credit because it allows a borrower to decide when he or she needs the money and how much. Moreover, no interest is charged on the untapped balance of the loan.
Although it is often assumed that an elderly person would want to use the funds from a reverse mortgage loan for health care, there are no restrictions--the funds can be used in any way. All borrowers must be at least 62 years of age to qualify for most reverse mortgages. In addition, a reverse mortgage cannot be taken out if there is prior debt against the home. Thus, either the old mortgage must be paid off before taking out a reverse mortgage or some of the proceeds from the reverse mortgage used to retire the old debt
Call us now for assistance (240) 453-0070. We can help you!
At Senior Life Care Planning, LLC we are dedicated to giving our clients the power to be informed individuals and to give peace of mind. We provide honest ways to protect your home, loved ones and independence in times of great need. We understand the emotional burden, confusion, anger, hopelessness, sense of injustice, fear and loneliness that come with long-term disability and end-of-life issues.
Every day we help and support families and individuals who are in crisis. We work with our clients to provide peace of mind and quality of life.
Senior Life Care Planning, LLC
One Research Court, Suite 450
Rockville MD 20850
240.453.0070
www.seniorlcp.com
Monday, July 13, 2009
Wednesday, July 8, 2009
Assisted Living Facility
The idea of Assisted Living is tremendously appealing – an older individual receiving necessary care and services in a home-like environment, while retaining choice and autonomy.
Assisted Living, is the fastest growing form of residential housing for older Americans and has filled the space between nursing homes and the residential home. With the assisted facility, many people enter their Assisted Living homes with the expectation that this will be their home for the rest of their lives. Also, they develop friendships and relationships with other residents. Therefore, the facility becomes their primary community.
Most Assisted Living facilities are licensed to care for residents only up to a particular need of care. A generic multi-level system might designate three levels: low, moderate and high (excludes skilled nursing care - nursing home level). When a resident has low care needs, the resident may reside at any type of Assisted Living facility. When the resident's care needs reach the moderate level, the resident is allowed to reside only at a facility licensed for moderate or high care needs. When the care needs increase to the high level, the resident is allowed only to reside in a facility licensed for high care needs. Quality of care standards are set for each level to assure that residents receive care that is adequate to meet their needs.
However, momentum toward Assisted Living, should not lead one to assume that Assisted Living is always the right choice, or that any and all health care conditions can be accommodated within Assisted Living. Some Assisted Living facilities have been known to increase their acceptance and retention of residents with significant health care needs that for which the facility is not equipped. Therefore, there must be a balance between two compelling and sometimes competing goals – allowing residents to "age in place" and assuring that residents receive an adequate and appropriate quality of care.
"Assisted Living" is not defined in any meaningful way by federal law. Currently, the Federal Government plays no significant role in setting Assisted Living facilities standards, guidelines or rules. However, "Assisted Living" has been defined by the State of Maryland as “a residential or facility- based program that provides housing and supportive services, supervision, personalized assistance, health related services, or a combination thereof that meets the needs of the individuals who are unable to perform or who need assistance in performing activities of daily living in a way that promotes optimum dignity and independence for the individuals.” But what does this mean?
The definition does little to specify exactly what level of service is required. The specifics are limited. What does optimum dignity mean? Does the definition mean that staffs are awake around the clock? What staffs are awake? What health related services are provided? Does this mean only assistance with the self-administered medication? The definition intimates that extensive health care is available. But, in fact, nothing in the definition guarantees any health care beyond self-administration of medication. Therefore, the definition fails to state clearly what services are made available to residents. Generally, the Assisted Living provider has full freedom to provide extensive, individualized services, but that same freedom allows less conscientious providers to cut corners and force out residents who are considered undesirable for one reason or another.
Additionally, the Assisted Living definition is written in an idealized, attractive term, which is vague and practically unenforceable. Rather than establishing standards directly, the State anticipates, to a great extent, that standards will be established through negotiations between a facility and an entering resident. However, there is little protection for the residents because, as a practical matter, admission agreements often are not negotiated but presented to incoming residents on a take-it-or-leave-it basis. Additionally, a 1997 Report form the General Accounting Office ("GAO") noted "[assisted living] contracts had no standard format, varied in detail and usefulness, and in some cases were vague and confusing." The GAO subsequently examined agreements in four states, and found one-third of the reviewed agreements contained language that the GAO considered unclear or potentially misleading.
Also, discharge from a Maryland Assisted Living facility is authorized for violation of the admission agreement. Therefore, the Assisted Living facility sets discharge justifications in an admission agreement. The facility may limit discharge to legitimate situations such as endangerment of other residents and nonpayment. Or, on the other hand, the facility may write an admission agreement with unfair discharge justifications; i.e., use of a wheelchair in the dining rooms. Consequently, the facility has extensive discretion to discharge a resident. With the State granting such discretion, we have two potential discharge problems: that a resident will be discharged too soon, or too late. In a too soon discharge, a facility may discharge a resident because their needs have become too expensive or inconvenient, even though the facility, if it wanted, could provide adequate care. The too late discharge, is often the result of a facility retaining a resident for whom the facility is incapable of providing care.
