Long-Term Care 101

Long-Term Care 101 

Today, many Americans  are faced with planning and paying for their own long-term care needs and the needs of the ones they care about.  Long-term care should be (ideally) a process that begins with a plan involving the person for whom care will be provided and the ones who will ensure its management.  The Administration on Aging (AOA) indicates that someone over 65 "has almost a 70% chance of needing some type of long-term care services and supports in their remaining years."  That being said, long-term care isn't just for the aged or elderly.  In fact, many Americans under the age 65 who are mentally or physically disabled require long-term care planning and assistance.  In planning for long-term care, be prepared to answer the following questions: What is long-term care? Who will need long-term care?  How long is long-term care?   How will I pay for the costs?  Who do I want to provide it?  Where will it be provided? When do I start planning?

What is long-term care?

Long-term care is coordination of and assistance with medical care and daily living tasks up to and including: meal preparation, hygiene, transportation, household upkeep, financial management, medication assistance, and legal decisions, to name just a few.  The spectrum of long-term care should expand or contract to meet the needs and capabilities of the loved one in need of care.

Who will need long-term care?

As mentioned above, the data is clear that a growing number of Americans will need some form of long-term care assistance.  In fact, the AOA reports that "In the 2000, almost 10 million people needed some form of long-term care in the United States. Of this population, 3.6 million (37%) were under age 65 and 6 million (63%) were over age 65..."  With that in mind, everyone should plan for their long-term care needs.  Most people will need help in at least one of the many areas that long-term care covers.  Therefore, its important to plan before advance planning is not possible.

How long is "long"-term care?

The answer, as with most things, is--it depends.  Statistically speaking, men who are in need of long-term care will need it for 2.2 years versus women who require longer care at 3.7 years. Those numbers are averages--meaning that any one particular person's needs may be smaller or greater.  To know and understand what your loved ones needs are and may be will depend on a care assessment and recommendations of health, financial, and legal professionals.

How will I pay for the costs?

Insurance:

Medicare v. Medicaid 

It is not uncommon for the insured or the family of the insured to be uncertain of what insurance may be currently in place.  In fact, many people throw out the words "Medicare" and "Medicaid" as though they are synonymous and THEY ARE NOT.  Medicare is not an insurance program designed to provide for long-term care needs.  In fact, generally speaking, Medicare only provides for skilled-services or rehabilitative services.  In a long-term care facility, Medicare will cover skilled-services for a period not to exceed 100 days.  For home healthcare service through Medicares, a doctor must certify that someone is need of one or more of the following: intermittent skilled nursing care, physical therapy, speech-language pathology services, or continued occupational therapy.  In contrast, Medicaid has a dedicated long-term care component for persons who meet disability and financial requirements.   At 1.5 million nursing home residents and 2.9 million community-based residents according to the Kaiser Family Foundation, Medicaid provides a substantial amount of care to the elderly, aged, and disabled in need of long-term care.

Veteran's Benefits

Contingent upon a veteran's status, service availability, clinical need, and enrollment, Veterans Home and Community Based Services are part of the VA Medical Benefit Package.  Also, Nursing Home and Residential Options are available for eligible veterans, subject to eligibility guidelines and enrollment.  Certain dependents and survivors may be eligible for services and benefits as well.

Long-Term Care Insurance

Long-term care insurance is designed to cover the costs of long-term care and can be used in combination with private funds to leverage more desirable placement and services alternatives.  Long-term care policy coverage is one option among many, but may easily be missed due to rising premium costs based on the insured's age making it financial difficult to purchase, or a failure to qualify due to advanced medical conditions that prevent underwriting of the policy. Also, it is key to remember that not every long-term care policy is made alike, even among the same insurance company.  Some terms of long-term care policies are negotiable like making the daily pay rate of the policy adjustable for inflation.

Private Pay

Private pay is an individual's ability to cover long-term care costs from his or her own resources.  Frequently, private-pay resources are leveraged in concert with other insurance benefits to provide for long-term care needs.

Who do I want to provide it?

Many Americans receive care from family members and friends.  However, what is less common is a conversation in advance about who those person(s) will be.  It is impossible to highlight how important it is to have discussions with the persons you or your family would like to serve as caregivers--desire alone will not ensure an ideal choice.  A long-term care provider should be a person or service provider that you know and trust. 

