How can a family pay for all the expenses associated with long term care? Nationwide, annual charges average over $40,000, while costs in some states have surpassed $70,000. Increasingly, private insurance is being used to cover such costs. For many families, establishing eligibility for government assistance--in the form of state Medicaid reimbursement--remains critical. But so-called "Medicaid planning" may no longer be viable due to the "look back rules."
The look-back rules apply to transfers of assets prior to the time an individual applies for Medicaid. To evaluate a person's eligibility for Medicaid assistance, your state's department of social services generally will take into account gifts of certain assets made within 36 months of the application (60 months in the case of transfers in trust). In other words, the state "looks back" at prior transfers.
The number of months of ineligibility following the gift is determined by dividing the value of the asset given away by the average monthly cost of private nursing home care. For example, if an asset worth $100,000 is transferred during one of these "look-back" periods and the average monthly cost of care in the state is $4,000, the applicant is not eligible for Medicaid assistance until 25 months after the gift.
In addition, other complicated rules govern (1) exempt and non- exempt property, (2) the amount of assets and income that may be retained by the applicant or his or her spouse and (3) the ability of the social services department to recoup its Medicaid payments from a deceased person's estate.
The importance of preserving assets to pay for nursing home costs can't be overstated. But that's only part of the story. The other part is finding a quality nursing home for a family member, especially if an extended stay is anticipated.
When you visit a facility, observe the interaction between staff and residents, especially those who may have special needs. You should also solicit comments and observations from residents and their visitors. If permission to do so is denied, that would be cause for concern. It is also a good idea to see the home in operation at different times of the day (including mealtimes).
Make sure to find out the frequency of physician visits to the facility and the number of patients attended to by each nurse or aide. Talk to the dietitian about menus and special dietary requirements.
Ask the nursing home administrator for copies of state social services inspection reports. (By law, the nursing home is required to make these reports publicly available.) You may want to check, too, with the state or local nursing home "ombudsman" who helps to resolve nursing home complaints.
We would be glad to assist you with your family's long-term care decisions.
The U.S. Department of Health and Human Services received 1,613 complaints of abuse involving nursing homes in 1997, up 14% over a three-year period. And other cases go unreported due to fear of retribution (source: The Wall Street Journal). Unfortunately, it is often difficult to check on a resident's status, especially if the facility isn't located nearby.
Added problem: A nursing home facility may employ several workers who have arrest records. This has been a contributing factor to high jury awards in lawsuits brought by injured residents. If you suspect that a family member is a victim of abuse, you should have the matter thoroughly investigated.
Invalid Waiver--In a new U.S. Supreme Court case, an employee signed a waiver releasing her employer from all claims in return for a severance package. But the employer had not met all the requirements of the Older Workers Benefit Protection Act (OWBPA). The employee then initiated a lawsuit against the employer based on age discrimination. Result: the employee was able to sue the employer under the OWBPA even though she kept the severance payments.
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Proof Of Harassment--A senior vice president of a firm was accused of sexual harassment. The company conducted a thorough investigation into the matter. After the V.P. was fired because of the alleged misconduct, he sued the firm for wrongful termination. But the California Superior Court sided with the employer. Reason: although it did not have absolute proof of misconduct, the employer had a "reasonable, good faith belief" that sexual harassment had occurred.