All assisted facilities are not the same, and can vary within the State. Therefore, proper evaluation of the facility and their contracts must be performed, because the obligations and rights pertaining to the Assisted Living facility may not protect your rights, but the facilities. Consequently, unenforceable contract language can be devastating to a resident if the provider is less interested in a resident's health and satisfaction, and thus takes advantage of the vagueness of the contract to provide the bare minimum services.
If you would like further information, please call our office at 301 663 9230.
Assisted Living, is the fastest growing form of residential housing for older Americans and has filled the space between nursing homes and the residential home. With the assisted facility, many people enter their Assisted Living homes with the expectation that this will be their home for the rest of their lives. Also, they develop friendships and relationships with other residents. Therefore, the facility becomes their primary community.
Most Assisted Living facilities are licensed to care for residents only up to a particular need of care. A generic multi-level system might designate three levels: low, moderate and high (excludes skilled nursing care - nursing home level). When a resident has low care needs, the resident may reside at any type of Assisted Living facility. When the resident's care needs reach the moderate level, the resident is allowed to reside only at a facility licensed for moderate or high care needs. When the care needs increase to the high level, the resident is allowed only to reside in a facility licensed for high care needs. Quality of care standards are set for each level to assure that residents receive care that is adequate to meet their needs.
However, momentum toward Assisted Living, should not lead one to assume that Assisted Living is always the right choice, or that any and all health care conditions can be accommodated within Assisted Living. Some Assisted Living facilities have been known to increase their acceptance and retention of residents with significant health care needs that for which the facility is not equipped. Therefore, there must be a balance between two compelling and sometimes competing goals – allowing residents to "age in place" and assuring that residents receive an adequate and appropriate quality of care.
"Assisted Living" is not defined in any meaningful way by federal law. Currently, the Federal Government plays no significant role in setting Assisted Living facilities standards, guidelines or rules. However, "Assisted Living" has been defined by the State of Maryland as “a residential or facility- based program that provides housing and supportive services, supervision, personalized assistance, health related services, or a combination thereof that meets the needs of the individuals who are unable to perform or who need assistance in performing activities of daily living in a way that promotes optimum dignity and independence for the individuals.” But what does this mean?
The definition does little to specify exactly what level of service is required. The specifics are limited. What does optimum dignity mean? Does the definition mean that staffs are awake around the clock? What staffs are awake? What health related services are provided? Does this mean only assistance with the self-administered medication? The definition intimates that extensive health care is available. But, in fact, nothing in the definition guarantees any health care beyond self-administration of medication. Therefore, the definition fails to state clearly what services are made available to residents. Generally, the Assisted Living provider has full freedom to provide extensive, individualized services, but that same freedom allows less conscientious providers to cut corners and force out residents who are considered undesirable for one reason or another.
Additionally, the Assisted Living definition is written in an idealized, attractive term, which is vague and practically unenforceable. Rather than establishing standards directly, the State anticipates, to a great extent, that standards will be established through negotiations between a facility and an entering resident. However, there is little protection for the residents because, as a practical matter, admission agreements often are not negotiated but presented to incoming residents on a take-it-or-leave-it basis. Additionally, a 1997 Report form the General Accounting Office ("GAO") noted "[assisted living] contracts had no standard format, varied in detail and usefulness, and in some cases were vague and confusing." The GAO subsequently examined agreements in four states, and found one-third of the reviewed agreements contained language that the GAO considered unclear or potentially misleading.
Also, discharge from a Maryland Assisted Living facility is authorized for violation of the admission agreement. Therefore, the Assisted Living facility sets discharge justifications in an admission agreement. The facility may limit discharge to legitimate situations such as endangerment of other residents and nonpayment. Or, on the other hand, the facility may write an admission agreement with unfair discharge justifications; i.e., use of a wheelchair in the dining rooms. Consequently, the facility has extensive discretion to discharge a resident. With the State granting such discretion, we have two potential discharge problems: that a resident will be discharged too soon, or too late. In a too soon discharge, a facility may discharge a resident because their needs have become too expensive or inconvenient, even though the facility, if it wanted, could provide adequate care. The too late discharge, is often the result of a facility retaining a resident for whom the facility is incapable of providing care.
All assisted facilities are not the same, and can vary within the State. Therefore, proper evaluation of the facility and their contracts must be performed, because the obligations and rights pertaining to the Assisted Living facility may not protect your rights, but the facilities. Consequently, unenforceable contract language can be devastating to a resident if the provider is less interested in a resident's health and satisfaction, and thus takes advantage of the vagueness of the contract to provide the bare minimum services.