Where will it be provided?

Many Americans hope that they and their family will be able to live in the family home or with other family for as long as possible.  Under certain conditions, that is possible; however, planning and level of care have a lot to do with where long-term care may be provided.  There are a spectrum of living arrangements, apart from the home, including: independent living, assisted living, intermediate care/nursing facility, and skilled nursing facility. These choices are available or not based on the level of care the care recipient requires. Here is some guidance from Medicare on how to choose a home health agency or a nursing home.

Here are a few resources to begin the search near you:

Nursing Home Compare: (Contains a comparison of nursing home ratings for every Medicare and Medicaid facility): http://www.medicare.gov/nursinghomecompare/search.html?AspxAutoDetectCookieSupport=1

Home Health Compare: (Contains comparison of home healthcare providers that Medicaire-certified): https://www.medicare.gov/homehealthcompare/

Eldercare Locator: (Searchable database to locate a variety of elder resources): http://www.eldercare.gov/Eldercare.NET/Public/Index.aspx

Senior Resource Guide: (Follow the link to locate a print copy near you): http://srgserv.com/publications/

When do I start planning?

Its really never too early to start planning.  The many questions long-term care raises are as much people-centered as they are financial, social service, and family oriented.  Considering personal preferences, family relationships and needs, available services, are critical bases for beginning a long-term care plan. The most important key to planning is to be active and develop a plan that is monitored as the long-term care recipient's needs and preferences change.

Mr. Henry has completed a seminar presentation series on this topic, which will be available in many venues.  To request Mr. Henry to present this series, or others on estate planning, probate, or incapacity planning, contact the Law Office of John B. Henry, III, Attorney & Counselor at Law.

This blog is designed for general information purposes only.  The information contained on this site should not be construed as legal advice or the creation of an attorney-client relationship. 

For more information, contact John B. Henry, III, Attorney at Law, to discuss your legal needs, and visit us at www.johnhenrylaw.com.

Family as Caregivers: No benefits and no resources...

Unfortunately, not every family member or friend for whom care must be provided may have independent resources.  In fact, this can be immensely distressing in the event of need for medical care.  Though the Affordable Care Act (ACA) has extended certain benefits and privileges to sectors of America that in years past had no access to healthcare, it does not mean that everyone has either taken advantage of the health insurance marketplace or were able to.  Indeed, in Texas, as there was no expansion of Medicaid, there are many Texans who remain without insurance coverage.  That being said, what do you in the event of needed medical services for a loved one who has no health insurance, no resources or benefits, or limited resources or benefits? Here are a few suggestions:

1. Find a Health Center near you.  A health center provides health and dental care to people of all ages, whether or not they have health insurance or the money to pay for health care.  The US Department of Health and Human Services maintains a database of such health centers: http://www.hrsa.gov/gethealthcare/affordable/index.html  
2. Early Childhood Intervention.  For a baby or young child who may have intellectual or developmental disabilities, the Department of Assistive and Rehabilitative Services (DARS) has a program called the Early Childhood Intervention.  Call or Visit: DARS Inquiries Line at 1-800-628-5115 or https://dmzweb.dars.state.tx.us/prd/citysearch to learn more.
3. Ask if reduced or no fee services are available.  Consider public or non-profit hospitals and clinics who offer repayment plans and/or reduced fees for low-income patients.  Some private hospitals offer such reduced fee or no fee services as well.  In fact, some private hospitals are required to offer such services called Hill-Burton Free or Reduced-Cost Care.  In 1946 Congress passed legislation that gave grants and loans for construction to various kinds of health facilities.  Though the program stopped providing funds in 1997, about 150 healthcare facilities nationwide are still required to provide free or low-cost care. To locate such a facility, follow this link: http://www.hrsa.gov/gethealthcare/affordable/hillburton/facilities.html .
4. Resources for HIV/AIDS.  The Ryan White HIV/AIDS Program assists low-income individuals diagnosed with HIV/AIDS who do not have health insurance.  Assistance includes healthcare and some other services.  To learn more, visit: http://hab.hrsa.gov/gethelp/index.html
5. Get to know a social worker.  Hospitals, nursing homes, agencies like MHMRA, all have social workers who navigate the system of healthcare, insurance, public benefits, and placement.  Finding a social worker at a facility near you (ideally, one that provides care for your loved one) can be a valuable asset as a care provider.
6. Find a home health agency. Sometimes a family member or loved one requires additional treatment or attention beyond what is offered at a hospital or out-patient facility.  A home health agency provides healthcare for an on-going injury or illness in the home.  Not every home health agency is made a like.  The Centers for Medicare and Medicaid Services (CMS) has developed a checklist to help in the selection of a home health agency: https://www.medicare.gov/what-medicare-covers/home-health-care/Home%20Health%20Agency%20Checklist.pdf.
7. Ensure you have legal authority.  A care provider should always ensure he or she has the legal authority either by the patient, by law, or by a properly drafted and executed directive by the patient or court of appropriate legal authority to make decisions.
8. Create a care plan.  A care plan is a living document that encapsulates the life of your loved one including items like a list of medical providers, statements of the preferences and desires of your loved one, a calender of renewal deadlines and re-certification periods, and copies of relevant advanced directives and powers of attorney, to name just a few items.  This document should periodically be reviewed to be updated or revised because it changes as you and the person you care for change.  It should assist you and the person who might have to step into your role make decisions and provide care.  The care plan is critically important for a loved one who does not have independent resources or benefits, because eventually, the person may become eligible for benefits or receive resources.  And, assessing how resources may interact with the benefits and vice versa are critical to maintaining eligibility.

