Boroson: Choose Nursing Home With Care, Expert Says
By
Warren Boroson, Daily Record
April 1, 2003
All nursing homes are bad, and your goal is to choose the best of the bad.
That's the frank assessment of elder-care lawyer Richard I. Miller. Or,
as he put it, "Some nursing homes are a lot worse than others."
Also, choose a home that's close to where the patient's relatives live,
he suggested, so they can visit the patient and watch out for his or her
interest.
Miller, who's with Bray, Chiocca & Miller in Parsippany, spoke
Wednesday before the Financial Breakfast Bunch of Morris County.
To pay long-term health-care costs, he went on, there are several
sources.
1. Private money.
2. Long-term care insurance. "People refuse to believe that they
can become ill," Miller warned, "but life is unpredictable.
Long-term insurance can buy freedom and choices."
3. Medicare, the government entitlement program for the elderly in
general, pays for less-than-acute long-term care for up to 100 days. The
patient must go from a three-night hospital stay to a rehab or nursing
home. The first 20 days are paid for in full; for days 21 to 100, the
co-payment is $105 a day.
Unfortunately, patients can lose their Medicare benefits if they have
"reached a plateau."
So, when do patients typically lose their Medicare benefits because
they have supposedly reached a plateau?
According to Miller, at day 19, 20 or 21. The explanation he gave:
nursing homes prefer to be paid by one source, not by more than one. Life
is simpler that way.
As Miller sees it, the question shouldn't be: Is the patient getting
any better? But: Will the patient get worse if the therapy stops?
Sometimes a health-care facility will try to end patients' Medicare
benefits by saying the patients "don't want to go to therapy."
Miller said, "What patient does?" Too often, he went on, the
problem is the patients are depressed. Yet if the depression is treated
through counseling and medication or both, "Their personalities may
blossom."
What these people need, he advised, is an advocate to look out for
their interests.
4. Medicaid, the government program that pays for long-term nursing
care for poor people.
Because of misinformation (or the lack of information), Miller argues,
many people wind up losing money to which they would have been entitled.
An example: Some people think that if an elderly person gave away money
in the past three years, that person is not entitled to Medicaid benefits.
This is a misconception. Many people confuse the 36-month Medicaid
look-back period with the penalty imposed on the transfer of assets.
When someone transfers assets to qualify for Medicaid during the
36-month look-back window, he explained, a penalty is imposed that makes
that person ineligible for benefits for a period of months.
In New Jersey, the ineligibility period is calculated by dividing the
amount transferred by $5,540. (That amount is supposedly the average
monthly nursing-home cost in the state.)
If someone in a nursing home gave $55,400 to his or her children in
January 2002, that person would be ineligible for Medicaid for 10 months
from the time he or she made the gift. ($55,400 divided by $5,540.)
So, if the individual was otherwise below the applicable Medicaid
resource threshold, he or she would qualify for Medicaid benefits in
November 2002 - only 11 months later - even though the gift was made
within the 36-month look-back period.
The lesson, Miller said: "It's never too late to do tax
planning."
He complained that someone may have spent his or her life making money,
preserving it and planning to pass it on. Then, at age 80, that person
might be at risk of losing it all in the final three years of life. A
hospital or nursing home that costs $80,000 or $90,000 a year can erase
all of the $200,000 to $500,000 nest egg that many older people have built
up.
The fact that people are living longer makes the problem all the more
common, Miller went on.
"Just look at all the assisted-living facilities being built
now," he said. "And those beds are being filled."
While Medicaid should be a last resort for an older person, Miller
said, the system essentially forces people to impoverish themselves to
receive benefits to cover long-term nursing-care costs.
"Money buys choices. Will there be money for a semiprivate room?
Or a private aide? Money to allow the person to go to a mall once a week
and to go to the movies? If there's no money set aside, where will these
extra amenities come from?"
The rules can be tricky, Miller added. Medicaid rarely pays for care at
assisted-living facilities. This may force patients with limited assets to
prematurely enter a nursing home rather than a less-restrictive
assisted-care facility, just so there's a payment source once private
funds are gone.
Another problem: An older person may be hospitalized and - instead of
going to a nursing home - decided to return home "because he doesn't
want to admit he needs a nursing home." But now, Medicare may not
cover his stay at a nursing home later because he went home after the
hospital instead of doing directly to the nursing home.
Miller urged older people to give someone power of attorney. One
reason: Courts don't seem to like the idea of older people giving away
their assets to their children to qualify for Medicaid. Older people who
are incapacitated may be barred from doing this, Miller explained. But
someone who has power of attorney can make this decision for them,
provided that the power of attorney authorizes such transfers.
This deliberate impoverishment isn't necessarily for the benefit of
"greedy" children, Miller said. It can also improve the older
people's lives. "I know an individual in a nursing home who had
smoked for 50 years. Who would pay for their cigarettes? If money had not
been set aside before she applied for Medicaid, who would have paid for
her cigarettes? What if the person wanted chocolate? The extra money can
pay for a better life for them. And isn't that the real purpose behind
trying to preserve assets?"
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