If you would like further information, please call our office at 301 663 9230.
SOME COMMON NURSING HOME PROBLEMS
Do these problems sound familiar?
1. “Medicaid does not pay for the service that you want.”
2. “The nursing staff will determine the care that you receive.”
3. “We don’t have enough staff to accommodate individual schedules. You will be woken up every morning at six am.”
4. “We don’t have enough staff. You should hire your own private-duty aide.”
5. “If we don’t tie your father into his chair he may fall or wander away from the nursing home. There’s just no way we can always be watching him.”
6. “Your mother needs medication in order to make her more manageable.”
7. “We must insert a feeding tube into your father because he is taking too long to eat,”
8. “Your children can visit you only during visiting hours.”
9. “We can’t admit your mother unless you sign the admission agreement as a “Guarantor” or “Responsible Party.”
10. “Please sign this arbitration agreement. It’s no big deal. Arbitrations allow disputes to be resolved quickly.”
11. “Medicare can’t pay for your nursing home care because we have determined that you need custodial care only.”
12. “We can’t give you therapy services because your Medicare reimbursement has expired, and Medicaid doesn’t pay for therapy.”
13. “Even though you’re now financially eligible for Medicaid payment, we don’t have an available Medicaid bed for you.”
14. “We don’t have to readmit you from the hospital because your hold-hold period has expired.”
15. “You must pay any amount set by the nursing home for extra charges.”
16. “We have no available space in which residents or family member could meet.”
17. “You must leave the nursing home because you are a difficult resident.”
18. “You must leave the nursing home because you are refusing medical treatment.”
Call us now for assistance (301) 663-9230
We can help you!
At Senior Life Care Planning, LLC we are dedicated to giving our clients the power to be informed individuals and to give peace of mind. We provide honest ways to protect your home, loved ones and independence in times of great need. We understand the emotional burden, confusion, anger, hopelessness, sense of injustice, fear and loneliness that come with long-term disability and end-of-life issues.
Every day we help and support families and individuals who are in crisis. We work with our clients to provide peace of mind and quality of life.
Senior Life Care Planning, LLC
1560 Oppossumtown Pike, Suite A-12
Frederick, MD 21702
301.663.9230
www.seniorlcp.com
1. “Medicaid does not pay for the service that you want.”
2. “The nursing staff will determine the care that you receive.”
3. “We don’t have enough staff to accommodate individual schedules. You will be woken up every morning at six am.”
4. “We don’t have enough staff. You should hire your own private-duty aide.”
5. “If we don’t tie your father into his chair he may fall or wander away from the nursing home. There’s just no way we can always be watching him.”
6. “Your mother needs medication in order to make her more manageable.”
7. “We must insert a feeding tube into your father because he is taking too long to eat,”
8. “Your children can visit you only during visiting hours.”
9. “We can’t admit your mother unless you sign the admission agreement as a “Guarantor” or “Responsible Party.”
10. “Please sign this arbitration agreement. It’s no big deal. Arbitrations allow disputes to be resolved quickly.”
11. “Medicare can’t pay for your nursing home care because we have determined that you need custodial care only.”
12. “We can’t give you therapy services because your Medicare reimbursement has expired, and Medicaid doesn’t pay for therapy.”
13. “Even though you’re now financially eligible for Medicaid payment, we don’t have an available Medicaid bed for you.”
14. “We don’t have to readmit you from the hospital because your hold-hold period has expired.”
15. “You must pay any amount set by the nursing home for extra charges.”
16. “We have no available space in which residents or family member could meet.”
17. “You must leave the nursing home because you are a difficult resident.”
18. “You must leave the nursing home because you are refusing medical treatment.”
Call us now for assistance (301) 663-9230
We can help you!
At Senior Life Care Planning, LLC we are dedicated to giving our clients the power to be informed individuals and to give peace of mind. We provide honest ways to protect your home, loved ones and independence in times of great need. We understand the emotional burden, confusion, anger, hopelessness, sense of injustice, fear and loneliness that come with long-term disability and end-of-life issues.
Every day we help and support families and individuals who are in crisis. We work with our clients to provide peace of mind and quality of life.
Senior Life Care Planning, LLC
1560 Oppossumtown Pike, Suite A-12
Frederick, MD 21702
301.663.9230
www.seniorlcp.com
IS YOUR LOVED ONE A 'SECOND-CLASS CITIZEN'?
Family members face some tough and traumatic issues when a loved one reaches the point of needing long-term nursing care. Of course, there is the worry about the welfare and comfort of the patient. Often, there is also concern about finances--and with good reason, with nursing care costs averaging $8,000 to $12,000 per month.