Future posts will cover some of these topics in more detail and include other areas helpful to being a care provider for your family or loved one.

This post is the first in a series called "Family as Caregivers."  It is true of so many families today that family members are acting as a caregiver for their young, disabled, and elderly, loved ones.  However, what is also true is that many are not adequately prepared to step into these roles when necessary.  There can be a huge learning curve in stepping into a caregiver or provider role, which may include things like assessing a loved one's level of care, discovering and selecting care providers, discontinuing patterns of unproductive or unhealthy conduct and relationships, creating a care plan, navigating available public benefits, finding funding sources, and establishing or modifying proper legal authority to act on behalf of a loved one.  Indeed, this topic encompasses many components and can be overwhelming; however, by creating a plan and finding community supports and resources, the caregiver or potential caregiver role can be made much more manageable.  

Mr. Henry has completed a seminar presentation series on this topic, which will be available in many venues.  To request Mr. Henry to present this series, or others on estate planning, probate, or incapacity planning, contact the Law Office of John B. Henry, III, Attorney & Counselor at Law.

This blog is designed for general information purposes only.  The information contained on this site should not be construed as legal advice or the creation of an attorney-client relationship. 

For more information, contact John B. Henry, III, Attorney at Law, to discuss your legal needs, and visit us at www.johnhenrylaw.com.

Early Childhood Intervention

Many parents today face raising children amidst a whole host of challenges, like economic downturn, limited to no family assistance, and expanded expectations at work without commensurate increases in pay and/or childcare to name a few.  These challenges may be compounded where a family is struggling with questions on how to assess or provide assistance for a baby or young child who may have an intellectual or developmental disability.  Fortunately, there are programs and services dedicated to early childhood intervention.  The Department of Assistive and Rehabilitative Services has an early childhood intervention program devoted to assisting families with these kind of concerns.  To learn more,  contact the number below and search via the link for services near you:

DARS Inquiries Line at 1-800-628-5115

https://dmzweb.dars.state.tx.us/prd/citysearch

This blog is designed for general information purposes only.  The information contained on this site should not be construed as legal advice or the creation of an attorney-client relationship. 

 

For more information, contact John B. Henry, III, Attorney at Law, to discuss your legal needs, and visit us at www.johnhenrylaw.com.

4-Year Requirement for Probate of Wills

Mom, Dad, Friend...left a will.  Do I have to probate it? If so, is there a time period required to probate the will?

These questions while seemingly vary simple are common traps that some fall into upon the passing a loved one.  For a will's terms to be made effective by law, the will must be probated.  Further, Texas law requires that a will be probated within four years from the date of the deceased individual's passing. Section 256.003(a) of the Texas Estates Code states:

A will may not be admitted to probate after the fourth anniversary of the testator's death unless it is shown by proof that the applicant for the probate of the will was not in default in failing to present the will for probate on or before the fourth anniversary of the testator's death.