For families whose loved ones have qualified for Medicaid assistance–or even for those thinking about applying for such assistance–there may be additional worries. Family members will often fear that as a Medicaid patient, their loved one will be a "second class citizen" and receive inferior care from the nursing facility compared with someone who is paying privately or through insurance. In my professional and personal experience, this fear is completely groundless. Moreover, as I always remind family members, it is against federal law for a nursing facility to discriminate among patients based on their source of payment. Any such discrimination carries a stiff penalty for the institution involved.
Secondly, a family that has preserved assets can tap into those funds to make the loved one more comfortable and content, to enhance his or her lifestyle in meaningful ways. Remember, Medicaid law permits the nursing home resident to keep only $68 of any income for his or her personal use; the rest goes to the nursing facility. With extra assets in your family’s pockets, your loved one can be given some extra "TLC." For example, a private-duty aide can be provided some of the time. Perhaps a grandchild dearly wants to fly down to visit with her incapacitated grandfather but lacks funds to pay for airfare. Conserved assets can underwrite this, too.
If all assets are depleted, dissension can sometimes arise among family members over who should pay for what. Who will pay for dental care? Who will pay for the cab that will take an aging father to a grandchild’s birthday party across town? The child’s parent or all the patient’s adult children? Do all the adult children agree Mom should be treated to a weekly hairset, and do they all pitch in equally? When the patient has assets preserved, they can be used to provide these extras to enhance their quality of life and alleviate family tension.
Call us now for assistance (301) 663-9230
We can help you!
At Senior Life Care Planning, LLC we are dedicated to giving our clients the power to be informed individuals and to give peace of mind. We provide honest ways to protect your home, loved ones and independence in times of great need. We understand the emotional burden, confusion, anger, hopelessness, sense of injustice, fear and loneliness that come with long-term disability and end-of-life issues.
Every day we help and support families and individuals who are in crisis. We work with our clients to provide peace of mind and quality of life.
Senior Life Care Planning, LLC
1560 Opossumtown Pike, Suite A-12
Frederick, MD 21702
301.663.9230
www.seniorlcp.com
For families whose loved ones have qualified for Medicaid assistance–or even for those thinking about applying for such assistance–there may be additional worries. Family members will often fear that as a Medicaid patient, their loved one will be a "second class citizen" and receive inferior care from the nursing facility compared with someone who is paying privately or through insurance. In my professional and personal experience, this fear is completely groundless. Moreover, as I always remind family members, it is against federal law for a nursing facility to discriminate among patients based on their source of payment. Any such discrimination carries a stiff penalty for the institution involved.
Secondly, a family that has preserved assets can tap into those funds to make the loved one more comfortable and content, to enhance his or her lifestyle in meaningful ways. Remember, Medicaid law permits the nursing home resident to keep only $68 of any income for his or her personal use; the rest goes to the nursing facility. With extra assets in your family’s pockets, your loved one can be given some extra "TLC." For example, a private-duty aide can be provided some of the time. Perhaps a grandchild dearly wants to fly down to visit with her incapacitated grandfather but lacks funds to pay for airfare. Conserved assets can underwrite this, too.
If all assets are depleted, dissension can sometimes arise among family members over who should pay for what. Who will pay for dental care? Who will pay for the cab that will take an aging father to a grandchild’s birthday party across town? The child’s parent or all the patient’s adult children? Do all the adult children agree Mom should be treated to a weekly hairset, and do they all pitch in equally? When the patient has assets preserved, they can be used to provide these extras to enhance their quality of life and alleviate family tension.
Call us now for assistance (301) 663-9230
We can help you!
At Senior Life Care Planning, LLC we are dedicated to giving our clients the power to be informed individuals and to give peace of mind. We provide honest ways to protect your home, loved ones and independence in times of great need. We understand the emotional burden, confusion, anger, hopelessness, sense of injustice, fear and loneliness that come with long-term disability and end-of-life issues.
Every day we help and support families and individuals who are in crisis. We work with our clients to provide peace of mind and quality of life.
Senior Life Care Planning, LLC
1560 Opossumtown Pike, Suite A-12
Frederick, MD 21702
301.663.9230
www.seniorlcp.com
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About Me
- Senior Life Care Planning
- Maryland, United States
- My life changed in the early to late 1990' My grandfather was living in Chevy Chase, Maryland. One night I received a call. I answered the phone, to hear that my grandfather, had fallen. Subsequently, he was taken to a nursing home. I was the attorney in the family, so everything was left to me. During this time, I had lots of questions: what options were available; what's a good nursing home, would he get good care; how are we going to pay for it? I tried to find answers to these questions. But I could only catch glimpses of the big picture. That research was my first act into the practice of elder law and life care planning. After granddad was in the nursing home. I researched this area and I started putting together what later turned out to be the beginning phases of my new life care planning practice and my calling.
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