Thus, presenting a will for probate within four years of the date of the testator's death is critical to a full and complete administration of the estate involved without having to go through many procedural steps required for such a probate.  Consulting with a probate attorney can be critical to accessing some of the many issues like this one involved in the probate and estate administration process.

This blog is designed for general information purposes only.  The information contained on this site should not be construed as legal advice or the creation of an attorney-client relationship. 

For more information, contact John B. Henry, III, Attorney at Law, to discuss your legal needs, and visit us at www.johnhenrylaw.com.

They're fighting over the body (Part 3): Other ways of directing disposition

This is the third blog entry in the series, "They're fighting over the body."  This entry focuses on other methods that could be used to direct disposition of one's remains other than the designation of agent in an appointment document called "Appointment of Agent to Control Disposition of Remains."

The Texas Health and Safety Code at Section 711.002(g) provides that an individual may direct disposition of remains, including cremation, in a will, a prepaid funeral contract (also known as a preneed burial plan), or a written instrument signed and acknowledged by such person.  As to a will, the Texas Health and Safety Code makes it quite clear that it need not be probated to make the directives enforceable.  Specifically, 711.002(h) states:

If the directions are in a will, they shall be carried out immediately without the necessity of probate.  If the will is not probated or is declared invalid for testamentary purposes, the directions are valid to the extent to which they have been acted on in good faith.As with any designation, its important to remember that these decisions should be reviewed periodically to determine whether or not the persons named or the wished contained in them still fit your desires.  These documents may be altered or revoked in a later writing signed and acknowledged by the principal or person who made the original designations and directions.

These options and how they fit into an individualized estate plan should be discussed with a qualified legal professional.

This blog is designed for general information purposes only.  The information contained on this site should not be construed as legal advice or the creation of an attorney-client relationship. 

For more information, contact John B. Henry, III, Attorney at Law, to discuss your legal needs, and visit us www.johnhenrylaw.com.

They're fighting over the body (Part 2): Appointment of Agent for Disposition of Remains

Not at all uncommon, family members disagree over funeral, burial, and preparation decisions.  One way of giving guidance about your wishes as to the aforementioned decisions is to put detailed language in a last will and testament.  Besides memorializing these kinds of wishes in a will, during your lifetime, you may designate an agent in a document called the "Appointment of Agent to Control Disposition of Remains." Section 711.002 of the Texas Health and Human Safety Code (a)(1) permits an individual to name an agent for just this purpose. It is important to note, too, that the agent not only has the right to make decisions but also bears the financial responsibility for the agency he or she has been granted.  Consequently, any agent or successor agents named in this appointment document must sign the document acknowledging their acceptance of the agency being granted.

This blog is designed for general information purposes only.  The information contained on this site should not be construed as legal advice or the creation of an attorney-client relationship. 

For more information, contact John B. Henry, III, Attorney at Law, to discuss your legal needs, and visit us www.johnhenrylaw.com.

They're fighting over the body (Part 1): Who decides?

With a time sensitive decision, like the disposition of remains, it should be handled with care and efficiency.  However, who is able to make those decisions as a matter of Texas law?  Under Section 711.002(a) of the Texas Health and Safety Code, a list of priority is given:

(1)  the person designated in a written instrument signed by the decedent;
(2)  the decedent's surviving spouse;
(3)  any one of the decedent's surviving adult children;
(4)  either one of the decedent's surviving parents;
(5)  any one of the decedent's surviving adult siblings; or
(6)  any adult person in the next degree of kinship in the order named by law to inherit the estate of the decedent.

What if a person of the highest priority fails, is unable, or is unwilling to act?  Under that same section, Texas law says that where a person fails to make final arrangements or appoint another person to make final arrangements for the disposition before the earlier of the 6th day after the date the person received notice of the decedent's death or the 10th day after the date the decedent died, the person is presumed to be unable or unwilling to control the disposition and their right terminates and passes to a person of the same priority level or down to the next level of priority.

Subsequent entries in this series, "They're Fighting Over the Body," will focus on potential options in addressing designating a person to make decisions concerning disposition of remains.

This blog is designed for general information purposes only.  The information contained on this site should not be construed as legal advice or the creation of an attorney-client relationship. 

For more information, contact John B. Henry, III, Attorney at Law, to discuss your legal needs, and visit us www.johnhenrylaw.com.